Renato de Toledo Leonardo

Flexibility and Torsional Strength of ProTaper and ProTaper Universal Rotary Instruments Assessed by Mechanical Tests

The purpose of this study was to assess how the geometric and dimensional changes made on ProTaper Universal (PTU) instruments in comparison with ProTaper (PT) instruments affected their flexibility and torsional strength. Two groups (n = 12) of each type of shaping (S1 and S2) and finishing (F1, F2, and F3) for both PT and PTU instruments were employed. Tip angle, instrument diameter at each millimeter, and cross-sectional area at 3 mm from the tip were the dimensional parameters measured. Flexibility and torsional strength of each instrument (n = 12) were assessed according to specification ISO 3630-1. Data were analyzed using analysis of variance (alpha = 0.05). Flexibility increased for S1 and F1 PTU instruments and decreased for F2 and F3, whereas torsional resistance increased for S2, F2, and F3. Changes in tip angle were accompanied by variation of tip geometry in all instruments.

A Comparison Study of Periapical Repair in Dogs' Teeth Using RoekoSeal and AH Plus Root Canal Sealers: A Histopathological Evaluation

The objective of the study was to evaluate the biocompatibility of RoekoSeal sealer Roeko (Dental Products, Langenau, Germany) with the periapical tissues of dogs and compare it with AH Plus sealer (Dentsply/De Trey, Konstanz, Germany). The pulps of 32 root canals were removed, the apical cementum layer perforated, the biomechanical preparation performed, and the root canals filled by lateral condensation technique. Ninety days after the surgery, the animals were euthanized, the bone with teeth removed, and the samples prepared for histopathological analysis. In group 1 (RoekoSeal Automix), deposition of mineralized tissue was observed, with complete newly mineralized apical formed tissue in 43.8% and partial sealing in 56.2%. In group 2 (AH Plus), in 12.5% there was complete newly mineralized apical formed tissue, in 75% the sealing was partial, and in 12.5% there was no sealing (p < 0.05). There were no differences between the groups in relation to the inflammatory infiltrate; thickness of the periodontal ligament; and the resorption of dentin, cementum or bone (p > 0.05).

An in vitro evaluation of apicoectomies and retropreparations using different methods

OBJECTIVESnThe aim of this study was to evaluate: 1) the apical root surface, gutta-percha interface, and preparation time of root-end resections made with burs, ultrasound, or laser; and 2) the thickness of surrounding dentin after laser or ultrasonic root-end cavity preparation.nnnSTUDY DESIGNn1) Thirty root-filled teeth were resected as follows: Zekrya bur in group I, Chemical Vapor Deposition (CVD) ultrasonic tip (9.5107-8) in group II, and ErCr:YSGG (Waterlase) in group III. The preparation time was recorded. Replicas of the resected root-ends were examined under a scanning electron microscope (SEM). 2) Thirty root-filled teeth were submitted to apicectomies and root-end cavities were prepared by using: CVD (6.1107-6) ultrasonic retrotips (group IV), EMS (DT-060) ultrasonic retrotips (group V), and ErCr:YSGG laser tips (group VI). Replicas of the root apices were examined under a SEM.nnnRESULTSnThere were no fissures or fractures on root-end surfaces. The bur produced the smoothest surface (P < .05). Group I had the lowest preparation time (P < .05). The best adaptation between the filling and the root canals walls was observed in group III, but it was not significantly different from group II (P < .05). No resected root-ends had cracks after preparation. Group VI showed the least minimum dentin thickness (P < .05).nnnCONCLUSIONSnThe 3 methods evaluated did not cause any injury to the root-end surface, but they harmed the apical adaptation. Laser tips removed more dentin than ultrasonic retrotips and should be used with care to avoid overpreparation.

Evaluation of Ultrasonic and ErCr:YSGG Laser Retrograde Cavity Preparation

Root end cavity preparation techniques aim to create a clean and properly shaped cavity in a short time. Although the use of ultrasonics has been widely recommended, a laser can also be used. This study evaluated the time required and quality of retrograde cavity preparations using ultrasonics or ErCr:YSGG laser. Thirty single-rooted teeth were instrumented, root filled, submitted to apicectomies, and grouped. Root end cavities were prepared by using the following: group 1 (G1): CVD (6.1107-6) ultrasonic retrotips (CVD-Vale, São José dos Campos, Brazil); group 2 (G2): EMS (DT-060/Berutti) ultrasonic retrotips (EMS, LeSentier, Switzerland); and group 3 (G3): ErCr:YSGG (G6/Waterlase; Biolase Technology, San Clemente, CA) laser tips. The time taken to complete the preparation was recorded. Epoxy resin replicas of the root apices were examined under a scanning electron microscope. The parameters for evaluation were the presence of fractures, and the quality of the preparations. The Waterlase showed the highest mean time for preparation of the root end cavities (p < 0.05), and there was no significant difference between the CVD and EMS groups (p > 0.05). Fractures in the cavosurface angle occurred only in G2. G1 and G2 showed better scores for quality of preparation than G3 (p < 0.05). These results suggest that root end cavities should be prepared by ultrasonic tips.

Efficacy of four irrigation needles in cleaning the apical third of root canals

This study aimed to evaluate the influence of irrigation needle gauge and design, and the final root canal diameter on the apical cleaning efficacy. Twelve human mandibular incisors were used. At different stages of root canal widening (sizes 20, 30 and 40 K-files), root canals were filled with radiopaque contrast medium. Four different needles were evaluated: 23G with side opening, 22G with apical opening, 30G with side opening and 30G with apical opening. Irrigation was carried out with 2mL distilled water. The same tooth was radiographed with a digital system several times to assess the four types of needle in those three stages of canal widening. Pre-irrigation (canals filled with contrast) and post-irrigation (canals with remaining contrast) images were submitted to digital subtraction using the Adobe Photoshop CS4 program. Pre-irrigation (filled with contrast) and subtracted (cleaned by irrigation) areas were outlined by a trained and blinded operator using the Image Tool 3.0 software. Their ratio was calculated to express the percentage of apical cleaning in each stage of canal widening (sizes 20, 30 and 40 K-files) with each of the four needles. Data obtained were subjected to one-way ANOVA and Tukeys tests. The 30G needles with side and apical opening promoted better apical cleaning at all stages of root canal widening (p<0.05). In conclusion, smaller diameter needles were more efficacious in cleaning the apical third of the root canals, regardless of their design.

Antibacterial effectiveness of several irrigating solutions and the Endox Plus system – an ex vivo study

AIMnTo compare the ex vivo antibacterial effectiveness of the Endox Plus system and sodium hypochlorite (NaOCl) in combination with BioPure MTAD (Tulsa Dental, Tulsa, OK, USA) or with EDTA in Enterococcus faecalis-contaminated root canals.nnnMETHODOLOGYnAfter initial preparation, the root canals of 70 single-rooted human teeth were inoculated with E. faecalis (ATCC 29212) and incubated for 21u2003days. Specimens were divided into five groups: Endox Plus/saline; 2.5% NaOCl/MTAD; 2.5% NaOCl/EDTA; saline (positive control); negative control (root canals not prepared, nor irrigated). Samples were collected using paper points. Microbiological analysis evaluated the number of CFUs. Data were analysed by anova and Tukey tests at 0.05 significance.nnnRESULTSnAll specimens had bacterial growth after the incubation period, with similar CFU per mL counts (Pu2003>u20030.05). After chemo-mechanical preparation, the number of bacteria in all groups reduced, except for the negative control. No significant differences were observed between 2.5% NaOCl/MTAD and 2.5% NaOCl/EDTA, but these groups had lower CFU counts than the other groups (Pu2003<u20030.05). In the final samples, an increase in the bacterial counts was observed for Endox Plus/saline, 2.5% NaOCl/MTAD, 2.5% NaOCl/EDTA and saline (Pu2003<u20030.05) with no significant differences between these groups.nnnCONCLUSIONSnThis ex vivo study revealed that the Endox Plus system was associated with a reduced antibacterial effectiveness compared with conventional irrigation using 2.5% NaOCl/MTAD and 2.5% NaOCl/EDTA. All irrigation procedures allowed recovery of bacteria 7u2003days after treatment, demonstrating persistence of contamination within the root canal system.

Endodontic chelators induce nitric oxide expression by murine-cultured macrophages.

INTRODUCTIONnEndodontic chelators may extrude to apical tissues during instrumentation activating cellular events on periapical tissues. This study assessed in vitro the expression of nitric oxide (NO) concentrations by murine peritoneal macrophages after contact with MTAD (Dentsply/Tulsa, Tulsa, OK), Tetraclean (Ogna Laboratori Farmaceutici, Muggio, Italy), Smear Clear (Sybron Endo, Orange, CA), and EDTA (Biodinâmica, Ibiporã, PR, Brazil).nnnMETHODSnMacrophage cells were obtained from Swiss mice after peritoneal lavage. Chelators were diluted in distilled water obtaining 12 concentrations, and MTT assay identified the concentrations, per group, displaying the highest cell viability (analysis of variance, p < 0.01). Selected concentrations were tested for NO expression using Griess reaction. Culture medium and lipopolysaccharide (LPS) were used as controls.nnnRESULTSnAnalysis of variance and Tukey tests showed that all chelators displayed elevated NO concentrations compared with the negative control (p < 0.01). MTAD induced the lowest NO expression, followed by Tetraclean, EDTA, and Smear Clear. No difference was observed between MTAD and Tetraclean (p > 0.01), Tetraclean and EDTA (p > 0.01), and EDTA and Smear Clear (p > 0.01). LPS ranked similar to both EDTA and Smear Clear (p > 0.01).nnnCONCLUSIONnThe tested endodontic chelators displayed severe proinflammatory effects on murine-cultured macrophages. Citric acid-based solutions induce lower NO release than EDTA-based irrigants.

Evaluation of cytotoxicity of two endodontic cements in a macrophage culture

Compared to gutta-percha, the endodontic cements are used in small quantity to seal root canals, but are indispensable to achieve hermetically sealed margins, where its biocompatibility depends on the sum of responses of each cell present in the periapical region. The object of this study was to evaluate the cytotoxicity of two endodontic cements, one based on epoxy resin (Sealer 26) and the other containing zinc oxide eugenol (Endofill) by using cultured peritoneal macrophages from Swiss mice to measure the induced production of nitric oxide. After solidification and pulverization, aliquots of 100mul of suspension containing 18mg/mL of the respective cements were added to 96-well tissue culture plates containing the tissue culture of macrophages at a concentration of 5.0X10(6) cells/ml. In the positive control group the cell culture was treated with 10mg/mL of lipopolyssaccharide from Escherichia coli 026:B6 and the cell culture alone represented the negative control. After 48 hours of incubation, at 37ºC, in 5% CO2, the cultures were placed in an ELISA automatic reader to evaluate the release of nitric oxide. The production of nitric oxide for cement Sealer 26 was between 36.1 and 313.0 mumols, with a mean of 143.82±111.03mumols, while for the Endofill these values were significantly less (p=0.01), varying from 50.8 to 125.7mumols, with a mean of 80.33±28.42 mumols. In the positive and negative control groups the mean release of nitric oxide was of 162.75mumols and 4.42mumols, respectively. There was no significant difference between the positive control group and cement Sealer 26 (p>0.05). Therefore, the cement Sealer 26 caused significantly greater toxicity to the macrophages, possibly due to the components from the epoxy resin and formaldehyde release during polymerization.

Apical Extrusion of Debris and Irrigants Using Different Irrigation Needles

This study evaluated the influence of irrigation tip, root canal curvature and final apical diameter on periapical debris and irrigant extrusion during root canal instrumentation. After being classified as mildly or moderately curved, the mesiobuccal root canals of 90 human molars were instrumented. The teeth were allocated into three groups according to the used needle type: a flat open-end needle (Group 1), a side-vented needle (Group 2) or a double side-vented needle (Group 3). The amount of extruded material after instrumentation was calculated for each group. The differences in irrigant and debris extrusion between the experimental groups were analyzed with the Mann-Whitney U test. Irrigation tips and final instrument diameter differences were analyzed with the Kruskal-Wallis test. Multiple groups were compared using the Mann-Whitney U-test with a Bonferroni correction at α=0.05. The amount of extruded material from the double side-vented needle was significantly less than the open-ended flat needle (p=0.008), but there was no difference compared to the side-vented needle (p=0.929). The results showed no effect of root curvature and final apical diameter on the amount of irrigant and debris extrusion (p>0.05). The double side-vented needles generated the least material extrusion to the periapical tissues. Irrigation needle type had the greatest influence on periapical irrigant and debris extrusion and the double side-vented needles may be safely used during endodontic therapy.

Biocompatibility of mineral trioxide aggregate flow and biodentine

AIMnTo evaluate the influence of powder-to-gel ratio (0.19xa0g powder to 50xa0μL of gel, thick MTA Flow, and 0.06xa0g powder to 50xa0μL of gel, fluid MTA Flow) on biocompatibility of MTA Flow (Ultradent Products Inc., South Jordan, UT, USA, lot: 2015122901) and compare it with Biodentine (Septodont Inc., Saint-Maur-des-Fossés, France, lot: B18542A).nnnMETHODOLOGYnThe materials were manipulated and inserted into polyethylene tubes for implantation in twenty rats. After 7, 15, 30 and 60xa0days, the specimens were removed and embedded in paraffin. Haematoxylin and eosin sections were used to count the number of inflammatory cells (IC) and fibroblastsxa0mm-2 (Fb). In the Massons trichrome-stained sections, the fibrous capsule thickness was measured; picrosirius red-stained sections were used for birefringent collagen quantification. The data were submitted to two-way ANOVA and Tukey test (Pxa0≤xa00.05).nnnRESULTSnA significantly lower number of IC and consequently higher number of Fb were observed in the capsules adjacent to thick MTA Flow at all periods, in comparison with other materials (Pxa0≤xa00.05). At 60xa0days, the quantity of birefringent collagen was significantly greater in the tissue in contact with thick MTA Flow, when compared with fluid MTA Flow and Biodentine.nnnCONCLUSIONSnAlthough thick MTA Flow induced a less intense inflammatory response, all evaluated materials are biocompatible because they allowed regression of this process after 60xa0days.