Smear layer influence on the apical seal of four different obturation techniques

The purpose of this study was the in vitro evaluation of four techniques for the obturation of the root canal system in the presence or absence of a smear layer. Ninety-six human upper central incisors were instrumented using the pressureless crown-down technique and irrigated with 5.25% NaOCl. The teeth that had the smear layer removed were irrigated with this solution in combination with 17% EDTA. The teeth were obturated with lateral condensation with an accessory or standardized cone as the main cone, with vertical condensation of warm gutta-percha or with thermoplasticized injectable gutta-percha. Apical leakage was assessed by measuring the linear penetration of methylene blue dye with a stereomicroscope. The results showed no significant differences in the degree of leakage with and without the smear layer when the samples were considered as a whole. However, when the groups were assessed separately, teeth in the lateral condensation with an accessory main cone group and teeth in the thermoplasticized group leaked less with a smear layer present. In contrast teeth with lateral condensation and a standardized main cone leaked more with a smear layer present. In the vertical condensation groups there was no difference attributable to the smear layer.     

Biocompatibility of sealers used in apical surgery: a histological study in rat subcutaneous tissue

The aim of this study was to evaluate the biocompatibility of sealers used in apical surgery in rat subcutaneous tissue. Sterile polyethylene tubes were filled with the following sealers: Sealapex, Sealapex with addition of zinc oxide, Sealer 26, Sealer 26 with thicker consistency (greater powder-to-resin ratio) and White MTA. The tubes were implanted in the dorsum of male rats and after 7, 21 and 42 days, the animals were killed, obtaining 5 specimens for each sealer in each evaluation period. The lateral surface of the tube was used as negative control. The inflammatory reaction to contact with the sealers was classified as absent, mild, moderate and severe. At 7 days, all sealers caused similar inflammatory reactions in the connective tissue of the animals, with most specimens presenting a moderate to intense chronic inflammatory reaction, with presence of multinucleated giant cells. At 21 days, Sealer 26 and Sealer 26 with thicker consistency presented more intense inflammatory reaction (p=0.004), whereas after 42 days, the inflammatory reaction ranged from absent to mild with statistically similar results for both materials (p=0.08). Except for MTA, all sealers presented foreign-body granulomatous reaction at 42 days. All sealers but Sealapex presented a statistically significant decrease of the inflammatory reaction over time. In conclusion, all sealers caused moderate to severe inflammation in the earlier evaluation period. However, Sealer 26 and Sealer 26 with thicker consistency caused more intense inflammatory reactions after 21 days of contact with the tissues and no granulomatous reaction was observed for MTA at the final period of analysis.     

Chlorhexidine induces DNA damage in rat peripheral leukocytes and oral mucosal cells

OBJECTIVE: Chlorhexidine digluconate is widely used in dental practice for decreasing plaque control, controlling gingivitis and disinfecting root canals. However, the undesirable effects of chlorhexidine digluconate regarding its genotoxicity are conflicting in the literature. Thus, the aim of this study was to investigate the genotoxicity of chlorhexidine digluconate in rat peripheral blood and oral mucosal cells by the single cell gel (comet) assay and micronucleus assay. METHODS: Thirty male Wistar rats were distributed into three groups: negative control; experimental group orally treated with 0.5 ml of 0.12% chlorhexidine digluconate, twice daily, during 8 days; and positive control, which received 4-nitroquinoline 1-oxide at 0.5 g/l by drinking water. RESULTS: A statistically significant increase of DNA damage was observed in leukocytes and oral mucosal cells of the chlorhexidine digluconate treated group, as assessed by the comet assay. However, no increase of micronucleated cells was detected in reticulocytes from peripheral blood cells. CONCLUSIONS: Taken together, the data indicate that chlorhexidine digluconate is able to induce primary DNA damage in leukocytes and in oral mucosal cells, but no chromosome breakage or loss in erythrocytes.     

Effect of peroxide-based bleaching agents on enamel ultimate tensile strength

This study evaluated the effects of peroxide bleaching regimens on the ultimate tensile strength (UTS) of human enamel. A resin composite block was built-up on the bonded occlusal surface of 14 extracted, sound, erupted third molars to enable posterior preparation for the microtensile test. The bonded teeth were serially sectioned in a buccal-lingual direction into approximately 0.7-mm thick slices. Each slice was trimmed with a fine diamond bur to reduce the area of the buccal, internal slope of the cusps to a dumb-bell shape with a cross-sectional area of less than 1 mm2. The samples were randomly divided into seven groups (n = 10): unbleached control group and bleached groups treated with six bleaching regimens. The specimens were tested in tension at 0.5 mm/minute and the data were analyzed by ANOVA and Tukey test. Specimens from the control group presented 51.3 +/- 8.6 MPa, while the UTS of bleached enamel ranged from 22.0 +/- 5.6 to 36.3 +/- 9.1 MPa. All bleaching procedures significantly reduced enamel UTS (p < 0.05). Differences were also observed among treatments. The results suggested that bleaching regimens can significantly reduce enamel UTS.     

Chemoluminescence generation and MTT dye reduction by polymorphonuclear leukocytes from periodontal disease patients

Alterations of polymorphonuclear leukocytes (PMNs) functions have been reported in patients with severe forms of some periodontal disease. In this study we evaluated the chemoluminescence generation and MTT dye reduction by human PMN in patients with juvenile periodontitis (JP), rapidly progressive periodontitis (RPP) and adult periodontitis (AP) during protein kinase C (PKC) activation or during the phagocytosis of opsonized zymosan. The results demonstrated that only PMNs of JP patients showed a decreased chemoluminescence generation and MTT dye reduction during the phagocytosis of opsonized zymosan (p < 0.05). The time to reach the maximal peak during the PKC activation on the chemoluminescence reaction was evaluated and JP PMNs patients demonstrated a depressed value (7.0 ± 0.4 min) compared with healthy volunteers (13.8 ± 0.5 min). The etiology and importance of such cellular alterations in the immunopathogenesis of the periodontal disease are discussed.     

Biofilm on the apical region of roots in primary teeth with vital and necrotic pulps with or without radiographically evident apical pathosis

Aim  To evaluate, by scanning electron microscopy (SEM), the presence of biofilms on the external surfaces of the apical third of roots of human primary teeth with vital or necrotic pulps with and without radiographically evident periradicular pathosis.
Methodology  Eighteen teeth were selected: group I – normal pulp ( n  = 5), group II – pulp necrosis without radiographic evidence of periapical pathosis ( n  = 7) and group III – pulp necrosis with well-defined radiographic periapical pathosis ( n  = 6). After extraction, the teeth were washed with saline and immersed in 0.03 g mL⁻¹ trypsin solution for 20 min. The teeth were then washed in sodium cacodilate buffer and stored in receptacles containing modified Karnovsky solution. The teeth were sectioned, dehydrated in an ethanol series, critical-point dried with CO₂, sputter coated with gold and the external root surface in the apical third examined by SEM.
Results  In the teeth of groups I and II, the apical root surfaces were covered by collagen fibres, with no evidence of bacteria (100%). In the teeth of group III, the root apices had no collagen fibres but revealed resorptive areas containing microorganisms (cocci, bacilli, filaments and spirochetes) in all cases (100%).
Conclusion  Microorganisms organized as biofilms on the external root surface (extraradicular infection) were detected in primary teeth with pulp necrosis and radiographically visible periapical pathosis.     

A preliminary protocol for multi-professional centers for the determination of signs and symptoms of temporomandibular disorders

The objective of the present study was to test a protocol for the quantification of the frequency and severity of signs and symptoms of temporomandibular disorders (TMD) according to patient perception during two phases of investigation. The protocol was developed based on the signs and symptoms most frequently reported in the literature and on the circumstances in which they produce discomfort. Eighty-four patients diagnosed with TMD by functional examination of the masticatory system responded to the protocol questions and indicated the severity of signs and symptoms using an eleven point numerical scale (Phase 1). Forty-two patients were fitted with an occlusal splint (treated group) and the remaining participants did not use a splint (control group). The protocol questions were asked after 50 days of treatment (Phase 2). Based on the results of nonparametric statistical analysis, the incidence of signs and symptoms was high in Phase 1 and significant, with no difference between the groups, whereas the treated and control groups differed in Phase 2. A comparison between Phases 1 and 2 showed that only the treated group presented a reduction in the severity of signs and symptoms. The study showed that using this protocol, it is possible to define the frequency and severity of symptoms as well as the effect of the treatment. The advantage of this protocol is that it would complement the data obtained using clinical examination with information provided by the patient in a measurable manner.     

EVALUATION OF APICAL DEVIATION IN ROOT CANALS INSTRUMENTED WITH K3 AND ProTaper SYSTEMS

Objectives:

this study evaluated the apical deviation of curved root canals instrumented with K3 and ProTaper systems.

Material and methods:

twenty root canals of human maxillary and mandibular first molars were employed, which were divided into 2 groups: group A (10 teeth) was instrumented with the K3 system, and group B (10 teeth) with the ProTaper system. Evaluation of deviation was performed by double radiographic exposure. Radiographs were achieved before and after instrumentation, with 0.3-second, thus allowing superimposition of images. Three-dimensional computerized tomograph was performed in 3 specimens in each group, as an additional means to evaluate the apical deviation.

Results:

were evaluated by the parametric test Student-Newman-Keuls at 5%, which did not reveal significance between groups concerning the apical deviation. The results of computerized tomograph images demonstrated that the larger deviation of the root canal occurred at the distolingual area for both systems.

Conclusions:

both techniques produced a mild apical deviation. Computerized microtomography was shown to be accurate for experimental endodontics studies.     

A morphological and tensile bond strength evaluation of an unfilled adhesive with low-viscosity composites and a filled adhesive in one and two coats

OBJECTIVE: The purpose of this study was to measure the tensile bond strength (TBS) testing of resin composite to dentin of three low-viscosity composites, in association with an unfilled adhesive, and a filled adhesive one and two coats respectively, and to evaluate and compare the SEM morphological observations. METHODS: The labial surface of 120 bovine lower incisors were ground to obtain a flat dentin surface allowing demarcation of a 4 mm diameter area with adhesive tape. The teeth were randomly divided in six groups of 20 each. The dentin of each ground surface was etched with 35% H(3)PO(4) for 15s, followed by application of the respective adhesive: Single Bond (SB) for Groups 1, 2, 3 and 6; Optibond Solo (OS) for Groups 4 and 5. In Groups 1 and 4, a resin composite rod with a wire loop was luted directly to the adhesive surface with Z100. Group 2 received an intermediate layer of Flow It (FI) composite; Group 3 received an intermediate layer of Protect Liner F (PLF) composite; Group 5 received a second coat of OS; and Group 6 received an intermediate layer of an experimental low-viscosity composite (EM). A resin composite rod was luted to the surface of each specimen with Z100 resin composite. All specimens were stored in distilled water at 37 degrees C for 24h prior to TBS testing. Each specimen was inspected by SEM and classified according to adhesive or cohesive failure mode. One specimen of each group was cut longitudinally, polished and prepared for SEM observation. RESULTS: The TBS values were: Group 1 (7.86MPa+/-2.28), Group 2 (7.62MPa+/-1.85), Group 3 (7.60MPa+/-2.14), Group 4 (7.96MPa+/-2.36), Group 5 (7.50MPa+/-2.70) and Group 6 (7.18MPa+/-2.40). No significant statistical differences were observed among the groups. However, the analyses of the failure mode presented a considerable variation. SIGNIFICANCE: The use of a filled adhesive or an unfilled adhesive along with a low-viscosity composite as an intermediate layer may provide a stress absorbing layer, whereby improving the preservation of the bonded interface area.     

Delayed neutrophil apoptosis in chronic periodontitis patients

BACKGROUND, AIMS: Neutrophil cells constitute the first defense barrier against the oral bacterial challenge in the periodontium. Reduction of neutrophils could impair this response against periopathogenic bacteria such as Porphyromonas gingivalis. Our previous work implicates the apoptosis of neutrophils in the pathogenesis of periodontitis. We now demonstrate that granulocyte monocyte-colony stimulating factor (GM-CSF) present in the gingival crevicular fluid (GCF) and secreted during the immune response reduces the apoptosis of neutrophils. METHOD: In this study, the presence of GM-CSF and tumor necrosis factor-alpha (TNF-alpha) in GCF was determined in samples obtained from adult patients with periodontitis and from control subjects with clinically healthy gingiva. GCF was collected for 30 s using Periopaper(R) strips, and cytokines were quantified by ELISA. We used ex vivo culture of gingival tissue biopsies for 2 and 4 days in the presence of GM-CSF. Apoptosis was determined using the terminal TdT-mediated dUTP-biotin nick end labeling (TUNEL) technique, and expression of Bax by immunohistochemistry. RESULTS: The presence of GM-CSF and TNF-alpha was detected in the majority of sites from periodontal patients (83.3% and 63.3%, respectively), presenting a total amount of 27.65 and 42.38 pg, respectively. GM-CSF reduces the neutrophil apoptosis determined by double staining with TUNEL and myeloperoxidase and by a reduction of Bax expression. CONCLUSIONS: These findings suggest a novel mechanism by which neutrophils specifically accumulate in adult patients with periodontitis.