Denise Piotto Leonardi

Chlorhexidine diminishes the loss of bond strength over time under simulated pulpal pressure and thermo-mechanical stressing

OBJECTIVES The purpose of this study was to investigate the effects of chlorhexidine (CHX) digluconate at 0.2% and 2% on dentin bonding durability of etch-and-rinse and self-etch adhesive systems. METHODS In this study were used 24 extracted non-carious human third-molars. The occlusal surfaces of the molar crowns were removed with a low-speed diamond saw to expose flat dentin surfaces. The tested materials were Single-Bond (SB) (two-step etch-and-rinse adhesive) and Clearfil Tri S Bond (CTSB) (all-in-one self-etch adhesive) used in association or not with CHX at 0.2% and 2%. The bonding systems were applied according to manufacturers instructions and followed by composite application (Z250). For each condition, half of the specimens was immediately submitted to microtensile test and half of them was submitted to long-term storage of 6 months under simulated pulpal pressure and thermo-mechanical stressing before testing. The data were analyzed using Two-Way ANOVA and Tukey post hoc test (alpha=0.05). Failure patterns of the specimens were observed using scanning electron microscopy. RESULTS The falling % in bond strength over the 6-month period was: SB control-43.64%; SB/0.2%CHX-23.79%; SB/2%CHX-26.42%; CTSB control-40.94%; CTSB/0.2%CHX-37.07%; CTSB/2%CHX-22.14%. The fracture modes were predominantly adhesive, mainly in the specimens of terminal groups. CONCLUSIONS CXH digluconate at 2% was able to diminish loss of microtensile bond strength over time associated to both etch-and-rinse and self-etch adhesives. Lower concentration of CHX (0.2%) was not able to diminish the loss of bond strength over time when associated to the self-etch adhesive CTSB.

Effectiveness of ProTaper, D‐RaCe, and Mtwo retreatment files with and without supplementary instruments in the removal of root canal filling material

AIM To assess the efficacy of different retreatment rotary files in removing gutta-percha and endodontic sealer from canals. METHODOLOGY Ninety straight single-rooted premolars were prepared up to a size 30 and filled with gutta-percha and sealer and then randomly assigned to six retreatment groups (n = 15). Groups I, III, and V were retreated using rotary systems ProTaper Universal Retreatment (PTUR), D-RaCe, and Mtwo Retreatment, respectively. Groups II, IV, and VI were retreated using the additional instruments F4, size 40, .04 taper RaCe, and size 40, .04 taper Mtwo, respectively. The roots were split vertically, and images of the halves were obtained using a high-resolution scanner and evaluated with AutoCAD software to calculate the percentage of residual material. Data were analyzed with Kruskal-Wallis and Student-Newman-Keuls tests using a 5% significance cutoff (P < 0.05). RESULTS There were no statistically significant differences (P > 0.05) between groups when additional instruments were used. The percentage of residual material was lowest in the PTUR group and was statistically significant only when compared to the D-RaCe system (P = 0.0038). CONCLUSIONS All root canals had residual filling material after retreatment even when additional instruments were used.

Influence of chlorhexidine concentration on microtensile bond strength of contemporary adhesive systems.

The purpose of this study was to investigate the influence of chlorhexidine (CHX) concentration on the microtensile bond strength (muTBS) of contemporary adhesive systems. Eighty bovine central incisors were used in this study. The facial enamel surface of the crowns was abraded with 600-grit silicon carbide paper to expose flat, mid-coronal dentin surfaces. The tested materials were Scotchbond Multipurpose (SMP), Single-Bond (SB), Clearfil SE Bond (CSEB) and Clearfil Tri S Bond (CTSB). All the materials were applied according to manufacturers instructions and followed by composite application (Z250). The teeth were randomly divided into 16 groups: for the etch-and-rinse adhesives (SMP and SB), 0.12% or 2% CHX was applied prior to or after the acid etching procedure. For the self-etch adhesives (CSEB and CTSB) 0.12% or 2% CHX was applied prior to the primer. Control groups for each one of the adhesive systems were also set up. The specimens were immediately submitted to muTBS testing and the data were analyzed using Analysis of Variance and the Tukey post hoc test (alpha = .01). The failure patterns of the specimens were observed using scanning electron microscopy. The effects of 2% CHX were statistically significant (p < 0.01) for the self-etch adhesives but were not significant for the etch-and-rinse adhesive systems. Analysis of the data demonstrated no statistical difference between the etch-and-rinse adhesive systems. CHX-based cavity disinfectants in concentrations higher than 0.12% should be avoided prior to the self-etch adhesive systems evaluated in this study to diminish the possibilities of reduction in bond strength.

Influence of protaper finishing files and sodium hypochlorite on cleaning and shaping of mandibuldar central incisors - a histological analysis

Objective: This study investigated the influence of the last apical instrument of the ProTaper system with and without 2.5% sodium hypochlorite for cleaning mandibular central incisors. Material and Methods: Thirty two mandibular central incisors were divided into six study groups: Group I – F1 instrument with 2.5% sodium hypochlorite; Group II – F1 and F2 with 2.5% sodium hypochlorite; Group III – F1, F2 and F3 with 2.5% sodium hypochlorite; Group IV – F1 with distilled water; Group V – F1 and F2 with distilled water; Group VI – F1, F2 and F3 with distilled water. The two remaining teeth comprised the negative control group. The specimens were prepared following the principles of the technique suggested by the manufacturer and then submitted to histological preparation and morphometric analysis. Data were analyzed statistically by the Kruskal Wallis test at 1% significance level. Results: There was statistically significant difference (p<0.01) between all study groups, except between Groups I and VI. Conclusions: It was concluded that no technique allowed complete cleaning of the root canals. However, the technique of finishing preparation of the apical third with the F3 instrument with 2.5% sodium hypochlorite irrigation was the most effective.

New Technologies to Improve Root Canal Disinfection.

Effective irrigant delivery and agitation are prerequisites to promote root canal disinfection and debris removal and improve successful endodontic treatment. This paper presents an overview of the currently available technologies to improve the cleaning of the endodontic space and their debridement efficacy. A PubMed electronic search was conducted with appropriate key words to identify the relevant literature on this topic. After retrieving the full-text articles, all the articles were reviewed and the most appropriate were included in this review. Several different systems of mechanical activation of irrigants to improve endodontic disinfection were analysed: manual agitation with gutta-percha cones, endodontic instruments or special brushes, vibrating systems activated by low-speed hand-pieces or by sonic or subsonic energy, use of ultrasonic or laser energy to mechanically activate the irrigants and apical negative pressure irrigation systems. Furthermore, this review aims to describe systems designed to improve the intracanal bacterial decontamination by a specific chemical action, such as ozone, direct laser action or light-activated disinfection. The ultrasonic activation of root canal irrigants and of sodium hypochlorite in particular still remains the gold standard to which all other systems of mechanical agitation analyzed in this article were compared. From this overview, it is evident that the use of different irrigation systems can provide several advantages in the clinical endodontic outcome and that integration of new technologies, coupled with enhanced techniques and materials, may help everyday clinical practice.

Efficacy of clinical and radiological methods to identify second mesiobuccal canals in maxillary first molars.

INTRODUCTION The success of endodontic treatment depends on the identification of all root canals. Technological advances have facilitated this process as well as the assessment of internal anatomical variations. The aim of this study was to compare the efficacy of clinical and radiological methods in locating second mesiobuccal canals (MB2) in maxillary first molars. METHODS Fifty patients referred for analysis; access and clinical analysis; cone-beam endodontic treatment of their maxillary first molars were submitted to the following assessments: analysis; access and clinical analysis; cone-beam computed tomography (CBCT); post-CBCT clinical analysis; clinical analysis using an operating microscope; and clinical analysis after Start X ultrasonic inserts in teeth with negative results in all previous analyses. RESULTS Periapical radiographic analysis revealed the presence of MB2 in four (8%) teeth, clinical analysis in 25 (50%), CBCT analysis in 27 (54%) and clinical analysis following CBCT and using an operating microscope in 27 (54%) and 29 (58%) teeth, respectively. The use of Start X ultrasonic inserts allowed one to detect two additional teeth with MB2 (62%). According to Vertuccis classification 48% of the mesiobuccal canals found were type I, 28% type II, 18% type IV and 6% type V. Statistical analysis showed no significant differences (p > 0.5) in the ability of CBCT to detect MB2 canals when compared with clinical assessment with or without an operating microscope. A significant difference (p < 0.001)was found only between periapical radiography and clinical/CBCT evaluations. CONCLUSION Combined use of different methods increased the detection ofthe second canal in MB roots, but without statistical difference among CBCT, operating microscope, Start X and clinical analysis.

Histological analysis of the biocompatibility of three different calcium hydroxide-based root canal sealers

Objective: To histologically evaluate the behavior of the subcutaneous tissue of rats after placement of polyethylene tubes filled with calcium hydroxide-based root canal sealers (Sealapex™, Apexit™ e Sealer 26™). Study design: The study employed 60 rats, which were divided into eight groups, being four experimental groups with 10 rats each, and four control groups with five rats. Analysis was conducted at 48 hours, 7, 21 and 60 days. Results: Histological analysis revealed that all sealers were irritant; however, the intensity varied between each sealer and as a function of time. At the initial periods (48 hours and seven days), all materials demonstrated similar outcomes, with inflammatory reaction from severe to moderate, respectively. At the final periods (21 and 60 days), the tissue reactions to the implants containing Sealapex™ displayed an active status yet with regression, compared to the Apexit™ and Sealer 26™. The control groups exhibited less inflammatory cells than the experimental groups, keeping a reaction status with regression. Conclusions: The results achieved in this study revealed that the Sealapex™ sealer was the most compatible, followed by Apexit™ and Sealer 26™

Resistance and Stress Finite Element Analysis of Different Types of Fixation for Mandibular Orthognathic Surgery

The aim of this study was to evaluate the stress and dislodgement resistance by finite element analysis of different types of fixation in mandibular orthognathic surgery. A 3D solid finite element model of a hemi-mandible was obtained. A bilateral sagittal split osteotomy was simulated and the distal segment was advanced 5 mm forward. After the adjustment and superimposing of segments, 9 different types of osteosynthesis with 2.0 miniplates and screws were simulated: A, one 4-hole conventional straight miniplate; B, one 4-hole locking straight miniplate; C, one 4-hole conventional miniplate and one bicortical screw; D, one 4-hole locking miniplate and 1 bicortical screws; E, one 6-hole conventional straight miniplate; F, one 6-hole locking miniplate; G, two 4-hole conventional straight miniplates; H, two 4-hole locking straight miniplates; and I, 3 bicortical screws in an inverted-L pattern. In each model, forces simulating the masticatory muscles were applied. The values of stress in the plates and screws were checked. The dislodgement resistance was checked at the proximal segment since the distal segment was stable because of the screen at the occlusal tooth. The regions with the lowest and highest displacement were measured. The offset between the osteotomized segments was verified by millimeter intervals. Inverted-L with bicortical screws was the model that had the lowest dislodgment and the model with the lowest tension was the one with two conventional plates. The results suggest that the tension was better distributed in the locking miniplates, but the locking screws presented higher concentration of tension.

Influence of Cervical and Apical Enlargement Associated with the WaveOne System on the Transportation and Centralization of Endodontic Preparations.

INTRODUCTION The aim of this study was to evaluate through computed microtomography the transportation and centralization of root canals instrumented using the WaveOne system (Dentsply Maillefer, Ballaigues, Switzerland) associated or unassociated with previous apical and cervical enlargements. METHODS Thirty-six mandibular molars were selected with independent mesial roots and curvatures and randomized into the following groups: PathFile (Dentsply Maillefer) before WaveOne Primary (the PFWO group), ProTaper Universal SX (Dentsply Maillefer) before WaveOne Primary (the SXWO group), and WaveOne Primary (the WO group). Computed microtomographic imaging was performed pre- and postpreparation to obtain measurements of mesial and distal dentin walls and calculations of root canal transportation (%) and centralization. One-way analysis of variance was performed to compare the different groups, repeated measures analysis of variance for comparison of the root thirds in each group, and the Student t test for comparisons between the mesiobuccal and mesiolingual canals. RESULTS Transportation of the cervical and middle thirds to the danger zone was observed in both roots, whereas the apical thirds were transported to the outer face of the curvature. In the PFWO and SXWO groups, less transportation was observed in the middle thirds of the mesiobuccal canals compared with the WO group (P < .05). Centralization remained almost unchanged in the SXWO group (P < .05). CONCLUSIONS In each group, transportation toward the danger zone was mostly observed in the cervical thirds of the mesiobuccal canals. Cervical or apical enlargement resulted in reduced transportation and improved centralization of the middle thirds compared with the exclusive use of the WaveOne system.

Performance of Three Single Instrument Systems in the Preparation of Long Oval Canals

This study aimed to evaluate the performance of the Wave One, Easy ProDesign Logic and One Shape systems in the preparation of long oval root canals. Forty-two mandibular incisors were randomized into three groups: Group I, Wave One Primary (WO) (#25.08); Group II, Easy ProDesign Logic (EPL) (#25.06) and Group III, One Shape (OS) (#25.06). Micro-computed tomography scans were obtained pre- and post-preparation of the samples. Instrument fractures or loss of working length did not occur in any of the groups. There was a statistically significant difference in total root canal volume between the WO and EPL (p<0.05) and OS systems (p<0.05) The mean percentages of instrumented canal area in the middle thirds were 76.9% in the WO, 62.3% in the EPL and 71.8% in the OS (p>0.05). The OS system had the strongest correlation between volume increase and instrumented area (R=0.63). The WO, EPL and OS systems presented mean preparation times of 2.13 min, 0.54 min, and 2.21 min (p<0.05), respectively. All three systems enabled the safe preparation of long oval root canals. The WO system most effectively increased root canal volume, but it did not affect the instrumented areas. The OS system had the strongest correlation between volume increase and instrumented area, while the EPL system was the fastest.