Patrícia Maria Poli Kopper

Antibacterial activity of two MTA‐based root canal sealers

AIM To evaluate the pH and antibacterial activity of Endo CPM Sealer and MTA Fillapex by two different methods, using white MTA and Endofill as references for comparison. METHODOLOGY Antibacterial activity was evaluated against Enterococcus faecalis (ATCC 29212). The agar diffusion test (ADT) was performed to evaluate the effect before setting. The materials were placed in four equidistant wells made in ten agar plates. After incubation at 37 °C for 48 h, the inhibition zones were measured using a digital paquimeter. The direct contact test (DCT) was performed to assess the antibacterial effect after setting. Suspensions of crushed materials were prepared and mixed with E. faecalis. After different periods of time (1, 6, 15 and 60 min), the survival of bacteria was assessed by using 10-fold serial dilution and cultivated on agar plates in triplicate. Colony-forming units (CFU) mL(-1) were calculated after incubation. pH values were also measured in triplicate. Comparison between sealers in the ADT and DCT was performed by the Kruskal-Wallis test. RESULTS In the ADT, inhibition zones were found with MTA Fillapex and Endofill. They were similar to each other and greater than the other sealers (P < 0.05). None of the tested sealers demonstrated antibacterial activity in the DCT, and thus, all sealers had similar bacterial counts compared with the negative control group (P > 0.05). White MTA and Endo CPM Sealer suspensions had pH values >11, whilst MTA Fillapex and Endofill had lower values. CONCLUSIONS MTA Fillapex and Endofill had an antibacterial effect against E. faecalis before setting, but none of the sealers maintained antibacterial activity after setting, despite the high pH of the MTA-based materials.

Dentin Inhibits the Antibacterial Effect of New and Conventional Endodontic Irrigants

INTRODUCTION This in vitro study aimed to compare the antibacterial effect of a new irrigant, QMiX, with that of conventional irrigation solutions in the presence or absence of dentin powder. METHODS Dentin powder was prepared from bovine incisors and sterilized. The following irrigants were tested against Enterococcus faecalis (ATCC 29212): 6% sodium hypochlorite (NaOCl), 1% NaOCl, QMiX, 2% chlorhexidine gluconate (CHX), and 17% EDTA. Sterilized saline solution was used as negative control. Survival of bacteria exposed to the irrigants in the presence or absence of dentin was monitored under planktonic conditions. Colony-forming units were counted, and log-transformed numbers were analyzed by using Kruskal-Wallis and Mann-Whitney tests. P values less than .05 were considered significant. RESULTS In the absence of dentin, after 10 seconds of contact with the bacterial suspension, 6% NaOCl showed the lowest bacterial count; the difference to the negative control was significant. After 30 seconds, 6% NaOCl displayed 0 colony-forming units per milliliter, whereas 1% NaOCl and QMiX showed reduced number of colonies in comparison with the negative control. After 1 minute, both concentrations of NaOCl presented no bacterial growth and QMiX reduced the number of colonies, but EDTA and CHX had bacterial counts similar to the negative control. Dentin had a significant inhibitory effect on 6% NaOCl (10 seconds), 1% NaOCl (10 seconds and 1 minute), and QMiX (10 seconds and 1 minute). After 6 hours, both concentrations of NaOCl, QMiX, and CHX killed all bacteria, regardless of the presence of dentin. CONCLUSIONS Six percent NaOCl was the most effective irrigant against E. faecalis. Saline and EDTA had no measurable antibacterial effect. Dentin delayed the antibacterial activity of NaOCl and QMiX but did not completely prevent their action.

Evaluation of bone tissue response to a sealer containing mineral trioxide aggregate.

INTRODUCTION This study analyzed bone tissue reactions to MTA Fillapex (Ângelus Industria de Produtos Odontológicos Ltda, Londrina, Brazil) compared with an epoxy resin-based material in the femur of Wistar rats. METHODS Bone tissue reactions were evaluated in 15 animals after 7, 30, and 90 days (n = 5 per period). Three surgical cavities were prepared on the femur and filled with 0.2 mL MTA Fillapex, AH Plus (Dentsply DeTrey GmbH, Konstanz, Germany), or no sealer (negative control). By the end of each experimental period, 5 animals were randomly euthanized. The samples were histologically processed and analyzed using a light microscope. The presence of inflammatory cells, fibers, and hard tissue barrier formation was evaluated. Differences among the groups and between the 3 experimental periods were evaluated by using 2-way analysis of variance followed by the Bonferroni post hoc test (P ≤ .05). RESULTS MTA Fillapex scored significantly higher for neutrophils at 7 days than at 90. At 7 days, the same occurred when comparing MTA Fillapex with AH Plus. The presence of lymphocytes/plasmocytes significantly decreased over time in all groups. Macrophages, giant cells, eosinophils, and fiber condensation presented no differences among groups and periods. Within 90 days, all groups presented complete hard tissue barrier formation. CONCLUSIONS The presence of mineral trioxide aggregate in MTA Fillapex composition did not improve the bone tissue repair. The presence of sealers provided the re-establishment of the original bone tissue structure and the inflammatory response decreased over time, so they can be considered biocompatible.

Accuracy of Cone-beam Computed Tomography and Periapical Radiography in Apical Periodontitis Diagnosis

INTRODUCTION This study aimed to investigate the correlation and the agreement between periapical radiography (PR) and cone-beam computed tomography (CBCT) correlating to histologic findings in the diagnosis of apical periodontitis (AP). METHODS One hundred thirty-four premolar root canals from 10 dogs were treated after AP induction. Four months later, the animals were killed, and standard digital PRs were obtained. The area of AP was measured by using ImageJ software. CBCT (i-CAT) images from each arch were obtained, and AP area and volume were measured by using Osiri-X software. The apical inflammatory infiltrate was evaluated under light microscopy. The correlation between imaging methods was evaluated by using the Pearson coefficient. The Bland-Altman method was used to assess the agreement between PR and CBCT data. The Spearman coefficient was used to correlate the imaging data and histologic findings. RESULTS Despite a strong correlation between PR and CBCT areas, the agreement limits were very broad (95% limits of agreement, 0.19-1.08). PR only measured, on average, 63% of CBCT values. Although there was a strong correlation between PR area and CBCT volume, the Bland-Altman method suggests that the larger the CBCT volume, the more underestimated the PR value. When APs had a volume smaller than 6 mm(3), the PR estimation of CBCT data was unpredictable. A positive correlation was found for PR area, CBCT area, CBCT volume, and histology data. CONCLUSIONS The diagnosis of AP based on PR data is clinically limited, and it should not be used for scientific investigations.

Biocompatibility of RealSeal, its primer and AH Plus implanted in subcutaneous connective tissue of rats

Objective This study tested rat connective tissue response to RealSeal, RealSeal primer or AH Plus after 7, 15, 30, 60 and 90 days of implantation. Material and methods Thirty Wistar rats had subcutaneous sockets created on their back and received four implants each of polyethylene tubes containing one of the materials tested according to the groups: AH (AH Plus Sealer); RS (RealSeal Sealer); RP (RealSeal Primer); CG (control group – empty tube). After histological processing, sections were analyzed to identify the presence of neutrophils, lymphocytes and plasma cells, eosinophils, macrophages and giant cells, as well as fibrous capsule and abscesses, by an examiner using light microscope. Kruskal- Wallis and multiple-comparisons test were used for statistical analysis. Significance level was set at 5%. Results Lymphoplasmacytic infiltrate scores significantly higher than those of the control group were observed at 14 and 60 days in AH group, and at 90 days in RS group (p<0.05). There were no differences in terms of presence of macrophages, giant cells, eosinophils, neutrophils or fibrosis. AH Plus group scored higher for abscesses at 7 days than after any other period (p=0.031). RP group scored higher for lymphoplasmacytic infiltrate at 14 days than at 90 days (p=0.04). Conclusion The main contribution of this study was to demonstrate that issues involved with tissue tolerance of a Resilon-containing sealer, RealSeal Sealer, cannot be attributed to its primer content.

Cutting Efficiency of Conventional and Martensitic Nickel-Titanium Instruments for Coronal Flaring

INTRODUCTION This study aimed at evaluating the influence of rotational speed and number of uses on the cutting efficiency of 4 nickel-titanium coronal flaring instruments against 2 substrates, bovine dentin and acrylic blocks. METHODS BioRaCe BR0, HyFlex CM1, ProFile OS#2, and ProTaper Sx were used in simulated lateral action against both substrates at 250 and 500 rpm up to 5 times, producing 5 notches in each block. Notch areas and lengths were measured under a stereomicroscope, and data were compared by using parametric tests (α = 0.05). RESULTS Against both substrates, HyFlex CM1 and ProFile OS#2 were the most and the least cutting efficient instruments, respectively (P < .05). Against acrylic, area and length values at 500 rpm were significantly higher than those at 250 rpm for all brands. Against dentin, significant differences were detected between 250 and 500 rpm for HyFlex CM1 and ProTaper Sx (area) and for BioRace BR0, HyFlex CM1, and ProTaper Sx (length). Regarding cutting efficiency loss, area and length for notches 1 and 2 (first notches) and 4 and 5 (last notches) were similar against acrylic. Against dentin, length values for notches 1 and 2 were significantly higher than those for notches 4 and 5 in ProFile OS#2 and ProTaper Sx. A strong correlation was detected between the overall results obtained on acrylic and dentin for area and length (P < .0001), although further analysis showed that data against acrylic were a poor predictor of data against dentin after repeated use. CONCLUSIONS HyFlex CM1 was the most cutting efficient instrument in lateral action. An increase in rotational speed improved the cutting efficiency. Results against acrylic showed a high correlation to data against dentin, but acrylic may not be a proper substrate when the intention is to assess cutting efficiency loss with repeated use.

Effect of Superoxidized Water and Sodium Hypochlorite, Associated or Not with EDTA, on Organic and Inorganic Components of Bovine Root Dentin

INTRODUCTION This study aimed to evaluate the effects of Sterilox (Sx), a superoxidized water, 5% and 2% sodium hypochlorite (5NaOCl and 2NaOCl), and 17% EDTA (E) on the organic and inorganic components of bovine dentin. METHODS Eighty bovine incisors were randomly divided into 8 groups (n = 10): 5NaOCl, 5NaOCl + E, 2NaOCl, 2NaOCl + E, Sx, Sx + E, E alone, and distilled water (H2O). Root canal instrumentation was performed by using the corresponding irrigant. The apical 15 mm was longitudinally sectioned into 2 fragments, one for light microscopy analysis in slides stained with picrosirius red (organic component) and the other for scanning electron microscopy analysis (inorganic component). Scores data obtained in the light microscopy analysis were submitted to the Kruskal-Wallis test, followed by multiple comparisons test (P < .05). Scanning electron microscopy images were analyzed descriptively. RESULTS The chemical solution 5NaOCl had a greater effect on the organic component of dentin in area and depth than 2NaOCl. The chemical solutions 5NaOCl + E, 5NaOCl and 2NaOCl + E caused the greatest change in the collagenous organic matrix near the root canal lumen. The chemical solution 2NaOCl showed similar behavior to Sx, associated or not with E, promoting more superficial disorganization of collagen in a smaller area. Demineralization was observed in all groups in which E was used. However, areas of erosion and open dentinal tubules were detected only when it was combined with NaOCl. CONCLUSIONS Five percent NaOCl promoted the most extensive damage to the organic component of dentin, and when associated to EDTA, dentinal erosion could be seen. Considering these specific aspects, 2% NaOCl and Sx had milder effects on bovine root dentin.

The impact of the addition of iodoform on the physicochemical properties of an epoxy-based endodontic sealer

Due to the low radiopacity of Sealer 26, iodoform is frequently empirically added to this sealer. Thus, the interference of this procedure with the physicochemical properties of Sealer 26 must be evaluated. Objective This study evaluated the influence of the addition of iodoform on setting time, flow, solubility, pH, and calcium release of an epoxy-based sealer. Material and Methods The control group was pure Sealer 26, and the experimental groups were Sealer 26 added with 1.1 g, 0.55 g or 0.275 g of iodoform. Setting time evaluation was performed in accordance with the ASTM C266-03 speciflcation. The analysis of flow and solubility was in accordance with the ISO 6876-2001 speciflcation. For the evaluation of pH and calcium ion release, polyethylene tubes were filled with the materials and immersed in flasks with 10 ml of deionized water. After 24 h, 7, 14, 21, 28, and 45 days pH was measured. In 45 days, the calcium released was evaluated with an atomic absorption spectrophotometer. Results The addition of iodoform increased setting time in comparison with pure sealer (P<0.05). As for flow, solubility, and calcium release, the mixtures presented results similar to pure sealer (p>0.05). In the 24 h period, the mixture with 1.1 g and 0.55 g of iodoform showed lower pH than pure sealer and than sealer added with 0.275 g of iodoform (P<0.05). Conclusions The iodoform added to Sealer 26 interferes with its setting time and solubility properties. Further studies are needed to address the clinical signiflcance of this interference.

Preflaring effects on the accuracy of three electronic apex locators

PURPOSE: To compare the accuracy of three electronic apex locators (EALs) and evaluate the influence of cervical preflaring in them. METHODS: The working length (WL) of thirty extracted human mandibular incisors was determined visually. All teeth were mounted in conducting medium and tested with: Novapex, Mini Apex Locator and Propex II. The electronic WL was determined before and after preflaring with LA Axxess burs. Differences between the electronic and visual WL were calculated and analyzed by Friedman and Wilcoxon tests. Radiographs were taken using the electronic WL of each EAL and the distance between the instrument tip and the radiographic apical vertex was measured. This value was compared to a reference or ideal value (1 mm) by one-sample t test. RESULTS: The Novapex was the most accurate EAL before and after the preflaring procedure, which was confirmed by the radiographic analysis. All EALs tested increased their accuracy after preflaring, but no significant difference was noted for the Novapex. CONCLUSION: The Novapex was more accurate compared to the Mini Apex and Propex II. Preflaring procedure was advantageous for all EALs.

In vivo analysis of post space sealing with different adhesive materials

This in vivo study analyzed the sealing ability of two adhesives in post spaces, cyanoacrylate (Super Bonder® - Henkel Loctite Adesivos Ltda., Itapevi, SP, Brazil) and ScotchbondTM Multi-Purpose (3M Dental Products, St. Paul, MN, USA), testing the hypothesis that their use would result in a decreased leakage through the remaining filling material. Forty extracted premolars (80 root canals) of dogs were used. The root canals were cleaned, shaped and filled by the lateral condensation technique using Sealer 26TM. The post space was created removing two thirds of the filling material within the root canal. The canals were randomly divided in three groups, which were treated as follows: Group A received the ScotchbondTM Multi-Purpose adhesive system; for Group B the cyanoacrylate adhesive, Super BonderTM, was employed; and no adhesive was applied into the post space for Group C (control group). A glass ionomer provisional restoration was placed allowing the sealer to set for 72 hours. Then the restoration was removed and the root canal was exposed to the oral environment for 45 days. The dogs were then killed and their jaws were removed. The post spaces were filled with India ink and the teeth were restored for 96 hours. Afterwards, the teeth were extracted and the roots were sectioned at the furcation for allocation to their specific groups. The teeth were turned transparent and the quantitative analysis of leakage was performed using light microscopy. The results showed no significant differences between groups, rejecting the initial hypothesis. Leakage occurred in a great extent in all specimens. Therefore, sealing post spaces with the adhesives used in this study was not an effective method to prevent microleakage.