Luiz Pascoal Vansan

In vitro fracture resistance of glass-fiber and cast metal posts with different lengths

STATEMENT OF PROBLEM Dental fractures can occur in endodontically treated teeth restored with posts. PURPOSE The purpose of this study was to evaluate the in vitro fracture resistance of roots with glass-fiber and metal posts of different lengths. MATERIAL AND METHODS Sixty endodontically treated maxillary canines were embedded in acrylic resin, except for 4 mm of the cervical area, after removing the clinical crowns. The post spaces were opened with a cylindrical bur at low speed attached to a surveyor, resulting in preparations with lengths of 6 mm (group 6 mm), 8 mm (group 8 mm), or 10 mm (group 10 mm). Each group was divided into 2 subgroups according to the post material: cast post and core or glass-fiber post (n=30). The posts were luted with dual-polymerizing resin cement (Panavia F). Cast posts and cores of Co-Cr (Resilient Plus) crowns were made and cemented with zinc phosphate. Specimens were subjected to increasing compressive load (N) until fracture. Data were analyzed with 2-way ANOVA and the Tukey-Kramer test (alpha =.05). RESULTS The ANOVA analysis indicated significant differences (P<.05) among the groups, and the Tukey test revealed no significant difference among the metal posts of 6-mm length (26.5 N +/-13.4), 8-mm length (25.2 N +/-13.9), and 10-mm length (17.1 N +/-5.2). Also, in the glass-fiber post group, there was no significant difference when posts of 8-mm length (13.4 N +/-11.0) were compared with the 6-mm (6.9 N +/-4.6) and 10-mm (31.7 N +/-13.1) groups. The 10-mm-long post displayed superior fracture resistance, and the 6-mm-long post showed significantly lower mean values (P<.001). CONCLUSIONS Within the limitations of this study, it was concluded that the glass-fiber post represents a viable alternative to the cast metal post, increasing the resistance to fracture of endodontically treated canines.

Effect of Chelating Solutions on the Microhardness of Root Canal Lumen Dentin

INTRODUCTION The greatest reduction in microhardness of the most superficial layer of dentin of the root canal lumen is desired. The use of chelating agents during biomechanical preparation of root canals removes smear layer, increasing the access of the irrigant into the dentin tubules to allow adequate disinfection, and also reduces dentin microhardness, facilitating the action of endodontic instruments. This study evaluated the effect of different chelating solutions on the microhardness of the most superficial dentin layer from the root canal lumen. METHODS Thirty-five recently extracted single-rooted maxillary central incisors were instrumented, and the roots were longitudinally sectioned in a mesiodistal direction to expose the entire canal extension. The specimens were distributed in seven groups according to the final irrigation: 15% EDTA, 10% citric acid, 5% malic acid, 5% acetic acid, apple vinegar, 10% sodium citrate, and control (no irrigation). A standardized volume of 50 μL of each chelating solution was used for 5 minutes. Dentin microhardness was measured with a Knoop indenter under a 10-g load and a 15-second dwell time. Data were analyzed statistically by one-way analysis of variance and Tukey-Kramer multiple-comparison test at 5% significance level. RESULTS EDTA and citric acid had the greatest overall effect, causing a sharp decrease in dentin microhardness without a significant difference (p > .05) from each other. However, both chelators differed significantly from the other solutions (p < .001). Sodium citrate and deionized water were similar to each other (p > .05) and did not affect dentin microhardness. Apple vinegar, acetic acid, and malic acid were similar to each other (p > .05) and presented intermediate results. CONCLUSION Except for sodium citrate, all tested chelating solutions reduced microhardness of the most superficial root canal dentin layer. EDTA and citric acid were the most efficient.

Effect of eugenol-based endodontic sealer on the adhesion of intraradicular posts cemented after different periods

Objective: This study evaluated in vitro the influence of an eugenol-based sealer (EndoFill) on the retention of stainless steel prefabricated posts cemented with zinc phosphate and resin-based (Panavia F) cements after different periods of root canal obturation, using the pull-out test. Material and methods: Sixty upper canines were decoronated and the roots were embedded in resin blocks. The specimens were distributed into 3 groups, according to the period elapsed between canal obturation and post cementation: Group I - immediately; Group II - 72 h and Group III - 4 months. The groups were subdivided according to the type of cement used for post cementation: A - zinc phosphate and B - Panavia F. Following the experimental periods, specimens were subjected to pull- out test in an Instron machine with application of tensile force at a crosshead speed of 0.5 mm/min until post dislodgement. The maximum forces required for post removal were recorded (kN) and means were subjected to statistical analysis by 2-way ANOVA and Tukey-Kramer test (α=0.001) Results: There were statistically significant differences (p<0.01) between the posts cemented with zinc phosphate cement (0.2112 kN) and Panavia F (0.0501 kN). However, no statistically significant differences (p>0.05) were found between the three post cementation periods, regardless of the cement. Conclusions: It was concluded that the eugenol-based sealer influenced the tensile strength of the posts cemented with the resin cement, but had no influence on the time waited between root canal obturation and post space preparation/post cementation.

Effectiveness of different final irrigation protocols in removing debris in flattened root canals

This study evaluated in vitro the capacity of debris removal from the apical third of flattened root canals, using different final irrigation protocols. Thirty human mandibular central incisors with a mesiodistal flattened root were prepared using rotary instrumentation by Endo-Flare 25.12 and Hero 642 30.06, 35.02, 40.02 files, irrigated with 2 mL of 1% NaOCl after each file. The specimens were randomly distributed into 5 groups according to the final irrigation of root canals: Group I: 10 mL of distilled water (control), Group II: 10 mL of 1% NaOCl for 8 min, Group III: 2 mL of 1% NaOCl for 2 min (repeated 4 times), Group IV: 10 mL of 2.5% NaOCl for 8 min, and Group V: 10 mL of 2.5% NaOCl for 2 min (repeated 4 times). The apical thirds of the specimens were subjected to histological processing and 6-microm cross-sections were obtained and stained with hematoxylin-eosin. The specimens were examined under optical microscopy at x40 magnification and the images were subjected to morphometric analysis using the Scion image-analysis software. The total area of root canal and the area with debris were measured in square millimeters. Analysis of variance showed no statistically significant difference (p>0.05) among the groups GI (2.39 +/- 3.59), GII (2.91 +/- 2.21), GIII (0.73 +/- 1.36), GIV (0.95 +/- 0.84) and GV (0.51 +/- 0.22). In conclusion, the final irrigation protocols evaluated in this study using the Luer syringe presented similar performance in the removal of debris from the apical third of flattened root canals.

Retention of radicular posts varying the application technique of the adhesive system and luting agent

This study evaluated in vitro the retention of intracanal cast posts cemented with dual-cure resin varying the application method of the primer/adhesive solution and luting agent in the prosthetic space prepared to receive the posts. Sixty endodontically treated maxillary canines had their crowns discarded, and their roots were embedded in acrylic resin. The prosthetic spaces were prepared with Largo burs mounted on a low-speed handpiece coupled to a parallelometer in order to maintain length and diameter of intraradicular posts constant and to guarantee that the preparations were parallel after casting. Two groups (n = 30) were randomly formed according to the device used to apply the adhesive system: microbrush or standard bristle brush (control). Each group was divided into 3 subgroups (n = 10) according to the technique used to place the luting agent into the root canal: using only a lentulo spiral before setting the post, applying it onto the post surface, or combining both methods. After 72 hours, the tensile force required to dislodge each post was determined by a universal testing machine (Instron 4444) set at a speed of 1 mm/min. The results indicated that the use of the microbrush yielded higher bond strength values (0.1740 +/- 0.04 kN) than those recorded for the bristle brush tip (0.1369 +/- 0.04 kN, p < 0.001). Bonferronis test demonstrated a higher retention (p < 0.001) in radicular post cemented with the technique that combined both methods (lentulo + post: 0.1787 +/- 0.03 kN) than that obtained with lentulo (0.1461 +/- 0.065 kN) or post (0.1416 +/- 0.03 kN) alone. The interactions between the adhesive system and luting agent application techniques presented statistical difference (p < 0.001). It was concluded that the best performance in terms of tensile strength among the tested conditions was obtained when the adhesive system was applied with a microbrush and the luting agent was taken into the root canal with lentulo spirals alone (0.1961 +/- 0.04 kN) and combining both methods (lentulo + post: 0.1911 +/- 0.02 kN).

Micro‑computed tomography and bond strength analysis of different root canal filling techniques

INTRODUCTION The aim of this study was to evaluate the quality and bond strength of three root filling techniques (lateral compaction, continuous wave of condensation and Taggers Hybrid technique [THT]) using micro-computed tomography (CT) images and push-out tests, respectively. MATERIALS AND METHODS Thirty mandibular incisors were prepared using the same protocol and randomly divided into three groups (n=10): Lateral condensation technique (LCT), continuous wave of condensation technique (CWCT), and THT. All specimens were filled with Gutta-percha (GP) cones and AH Plus sealer. Five specimens of each group were randomly chosen for micro-CT analysis and all of them were sectioned into 1 mm slices and subjected to push-out tests. RESULTS Micro-CT analysis revealed less empty spaces when GP was heated within the root canals in CWCT and THT when compared to LCT. Push-out tests showed that LCT and THT had a significantly higher displacement resistance (P<0.05) when compared to the CWCT. Bond strength was lower in apical and middle thirds than in the coronal thirds. CONCLUSIONS It can be concluded that LCT and THT were associated with higher bond strengths to intraradicular dentine than CWCT. However, LCT was associated with more empty voids than the other techniques.

Evaluation of 17% EDTA and 10% citric acid in smear layer removal and tubular dentin sealer penetration

The purpose of this study was to compare the efficacy of different chelating solutions (17% EDTA and 10% citric acid) on the smear layer removal, and their effect on tubular dentin sealer penetration. Sixty root canals were prepared and distributed into four groups (n = 15) according to the final irrigation protocol: G1, final irrigation with 2.5 mL of distilled water; G2, final irrigation with 2.5 mL of 2.5% sodium hypochlorite solution; G3, final irrigation with 2.5 mL of 17% EDTA; and G4, final irrigation with 2.5 mL of 10% citric acid. Five specimens from each group were not filled to assess smear layer removal by scanning electron microscopy. Ten specimens from each group were filled for analysis of sealer penetration into dentinal tubules by confocal laser scanning microscopy. Smear layer removal (Kruskal–Wallis and Dunns tests) and sealer penetration (F and Tukeys tests) were statistically analyzed with 95% of significance level. G3 and G4 had greater smear layer removal rates in the cervical and middle thirds, in comparison with G1 and G2 (p < .05). G3 and G4 had the highest percentages of sealer penetration in all thirds, in comparison with G1 and G2 (p < .05). Smear layer removal was effective only at the cervical and middle thirds when the chelating solutions were used. Sealer penetration into the dentinal tubules significantly increased in all root thirds when the specimens were treated with both chelating solutions.

The Impact of Apical Patency in the Success of Endodontic Treatment of Necrotic Teeth with Apical Periodontitis: A Brief Review

Accumulation of soft tissue or dentinal remnants in the apical region is a common event that can cause blockage of root canals. This event can be avoided if apical patency is performed during the root canal shaping procedures. However, there is no consensus on the role of apical patency in relation to the success of endodontic treatment of necrotic teeth with apical periodontitis. Therefore, the purpose of this paper was to conduct a brief review on the role of apical patency in guaranteeing the success of endodontic treatments of necrotic teeth with apical periodontitis considering two other key points; the root canal anatomy and microbiology.

Histological analysis of the biocompatibility of calcium hydroxide associated with a new vehicle

BACKGROUND Several substances have been researched to act as vehicles associated with calcium hydroxide. The specific type of vehicle is directly related to the effectiveness of the ionic dissociation, antimicrobial action, and biocompatibility of this medication. AIM To make a histological evaluation of the biocompatibility of calcium hydroxide associated with a new vehicle (triethanolamine), compared with polyethylene glycol, saline solution, and olive oil. MATERIALS AND METHODS Fifty mice of guinea pig species were randomly divided into five groups (n = 10) according to each vehicle used--Group 1: calcium hydroxide, Group 2: triethanolamine, Group 3: polyethylene glycol, Group 4: saline solution, and Group 5: olive oil--and further divided into subgroups according to the two analysis periods--(a) 30 and (b) 90 days. Teflon carriers filled with the evaluated substances were placed in standardized bone cavities in the anterior mandible region. The animals were euthanized to perform a histological analysis after the time periods analyzed. RESULTS In 30 days, specimens from Groups 1, 3, and 5 showed a very pronounced inflammatory response. Specimens from Group 2 showed an inflammatory reaction ranging from mild to severe, with rapid resorption of the material and progressive advancement of osteoid tissue into the teflon carriers. Specimens from Group 4 showed a moderate inflammatory reaction. In 90 days, specimens from Group 1 showed a very pronounced fibrous replacement. In regard to Group 2 specimens, the tested material was solubilized and replaced by newly formed bone tissue. For Groups 3 and 5 specimens, the inflammatory reaction went from acute to moderate. In relation to Group 4 specimens, an organized bone formation process was observed. CONCLUSIONS Specimens from Group 2 showed higher biocompatibility, especially as compared with the specimens from Groups 3 and 5.

Connective Tissue Reaction of Rats to a New Zinc‐Oxide‐Eugenol Endodontic Sealer

The aim of this study was to evaluate the biocompatibility in rat subcutaneous connective tissue of a new zinc oxide endodontic sealer (Endomethasone N) compared to those provided by Endofill and Sealer 26. Polyethylene tubes containing the test materials were implanted into dorsal subcutaneous connective tissue of Wistar albino rats. After 7 and 42 days, the implants with the surrounding tissue were collected, fixed, and processed for histologic evaluation. Sections were evaluated for the presence of inflammatory cells (poly or monomorfonuclear), blood vessels, necrosis area, and thickness of fibrous capsule. Comparisons between groups and time‐periods were performed with Kruskal–Wallis and Mann–Whitney U non‐parametric tests for 5% significance level. No differences in the biocompatibility patterns among the materials for the 2 experimental periods were observed. Independently of the sealer, the tissue behavior showed a tendency to decrease the irritation effect over time. It can be concluded that all sealers are irritant, but its toxicity decreased with time. Endomethásone N showed biocompatible characteristics comparable with those provided by Endofill and Sealer 26. Microsc. Res. Tech. 76:1292–1296, 2013.