Melissa Andréia Marchesan

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.

Effectiveness of Manual and Rotary Instrumentation Techniques for Cleaning Flattened Root Canals

The cleaning capacity of manual and rotary instrumentation techniques in mesial-distal flattened canals was studied by morphometric analysis. Twenty human mandibular incisors were divided into two groups of 10 teeth each: group 1, crown-down technique with rotary instrumentation using ProFile .04; group 2, crown-down technique with manual instrumentation using K-files. The teeth were evaluated with an optic microscope that was coupled to a computer to determine the percentage of root canal area with debris. The nonparametric Mann-Whitney U test showed a statistically significant difference at the level of 1% between the techniques. The manual technique was more efficient in cleaning mesial-distal flattened root canals than the rotary technique, although neither completely cleaned the root canal.

Effect of Er:YAG laser on adhesion of root canal sealers.

This in vitro study evaluated the effect of Er:YAG laser on adhesion to human dentin of Grossman, Endomethasone, N-Rickert, and Sealer 26 root canal sealers. The crowns of 40 human molars were cut on the occlusal side until a flat dentin surface was obtained. The teeth were divided into two groups: group 1, no laser application; and group 2, irradiation with Er:YAG laser (KaVo Key Laser 2; 11 mm focal distance, perpendicular to the dentin surface, 4 Hz frequency, 200 mJ energy, 62 J total energy and 313 pulses, 1-min application time, and 2.25 W power). Five samples were tested for each sealer and each group. An Instron universal testing machine was used for the adhesion test. Sealer 26 showed the best adhesion both with and without laser application (p < 0.01). Grossman and N-Rickert sealers had intermediate values, and Endomethasone had the worst adhesion. Application of Er:YAG laser did not alter the adhesion of Grossman, N-Rickert, or Endomethasone sealers. However, laser application increased the adhesion of Sealer 26. The epoxy resin-based root canal sealer (Sealer 26) adhered better to dentin prepared with and without Er:YAG laser than the zinc oxide/eugenol-based sealers (Endomethasone, N-Rickert, and Grossman).

Temperature variation at the external root surface during 980-nm diode laser irradiation in the root canal

OBJECTIVE To assess the temperature variation in the cervical, middle and apical thirds of root external wall, caused by 980-nm diode laser irradiation with different parameters. METHODS The roots of 90 canines, had their canals instrumented and were randomly distributed into 3 groups (n=30) according to the laser potency (1.5 W, 3.0 W and 5.0 W). Each group was subdivided into 3 (n=10) according to the frequency (CM, 100 Hz and 1000 Hz), and each subgroup divided into 2 (n=5): dried canal or filled with distilled water. The maximum temperature values were collected by 3 thermocouples located at each third of the root external wall and recorded by digital thermometers. RESULTS The groups irradiated in the continuous mode (CM) presented the highest values (11.82+/-5.78), regardless of the canals were dry or not, which were statistically different (p<0.01) from those obtained with 100 Hz (6.22+/-3.64) and 1000 Hz (6.00+/-3.36), which presented no statistical difference between them (p>0.01). The groups irradiated with 5.0 W presented the greatest temperature variation (12.15+/-5.14), followed by 3.0 W (7.88+/-3.92) and 1.5 W (4.02+/-2.16), differing between them (p<0.01). The cervical third of the root presented the highest temperature rises (9.68+/-5.80), followed by the middle (7.66+/-4.87) and apical (6.70+/-4.23), with statistical difference among them (p<0.01). After 30s from the end of irradiation, all the specimens presented temperature variation lower than 10 degrees C. CONCLUSIONS Application of 980-nm diode laser in the root, at 1.5 W in all operating modes, and 3.0 W, in the pulsed mode, for 20s, can safely be used in endodontic treatment, irrespective of the presence of humidity.

Morphometrical analysis of cleaning capacity using nickel-titanium rotary instrumentation associated with irrigating solutions in mesio-distal flattened root canals

Variations in the internal anatomy of root canals may interfere with the success of root canal because tissue remnants may remain in the isthmus, re-entrances and ramifications of flattened root canals making instrumentation more difficult. Successful root canal treatment depends fundamentally on shaping, cleaning, disinfection and obturation. This study verified the quality of cleaning of ProFile .04 rotary technique associated with different irrigating solutions: 0.5% sodium hypochlorite, calcium hydroxide + Tergentol and 2% chlorhexidine in canals with mesio-distal flattening. Twelve human mandibular central incisors were randomly divided into 3 groups and instrumented up to ProFile 0.4 #35 file after cervical preparation, and processed histologically. After optical microscopic evaluation, statistical analysis showed that the percentage of cleaning of the three irrigating solutions was statistically different. Two-by-two comparisons classified the irrigating solutions in increasing order of cleaning: calcium hydroxide + Tergentol < chlorhexidine < 0.5% sodium hypochlorite.

Ultrastructural analysis of root canal dentine irradiated with 980-nm diode laser energy at different parameters

OBJECTIVE The purpose of this in vitro study was to investigate using the scanning electron microscope (SEM) the ultrastructural morphological changes of the radicular dentine surface after irradiation with 980-nm diode laser energy at different parameters and angles of incidence. BACKGROUND DATA There have been limited reports on the effects of diode laser irradiation at 980 nm on radicular dentin morphology. MATERIALS AND METHODS Seventy-two maxillary canines were sectioned and roots were biomechanically prepared using K3 rotary instruments. The teeth were irrigated with 2 mL of distilled water between files and final irrigation was performed with 10 mL of distilled water. The teeth were then randomly divided into five groups (n = 8 each) according to their diode laser parameters: Group 1: no irradiation (control); group 2: 1.5 W/continuous wave (CW) emission (the manufacturers parameters); group 3: 1.5 W/100 Hz; group 4: 3 W/CW; and group 5: 3 W/100 Hz. Laser energy was applied with helicoid movements (parallel to the canal walls) for 20 sec. Eight additional teeth for each group were endodontically prepared and split longitudinally and irradiation was applied perpendicularly to the root surface. RESULTS Statistical analysis showed no difference between the root canal thirds irradiated with the 980-nm diode laser, and similar results between the parameters 1.5 W/CW and 3 W/100 Hz (p > 0.05). CONCLUSION When considering different output powers and delivery modes our results showed that changes varied from smear layer removal to dentine fusion.

Effect of eugenol-based endodontic cement on the adhesion of intraradicular posts

The present study evaluated, in vitro, the influence of an eugenol-based endodontic sealer (EndoFill) on the adhesion of intra-radicular posts cemented with a resin-based cement (Enforce) ou a zinc phosphate cement. Twenty-four single-rooted maxillary canines were divided into 2 groups (n=12) and obturated with either gutta-percha points plus EndoFill or gutta-percha points alone (no cement). In each group, half of intracanal posts (n=6) were cemented with Enforce resin-based cement and half with zinc phosphate cement. Specimens were submitted to pull-out test in an Instron machine and tensile force was applied at a crosshead speed of 0.5 mm/min until post dislodgement. The maximum forces required for post removal was recorded (N) and means were submitted to statistical analysis by Kruskal-Wallis test (p<0.01). Posts cemented with zinc phosphate cement were significantly more retentive (353.4 N) than those cemented with Enforce (134.9 N) (p<0.01). Regarding the influence of the eugenol-based cement (EndoFill) on post retention, there was statistically significant difference (p<0.01) only between the groups cemented with Enforce, i.e., in the canals filled with EndoFill + guta-percha there was lower bond strength than in the canals filled with gutta-percha points alone (101.5 and 168.2 N, respectively). In conclusion, the zinc-phosphate-based cement showed greater post retention than the resin-based cement. The findings of this study suggest that the eugenol-containing sealer interfered with the adhesive properties of the resin-based cement.

Effect of 980-nanometer diode laser on root canal permeability after dentin treatment with different chemical solutions.

This study evaluated the effect of 980-nm diode laser at different parameters on root canal dentin permeability associated with different irrigants. Seventy-five canines were sectioned at 15 mm from the apex, prepared mechanically up to #40 .02 instrument, and irrigated with 2 mL distilled water. Final irrigation (10 mL) was used as follows: (1) distilled water; (2) 1% NaOCl; (3) 17% ethylenediaminetetraacetic acid + a cationic surfactant cetyltrimethylammonium bromide (EDTAC). Laser was applied at 1.5 or 3.0 W as either continuous wave or pulsed wave (100 Hz). The teeth were then processed histochemically, the percentage of copper ion penetration into the dentin of the canal walls was counted, and the data were analyzed statistically with the Tukey-Kramer test (alpha < .01). When laser was associated with water, an increase in permeability was found, whereas permeability decreased when associated with EDTAC. Dentin permeability after laser irradiation was directly dependent on the solution used for final irrigation.

Coronal resistance to fracture of endodontically treated teeth submitted to light-activated bleaching

OBJECTIVES The aim of this study was to assess the fracture resistance of endodontically treated teeth submitted to bleaching with 38% hydrogen peroxide activated by light-emitting diode (LED)-laser system. METHODS Fifty maxillary incisors were endodontically treated, received a zinc phosphate barrier and were embedded in acrylic resin until cemento-enamel junction. The specimens were distributed into five groups (n=10) according to the number of bleaching sessions: GI, no treatment (control); GII, one session; GIII, two sessions; GIV, three sessions and GV, four sessions. The whitening gel was applied to the buccal surface of the tooth and inside the pulp chamber for three times in each session, followed by LED-laser activation. Specimens were submitted to the fracture resistance test (kN) and data were submitted to the Tukey-Kramer multiple comparisons test. RESULTS No significant difference (p>0.05) was found between GI (0.71+/-0.30) and GII (0.65+/-0.13), which presented the highest strength values to fracture. Groups III (0.35+/-0.17), IV (0.23+/-0.13) and V (0.38+/-0.15) showed lower resistance to fracture (p<0.01) when compared to GI and GII. CONCLUSIONS The fracture resistance of endodontically treated teeth decreased after two sessions of bleaching with 38% hydrogen peroxide activated by LED-laser system.

Smear layer removal and chelated calcium ion quantification of three irrigating solutions.

The purpose of this study was to evaluate, by scanning electron microscopy (SEM), smear layer removal and quantify, by atomic absorption spectrophotometry, the amount of calcium ion present in the chelating solutions after their use. Sixteen extracted canines were instrumented using the step-back technique and were assigned to 3 groups according to the irrigating solution used: G1: 1 mL 17% EDTAC between each file; G2: 1 mL 17% CDTA; G3: 1 mL 17% EGTA. The solutions were collected after use. The teeth were cleaved longitudinally, evaluated under SEM and assessed for smear layer by blinded examiners and scored from 1 to 4. In order to quantify calcium ion release, the collected solutions were examined by atomic absorption spectrophotometry. Freidmans test was used for statistical analysis of SEM values and showed that canals irrigated with 17% EDTAC and 17% CDTA had significantly less smear layer throughout the canals than 17% EGTA (p<0.01). For analysis of the collected solutions, Tukeys test was used and showed that EDTAC and CDTA had a greater amount of calcium ions (22.8+/-7.54 and 60.6+/-20.67 microg/mL, respectively) compared to EGTA (70.5+/-14.2 microg/mL) (p<0.01). The association both methodologies may contribute to the understanding of how these solutions act in the root canal.