ABSTRACT Objectives This study evaluated the antimicrobial efficacy of ozone therapy in teeth contaminated with Pseudomonas aeruginosa, Enterococcus faecalis, and Staphylococcus aureus using a mono-species biofilm model. Parallel to this, the study aimed to evaluate the cytotoxicity of ozone for human gingival fibroblasts. Material and Methods: One hundred and eighty single-root teeth were contaminated with a mono-species biofilm of Enterococcus faecalis, Pseudomonas aeruginosa, and Staphylococcus aureus. Groups were formed: Group I – control; Group II – standard protocol; Group III – standard protocol + ozone gas at 40 µg/mL; and Group IV – standard protocol + aqueous ozone at 8 µg/mL. In parallel, human gingival fibroblasts were submitted to the MTT test. Cells were plated, then ozone was applied as follows: Group I (control) – broth medium; Group II – aqueous ozone at 2 µg/mL; Group III – aqueous ozone at 5 µg/mL; and Group IV – aqueous ozone at 8 µg/mL. Data were submitted to the Kruskal Wallis test and Bonferroni post hoc analyses to assess microbiology and cytotoxicity, respectively (p<0.05%). Results The results revealed antimicrobial efficacy by Group IV with no CFU count. The cytotoxicity assay showed Groups III and IV to be the most aggressive, providing a decrease in cell viability at hour 0 from 100% to 77.3% and 68.6%, respectively. Such a decrease in cell viability was reverted, and after 72 hours Groups III and IV provided the greatest increase in cell viability, being statistically different from Groups I and II. Conclusion According to the applied methodology and the limitations of this study, it was possible to conclude that ozone therapy improved the decontamination of the root canal ex vivo. Ozone was toxic to the cells on first contact, but cell viability was recovered. Thus, these findings suggest that ozone might be useful to improve root canal results.

OBJETIVO: Avaliar um método estratégico nas aulas práticas, utilizando micro câmeras e monitores de vídeo para transmitir demonstrações da técnica operatória, comparando-o com o método de ensino aprendizagem clássico. METODOLOGIA: Foram aplicados 52 questionários direcionados aos alunos do 4º ano (grupo 1) submetidos a esta nova prática e aos do 3º ano (grupo 2) submetidos a metodologia de ensino tradicional. Este questionário também possibilitou detectar os principais problemas enfrentados pelos discentes durante o aprendizado desta etapa operatória. RESULTADOS: A fase de cirurgia de acesso foi considerada de difícil execução por ambos os grupos (G1- 30,8 % e G2- 34,6%), sendo a manobra de localização dos orifícios de entrada dos canais a etapa mais complicada. Quanto à avaliação da metodologia empregada no 3º ano, 23,1% dos alunos a consideraram excelente, 38,4% ótima, e 38,5% boa, ao passo que nenhum dos estudantes (0%) consideraram o método como regular, ruim ou péssimo. Uma menor ocorrência de erros (P<0,05), foi relatada pelos alunos do 3º ano (G1- 50% e G2- 34.6%). CONCLUSÃO: A nova estratégia de ensino favoreceu a aprendizagem, diminuiu a incidência de erros e foi considerada eficaz pelos alunos.

PURPOSE: To evaluate a strategic method of real time visual demonstration of the operatory procedures using an intraoral camera system and monitor videos, comparing them to those of conventional laboratory classes. METHODS: Fifty-two structured, multiple choice questionnaires were applied to undergraduate students of the 4th year (G1) and 3rd year (G2) submitted to the traditional and strategic teaching methods, respectively. These tests were also able to detect the main problems faced by the students during the training of this operatory phase. RESULTS: Students of both groups (G1- 30.8% and G2- 34.6%) considered the access cavity to be one of the most difficult phase of endodontic treatment. The results of the evaluation among the 3rd year students demonstrated that 23.1% graded the new method as excellent, 38.4% as very good and 38.5 % as good, whereas none of the students (0%) considered the method to be regular, bad or very bad. A minor accident occurrence (P<0.05) was reported by the 3rd year students (G1- 50% and G2- 34.6%). CONCLUSION: The new strategy was found to favor learning, reduce the incidence of errors and was appraised as efficient by the students.

Nitric oxide (NO) has been considered a key molecule in infammation. OBJECTIVE: The aim of this study was to evaluate the effect of treatment with L-NAME and sodium nitroprussiate, substances that inhibit and release NO, respectively, on tissue tolerance to endodontic irrigants. MATERIAL AND METHODS: The vital dye exudation method was used in a rat subcutaneous tissue model. Injections of 2% Evans blue were administered intravenously into the dorsal penial vein of 14 male rats (200-300 g). The NO inhibitor and donor substances were injected into the subcutaneous tissue in the dorsal region, forming two groups of animals: G1 was inoculated with L-NAME and G2 with sodium nitroprussiate. Both groups received injections of the test endodontic irrigants: acetic acid, 15% citric acid, 17% EDTA-T and saline (control). After 30 min, analysis of the extravasated dye was performed by light absorption spectrophotometry (620 nm). RESULTS: There was statistically signifcant difference (p<0.05) between groups 1 and 2 for all irrigants. L-NAME produced a less intense infammatory reaction and nitroprussiate intensifed this process. CONCLUSIONS: Independently of the administration of NO inhibitors and donors, EDTA-T produced the highest irritating potential in vital tissue among the tested irrigating solutions.

OBJECTIVE: New drugs have to be assessed in endodontic therapy due to the presence of microorganisms resistant to therapeutic procedures. Thus, this study evaluated the time- and concentration-dependent cytotoxicity of different antibiotics used in endodontic therapy. MATERIAL AND METHODS: Human gingival fibroblasts were treated and divided into the following experimental groups: Group I - control; Group II - ciprofoxacin hydrochloride; Group III - clyndamicin hydrochloride; and Group IV - metronidazole. Each drug was used at concentrations of 5, 50, 150, and 300 mg/L for 24, 48, 72, and 96 h. Cytotoxicity was evaluated by the MTT assay [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] and spectrophotometric reading of ELISA plates. The results were analyzed by BioEstat 4.0 software using Kruskal-Wallis and Dunn's tests at a signifcance level of 5%. Cell viability was assessed for the different concentrations and times. RESULTS: All drugs presented dose-dependent cytotoxicity. Concentrations of 5 and 50 mgjL produced viable fibroblasts at all experimental times in all groups. CONCLUSIONS: Cell viability at 24 h was greater than in the other experimental times. Comparison between the same concentrations of antibiotics at different times showed that metronidazole presented the highest cell viability at 72 and 96 h compared to the other antibiotics, whereas clyndamicin hydrochloride showed higher cell viability at 72 h than ciprofoxacin hydrochloride.

Durante a terapia endodôntica, a ação de limpeza é realizada com os instrumentos endodônticos auxiliada por substâncias químicas. Sendo assim, é importante que o endodontista conheça como são os instrumentos. Este trabalho visou avaliar a qualidade do acabamento de superfície de instrumentos endodônticos rotatórios por meio de microscopia eletrônica de varredura. Foram selecionados, 50 instrumentos endodônticos rotatórios nos números de 20, 25 e 30, das marcas Profile, Protaper, Race, Hero e K3 Endo, da forma como são encontradas no mercado e sem nenhum preparo prévio. Os instrumentos tiveram seus 3 milímetros finais fotomicrografados em microscópio eletrônico de varredura com ampliação de x190. As imagens foram avaliadas por três profissionais especialistas, e os resultados anotados em planilhas. A metodologia aplicada permitiu concluir que todos os instrumentos das marcas comerciais avaliadas apresentaram inadequações no acabamento da superfície. Cabe aclarar que, observando os critérios selecionados utilizados para avaliação a maioria das amostras apresentaram o mínimo de duas alterações e o máximo de sete por instrumento avaliado.

During endodontic therapy, cleaning of root canals is performed using endodontic files and auxiliary chemical substances, and it is important that the endodontist be familiar with the instruments used in daily practice. This study evaluated, under scanning electron microscopy (SEM), the quality of the surface finishing of unused rotary endodontic instruments. Fifty sizes 20, 25 and 30 rotary files from different commercial brands (ProFile, Protaper, Race, Hero and K3 Endo) were removed directly from their packages and had their final 3 mm examined with a scanning electron microscope at x190 magnification with no previous preparation. The images were evaluated by 3 skillful, calibrated, blinded observers according to the following criteria: cutting edge, debris, grooves, microcavities, tip shape, tip position, scraping and transition angle. Data were recorded in worksheets designed for the study. Irregular edges were observed in 50-100% of the files. Except for ProFile, all commercial brands presented surface debris in 100% of samples. Only Race files showed no grooves or microcavities. K3 Endo files presented the best tip centralization. Excetp for ProTaper files, all commercial brands presented blunt-cutting edges in 100% of samples. All types of files presented surface scraping. K3 Endo files and Protaper had a high percentage of transition angle. Based on the evaluation criteria used in the present study, most samples presented a minimum of 2 alterations and a maximum of 7 alterations per instrument. Under the tested conditions, the quality of the surface finishing of the examined instruments was not as expected, given that no instrument was free of imperfections and most of them presented at least 2 and up to 7 types of surface defects. These results suggest that the manufacturing process and the packaging conditions of rotary endodontic instruments are far from ideal.

In some situations, endodontic infections do not respond to therapeutic protocol. In these cases, it is suggested the administration of an alternative intracanal medication that presents a wide spectrum of action and has an in-depth effect on the root canal system. The purpose of this study was to assess the antimicrobial action of ciprofloxacin, metronidazole and polyethylene glycol and natrosol vehicles with different associations and concentrations. The minimum inhibitory concentration (MIC) was determined by using the agar dilution method. The culture media (Müller-Hinton agar) were prepared containing antimicrobial agents at multiple two-fold dilutions of 0.25 to 16 µg/mL, and with the vehicles at the concentrations of 50, 45, 40, 35, 30 and 25%. Twenty-three microbial strains were selected for the study. Metronidazole was not capable of eliminating any of the tested microorganisms. The association of ciprofloxacin with metronidazole resulted in a reduction of the MIC. The vehicle polyethylene glycol inhibited the growth of 100% of the tested strains, while natrosol inhibited 18% of the strains. Ciprofloxacin formulations with polyethylene glycol presented better effects than those of formulations to which metronidazole was added. It was possible to conclude that ciprofloxacin presented antimicrobial action against all tested bacterial strains, and its association with metronidazole was synergic. The vehicle polyethylene glycol showed antimicrobial effect and the ciprofloxacin/polyethylene glycol association was the most effective combination for reducing the tested bacteria and yeasts.

A problemática dos casos envolvendo pacientes portadores de lesões periapicais resistentes é a eliminação da infecção que atinge a região periapical. Esta infecção é composta por microrganismos e seus subprodutos alojados no cemento e dentina do terço apical, sob forma de biofilme microbiano. A execução da cirurgia paraendodôntica com vistas à promoção da saúde do periápice, invariavelmente resume-se em remover mecanicamente os agentes causadores da doença, com objetivo de proporcionar a reparação. O propósito deste estudo foi avaliar o resultado da irradiação com laser de Er:YAG no terço apical de dentes recém extraídos com relação à infecção microbiana na superfície do ápice radicular. O laser Er:YAG foi empregado para irradiação de ápices radiculares, com ponteira experimental de contato (Chisel, Morita co.), utilizando energia de potência de 100 mJ, 10 Hz, por 3 vezes em área delimitada no terço apical das raízes. Os resultados do estudo em microscopia eletrônica de varredura mostraram a eliminação do tecido periodontal remanescente juntamente com quantidade significativa de microrganismos. Portanto, pode-se concluir que o laser de Er:YAG nas condições experimentais testadas mostrou-se efetivo na remoção de microrganismos do tecido periodontal contaminado e do cemento sem expor a dentina subjacente.

One problem in cases of healing-resistant periapical lesions is to eradicate the contamination at the periapical area. This contamination is due to the microbiological biofilm formed by microorganisms and their subproducts lodged in apical third of the root, on both cementum and dentin surface. Paraendodontic surgery consists of the mechanical removal of harmful agents to promote healing and periapical health. The purpose of this study was to assess the results of Er:YAG laser irradiation on the apical root third of newly extracted teeth to eliminate microbial contamination on root apex surface. Apical irradiation was performed with an Er:YAG laser device using an experimental contact tip, at 100 mJ, 10 Hz, 1 W, 39 J/cm², 3 times on the target area. SEM analysis showed the elimination of part of the irradiated cementum and the formation of small roughened without exposing the subjacent dentin. Vaporization of the remaining periodontal tissue and removal of microbiological apical biofilm (MAB) were also observed on the irradiated areas. Under the tested conditions and based on the findings of this study, Er:YAG laser may be considered effective for removal of microbiological apical biofilm.

O insucesso das cirurgias apicais é geralmente atribuído ao selamento marginal inadequado das retrocavidades, caracterizado pelo contato ineficiente entre o material retrobturador e a superfície dentinária, o que acaba por permitir a percolação de microorganismos provenientes do canal radicular para a região do periápice. Este trabalho teve como objetivos a análise da penetrabilidade tubular de materiais retrobturadores e a avaliação da permeabilidade marginal dentinária após irradiação das retrocavidades com laser de Er;Cr:YSGG e retrobturação com MTA ou cianoacrilato. Vinte e dois dentes humanos unirradiculares tiveram a coroa seccionada, foram tratados endodonticamente e tiveram os 3 mm apicais removidos. As retrocavidades foram preparadas com broca em baixa rotação. Vinte raízes foram aleatoriamente divididas em 4 grupos (n=5): GI e GII - retrobturação com MTA e cianoacrilato, respectivamente; GIII e GIV - retrocavidades irradiadas com laser de Er;Cr:YSGG (2,78 µm, 4 W, 20 Hz, 70,8 J/cm²) e retrobturação com MTA e cianoacrilato, respectivamente. As duas raízes restantes atuaram como controles positivo e negativo. A análise da infiltração do corante rodamina B (p=0,05) demonstrou que a irradiação com laser e a retrobturação com MTA apresentaram níveis de permeabilidade significantemente maiores (p<0,05). A retrobturação com cianoacrilato proporcionou níveis de permeabilidade significantemente menores em ambas as situações (EDTA-T ou laser). A análise das micrografias revelaram maior penetração tubular do cianoacrilato quando comparado ao MTA, indicando um selamento marginal mais eficiente. De acordo com os resultados obtidos, foi possível concluir que o cianoacrilato promoveu uma menor permeabilidade da retrobturação, independentemente do método utilizado para o retropreparo, sugerindo, portanto, uma condição mais favorável ao estabelecimento da reparação periapical.

Apicoectomy failure is generally related to inappropriate marginal sealing of the retrocavity, which allows percolation of microorganisms and their products from root canal system to periapex. This study evaluated tubular penetration of canal sealers and marginal permeability after retrocavity irradiation with Er;Cr:YSGG laser and retrofilling with MTA or cyanoacrylate. Twenty-two single-rooted teeth were decoronated and endodontically treated, their apical 3 mm were resected and the root ends were retroprepared with a low-speed bur. Twenty roots were randomly assigned to 4 groups (n=5): GI and GII - retrofilling with MTA and cyanoacrylate, respectively; GIII and GIV - retrocavity irradiation with Er;Cr:YSGG laser (2.78 µm, 4 W, 20 Hz, 70.8 J/cm²) and retrofilling with MTA and cyanoacrylate, respectively. The remaining 2 roots served as positive and negative controls. The analysis of rhodamine B dye infiltration (p=0.05) demonstrated that laser irradiation and MTA retrofilling presented significantly higher permeability rates (p<0.05). Retrofilling with cyanoacrylate showed significantly lower permeability, either when laser was used or not on retrocavity. SEM analysis depicted more cyanoacrylate penetration through dentinal tubules when compared to MTA, suggesting a more efficient marginal sealing. Based on these results, it may be concluded that cyanoacrylate provided a less permeable retrofilling regardless of the retropreparation method, suggesting a more favorable condition to the establishment of the periapical healing.

Este experimento teve como objetivo avaliar in vitro os efeitos da interação entre soluções irrigantes desmineralizadoras (EDTA-T e ácido cítrico), medicação intracanal (NDP) e laser Er:YAG na permeabilidade dentinária. Foram utilizados 51 dentes unirradiculares extraídos que, após o preparo químico-cirúrgico, foram divididos em sete grupos experimentais: grupos I e II - irrigação final com solução de EDTA-T e ácido cítrico, respectivamente; grupos III e IV - irrigação final com EDTA-T e ácido cítrico, respectivamente, mais a associação entre solução irrigante e laser Er:YAG; grupos V e VI - irrigação final com EDTA-T e ácido cítrico, respectivamente, mais a associação entre medicação intracanal e laser Er:YAG, e grupo VII (controle) - irrigação final com água destilada. Os canais radiculares foram preenchidos com o corante rodamina B solubilizado na medicação de uso intracanal NDP. Após o período experimental, as amostras foram cortadas transversalmente para posterior leitura com o software ImageLab. A análise dos resultados permitiu concluir que existiram diferenças estatisticamente significantes (p < 0,05) quanto à penetração da solução corante-medicação intracanal nos diferentes grupos. Os grupos III e IV apresentaram menores valores de permeabilidade dentinária quando comparados aos outros e, finalmente, os melhores resultados foram obtidos quando da interação entre a solução irrigante desmineralizadora e a associação medicação intracanal/laser Er:YAG (grupos V e VI). Nesses, constatou-se que a diferença de penetração da solução corante-medicação intracanal no terço apical foi, em média, 29% maior do que nos demais grupos.

The purpose of this study was to evaluate in vitro the effects of different associations between irrigating solutions (EDTA-T and citric acid), intracanal medicament (NDP), and Er:YAG laser irradiation on dentin permeability. Fifty-one extracted single-rooted teeth were instrumented and divided into seven groups. Groups GI and GII had final irrigation with a demineralizing solution only (EDTA-T and citric acid, respectively). Groups GIII and GIV had final irrigation with EDTA-T and citric acid, respectively, plus an association of irrigating solution and Er:YAG laser. Groups GV and GVI had final irrigation with EDTA-T and citric acid, respectively, plus an association of intracanal medication and Er:YAG laser. Group GVII (control group) had final irrigation with distilled water. All root canals were filled with NDP associated with rhodamine B dye. After the experimental period, the samples were transversely cut into six 2.0 mm thick slices for subsequent reading using the ImageLab software. Analysis of the results allowed us to conclude that there were statistically significant differences (p < 0.05) between the groups as to the penetration of the dye-intracanal medication solution. Groups III and IV presented smaller values of dentinal permeability when compared to the other groups. The best results were obtained with the interaction between a demineralizing irrigating solution and the association of intracanal medicament and laser Er:YAG (groups V and VI). In these groups the observed penetration of the intracanal medicament plus dye solution in the apical third was, on average, 29% greater than in the other groups.

A proposta do presente experimento foi avaliar in vitro a permeabilidade da dentina no assoalho da câmara pulpar de dentes decíduos com o emprego do 2-octil cianoacrilato e laser de Er:YAG. Foram empregados 24 molares decíduos, divididos em quatro grupos. Após preparo químico-cirúrgico, cada grupo recebeu um tratamento diferente: Grupo 1 - controle, sem tratamento; Grupo 2 - o assoalho da câmara pulpar foi coberto com uma fina camada de 2-octil cianoacrilato; Grupo 3 - o assoalho da câmara pulpar foi irradiado com laser de Er:YAG (250 mJ, 10 Hz por 30 segundos, energia total de 80 J e 320 pulsos), e coberto com uma fina camada de 2-octil cianoacrilato; e Grupo 4 - o assoalho da câmara pulpar foi irradiado com laser de Er:YAG, nos parâmetros já descritos. Em seguida, os espécimes receberam aplicação do corante azul de metileno a 0,5%, por 15 minutos. Todos os espécimes foram cortados no sentido mésio-distal, foi realizada a leitura das imagens digitalizadas no programa ImageLab e os resultados obtidos foram submetidos à análise estatística. As amostras do Grupo 4 (Er:YAG) apresentaram as maiores médias em porcentagem de área corada (19,5%), seguidas das do Grupo 1 (11,1%), Grupo 3 (1,4%) e Grupo 2 (0,2%), respectivamente. O modelo experimental empregado permitiu concluir que os espécimes condicionados com 2-octil cianoacrilato (Grupo 2) e laser de Er:YAG associado ao 2-octil cianoacrilato (Grupo 3) apresentaram redução da permeabilidade, e os espécimes tratados com laser de Er:YAG (Grupo 4) apresentaram aumento da permeabilidade da área analisada.

The purpose of this study was to evaluate in vitro the dentin permeability of the deciduous pulp chamber floor after employing 2-octyl cyanoacrylate and Er:YAG laser. Twenty four deciduous molars were used, divided into four groups. After chemical-surgical preparation each group received a different treatment: Group 1 - control, without treatment; Group 2 - the floor of the pulp chamber was covered with a fine layer of 2-octyl cyanoacrylate; Group 3 - the floor of the pulp chamber was irradiated with Er:YAG laser (250 mJ, 10 Hz for 30 seconds, 80 J of energy and 320 pulses), and covered with a fine layer of 2-octyl cyanoacrylate; and Group 4 - the floor of the pulp chamber was irradiated with Er:YAG laser set at the parameters already described. After that the specimens received application of 0.5% methylene blue, for 15 minutes. The teeth were cut, photographed, and the digitalized images were analyzed using the ImageLab program. The results obtained were submitted to statistical analysis. Group 4 (Er:YAG) presented the largest averages in percentage of dye penetration area (19.5%), followed by Group 1 (11.1%), Group 3 (1.4%) and Group 2 (0.2%). The experimental model allowed to conclude that the specimens conditioned with 2-octyl cyanoacrylate (Group 2) and Er:YAG laser associated to 2-octyl cyanoacrylate (Group 3) presented a decrease in permeability, and the specimens treated with Er:YAG laser (Group 4) presented an increase in permeability of the analyzed area.

Estudaram-se as alterações vasculares do tecido conjuntivo subcutâneo de ratos induzidas por sistemas adesivos dentinários (único passo), comparados com solução fisiológica (controle negativo) e Furacin (controle positivo), durante a fase exsudativa do processo inflamatório. Com esse propósito, injetaram-se intravenosamente, na veia do pênis de ratos, 20 mg/kg de peso corporal de "Evan's blue", e no tecido subcutâneo inoculou-se 0,1 ml de cada substância a ser analisada. Após intervalo de três horas os animais foram sacrificados, suas peles excisadas e recortadas com perfurador de 2,5 cm de diâmetro. As peças foram imersas imediatamente em oito ml de formamida e levadas ao banho-maria a 37ºC, por 72 horas, para remoção do corante. O líquido contendo o corante extravasado foi filtrado, analisado no espectrofotômetro (620 nm) e classificado segundo os critérios estabelecidos por Nagem-Filho, Pereira (1976). O potencial irritativo dos produtos, após análise estatística, se apresentou em ordem decrescente: Furacin (considerado como grau de magnitude severo) > Single Bond e Bond 1 (que se mostraram significamente similares, classificados como moderados) > soro fisiológico (comportando-se como não-significante quanto ao grau de irritação).

The vascular changes in the subcutaneous connective tissue of rats induced by dentin bonding systems (one step) was studied and compared to those induced by saline solution (negative control) and Furacin (positive control), during the exudative phase of the inflammatory process. Twenty mg/kg of Evan's blue were injected intravenously in the vein of the rats' penises; 0.1 ml of each substance tested was inoculated in the subcutaneous tissue. After a 3 hour period the animals were sacrificed and their skins were excised and punched out with a standard steel 2.5 cm in diameter. The specimens were immediately immersed in 8 ml of formamide and taken to a double boiler for 72 hours at 37ºC, to remove the dye. The liquid containing the overflowed dye was filtered, analyzed in the spectrophotometer (620 nm) and classified according to the criteria established by Nagem-Filho, Pereira (1976). After statistical analysis, the irritative potential of the substances was ranked as follows: Furacin (severe) > Single Bond and Bond 1 (moderate - no significant differences between the dentin bonding systems tested) > saline solution (not significant as regards the irritation degree).