Effects of using different root canal sealers and protocols for cleaning intraradicular dentin on the bond strength of a composite resin used to reinforce weakened roots / Efectos del uso de diferentes selladores de conductos radiculares y protocolos para limpiar la dentina intrarradicular sobre la fuerza de unión de una resina compuesta utilizada para reforzar raíces debilitadas

Background: This study evaluated the effects of using different root canal sealers and protocols for cleaning intraradicular dentin on the bond strength of a composite resin used to reinforce weakened roots. Material and Methods: Sixty-four roots of extracted human maxillary canines were weakened, prepared and filled with two different endodontic sealers (Endofill and AH Plus). In half of the sample, set aside for each respective sealer, excess filling material was cleaned. In the other half, the weakened areas were not cleaned, and the excess of sealer was spread on the intraradicular dentin. Intentionally worn areas inside each root were restored with a microhybrid light-cure composite resin (Z100) to reinforce them, with and without acid etching. Prefabricated metal posts were fixed with a dual resin cement (RelyX ARC), and the specimens were submitted to a pull-out test. Statistical analysis was performed by means of Shapiro-Wilk, analysis of variance (one-way ANOVA) and Tukey-Kramer tests (p<0.05). Results: The groups filled with Endofill (GI, GII, GIII, GIV) had the lowest bond strength values, which were similar among each other (p>0.05).The greatest bond strength values were observed in roots filled with AH Plus (GV, GVI, GVII, GVIII), mainly without cleaning of the weakened areas, and followed by acid etching (GVII), and also with cleaning of the weakened areas, however, with no acid etching (GVI) (p<0.05). Conclusion: The greatest bond strength values were observed in roots filled with AH Plus; (1) without cleaning of the weakened areas and with acid etching, and; (2) with cleaning of the weakened areas, but without acid etching.

Antecedentes: este estudio evaluó los efectos del uso de diferentes selladores de conductos radiculares y protocolos para limpiar la dentina intrarradicular sobre la fuerza de unión de una resina compuesta utilizada para reforzar las raíces debilitadas. Material y Métodos: Sesenta y cuatro raíces de caninos maxilares humanos extraídos fueron debilitadas, preparadas y rellenadas con dos selladores endodónticos diferentes (Endofill y AH Plus). En la mitad de la muestra, reservada para cada sellador respectivo, se limpió el exceso de material de relleno. En la otra mitad, las áreas debilitadas no se limpiaron y el exceso de sellador se esparció sobre la dentina intrarradicular. Las áreas desgastadas intencionalmente dentro de cada raíz se restauraron con una resina compuesta fotopolimerizable microhíbrida (Z100) para reforzarlas, con y sin grabado ácido. Los postes metálicos prefabricados se fijaron con un cemento de resina dual (RelyX ARC) y los especímenes se sometieron a una prueba de extracción. El análisis estadístico se realizó mediante Shapiro-Wilk, análisis de varianza (ANOVA de una vía) y pruebas de Tukey-Kramer (p<0,05). Resultados: Los grupos rellenos con Endofill (GI, GII, GIII, GIV) presentaron los valores más bajos de fuerza de unión, los cuales fueron similares entre sí (p>0,05). Los mayores valores de fuerza de unión se observaron en raíces rellenas con AH Plus (GV, GVI, GVII, GVIII), principalmente sin limpieza de las áreas debilitadas, seguido de grabado ácido (GVII), y también con limpieza de las áreas debilitadas aunque sin grabado ácido (GVI) (p<0.05). Conclusión: Los mayores valores de fuerza de unión se observaron en las raíces rellenas con AH Plus; (1) sin limpieza de las áreas debilitadas y con grabado ácido, y; (2) con limpieza de las áreas debilitadas, pero sin grabado ácido.

Post preparation: cleanness achieved by different irrigating protocols / Preparación para poste: limpieza lograda por diferentes protocolos de irrigación

ABSTRACT The aim of this study was to evaluate the ability of different irrigation protocols to remove from the walls of the root canal and entrance to dentinal tubules the smear layer produced during preparation for a fiber post. Fifty decoronated human lower premolars were treated endodontically and the apical third of the canal was filled with a single gutta-percha point using warm vertical compaction. Ten millimeters were left free for post preparation, which was done by sequential use of a Largo #1 drill and Exacto #3 pilot drill (Angelus, Brazil), with irrigation with distilled water upon each instrument change. Samples were distributed randomly into 5 groups (n=10). G 1: No irrigation after post preparation. G 2: Distilled water activated for 60 s + distilled water. G 3: 5.25% NaOCl 15 s+ distilled water. G 4: 17% EDTA (Farmadental, Argentina) 60 s + 5.25% NaOCl 15 s + distilled water. G 5: 10% polyacrylic acid (Densell) 15 s + distilled water. Irrigant was activated mechanically with a low-speed conical brush. Roots were then split longitudinally in vestibular-lingual direction. Each surface was observed under SEM in its different thirds. Microphotographs were taken at 150X and 600X magnification and results analyzed statistically using Kruskall Wallis and Friedman tests (p<0.05). The results [mean (standard deviation)] were: for 150X: G1 11.00 (1.33), G2 7.50 (3.13), G3 6.30 (2.58), G4 2.20 (2.80), G5 4.30 (1.50), and for 600X G1 11.40 (0.84), G2 10.00 (1.94), G3 7.70 (3.33), G4 5.80 (3.70), G5 7.20 (2.65). The statistical analysis showed significant differences between irrigants (p<0.05) but not between root thirds (p>>0.05). The EDTA+NaOCl combination and polyacrylic acid showed greater capacity to remove the smear layer created during post preparation.

RESUMEN El objetivo del presente trabajo fue evaluar la capacidad de diferentes protocolos de irrigación para remover el barro dentinario de las paredes del conducto y entrada de los túbulos dentinarios, producido durante la preparación para anclaje intarradicular. Se utilizaron 50 premolares inferiores humanos a los cuales se les cortó la corona clínica. Luego se les realizó tratamiento endodóntico y obturación del tercio apical con cono único de conicidad aumentada y compactación vertical caliente. Se dejaron libres 10 mm para la preparación para poste que se realizó utilizando secuencialmente fresa de Largo # 1y fresa piloto Exacto #1(Angelus, Brasil), irrigando a cada cambio de instrumento con agua destilada. Las muestras fueron distribuidas aleatoriamente en 5 grupos (n=10). G 1: No se efectuó ningún lavaje. Los irrigantes fueron activados con cepillo mecánico cónico a baja velocidad. G 2: Agua destilada activada 60 s+ agua destilada G 3: NaOCl al 5,25%, 15 s+ agua destilada. G 4: EDTA al 17% (Farmadental, Argentina) 60 s +NaOCl al 5,25% 15 s , + agua destilada. G 5 : Ácido poliacrílico al 10% ( Densell) 15 s + agua destilada. Posteriormente, las raíces fueron seccionadas longitudinalmente en sentido vestíbulo lingual. Cada superficie fue observada al MEB en sus diferentes tercios. Las micrografías se realizaron a 150 y 600 X y los resultados analizados estadísticamente mediante test de Kruskall Wallis y Friedman (p<0,05), Los resultados [Medias (desviaciones estándar)] fueron: para 150X G1 11,00(1,33), G2 7,50 (3,13), G3 6,30 (2,58), G4 2,20 (2,80), G5 4,30 (1,50) y para 600X G1 11,40 (0,84), G2 10,00 (1,94), G3 7,70 (3,33), G4 5,80 (3,70), G5 7,20 (2,65). El análisis estadístico mostró diferencia significativa entre irrigantes (p<0,05) pero no entre tercios radiculares (p>0,05). La combinación de EDTA+NaOCl y el ácido poliacrílico tendrían mayor capacidad de remoción del barro dentinario creado durante la preparación para poste.

Comparación de desinfección de diferentes marcas de punta de gutapercha con hipoclorito de sodio / Comparison of disinfection of different brands of gutta-percha tip with sodium hypochlorite

En la terapia endodóncica uno de los principales objetivos es eliminar y prevenir la infección o reinfección del sistema de conductos radiculares y/o los tejidos perirradiculares. Los materiales de obturación utilizados podrían introducir microorganismos a este sistema previamente desinfectado e impedir el éxito del tratamiento. Diversos estudios han demostrado que los conos de gutapercha pueden estar contaminados al ser tomados directamente del empaque, aún sellado y recién abierto. Objetivo: Comparación del grado de desinfección de tres marcas diferentes de puntas de gutapercha. Material y métodos: Es un estudio experimental, comparativo, observacional y de corte transversal. En el cual se analizarán tres marcas diferentes de gutaperchas #35 (Maillefer, Hygienic y Meta-Biomed) para saber qué desinfección hay con el hipoclorito de sodio (NaOCl) al 5.25%. Se llevó a cabo el análisis descriptivo para determinar medidas de tendencia central y medidas de dispersión mediante la prueba estadística de ANOVA p ≤ 0.05. Conclusión: De acuerdo con los resultados de nuestro estudio no se encontró diferencia significativa sobre la marca de gutapercha y el grado de descontaminación después de un minuto de ser sumergidas en hipoclorito de sodio al 5.25% (AU)

In endodontic therapy one of the main objectives is to eliminate and prevent infection or reinfection of the root canal system and/or periradicular tissues. The sealing materials used could introduce microorganisms to this previously disinfected system and impede the success of the treatment. Several studies have shown that gutta-percha cones can be contaminated by being taken directly from the package, still sealed and newly opened. Objective: Comparison of the degree of disinfection of 3 different brands of gutta-percha points. Material and methods: It is an experimental, comparative, observational and cross-sectional study. Where 3 different brands of gutta percha # 35 (Maillefer, Hygienic and Meta-Biomed) will be analyzed to know what disinfection there is with sodium hypochlorite (NaOCl) at 5.25%. The descriptive analysis was carried out to determine measures of central tendency and measures of dispersion through the statistical test of ANOVA p ≤ 0.05. Conclusion: According to the results of our study there is no significant difference on the gutta-percha brand and its decontamination at the moment of being submerged in 5.25% sodium hypochlorite (AU)

Penetration of bioceramic and epoxy-resin endodontic cements into lateral canals

Abstract: The aim of the present study was to assess the penetration capacity of two endodontic cements, Endosequence BC Sealer and AH Plus, in artificial lateral canals. Twenty-six two-rooted, maxillary first premolars were instrumented to size 40.06 using K3 files. In each root, six lateral canals of two diameters (0.06 and 0.10 mm) were created with a working length of 2, 4, and 6 mm. The specimens were randomly divided into two groups according to the endodontic cement to be used (Endosequence BC Sealer and AH Plus) and obturated by the single-cone technique. The specimens were imaged by digital periapical radiography and scores from 0 to 4 were attributed according to the degree of penetration by sealers into the lateral canals. Data were analyzed statistically by Kruskal-Wallis and Student-Newman-Keuls tests, and a significance level of p < 0.05 was adopted. No significant difference was observed between the two endodontic cements used to fill the simulated lateral canals (p > 0.05). The diameter of lateral canals only influenced the capacity of the Endosequence BC Sealer in filling the canals, and presented greater penetration in the lateral canals of diameter 0.10 mm (p < 0.05). We concluded that the bioceramic endodontic cement Endosequence BC Sealer presented similar ability as AH Plus to fill simulated lateral canals.

A randomized clinical trial of cavity liners after selective caries removal: one-year follow-up

Abstract Alternatives for the treatment of caries disease, such as minimally invasive approaches, have been developed in recent years. Objective: To carry out clinical and radiographic evaluations of three cavity liners after selective caries removal. Methodology: Thirty-six primary molars with deep occlusal caries lesions without pulp involvement (from children of both genders, aged between 5 and 8 years) were randomly divided into the following groups: calcium hydroxide cement (CHC) group; mineral trioxide aggregate (MTA) group and Portland cement with added zirconium oxide (PCZ) group. The following-up period was 6- and 12-month. The clinical and radiographic success rates were evaluated through chi-square test. The radiographic measurements were compared by ANOVA followed by Tukey's test (p<0.05). Results: Thirty-six patients were included, but thirty-four returned for 12-month follow-up. The overall success rate of the therapy for the three groups was 94.11% and no statistically significant differences occurred in the comparison among groups (p>0.05). Nineteen radiographs were selected to measure the dentin barrier thickness. The intragroup comparison presented a statistically significant increase of the dentin barrier for all groups, at 12-month follow-up. However, the MTA group showed increase of the dentin barrier, over time, 6- to 12-month follow-up. The intergroup comparison revealed no statistically significant differences (p>0.05). Conclusion: The clinical and radiographic data showed that all cavity liners provided effective treatment of primary teeth after selective caries removal.

Effect of ultrasonic and Nd: Yag laser activation on irrigants on the push-out bond strength of fiber post to the root canal

Abstract Objective: This in vitro study aimed to compare the efficacy of irrigants using various irrigation activation methods to the push-out bond strengths of fiber post to root canal luted with self-adhesive resin cement (SARC). Methodology: Forty-eight decoronated human canines were used. The specimens were divided into four groups corresponding with the post-space irrigation process and were treated as follows: distilled water (DW) (Control) group received 15 mL of DW; sodium hypochlorite (NaOCl)+ethylenediaminetetraacetic acid (EDTA) group was treated with 5 mL of 5.25% NaOCl, 5 mL of 17% EDTA, and 5 mL of DW; passive ultrasonic irrigation (PUI) group was treated with 5 mL of 5.25% NaOCl, 5 mL of 17% EDTA, and 5 mL of DW, and each irrigant was agitated with an ultrasonic file; and laser activated irrigation (LAI) group was treated with 5 mL of 5.25% NaOCl, 5 mL of 17% EDTA, and 5 mL of DW, and each irrigant was irradiated with Nd: YAG laser. Fiber posts were luted with SARC, and a push-out test was performed. Data was analyzed using one-way analysis of variance and Tukey HSD test. Results: The bond strength values for the groups obtained were as follows: Control (10.04 MPa), NaOCl+EDTA (11.07 MPa), PUI (11.85 MPa), and LAI (11.63 MPa). No statistically significant differences were found among all experimental groups (p>0.05). The coronal (12.66 MPa) and middle (11.63 MPa) root regions indicated a significantly higher bond strength compared with the apical (9.16 MPa) region (p<0.05). Conclusions: Irrigant activation methods did not increase the bond strength of fiber post to canal.

Effect of peracetic acid used as single irrigant on the smear layer, adhesion, and penetrability of AH Plus

Abstract The aim of this study was to evaluate the effect of peracetic acid (PAA) as a single irrigant on the smear layer, on the intraradicular dentinal bond strength, and on the penetrability of an epoxy-based resin sealer into the dentinal tubules. A total of 120 roots were distributed into 4 groups according to the irrigant used in root canal preparation: 1% PAA (PAA); 2.5% NaOCl followed by final irrigation with 17% EDTA and 2.5% NaOCl (NaOCl-EDTA-NaOCl); 2.5% NaOCl (NaOCl); and saline solution (SS). The smear layer was evaluated using scanning electron microscopy. The bond strength of an epoxy-based resin sealer (AH Plus) to root dentin was evaluated by the push-out test and penetrability of the sealer into dentinal tubules was observed by confocal laser microscopy. The results were analyzed by the Kruskal-Wallis and the Dunn post-test (α = 0.05). The use of 1% PAA as single root canal irrigant provided smear layer removal and improved the penetrability and bond strength of AH Plus to root dentin in a manner similar to that of the NaOCl-EDTA-NaOCl group (p > 0.05). The NaOCl and SS groups had higher values of smear layer and lower values of sealer penetrability and dentin bond strength than the PAA and NaOCl-EDTA-NaOCl groups (p < 0.05). Thus, 1% PAA has the potential to be used as a single irrigant in root canals.

Effects of dodecacalcium hepta-aluminate content on the setting time, compressive strength, alkalinity, and cytocompatibility of tricalcium silicate cement

Abstract Objective This study aimed to investigate the effects of dodecacalcium hepta-aluminate (C12A7) content on some physicochemical properties and cytocompatibility of tricalcium silicate (C3S) cement using human dental pulp cells (hDPCs). Material and Methods High purity C3S cement was manufactured by a solid phase method. C12A7 was mixed with the cement in proportions of 0, 5, 8, and 10 wt% (C12A7-0, −5, −8, and −10, respectively). Physicochemical properties including initial setting time, compressive strength, and alkalinity were evaluated. Cytocompatibility was assessed with cell viability tests and cell number counts. Statistical analysis was performed by using one-way analysis of variance (ANOVA) and Tukey's test (p<0.05). Results The initial setting time of C3S-based cement was shorter in the presence of C12A7 (p<0.05). After 1 day, C12A7-5 showed significantly higher compressive strength than the other groups (p<0.05). After 7 days, the compressive strength of C12A7-5 was similar to that of C12A7-0, whereas other groups showed strength lower than C12A7-0. The pH values of all tested groups showed no significant differences after 1 day (p>0.05). The C12A7-5 group showed similar cell viability to the C12A7-0 group (p>0.05), while the other experimental groups showed lower values compared to C12A7-0 group (p<0.05). The number of cells grown on the C12A7-5 specimen was higher than that on C12A7-8 and −10 (p<0.05). Conclusions The addition of C12A7 to C3S cement at a proportion of 5% resulted in rapid initial setting time and higher compressive strength with no adverse effects on cytocompatibility.

Demetallization of Enterococcus faecalis biofilm: a preliminary study

Abstract Objectives To determine the concentration of calcium, iron, manganese and zinc ions after the application of chelator to Enterococcus faecalis biofilms. Material and Methods Fifty bovine maxillary central incisors were prepared and inoculated with E. faecalis for 60 days. The following were used as irrigation solutions: 17% EDTA (pH 3, 7 and 10), 2.5% sodium hypochlorite (NaOCl) combined with 17% EDTA (pH 3, 7 and 10), distilled water (pH 3, 7 and 10), and 2.5% NaOCl. Each solution was kept in the root canal for five minutes. Fifteen uncontaminated root canals were irrigated with 17% EDTA (pH 3, 7 and 10). Six teeth were used as bacterial control. The number of calcium, iron, manganese and zinc ions was determined using flame atomic absorption spectrometry. Mean ± standard deviation (SD) values were used for descriptive statistics. Results Calcium chelation using 17% EDTA at pH 7 was higher than at pH 3 and 10, regardless of whether bacterial biofilm was present. The highest concentration of iron occurred at pH 3 in the presence of bacterial biofilm. The highest concentration of manganese found was 2.5% NaOCl and 17% EDTA at pH 7 in the presence of bacterial biofilm. Zinc levels were not detectable. Conclusions The pH of chelating agents affected the removal of calcium, iron, and manganese ions. The concentration of iron ions in root canals with bacterial biofilm was higher after the use of 17% EDTA at pH 3 than after the use of the other solutions at all pH levels.

Immunohistological study of the effect of vascular Endothelial Growth Factor on the angiogenesis of mature root canals in rat molars

Abstract Tissue bioengineering has been applied to Endodontics to seek a more biological treatment. The presence of blood vessels is crucial for cell nutrition during tissue formation. Objective This study analysed the application of vascular endothelial growth factor (VEGF) in the angiogenesis of mature root canals. Material and methods Upper first molars of twelve 13-week old Wistar male rats were used. The root pulp of the mesiobuccal canal was removed and the root canal instrumented with K-files up to size #25. Periapical bleeding was induced into the root canal by introducing a #15 K-file beyond the apex. The teeth on the right side of the arch were filled up with blood clot (G1), whereas those on the left side were filled up with blood clot plus 50 ng/ml of VEGF (G2). Teeth were sealed with light-curing glass-ionomer cement and the animals were sacrificed after 60 days. The maxilla was dissected and fixed before obtaining serial sections for histological processing with haematoxylin-eosin (HE) and immunohistochemical factor-VIII. Immunohistochemical labelling was evaluated using scores for statistical analysis. Results Immunohistological analysis demonstrated the presence of angiogenesis in both groups, but with higher angiogenic maturation in G2 during the experimental period (p<0.05). HE staining showed connective tissue with absence of odontoblasts in all specimens. Conclusions It can be concluded that it is possible to obtain angiogenesis in mature root canals with or without the use of VEGF, although the latter tends to accelerate blood vessel formation.

Bond strength values of fiberglass post to flared root canals reinforced with different materials

Abstract The aim of this study was to compare in vitro the bond strength (BS) between fiberglass posts and flared root canals reinforced with different materials. The roots of 48 premolars were endodontically treated. After one week, the root canals were prepared to simulate an oversized root canal, except for the positive control group (PCG), which was cemented with a prefabricated fiber post (PFP) compatible with the root canal size, simulating an ideal adaptation. The other samples (n=8/group) were used to test alternative restorative techniques for filling root canals: negative control group (NCG [PFP with a smaller diameter than of the root canal]), composite resin group - CRG, bulkfill group - BFG, self-adhesive cement group - SAG, and glass ionomer group - GIG. The posts were cemented and after 1 week, each root was sectioned transversely into six 1-mm thick discs and the push-out test was done to evaluate the BS. Data were analyzed by two-way repeated measures ANOVA and Tukey's tests (α=0.05). The highest BS value was observed for PCG. The NCG and the GIG groups showed the lowest BS values. Root reinforcement with conventional and bulk-fill composite resins showed the highest BS values; however, the bulk-fill resin was the only treatment able to maintain high BS values in all regions of the root canal. The self-adhesive cement showed intermediate results between CRG and GIG. Root reinforcement with bulk-fill composite resin is an effective option for flared root canals before cementation of a prefabricated fiber post.

Push-out bond strength of different tricalcium silicate-based filling materials to root dentin

Abstract: The aim of this study was to evaluate the bond strength of different triccalcium silicate cements to retrograde cavity using a push out test. Thirty maxillary central incisors were shaped using #80 hand files and sectioned transversally. Root slices were obtained from the apical 4 mm after eliminating the apical extremity. The specimens were embedded in acrylic resin and positioned at 45° to the horizontal plane for preparation of root-end cavities with a diamond ultrasonic retrotip. The samples were divided into three groups according to the root-end filling material (n = 10): MTA Angelus, ProRoot MTA and Biodentine. A gutta-percha cone (#80) was tugged-back at the limit between the canal and the root-end cavity. The root-end cavity was filled and the gutta-percha cone was removed after complete setting of the materials. The specimens were placed in an Instron machine with the root-end filling turned downwards. The push-out shaft was inserted in the space previously occupied by the gutta-percha cone and push out testing was performed at a crosshead speed of 1.0 mm/min. There was no statistically significant difference in resistance to push out by the materials tested (p > 0.01). MTA Angelus and ProRoot MTA showed predominantly mixed failure while Biodentine exhibited mixed and cohesive failures. The tricalcium silicate-based root-end filling materials showed similar bond strength retrograde cavity.

Can intra-radicular cleaning protocols increase the retention of fiberglass posts? A systematic review

Abstract The presence of residues within the root canal after post-space preparation can influence the bond strength between resin cement and root dentin when using fiberglass posts (FGPs). Currently, there is no consensus in the literature regarding what is the best solution for the removal of debris after post-space preparation. This systematic review involved "in vitro" studies to investigate if cleaning methods of the root canal after post-space preparation can increase the retention of FGPs evaluated by the push-out test. Searches were carried out in PubMed (MEDLINE) and Scopus databases up to July2017. English language studies published from 2007 to July 2017 were selected. 475 studies were found, and 9 were included in this review. Information from the 9 studies were collected regarding the number of samples, storage method after extraction, root canal preparation, method of post-space preparation, endodontic sealer, resin cement, cleaning methods after post-space and presence of irrigant activation. Five studies presented the best results for the association of sodium hypochlorite (NaOCl) and ethylenediamine tetra-acetic acid (EDTA), while in the other 4 studies, the solutions that showed improved retention of FGPs were photon-induced photoacoustic streaming (PIPS), Qmix, Sikko and EDTA. The results showed heterogeneity in all comparisons due to a high variety of information about cleaning methods, different concentrations, application time, type of adhesive system and resin cements used. In conclusion, this review suggests that the use of NaOCl/EDTA results in the retention of FGPs and may thus be recommended as a post-space cleaning method influencing the luting procedure.

Experimental furcal perforation treated with mineral trioxide aggregate plus selenium: immune response

Abstract The aim of this study is to evaluate the expression of cytokines in response to mineral trioxide aggregate (MTA) plus selenium in germ-free mice with experimental furcal perforation. The first left maxillary molar was opened, and the furcal area was perforated and treated with post-MTA-Se (experimental group). The same surgical intervention was performed for the maxillary right first molar, which was treated with MTA (control group). Fifteen mice were sacrificed 7, 14, and 21 days after furcal perforation, and periapical tissue samples were collected. The mRNA expression levels of the cytokines TGF-β, TNF-α, IFN-γ, HPRT, IL-10, IL-4, RANK, RANKL, IL-1, and IL-17 were assessed by using real-time polymerase chain reaction. In the experimental group, at 21-days post-MTA-Se sealing, the mRNA levels of TNF-α and IL-10 were upregulated compared with those in the control group (p < 0.05). Futher assessment revealed basal mRNA expression levels of IL-1α, IFN-γ, RANK, RANKL, IL-17A, IL-4, and TGF-β, over long experimental times, in both the experimental and control groups (p > 0.05). In conclusion, MTA+Se sealing favoured increased expression of IL-10 and TNF-α at later time points (day 21).

Evaluation of the efficacy of filling material removal and re-filling after different retreatment procedures

Abstract This study analyzed the influence of different retreatment protocols on amount of remaining filling material and amount of new sealer after endodontic retreatment. Forty mandibular molars with curved mesial roots were prepared with ProTaper Universal system, and filled with AH Plus sealer mixed with 0.1% rhodamine B and gutta-percha. After 7 days, the specimens were randomized according to the retreatment protocol (n = 10): ProTaper Retreatment System (PTR); PTR+Orange Oil (PTR+OO); PTR+Passive Ultrasonic Irrigation (PTR+PUI). No retreatment was performed in the control group (CG). After retreatment, the root canals were filled with AH Plus mixed with 0.1% fluorescein and gutta-percha. Samples were evaluated under confocal laser scanning microscopy and analyzed using Image J software. Data were analyzed using Kruskal-Wallis and Dunn tests (p < 0.05). Regarding presence of residual filling, the Kruskal-Wallis test indicated no differences among the different retreatment techniques in the perimeter and the isthmus analyses (p > 0.05); however, PTR+PUI was associated with a lesser amount of residual filling material in the canal area analysis (p < 0.05). In evaluating the new filling, the perimeter analysis showed a lesser amount of new endodontic sealer in the PTR group (p < 0.05). Moreover, the PTR+PUI group presented a significantly greater amount of new endodontic sealer in the canal area analysis (p < 0.05). There was no difference among groups in the isthmus analysis (p > 0.05). It can be concluded that PTR associated to PUI yielded better results in removing root canal filling material from the canal area. However, none of the protocols resulted in root walls completely free of remnants.

Effect of photodynamic therapy and non-thermal plasma on root canal filling: analysis of adhesion and sealer penetration

Abstract Objective The aim of this study was to evaluate the effect of photodynamic therapy (PDT) and non-thermal plasma (NTP) on adhesion and sealer penetration in root canals. Material and Methods Sixty single-rooted premolars were used. The teeth were prepared using a crown-down technique. NaOCl and EDTA were used for irrigation and smear layer removal, respectively. The root canals were divided into three groups: control, PDT, and NTP. After treatments, the roots were filled using gutta-percha and either AH Plus (AHP) or MTA Fillapex (MTAF) sealers. Samples were sectioned at 4, 8, and 12 mm from the apex (1-mm slices)and analyzed by the push-out bond strength test (adhesion) and confocal laser scanning microscopy (sealer penetration). Data were statistically evaluated using Kruskal-Wallis, Dunn's, and Spearman's tests. Results Regarding AHP, bond strength was similar in the NTP group and in the control group, but significantly lower in the PDT group. As to MTAF, both therapies showed lower values than the control group. In the confocal analysis of AHP, maximum and mean penetration, and penetrated area were statistically higher in the control group than in the PDT and NTP groups. Penetrated perimeter was similar among groups. Regarding MTAF, all parameters yielded better results in the NTP than in the control group. The PDT and control groups showed similar results except for penetrated area. Conclusion PDT and plasma therapy affected the adhesion and sealer penetration of root canals filled with AH Plus and MTA Fillapex and there is no positive correlation between adhesion and sealer penetration.

Effectiveness of various irrigation protocols for the removal of calcium hydroxide from artificial standardized grooves

Abstract Objective The aim of this study was to investigate the ability of laser-activated irrigation (LAI), XP-endo Finisher, CanalBrush, Vibringe, passive ultrasonic irrigation (PUI), and conventional syringe irrigation systems on the removal of calcium hydroxide (CH) from simulated root canal irregularities. Material and Methods The root canals of one hundred and five extracted single-rooted teeth were instrumented using Reciproc rotary files up to size R40. The teeth were split longitudinally. Two of the three standard grooves were created in the coronal and apical section of one segment, and another in the middle part of the second segment. The standardized grooves were filled with CH and the root halves were reassembled. After 14 days, the specimens were randomly divided into 7 experimental groups (n=15/group). CH was removed as follows: Group 1: beveled needle irrigation; Group 2: double side-vented needle irrigation; Group 3: CanalBrush; Group 4: XP-endo Finisher; Group 5: Vibringe; Group 6: PUI; Group 7: LAI. The amount of remaining CH in the grooves was scored under a stereomicroscope at 20× magnification. Statistical evaluation was performed using Kruskal-Wallis and Bonferroni-Correction Mann-Whitney U tests. Results Groups 1 and 2 were the least efficient in eliminating CH from the grooves. Groups 6 and 7 eliminated more CH than the other protocols; however, no significant differences were found between these two groups (P>.05). Conclusions Nevertheless, none of the investigated protocols were able to completely remove all CH from all three root regions. LAI and PUI showed less residual CH than the other protocols from artificial grooves.

Is the bonding of self-adhesive cement sensitive to root region and curing mode?

Abstract Objectives To evaluate the influence of two curing techniques on the degree of conversion (DC) of resin cements and on bond strength (BS) of fiber posts in different regions of root dentin. Material and Methods Twenty single-rooted premolars were endodontically treated, and the post spaces were prepared. The roots were randomly divided into two groups (n=10), according to the activation mode of the resin cement RelyX™ U200 (3M ESPE Saint Paul, MN, USA): conventional (continuous activation mode) and soft-start activation mode (Ramp). The posts (WhitePost DC/FGM) were cemented according to the manufacturer’s recommendations and, after one week, the roots were cross-sectioned into six discs each of 1-mm thickness, and the cervical, medium, and apical thirds of the root canals were identified. The DC was evaluated under micro-Raman spectroscopy and the BS was evaluated by the push-out test. The data were analyzed by two-way ANOVA and Tukey’s test (α=0.05). Results Neither the activation mode nor the root regions affected the DC of the resin cement. Higher BS was achieved in the soft-start group (p=0.036); lower BS was observed in the apical third compared to the other root regions (p<0.001). Irrespective of the activation mode and root region, the mixed failure mode was the most prevalent. Conclusion The BS of fiber posts to root canals can be improved by soft-started polymerization. The DC was not affected by the curing mode.

Molecular and morphological surface analysis: effect of filling pastes and cleaning agents on root dentin

Abstract The quality of the dentin root is the most important factor for restoration resin sealing and drives the outcome of endodontic treatment. Objective This study evaluated the effect of different filling pastes and cleaning agents on the root dentin of primary teeth using Fourier-transformed Raman spectroscopy (FT-Raman), micro energy-dispersive X-ray fluorescence (µ-EDXRF) and scanning electron microscopic (SEM) analysis. Material and Methods Eighty roots of primary teeth were endodontically prepared and distributed into 4 groups and filled according to the following filling pastes: Control-no filling (CP), Calen®+zinc oxide (CZ), Calcipex II® (CII), Vitapex® (V). After seven days, filling paste groups were distributed to 4 subgroups according to cleaning agents (n=5): Control-no cleaning (C), Ethanol (E), Tergenform® (T), 35% Phosphoric acid (PA). Then, the roots were sectioned and the dentin root sections were internally evaluated by FT-Raman, µ-EDXRF and SEM. Data was submitted to two-way ANOVA and Tukey tests (α=0.05). Results Regarding filling pastes, there was no significant difference in organic content. CP provided the lowest calcium values and, calcium/phosphoric ratio (Ca/P), and the highest phosphoric values. For cleaning agents there was no difference in organic content when compared to the C; however, T showed significantly higher calcium and Ca/P than PA. All groups showed similar results for phosphorus. The dentin smear layer was present after use of the cleaning agents, except PA. Conclusion The filling pastes changed the inorganic content, however they did not change the organic content. Cleaning agents did not alter the inorganic and organic content. PA cleaned and opened dentin tubules.

Effect of final irrigation protocols on microhardness reduction and erosion of root canal dentin

Abstract This study aimed to evaluate the effect of final irrigation protocols on microhardness reduction and erosion of root canal dentin. Sixty root canals from mandibular incisors were instrumented and randomly divided into six groups (n = 10) according to the irrigant used: QMiX, 17% EDTA, 10% citric acid (CA), 1% peracetic acid (PA), 2.5% NaOCl (solution control), and distilled water (negative control). The chelating solutions were used to irrigate the canal followed by 2.5% NaOCl as a final flush. After the irrigation protocols, all specimens were rinsed with 10 mL of distilled water to remove any residue of the chemical solutions. Before and after the final irrigation protocols, dentin microhardness was measured with a Knoop indenter. Three indentations were made at 100 µm and 500 µm from the root canal lumen. Afterwards, the specimens were prepared for scanning electron microscopic analysis and the amount of dentin erosion was examined. Wilcoxon and Kruskal-Wallis tests were used to analyze the results with a significance level set at 5%. At 100 µm, all protocols significantly reduced dentin microhardness (p < .05), while at 500 µm, this effect was detected only in the EDTA and QMiX groups (p < .05). CA was the irrigant that caused more extensive erosion in dentinal tubules, followed by PA and EDTA. QMiX opened dentinal tubules, but did not cause dentin erosion. Results suggest that QMiX and 17% EDTA reduced dentin microhardness at a greater depth. Additionally, QMiX did not cause dentin erosion.