Claudio Maniglia-Ferreira

Brazilian gutta-percha points: Part I: chemical composition and X-ray diffraction analysis

Eight nonstandardized gutta-percha points commercially available in Brazil (Konne, Tanari, Endopoint, Odous, Dentsply 0.04, Dentsply 0.06, Dentsply TP and Dentsply FM) were analysed chemically and by X-ray diffraction, and their chemical compositions were compared. The organic fraction (gutta-percha polymer and wax/resin) of the gutta-percha points was separated from the inorganic fraction (ZnO and BaSO4) by dissolving them in chloroform. The gutta-percha polymer was precipitated with acetone. The inorganic fraction was analysed by elemental microanalysis. Energy-dispersive X-ray microanalysis (EDX) and X-ray diffraction were employed to identify the chemical elements and compounds (barium sulfate and zinc oxide). The barium sulfate content was calculated based on the percentage of sulfur found in the elemental microanalysis. All analyses were repeated three times. The means and standard deviations of the percentage by weight of gutta-percha in the points were: Konne (17.6 +/- 0.30), Tanari (15.2 +/- 0.30), Endopoint (16.7 +/- 0.23), Odous (18.8 +/- 0.20), Dentsply 0.04 (15.7 +/- 0.17), Dentsply 0.06 (16.6 +/- 0.17), Dentsply TP (21.6 +/- 0.15) and Dentsply FM (16.3 +/- 0.23). The means and standard deviations of the zinc oxide content were: Konne (79.9 +/- 0.10), Tanari (81.9 +/- 0.07), Endopoint (81.3 +/- 0.40), Odous (79.7 +/- 0.26), Dentsply 0.04 (77.9 +/- 0.03), Dentsply 0.06 (78.2 +/- 0.07), Dentsply TP (69.8 +/- 0.19) and Dentsply FM (72.6 +/- 0.70). The method utilized was appropriate to quantify gutta-percha, wax/resin, zinc oxide and barium sulfate. Cone brands without barium sulfate were found. An unusual high wax/resin percentage was detected in Dentsply FM (p = 0.0003). Dentsply TP showed the highest gutta-percha percentage.

Cleaning ability of chlorhexidine gel and sodium hypochlorite associated or not with EDTA as root canal irrigants: a scanning electron microscopy study.

The aim of this study was to evaluate the cleaning efficacy of 2% chlorhexidine gluconate gel (CHX) compared to 2.5% sodium hypochlorite solution (NaOCl) associated or not with 17% EDTA used as irrigants during the biomechanical preparation. Fifty freshly extracted single-rooted human teeth with complete apex formation were randomly divided into five groups: G1 - sterile saline, G2 - 2.5% NaOCl, G3 - 2% CHX, G4 - 2.5% NaOCl + EDTA and G5 - 2% CHX + EDTA. The specimens of G1 were subdivided into two control groups. The teeth were decoronated and the coronal and middle root thirds were prepared with Gates-Glidden burs, and the apical third was reserved to manual instrumentation. All procedures were performed by a single operator. In all groups, 2 mL of irrigant was delivered between each file change. The teeth were sectioned and prepared for analyses under scanning electron microscopy (SEM). SEM micrographs were graded according to a score scale by two examiners. Data were analyzed statistically by Kruskal-Wallis and Dunn tests at 1% significance level. The best results were obtained in the groups in which the irrigant was used followed by the chelating agent. No statistically significant difference was observed among G4, G5 and the positive control group (p<0.01). The groups G2 and G3 were significantly different from the others, presenting the worst cleaning capacity. In conclusion, the use of the chelating agent is necessary to obtain clean canal walls, with open tubules and no heavy debris. The use of 2% chlorhexidine gluconate gel alone is not able to remove the smear layer.

Six root canals in maxillary first molar

In this clinical article we report an unusual anatomy that was detected in a maxillary first molar with 6 root canals. The possibility of 6 root canals in this tooth is quite small; however, it must be taken into account in clinical and radiographic evaluation during endodontic treatment. Many times their presence is noticed only after canal treatment, owing to continuing postoperative discomfort.

Degradation of trans‐polyisoprene after root filling with thermoplasticized techniques

AIM To evaluate ex vivo degradation of gutta-percha following six thermoplastic obturation techniques. METHODOLOGY Ninety human-extracted mandibular premolars were selected and divided randomly into nine groups for filling. Group 1: thermomechanical compaction for 3 s with Konne gutta-percha points (Konne Ind. e Com. de Mat. Odontol., Belo Horizonte, MG, Brazil); Group 2: thermomechanical compaction for 3 s with Dentsply TP gutta-percha points (Dentsply Indústria e Comércio Ltda, Petrópolis, R.J. Brazil); Group 3: thermomechanical compaction for 10 s with Konne; Group 4: thermomechanical compaction for 10 s with Dentsply TP; Group 5: warm vertical condensation using System B (EIE/Analytic, Richmond, WA, USA) with Konne; Group 6: warm vertical condensation using System B with Dentsply TP; Group 7: vertical condensation with Konne; Group 8: vertical condensation with Dentsply TP; Group 9: Microseal cone (Analytic Endodontics, Glendora, CA, USA). A further four groups were assessed without using teeth, Group 10: Microseal microflow (Analytic Endodontics); Group 11: Obtura (Obtura Corporation, Penton, MO, USA); Group 12: Obtura flow (Obtura Corporation); Group 13: Thermafil (Dentsply Maillefer, Tulsa, OK, USA). The filling material was removed from the root canal and trans-1,4-polyisoprene isolated by solubilization of the root filling remnants in chloroform followed by filtration and centrifugation. By gel permeation chromatography and infrared spectroscopy, the occurrence and degree of degradation were assessed. The results were analysed statistically using the Kruskal-Wallis test. With differential scanning calorimetry, the thermal behaviour of the gutta-percha was determined. RESULTS A significant decrease in polymer molar mass and the production of carboxyl and hydroxyl groups in the polymer were observed with thermomechanical compaction used for 10 s and vertical condensation filling techniques (P = 0.0001 and P = 0.0005, respectively). Other techniques caused no polymer degradation. CONCLUSION Polyisoprene degrades with high temperature. Thermomechanical compaction for 10 s and vertical condensation were associated with the greatest degradative process.

Brazilian gutta-percha points. Part II: thermal properties

This study was undertaken to explore the effect of heating on gutta-percha, analyzing the occurrence of endothermic peaks corresponding to the transformation that occurs in the crystalline structure of the polymer during thermal manipulation. This study also sought to determine the temperature at which these peaks occur, causing a transformation from the beta- to the alpha-form, and from the alpha- to the amorphous phase. Eight nonstandardized gutta-percha points commercially available in Brazil (Konne, Tanari, Endopoint, Odous, Dentsply 0.04, Dentsply 0.06, Dentsply TP, Dentsply FM) and pure gutta-percha (control) were analysed using differential scanning calorimetry (DSC) and thermogravimetry analysis (TGA). The transition temperatures were determined and analysed. With the exception of Dentsply 0.04 and Dentsply 0.06, the majority of the products showed thermal behaviour typical of beta-gutta-percha, with two endothermic peaks, exhibiting two crystalline transformations upon heating from ambient temperature to 130 degrees. Upon cooling and reheating, few samples presented two endothermic peaks. It was concluded that heating dental gutta-percha to 130 degrees C causes changes to its chemical structure which permanently alter its physical properties.

Chemical composition and thermal behavior of five brands of thermoplasticized gutta‑percha

Objective: The aim of this study was determine the chemical composition and thermal behavior of Thermafil (TH), Microseal Cone (MC), Microseal Microflow (MF), Obtura (OB) and Obtura Flow (OF). In addition, their thermal behavior in response to temperature variations was studied by differential scanning calorimetry (DSC) to determine the temperature at which gutta-percha switches from the beta to alpha form, and from the alpha to the amorphous phase. Materials and Methods: The organic and inorganic fractions were separated by dissolution in chloroform. Gutta-percha (GP) was precipitated with acetone. The inorganic fraction was analyzed via Elemental Microanalysis. Energy Dispersive X-ray Microanalysis and X-ray Diffraction were used to identify the chemical elements and compounds (BaSO 4 and ZnO). Thermal analysis was conducted using DSC. Results: The organic and inorganic fractions ranged from 21.3% and 26.9% of weights, respectively. MC and MF showed the highest percentages of organic compounds (P = 0.0125). All specimens exhibited two crystalline transformations when heated from ambient temperature to 130°C. MC presented the highest percentage of GP. Conclusions: No correlation was observed between chemical composition and thermal behavior. Each of the products showed thermal behavior that is typical of beta-phase gutta-percha.

Clinical relevance of trans 1,4-polyisoprene aging degradation on the longevity of root canal treatment

This in vivo study investigated the time of degradation of root filling material (trans 1,4-polyisoprene) retrieved from endodontically treated teeth and correlated the occurrence of degradation with the longevity of endodontics. Thirty-six root-filled teeth with different filling times (2 to 30 years) and with and without periapical lesions were selected. All teeth presented clinical indication for root canal retreatment. The association among filling time, presence of periapical lesion and root filling material degradation was investigated. Root filling samples were retrieved from the root canals using a Hedströ m file without solvent. The trans 1,4-polyisoprene was isolated by root filling solubilization in chloroform followed by filtration and centrifugation. GPC and FT-IR were the analytical techniques utilized. Degradation of trans 1,4-polyisoprene occurred with time, as a slow process. It is an oxidative process, and production of carboxyl and hydroxyl groups in the residual polymer were observed. Statistically significant decrease of molar mass was observed after 5 (p=0.0001) and 15 (p=0.01) years in teeth with and without periapical lesion, respectively. Bacteria participated in polymer degradation. Gutta-percha aging was proven an important factor for the long-term success of endodontic treatment. The findings of the present study showed that, after 15 years, polymer weight loss may decrease the capacity of the filling mass to seal the root canal space and prevent re-infection, thus compromising significantly the longevity of root canal therapy.

Ex vivo evaluation of coronal and apical microbial leakage of root canal--filled with gutta-percha or Resilon/Epiphany root canal filling material.

OBJECTIVE This ex vivo study compared coronal and apical microleakage of root canals filled with Resilon/Epiphany (RE) or gutta-percha/Grossman sealer (GP), using either lateral condensation (LC) or System B (SB) technique. MATERIALS AND METHODS Specimens in eight experimental groups were obturated using the following materials and techniques: Groups 1 and 3--GP and LC; groups 2 and 4--GP and SB; groups 5 and 7--RE and LC; groups 6 and 8--RE and SB. Apical and coronal leakages were tested using bacterial methods. For coronal analysis, the number of days required for complete contamination of the root canals was recorded according to observation of the brain heart infusion broth turbidity for 15 weeks. For apical analysis, the teeth were cleaved and the leakage was measured at 30 days. Data were collected for each sample and analyzed statistically with the Chi-square and ANOVA tests. RESULTS Leakage was found in all groups. The difference between filling materials, obturation techniques, and median time of leakage was not statistically significant for coronal ( P=0.847) and apical ( P=0.5789) leakages. CONCLUSION There were no differences between the different filling materials (gutta-percha/Grossman sealer and Resilon/Epiphany) and obturation techniques (lateral condensation and system B technique) in coronal or apical leakages.

Three root canals in the maxillary second premolar

In this study, we report an endodontic treatment of the maxillary second premolar with three root canals and distinct foramens. The possibility of three root canals in this tooth is quite small; however, it must be taken into account in clinical and radiographic evaluation during endodontic treatment. Many times, their presence is noticed only after canal treatment due to continuing post-operative discomfort.

Intentional Replantation of an Avulsed Immature Permanent Incisor: A Case Report

Abstract This case report discusses the successful endodontic treatment of an open apex maxillary right permanent central incisor that had been avulsed and incorrectly replanted in a 7‐year‐old patient. The tooth was carefully re‐extracted followed by cleaning of the alveolar socket and immediate replantation. However, pulp necrosis was diagnosed, and regenerative endodontic treatment was performed. The root canal system was disinfected by passive ultrasonic irrigation with 2.5% sodium hypochlorite. At the first visit, the tooth was repositioned and immobilized with an appropriate semirigid splint. After 14 days, the splint was removed, and the diagnosis of pulp necrosis was confirmed by thermal testing. The root canal was emptied, disinfected, and filled with calcium hydroxide paste, which was left in place for 7 days. At the third visit, calcium hydroxide was removed with hand files and passive ultrasonic irrigation, and the canal was filled with a mixture of double antibiotic paste (metronidazole/ciprofloxacin) and zinc oxide. The antibiotic paste was left in place for 30 days. At the final visit, the paste was removed and the periapical area stimulated with a #80 K‐file to encourage clot formation within the pulp cavity. A mineral trioxide aggregate paste cervical plug was placed, and the tooth was restored with glass ionomer cement. Clinical and imaging (radiographic and tomographic) follow‐up at 3, 6, 12, and 36 months showed endodontic success with continued root formation.