Análise do diâmetro de cones acessórios calibrados por réguas calibradoras / Diameter analysis of accessory cones calibrated by calibrating rulers

O objetivo do presente estudo foi de comparar o diâmetro dos cones acessórios FM EL calibrados por duas réguas calibradoras com seus respectivos diâmetros nominais. Foram calibrados 80 cones de guta percha FM EL (Odous de Deus) utilizando duas réguas calibradoras das seguintes marcas: Prisma e Denco. Os cones foram divididos em 8 grupos (n=10) de acordo com a régua e com o diâmetro em que foram calibrados. Posteriormente, os cones foram fotografados e tiveram seus D0 mensurados através do software ImageJ. Após a realização da análise estatística utilizando-se os testes de Normalidade de Shapiro-Wilk e o teste t Student (Distribuição Normal), obteve-se os seguintes resultados: não houve diferença estatisticamente significativa com o valor de referência na régua prisma nos cones 40, isto é, em todas as outras situações encontrou-se diferença com os valores de referência. Quando foram comparados os valores das medianas e desvio padrão das duas réguas calibradoras também houve diferença estatisticamente significativa (p<0,05) nos cones 25, 35 e 40. Os cones acessórios FM EL (Odous de Deus) calibrados com a régua Denco diferiram dos diâmetros nominais da régua. Assim, deve-se estar atento à exatidão e precisão desses instrumentos a fim de se evitar possíveis erros de mensuração e interpretação capazes de comprometer o êxito da obturação no tratamento endodôntico.

The aim of the present study was to compare the diameter of the FM EL accessory cones calibrated by two calibrating rulers with their respective nominal diameters 80 FM EL gutta percha cones (Odous of God) were calibrated using two calibrating culers of the following brands: Prisma and Denco. The cones were divided in 8 groups (n=10) according to the ruler and the diameter in which they were calibrated. Posteriorly, the cones were photographed and nad their D0 neasured through the software ImageJ. After performing the statistical analysis using the Shapiro- Wilk Normality tests and the Student T test (Normal Distribution), the following results were obtained: there was no stastistically significant difference with the reference value in the prism rule in the cones 40, that is, in all other situations, a difference was found with the reference values. When the median values and standard deviation of the two calibrating rulers were compared, there was also a statistically significant difference (p<0,05) in cones 25, 35 and 40. The FM EL (Odous of God) accessory cones calibrated eita the Denco ruler differed from the nominal diameters of the ruler. Thus, one must pay attention to the accuracy and precision of these instruments in order to avoid possible errors of measurement and interpretation capable of compromising the success of filling in endodontic treatment.

Postoperative pain in oncological patients subjected to nonsurgical root canal treatment: a prospective case-control study.

OBJECTIVES: The purpose of this prospective study was to evaluate the incidence and intensity of postoperative pain in oncological patients with infected teeth subjected to nonsurgical root canal treatment or retreatment. METHODS: Teeth with apical periodontitis from healthy control patients and oncological patients (n = 70 per group) were root canal treated/retreated and evaluated for the development of postoperative pain. Patients from the two groups were matched for tooth type, gender, clinical manifestation of apical periodontitis, and intervention type. A visual analogue scale (VSA) was used to evaluate the incidence of postoperative pain at 24 h, 72 h, 7d, and 15d after chemomechanical procedures. Data were statistically analyzed for the incidence and intensity of postoperative pain in the two groups. RESULTS: Preoperative pain occurred in 10% of the individuals and in all these cases pain showed a reduction in intensity or was absent after endodontic intervention at 24-h evaluation. The overall incidence of postoperative pain at 24 h was 14% in oncology patients and 30% in controls (p = 0.03). At 72 h, the respective corresponding figures were 4% and 8.5% (p > 0.05). At 7 and 15 days, all patients were asymptomatic, irrespective of the group. CONCLUSIONS: No significant differences in postoperative pain were found between control and oncological patients. The low incidence of postoperative pain observed in both groups supports the routine use of nonsurgical root canal treatment/retreatment as valid options in oncological patients. CLINICAL RELEVANCE: Oncological patients had no increased risk of postoperative pain in comparison with control patients.

Outcome of Nonsurgical Root Canal Treatment of Teeth With Large Apical Periodontitis Lesions: A Retrospective Study.

INTRODUCTION: This study reported on the outcome of the nonsurgical root canal treatment/retreatment of teeth with large apical periodontitis lesions. The influence of some variables on the prognosis was also evaluated. METHODS: The study included 199 teeth with large apical periodontitis lesions from 184 patients, treated/retreated by a single operator. Most teeth were managed in a single visit using NaOCl irrigation. Cases were followed up periodically from >1 to 8 years. Treatment/retreatment outcome was evaluated by clinical and radiographic/tomographic criteria and categorized as healed, healing, or diseased. For statistical analysis, data were dichotomized in such a way that healing cases were considered as success in a loose criterion or failure in a rigid one. RESULTS: Clinical/radiographic analyses revealed that 67% of the initial treatment cases were classified as healed, 22.5% as healing, and 11% as diseased. Treatment success rates were 89% (loose) and 67% (rigid). Variables that influenced the treatment outcome included previous abscess and antibiotic use, very large lesions (≥10 mm), and a sinus tract. The median follow-up time for treatment was 31.5 months. As for retreatment cases, 47% were healed, 32% were healing, and 21% were diseased. Retreatment success rates were 79% (loose) and 47% (rigid), in a median follow-up of 32 months. Cases evaluated by cone-beam computed tomography had lower healed rates. CONCLUSIONS: Findings demonstrate that high favorable outcome rates can be achieved by nonsurgical root canal treatment or retreatment of teeth with large apical periodontitis lesions.

Guided Endodontic Treatment of Mandibular Incisor with Pulp Canal Obliteration following Dental Trauma: A Case Report.

Root canal obliteration is caused by hard tissue apposition and is often associated with teeth with a history of trauma, orthodontic movement, caries reaction, restorative procedures near the pulp chamber, and teeth of elderly patients. Preoperative planning of root canal treatment should be thorough and include an assessment of the patient's signs and symptoms in addition to the evaluation of complementary examinations. In a 27-year-old patient with dyschromia of the lower central incisor, a history of dental trauma, and a positive response to vertical percussion, an initial periapical radiograph was obtained that showed calcification of the canal and presence of a periapical lesion. The patient presented with pain on chewing, a positive response to palpation and a vertical percussion test. The diagnosis was symptomatic apical periodontitis. A cone-beam computed tomography scan was requested and a surface scan was performed to establish a static guide. The root canal was accessed in the middle third of the root and the canal was located using a minimally invasive approach. The root canal was treated conventionally. Results obtained showed the success of the treatment after a 3-year clinical and radiographic follow-up. Therefore, the use of an endodontic guide in cases of calcified canals significantly reduces the clinician's working time and offers a more predictable approach to the treatment of these pathologies.

Effects of increasing instrument size and taper on the disinfection and shaping of mandibular incisors.

This study assessed canal preparation effects on disinfection and dentin preservation. Thirty mandibular incisors were paired into two experimental groups (n = 10). Following contamination, the initial microbial sample was collected. Instruments 30/0.03 (Group 1) and 30/0.05 (Group 2) were employed and a second sample was obtained. Canals were enlarged using instruments 40/0.03 and 40/0.05, respectively, and a third sample was collected. Final irrigation was performed, and sample S4 obtained. A final scan evaluated volume, surface area, unprepared areas, removed dentin and dentin thickness. Data were analysed using Student t-test, Mann-Whitney, Kruskal-Wallis and Dunn tests. A significant difference was observed between S1 and other time points (p < 0.05). Comparison between groups showed no differences in bacterial loads and in the percentage of microbial reduction (p > 0.05). Group 2 exhibited greater reduction in dentin thickness than group 1 in the mesial aspect of the root (p < 0.05). Instrument 30/0.03 might provide effective disinfection and safety during mandibular incisors canal preparation.

Filling Material Bond Strength to Dentin Is Positively Influenced by the Agitation of Endodontic Final Irrigating Solutions.

Introduction: The final step of irrigation has been considered to of increase the bonding strength of filling material to dentin. This study investigated the impact of three final-step irrigation methods on the endodontic sealer bond strength to dentin by using a micro push-out test. Materials and Methods: Palatal roots of human maxillary molars were cleaned and shaped and randomly divided in six groups (n=15) according to the final-step irrigation method and the type of root canal sealer used. The solutions used for the final-step irrigation were 17% ethylenediaminetetraacetic acid and 2.5% sodium hypochlorite, which underwent three methods: 1) syringe-needle irrigation/conventional, 2) passive ultrasonic irrigation, and 3) XP-endo Finisher agitation. The root canal sealers used were: EndoSequence BC Sealer, and AH-Plus sealer. Roots were obturated with the single cone technique and then, cross-sectioned in 2-mm-thick slices (3 slices from each root). Push-out test was performed on the sliced specimens (cervical, middle, and apical thirds) with a universal testing machine. Bond strength values were recorded in megapascal (MPa). Subsequently, each specimen was longitudinally split to verify the type of failure. Data analysis was performed using Johnson transformation, three-way analysis of variance, Tukey's post-hoc tests, and the partial Eta squared test. Results: There were significant differences in bond strength between the sealers [AH: 4.46±2.24 and BC: 3.47±2.19 MPa (P<0.001)]; between final-step irrigation methods [passive ultrasonic irrigation: 4.52±2.25, XP-endo Finisher: 3.93±3.93 and syringe-needle irrigation/conventional: 3.37±2.51 MPa (P<0.001)], and between the root canal thirds represented by the sliced specimens [cervical: 5.45±2.39, middle: 4.14±1.99 and apical: 2.30±1.30 MPa (P<0.001)]. The interaction between the variables had no significance (P>0.05). Conclusion: Agitation of the final irrigating solution may improve the bonding of the sealer to canal walls. AH-Plus sealer had the highest bond strength. The bond strength reduced significantly towards the apical third.

Nivel de ansiedad y dolor dental en diferentes momentos en el tratamiento de conductos durante la pandemia por COVID-19 / Level of anxiety and dental pain at different times in root canal treatment during the COVID-19 pandemic / Nível de ansiedade e dor dentária em diferentes momentos do tratamento de canal durante a pandemia de COVID-19

RESUMEN Objetivo : Evaluar el nivel de ansiedad dental (AD) y dolor dental (DD) en diferentes momentos en el tratamiento de conductos durante la pandemia por COVID-19. Materiales y métodos : Estudio observacional, descriptivo y longitudinal. La muestra estuvo constituida por 68 participantes de la Clínica Estomatológica del Hospital Militar Central (HMC), que cumplieron con los criterios de inclusión y exclusión. El procedimiento consistió en el registro del nivel de AD y DD de los pacientes en distintos momentos del tratamiento de conductos mediante una escala visual analógica (EVA). Resultados : Antes del procedimiento, los participantes mostraron 3,66 ± 1,83 de AD y 4,54 ± 1,79 de DD; durante el procedimiento, obtuvieron valores de 3,13 ± 1,96 y 2,09 ± 1,39 de AD y 2,96 ± 1,57 y 1,82 ± 1,09 de DD; y al culminar el procedimiento, tuvieron 0,75 ± 0,74 de AD y 0,53 ± 0,72 de DD. Conclusiones : La AD y el DD estuvieron presentes antes de iniciar el tratamiento, pero, conforme se avanzaba con el procedimiento, sus niveles fueron disminuyendo.

ABSTRACT Objective : To evaluate the level of dental anxiety (DA) and dental pain (DD) at different times in root canal treatment during the COVID-19 pandemic. Materials and methods : Observational, descriptive, and longitudinal study. The sample consisted of 68 participants from the Stomatology Clinic of the Hospital Militar Central (HMC), who met the inclusion and exclusion criteria. The procedure consisted of recording the level of AD and DD of the patients at different times during root canal treatment using a visual analog scale (VAS). Results : Before the procedure, participants showed 3.66±1.83 of AD and 4.54±1.79 of DD; during the procedure, they obtained values of 3.13±1.96 and 2.09±1.39 of AD and 2.96±1.57 and 1.82±1.09 of DD; and at the end of the procedure, they had 0.75±0.74 of AD and 0.53±0.72 of DD. Conclusions : AD and DD were found to be present before starting treatment, but as the procedure progressed their levels decreased.

RESUMO Objetivo : avaliar o nível de ansiedade dentária (AD) e dor dentária (DD) em diferentes momentos do tratamento de canal durante a pandemia da COVID-19. Materiais e métodos : Estudo observacional, descritivo e longitudinal. A amostra foi composta por 68 participantes da Clínica de Estomatologia do Hospital Militar Central (HMC), que atenderam aos critérios de inclusão e exclusão. O procedimento consistiu em registar o nível de DA e DD dos pacientes em diferentes momentos durante o tratamento do canal radicular, utilizando uma escala visual analógica (EVA). Resultados : antes do procedimento, os participantes apresentavam 3,66±1,83 de DA e 4,54±1,79 de DD; durante o procedimento, obtiveram valores de 3,13±1,96 e 2,09±1,39 de DA e 2,96±1,57 e 1,82±1,09 de DD; e, no final do procedimento, apresentavam 0,75±0,74 de DA e 0,53±0,72 de DD. Conclusões : A DA e a DD estavam presentes antes do início do tratamento, mas à medida que o procedimento avançava, os seus níveis diminuíram.

Calcium hypochlorite cytotoxicity mechanism in fibroblasts and effect on osteoblast mineralization.

AIM: To determine the cytotoxicity mechanism of 2.5% calcium hypochlorite [Ca(OCl)2 ] in L929 fibroblasts and the effect of this solution on human osteoblast-like cells (Saos-2) mineralization, compared to that of 2.5% sodium hypochlorite (NaOCl). METHODOLOGY: L929 fibroblasts were exposed to Ca(OCl)2 and NaOCl at different dilutions for 10 min. Cell metabolism was assessed by methyl-thiazole-tetrazolium (MTT); lysosome integrity, by neutral red (NR) assay; type of cell death, by flow cytometry (apoptosis/necrosis); cytoskeleton, by actin and α-tubulin fluorescence and cell ultrastructure, by transmission electron microscopy (TEM). The alkaline phosphatase (ALP) activity and mineralized nodule formation were determined in Saos-2 by thymolphthalein release and alizarin red staining (ARS), respectively. The data were analysed by two-way anova and Bonferroni's post-test (α = .05). RESULTS: Ca(OCl)2 promoted higher cell viability and a lower percentage of apoptosis and necrosis than NaOCl (p < .05). Ca(OCl)2 and NaOCl decreased cell metabolism and lysosome integrity, induced the breakdown of microtubules and actin filaments, promoted alterations of rough endoplasmic reticulum and disruption of mitochondrial cristae. Additionally, Ca(OCl)2 did not induce ALP activity and had no effect on mineralized nodules formation. CONCLUSIONS: Although Ca(OCl)2 and NaOCl promoted the same cytotoxicity mechanism, Ca(OCl)2 was less cytotoxic than NaOCl. As for ALP activity, no differences were observed between NaOCl and Ca(OCl)2 . The production of mineralized nodules induced by Ca(OCl)2 was lower than those induced by NaOCl, but was not different from those induced by the control group.

Influence of root canal sealer composition on postoperative pain after endodontic treatment of permanent teeth: a systematic review and meta-analyses / Influência da composição do cimento endodôntico na dor pós-operatória de dentes permanentes tratados endodonticamente: uma revisão sistemática e meta-análise

Postoperative pain is a frequent complication after root canal treatment. Its management is an important aspect of endodontic practice. Some treatment-related parameters were associated with the development of postoperative pain, including the sealer composition and extrusion. Objective: This systematic review aimed to answer the clinical question: Do root canal sealers composition influence postoperative pain after endodontic treatment of permanent teeth? Material and Methods: Electronic searches were conducted in PubMed, Scopus, Web of Science, Cochrane, LILACS, and grey literature databases until September 2021. The studies were qualitatively assessed using the RoB2 tool (Cochrane) and the certainty of evidence (GRADE). Sensitivity and pooled estimates were calculated using a random-effects model. Twelve articles were included. Results: The risk of bias was high in one study, low in nine, and two had some concerns. Qualitative analyses showed no influence of sealer extrusion on postoperative pain. Meta-analyses showed no significant difference in postoperative pain with moderate to very low levels of certainty between AH Plus and calcium silicate-based sealers, in a 95% confidence interval. Analysis between AH Plus, Zinc Oxide and Eugenol (ZOE), and calcium hydroxide (Ca(OH)2)-based sealers were not performed due to heterogeneity and lack of data. Conclusion: Literature showed contrasting results in postoperative pain between AH Plus and ZOE-based sealers, with low to moderate certainty of evidence. Regarding Ca(OH)2-based sealers, a single study with a low level of certainty concluded that AH Plus presented less postoperative pain than Apexit Plus. Therefore, further studies are needed to assess the influence of these sealers on postoperative pain. Evidence showed no difference in postoperative pain between AH Plus and calcium silicate-based sealers. Sealer extrusion is a variable that requires further studies (AU)

A dor pós-operatória é uma complicação frequente após o tratamento endodôntico. O seu manejo é um importante aspecto na prática endodôntica. Algumas variáveis relacionados ao tratamento foram associados com o desenvolvimento da dor pós-operatória, incluindo a composição e extrusão dos cimentos endodônticos. Objetivo: Esta revisão sistemática objetivou responder a seguinte pergunta clínica: A composição dos cimentos endodônticos podem influenciar a dor pós-operatória de dentes permanentes tratados endodonticamente?Material e Métodos: Buscas eletrônicas foram realizadas nas bases de dados no PubMed, Scopus, Web of Science, Cochrane, LILACS, e literatura cinzenta até setembro de 2021. Os estudos foram avaliados qualitativamente usando a ferramenta RoB2 (Cochrane) e a certeza de evidência (GRADE). A sensibilidade e as estimativas agrupadas foram calculadas usando um modelo de efeitos aleatórios. Doze artigos foram incluídos. Resultados: O risco de viés foi alto em um estudo, baixo em nove e dois tiveram algumas preocupações. A análise qualitativa mostrou que não há influência da extrusão do cimento na dor pós-operatória. A meta-análise mostrou que não houve diferença estatisticamente significante na dor pós-operatória entre o AH Plus e os cimentos a base de silicato de cálcio com moderada a muito baixa certeza de evdência. Análises entre os cimentos AH Plus, óxido de zinco e eugenol (OZE) e hidróxido de cálcio não foram realizados devido a heterogeneidade e falta de dados. Conclusão:A literatura sugere resultados contrastantes com relação a dor pós-operatória e entre os cimentos AH Plus e OZE, com baixa a moderada certeza de evidência. Já os cimentos a base de hidróxido de cálcio, um único estudo com baixa certeza de evidência concluiu que o AH Plus apresentou menos dor pós tratamento endodôntico do que o Apexit Plus. Portanto,mais estudos são necessários para avaliar a influência desses tipos de cimentos na dor pós-operatória. Com relação ao cimento AH Plus e os cimentos a base de silicato de cálcio não houve diferença estatística entre eles e a dor. A extrusão dos cimentos é uma variável que requer mais estudos (AU)

Impact XP-endo finisher on the 1-year follow-up success of posterior root canal treatments: a randomized clinical trial.

OBJECTIVE: To evaluate the clinical relevance of using the XP-endo Finisher as a supplementary tool to improve the success of root canal treatment of posterior teeth with apical periodontitis, as assessed by 1-year follow-up. METHODS: A randomized clinical trial was conducted with 92 posterior teeth with apical periodontitis. Root canal treatment was performed using a single reciprocating file, with or without the supplementary use of the XP-endo Finisher. The status of apical periodontitis was assessed using the periapical index (PAI) at baseline and 1 year follow-up. Changes on PAI indicated that the lesions were healed, healing, or not healed. Successful treatments were defined as healed or healing lesions without clinical symptoms. Chi-square analysis and logistic regression were used for data analysis (α = 0.05). RESULTS: There was no significant difference in the distribution of healing status between the XP-endo Finisher group and the control group (p = 0.690). The success rates were also similar, with 81% in the XP-endo Finisher group and 78% in the control group. However, gender had a significant impact on success rates, with higher rates observed in females. CONCLUSIONS: The use of the XP-endo Finisher file as a supplementary tool did not affect the success rate of root canal treatment in posterior teeth with apical periodontitis. The findings indicate that the XP-endo Finisher file has limited clinical relevance in improving treatment outcomes for root canal treatment in posterior teeth with apical periodontitis. CLINICAL TRIAL REGISTRATION: The study protocol was registered in the Brazilian Clinical Trials Registry under identification number RBR-76w7cj (June 19, 2018).

Síndrome de Sjögren y endodoncia, consideraciones a propósito de un caso / Sjögren's syndrome and endodontics, clinical case and considerations

El síndrome de Sjögren (SS) es una enfermedad autoinmune que afecta a las glándulas salivales y lagrimales. Se expone el caso clínico de una paciente de 67 años de género femenino que consulta por dolor en múltiples dientes; relata sensación de boca seca (xerostomía) y sequedad ocular (xeroftalmia). Al examen intraoral, se observan múltiples caries en superficies atípicas, mucosas secas, saliva espumosa y notoria depapilación lingual. Se sospecha de SS, derivando a medicina interna y confirmándose el diagnóstico. En paralelo, se inicia el tratamiento odontológico, realizando adaptaciones en los procedimientos para aliviar la sintomatología del SS, especialmente durante tratamientos endodónticos.

Sjögren's syndrome (SS) is an autoimmune disease that affects the salivary and lacrimal glands. The clinical case of a 67-year-old female patient who consulted for pain in multiple teeth is exposed. Additionally, she reports a sensation of dry mouth (xerostomia) and dry eyes (xerophthalmia). During the intraoral examination, the following findings are noticed: multiple cavities on atypical surfaces, dry mucous membranes, foamy saliva, and atrophic glossitis. SS is suspected, referring to internal medicine and confirming the diagnosis. In parallel, dental treatment is initiated, making adaptations in the procedures to alleviate the symptoms of SS, especially during endodontic treatments.

Clinical Study of Antimicrobial Efficacy of Laser Ablation Therapy with Indocyanine Green in Root Canal Treatment.

INTRODUCTION: Laser ablation (LA) therapy is used as an adjunct to endodontic treatment to improve microbial reduction. However, studies evaluating the impact of LA with indocyanine green (ICG) are scarce. This study aimed to evaluate the antimicrobial efficacy of LA therapy with ICG in root canal treatment. METHODS: Sixty patients with periapical lesions in teeth with a single canal and absence of pain, edema, and previous treatment were selected. Patients were randomly allocated into 3 groups according to the apical sizes used (n = 20); 25/04, 30/04, and 35/04 were the final sizes used. In half the patients of each group, 2.5% sodium hypochlorite was used as an irrigating solution, and in the other half, saline solution was used. After instrumentation, all patients received LA therapy with ICG. Root canal sampling was performed before (S1) and after (S2) root canal instrumentation and immediately after LA therapy with ICG (S3). Colony-forming units were counted, and statistical tests were applied (P < .05). RESULTS: There was a significant reduction in colony-forming units from S1 to S2 in all treatment protocols (P < .05); 2.5% sodium hypochlorite as an irrigating solution showed a greater microbial reduction compared with saline solution (P < .05). LA therapy with ICG further reduced the microbial counts significantly (S2 to S3 and S1 to S3) whether sodium hypochlorite or saline was used (P < .05). CONCLUSIONS: LA therapy with ICG significantly increased microbial reduction in root canals regardless of instrumentation sizes or the irrigation solution used.

Association between single-nucleotide polymorphisms in serotonin receptor 2A and melatonin receptor 1A genes and pain after root canal treatment.

AIM: This study aimed to investigate whether single-nucleotide polymorphisms (SNPs) in the genes encoding 5-HTR2A (5-Hydroxytryptamine (serotonin) receptor 2A) and MTNR1A (melatonin receptor 1A) may contribute to postoperative pain perception after root canal treatment. We hypothesised that SNPs in HTR2A and MTNR1A genes were associated with postoperative pain after root canal treatment. METHODOLOGY: This genetic cohort study enrolled patients with single-rooted teeth diagnosed with pulp necrosis and asymptomatic apical periodontitis before root canal treatment. Root canal treatment was performed in one session using a standardized protocol. Postoperative pain and tenderness were assessed using a visual analogue scale (recorded every day for 7 days and on the 14th and 30th days after root canal treatment). Genomic DNA was extracted from saliva and used to genotype the SNPs in HTR2A (rs4941573 and rs6313) and MTNR1A (rs6553010, rs6847693 and rs13140012) using real-time polymerase chain reaction. Genotypes were compared using univariate and multivariate Poisson regression with generalized estimating equations (p < .05). RESULTS: In total, 108 patients were enrolled in this study. The SNPs rs6553010 (MTNR1A), rs4941573 and rs6313 (HTR2A) were associated with an increased risk of developing pain after root canal treatment (p < .05). CONCLUSIONS: This study suggests that SNPs in HTR2A and MTNR1A influence pain response after root canal treatment.

Use of a Cellulase from Trichoderma reesei as an Adjuvant for Enterococcus faecalis Biofilm Disruption in Combination with Antibiotics as an Alternative Treatment in Secondary Endodontic Infection.

Apical periodontitis is an inflammation leading to the injury and destruction of periradicular tissues. It is a sequence of events that starts from root canal infection, endodontic treatment, caries, or other dental interventions. Enterococcus faecalis is a ubiquitous oral pathogen that is challenging to eradicate because of biofilm formation during tooth infection. This study evaluated a hydrolase (CEL) from the fungus Trichoderma reesei combined with amoxicillin/clavulanic acid as a treatment against a clinical E. faecalis strain. Electron microscopy was used to visualize the structure modification of the extracellular polymeric substances. Biofilms were developed on human dental apices using standardized bioreactors to evaluate the antibiofilm activity of the treatment. Calcein and ethidium homodimer assays were used to evaluate the cytotoxic activity in human fibroblasts. In contrast, the human-derived monocytic cell line (THP-1) was used to evaluate the immunological response of CEL. In addition, the secretion of the pro-inflammatory cytokines IL-6 and TNF-α and the anti-inflammatory cytokine IL-10 were measured by ELISA. The results demonstrated that CEL did not induce the secretion of IL-6 and TNF-α when compared with lipopolysaccharide used as a positive control. Furthermore, the treatment combining CEL with amoxicillin/clavulanic acid showed excellent antibiofilm activity, with a 91.4% reduction in CFU on apical biofilms and a 97.6% reduction in the microcolonies. The results of this study could be used to develop a treatment to help eradicate persistent E. faecalis in apical periodontitis.

Periradicular repair after single- and two-visit root canal treatments using ultrasonic irrigant activation and calcium hydroxide dressing of teeth with apical periodontitis: study protocol for randomized controlled trials.

BACKGROUND: In certain clinical situations, root canal treatment in teeth with apical periodontitis is performed in multiple visits, with the use of intracanal dressing between visits, aiming to reduce microorganisms and their by-products of the root canal system prior to filling. However, in recent years, discussions have been growing about the real need for the use of intracanal dressing in these cases. The use of ultrasonic activation of the auxiliary chemical substance has increased the potential for decontamination promoted during the chemomechanical preparation of the root canal. Thus, this study is designed to explore whether the use of intracanal dressing between visits during endodontic treatment favors periradicular repair in teeth with apical periodontitis. METHODS: This is a randomized, prospective, double-blinded, controlled clinical trial designed to evaluate 3 distinct clinical approaches used during endodontic therapy: group 1-root canal treatment in a single visit (RCT-SV); group 2-root canal treatment in two visits with intracanal dressing (RCT-TVWD); and group 3-root canal treatment in two visits without intracanal dressing (RCT-TVWOD). A total of 150 adult patients aged 18 to 60, with at least one tooth diagnosed with asymptomatic apical periodontitis and periradicular lesion (confirmed with a cone beam computed tomography (CBCT)), will be randomized and will undergo one of the types of clinical approaches during endodontic therapy. Patients' postoperative pain levels will also be recorded in periods of 24, 48, and 72 h and 7 days. Subsequently, clinical findings and long-term follow-up evaluations, with periradicular repair, will be performed at 6 and 12 months by intraoral periapical radiograph (IOPAR) and CBCT at the 24-month follow-up. DISCUSSION: This study will evaluate the periradicular repair of mandibular molar teeth with apical periodontitis, providing information about the efficacy, benefits, and safety of performing the endodontic treatment in a single and two visits, with and without the use of calcium hydroxide dressing. All endodontic therapy procedures will be performed under a dental operating microscope and using ultrasonic activation of auxiliary chemical substances. These results may contribute to changes in the clinical approaches adopted during endodontic therapy of teeth with apical periodontitis and reveal the potential of complementary approaches that aim to enhance the decontamination of the root canal system during the preparation stage. TRIAL REGISTRATION: ClinicalTrials.gov NCT05256667. Registered on 24 February 2022.

Influence of antimicrobial photodynamic therapy on the bond strength of endodontic sealers to intraradicular dentin: A systematic review and meta-analysis.

BACKGROUND: The objective of this systematic review and meta-analysis (SRMA) was to investigate the influence of antimicrobial photodynamic therapy (aPDT) on the bond strength of endodontic sealers to intraradicular dentin. METHODS: This SRMA followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and was registered in the International Prospective Registry of Systematic Reviews (PROSPERO) (CRD42022319856). A population, intervention, control, and outcome (PICO) question was formulated: "Does antimicrobial photodynamic therapy decrease the bond strength of root canal sealers?". A literature search was performed in PubMed/MEDLINE, Embase, Web of Science, Scopus, Cochrane Library, and ProQuest databases until July 2022. Joanna Briggs Institute Critical Assessment Guidelines for Quasi-Experimental Studies were used for quality assessment. The meta-analysis was based on the inverse variance (IV) method (p<0.05). RESULTS: Out of an initial 345 articles, 8 in vitro studies were included, published between 2013 and 2022. The studies were qualitatively analyzed; two studies showed a positive effect, two studies a negative effect, and the other studies showed no effect on bond strength of endodontic sealers to intraradicular dentin. Seven of the studies were included in the SRMA, which indicated that there was no significant difference in bond strength when using aPDT (P = 0.90; MD: -0.03; 95% CI: -0.46 to -0.41). There was a high level of evidence for each meta-analysis outcome. CONCLUSION: It can be concluded that the use of aPDT as a method of root canal disinfection does not negatively influence the bond strength of endodontic sealers in the root canal.

Guided endodontics of calcified canals: The drilling path of rotary systems and intracanal dentin wear.

This study evaluated the drilling path (mm) and the dentin wear (mm3 ) of two instruments used during guided endodontic access. Twenty mandibular incisors with calcified canals were selected using cone-beam computed tomography (CBCT) and fixed in articulated models. Preoperative CBCT scans were performed in combination with intraoral scanning, and the images were reconstructed in the Blue Sky Bio software for access planning and printing the guides. The access cavity was drilled with 1.0-mm-diameter bur (DSP) and 0.8-mm-diameter bur (Munce). Postoperative CBCT was performed, and the images obtained preoperative and postoperative were superimposed for the analyses. Data were analysed by a t-test and linear regression (α = 0.05). No difference was found in the drilling path (p = 0.422). However, the Munce bur had higher dentin wear than the DSP bur (p = 0.011). A positive linear correlation (R2  = 0.859) was found between the factors.

Effect of different activation methods on the intratubular penetration of CaOH2 paste: Ex-vivo analysis by confocal laser scanning microscopy.

The aim of this study was to evaluate the maximum penetration depth (MPD) and penetration area (PA) of CaOH2 paste agitated by different methods and to measure the pH after performing these methods. Fifty-five mandibular premolars were divided into control, GL and 4 experimental groups, GEC, GXP, GEDDY and GI (n = 11), where the paste was agitated with Easy Clean, XP-endo Finisher, EDDY and Irrisonic, respectively. The canals were instrumented and irrigated with NaOCl. The paste was manipulated with propylene glycol and rhodamine B dye. Root sections were examined using confocal laser scanning microscopy. There was no difference between groups regarding PA (p > 0.05). At 5 mm, MPD was greater in GEC than in GL or GEDDY, and greater in GI than in GL (p < 0.05). At 2 mm, MPD was greater in GEC than in the other groups (p < 0.05). In conclusion, both Easy Clean and Irrisonic promoted deeper paste penetration and were associated with higher pH levels.

Regenerative endodontic procedure combined with non-surgical root canal treatment in an immature permanent maxillary molar: A 7-year follow-up case report.

The aim of this report is to present the results of a personalised endodontic treatment for an immature molar, using regenerative endodontic procedure (REP) combined with non-surgical root canal treatment (NSRCT), with 7 years of follow-up. The tooth#3 presented combined endodontic pathologies in each root, with different pulpal and periapical status. A REP in the palatal (P) canal and a NSCRT in the mesio-buccal (MB) and disto-buccal (DB) canals were performed. Absence of clinical signs/symptoms and continuous palatal root development with apical closure were observed over 4-years. After 5-years an apical lesion in the MB root was observed. Both MB canals were selectively retreated by completely filling them with TotalFill BC RRM Fast Set putty. After 7-years, the tooth remained functional and the apical lesion was resolving. The palatal root was completely mature. This case report reveals the potential for use of combined treatment approaches for immature multirooted teeth.

Tomografía computarizada en la identificación de la sinusitis odontogénica de origen endodóntico: reporte de un caso / Computerized tomography in the identification of odontogenic sinusitis of endodontic origin: report of a case

Objetivo: se presenta el caso clínico de sinusitis de origen endodóntico, conocida como síndrome en-doantral, haciendo énfasis en la dificultad de diag-nóstico con radiografía periapical y la importancia de la tomografía computarizada. Caso clínico: una mujer de 32 años, con antecedentes de apretamiento dental nocturno y sinusitis recurrente, fue remitida para evaluación endodóntica. El examen clínico reve-ló sensibilidad a la percusión y palpación en la unidad dental. La radiografía periapical no indicó lesión en el diente 16 y la prueba de sensibilidad pulpar fue ne-gativa, además, la tomografía computarizada reveló una extensa lesión periapical y comunicación entre la raíz del diente 16 y el seno maxilar, confirmada por la pérdida de la continuidad de la imagen hiperdensa en el suelo del seno, lo que llevó al tratamiento endo-dóntico. El control de la infección dental resolvió la sinusitis, resaltando la importancia del diagnóstico preciso y el tratamiento en casos de sinusitis odon-togénica. Conclusión: este caso destaca el valor de la tomografía computarizada como herramienta diag-nóstica crucial en contextos clínicos complejos (AU)

Objective: the clinical case of sinusitis of endodontic origin, known as endoantral syndrome, is presented, emphasizing the difficulty of diagnosis with periapical radiography and the importance of computed tomography. Clinical case: a 32-year-old woman, with a history of tooth clenching and recurrent sinusitis, was referred for endodontic evaluation. The clinical examination revealed sensitivity to percussion and palpation in the dental unit. The periapical radiograph did not indicate a lesion in tooth 16 and the pulp sensitivity test was negative, in addition, the computed tomography revealed an extensive periapical lesion and communication between the root of tooth 16 and the maxillary sinus, confirmed by the loss of continuity of the hyperdense image in the sine floor, which led to endodontic treatment. Dental infection control resolved sinusitis, highlighting the importance of accurate diagnosis and treatment in cases of odontogenic sinusitis. Conclusion: this case highlights the value of computerized tomography as a crucial diagnostic tool in complex clinical contexts (AU)