Júlio César Emboava Spanó

Mechanism of action of sodium hypochlorite

The choice of an irrigating solution for use in infected root canals requires previous knowledge of the microorganisms responsible for the infectious process as well as the properties of different irrigating solutions. Complex internal anatomy, host defenses and microorganism virulence are important factors in the treatment of teeth with asymptomatic apical periodontitis. Irrigating solutions must have expressive antimicrobial action and tissue dissolution capacity. Sodium hypochlorite is the most used irrigating solution in endodontics, because its mechanism of action causes biosynthetic alterations in cellular metabolism and phospholipid destruction, formation of chloramines that interfere in cellular metabolism, oxidative action with irreversible enzymatic inactivation in bacteria, and lipid and fatty acid degradation. The aim of this work is to discuss the mechanism of action of sodium hypochlorite based on its antimicrobial and physico-chemical properties.

Atomic Absorption Spectrometry and Scanning Electron Microscopy Evaluation of Concentration of Calcium Ions and Smear Layer Removal With Root Canal Chelators

AIM The aim of this study was to evaluate the concentration of calcium ions and smear layer removal by using root canal chelators according to flame atomic absorption spectrophotometry and scanning electron microscopy. Forty-two human maxillary central incisors were irrigated with 15% ethylenediaminetetraacetic acid (EDTA), 10% citric acid, 10% sodium citrate, apple vinegar, 5% acetic acid, 5% malic acid, and sodium hypochlorite. The concentration of calcium ions was measured by using flame atomic absorption spectrometry, and smear layer removal was determined by scanning electron microscopy. Mean +/- standard deviation, one-way analysis of variance, Tukey-Kramer, Kruskal-Wallis, Dunn, and kappa tests were used for statistical analysis. The use of 15% EDTA resulted in the greatest concentration of calcium ions followed by 10% citric acid; 15% EDTA and 10% citric acid were the most efficient solutions for removal of smear layer.

Influence of cervical preflaring on apical file size determination in maxillary lateral incisors

The purpose of this study was to investigate the influence of cervical preflaring on determination of the initial apical file in maxillary lateral incisors. Forty human lateral incisors with complete root formation were used. After standard access cavities, a size 06 K-file was inserted into each canal until the apical foramen was reached. The WL (WL) was set 1 mm short of the apical foramen. Four groups (n=10) were formed at random, according to the type of cervical preflaring performed. Group 1 received the initial apical instrument without previous preflaring of the cervical and middle root canal thirds. Group 2 had the cervical and middle root canal thirds enlarged with nickel-titanium Orifice Opener instruments. Group 3 had the cervical and middle root canal thirds enlarged with Gates-Glidden drills. Titanium-nitrite treated, stainless steel LA Axxess burs were used for preflaring the cervical and middle root canal thirds of group 4. Each canal was sized using manual K-files, starting with size 08 files with passive movements until the WL was reached. File sizes were increased until a binding sensation was felt at the WL, and the instrument size was recorded for each tooth. The apical region was then observed under a stereoscopic magnifier, images were recorded digitally and the differences between root canal and maximum file diameters were recorded (in mm) for each sample. Significant differences were found between the groups regarding the anatomical diameter at the WL and the first file to bind the canal (p = 0.01). The major discrepancy was found when no preflaring was performed (0.1882 mm average). Canals preflared with Orifice Opener instruments (0.0485 mm average) and Gates-Glidden drills (0.1074 mm average) also showed great discrepancy. The LA Axxess burs produced the smallest differences between anatomical diameter and first file to bind (0.0119 mm average). Instrument binding technique for determining anatomical diameter at WL was not accurate. Preflaring of the cervical and middle thirds of the root canal improved anatomical diameter determination; the instrument used for preflaring played a major role on determination of the anatomical diameter at the WL. Canals preflared with LA Axxess burs created a more accurate relationship between file size and anatomical diameter.

Detection of Para-Chloroaniline, Reactive Oxygen Species, and 1-Chloro-4-Nitrobenzene in High Concentrations of Chlorhexidine and in a Mixture of Chlorhexidine and Calcium Hydroxide

INTRODUCTION Chlorhexidine (CHX) is likely to decompose into reactive by-products. This study evaluated the generation of 4-chloroaniline (pCA), reactive oxygen species (ROS), and 1-chloro-4-nitrobenzene in high concentrations of CHX and in a mixture of CHX and calcium hydroxide at different time points. METHODS A gas chromatography method was developed to detect pCA and CHX by-products. Mass spectroscopy was used to elucidate the structure of compounds. The samples, which were kept at 36.5°C and 95% relative humidity during the study, were analyzed immediately and 7 days after preparation. RESULTS pCA was detected in the 2% CHX solution and in the mixture of CHX and calcium hydroxide at all time points. pCA concentrations increased after storing under those conditions. The 2% CHX solution alone and the mixture of CHX and calcium hydroxide released ROS at all time points, but 1-chloro-4-nitrobenzene was not found. CONCLUSIONS pCA and ROS were identified as by-products of the 2% CHX aqueous solution alone and as ointment base of calcium hydroxide paste.

In vitro evaluation of the thermal alterations on the root surface during preparation with different Ni-Ti rotary instruments

The present study evaluated, in vitro, the temperature alterations on the external root surface during instrumentation with four different rotary systems. A total of 20 extracted human maxillary lateral incisors were instrumented using either the ProFile, MicroMega, Quantec or K3 systems and the thermal alterations on the root surface were recorded by means of three thermocouples attached to the coronal, middle and apical portions of the root. Mean temperature increases no higher than 0.4 degrees C +/- 1.0 degrees C (ProFile system) were recorded, which indicates that these instruments are safe for the surrounding periodontal tissues.

Heat generated by Er:YAG laser in the pulp chamber of teeth submitted to removal of dental tissue and composite resin

The knowledge about and control of thermal energy produced by Er:YAG laser after irradiating hard dental tissues and compound resin is important because the pulp, like all vital biological tissue, has a certain capacity for supporting stimulus. The objective of this study was to analyze the thermal variation generated by Er:YAG laser (λ=2.94μm) during the preparation of a Class I cavity in the dental structure and in the removal of microhybrid Z100 (3M) compound resin. An evaluation was made of 30 maxillary human pre-molar teeth from the bank of the Endodontic Laboratory Center of Ribeirao Preto Dental School, Brasil. The sample was divided into 6 groups of 5 teeth each: Group 1, preparation of Class I cavity with Er:YAG laser (350mJ, 3Hz, 343 impulses, 120J, 113 seconds); Group 2, preparation of Class I cavity with Er:YAG laser (350mJ, 4Hz, 343 impulses, 120J, 81 seconds); Group 3, preparation of Class I cavity with Er:YAG laser (350mJ, 6Hz, 343 impulses, 120J, 58 seconds); Group 4, removal of compound resin from Class I preparation with Er:YAG laser (350mJ, 3Hz, 258 impulses, 90J, 85 seconds); Group 5, removal of compound resin from Class I preparation with Er:YAG laser (350mJ, 4Hz, 258 impulses, 90J, 67 seconds); Group 6, removal of compound resin from Class I preparation with Er:YAG laser (350mJ, 6Hz, 258 impulses, 42 seconds). The laser used was KaVo Key 2 (Biberach, Germany), λ=2,94μm, P=3 Watts, pulse duration of 250μs, with air-water cooling. The increase in temperature during dental preparation and the removal of the compound resin was evaluated by means of a Tektronix DMM916 Thermocouple (Consitec, Brasil). The results showed that the application of laser for the removal of the hard dental tissues and for the removal of compound resins with the pulse frequencies 3, 4 and 6 Hz did not generate heating greater than 3.1°C and remained within the histopathological limits permitted for pulp tissue (5.5°C) and there was a significant statistical difference between the heat generated by the application of laser in the removal of the hard dental tissues and in the removal of compound resins (p<0.01). The average increase in temperature of the compound resin component was greater than the tooth.

In vitro evaluation of smear layer removal by Er:YAG laser application with five different fiberoptic tip withdrawl techniques

This study evaluated smear layer removal in apical and middle root thirds using five different fiberoptic tip withdrawal techniques. Thirty human canines were instrumented using 2.5% sodium hypochlorite, with a final irrigation of distilled water, and divided randomly in 6 different groups. Er:YAG laser was applied in 5 groups with a 50/28 fiberoptic tip (250 mJ input, 112 mJ output, 10 Hz, 1 mm from apex) with distinct withdrawal techniques. Group 6 did not receive laser irradiation. Two pieces of each root canal (middle and apical thirds) were obtained under the SEM and analyzed for the amount of smear layer. Results showed statistical differences (p<0.05) between treatments and significant differences (p<0.01) between radicular thirds. It can be concluded that 1) all withdrawal techniques produced the same results on smear layer removal and 2) the middle third presented less smear layer t han the apical third after Er:YAG laser irradiation.

In vitro evaluation of smear layer removal by Er:YAG laser application with five different fiberoptic tip withdrawal techniques

This study evaluated smear layer removal in apical and middle root thirds using five different fiberoptic tip withdrawal techniques. Thirty human canines were instrumented using 2.5% sodium hypochlorite, with a final irrigation of distilled water, and divided randomly in six different groups. Er:YAG laser was applied in five groups with a 50/28 fiberoptic tip (250 mJ input, 112 mJ output, 10 Hz, 1 mm from apex). Group 6 did not receive laser irradiation. Two pictures of each root canal (middle and apical thirds) were obtained under SEM and analyzed for the amount of smear layer. Results showed no statistical differences (p>0.05) between treatments and significant differences (p<0.01) between radicular thirds. It can be concluded that (1) all withdrawal techniques produced the same results on smear layer removal and (2) the middle third presented less smear layer than the apical third after Er:YAG laser irradiation.

Effects of Er:YAG and Nd:YAG laser irradiation on the permeability of instrumented root canal walls

The aim of this study was to evaluate the effect of Er:YAG and Nd:YAG laser on radicular dentine permeability when using distilled and deionized water and 1% sodium hypochlorite as irrigating solutions. Thirty human maxillary canines obtained from laboratory stock and conserved in 0.1% thymol until use were divided randomly into six groups of five teeth each. The root canals were instrumented with K files and the step-back technique. The surgical diameter was achieved 4 files above the original anatomical diameter. Group I, the teeth were irrigated with distilled and deionized water; Group II, the teeth were irrigated with 1% sodium hypochlorite, Group II the teeth were irrigated with distilled and deionized water and then Er:YAG laser was applied with 140mJ, 15Hz, 300 pulses and 42J; group 4 the teeth were irrigated with 1% sodium hypochlorite and Er:YAG laser was applied in the same parameters as Group III, Group V, the teeth received irrigation with distilled and deionized water and Nd:YAG laser application with 150mJ, 15Hz, 2,25W and Group VI the teeth were irrigated with 1% sodium hypochlorite and Nd:YAG laser was applied with the same parameters as Group V. During laser application the teeth were always filled with irrigating solution. The fiber optic tip was introduced until the apex and the laser was activated. The tip was withdrawn gently with helicoidally movement from the apex until the pulp chamber. After preparation the teeth were immersed in 10% copper sulfate for 30 minutes, in vacuum for the first 5 minutes. The teeth were then placed in a 1% rubianic acid alcohol solution for the same periodsin solution and in vacuum as above. Upon completion of this reaction the teeth were sectioned transversally, in 150micrometers slices, and sanded, washed, dehydrated, cleared and mounted on glass slides for microscopic examination. The quantification of the penetration of copper ions was done by morphmetric analysis with a 400-point grid. The data was submitted to statistical analysis and shoed normality and hemocedacity of the sample, parametric analysis was applied. The Tukey test showed that the cervical and middle thirds were statistically similar (p>0.05) and greater than the apical third (p<0.05). The Scheffe test showed greater dentine permeability in root canals where water and Er:YAG laser were used and significant different from the other treatments (p<0.05). The use of 1% sodium hypochlorite with Nd:YAG laser, distilled and deionized water with Nd:YAG laser and the use of water, were statistically similar (p<0.05) and increased less dentine permeability when compared to other groups. The use of 1% sodium hypochlorite with and without Er:YAG laser application presented statistically similar permeability values (p>0.05) and positioned in an intermediate among the treatments.