Physicochemical,biological, and antibacterial evaluation of tricalcium silicate-based reparative cements with different radiopacifiers

ObjectiveTo evaluate tricalcium silicate-based (TCS) experimental materials, associated with zirconium oxide (ZrO₂), calcium tungstate (CaWO₄) or niobium oxide (Nb₂O₅) radiopacifiers, in comparison with MTA Repair HP (Angelus).MethodsPhysicochemical tests: setting time, radiopacity, pH and solubility. In vitro assays: cytotoxicity: MTT and Neutral Red – NR; cell bioactivity: alkaline phosphatase activity (ALP), Alzarin red staining (ARS) and real time PCR (qPCR). Antibacterial activity: direct contact on Enterococcus faecalis in the planktonic form. Physicochemical and ARS data were submitted to ANOVA/Tukey tests; antibacterial activity, to Kruskall–Wallis and Dunn tests; MTT, NR, ALP and qPCR were analyzed by ANOVA/Bonferroni tests (α = 0.05).ResultsTCS + CaWO₄ presented the longest setting time and MTA HP the shortest. Except for TCS, all the materials presented radiopacity above 3 mmAl. The cements had alkaline pH, antibacterial activity, low solubility and no cytotoxic effects. The highest ALP activity occurred in 14 days, especially to TCS, TCS + ZrO₂ and TCS + CaWO₄. TCS + ZrO₂, TCS + Nb₂O₅ and MTAHP had higher mineralized nodule formation than those of the negative control (NC). After 7 days, there was no difference in mRNA expression for ALP, when compared to NC. However, after 14 days there was no overexpressed ALP mRNA, especially TCS + Nb₂O₅, in relation to the CN. All the materials presented antimicrobial action.SignificanceThe pure tricalcium silicate associated with ZrO₂, CaWO₄ or Nb₂O₅ had appropriate physicochemical properties, antibacterial activity, cytocompatibility and induced mineralization in Saos-2, indicating their use as reparative materials.     

Postoperative Pain after Treatment Using the GentleWave System: A Randomized Controlled Trial

IntroductionCleaning and shaping are necessary to allow for the delivery of irrigants and medicaments to the apical third of the canal. Standard treatment irrigation generally uses a conventional needle and some frequency of sonic activation. The GentleWave System (GWS; Sonendo, Inc, Laguna Hills, CA) combines irrigant delivery with multisonic activation. This randomized clinical trial aimed to determine if the GWS significantly decreases the incidence and intensity of postoperative pain.MethodsPatients used a numeric rating scale to record their pain level at the 6-hour time point before treatment. All participants were randomly divided into 2 groups and were blind to the treatment they received. The standard (control) group received endodontic treatment with conventional side-vented needle irrigation and ultrasonic activation. The second group received treatment with the GWS. Following treatment, patients used a numeric rating scale to record their pain level at 6, 24, 72, and 168 hours.ResultsIn the standard treatment group, 72.2% of patients experienced at least 1 occurrence of postoperative pain, whereas in the GWS group, 83.3% of patients experienced at least 1 occurrence of postoperative pain. The highest pain intensity level for both treatments occurred at the 6-hour posttreatment time point. All pain decreased with time after the 6-hour posttreatment time point (P < 1.237e⁻⁷).ConclusionsThere was no significant difference in the incidence or intensity of postoperative pain after either treatment group. However, both groups reported a statistically significant decrease in pain with time.     

Analysis of the reaction of subcutaneous tissues in rats and the antimicrobial activity of calcium hydroxide paste used in association with different substances

The aim of this study was to evaluate the subcutaneous tissue response in rats and the antimicrobial activity of intracanal calcium hydroxide dressings mixed with different substances against E. faecalis. Fifty four rats were divided into three experimental groups according to the vehicle in the calcium hydroxide treatment: 0.4% chlorohexidine in propylene glycol (PG), Casearia sylvestris Sw in PG and calcium hydroxide+PG (control group). The pastes were placed into polyethylene tubes and implanted into the subcutaneous tissue. After 7, 14 and 30 days, the samples were processed and histologically evaluated (hematoxylin and eosin). The tissue surface in contact with the material was analyzed, and the quantitative analysis determined the volume density occupied by the inflammatory infiltrate (giant cells, polymorphonuclear cells and mononuclear cells), fibroblasts, collagen fibers and blood vessels. For the antimicrobial analysis, 20 dentin blocks infected with E. faecalis were treated with calcium hydroxide pastes in different vehicles; 0.4% chlorhexidine in PG, PG, extract from Casearia sylvestris Sw in PG and a positive control (infection and without medication) for 7 days. The efficiency of the pastes was evaluated by the live/dead technique and confocal microscopy. The results showed that 0.4% chlorhexidine induced a higher inflammatory response than the other groups. The Casearia sylvestris Sw extract showed satisfactory results in relation to the intensity of the inflammatory response. In the microbiological test, there were no statistical differences between the evaluated intracanal dressings and the percentage of bacterial viability was between 33 and 42%. The control group showed an 86% viability. Antimicrobial components such as chlorhexidine or Casearia sylvestris Sw did not improve the antimicrobial activity against E. faecalis in comparison to the calcium hydroxide+PG treatment. In addition, the incorporation of chlorhexidine in the calcium hydroxide paste promoted the highest inflammatory response.     

Effect of low-level laser therapy on postoperative endodontic pain: An updated systematic review

ObjectiveTo evaluate the influence of low-level laser therapy (LLLT) on postoperative pain after endodontic treatment.MethodsThe PICOS strategy was used to identify randomized clinical trials comparing low-level laser therapy and mock laser therapy to manage postoperative pain after endodontic treatment, retreatment, and endodontic surgery. An electronic search was performed in MEDLINE through PubMed, Web of Science, LILACS, Scopus and Cochrane Library, OpenGrey and Google Scholar. Quality assessment was performed using the Cochrane Collaboration’s tool for assessing the risk of bias. The quality of evidence was rated on the basis of the GRADE approach.ResultsTwelve studies were included in the qualitative synthesis. Within the 12 studies, 7 articles were classified as “low risk of bias,” 4 studies were considered “unclear risk of bias” and 1 study was considered "high risk of bias." Six studies evaluated the postoperative pain after primary root canal treatment, two studies after root canal retreatment and four after periapical surgery. Most of the studies reported significantly less postoperative pain after LLLT in different time periods; two studies found no differences. The certainty of evidence was classified as low and very low to treatment / retreatment and endodontic surgery, respectively.ConclusionsBased on the limited quality evidence, most of the included studies reported significantly less postoperative pain after LLLT. However, the lack of standardization in laser parameters, use of medications and the certainty of evidence classified as low and very low indicate the need for further studies.     

Quality Assessment of Randomized Clinical Trials Reporting in Endodontic Journals: An Observational Study from 2012 to 2017

Introduction

Reports on randomized clinical trials (RCTs) are of critical importance because readers of research often do not access the full text. This study aimed to assess the reporting quality of RCTs in 2 leading endodontic journals.

Development of a Basic Root canal Treatment (BRT) for primary oral health care — evaluation after one year

Objectives : Atraumatic Restorative Treatment (ART) was a major step forward in community dentistry but treatment options for deep carious lesions or pulp involvement still focus on tooth extraction in under‐served areas worldwide. To bridge the gap between ART and extraction this pilot study aimed to develop and follow‐up a basic root canal treatment for rural dental health facilities in the Republic of The Gambia (West Africa), faced with an environment lacking technical equipment and developing primary oral health care. Methods : 25 single rooted teeth with acute irreversible pulpitis were root canal treated with a standardised endodontic instrument kit and a specific procedure. A step‐back technique was used with intermittent chlorhexidine 0.2% and saline irrigation. Root canal obturation was performed using a single‐cone technique with gutta‐percha using Grossman's root canal cement. Coronal filling was carried out by using ART. Clinical examinations were documented before treatment, one day, five days, six months and twelve months postoperatively. Results : None of the root canal fillings had to be revised due to postoperative complications. In 9 out of 25 teeth, transitory apical pain disappeared after a few days. After six months, all ART fillings appeared clinically acceptable, two fillings had to be corrected. Four class II restorations and three class IV restorations needed replacement after 12 months. Patients' assessment of health related quality of life improved significantly, especially concerning dental pain, chewing ability and fitness for work. Conclusions : Preliminary clinical follow‐ups showed encouraging results for the basic root canal treatment approach. Longitudinal clinical studies with greater populations are required to substantiate these results. Modifications in the coronal filling technique are preferable to improve the clinical performance of extended ART cavity restorations.     

Root canal medicaments

The ultimate goals of endodontic treatment are complete removal of bacteria, their byproducts and pulpal remnants from infected root canals and the complete seal of disinfected root canals. Intracanal medicaments have been thought an essential step in killing the bacteria in root canals; however, in modern endodontics, shaping and cleaning may be assuming greater importance than intracanal medicaments as a means of disinfecting root canals. Until recently, formocresol and its relatives were frequently used as intracanal medicaments, but it was pointed out that such bactericidal chemicals dressed in the canal distributed to the whole body from the root apex and so might induce various harmful effects including allergies. Furthermore, as these medicaments are potent carcinogenic agents, there is no indication for these chemicals in modern endodontic treatment. Today, biocompatibility and stability are essential properties for intracanal medicaments. The more modern meaning of intracanal dressing is for a blockade against coronal leakage from the gap between filling materials and cavity wall. Calcium hydroxide has been determined as suitable for use as an intracanal medicament as it is stable for long periods, harmless to the body, and bactericidal in a limited area. It also induces hard tissue formation and is effective for stopping inflammatory exudates. Single‐visit endodontics, where intracanal medicaments are not used, is generally not now contraindicated and various reports have shown that the clinical outcomes between single‐ and multiple‐ visit endodontics are similar. There is no reason to counsel against single‐visit endodontics: however, if multiple‐visit endodontics is chosen, calcium hydroxide is recommended to be used as an intracanal medicament.     

What Is the Microbial Profile in Persistent Endodontic Infections? A Scoping Review

IntroductionThis scoping review aimed to map the evidence about the microbiota found in persistent endodontic infections.MethodsThe study protocol was prospectively registered and is available at https://osf.io/3g2cp. The electronic search was performed in MEDLINE via PubMed, Lilacs, BBO, Scopus, Web of Science, Cochrane Library, and Embase. The eligibility criteria were based on the PCC acronym, where P (Population) represents patients with teeth presenting persistent endodontic infection, C (Concept) represents microbial profile, and C (Context) represents undergoing endodontic retreatment. Clinical studies that evaluated the microbial profile of samples collected from root canals of teeth undergoing retreatment, using classical or molecular methods, were included. Studies that did not show a minimum period of 1 year between primary endodontic treatment and retreatment or did not radiographically evaluate the quality of primary root canal filling were excluded. Two reviewers independently selected the articles and collected data.ResultsFrom a total of 957 articles, 161 were read in full, and 32 studies were included. The most prevalent species were Enterococcus faecalis, Parvimonas micra, Porphyromonas endodontalis, Porphyromonas gingivalis, Prevotella intermedia, Dialister invisus, Propionibacterium acnes, Tannerella forsythia, and Treponema denticola. Cases with symptomatology or inadequate root canal filling presented an increase in specific bacterial species compared to those with no symptomatology or adequate filling. A greater number of microorganisms was observed in teeth with inadequate coronal restoration compared to those with adequate restoration.ConclusionsPersistent endodontic infections have a polymicrobial profile identified by the commonly used methods for bacterial detection/identification and are subject to the limitations present in each of those methods.