Bruno Martini Guimarães

Assessment of Color Stability of White Mineral Trioxide Aggregate Angelus and Bismuth Oxide in Contact with Tooth Structure

INTRODUCTION Dental discoloration with use of materials containing bismuth oxide has been reported. It is postulated that the discoloration is a result of chemical interaction of bismuth oxide with dentin. The aim of the study was to analyze dental color alteration and the chemical interaction of bismuth oxide with the main components present in composite (methacrylate) and in dentin (collagen). METHODS Fifty bovine teeth were prepared and filled with white mineral trioxide aggregate (MTA) Angelus, Portland cement (PC) with 20% zirconium oxide, or PC with 20% calcium tungstate and then sealed with composite. Triple antibiotic paste and unfilled samples were the positive and negative controls, respectively. The specimens were stored in separate flasks immersed in tap water at 37°C with ambient light blocked out. The color assessment was performed with a spectrophotometer at different intervals, namely before filling and 24 hours, 15 days, and 30 days after filling. The color change and the luminosity were calculated. The statistical analysis was performed by using nonparametric Kruskal-Wallis and Dunn tests (P < .05). The interaction of the bismuth oxide, zirconium oxide, and calcium tungstate with collagen and methacrylate was assessed by placing the materials in contact, followed by color assessment. RESULTS The analysis of color change values showed that all the materials presented color alteration after the evaluated periods. Statistically higher luminosity was verified for PC/20% zirconium oxide in comparison with white MTA Angelus (P < .05). The teeth filled with white MTA Angelus demonstrated a grayish discoloration with evident dentin staining. Bismuth oxide exhibited a color change when in contact with collagen. CONCLUSIONS The color of white MTA Angelus was altered in contact with dental structures. Collagen, which is present in dentin matrix, reacted with bismuth oxide, resulting in a grayish discoloration. The use of an alternative radiopacifier to replace bismuth in white MTA is indicated.

Physical Properties and Interfacial Adaptation of Three Epoxy Resin–based Sealers

INTRODUCTION The aim of the study was to evaluate the radiopacity, solubility, flow, film thickness, setting time, and adaptation to the root canal walls of 3 epoxy resin-based sealers: AH Plus, Acroseal, and Adseal. METHODS Physical tests were performed following American National Standards Institute/American Dental Associations requirements. For interfacial adaptation analysis, 30 maxillary canines were shaped by using ProTaper instruments. The specimens were divided into 3 groups (n = 10): group 1, AH Plus; group 2, Acroseal; and group 3, Adseal. The sealers were mixed with rhodamine B dye, and the canals were filled by using the lateral compaction technique. The percentage of gaps and voids area was calculated at 2, 4, and 6 mm levels from the apex. Statistical evaluation was performed by using analysis of variance for physical analysis and nonparametric Kruskal-Wallis and Dunn tests for interfacial adaptation (P < .05). RESULTS No statistical differences were found for adaptation, percentage of voids, solubility, flow, and film thickness among the sealers (P > .05). AH Plus was significantly more radiopaque (P < .05). For the setting time, there were statistical differences among all the studied sealers (P < .05). CONCLUSIONS AH Plus, Acroseal, and Adseal presented similar root canal adaptation, solubility, flow, and film thickness. Statistical differences were found for radiopacity and setting time (P < .05).

Microscopic analysis of the quality of obturation and physical properties of MTA Fillapex

This study analyzed the quality of obturation and physical properties of MTA Fillapex and AH Plus sealer. A sample of 30 human maxillary central incisors were instrumented with Protaper until a F5 (50/05) file. Both sealers were mixed with Rhodamine‐B dye to allow visualization on a confocal laser‐scanning microscope (CLSM). Next, the canals were filled using the single cone technique. After setting, all samples were sectioned at 2, 4, and 6 mm from the apex. CLSM was used to analyze the gaps and sealer penetration into the dentinal tubules. All samples were scanned 10 µm below the dentin surface and images were recorded at 100× magnification using the fluorescent mode. Additionally, the solubility, flowability and setting time of the sealers were evaluated. All the measured quantities of the examined materials were evaluated for significant differences by means of statistical analysis. The CLSM analysis of the MTA Fillapex showed the highest percentage of gaps at all sections (P = 0.0001). Physical tests revealed adequate properties for both sealers except for a higher solubility of the MTA Fillapex (P = 0.0001). The MTA Fillapex presented flowability and intratubular penetration similar to the AH Plus. Nevertheless, the MTA Fillapex sealer presented a higher solubility and considerable quantity of gaps between the sealer/dentin interface in relation to the AH Plus sealer. Clinicians must take into consideration, the quality of endodontic sealers as it is essential in the outcome of the root canal filling. Microsc. Res. Tech. 77:1031–1036, 2014.

Color Stability, Radiopacity, and Chemical Characteristics of White Mineral Trioxide Aggregate Associated with 2 Different Vehicles in Contact with Blood

INTRODUCTION Discoloration of mineral trioxide aggregate (MTA) can be exacerbated by the interaction of the cement with body fluids such as blood. This study aimed to analyze the color alteration, chemical characteristics, and radiopacity of MTA manipulated with 2 different vehicles after immersion in blood or distilled water (DW). METHODS MTA mixed with 100% DW or 80% DW/20% propylene glycol (PG) as vehicles were placed into rubber rings and incubated at 37°C and 100% relative humidity until set. Color assessment and scanning electron microscopy/energy-dispersive spectroscopy analysis were performed after setting and repeated after 7, 15, and 30 days after immersion in blood and DW. Statistical analysis for color alteration and radiopacity was performed using nonparametric Kruskal-Wallis and Dunn tests (P < .05). RESULTS When 80% DW/20% PG was used as the vehicle, significantly lower color alterations were observed for all time periods compared with 100% DW when immersed in blood (P < .05). All surfaces displayed morphologic changes after immersion in both media because of loss of bismuth. A decrease in radiopacity was observed over time in all groups, with a statistically significant difference after 30 days for groups DW immersed in blood and 80% DW/20% immersed in both media (P < .05). CONCLUSIONS The ratio of 80% DW/20% PG as a vehicle for MTA results in a lower color alteration when in contact with blood.

Influence of ultrasonic activation of 4 root canal sealers on the filling quality.

INTRODUCTION The purpose of this study was to evaluate the effects of ultrasonic activation on the filling quality (intratubular sealer penetration, interfacial adaptation, and presence of voids) of 4 epoxy resin-based sealers. METHODS Eighty-four extracted human canines were divided into 4 groups (n = 20) according to the sealer used to obturate the root canals instrumented with F5 ProTaper instruments (50/05) (Dentsply Maillefer, Ballaigues, Switzerland). The canals were filled by the lateral compaction technique. Previously, the sealers were labeled with rhodamine B dye to allow analysis under a confocal microscope. At the time of obturation, the specimens were divided again into 2 groups (n = 10) according to the ultrasonic activation of the sealers: ultrasonically activated and nonultrasonically activated groups. All samples were sectioned at 2, 4, and 6 mm from the apex. The percentages of voids, gaps, and dentinal sealer penetration segments of the canal were analyzed. RESULTS Regarding the sealer penetration segments, there was a significant increase for the AH Plus (Dentsply Maillefer), Acroseal (Specialités Septodont, Saint Maur-des-Fossés, France), and Sealer 26 (Dentsply Maillefer) at the 4-mm level and the AH Plus and Sealer 26 at the 6-mm level with ultrasonic activation (P < .05). Concerning the gaps, the ultrasonic activation promoted a smaller presence for all sealers at the 4- and 6-mm levels (P < .05). No statistical significant differences were found for the percentages of voids (P < .05). CONCLUSIONS The use of ultrasonic activation of an epoxy resin-based sealer promoted greater dentinal sealer penetration and less presence of gaps.

Antimicrobial Activity and Synergism of Lactoferrin and Lysozyme Against Cariogenic Microorganisms

The present study evaluated the antimicrobial in vitro effects of the salivary proteins lactoferrin and lysozyme on microorganisms involved in the carious process, obtaining their minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC). Streptococcus mutans (ATCC 25175) and Lactobacillus casei (ATCC 7469) were submitted to broth macrodilution of lysozyme at 80 mg/mL and lactoferrin at 200 mg/mL. The tubes were read in a spectrophotometer after they had been incubated at 37 °C for 18 h, in a carbon dioxide chamber, in order to read the MIC. A new subculture was carried on agar plates to obtain the MBC. The agar diffusion method was also tested, using BHI agar with 100 µL of the standardized microbial inocula. Filter-paper disks soaked in 10 µL of the solutions lactoferrin (200 µg/mL) and lysozyme (80 µg/mL) were placed on the agar surface. Inhibition halos were not observed on the plates, showing the absence of the antimicrobial effects of these proteins in this method. The bactericidal and bacteriostatic effects of lysozyme on L. casei were 50.3 mg/mL and 43.1 mg/mL respectively. The bactericidal and bacteriostatic effects on S. mutans were 68.5 mg/mL and 58.7 mg/mL. Lactoferrin did not induce any inhibitory effects on any microorganism, even in the concentration of 200 mg/mL. There was not a synergic antimicrobial effect of proteins, when they were tested together, even in the concentration of 42.8 mg/mL of lysozyme and 114 mg/mL of lactoferrin (the highest values evaluated). S. mutans and L. casei were only inhibited by lysozyme, not affected by lactoferrin and by the synergic use of both proteins.

Zinc Oxide Inhibits Dental Discoloration Caused by White Mineral Trioxide Aggregate Angelus

Introduction The aim of the study was to investigate the addition of variable amounts of zinc oxide to inhibit dental discoloration caused by mineral trioxide aggregate (MTA) Angelus. Methods MTA Angelus and MTA with additions of 5%, 15%, and 45% zinc oxide (ZnO) in weight were tested. The set cements were characterized by using a combination of scanning electron microscopy, energy dispersive spectroscopy, and x‐ray diffraction. Radiopacity and setting time were analyzed according to American National Standards Institute/American Dental Association (57/2012) and American Society for Testing and Materials (C266‐08). Volume change was evaluated by using micro–computed tomography analysis. The pH and calcium ion release were measured after 3 hours, 24 hours, and 28 days. Dental discoloration in contact with the cements was measured after 24 hours, 28 days, and 90 days. Biocompatibility to subcutaneous implantation in rats was verified after 30 and 60 days. Results Addition of ZnO did not alter significantly the radiopacity, setting time, volume change, pH, and biocompatibility compared with MTA Angelus (P > .05). Calcium ion release increased with addition of ZnO (P < .05). Proportions of 15% and 45% ZnO interfered in hydration. The 5% ZnO addition was sufficient to prevent the dental discoloration observed with MTA Angelus. Conclusions The addition of 5%, 15%, or 45% zinc oxide to MTA Angelus inhibits dental discoloration without modifying the radiopacity, setting time, volume change, pH, and biocompatibility. Highlights5%, 15%, and 45% zinc oxide added to MTA Angelus was tested to inhibit dental discoloration.Zinc oxide prevented dental discoloration in human and bovine tooth model.The addition did not interfere with radiopacity, setting time, or volume change.pH was not affected and calcium ion release increased with zinc oxide.Inflammation degree in subcutaneous implantation was similar in all groups.

Influence of bismuth oxide concentration on the pH level and biocompatibility of white Portland cement

Objectives To investigate if there is a relation between the increase of bismuth oxide and the decrease of pH levels and an intensification of toxicity in the Portland cement. Material and Methods White Portland cement (WPC) was mixed with 0, 15, 20, 30 and 50% bismuth oxide, in weight. For the pH level test, polyethylene tubes were filled with the cements and immersed in Milli-Q water for 15, 30 and 60 days. After each period, the increase of the pH level was assessed. For the biocompatibility, two polyethylene tubes filled with the cements were implanted in ninety albino rats (n=6). The analysis of the intensity of the inflammatory infiltrate was performed after 15, 30 and 60 days. The statistical analysis was performed using the Kruskal-Wallis, Dunn and Friedman tests for the pH level and the Kruskal-Wallis and Dunn tests for the biological analysis (p<0.05). Results The results showed an increase of the pH level after 15 days, followed by a slight increase after 30 days and a decrease after 60 days. There were no significant statistical differences among the groups (p>0.05). For the inflammatory infiltrates, no significant statistical differences were found among the groups in each period (p>0.05). The 15% WPC showed a significant decrease of the inflammatory infiltrate from 15 to 30 and 60 days (p<0.05). Conclusions The addition of bismuth oxide into Portland cement did not affect the pH level and the biological response. The concentration of 15% of bismuth oxide resulted in significant reduction in inflammatory response in comparison with the other concentrations evaluated.

Evaluation of dentin desensitization protocols on the dentinal surface and their effects on the dentin bond interface

OBJECTIVES To evaluate the effect of desensitizing agent containing calcium phosphate nanoparticles on the bond strength of etch-and-rinse adhesive system (Scotchbond Multi-Purpose), presence of precipitate, dentinal tubule obliteration and hybrid layer formation in dentin in comparison with potassium nitrate plus sodium fluoride or strontium chloride compounds. METHODS 150 bovine incisors were treated with (n = 10): G1, Desensibilize Nano P (Ca3(PO4)2+5%KNO3+0.9%NaF); G2, Desensibilize (10%SrCl2+5%KNO3); G3, Desensibilize KF2% (5%KNO3+0.2%NaF); G4, Ultra EZ (3%KNO3+0.25%NaF) and G5, no treated (control). Scanning electron microscopy was used to assess the incidence of precipitates (500×) and obliterated dentinal tubule counts (1.000×). The adhesive system was used after all desensitization treatments. The bond strength (n = 40) and the fracture pattern were evaluated. Confocal laser microscopy was used to quantify the hybrid layer formation in dentin. RESULTS G1 and G2 presented higher adhesive system bond strength (MPa) than G4 and G5, however no significant differences were observed in comparison with G3. Cohesive fracture was frequently found: G1 (58.5%), G2 (51.3%) and G3 (43.8%). G1 showed the highest incidence of precipitates and the highest number of blocked dentinal tubules. G1 and G2 presented similar hybrid layer formation and the highest hybrid layer formation values. CONCLUSIONS Desensibilize Nano P (G1) favored the bond strength of the adhesive system to dentin, increased the precipitation of residues, obliteration of dentinal tubules, and hybrid layer formation in comparison with other agents. CLINICAL RELEVANCE Desensitizers promote dentin obliteration, however, may affect dentin bonding.

Influence of the instrument used for cervical preflaring on the precision of 2 Eletronic Apex Locators

ABSTRACT ObjectiveThis study was aimed at evaluating the influence of cervical preflaring using LA-Axxes No. 1 bur (SybronEndo, Glendora, USA) or S1 and SX ProTaper files (Dentsply Maillefer, Ballaigues, Switzerland) on the accuracy of the Electronic Apex Locators (EALs): Root ZX mini (J. Morita Corporation, Tokyo, Japan), and Joypex 5 (Denjoy, Changsha, China).MethodsThirty mandibular incisors were accessed, and the root canal length (RCL) was determined with a K-file #15, with the aid of a st ereo microscope. Afterwards, the specimens were divided into 2 groups (n = 15) referring to the cervical preflaring with LA-Axxess or ProTaper files. The teeth were embedded in alginate and the RCL was determined by the EALs before and after preflaring. Data were classified into: accurate, if the difference in RCL measurement were ≤0.05 mm; and inaccurate, if the difference were >0.5 mm or beyond the RCL.ResultsMcNemars test ( α 0.05) af ter the cervical preflaring, regardless of the used instrument. ConclusionThe preflaring procedure increased the number of accurate measurements for both EALs, with statistical difference for Joypex 5 w hen the preflaring was performed with LA-Axxess. However, after the cervical preflaring, the EALs showed similar accuracy, regardless of the used instrument.Indexing terms: Dental instruments. Endodontics. Odontometry.