Aim This study investigated the influence in vitro of different sodium hypochlorite (NaOCl) agitation protocols associated or not with DualRinse (HEDP) on the temperature of the solution. Methods Forty-eight premolars were instrumented and their apical third sealed to allow a closed irrigation system. The teeth remained immersed in a basin of warm water (37°C). The teeth were divided into the groups: G1 ( NaOCl+Passive Ultrasonic Irrigation (PUI)), G2 ( N a O C l / H E D P + P U I), G3 ( NaOCl + EasyClean (EC)) and G4 ( N a O C l / H E D P + E C). The canals were filled with the respective solutions and after 180 seconds the first temperature measurement was taken (T0). Then, the solutions were agitated, following the different protocols, for 60 seconds and a new measurement was performed (T60). The temperature was measured using a digital thermometer for type “K” sensors that was inserted into the middle third of the teeth. At the end of the measurements, the teeth were sectioned and prepared for scanning electron microscopy. The dentinal wall of middle third was graded according to the amount of debris and smear layer remaining on the walls. The results were analyzed using ANOVA test and Tukey’s multiple comparisons (p<0.05). Results G1 and G2 had an average increase in temperature of 1.1°C and 1.65°C, respectively (p>0.05). EasyClean caused a decrease in the temperature of the solutions in both groups, without a significant statistical difference with T0 (p>0.05). Regarding cleaning, it was only possible to observe clean dentinal tubules in the groups with the chelator. PUI discretely increased the temperature of the solution, regardless of the solution. The opposite effect was observed after activation with EasyClean. Conclusion The association of NaOCl with a chelating agent promoted the cleaning of the dentinal tubules.

Resumo O objetivo deste estudo foi investigar as propriedades físico-químicas e biológicas de um cimento reparador experimental à base de silicato de tricálcio contendo diclofenaco de sódio (CERD). Para o teste físico-químico, MTA, Biodentine e CERD foram manipulados e discos de cimentos foram preparados para avaliar o tempo de presa e a radiopacidade. Retrocavidades foram feitas em dentes de acrílico e preenchidas com cimentos para análise de solubilidade por 7 dias. Tubos de polietileno contendo cimentos foram preparados e os íons cálcio e o pH foram mensurados às 3h, 24h, 72h e 15 dias. Para o teste biológico, SAOS-2 foram cultivadas, expostas aos extratos de cimentos e a proliferação celular foi investigada pelo ensaio de MTT às 6h, 24h e 48h. Tubos de polietileno contendo cimentos foram implantados em ratos Wistar. Após 7 e 30 dias, os tubos foram removidos e processados para análises histológicas. Dados paramétricos e não paramétricos foram realizados. Nenhuma diferença foi identificada em relação ao tempo de presa, radiopacidade e solubilidade. Biodentine liberou mais íons de cálcio do que MTA e CERD; no entanto, nenhuma diferença entre MTA e CERD foi detectada. O pH alcalino foi observado para todos os cimentos e o Biodentine exibiu o pH mais alto. Todos os cimentos promoveram aumento na proliferação celular às 24h e 48h, exceto o CERD às 48h. Biodentine estimulou o metabolismo celular em relação ao MTA e CERD, enquanto CERD foi mais citotóxico do que MTA em 48h. Além disso, nenhuma diferença foi encontrada na resposta inflamatória e na capacidade de mineralização para todos os cimentos. CERD demonstrou propriedades semelhantes a outros cimentos endodônticos disponíveis.

Abstract The aim of this study was to investigate the physicochemical and biological properties of an experimental tricalcium silicate-based repair cement containing diclofenac sodium (CERD). For the physicochemical test, MTA, Biodentine and CERD were mixed and cement disc were prepared to evaluate the setting time and radiopacity. Root-end cavity were performed in acrylic teeth and filled with cements to analyze the solubility up to 7 days. Polyethylene tubes containing cements were prepared and calcium ions and pH were measured at 3h, 24h, 72h and 15 days. For the biological test, SAOS-2 were cultivated, exposed to cements extracts and cell proliferation were investigated by MTT assay at 6h, 24h and 48h. Polyethylene tubes containing cements were implanted into Wistar rats. After 7 and 30 days, the tubes were removed and processed for histological analyses. Parametric and nonparametric data were performed. No difference was identified in relation to setting time, radiopacity and solubility. Biodentine released more calcium ion than MTA and CERD; however, no difference between MTA and CERD were detected. Alkaline pH was observed for all cements and Biodentine exhibited highest pH. All cements promoted a raise on cell proliferation at 24h and 48h, except CERD at 48h. Biodentine stimulated cell metabolism in relation to MTA and CERD while CERD was more cytotoxic than MTA at 48h. Besides, no difference on both inflammatory response and mineralization ability for all cement were found. CERD demonstrated similar proprieties to others endodontic cements available.

Resumo Novas formulações de agregado de trióxido mineral (MTA) são constantemente introduzidas no mercado, geralmente em forma de pó e líquido. O Biocerâmico (Bio-C) Reparador (Repair) é um material pronto para uso sugerido como substituto do MTA, mas suas propriedades precisam ser estudadas. Este estudo avaliou a citotoxicidade, biocompatibilidade e biomineralização do Bio-C Repair comparado ao MTA-High Plasticity (MTA-HP) e MTA branco da Angelus (MTA-Ang). Fibroblastos L929 foram expostos a extratos dos materiais (não diluído, ½ e ¼ diluições; 6, 24 e 48 h). Tubos de polietileno contendo os materiais ou vazios (controle) foram implantados no tecido subcutâneo de ratos. Após 7 e 30 dias (n=8), os espécimes foram removidos para análises (hematoxilina-eosina, von Kossa e luz polarizada). Os dados da citotoxicidade foram analisados estatisticamente pelo teste de two-way ANOVA, e os dados da biocompatibilidade pelos testes de Kruskal-Wallis e Dunn (p<0,05). As células expostas aos materiais apresentaram maior viabilidade celular na maior parte dos períodos, comparados com o controle (p<0,05). O extrato não diluído e ½ diluição do MTA-HP apresentaram maior citocompatibilidade do que Bio-C Repair às 6h, e com ¼ diluição às 24h (p<0,05); o MTA-Ang branco apresentou maior citocompatibilidade do que o Bio-C Repair na maior parte dos períodos (p<0,05). O extrato não diluído do MTA-Ang branco apresentou maior citocompatibilidade às 6 e 24 h comparado ao MTA-HP, e com ½ diluição às 24h (p<0,05). A citocompatibilidade dos materiais foi semelhante às 48 h para a maior parte das diluições (p>0,05). Aos 7 e 30 dias, os grupos apresentaram inflamação moderada e leve, respectivamente (p>0,05). Todos os materiais mostraram estruturas positivas para von Kossa e luz polarizada. Em conclusão, o Bio-C Repair teve citocompatibilidade semelhante aos materiais à base de MTA, é biocompatível e induz à biomineralização.

Abstract New mineral trioxide aggregate (MTA) formulations are constantly introduced in the market, usually in a powder-and-liquid form. Bioceramic (Bio-C) Repair is a ready-for-use material suggested as substitute for MTA, but its properties need to be studied. This study evaluated the cytotoxicity, biocompatibility and biomineralization of Bio-C Repair compared to MTA Repair High-Plasticity (MTA-HP) and white MTA-Angelus (MTA-Ang). L929 fibroblasts were exposed to material-extracted (undiluted, ½ and ¼ dilutions; 6, 24 and 48h). Polyethylene tubes with material or empty (control) were implanted in the subcutaneous tissue of rats. After 7 and 30 days (n=8), the specimens were removed for analysis (hematoxylin-eosin, von Kossa and polarized light). Cytotoxicity data were statistically analyzed by two-way ANOVA, and biocompatibility data by Kruskal-Wallis and Dunn tests (p<0.05). The cells exposed to the materials had greater viability at most of the periods compared with control (p<0.05). The undiluted and ½ dilutions of MTA-HP extract showed higher cytocompatibility than Bio-C Repair at 6 h and with the ¼ dilution at 24 h (p<0.05); the white MTA-Ang showed higher cytocompatibility than Bio-C Repair at most of periods (p<0.05). The undiluted white MTA-Ang extract had higher cytocompatibility at 6 and 24h than MTA-HP, and with ½ dilution at 24h (p<0.05). The materials’ cytocompatibility was similar at 48h for most dilutions (p>0.05). At 7 and 30 days, the groups had moderate and mild inflammation, respectively (p>0.05). All materials showed positive structures for von Kossa and polarized light. In conclusion, Bio-C Repair had similar cytocompatibility to MTA-based materials is biocompatible and induces biomineralization.

Abstract: Endodontic medicine, which addresses the bidirectional relationship between endodontic infections and systemic diseases, has gained prominence in the field of endodontics. There is much evidence showing that while systemic disease may influence the pathogenesis of endodontic infection, endodontic infection can also cause systemic alterations. These alterations include more severe bone resorption and inflammation in the periapical area as well as enhanced systemic disease symptoms. Similarly, many reports have described the impact of systemic diseases on the tissue responses to dental materials. Conversely, the local use of dental materials may show systemic effects in the form of altered production of biomarkers. Thus, studies to better understand the mechanisms related to those connections are extremely important. In this context, the objective of this review was to analyze and discuss the current literature regarding the connections among these three factors—systemic diseases, endodontic infection, and endodontic dental materials—and determine how these connections may interfere in the systemic health status and the endodontic treatment outcomes, which are represented by periapical wound healing.

Abstract Tissue repair is an essential process that reestablishes tissue integrity and regular function. Nevertheless, different therapeutic factors and clinical conditions may interfere in this process of periapical healing. This review aims to discuss the important therapeutic factors associated with the clinical protocol used during root canal treatment and to highlight the systemic conditions associated with the periapical healing process of endodontically treated teeth. The antibacterial strategies indicated in the conventional treatment of an inflamed and infected pulp and the modulation of the host's immune response may assist in tissue repair, if wound healing has been hindered by infection. Systemic conditions, such as diabetes mellitus and hypertension, can also inhibit wound healing. The success of root canal treatment is affected by the correct choice of clinical protocol. These factors are dependent on the sanitization process (instrumentation, irrigant solution, irrigating strategies, and intracanal dressing), the apical limit of the root canal preparation and obturation, and the quality of the sealer. The challenges affecting the healing process of endodontically treated teeth include control of the inflammation of pulp or infectious processes and simultaneous neutralization of unpredictable provocations to the periapical tissue. Along with these factors, one must understand the local and general clinical conditions (systemic health of the patient) that affect the outcome of root canal treatment prediction.

Abstract The aim of this study was to evaluate the influence of diabetes mellituson tissue response and mineralization ability of Sealapex®and MTA Fillapex® sealers. Twenty-four Wistar rats were divided into two groups: diabetic and non-diabetic. The materials were placed in polyethylene tubes and implanted into dorsal connective tissue of rats for 7 and 30 days. Six animals from each group received injection of calcein, alizarin, and oxytetracycline on days 7, 14, and 21, respectively. The animals were killed after 7 and 30 days and specimens were prepared for histologic analysis by staining with hematoxylin and eosin or Von Kossa or left unstained for polarized light or fluorescence microscopy. On day 7, inflammatory reactions were characterized. Moderate inflammatory responses were observed for all groups and on day 30, a mild inflammatory response against MTA Fillapex® and a moderate inflammatory response against Sealapex® were observed. Von Kossa-positive structures were observed in response to both materials and birefringent structures were observed upon polarized light analysis; these had no relation to the diabetic condition (p > 0.05). The fluorescence intensity was unaffected in diabetic rats (p > 0.05). In conclusion, diabetes mellitus did not influence the tissue response or mineralization stimulated by Sealapex® or MTA Fillapex®.