ABSTRACT Objective to investigate the quality of root canal treatments performed by undergraduate students. Methods 274 root-filled teeth (excluding molars) from the Department of Endodontology of the Federal University of Santa Catarina in a nine-year period were selected and evaluated by two calibrated examiners. The evaluation was based on tooth type, number of root canals, presence or absence curvature, length of filling material considered the radiographic apex as reference (considered adequate shorter than 2mm from radiographic apex), filling material density, filling taper, and overall quality of RCT. Chi-square and Fisher exact tests were performed to analyze associations between variables of interest (p<0.05). Results 197 RCT were classified as acceptable (71.9%). The frequency of adequate RCT was significantly higher in incisor (79.4%) than in premolars (66.4%) or canines (58.1%) (p=0.015). The number of canals did not influence root canal quality in this sample (p>0.05). The factor more frequently identified as unacceptable was filling length (26.6%). All RCT performed in curved teeth and classified as unacceptable were underfilled. Procedural errors, such as perforations or instrumental separation, were not found in this sample. Conclusion The most common criteria identified as unacceptable was the length of the filling material. Incisors had better quality assessment rates than canines and premolars. The high-quality rates found in this sample may be linked to the professor/student rates.
RESUMO Objetivo Investigar a qualidade dos tratamentos endodônticos realizados por alunos de graduação em odontologia. Métodos 274 dentes (excluindo molares) com endodontia realizada no Departamento de Endodontia da Universidade Federal de Santa Cataria durante 9 anos foram avaliados por dois examinadores calibrados. A avaliação foi baseada no tipo de dente, número de condutos radiculares, presença ou ausência de curvatura, nível da obturação em relação ao ápice radiográfico (considerado adequado quando a menos de 2mm do ápice radiográfico), densidade do material obturador, espessura da obturação e qualidade geral do tratamento. Teste qui quadrado e exato de Fisher foram usados para avaliar a associação entre as variáveis de interesse (p<0.05). Resultados 197 tratamentos foram considerados adequados (71.9%). A frequência de tratamentos adequado foi maior em incisivos (79.4%), do que em pré-molares (66.4%) e caninos (58.1%) (p=0.015). O número de canais não influenciou a qualidade do tratamento nessa amostra (p>0.05). O fator mais associado a tratamentos com qualidade inadequada foi o nível da obturação (26.6%). Todos os tratamentos inadequados, em dentes com curvatura, estavam com obturação mais do que 2mm aquém do ápice. Não houveram erros, como perfuração ou separação de instrumentais. Conclusão O critério mais frequentemente identificado como inadequado foi o nível apical da obturação. Tratamentos realizados em incisivos resultaram em qualidade superior aos em caninos e pré-molares. A alta qualidade dos tratamentos dessa amostra pode estar relacionada com a razão estudante/professor.
Abstract This systematic review aimed to evaluate whether alternative materials to conventional triple antibiotic paste (TAP - metronidazole, ciprofloxacin, and minocycline) and grey mineral trioxide aggregate (GMTA) could avoid tooth discoloration in teeth submitted to Regenerative Endodontic Procedure (REP). It was also investigated if dental bleaching is able to reverse the color of darkened teeth due to REP. The search was conducted in four databases (Medline via PubMed, Scopus, ISI Web of Science and BVS - Virtual health library), following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The retrieved papers were uploaded in the software EndNoteTM and two reviewers independently selected the studies and extracted the data. Only studies in humans (case reports, case series, clinical trials) were included in the review. From 1,122 potentially eligible studies, 83 were selected for full-text analysis, and 38 were included in the review. The included studies were mainly case reports (76.3 %). The studies described a total of 189 teeth submitted to REP. From these, about 54% of teeth presented some degree of discoloration. Most teeth presenting color alteration were treated with TAP, especially when combined with GMTA. Only three studies performed dental bleaching to restore the color of teeth and neither bleaching technique was able to restore the original color of the crowns. The use of alternative materials to TAP and GMTA, such as double antibiotic paste or Ca(OH)2 pastes and white mineral trioxide aggregate or BiodentineTM, reduces the occurrence of tooth discoloration.
Resumo Esta revisão sistemática teve como objetivo avaliar se materiais alternativos à pasta tri-antibiótica convencional (TAP, em Inglês - metronidazol, ciprofloxacina e minociclina) e ao agregado trióxido mineral cinza (MTA cinza) poderiam evitar a descoloração dentária em dentes submetidos ao procedimento endodôntico regenerativo (REP, em Inglês). Também foi investigado se o clareamento dental é capaz de reverter a cor dos dentes escurecidos devido ao REP. A busca foi realizada em quatro bases de dados (Medline via PubMed, Scopus, ISI Web of Science e BVS - Biblioteca Virtual de Saúde), seguindo os Principais Itens para Relatar Revisões Sistemáticas e Meta-análises. Os artigos obtidos foram carregados no software EndNoteTMe dois revisores independentes selecionaram os estudos e extraíram os dados. Apenas estudos em humanos (relatos de casos, séries de casos, ensaios clínicos) foram incluídos na revisão. De 1.122 estudos potencialmente elegíveis, 83 foram selecionados para análise do artigo completo, e 38 foram incluídos na revisão. Os estudos incluídos foram principalmente relatos de casos (76,3%). Os estudos descreveram um total de 189 dentes submetidos ao REP. Destes, cerca de 54% dos dentes apresentaram algum grau de descoloração. A maioria dos dentes com alteração de cor foi tratada com TAP, principalmente quando combinada com MTA-cinza. Apenas três estudos realizaram o clareamento dental para restaurar a cor dos dentes e nem a técnica de clareamento conseguiu restaurar a cor original das coroas. O uso de materiais alternativos à TAP e ao MTA cinza, como a pasta bi-antibiótica, pasta de Ca(OH)2e MTA branco ou BiodentineTM, reduz a ocorrência de descoloração dentária.
Abstract The purpose of this study was to evaluate if the renewal of milk as a storage medium, every 12, 24 and 48 h, is able to increase its ability to maintain human periodontal ligament fibroblasts (PDLF) viability over time. PDLF were soaked in Minimum Essential Medium at 37 °C (MEM-37) (positive control), tap water (Water) (negative control) and in skimmed milk (44 wells) at 5 °C and 20 °C. The skimmed milk was renewed every 12 h (Milk-12), 24 h (Milk-24) and 48 h (Milk-48) in 11 wells of each plate, and the milk in the remaining 11 wells of each plate was maintained in situ (not renewed milk) (NRM). After 24, 48, 72, 96 and 120 h, cell viability was determined by the tetrazolium salt-based colorimetric (MTT) assay. Data were statistically analyzed by Kruskal-Wallis, Scheffé and Mann-Whitney tests (a=5%). At 5 °C, only Milk-48 was significantly better than NRM. At 20 °C, NRM was more effective than Milk-12 and Milk-24 in all time periods. In relation to the temperature (5 °C or 20 °C), renewal of milk at 5 °C was better in maintaining cell viability than the renewal at 20 °C. In conclusion, the renewal of milk was able to increase its ability to maintain cell viability only when performed every 48 h in milk maintained at 5 °C.
Resumo O objetivo deste estudo foi avaliar se a renovação do leite, a cada 12, 24 e 48 h, é capaz de aumentar sua capacidade de manter a viabilidade de fibroblastos do ligamento periodontal humano (FLPH) ao longo do tempo. FLPH foram conservados em Meio Essencial Mínimo a 37 °C (MEM-37) (controle positivo), água da torneira (água) (controle negativo) e em leite desnatado (44 poços) a 5 °C e 20 °C. O leite desnatado foi renovado a cada 12 h (leite-12), 24 h (leite-24) e 48 h (leite-48) em 11 poços de cada placa, e em outros 11 poços de cada placa o leite foi deixado in situ (leite não renovado) (LNR). Depois de 24, 48, 72, 96 e 120 h, a viabilidade celular foi determinada pelo ensaio colorimétrico à base de sal tetrazólio (MTT). Os dados foram analisados estatisticamente pelos testes de Kruskal-Wallis, Scheffé e Mann-Whitney (α=5%). A 5 °C, somente o leite-48 foi significantemente melhor do que o LNR. A 20 °C, LNR foi mais efetivo do que o leite-12 e leite-24 em todos os períodos de tempo. Em relação à temperatura (5 °C ou 20 °C), a renovação do leite a 5 °C foi melhor na manutenção da viabilidade celular do que a renovação a 20 °C. Concluindo, a renovação do leite foi capaz de aumentar sua habilidade em manter a viabilidade celular apenas quando realizada a cada 48 h no leite mantido a 5 °C.
Abstract Regenerative endodontic procedure (REP) has been proposed as a new approach to treat immature permanent teeth. However, materials used in REP for root canal disinfection or cervical sealing may induce tooth discoloration. Objectives To assess tooth crown’s color after intracanal treatment with triple antibiotic paste (TAP) or calcium hydroxide (CH); cervical sealing with glass ionomer cement (GIC) or mineral trioxide aggregate (MTA); and bleaching with carbamide peroxide. Material and Methods After pulp removal and color spectrophotometer measurement, 50 bovine incisors were divided into 4 experimental groups and one control (untreated). Experiments were performed in phases (Ph). Ph1: TAP (ciprofloxacin, metronidazole, minocycline), TAPM (ciprofloxacin, metronidazole, amoxicillin), DAP (ciprofloxacin, metronidazole), or CH treatment groups. After 1 and 3 days (d); 1, 2, 3 weeks (w); and 1, 2, 3 and 4 months (m), color was measured and medications were removed. Ph2: GIC or MTA cervical sealing, each using half of the specimens from each group. Color was assessed after 1d, 3d; 1w, 2w, 3w; 1m and 2m. Ph3: Two bleaching sessions, each followed by color measurement. Data were analyzed with ANOVA and post-hoc Holm-Sidak method. Results Ph1: Specimens of TAP group presented higher color alteration (ΔE) mean than those of TAPM group. No significant difference was found among TAP or TAPM and CH, DAP or Control groups. Ph2: cervical sealing materials showed no influence on color alteration. Ph3: Different ΔE means (from different groups), prior to bleaching, became equivalent after one bleaching session. Conclusions TAP induces higher color alteration than TAPM; color alteration increases over time; cervical sealing material has no influence on color alteration; and, dental bleaching was able to recover, at least partially, the tooth crown’s color.
Abstract The objective of this study was to evaluate the effectiveness of various storage media at 20 °C in maintaining the viability of human periodontal ligament fibroblasts (HPLF) over time. HPLF were maintained at 20 °C in skim milk (SM), whole milk (WM), freshly prepared Hank's balanced salt solution (HBSS), Save-A-Tooth(r), natural coconut water (NCW), coconut water industrialized (ICW) and tap water (negative control) for 3, 6, 24, 48, 72, 96 and 120 h. Cells maintained in Minimal Essential Medium (MEM-37) at 37 °C served as a positive control. Cell viability was determined by MTT assay. Statistical analysis was performed by Kruskal-Wallis test and Scheffe test (α = 5%). From 24 h, NCW was significantly better in maintaining cell viability than all other tested storage media (p<0.05). SM and WM were significantly better than HBSS for up to 72 h. Save-A-Tooth(r) and ICW were the worst conservation storage media. In conclusion, the effectiveness of the tested storage media to maintain the viability of the periodontal ligament cells was as follows, in a descending order: NCW > MEM-37> SM and IM> HBSS> ICW > Save-A-Tooth(r)> tap water.
Resumo O objetivo deste estudo foi avaliar a efetividade de vários meios de conservação a 20 °C em manter a viabilidade de fibroblastos do ligamento periodontal humano (FLPH) ao longo do tempo. FLPH foram conservados a 20 °C em leite desnatado (LD), leite integral (LI), solução salina balanceada de Hank (HBSS) recém preparada, Save-A-Tooth(r) (Save), água de coco natural (ACN), água de coco industrializada (ACI) e água de torneira (água - controle negativo) por 3, 6, 24, 48, 72, 96 e 120 h. Células conservadas em Meio Essencial Mínimo (MEM-37) a 37 °C serviram como controle-positivo. A viabilidade celular foi determinada pelo ensaio MTT. A análise estatística dos dados foi realizada pelos testes Kruskal-Wallis e Scheffé (α=5%). A partir de 24 h, ACN foi significantemente melhor em manter a viabilidade celular do que todos os outros meios testados (p<0,05). LD e LI foram significantemente melhores do que a HBSS por até 72 h. Save e ACI foram os piores meios de conservação. Concluindo, a efetividade dos meios de conservação testados em manter a viabilidade das células do ligamento periodontal foi a seguinte em ordem decrescente: ACN > MEM-37 > LD e LI > HBSS > ACI > Save > água.
Abstract Revascularization of immature teeth with necrotic pulps traditionally involves the use of triple antibiotic paste, which may sometimes lead to undesirable complications. The objective of this study was to assess tissue repair in immature dog teeth with apical periodontitis subjected to revascularization, comparing two different pastes used for root canal disinfection. Apical periodontitis was induced in 30 dog premolars. Teeth were randomly divided into three experimental groups: root canals filled with triple antibiotic paste (n = 10); root canals filled with 1% propolis paste (n = 10); and no medication (n = 10). An additional group (n = 10, no intervention) was used as control. After 7 months, the jaws were histologically evaluated for the following variables: newly formed mineralized tissue (present/absent); vital tissue in the canal space (absent/periodontal ligament-like/pulp-like); apical extension of root (present/absent); and severity of inflammatory process (absent/mild/moderate/severe). There were no statistically significant differences among the experimental groups in new mineralized tissue formation and apical root development. The formation of vital tissue in the canal space, in turn, was statistically different between the triple paste and propolis groups: vital tissues were present in all revascularized teeth disinfected with propolis paste (100%), compared to 71% of those disinfected with the triple paste. Severity of inflammatory process was different between the triple paste and no medication groups. The new tissues formed onto canal walls and in the root canal space showed characteristics of cementum and periodontal ligament, respectively. Propolis may have some advantages over the triple paste for the revascularization of immature teeth.
<sec><title>Aim:</title><p> To analyze the influence of exposure and time of exposure to phosphate buffered saline (PBS) on the push-out bond strength (BS) of Biodentine to dentine.</p></sec><sec><title>Methods:</title><p> Eighty 2-mm-thick dentin discs were obtained from transversal sections of human teeth roots. The space of the canal was enlarged using #2-#5 Gates-Glidden burs to obtain 1.3-mm-diameter standardized cavities. The discs were immersed in 17% EDTA followed by 1% NaOCl and dried. The spaces of the canals were filled with Biodentine and the samples were divided into 2 groups (n=40) according to the storage: G1: exposure to moistened cotton pellet; G2: exposure to PBS. After 30 min, 1, 3 and 28 days, 10 samples of each group were subjected to the push-out test. Data were analyzed using ANOVA and Tukey test (p < 0.05).</p></sec><sec><title>Results:</title><p> The specimens exposed to PBS had lower BS (p < 0.05), except for the 1-day period (p = 0.6017). In specimens of Group 1 the BS increased up to 3 days (p < 0.05). In specimens in Group 2, the BS increased from 30 min to 1 day (p < 0.0001) and remained stable up to 3 days (p = 0.9876). At 28 days, a significant decrease was observed in the BS values of both groups (p < 0.05).</p></sec><sec><title>Conclusions:</title><p> The exposure of Biodentine to PBS led to lower BS values. In general, the BS increased gradually up to 3 days and reduced at 28 days.</p></sec>
OBJECTIVE: The aim of this study was to evaluate the influence of exposure of the mineral trioxide aggregate (MTA) - with and without calcium chloride (CaCl2) - to phosphate-buffered saline (PBS) on the apical microleakage using a glucose leakage system. MATERIAL AND METHODS: Sixty root segments were randomly divided into 4 experimental groups (n=15). After resecting the apical segments and enlarging the canals with Gates-Glidden drills, the apical cavities were filled with MTA with or without CaCl2 and the root canals were dressed with a moistened cotton pellet or PBS, as follows: 1) MTA/cotton pellet; 2) MTA/PBS; 3) MTA+10%CaCl2/cotton pellet; 4) MTA+10%CaCl2/PBS. All root segments were introduced in floral foams moistened with PBS. After 2 months, all root segments were prepared to evaluate the glucose leakage along the apical plugs. The amount of glucose leakage was measured following an enzymatic reaction and quantified by a spectrophotometer. Four roots were used as controls. The data were analyzed using Kruskal-Wallis and Mann-Whitney tests (p<0.05). RESULTS: There were no differences between groups 1 and 2 (p>0.05), and 3 and 4 (p>0.05). The addition of CaCl2 to the MTA significantly decreased its sealing ability (p<0.05). CONCLUSION: The interaction with PBS did not improve the MTA sealing ability. The addition of CaCl2 to the MTA negatively influenced the apical seal.
AIM: To evaluate the effect of different irrigant solutions employed during removal and replacement of calcium hydroxide paste on the diffusion of hydroxyl ions through root canal dentine in vitro. METHODOLOGY: Thirty-five maxillary and mandibular human canines with straight and fully developed roots were used. After mechanical preparation up to 1mm short of tooth length, 30 canals were filled with calcium hydroxide paste and 5 canals were left empty; all teeth had their coronal accesses properly sealed. Teeth were placed in plastic containers with distilled water, and pH was read after 30 days when the paste from 20 teeth was renewed. After removal of the paste by endodontic instrumentation and irrigation with distilled water, canals were replenished with newly mixed paste in Group 1 and 2. In these groups, final irrigation was conducted with 5 mL of EDTA followed by 5 mL of NaOCl in specimens in Group 1, and 5 mL of NaOCl only in specimens in Group 2. In 10 teeth the paste was not replenished at 30 days (Group 3). All specimens were returned to the containers with fresh distilled water, and the pH was recorded after another 30 days. The differences between the first (30d) and second (60d) pH readings were calculated and submitted to analysis of variance and individual comparisons using the Scheffeé's test. RESULTS: Results of mean analysis on differences of pH readings showed that greater diffusion had occurred on specimens in Group 3. Individual comparisons using Scheffeé's test showed statistical significance between Groups 2 and 3, and equivalence between all other groups. CONCLUSION: It was concluded that the use of EDTA did not enhance diffusion of hydroxyl ions through root canal dentine.
OBJETIVO: O objetivo desta pesquisa foi comparar o efeito de diferentes irrigantes, usados durante a troca da pasta de hidróxido de cálcio, sobre a difusão de íons hidroxila. METODOLOGIA: Foram empregados 35 caninos humanos, com canais retos e raízes totalmente formadas. Efetuado o preparo mecânico até 1 mm aquém do comprimento do dente, 30 canais foram preenchidos com pasta de hidróxido de cálcio e 5 permaneceram vazios (controle). Após o selamento, os dentes foram colocados em frascos plásticos contendo água destilada. Passados 30 dias, o pH da água foi medido e a pasta de 20 dentes foi renovada. Depois de removê-la com água destilada e instrumentos endodônticos e, antes de repô-la, foi feita uma irrigação com 5 ml de EDTA seguida de 5 ml de NaOCl (Grupo 1) ou somente com 5 ml de NaOCl (Grupo 2). Em 10 dentes, a pasta não foi renovada (Grupo 3). Os dentes foram repostos em seus frascos com nova água destilada e, após 30 dias, o pH foi novamente registrado. As diferenças nas medidas de pH, realizadas aos 30 e 60 dias, foram calculadas e submetidas à análise de variância e a comparações individuais pelo teste de Scheffeé. RESULTADOS: A análise das diferenças mostrou que a difusão foi maior nos dentes do Grupo 3. Comparações individuais usando o teste de Scheffeé mostraram significância estatística entre os Grupos 2 e 3 e equivalência entre todos os outros grupos. CONCLUSÃO: O uso do EDTA não aumentou a difusão de íons hidroxila através da dentina radicular.