Comparative evaluation of inter appointment pain and analgesic intake with calcium hydroxide and triple antibiotic paste as intracanal medicaments in patients with apical periodontitis ­ a randomized controlled single-blinded clinical trial / Avaliação comparativa da dor entre consultas e ingestão de analgésicos com hidróxido de cálcio e pasta de antibióticos triplos como medicamentos intracanais em pacientes com periodontite apical - um ensaio clínico randomizado controlado simples-cego

Objective: This study aimed to evaluate the effect of calcium hydroxide and triple antibiotic paste as intracanal medication on the interappointment pain at 8, 24, and 48 hours postoperatively in patients with symptomatic apical periodontitis undergoing multiple visit root canal treatment. Material and Methods: Two hundred and seven systemically healthy patients under the age group of 18-45 years with mandibular molars presenting with symptomatic apical periodontitis which require root canal treatments were included in this study. After access cavity preparation, cleaning and shaping was done till ISO 25 size file, and the patients were randomized into three groups (each group of 69 samples). Group I: no medicament, group II: calcium hydroxide and group III: triple antibiotic paste (TAP). Postoperative pain was evaluated at 8 hours, 24 hours and 48 hours. Results: The results showed that at 8 hours, 24hours and 48hours, there was a statistical difference between I and III (p < 0.05); and Group III and Group II (p < 0.05). Within the group, there was a statistical difference at all time points IN Group I and II (p < 0.05) except between 24 hours and 48 hours in the Group III (p > 0.05). Conclusion: Within the limitations of this study, TAP was more effective than calcium hydroxide in relieving pain and reducing the analgesic intake at the first 24hours.(AU)

Objetivo: Este estudo teve como objetivo avaliar o efeito do hidróxido de cálcio e da pasta tripla de antibiótico como medicação intracanal na dor na interconsulta às 8, 24 e 48 horas de pós-operatório em pacientes com periodontite apical sintomática submetidos ao tratamento endodôntico por múltiplas visitas. Material e Métodos: Duzentos e sete pacientes sistemicamente saudáveis com idade inferior a 18-45 anos com molares inferiores apresentando periodontite apical sintomática que requerem tratamento de canal radicular foram incluídos neste estudo. Após o preparo da cavidade de acesso, a limpeza e modelagem foram feitas até arquivo ISO 25, e os pacientes foram randomizados em três grupos (cada grupo de 69 amostras). Grupo I: sem medicamento, grupo II: hidróxido de cálcio e grupo III: pasta tripla de antibiótico (TAP). A dor pós-operatória foi avaliada em 8 horas, 24 horas e 48 horas. Resultados: Os resultados mostraram que às 8 horas, 24 horas e 48 horas, houve diferença estatística entre I e III (p <0,05); e Grupo III e Grupo II (p <0,05). Dentro do grupo, houve diferença estatística em todos os momentos do Grupo I e II (p <0,05), exceto entre 24 horas e 48 horas no Grupo III (p>0,05). Conclusão: Dentro das limitações deste estudo, o TAP foi mais eficaz do que o hidróxido de cálcio no alívio da dor e na redução da ingestão de analgésicos nas primeiras 24 horas. (AU)

Application of poly(lactic-co-glycolic acid) in the treatment of pulp diseases / 口腔疾病防治

@#The development of materials science is of great significance to the treatment of dental pulp diseases. Poly lactic acid glycolic acid (PLGA) copolymer is an organic macromolecule compound that is widely used in the preparation of biomedical materials. In recent years, PLGA, as a drug/molecular loaded system and tissue regeneration scaffold, has shown prospects for application in the treatment of dental pulp diseases. This paper will review the application of PLGA in the treatment of dental pulp diseases and provide a basis for its further development and utilization. The results of the literature review show that PLGA is a drug/molecular delivery system that is mainly used in the improvement of pulp capping materials, root canal disinfectant and apexification materials. PLGA-improved pulp capping agents can prolong the action time of the drug and reduce toxicity. The modified root canal disinfectant can realize the sustained release of drug, make the drug penetrate deeper into the subtle structure, and contact more widely with the pathogenic bacteria. The modified apexification materials can provide more convenient administration methods for apexifixment. As a scaffold for tissue engineering, PLGA is mainly used in the study of pulp regeneration. The optimization of PLGA physical properties and action environment can provide a more suitable microenvironment for seed cells to proliferate and differentiate. How to utilize the advantages of PLGA to develop a more suitable material for endodontic application needs further study.

Comparative Evaluation of Inter Appointment Pain and Analgesic Intake with Calcium Hydroxide and Triple Antibiotic Paste As Intracanal Medicaments In Patients With Apical Periodontitis ­ A Randomized Controlled Single-Blinded Clinical Trial / Avaliação comparativa da dor entre consultas e ingestão de analgésicos com hidróxido de cálcio e pasta de antibióticos triplos como medicamentos intracanais em pacientes com periodontite apical - um ensaio clínico randomizado controlado simples-cego

Objective: This study aimed to evaluate the effect of calcium hydroxide and triple antibiotic paste as intracanal medication on the interappointment pain at 8, 24, and 48 hours postoperatively in patients with symptomatic apical periodontitis undergoing multiple visit root canal treatment. Material and Methods: Two hundred and seven systemically healthy patients under the age group of 18-45 years with mandibular molars presenting with symptomatic apical periodontitis which require root canal treatments were included in this study. After access cavity preparation, cleaning and shaping was done till ISO 25 size file, and the patients were randomized into three groups (each group of 69 samples). Group I: no medicament, group II: calcium hydroxide and group III: triple antibiotic paste (TAP). Postoperative pain was evaluated at 8 hours, 24 hours and 48 hours. Results: The results showed that at 8 hours, 24hours and 48hours, there was a statistical difference between I and III (p < 0.05); and Group III and Group II (p < 0.05). Within the group, there was a statistical difference at all time points IN Group I and II (p < 0.05) except between 24 hours and 48 hours in the Group III (p > 0.05). Conclusion: Within the limitations of this study, TAP was more effective than calcium hydroxide in relieving pain and reducing the analgesic intake at the first 24 hours (AU)

Objetivo: Este estudo teve como objetivo avaliar o efeito do hidróxido de cálcio e da pasta tripla de antibiótico como medicação intracanal na dor na interconsulta às 8, 24 e 48 horas de pós-operatório em pacientes com periodontite apical sintomática submetidos ao tratamento endodôntico por múltiplas visitas. Material e Métodos: Duzentos e sete pacientes sistemicamente saudáveis com idade inferior a 18-45 anos com molares inferiores apresentando periodontite apical sintomática que requerem tratamento de canal radicular foram incluídos neste estudo. Após o preparo da cavidade de acesso, a limpeza e modelagem foram feitas até arquivo ISO 25, e os pacientes foram randomizados em três grupos (cada grupo de 69 amostras). Grupo I: sem medicamento, grupo II: hidróxido de cálcio e grupo III: pasta tripla de antibiótico (TAP). A dor pós-operatória foi avaliada em 8 horas, 24 horas e 48 horas. Resultados: Os resultados mostraram que às 8 horas, 24 horas e 48 horas, houve diferença estatística entre I e III (p <0,05); e Grupo III e Grupo II (p <0,05). Dentro do grupo, houve diferença estatística em todos os momentos do Grupo I e II (p <0,05), exceto entre 24 horas e 48 horas no Grupo III (p> 0,05). Conclusão: Dentro das limitações deste estudo, o TAP foi mais eficaz do que o hidróxido de cálcio no alívio da dor e na redução da ingestão de analgésicos nas primeiras 24 horas. (AU)

Uso de propóleo con hidróxido de calcio como medicación intraconducto en periodontitis apical asintomática. Reporte de caso / Uso de própolis com hidróxido de cálcio como medicação intraconducto na periodontite apical assintomática. Relato de Caso / Use of propolis with calcium hydroxide as an intracanal medicament in asymptomatic apical periodontitis. A case report

Resumen La miel y sus productos, a lo largo de la historia, han sido usados por diversas civilizaciones con fines terapéuticos debido a sus efectos curativos. En la actualidad existe un renovado interés en el uso de la apiterapia como coadyuvante en diversos tratamientos médicos, en donde destaca el propóleo por sus propiedades bactericidas, antiinflamatorias, anticancerígenas, entre otras. El objetivo de este artículo es describir un caso de un primer molar inferior izquierdo con diagnóstico de necrosis pulpar y periodontitis periapical asintomática que fue manejado con el uso de la mezcla de propóleo con hidróxido de calcio como medicación intraconducto entre citas, logrando observar un proceso de reparación ósea durante este lapso. Se concluye que el propóleo es una alternativa viable como coadyuvante del hidróxido de calcio en los casos que está indicada la medicación intraconducto.

Resumo O mel e seus produtos, ao longo da história, têm sido utilizados por várias civilizações para fins terapêuticos devido aos seus efeitos curativos. Atualmente, há um interesse renovado no uso da apiterapia como adjuvante em vários tratamentos médicos, onde a própolis se destaca por seu bactericida, antiinflamatório, anticâncer, entre outros. O objetivo deste artigo é descrever um caso de primeiro molar inferior esquerdo com diagnóstico de necrose pulpar e periodontite periapical assintomática que foi gerenciada com o uso da mistura de própolis com hidróxido de cálcio como medicamento intraconducto entre as consultas, conseguindo observar um processo de reparo ósseo durante esse período. Em conclusão, a própolis é uma alternativa viável como adjuvante ao hidróxido de cálcio nos casos indicados por medicação intraconducto.

Abstract Various civilizations have used honey and its products for therapeutic purposes throughout history because of their healing effects. There is a renewed interest in the use of apitherapy as an adjunct in various medical treatments. Propolis stands out for its bactericidal, anti-inflammatory, and anti-cancer properties, among others. This paper aims to describe the case of a lower left first molar diagnosed with pulp necrosis and asymptomatic periapical periodontitis that was managed with a mixture of propolis and calcium hydroxide as an intracanal medicament between appointments. A bone repair process was observed during this period. It is concluded that propolis is a viable alternative as a calcium hydroxide adjuvant when intracanal medication is indicated.

Resposta imune periapical à medicação intracanal à base de hidróxido de cálcio e selênio / Periapical immune response to intracanal medication based on calcium hydroxide and selenium

O tratamento endodôntico tem como objetivo eliminar a contaminação microbiana dos sistemas de canais radiculares (SCR) por meio da instrumentação mecânica e irrigação química (PMQ). Quando não for possível a resolução em uma única sessão, o SCR deverá ser preenchido com uma medicação intracanal para evitar a recolonização microbiana tardia. O presente estudo teve como objetivo avaliar a ação do hidróxido de cálcio, mundialmente utilizado como medicação intracanal, associado ao selênio (H.C + Se), em dentes portadores de necrose pulpar. A amostra foi composta por 60 pacientes que possuiam dentes com indicação de tratamento endodôntico, divididos em grupos (n=15): sem medicação intracanal (Empty); que foram medicados com hidróxido de cálcio (H.C), Selênio (Se) e hidróxido de cálcio + selênio (H.C + Se). Após a abertura coronária, 3 cones de papel absorvente foram inseridos no terço inicial do conduto e mantidos por 2 min para avaliação microbiana. Após o PMQ, novos cones foram introduzidos nos SCR, ultrapassando-se 2mm do ápice radicular, e mantidos no tecido perirradicular por 2min para a coleta do fluido intersticial periapical. A coleta foi novamente realizada 15 dias após o PMQ. A expressão gênica do mRNA do fragmento 16S de procariontes, das citocinas INF-γ, TNF-α, IL-1α, IL-17A, IL-10, IL-6 e MCP-1 foram quantificadas por PCR em tempo real. O mRNA 16S foi avaliado antes do PMQ e 15 dias após, nos grupos sem medicação e com medicação intracanal. A redução significativa da carga microbiana foi observada apenas no grupo com medicação intracanal (p<0,05). Observou-se um aumento da expressão gênica das citocinas (T15) TNF-α e IL-10 no grupo H.C+Se em comparação aos demais grupos (p<0,05). A expressão de mRNA de IFN-γ reduziu nos grupos tratados com as medicações (H.C, Se, H.C + Se). Conclui-se que o uso de medicação intracanal é imprescindível para se evitar a recolonização do SCR. A inclusão do selênio na pasta de hidróxido de cálcio resultou na potencialização da expressão de citocinas que permitirão o reparo dos tecidos perirradiculares.

Endodontic treatment aims to eliminate the microbial contamination of the root canal system (RCS) and is achieved with the use of mechanical instrumentation and chemical irrigation. When resolution in a single session is not possible, the RCS should be filled with intracanal medication to avoid subsequent recolonization. The present study aimed to evaluate the effect of calcium hydroxide, wich is used globally as an intracanal medication, in combination with selenium (CH + Se) as an intracanal medication in teeth with pulp necrosis. The sample consisted of 60 patients requiring endodontic treatment who were divided into groups: without intracanal medication (empty) and with medication; calcium hydroxide (CH), selenium (Se) and calcium hydroxide + selenium (CH + Se) (n = 15). After the coronary opening, three absorbent paper cones were inserted in the initial third of the RCS and maintained for 2min for microbial evaluation. After the cleaning and shaping procedures, new cones were introduced into the RCS, extending 2 mm from the root apex and were kept in the periradicular tissue for 2 min' to collect the periapical fluid. The collection was also performed 15 days later. Real time PCR was used to quantify the expression of the prokaryotic 16S ribosomal RNA gene. Additionally, the cytokines IFN-γ, TNF-α, IL-1α, IL-17A, IL-10, IL-6 and MCP-1 were also quantified by real-time PCR. The 16S mRNA was evaluated before the cleaning and shaping procedures and 15 days later in the groups treated with or without medication. A significant reduction in the microbial load was observed only in the intracanal group (p <0.05). There was an increase in the gene expression level of the cytokines (T15) TNF-α and IL-10 in the CH+ group compared to the other groups (p <0.05). The expression of IFN-γ mRNA was reduced in the groups treated with the medications (CH, Se, and CH + Se). The findings of the present study indicate that in the case of treatment over multiple sessions, the use of intracanal medication is essential to avoid the recolonization of the RCS. The inclusion of selenium with calcium hydroxide resulted in the potentiation of the anti-inflammatory phase of the periradicular tissues.

Effect of Intracanal Medicaments on Push-out Bond Strength of Calcium Silicate-based Materials / 대한소아치과학회지

The purpose of this study was to evaluate the effect of the intracanal medicaments on the push-out bond strength of the calcium silicate-based materials.Forty extracted single-root human mandibular premolars were sectioned below cementoenamel junction. Standardized root canal dimension was obtained with a parallel post drill. The specimens were randomly divided into a control group (no medicament), and experimental groups received medicaments with either CH (calcium hydroxide), DAP (double antibiotic paste; a mixture of ciprofloxacin and metronidazole), or TAP (triple antibiotic paste; a mixture of minocycline, ciprofloxacin and metronidazole). Following removal of medicaments with irrigation, roots were cut into sections with 1-mm-thickness. Thereafter, calcium silicate-based materials are applied to the specimens : (i) ProRoot MTA® and (ii) Biodentine®. A push-out bond strength was measured and each specimen was examined to evaluate failure mode.Intracanal medication using CH significantly increased the bond strength to the root dentin. But there are no significant differences on the bond strength of ProRoot MTA® or Biodentine® among TAP, DAP and control groups. The dislodgement resistance of Biodentine® from root dentin was significantly higher than that of ProRoot MTA® regardless of the type of intracanal medicaments.

Effects of intracanal medicaments and the remaining cavity wall on fracture strength of endodontically treated molars / Efeitos dos medicamentos intracanais e do muro de cavidade remanescente na força de fratura dos molares endodonticamente tratados

Objective: The aim of this study was to investigate the effects of the short-term intracanal application of two medicaments on the fracture strength of root-filled molar teeth with different levels of tooth structure loss. Material and Methods: Standard access cavities of totally 84 intact maxillary molar teeth were prepared in 72 teeth and were divided into 3 main groups. Standard access cavities were kept in the first group, while mesio-occlusal-distal cavities (MOD) were prepared in the second and third groups. One-half of the palatinal walls were removed in the third group. Twelve sound teeth were used in the fourth group as control. Each group was then assigned into two subgroups according to the medicament used (n=12): 2% chlorhexidine gel and calcium hydroxide. Samples were stored at 37°C and 100% humidity for 1 week. Then the teeth were inserted into a universal testing machine and vertically loaded (5 mm/min) from the occlusal surface. The data was recorded in Newtons and statistically evaluated using a Univariate ANOVA and a Tukey as post hoc test. Results: A significant difference was found among the test groups (p <0.01). No significant difference was found according to the medicament used (p>0.05), however the number of remaining walls significantly affected the fracture strength (p <0.01). The first group with access cavity showed mostly repairable fractures (60%­80%) whereas the others showed mostly nonrepairable fracture patterns s (60%­90%). Conclusion: In conclusion, the fracture strength of endodontically treated teeth is related to the structure loss rather than the intracanal medicament used. (AU)

Objetivo: O objetivo deste estudo foi investigar os efeitos da aplicação intracanal de curto prazo de dois medicamentos sobre a resistência à fratura de dentes molares preenchidos com raízes com diferentes níveis de perda de estrutura dentária. Material e Métodos: cavidades de acesso padrão de totalmente 84 dentes molar maxilares intactos foram preparadas em 72, dentes e foram divididas em 3 grupos principais. As cavidades de acesso padrão foram mantidas no primeiro grupo, enquanto as cavidades mesooclusais-distal (MOD) foram preparadas no segundo e terceiro grupos. A metade das paredes palatinas foi removida no terceiro grupo. Doze dentes de som foram utilizados no quarto grupo como controle. Cada grupo foi então atribuído em dois subgrupos de acordo com o medicamento utilizado (n = 12): 2% de gel de clorhexidina e hidróxido de cálcio. As amostras foram armazenadas a 37 ° C e 100% de umidade por 1 semana. Em seguida, os dentes foram inseridos em uma máquina de teste universal e carregados verticalmente (5 mm / min) da superfície oclusal. Os dados foram registrados em Newtons e avaliados estatisticamente usando uma ANOVA Univariada e um Tukey como teste post hoc. Resultados: uma diferença significativa foi encontrada entre os grupos de teste (p <0,01), no entanto, o número de paredes restantes afetou significativamente a resistência à fratura (p <0,01). O primeiro grupo com cavidade de acesso apresentou fracturas principalmente reparáveis (60% -80%), enquanto as demais apresentaram padrões de fratura não reparáveis (60% -90%). Conclusão: Em conclusão, a resistência à fratura dos dentes tratados endodonticamente está relacionada à perda da estrutura em vez do medicamento intracanal utilizado.(AU)

Antimicrobial efficacy of new triple antibiotics in combination with calcium hydroxide for Enterococcus faecalis: An In vitro comparative study / 第二军医大学学报

Objective To evaluate the antibacterial effects of the combination of calcium hydroxide and new triple antibiotics against Enterococcus faecalis (E. faecalis). Methods Eighty single rooted premolar teeth (intact and normal development) were included in this study. E. faecalis infected model was established in vitro. Model teeth were divided randomly into five groups with 16 teeth in each group, and the teeth in the five groups were treated using normal saline (NS group), calcium hydroxide (CH group), conventional triple antibiotics (mixed with metronidazole, minocycline and ciprofloxacin, TAP group), new triple antibiotics (mixed with ornidazole, minocycline and ciprofloxacin, NTAP group) or new triple antibiotics in combination with calcium hydroxide (NTAPTCH group), respectively, as intracanal medicament. The colony-forming units were counted at day 3 and day 7 after operation using colony-counting method. Scanning electronmicroscope was used to confirm the bacterial counting results. Results The colony-forming units on day 3 and day 7 of post-operation in the NTAP and NTAPTCH groups were both significantly lower than those in the TAP and CH groups (both P0.05). Scanning electron microscope results showed fewer bacteria on the root canal walls in the NTAP and NTAP + CH groups than the other three groups. Conclusion Antibacterial effect of new triple antibiotic used alone or in combination with calcium hydroxide for E. Faecalis issuperior to conventional triple antibiotics and calciumhydroxide. So new triple antibiotic used alone or in combination with calcium hydroxide can be considered as an effective alternative intracanal medicament.

Antimicrobial and antifungal efficacy of Spilanthes acmella as an intracanal medicament in comparison to calcium hydroxide: An in vitro study.

Background: Repeated endodontic failures are due to pathogens like Enterococcus faecalis and Candida albicans which are resistant to the common intracanal medicaments like calcium hydroxide (Ca[OH]2). Aims: To determine the role of commonly used folk medicine, Spilanthes acmella (SPA) against root canal pathogens like E. faecalis, C. albicans, Staphylococcus aureus, Streptococcus sp, and to compare its efficacy with Ca(OH)2, a popularly used intracanal medicament. Materials and Methods: Bacterial strains of S. aureus, Streptococcus sp., E. faecalis, and fungal strains of C.albicans were tested against different concentrations of SPA and Ca(OH)2. Seven days old cultures of test organisms were seeded onto agar plates and uniformly spread with a spreader. Five to six wells (8 mm) were made on agar plate to which different concentrations of the test solutions were added. The inoculated plates were kept in an incubator at 37°C for 48 h and inhibition zones were measured. Statistical Analysis: Results of SPA were compared with results of Ca(OH)2 statistically using Mann–Whitney U test. Results: A significant zone of inhibition was obtained with SPA and was found to increase as the concentration increased for C. albicans. SPA showed a significant zone of inhibition at 2–5% and 10% whereas Ca(OH)2 showed a zone of inhibition only at 10% for E. faecalis. SPA showed a zone of inhibition only at 10%, whereas, Ca(OH)2 showed a significant zone of inhibition at 5% and 10% for S. aureus and Streptococcus sp., respectively. Conclusion: SPA possesses remarkable antibacterial and antifungal activity against common root canal pathogens which are responsible for repeated endodontic failures such as E. faecalis and C. albicans when compared with medicaments like Ca(OH)2.

Antimicrobial effect of calcium hydroxide as an intracanal medicament in root canal treatment: a literature review - Part II. in vivo studies

The first part of this study reviewed the characteristics of calcium hydroxide (Ca(OH)2) and summarized the results of in vitro studies related to its antimicrobial effects. The second part of this review covers in vivo studies including human clinical studies and animal studies. The use of Ca(OH)2 as an intracanal medicament represented better histological results in animal studies. However, human clinical studies showed limited antimicrobial effects that microorganisms were reduced but not eliminated through the treatment, and that some species had resistance to Ca(OH)2. Most of clinical outcome studies supported that there is no improvement in healing of periapical lesions when Ca(OH)2 was applied between appointments. Further studies are required for the antimicrobial effects of Ca(OH)2, and search for the ideal material and technique to completely clean infected root canals should be continued.

Antimicrobial effect of calcium hydroxide as an intracanal medicament in root canal treatment: a literature review - Part II. in vivo studies

The first part of this study reviewed the characteristics of calcium hydroxide (Ca(OH)2) and summarized the results of in vitro studies related to its antimicrobial effects. The second part of this review covers in vivo studies including human clinical studies and animal studies. The use of Ca(OH)2 as an intracanal medicament represented better histological results in animal studies. However, human clinical studies showed limited antimicrobial effects that microorganisms were reduced but not eliminated through the treatment, and that some species had resistance to Ca(OH)2. Most of clinical outcome studies supported that there is no improvement in healing of periapical lesions when Ca(OH)2 was applied between appointments. Further studies are required for the antimicrobial effects of Ca(OH)2, and search for the ideal material and technique to completely clean infected root canals should be continued.

Regression of large periapical lesion using calcium hydroxide therapy: a six-year follow-up case report / Regressão de lesão periapical grande usando terapia à base de hidróxido de cálcio: um reporte de caso com 6 anos de acompanhamento

Lesões periradiculares ocorrem em dentes não vitais como resultado de uma agressão crônica devido a presença de microrganismos dentro do canal radicular, as quais podem ser observadas como uma lesão radiolúcida durante o exame radiográfico; o tratamento varia de acordo com métodos cirúrgicos ou não-cirúrgicos. Este reporte de caso descreve a regressão de uma lesão periapical grande usando um tratamento endodôntico não-cirúrgico em associação com medicação intracanal à base de hidróxido de cálcio. Após exame do paciente e análise radiográfica, uma lesão radiolúcida com 13 mm (no maior diâmetro) foi observada no dente número 12. O tratamento endodôntico foi realizado e Calen-CMCP (S.S. White Artigos Dentários Ltda., Rio de Janeiro, RJ, Brazil) foi aplicado dentro do canal, o qual foi substituído por nova medicação a cada 2 semanas durante 2 meses. A lesão regrediu progressivamente a partir de cada troca de medicação. Além disso, após acompanhamento de 6 anos o dente permaneceu livre de infecção e o tecido ósseo foi completamente regenerado. Conclui-se que terapia à base de hidróxido de cálcio pode estimular de maneira conservadora a regressão de lesões periapicais grandes...

Periradicular lesions occur in non-vital teeth as the result of a chronic aggression by the presence of microorganisms into the root canal, which may appear as a radiolucent lesion in the radiographic exam; treatment varies according to surgical or nonsurgical methods. This case report describes the regression of a periradicular lesion using a nonsurgical endodontic treatment in association with intracanal calcium hydroxide-based medicament. After patient examination and radiographic analysis, a 13 mm (in maximum diameter) radiolucent lesion was observed in tooth number 12. The endodontic treatment was done and Calen-CMCP (S.S. White Artigos Dentários Ltda., Rio de Janeiro, RJ, Brazil) was placed into the root canal, which was changed after every two weeks during two months. It was observed a progressive centrifugal regression of the lesion after every renewing of the medicament. In addition, after six-year follow-up the tooth was still free of re-infection and bone tissue was completely regenerated. In conclusion, calcium hydroxide therapy can conservatively stimulate the regression of large periradicular lesions...

Antimicrobial effect of calcium hydroxide as an intracanal medicament in root canal treatment: a literature review - Part I. In vitro studies

The goal of endodontic treatment is the prevention and control of pulpal and periradicular infections. Calcium hydroxide (Ca(OH)2) has been widely used in endodontics as an intracanal medicament to eliminate the remaining microorganisms after chemomechanical preparation. The purpose of this article is to review the antimicrobial properties of Ca(OH)2 as an intracanal medicament in root canal treatment. The first part of this review details the characteristics of Ca(OH)2 and summarizes the results of in vitro studies related to its antimicrobial effect. The antimicrobial effect of Ca(OH)2 results from the release of hydroxyl ions when it comes into contact with aqueous fluids. Ca(OH)2 has a wide range of antimicrobial effects against common endodontic pathogens, but is less effective against Enterococcus faecalis and Candida albicans. The addition of vehicles or other agents might contribute to the antimicrobial effect of Ca(OH)2.

Antibacterial effect of bioactive glass in combination with powdered enamel and dentin.

Background and Objectives: In endodontics, various intracanal medications have been advocated to eliminate bacteria after root canal instrumentation. A recent study has revealed that addition of powdered dentin to bioactive glass (BAG) led to increased glass dissolution, and an increased antibacterial efficacy. Therefore, the present study was undertaken to compare the effect of enamel and dentin powder on the antibacterial efficacy of a commercially available BAG. Materials and Methods: Dentin blocks (dbs) were prepared from single rooted human teeth. These dbs were infected with Enterococcus faecalis for two weeks in Tryptic Soy Broth (TSB), while negative controls were kept in sterile TSB. In group I, the infected dbs were filled with BAG, in group II with BAG + Enamel powder and group III with BAG + Dentin powder. Dentin samples were harvested from the dbs and cultured. Statistical Analysis: Kruskal-Wallis ANOVA was used for multiple group comparison followed by Scheffe's post hoc test for pair-wise comparisons. Results: All the combinations of BAG evaluated significantly reduced the bacterial counts compared to the control group. However, at the end of 24 hours, three days, and five days BAG + Dentin powder showed significant reduction ( P < 0.01) in bacterial counts compared to the other experimental groups. Conclusion: Among the various materials evaluated, it appeared that though BAG exhibits antimicrobial efficacy, the addition of powdered enamel and dentin in aqueous suspension definitely enhanced this property. However, the addition of enamel powder BAG did not significantly alter its antimicrobial efficacy compared to BAG + dentin powder.

Antimicrobial effect and pH of chlorhexidine gel and calcium hydroxide alone and associated with other materials

The purposes of this study were to evaluate the effectiveness of 2 percent chlorhexidine (CHX) gluconate gel, calcium hydroxide [Ca(OH)2] and their combination with iodoform and zinc oxide powder as intracanal medications against select microorganisms, and to measure the pH changes caused by these medications. Antimicrobial activity was determined by the agar diffusion method. The zones of growth inhibition were measured and the results were analyzed statistically by Kruskal-Wallis test (p<0.05). The pH of the pastes was measured right after preparation, after 24 h and 1 week later. The largest mean zones of microbial inhibition were produced by 2 percent CHX gel, followed by Ca(OH)2 + 2 percent CHX gel + iodoform, Ca(OH)2 + 2 percent CHX gel, Ca(OH)2 + 2 percent CHX gel + zinc oxide, and Ca(OH)2 + water. The mean pH of all medications stayed above 12.0 during the whole experiment, except for CHX gel (pH=7.0). The results of this study showed that all medications had antimicrobial activity, but the most effective against the tested microorganisms were 2 percent CHX gel, followed by its combination with Ca(OH)2 and iodoform.

O objetivo do estudo foi avaliar, in vitro, a efetividade antimicrobiana da clorexidina gel 2 por cento (CHX) e hidróxido de cálcio, isoladamente e associados com iodofórmio e pó de óxido de zinco como medicamentos intracanais frente a microrganismos e medidos pHs das diferentes medicações. A atividade antimicrobiana foi determinada pelo método de difusão em ágar. As áreas de inibição de crescimento foram medidas e os resultados estatisticamente analisados utilizando-se o teste de Kruskal-Wallis (p<0,05). O pH das pastas foi mensurado após a manipulação, após 24 h e após uma semana. Os resultados mostraram que a maior zona de inibição foi da CHX gel 2 por cento, seguida pelo Ca(OH)2 + 2 por cento CHX gel, Ca(OH)2 + 2 por cento CHX gel + iodofórmio, Ca(OH)2 + 2 por cento CHX gel +óxido de zinco, Ca(OH)2 + água. A média de pH de todos os medicamentos intracanais foi de 12 durante todo o experimento, exceto com CHX gel 2 por cento (pH=7,0). Estes resultados permitiram concluir que todos os medicamentos tiveram atividade antimicrobiana, no entanto, a maior foi da CHX gel 2 por cento, seguido da associação com o Ca(OH)2. e iodofórmio.

Efeito de soluções irrigadoras e do hidróxido de cálcio como curativo de demora sobre o LPS-Endotoxina: estudo histopatológico em dentes de cães / Effect of biomechanical preparation associated with different irrigant solutions and calcium hydroxide used as root canal dressing on bacterial LPS: histopathological evaluation in dog's teeth

O objetivo deste estudo foi avaliar o efeito do preparo biomecânico coadjuvado por diferentes soluções irrigadoras e da sua associação a um curativo de demora à base de hidróxido de cálcio em canais radiculares de dentes de cães contendo endotoxina (LPS bacteriano). Foram utilizados 137 raízes de pré-molares com vitalidade pulpar de 7 cães, cujos canais radiculares, após pulpectomia foram preenchidos por solução de LPS de Eschechia coli na concentração de 10mg/mL, por 10 dias, quando receberam os seguintes procedimentos: Nos grupos I a V foi realizado o preparo biomecânico dos canais radiculares, coadjuvado pelas seguintes soluções irrigadoras: solução de hipoclorito de sódio a 1, 2,5 e 5% (grupos I a III); solução de digluconato de clorexidina a 2% (Grupo IV); soro fisiológico (Grupo V). No grupo VI, a solução de LPS foi mantida no canal radicular durante todo o período experimental e no grupo VII, após o preparo biomecânico coadjuvado por soro fisiológico, os canais radiculares foram preenchidos por pasta à base de hidróxido de cálcio (Calen). Decorridos 60 dias, os animais foram mortos e as peças submetidas ao processamento histológico para avaliação do reparo apical e periapical. A avaliação histopatológica demostrou que, os grupos I a VI, que não receberam curativo de demora apresentaram maior intensidade de infiltrado inflamatório, espessura do ligamento periodontal e reabsorção cementária e óssea (p<0,05) do que o grupo VII, o qual recebeu curativo de demora à base de hidróxido de cálcio. Conclui-se que o preparo biomecânico coadjuvado por diferentes soluções irrigadoras não foi capaz de inativar a endotoxina. Porém, o emprego do curativo de demora á base de hidróxido de cálcio mostrou-se eficaz na inativação, in vivo, dos efeitos tóxicos da endotoxina

The aim of this study was to evaluate the effect of biomechanical preparation with different irrigating solutions and its association with a calcium hydroxide based root canal dressing (Calen) in root canals of dog´s teeth containing endotoxin (bacterial LPS). One hundred and thirtyseven root canals of pre-molars with pulp vitality from 7 mongrel dogs were used. The root canals, after pulpectomy, were filled with LPS solution from Escherichia coli with 10mg/mL, for 10 days. Then, they were submitted to the following treatments: In the groups I to V, biomechanical preparation of root canals was done using the following irrigating solutions: 1, 2.5 and 5% sodium hypochlorite solution in the groups I to III; 2.0% digluconate chlorhexidine (Group IV); saline solution (Group V). In the group VI, LPS solution was mantained in the root canal during all the experimental period and in the group VII, after the biomechanical preparation using saline solution as irrigating solution, the root canals were filled with a calcium hydroxide based root canal dressing (Calen). After 60 days, the animals were killed and the obtained histological sections were processed for evaluation of the apical and periapical repair. The histopathological evaluation showed that, the groups I to VI, with no root canal dressing demonstrated more intensive inflammatory infiltrate, thickness of periodontal ligament and cement and osseus reabsorption (p<0,05) than group VII, that received a root canal dressing based on calcium hydroxide. In conclusion, the biomechanical preparation with different irrigating solutions didn't inativate the endotoxin. The intracanal dressing based on calcium hydroxide was efficient, in vivo, in the inativation of the deletery effects of endotoxin