Abstract Dental referrals to the Endodontics Specialty Clinic (ESC) are routine owing to the complexity of endodontic treatments. To obtain a better prognosis for treatment, students/dentists must perceive their technical limits. This study sought to investigate the referrals of patients to the ESC from different clinics of the Piracicaba Dental School, State University of Campinas - SP, Brazil, and check: a) the demographic profile of patients and the most commonly affected tooth; b) the clinic with the largest number of referrals; c) the reasons for referrals; d) the complexity of the cases; e) and the difficulty in assessing the referred cases based on the classification provided by the American Association of Endodontists (AAE) and Souza-Filho. The study sample consisted of patients’ electronic dental referral records from February 2015 to June 2019. A total of 1,707 patients were referred to the ESC during the study period, and 62.4% were female. Lower molars were the most frequently involved teeth (34.8%), and 60.7% of the cases were referred due to the presence of root curvature. The AAE classification showed prevalence of highly difficult cases (71.3%), whereas Souza-Filho classification demonstrated a high rate of class III cases (85.8%). This study highlights the difficulties encountered by undergraduate students before or during endodontic treatments, reinforcing the need for clear criteria for selecting cases appropriate for each education level, thus improving endodontic treatment prognosis. (ESC treatments studentsdentists dentists limits School SP Brazil check tooth b c d e (AAE SouzaFilho. SouzaFilho Souza Filho. Filho 201 2019 1707 1 707 1,70 period 624 62 4 62.4 female 34.8%, 348 34.8% , 34 8 (34.8%) 607 60 7 60.7 curvature 71.3%, 713 71.3% 71 3 (71.3%) 85.8%. 858 85.8% . 85 (85.8%) level 20 170 70 1,7 6 62. 34.8 (34.8% 60. 71.3 (71.3% 85.8 (85.8% 2 17 1, 34. (34.8 71. (71.3 85. (85.8 (34. (71. (85. (34 (71 (85 (3 (7 (8 (

Abstract This review aimed to determine the prevalence of species of yellow, purple and green microbial complexes in root canals (RC) and periodontal pockets (PP) of teeth with endodontic-periodontal lesions. For this purpose, two reviewers searched the literature up to January 2022. Studies reporting the prevalence of species of the yellow, purple and green microbial complexes in teeth diagnosed with endodontic-periodontal lesions were included. The risk of bias of the included studies was assessed using the 14 criteria from the NIH Quality Assessment Tool. Of 1,611 references identified in the initial search, only four studies were eligible and included in the qualitative analysis. The profile and prevalence rates of bacterial species in RC and PP varied among the included studies: levels of Agregatibacter actinomycetemcomitans (12% RC, 58% PP), Capnocytophaga granulosa (10% RC, 35% PP), Capnocytophaga sputigena (15-70% RC, 0-30% PP), Streptococcus mitis (30% RC, 35% PP), Streptococcus sanguinis (30% RC, 35% PP), and Veillonella parvula (70% RC, 50% PP) were identified. The high methodological heterogeneity prevented grouping and quantitative analysis of data. The risk of bias was considered ‘moderate’ for all studies. The included studies identified the presence of seven bacterial species belonging to the yellow, purple, and green microbial complexes in RC and PP, but with different prevalence rates. Future clinical studies are encouraged to investigate the presence and role of these species in the occurrence and development of endodontic-periodontal lesions. yellow (RC (PP endodonticperiodontal endodontic purpose 2022 1 Tool 1611 611 1,61 search 12% 12 (12 58 , 10% 10 (10 35 1570% 1570 15 70% 70 (15-70 030% 030 0 30% 30 0-30 (30 (70 50 data ‘moderate moderate 202 161 61 1,6 (1 5 3 157 7 (15-7 03 0-3 (3 (7 20 16 6 1, ( (15- 0- 2 (15

Aim The objective of this study was to describe a case series concerning internal bleaching of anterior traumatized teeth that underwent regenerative endodontic procedures (REP). Methods Seven non-vital maxillary anterior teeth discolored after regenerative endodontic procedures were included and divided into two groups according to the medication protocol used in the REP: (1) Triple antibiotic paste (TAP) group (n=4); (2) Calcium hydroxide and 2% chlorhexidine gel (HC+CHX) (n=3). The bleaching technique used was walking bleach, where sodium perborate associated with distilled water was used. Bleaching agent was replaced weekly until the darkened tooth was slightly lighter than the adjacent tooth. The color was recorded with the aid of a digital spectrophotometer in two moments (T1: prior the first session of bleaching, T2: fourteen days after the last session of bleaching). The change in color after the procedure (ΔE) was calculated and reported in a descriptive analysis. Results The ΔE for all teeth showed color differences exceeding the perceptibility threshold (ΔE > 3.7). Both groups showed similar ΔE (TAP: 18.3 ± 11.5; HC+CHX: 14 ± 11.2) at the end of the treatment. The average number of sessions needed to achieve satisfactory results was 1.7 ± 0.6 for HC+CHX group and 2.3 ± 0.5 for TAP group. Conclusion Internal bleaching with sodium perborate associated with distilled water is effective in treating discolored teeth after regenerative endodontic procedures.

Abstract This study reports the SARS-CoV-2 outbreak and its impact on dental practice and education in Brazil. A literature review involving medical and dental interests was performed based on recent general findings about the infection (research and relevant guidelines). COVID-19 is a high transmissible, unpredictable systemic disease, involving a viral replication phase, followed by an inflammatory phase that can evolve into hyperinflammation that leads to a cytokine storm and other serious issues including sepsis, shock and multiple organ failure. The dentists are directly impacted by the new coronavirus as they work with the oral cavity that is irrigated by the saliva and receive the respiratory aerosols and droplets from the patient. In conclusion, the world is facing a completely new situation that deserves the comprehension of the population and close attention of the authorities. Following protocols to attend patients can prevent the dissemination of the virus, cross-infection, and the contamination of health care professionals. New strategies need to be developed to enhance the existing teaching and learning protocols in Universities and to allow research to continue.

Resumo Este estudo descreve o surto de SARS-CoV-2 e o impacto na prática e Ensino em odontologia no Brasil. Foi realizada uma revisão da literatura acerca de interesses médico e odontológico baseada em achados recentes sobre a infecção (pesquisa e diretrizes relevantes). COVID-19 é uma doença sistêmica altamente transmissível, imprevisível, envolvendo a fase de replicação viral, seguida da fase inflamatória que pode evoluir para um estado de hiper inflamação, levando a uma “tempestade de citocinas” e outros sintomas tais como sepse, choque e falência múltipla de órgãos. Os dentistas são diretamente impactados pelo novo coronavírus uma vez que trabalham com a cavidade oral que é irrigada pela saliva, e recebe aerossóis e gotículas oriundas da respiração do paciente. Concluiu-se que o mundo está enfrentando uma situação completamente nova e merece a compreensão da população e atenção das autoridades. Seguir protocolos para o atendimento de paciente pode prevenir a disseminação do virus, infecção cruzada e a contaminação de profissionais da saúde. Novas estratégias precisam ser desenvolvidas para melhorar os protocolos de Ensino e aprendizagem existentes nas universidades e permitir que a pesquisa continue.

Abstract This study evaluated the physicochemical, biological, and antimicrobial properties of a new hydraulic calcium silicate-based modified material, and compared it with MTA Repair HP and MTA Angelus. The materials were assessed regarding color luminosity (L), color change, radiopacity, setting time, and ISO 6876:2012 linear flow. Volumetric filling and volume change were evaluated using microcomputed-tomography (µCT). Chemical characterization after 28 days in Hank’s Balanced Salt Solution (HBSS) and pH analysis were also assessed. Biological characterization of cytotoxicity and microbiological assessment were also undertaken. Shapiro-Wilk, ANOVA, Levene and post hoc analyses with Bonferroni correction were performed, adopting a 5% significance level (p <0.05). Bio-C Pulpo exhibited the highest L values after 90 days. All tested materials demonstrated color change during the analyses, and had radiopacity above 5 mm Al. MTA Repair HP set faster than Bio-C Pulpo, whereas the latter had the highest linear flow. MTA Repair HP had the highest volumetric filling in µCT analysis. Bio-C Pulpo showed the highest alkalinity during all tested periods, and the highest volumetric loss (above 9%), in comparison with MTA Repair HP and MTA Angelus. Bio-C Pulpo did not form calcium hydroxide after hydration. MTA Repair HP demonstrated the highest cytocompatibility, and Bio-C Pulpo, the highest cytotoxicity. No inhibition halos were observed for any material, and similar higher turbidity values were seen after direct contact. Composition additives used in Bio-C Pulpo modified its properties, and both the absence of calcium hydroxide deposition after hydration, and the related cytotoxicity of this material are of particular concern.

Resumo: O estudo buscou investigar a prevalência de trauma dentário em crianças e adolescentes brasileiros. Foi realizada uma revisão sistemática em oito bases de dados: MEDLINE (via PubMed), LILACS, BBO, Scopus, Embase, Web of Science, Open Access Theses and Dissertations e OpenThesis. Foram incluídos apenas estudos de prevalência que usavam métodos de amostragem probabilística, sem limitação de ano ou idioma de publicação. Para avaliar o risco individual de viés, foram utilizadas as ferramentas de avaliação crítica da JBI para estudos de prevalência. Os estudos individuais foram combinados na metanálise com o uso do modelo de efeitos aleatórios. A heterogeneidade entre os estudos foi analisada pelas estatísticas Q de Cochran e I-quadrado. A análise de metarregressão foi realizada para avaliar as fontes de heterogeneidade. A abordagem GRADE avaliou a certeza das evidências entre os estudos incluídos. A busca resultou em 2.069 registros, dos quais 36 foram incluídos no estudo. Os estudos elegíveis foram publicados entre 2000 e 2021, com uma amostra total de 40.194 crianças e adolescentes. A maioria dos estudos (75%) teve baixo risco de viés. Nos dentes permanentes, a prevalência de trauma dentário foi de 21% (IC95%: 16,0; 26,0) e nos dentes decíduos foi de 35% (IC95%: 26,0; 44,0). A prevalência de trauma dentário foi mais alta no sexo masculino que no feminino, para ambas as dentições. Com base na baixa certeza, a prevalência das lesões dentárias traumáticas em crianças e adolescentes brasileiros é mais alta que no resto do mundo, tanto nos dentes decíduos quanto nos permanentes. Além disso, a prevalência de trauma dentário é mais alta em meninos que em meninas.

Abstract: This study aimed to investigate the prevalence of dental trauma in Brazilian children and adolescents. A systematic review was conducted considering eight databases: MEDLINE (via PubMed), LILACS, BBO, Scopus, Embase, Web of Science, Open Access Theses and Dissertations, and OpenThesis. Only prevalence studies that used a probabilistic sampling method were included, without restriction on year or language of publication. The JBI critical appraisal tools for prevalence studies were used to assess the individual risk of bias. The individual studies were combined in the meta-analysis using the random-effects model. The heterogeneity between the studies was analyzed by Cochran’s Q and the I-square statistics. A meta-regression analysis was performed to evaluate the sources of heterogeneity. The GRADE approach assessed the certainty of evidence across included studies. The search resulted in 2,069 records, of which 36 were included in the study. The eligible studies were published from 2000 to 2021, with a total sample of 40,194 children and adolescents. Most studies (75%) had a low risk of bias. In permanent teeth, the prevalence of dental trauma was 21% (95%CI: 16.0; 26.0) and in deciduous teeth; 35% (95%CI: 26.0; 44.0). The prevalence of dental trauma among boys was higher than among girls for both dentitions. Based on a low certainty, the prevalence of traumatic dental injuries in Brazilian children and adolescents is higher than that found worldwide both in deciduous and permanent teeth. Also, the prevalence of dental trauma among boys is higher than among girls.

Resumen: Este estudio tuvo como meta investigar la prevalencia de trauma dental en niños y adolescentes brasileños. Se realizó una revisión sistemática considerando ocho bases de datos: MEDLINE (via PubMed), LILACS, BBO, Scopus, Embase, Web of Science, Open Access Theses and Dissertations y OpenThesis. Solamente se incluyeron estudios de prevalencia que usaron un método de muestreo probabilístico, sin restricción sobre el año o lengua de publicación. Se usó las herramientas de evaluación crítica del JBI para estudios de prevalencia studies para evaluar el riesgo individual de sesgo. Los estudios individuales se combinaron en metaanálisis, usando un modelo de efectos aleatorios. La heterogeneidad entre los estudios se analizó mediante las estadísticas de Cochran Q e I-cuadrado. Se realizó un análisis de meta-regresión para evaluar las fuentes de heterogeneidad. El enfoque GRADE evaluó la certidumbre de evidencia a través de los estudios incluidos. La búsqueda resultó en 2.069 registros, de los cuales treinta y seis se incluyeron en el estudio. Los estudios elegibles se publicaron entre 2000 y 2021, con una muestra total de 40.194 niños y adolescentes. La mayoría de los estudios (75%) tenían un bajo riesgo de sesgo. En los dientes permanentes la prevalencia de trauma dental fue 21% (IC95%: 16,0; 26,0) y en los dientes deciduos la prevalencia de trauma dental fue 35% (IC95%: 26,0; 44,0). La prevalencia trauma dental entre niños fue más alta que entre niñas en ambas denticiones. Basado en una baja certidumbre, la prevalencia de lesiones traumáticas dentales en niños y adolescentes brasileños es más alta que la encontrada en el resto del mundo, tanto en dientes deciduos como en dientes permanentes. Asimismo, la prevalencia de trauma dental entre niños es más alta que entre niñas.

Resumo: O estudo buscou investigar a prevalência de trauma dentário em crianças e adolescentes brasileiros. Foi realizada uma revisão sistemática em oito bases de dados: MEDLINE (via PubMed), LILACS, BBO, Scopus, Embase, Web of Science, Open Access Theses and Dissertations e OpenThesis. Foram incluídos apenas estudos de prevalência que usavam métodos de amostragem probabilística, sem limitação de ano ou idioma de publicação. Para avaliar o risco individual de viés, foram utilizadas as ferramentas de avaliação crítica da JBI para estudos de prevalência. Os estudos individuais foram combinados na metanálise com o uso do modelo de efeitos aleatórios. A heterogeneidade entre os estudos foi analisada pelas estatísticas Q de Cochran e I-quadrado. A análise de metarregressão foi realizada para avaliar as fontes de heterogeneidade. A abordagem GRADE avaliou a certeza das evidências entre os estudos incluídos. A busca resultou em 2.069 registros, dos quais 36 foram incluídos no estudo. Os estudos elegíveis foram publicados entre 2000 e 2021, com uma amostra total de 40.194 crianças e adolescentes. A maioria dos estudos (75%) teve baixo risco de viés. Nos dentes permanentes, a prevalência de trauma dentário foi de 21% (IC95%: 16,0; 26,0) e nos dentes decíduos foi de 35% (IC95%: 26,0; 44,0). A prevalência de trauma dentário foi mais alta no sexo masculino que no feminino, para ambas as dentições. Com base na baixa certeza, a prevalência das lesões dentárias traumáticas em crianças e adolescentes brasileiros é mais alta que no resto do mundo, tanto nos dentes decíduos quanto nos permanentes. Além disso, a prevalência de trauma dentário é mais alta em meninos que em meninas.

Abstract: This study aimed to investigate the prevalence of dental trauma in Brazilian children and adolescents. A systematic review was conducted considering eight databases: MEDLINE (via PubMed), LILACS, BBO, Scopus, Embase, Web of Science, Open Access Theses and Dissertations, and OpenThesis. Only prevalence studies that used a probabilistic sampling method were included, without restriction on year or language of publication. The JBI critical appraisal tools for prevalence studies were used to assess the individual risk of bias. The individual studies were combined in the meta-analysis using the random-effects model. The heterogeneity between the studies was analyzed by Cochran’s Q and the I-square statistics. A meta-regression analysis was performed to evaluate the sources of heterogeneity. The GRADE approach assessed the certainty of evidence across included studies. The search resulted in 2,069 records, of which 36 were included in the study. The eligible studies were published from 2000 to 2021, with a total sample of 40,194 children and adolescents. Most studies (75%) had a low risk of bias. In permanent teeth, the prevalence of dental trauma was 21% (95%CI: 16.0; 26.0) and in deciduous teeth; 35% (95%CI: 26.0; 44.0). The prevalence of dental trauma among boys was higher than among girls for both dentitions. Based on a low certainty, the prevalence of traumatic dental injuries in Brazilian children and adolescents is higher than that found worldwide both in deciduous and permanent teeth. Also, the prevalence of dental trauma among boys is higher than among girls.

Resumen: Este estudio tuvo como meta investigar la prevalencia de trauma dental en niños y adolescentes brasileños. Se realizó una revisión sistemática considerando ocho bases de datos: MEDLINE (via PubMed), LILACS, BBO, Scopus, Embase, Web of Science, Open Access Theses and Dissertations y OpenThesis. Solamente se incluyeron estudios de prevalencia que usaron un método de muestreo probabilístico, sin restricción sobre el año o lengua de publicación. Se usó las herramientas de evaluación crítica del JBI para estudios de prevalencia studies para evaluar el riesgo individual de sesgo. Los estudios individuales se combinaron en metaanálisis, usando un modelo de efectos aleatorios. La heterogeneidad entre los estudios se analizó mediante las estadísticas de Cochran Q e I-cuadrado. Se realizó un análisis de meta-regresión para evaluar las fuentes de heterogeneidad. El enfoque GRADE evaluó la certidumbre de evidencia a través de los estudios incluidos. La búsqueda resultó en 2.069 registros, de los cuales treinta y seis se incluyeron en el estudio. Los estudios elegibles se publicaron entre 2000 y 2021, con una muestra total de 40.194 niños y adolescentes. La mayoría de los estudios (75%) tenían un bajo riesgo de sesgo. En los dientes permanentes la prevalencia de trauma dental fue 21% (IC95%: 16,0; 26,0) y en los dientes deciduos la prevalencia de trauma dental fue 35% (IC95%: 26,0; 44,0). La prevalencia trauma dental entre niños fue más alta que entre niñas en ambas denticiones. Basado en una baja certidumbre, la prevalencia de lesiones traumáticas dentales en niños y adolescentes brasileños es más alta que la encontrada en el resto del mundo, tanto en dientes deciduos como en dientes permanentes. Asimismo, la prevalencia de trauma dental entre niños es más alta que entre niñas.

Abstract Tricalcium silicate-based cement are materials used in reparative and regenerative procedures in endodontics. A recently proposed formulation aimed to enhance handling during clinical use with a versatile material applicable by syringe. Although, the use of bismuth oxide as radiopacifier and grey raw powder are drawbacks considering aesthetics. Objectives Evaluate physicochemical, biological, and antimicrobial properties of Grey-MTAFlow (Ultradent) and assess whether the addition of zinc oxide (ZnO) prevents dentinal discoloration caused by bismuth oxide. Methodology Grey-MTAFlow was manipulated in 'thin' consistency for all tests. Luminosity, color change, ion migration to dentine, radiopacity, setting time, ISO 6876:2012 linear flow, volumetric lateral flow and central filling of simulated grooves scanned using micro-computed tomography (μCT), pH, calcium release, volumetric change using μCT, chemical characterisation, cytotoxicity, and antimicrobial activity were assessed. Addition of 5% ZnO to Grey-MTAFlow and a bismuth-containing experimental composition were comparatively tested. Statistical analyses used Shapiro-Wilk, T-test, ANOVA, and Kolmogorov-Smirnov (p<0.05). Results The addition of ZnO to Grey-MTAFlow prevented dentine darkening after 90 days due to bismuth migration reduction, although no statistical difference was found (p=0.863). ZnO addition significantly enhanced Grey-MTAFlow radiopacity without differences in initial setting time. Grey-MTAFlow presented an ISO linear flow of 10.9 mm and a balanced volumetric lateral flow with central filling in μCT evaluation. All compositions presented an alkaline pH after immersion. Grey-MTAFlow had a significantly higher calcium ion release after 28 days in comparison to 24 hours (p=0.011) and volumetric expansion of 0.4±1.8% after immersion. ZnO addition altered the hydrated cement matrix once calcium hydroxide (portlandite) could not be detected in characterisation. Neither of the materials produced inhibition halos nor reduced bacterial turbidity, but all presented cytocompatibility above 100%. Conclusion Grey-MTAFlow expanded after immersion and exhibited higher luminosity values after the evaluation period when ZnO was added, but chemical modifications after this addition occurred.

Abstract: This study investigated the effectiveness of XP-Endo Finisher (XPF) associated with XP-Endo Shaper (XPS) or Reciproc Blue (RB) files in reducing bacterial load in oval-shaped root canals (RC) during chemomechanical preparation (CMP) using 0.9% saline solution (NaCl) or 2.5% sodium hypochlorite (NaOCl). Eighty mandibular incisors with single oval-shaped RC were contaminated with Enterococcus faecalis. The teeth were randomly assigned to eight experimental groups (n = 10) according to the CMP, as follows: G1: XPS, G2: XPS + XPF, G3: RB, and G4: RB + XPF. CMP was performed with NaCl or NaOCl. The reduction of bacterial load was assessed by colony-forming unit count before (S1) and after (S2) CMP. Data normality was verified by using Shapiro-Wilk test. ANOVA, Tukey's test, and Bonferroni post-hoc test were used at a 5% significance level. Culturable bacteria were present in all S1 samples (p>0.05). All instrumentation techniques were effective in reducing bacterial load, irrespective of the irrigating solution (p < 0.05). With the use of NaCl, RB was more effective than XPS (p = 0.035). With the use of NaOCl, XPS and RB presented similar effectiveness (p = 0.779). XPF enhanced the bacterial reduction of both systems tested (p < 0.05). The use of NaOCl improved the CMP, irrespective of the instrumentation technique used (p < 0.05). In conclusion, XPS and RB files are effective in reducing bacterial levels in oval-shaped RC. The use of XPF as a method of agitation of the irrigating solution improved the cleaning efficiency of both file systems tested. Mechanical preparation performed with saline solution decreased culturable bacteria from the root canal, but antimicrobial substances such as NaOCl should be used to achieve a significantly better disinfection.

RESUMO Objetivo: Este estudo retrospectivo avaliou o perfil demográfico dos pacientes e as características clínicas das urgências dentárias em um Serviço de Plantão de Urgências de uma Faculdade brasileira de Odontologia. Métodos: Durante o período de junho de 2013 a maio de 2014, os dados foram coletados de 1.345 registros clínicos, com informações sobre a queixa principal, gênero, idade, alteração sistêmica, inspeção clínica do dente afetado, diagnóstico pulpar e periapical, o tipo de procedimento realizado e se houve necessidade de medicação sistêmica pós-operatória. Os dados foram analisados usando o software SAS e o teste do qui-quadrado foi utilizado para verificar a presença ou ausência de significância estatística ao nível de 5%. Resultados: A dor dental (53,3%) foi a queixa principal mais encontrada. Pacientes do gênero feminino (63,1%), com idade entre 29-48 anos (42%), sem condições sistêmicas (75%) e com dentes cariados (25%) foram os mais prevalentes. Além disso, o envolvimento de molares inferiores (29,81%) e o diagnóstico de pulpite irreversível (30,42%) foram os achados mais frequentes. O tratamento endodôntico de urgência (45,8%) foi o procedimento mais realizado. A pulpite irreversível (30,4%) e a necrose pulpar associada a periodontite apical aguda (21,9%) foram as condições mais frequentes que necessitaram de tratamento endodôntico de urgência e, na maioria dos casos, não houve prescrição de medicamentos sistêmicos pós-operatórios (95,7%). Conclusão: A prevalência de urgências endodônticas durante o período de um ano enfatiza a necessidade de diagnósticos mais precisos e a importância de oferecer esse serviço à população.

ABSTRACT Objective: This retrospective study evaluated the demographic profile of patients and the clinical characteristics of dental emergencies in a brazilian university outpatient clinic. Methods: During the period from June 2013 to May 2014, data were collected from 1.345 clinical records. Chief complaint, gender, age, systemic alteration, clinical inspection of the affected tooth, pulp and periapical diagnosis, the type of procedure performed and whether there was the need for post-operative systemic medication. Data were analyzed using the SAS software and chi-square test was used to verify the presence or absence of statistical significance at a level of 5%. Results: Dental pain (53.3%) was the main reason why people attended the emergency service, that is, female patients (63.1%), aged 29-48 years old (42%), patients without systemic conditions (75%), and patients with decayed teeth (25%). In addition, involvement of lower molars (29.81%) and diagnosis of irreversible pulpitis (30.42%) were the most frequent findings. Emergency endodontic treatment (45.8%) was the most performed procedure. Irreversible pulpitis (30.4%) and pulp necrosis associated with acute apical periodontitis (21.9%) were the most frequent conditions requiring emergency endodontic treatment, and in most cases, there was no need for post-operative systemic medications (95.7%). Conclusion: The prevalence of endodontic emergencies during the period of one year emphasizes the need for more accurate diagnosis and the importance of providing this service to the population.

Abstract: Evidence shows the polymicrobial etiology of endodontic infections, in which bacteria and their products are the main agents for the development, progression, and dissemination of apical periodontitis. Microbial factors in necrotic root canals (e.g., endotoxin) may spread into apical tissue, evoking and supporting a chronic inflammatory load. Thus, apical periodontitis is the result of the complex interplay between microbial factors and host defense against invasion of periradicular tissues. This review of the literature aims to discuss the complex network between endodontic infectious content and host immune response in apical periodontitis. A better understanding of the relationship of microbial factors with clinical symptomatology is important to establish appropriate therapeutic procedures for a more predictable outcome of endodontic treatment.

Abstract This study aimed to evaluate the influence of different ethanol concentrations on dentin roughness, surface free energy, and contact angle between AH Plus and the root canal dentin. One hundred human maxillary anterior teeth were split longitudinally and 200 dentin specimens were polished to make the surface flatter and smoother. An acrylic bar was positioned between two dentin specimens and impression material was added to create a block, simulating an instrumented root canal space. Specimens were removed from the mold and cleaned in an ultrasonic bath for 10 min. Thereafter, dentin specimens were divided into four groups (n = 50) according to the drying methods used: a) wet: vacuum only, b) paper points: vacuum + absorbent paper points, c) 70% alcohol: 70% alcohol (1 min) + vacuum + absorbent paper points, and d) 100% alcohol: 100% alcohol (1 min) + vacuum + absorbent paper points. A rugosimeter and a goniometer were used to verify the roughness (Ra) and to measure the surface free energy and the contact angle between the AH Plus sealer and the root canal dentin. ANOVA and Tukey tests (α = 0.05) were used for statistical analysis. The 70% and 100% ethanol groups showed significantly decreased roughness as well as increased surface free energy in the root canal dentin when compared to the wet and paper point groups. In addition, ethanol significantly reduced the contact angle between the AH Plus sealer and the root canal dentin. Ethanol solutions (70% and 100%) provide better wettability of AH Plus sealer on dentin surfaces.

Resumo Introdução Sangue é um material biológico com alto potencial de transmissão de infecção em ambientes odontológicos, incluindo herpes simples, hepatites e AIDS. Objetivo Investigar a eficácia do luminol em detector sangue em limas endodônticas antes e após o processo de esterilização. Material e método Luminol foi utilizado para investigar a presença ou ausência de vestígios tecido sanguíneo em 50 limas endodônticas, visíveis ou não à olho nu, após a realização do tratamento endodôntico e após o processo de limpeza/esterilização. Os resultados obtidos foram tabulados e analisados estatisticamente utilizando o teste de Friedman com nível de significância de 5% (p<0,05). Resultado A olho nú, foi observado que 31/50 limas não apresentaram vestígios de sangue, 8/50 apresentaram uma leve presença de sangue e 11/50 apresentaram uma presença considerável de sangue após o tratamento endodôntico. Após a utilização do luminol, entretanto, 16/50 limas endodônticas não apresentaram vestígios de sangue, 19/50 apresentaram uma leve presença de sangue e 15/50 apresentaram uma presença considerável de sangue. Após o processo de limpeza e esterilização não foi detectado sangue nas limas endodônticas. Conclusão A solução de luminol é efetiva na detecção de tecido sanguíneo em limas endodônticas, validando o processo de limpeza/esterilização.

Abstract Introduction Blood is a biological material with high potential of infectious transmission in dental environments, including herpes simplex, hepatitis and AIDS. Aim To investigate the efficacy of luminol in detecting blood in endodontic files before and after the sterilization process. Material and method Luminol was used to investigate the presence or absence of traces of blood tissue in 50 endodontic files, visible to naked eye or not, after performing endodontic treatment and after the cleaning/sterilization process. The results obtained were tabulated and statistically analyzed by using the Friedman’s test at a significance level of 5% (p<0.05). Result By naked eye, it was found that 31/50 files showed no trace of blood, 8/50 showed a slight presence of blood and 11/50 showed a considerable presence of blood after endodontic treatment. After the use of luminol, however, 16/50 endodontic files showed no trace of blood, 19/50 showed a slight presence of blood and 15/50 showed a considerable presence of blood. After the cleaning and sterilization process, no blood was detected in the files. Conclusion It was concluded that the luminol solution is effective in detecting blood tissue in endodontic files as well as in validating the cleaning/sterilization process.

Resumo O objetivo deste estudo clínico foi avaliar a relação entre a demora na procura por tratamento e o desenvolvimento de reabsorções inflamatórias externas em dentes luxados com ápice fechado. A amostra desta pesquisa foi constituída por 67 pacientes que apresentaram 133 dentes traumatizados, dos quais 56 foram acometidos por luxação extrusiva, 69 por luxação lateral e 8 por luxação intrusiva, proservados por no mínimo 24 meses. Foi registrado o tempo decorrido entre a data do trauma e o primeiro atendimento. Verificou-se a ocorrência de necrose pulpar e reabsorções inflamatórias externas em cada tipo de traumatismo. O Teste Exato de Fisher foi aplicado para verificar a influência da data do atendimento inicial e o desenvolvimento de reabsorções inflamatórias externas em cada tipo de luxação e o teste de Odds Ratio foi aplicado para verificar o risco do desenvolvimento de reabsorções inflamatórias externas em função da demora na procura por tratamento. Os resultados revelaram que a necrose pulpar foi verificada em 105 dentes luxados (78,9%) e a reabsorção inflamatória externa foi verificada em 17.8% das luxações extrusivas (10), sendo 15,9% das luxações laterais (11) e 25% das luxações intrusivas (2). A demora na procura por tratamento influenciou o desenvolvimento de reabsorções infamatórias externas nas luxações laterais (p=0,0174). Os pacientes que procuraram tratamento após 45 dias da data do trauma apresentaram 3,4 vezes mais chance de desenvolver reabsorção inflamatória externa do que os pacientes que procuraram tratamento logo após o traumatismo. Conclui-se que o tratamento tardio após a ocorrência do traumatismo pode prejudicar o prognóstico e favorecer o desenvolvimento de reabsorções inflamatórias externas em dentes luxados com ápice fechado.

Abstract This clinical study aimed to evaluate the relationship of the delay between dental trauma and the initial attendance to the development of external inflammatory root resorption in permanent teeth affected by severe luxation. Sixty-seven patients, aged between 11 and 56 years, presenting 133 injured teeth with closed apex (56 extrusive luxation, 69 lateral luxation and 8 intrusive luxation) were followed up for a minimum of 24 months. The time elapsed between dental trauma and the initial attendance was recorded. The presence of necrotic pulp and external inflammatory resorption for each type of trauma was verified. Fisher’s exact test was used to verify the influence of the initial attendance date at the Dental Trauma Center and the development of inflammatory resorption (p<0.05). The odds ratio was used to check the risk of developing external inflammatory resorption due to delay in seeking treatment. Pulp necrosis was observed in 105 teeth (78.9%) and external inflammatory resorption was detected in 17.8% cases of extrusive luxation (10 teeth), 15.9% of lateral luxation (11 teeth) and 25% of intrusive luxation (2 teeth). For lateral luxation, extended delay between the date of injury and initial attendance influenced the occurrence of external inflammatory resorption (p=0.0174). Patients who began treatment 45 days after the injury were 3.4 times more likely to develop external inflammatory resorption than patients who sought treatment after the trauma. Treatment late after the occurrence of dental trauma can impair the prognosis and result in the development of external inflammatory resorption in luxated teeth.

Resumo Este estudo clínico investigou e quantificou bactérias cultiváveis e seus níveis de endotoxinas na infecção endodôntica persistente, determinando a sua antigenicidade contra macrófagos e células de fibroblastos através de IL-1β e TNF-α; e avaliando sua relação com características clínicas e radiográficas. As amostras dos canais radiculares foram obtidas após a desobturação. Técnicas de cultura foram utilizadas para determinar a contagem de bactérias e a quantificação de endotoxinas foram determinadas por ensaio de LAL. Análise por PCR (16S rDNA) foi utilizada para a detecção bacteriana. Células 264,5 macrófagos e fibroblastos V79 foram estimuladas com conteúdo endodôntico. IL-1β e TNF-α produzidas pelas células avaliadas foram medidas por ensaio de ELISA. As medianas de bactérias e endotoxinas foram 1,24x105 UFC/mL e 9,62 EU/mL, respectivamente. Porphyromonas endodontalis foi a espécie mais frequentemente detectada. Níveis mais elevados de endotoxinas foram encontrados em dentes com dor à palpação (23,56 EU/mL) quando comparado a sua ausência (8,21 EU/mL). Maiores áreas de destruição óssea foram relacionados com níveis mais elevados de endotoxinas e IL-1β e TNF-α. O estudo revelou presença de espécies de bactérias Gram-negativas em infecção endodôntica persistente, com níveis elevados de endotoxinas relacionados a maior destruição óssea periapical e presença de sintomatologia. Além disso, grandes áreas de destruição óssea foram relacionados com níveis mais elevados de IL-1β e TNF-α secretadas por macrófagos e fibroblastos.

Abstract This clinical study investigated and quantified cultivable bacteria and their levels of endotoxins in persistent endodontic infection, determining their antigenicity against macrophages and fibroblast cells by IL-1β and TNF-α secretion and evaluating their relationship with clinical and radiographic features. Samples from the root canals were obtained after root filling removal. Culture techniques were used to determine the bacterial count and the endotoxins were determined by LAL-assay. PCR analysis (16S rDNA) was used for bacterial detection. Raw 264.5 macrophages and V79 fibroblast were stimulated with endodontic contents. ELISA assay measured the amounts of IL-1ß/TNF-?#61537; secretion. Bacteria and endotoxin medians were 1.24x105 CFU/mL and 9.62 EU/mL, respectively. Porphyromonas endodontalis was the most frequently detected species. Higher levels of endotoxins were found in teeth with pain on palpation (23.56 EU/mL) rather than in its absence (8.21 EU/mL). Larger areas of bone destruction were related to higher levels of endotoxins and IL-1β and TNF-α secretion. The study findings revealed the presence of Gram-negative bacteria species in persistent endodontic infection, with their endotoxins related to both severity of bone destruction and development of symptomatology. Moreover, larger areas of bone destruction were related to higher levels of IL-1β and TNF-α secreted by macrophages and fibroblast cells.