Antibacterial effectiveness of several irrigating solutions and the Endox Plus system - an ex vivo study.

AIM: To compare the ex vivo antibacterial effectiveness of the Endox Plus system and sodium hypochlorite (NaOCl) in combination with BioPure MTAD (Tulsa Dental, Tulsa, OK, USA) or with EDTA in Enterococcus faecalis-contaminated root canals. METHODOLOGY: After initial preparation, the root canals of 70 single-rooted human teeth were inoculated with E. faecalis (ATCC 29212) and incubated for 21 days. Specimens were divided into five groups: Endox Plus/saline; 2.5% NaOCl/MTAD; 2.5% NaOCl/EDTA; saline (positive control); negative control (root canals not prepared, nor irrigated). Samples were collected using paper points. Microbiological analysis evaluated the number of CFUs. Data were analysed by anova and Tukey tests at 0.05 significance. RESULTS: All specimens had bacterial growth after the incubation period, with similar CFU per mL counts (P > 0.05). After chemo-mechanical preparation, the number of bacteria in all groups reduced, except for the negative control. No significant differences were observed between 2.5% NaOCl/MTAD and 2.5% NaOCl/EDTA, but these groups had lower CFU counts than the other groups (P < 0.05). In the final samples, an increase in the bacterial counts was observed for Endox Plus/saline, 2.5% NaOCl/MTAD, 2.5% NaOCl/EDTA and saline (P < 0.05) with no significant differences between these groups. CONCLUSIONS: This ex vivo study revealed that the Endox Plus system was associated with a reduced antibacterial effectiveness compared with conventional irrigation using 2.5% NaOCl/MTAD and 2.5% NaOCl/EDTA. All irrigation procedures allowed recovery of bacteria 7 days after treatment, demonstrating persistence of contamination within the root canal system.

Quantification of peroxide ion passage in dentin, enamel, and cementum after internal bleaching with hydrogen peroxide.

The aim of this study was to evaluate the amount of peroxide passage from the pulp chamber to the external enamel surface during the internal bleaching technique. Fifty bovine teeth were sectioned transversally 5 mm below the cemento-enamel junction (CEJ), and the remaining part of the root was sealed with a 2-mm layer of glass ionomer cement. The external surface of the samples was coated with nail varnish, with the exception of standardized circular areas (6-mm diameter) located on the enamel, exposed dentin, or cementum surface of the tooth. The teeth were divided into three experimental groups according to exposed areas close to the CEJ and into two control groups (n=10/group), as follows: GE, enamel exposure area; GC, cementum exposed area; GD, dentin exposed area; Negative control, no presence of internal bleaching agent and uncoated surface; and Positive control, pulp chamber filled with bleaching agent and external surface totally coated with nail varnish. The pulp chamber was filled with 35% hydrogen peroxide (Opalescence Endo, Ultradent). Each sample was placed inside of individual flasks with 1000 µL of acetate buffer solution, 2 M (pH 4.5). After seven days, the buffer solution was transferred to a glass tube, in which 100 µL of leuco-crystal violet and 50 µL of horseradish peroxidase were added, producing a blue solution. The optical density of the blue solution was determined by spectrophotometer and converted into microgram equivalents of hydrogen peroxide. Data were submitted to Kruskal-Wallis and Dunn-Bonferroni tests (α=0.05). All experimental groups presented passage of peroxide to the external surface that was statistically different from that observed in the control groups. It was verified that the passage of peroxide was higher in GD than in GE (p<0.01). The GC group presented a significantly lower peroxide passage than did GD and GE (p<0.01). It can be concluded that the hydrogen peroxide placed into the pulp chamber passed through the dental hard tissues, reaching the external surface and the periodontal tissue. The cementum surface was less permeable than were the dentin and enamel surfaces.

Effect of compression load and temperature on thermomechanical tests for gutta-percha and Resilon®.

AIM: To analyse a method used to evaluate the thermomechanical properties of gutta-percha and Resilon(®) at different temperatures and compression loads. METHODOLOGY: Two hundred and seventy specimens measuring 10 mm in diameter and 1.5 mm in height were made from the following materials: conventional gutta-percha (GCO), thermoplastic gutta-percha (GTP) and Resilon(®) cones (RE). After 24 h, the specimens were placed in water at 50 °C, 60 °C or 70 °C for 60 s. After that, specimens were placed between two glass slabs, and loads weighing 1.0, 3.0 or 5.0 kg were applied. Images of the specimens were digitized before and after the test and analysed using imaging software to determine their initial and final areas. The thermomechanical property of each material was determined by the difference between the initial and final areas of the specimens. Data were subjected to anova and SNK tests at 5% significance. To verify a possible correlation between the results of the materials, linear regression coefficients (r) were calculated. RESULTS: Data showed higher flow area values for RE under all compression loads at 70 °C and under the 5.0 kg load at 60 °C (P < 0.05). Regarding gutta-percha, GTP showed higher flow under loads weighing 3.0 and 5.0 kg, at 60 and 70 °C (P < 0.05). GCO presented higher flow at 70 °C with a load of 5.0 kg. Regression analyses showed a poor linear correlation amongst the results of the materials under the different experimental conditions. CONCLUSION: Gutta-percha and Resilon(®) cones require different compression loads and temperatures for evaluation of their thermomechanical properties. For all materials, the greatest flow occurred at 70 °C under a load of 5.0 kg; therefore, these parameters may be adopted when evaluating endodontic filling materials.

Effect of filling technique and root canal area on the percentage of gutta-percha in laterally compacted root fillings.

AIM: To determine the influence of filling technique and root canal area on the percentage of gutta-percha (PGP) in laterally compacted root fillings. METHODOLOGY: Sixty extracted canine teeth were accessed and the root canals instrumented to the same size. They were then divided in three groups and filled with laterally compacted gutta-percha cones and AH Plus using different techniques. A variation of cold lateral compaction using a sequence of spreaders prior to accessory cone placement was compared to two commonly-used techniques. Twenty additional canines with prepared root canals were used as negative controls in which gutta-percha was introduced into the canals but no compaction applied. The roots were sectioned horizontally at 3 and 6 mm from the apex and micro-photographs taken. Using software, the area of the canals and gutta-percha at each level were measured and PGP calculated. A Multivariate analysis was used to determine the variables influencing PGP. A linear regression test was used to verify the variation in PGP explained by canal area. RESULTS: At each level the largest canal was two to three times wider than the smallest. Canal area significantly influenced the PGP at both levels (P < 0.05), however, the variation in PGP was only partially explained by canal area (r(2) = 0.154, 6 mm; r(2) = 0.119, 3 mm). The PGP at the 3 mm level was lower than at 6 mm (P = 0.003). The spreader-sequence technique achieved a higher PGP than the other two techniques (P = 0.00002). The control group had the lowest area of GP. CONCLUSIONS: Variations in root canal filling technique and canal area influenced the percentage of gutta-percha of laterally compacted root fillings. The percentage of gutta-percha was lower at the 3 mm level compared to the 6 mm level.

Periapical radiographs overestimate root canal wall thickness during post space preparation.

AIM: To evaluate differences between anatomic and radiographic measurements of root canal wall thickness (RCWT) after each root canal preparation stage during post placement. METHODOLOGY: Twenty mandibular premolars with a single canal were decoronated and the roots embedded in resin using a teflon muffle. Roots were sectioned horizontally at a pre-established level and canals were prepared for post placement. Endodontic hand files were used for root canal preparation, followed by Gates Glidden drills and Peeso reamers. Standardized radiographs and photographs at pre-established measurement levels were taken before preparation, after root canal instrumentation, after Gates Glidden preparation and after Peeso enlargement. All images were digitized and RCWT at the mesial and distal walls measured (IMAGETOOL 3.0). Differences between radiographic and anatomic measurements were analysed with paired t-tests. anova was used to compare the percentages of radiographic distortions. RESULTS: Regardless of the time-point evaluated, RCWT determined by radiographs were greater than the respective anatomic measurements (P < 0.05). The difference detected at each stage was similar and constant (P > 0.05). CONCLUSIONS: Throughout preparation for post placement, radiographic images overestimated the RCWT by approximately 25%, regardless of the clinical stage evaluated.

Effect of different irrigation solutions and calcium hydroxide on bacterial LPS.

AIM: To evaluate the effect of biomechanical preparation with different irrigating solutions and calcium hydroxide dressing in dog root canals containing bacterial endotoxin (lipopolysaccharides; LPS). METHODOLOGY: One hundred and forty premolar roots from seven dogs were filled with Escherichia coli LPS for 10 days (three roots were lost during histological processing). The following irrigating solutions were used for biomechanical preparation: 1% (group I, n = 20), 2.5% (group II, n = 19) and 5% sodium hypochlorite (group III, n = 19), 2% chlorhexidine digluconate (group IV, n = 20) and physiological saline solution (group V, n = 19). In group VI (n = 20), the LPS solution was maintained in the root canal during the entire experiment and in group VII (n = 20), after biomechanical preparation with saline solution, the root canals were filled with a calcium hydroxide dressing (Calen; control). After 60 days, the animals were sacrificed and the following parameters of periapical disease were evaluated: (a) inflammatory infiltrate, (b) periodontal ligament thickness, (c) cementum resorption and (d) bone resorption. Scores were given and data were analysed statistically with the Kruskal-Wallis and Dunn tests (P < 0.05). RESULTS: Histopathological evaluation showed that groups I-VI had more inflammatory infiltrate, greater periodontal ligament thickening and greater cementum and bone resorption (P < 0.05) compared to group VII, which received the calcium hydroxide intracanal dressing. CONCLUSIONS: Biomechanical preparation with the irrigating solutions did not inactivate the effects of the endotoxin but the calcium hydroxide intracanal dressing did appear to inactivate the effects induced by the endotoxin in vivo.