Introdução: A obturação de dentes decíduos deve ser realizada com pastas obturadoras que mantenham o dente em condições compatíveis com saúde até o período de exfoliação. Diversos são os materiais utilizados para este propósito; entretanto, as pastas iodoformadas têm estado em evidencia. A pasta Guedes Pinto é um dos materiais mais utilizados no tratamento endodôntico de dentes decíduos no Brasil. No entanto, ensaios clínicos randomizados (ECR) bem delineados não foram realizados para testar o desempenho clínico deste material. Objetivo: Este ECR de não-inferioridade triplo-cego objetivou avaliar o desempenho de dois materiais obturadores para pulpectomia em dentes decíduos durante dois anos: Pasta Guedes e Pasta Vitapex®, além de fatores relacionados com o sucesso dos tratamentos. Material e métodos: Foram incluídos dentes decíduos com necessidade de tratamento endodôntico em crianças que procuraram atendimento na Faculdade de Odontologia da Universidade de São Paulo. Os tratamentos foram realizados por uma única operadora treinada para os procedimentos, com instrumentação manual e seguindo um protocolo operatório padrão. Após o término do preparo químico mecânico os dentes eram randomizados para um dos dois grupos. A lista de randomização foi gerada em blocos de tamanhos desiguais e estratificada por dentes anteriores e posteriores. Como os dois materiais foram inseridos em seringas idênticas sem identificação relacionada ao grupo que pertenciam, apresentavam cor e radiopacidade semelhantes, o operador, as crianças que receberam o tratamento e o avaliador nos tempos de acompanhamento eram cegos em relação ao tratamento recebido. As crianças foram acompanhadas após 3, 6, 12, 18 e 24 meses com exames clínicos e radiográficos. O desfecho primário foi o sucesso do tratamento na avaliação clínica e radiográfica. Os sucessos de tratamento foram avaliados por análise de sobrevida de Kaplan-Meyer e regressão de Cox ajustada pelo efeito de conglomerado (p <0,05), tendo sido calculados os valores de Hazard Ratio (HR) e respectivos intervalos de confiança a 95% (IC95%). Resultados: Foram tratados 104 dentes de 61 crianças (3-7 anos de idade) e acompanhados por 24 meses (taxa de resposta de 98%). A taxa de sucesso da pasta Vitapex® foi de 78,4% e da pasta Guedes foi de 86,7%. Portanto, a Pasta Guedes não foi significativamente pior do que a pasta obturadora controle (HR=0,57; IC95%=0,20 a 1,60). Dentre as variáveis avaliadas, apenas o diagnóstico inicial apresentou associação significativa com os insucessos, sendo que dentes necrosados falharam mais que dentes vitais (HR=4,95; 95%IC=1,16 a 21,00). Conclusões: A pasta Guedes-Pinto tem desempenho similar à pasta Vitapex®, sendo que ambas apresentam taxa de sucesso satisfatório. Dentes necrosados apresentam um pior prognóstico do que dentes vitais. / Background: The filling procedure of primary teeth should be performed with pastes that maintain the tooth healthy until the period of exfoliation. Several materials are used for this purpose; however, iodoformed pastes have been in evidence. The Guedes Pinto paste is one of the most used materials for endodontic treatment of primary teeth in Brazil. However, well-designed randomized clinical trials (RCT) have not been performed to test this material. Aim: This triple-blind non-inferiority RCT aimed to evaluate the performance of two filling materials for pulpectomy in primary teeth during two years: Guedes paste and Vitapex® paste. Moreover, other factors associated to the treatment success. Material and methods: Primary teeth with necessity of endodontic treatment in children who looked for dental treatment at the School of Dentistry of the University of São Paulo were included. The treatments were performed by a single operator trained for the procedures, with manual instrumentation according to a standard operating protocol. After full canals instrumentation, the teeth were randomly allocated to one of two groups. Randomization was performed using permuted blocks and stratified by anterior or posterior teeth. As the two materials were stored in identical syringes, without identification related to the materials, operator, children who received the treatment and the examiner in the different follow-ups were blinded. according to the treatment received. The children were followed-up for 3, 6, 12, 18 and 24 months with clinical and radiographic assessments. The primary outcome was the success at both clinical and radiographic evaluation. Treatment successes were compared by Kaplan-Meyer survival analysis and Cox regression adjusted by cluster (p<0.05), and Hazard Ratio (HR) values and respective 95% confidence intervals (95%CI) were calculated. Results: 104 teeth from 61 children (3-7 yrs-old) were treated and followed-up (98% response rate). The success rate of the Vitapex® was 78.4% and the Guedes paste was 86.7%. Therefore, Guedes paste was not significantly inferior than the control group (HR=0.57; 95%CI=0.20 to 1.60). Considering other variables, initial diagnosis showed significant association with failures; necrotic teeth had higher failures rates than vital teeth (HR=4.95; 95%CI=1.16 to 21.00). Conclusions: Guedes-Pinto paste presents similar performance than Vitapex® paste, and both present good success rates. Necrotic teeth presents worse prognosis than vital teeth.

A obturação do canal radicular é uma etapa fundamental para o sucesso do tratamento endodôntico. É desejável que os materiais empregados nesta fase não interferiram negativamente com o reparo tecidual, mas preferencialmente estimulem a regeneração dos tecidos periapicais. Recentemente, cones de guta-percha combinados com material biocerâmico foram desenvolvidos com esta finalidade. Sendo assim, o objetivo deste estudo foi investigar o potencial citotóxico e biomodulador de cones de guta-percha convencionais, de cones de guta-percha contendo biocerâmica e de cones de polímero sobre células de ligamento periodontal in vitro. Cultura de fibroblastos de ligamento periodontal foi estabelecida a partir de terceiro molar humano. As células foram estimuladas com extratos de cones de guta-percha convencional, de cones de guta-percha contendo biocerâmica e de cones de polímero em diluição seriada para teste de viabilidade celular por meio do método MTT (Brometo de Difeniltetrazólio 3-(4,5-Dimetiltiazol-2-yl) após 72 h. Em seguida, a diluição de 1/5 foi empregada para estimulação das células por 72 h para detecção da expressão gênica de colágeno tipo I e proteína cementária 1 (CEMP-1) por RT-qPCR. Os dados foram estatisticamente analizados por meio de ANOVA sendo considerados significativos valores de p < 0,05. Os resultados observados de forma que, em extrato puro em extrato puro 1:1, houve comprometimento da viabilidade celular tanto para o extrato de cone de guta-percha quanto para o extrato do cone Cpoint podendo ser considerados citotóxicos. Nas outras diluições não houve diferença significativa neste parâmetro. Em relação à expressão gênica de colágeno, não foram observadas diferenças significativas quando da presença dos extratos. Para CEMP-1, significativa indução da expressão gênica foi observada para o cone de guta-percha. Conclui-se, através da análise dos resultados, que o cone de guta-percha e o cone de polímero são os mais citotóxicos em extrato puro, porém a guta-percha foi o único material que induziu uma expressão significativa de CEMP-1 que auxilia no reparo tecidual. O Col1 não foi induzido em nenhuma das amostras, porém também não foi inibido que indica que nenhum dos 3 tipos de cone interfere no reparo tecidual. / Root canal obturation is a fundamental step for successful endodontic treatment. It is desirable that the materials employed at this stage did not adversely interfere with tissue repair but rather stimulate the regeneration of the periapical tissues. Recently, gutta-percha points combined with bioceramic materials were developed for this purpose. Thus, the objective of this study was to investigate the cytotoxic and biomodulatory potential of conventional gutta-percha points, gutta-percha points containing bioceramics and polymer points on periodontal ligament cells in vitro. Culture of periodontal ligament fibroblasts was established from one human third molar. The cells were stimulated with extracts of cones of conventional gutta-percha points, gutta-percha containing bioceramics and polymer points in serial dilution for cell viability test using the MTT assay [Diphenyltetrazolium Bromide 3- (4,5)]. Next, the 1/5 dilution was used to stimulate the cells for 72 h to detect the gene expression of type I collagen and cement protein 1 (CEMP-1) by RT-qPCR. Data were statistically analyzed by means of ANOVA being considered significant values of p <0.05. The results observed was that in a pure 1: 1 extract, there was impairment of cell viability for both the guta-percha cone extract and the Cpoint cone extract and could be considered cytotoxic. At the other dilutions, no significant difference on this parameter was observed. Regarding the gene expression of collagen, no significant differences were observed at the presence of extracts. For CEMP-1, significant induction of gene expression was observed for gutta-percha points. In conclusion, the analysis of the results showed that the gutta-percha and polymer points are the most cytotoxic at pure extract, however gutta-percha was the only material that induced a significant expression of CEMP-1 which assists the tissue repair. Col1 was not induced in any of the samples but was also not inhibited indicating that none of the 3 cone types interfere in tissue repair.

Purpose: The aim of this study was to assess the outcome of treatment of teeth with open apices managed by the orthograde placement of a bioceramic apical barrier as well as to identify potential outcome factors for this type of treatment. Methods: Patient records were pooled from graduate resident cases completed at Virginia Commonwealth University between January 1, 2010 and May 31, 2018. A total of 515 patients were identified using relevant ADA codes and a key word search within the patient record database. A total of 104 patients (119 teeth) had an open apex that had NSRCT utilizing a bioceramic apical barrier, with 32 of the patients (36 teeth) returning for follow-up. Results: Of the 36 examined teeth (30.8% recall rate),72% were considered healed. 92% were considered healed or healing. No predictive variable analyzed had a significant effect on the outcome. Conclusion: Overall, these results indicate that a bioceramic apical barrier technique is a promising treatment option for obturating teeth with open apices during NSRCT.

Purpose: This study aimed to survey current 3rd and 4th year dental students, academic deans, and department chairs within U.S. dental schools to analyze the level of understanding; education; guidelines; and overall awareness regarding antibiotic use within dentistry and antimicrobial resistance. Methods: A 25-question survey intended for 3rd and 4th year dental students and a 20-question survey intended for academic deans and various department chairs of U.S dental schools were each developed utilizing REDCap. The survey invitations were sent via e-mail to the current academic dean of each U.S. dental school for distribution. Results: There were a total of 18 respondents from the academic dean and department chair survey and 172 student respondents. Overall, 71% of students reported that they could benefit from more education regarding antibiotics. The majority of both groups agreed that dentistry should play an important role in reducing antimicrobial resistance, but most dental students were ‘not at all familiar’ with the term antimicrobial stewardship and several were unsure if clinical guidelines were present at their schools. Conclusion: Improvements to the dental educational curriculum regarding the responsible use of antibiotics, along with the implementation of stewardship programs within dentistry are strongly encouraged.

Purpose: Determine the timeframe of bacterial penetration that occurs to the apex when obturation material (gutta percha) is exposed to bacteria for a set period of time (45 days) and to determine if bacterial penetration of the obturated root is influenced by the type of irrigant used during the final rinse (17% EDTA vs 2% Chlorhexidine vs full strength 5.25% NaOCl). Methods: Thirty-six extracted teeth, including six controls, were instrumented and irrigated with 5.25% NaOCl followed by a final rinse of either: 17% EDTA, 2% Chlorhexidine, or 5.25% NaOCl, and then obturated. Each root was suspended between two chambers: the coronal chamber inoculated with brain heart infusion broth and 〖10〗^8 colony-forming units of Enterococcus faecalis, the apical chamber with brain heart infusion broth. The latter was checked daily for turbidity, indicating bacterial leakage. Results: After excluding teeth with clear indications of experimental failure, 21 teeth were included in the analysis. Leakage rates were not significantly difference across the three groups (Chlorhexidine: 14%, EDTA: 67%, NaOCl: 50%; p-value=0.1581). Time to leakage was not significantly difference across the three groups (p-value=0.2470). Conclusion: Within the limitations of this study it was shown that leakage occurs between 4-42 days and that there was no significant difference between the different solutions in preventing leakage.

Orientador: Rogério de Castilho Jacinto / Coorientador: Frederico Canato Martinho / Banca: Eloi Dezan Junior / Banca: Giselle Prisiclla Cruz Abi Rached / Resumo: O objetivo deste estudo clínico foi avaliar a eficácia de dois sistemas rotatórios: HyFlex CM e ProTaper Next na remoção de bactérias cultiváveis e endotoxinas de canais radiculares infectados. Vinte e quatro canais radiculares de molares e pré-molares com necrose pulpar e lesão periapical foram selecionados e divididos aleatoriamente em 2 grupos: HyFlex CM (n = 12); e ProTaper Next (n = 12). As amostras foram coletadas antes e após o preparo biomecânico e inoculadas em frascos específicos. A irrigação foi realizada com hipoclorito de sódio a 2,5%. Um teste turbidimétrico LAL (Pyrogent 5000 - Lonza, Walkersville, MD, EUA) foi utilizado para quantificar endotoxinas. Cultura microbiológica foi utilizada para determinar a contagem de unidades formadoras de colônias bacterianas (UFC/mL). Os dados coletados foram analisados estatisticamente usando SigmaPlot 12.0 para Windows (Systat Software Inc., San Jose, CA). Foi realizado o teste estatístico de Two-Way ANOVA e o nível de significância foi de 5%. Nas coletas antes do preparo biomecânico, bactérias cultiváveis e endotoxinas foram evidenciadas em 100% das amostras. A análise de cultura revelou que não houve uma diferença estatisticamente significativa na redução bacteriana entre os dois sistemas de instrumentação. As endotoxinas estavam presentes em 100% dos canais após a instrumentação e não houve diferença estatística entre os dois sistemas na redução de endotoxinas. Assim, concluímos que ambos os sistemas de instrumentação for... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The aim of this clinical study was to compare the effectiveness of two rotary systems: HyFlex CM and ProTaper Next on the removal of cultivable bacteria and endotoxins from primarily infected root canals. Twenty-four root canals of molars and premolars with pulp necrosis were selected and randomly divided into 2 groups: HyFlex CM (n = 12); and ProTaper Next (n = 12). Samples were collected before and after the biomechanical preparation and inoculated in specific flasks. Irrigation was performed using 2.5% sodium hypochlorite. A kinetic turbidimetric lysate assay of limulus amoebocytes was used to quantify endotoxins. Microbiological culture was used to determine the count of bacterial colony forming units (CFU/mL). Data collected were statistically analyzed using SigmaPlot 12.0 for Windows (Systat Software Inc, San Jose, CA). The Two-Way ANOVA statistical test was performed and the level of significance was 5%. In the samples before the biomechanical preparation, cultivable bacteria and endotoxins were evidenced in 100% of the cases. The culture analysis revealed that there was no statistically significant difference in the bacterial reduction between the two instrumentation systems. Endotoxins were present in 100% of the canals after instrumentation, and there was no statistical difference between the two systems in endotoxin reduction. Thus, it was concluded that both instrumentation systems were effective in reducing root canal bacteria and endotoxins with primary endodont... (Complete abstract click electronic access below) / Mestre

Orientador: Eloi Dezan Junior / Banca: Luciano Tavares Angelo Cintra / Banca: Maria Angélica Marciano da Silva / Banca: Juliane Maria Guerreiro Tanomaru / Banca: Francine Benetti / Resumo: Introdução: O tratamento endodôntico visa manter ou restabelecer a saúde do periodonto através do preparo biomecânico, utilizando instrumentos de níquel- titânio automatizados e associados com insertos ultrassônicos para potencializar a ação dos irrigantes. Os materiais empregados na endodontia que permanecerão em contato com tecidos devem apresentar biocompatibilidade e preferencialmente ser biomineralizador, a fim de selar comunicações (fisiológicas/iatrogênicas), isolando o sistema de canais radiculares. Objetivos: 1- Avaliar a resistência à fadiga cíclica das limas reciprocantes Genius e EdgeFile X1 Small, comparados à lima WaveOne Gold Primary; 2- Avaliar a capacidade de limpeza de um inserto ultrassônico de níquel titânio em ativação da irrigação de forma contínua e passiva; 3- Avaliar a biocompatiblidade e biomineralização do cimento reparador MTA Flow. Material e Métodos: Para avaliar a resistência à fadiga cíclica dos sistemas Genius, EdgeFile e WaveOne Gold, 80 instrumentos foram utilizados (n=20), divididos em 4 grupos experimentais: Genius 25.04, Genius 30.04; EdgeFile X1 Small e Wave One Gold Primary, acionados em um canal artificial de aço inoxidável com ângulo de curvatura de 60º e raio de curvatura de 5 mm. O tempo decorrido da ativação do motor foi gravado em um cronômetro digital e parado assim que a fratura foi detectada. O número de ciclos até a falha (NCF) e o tempo para fratura (TF) foram calculados e os comprime... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: The endodontic treatment aims to maintain or restore periodontal health through biomechanical instrumentation with nickel-titanium automatized instruments, associated with an ultrasonic tip to activate the irrigant, enhancing cleanness. Materials used in endodontics that will remain in contact with tissues, should demonstrate properties as biocompatibility and biomineralization ability, in order to seal communications (physiological/iatrogenic) isolating the root canal system. Objectives: 1- Evaluate the cyclic fatigue resistance of reciprocating Genius and EdgeFile X1 Small instruments compared to Waveone Gold Primary instruments; 2- Evaluate the cleaning effectiveness of a nickel-titanium ultrasonic tip in continuous and passive irrigant activation; 3-Evaluate the biocompatibility and biomineralization of MTA Flow repair cement. Materials and Methods: To evaluate the cyclic fatigue resistance of Genius, EdgeFile and WaveOne Gold, 80 instruments were used (n = 20), divided into 4 experimental groups: Genius 25.04, Genius 30.04; EdgeFile X1 Small and Wave One Gold Primary, reciprocating in a stainless steel artificial canal with a 60° angle of curvature and 5mm radius of curvature. The elapsed time of the motor activation was recorded in a digital timer and stopped as soon as the fracture was detected. The number of cycles to fracture (NCF) and time to fracture (TF) were calculated and the fractured segments lengths measured. To evaluate the ultrasonic tip clean... (Complete abstract click electronic access below) / Doutor

Includes bibliographical references. / 2 v. : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Presents a survey of the author's investigations into endodontic problems in Australia and a review of his development of a new treatment for invasive cervical resorption using trichloracetic acid. / Thesis (D.D.Sc.)--Adelaide University, Dept. of Dentistry, 2001

The purpose of this study was to determine duration time, breakage and apical displacement, whilst using six different endodontic filing systems to prepare molar teeth. A total of 96 molar teeth were used in the study, divided equally, ie 16 teeth per system selected randomly, totalling 48 canals per system. A standardised access cavity was prepared for all the teeth before selection. The canals were filed according to the manufacturers&rsquo / guidelines. The result showed that PROTAPER&reg / , K3&trade / and the combination of: HERO Shaper&reg / , HERO Apical&reg / and Endoflare&reg / (Referred from hereon as HERO System for convenience) were statistically faster than PROFILE&reg / and FlexMaster&reg / , which were in turn faster than AETTM. Although breakage did occur in K3&trade / and HERO System this was not deemed statistically significant. Apical displacement occurred in the form of Type 1 in the AETTM, PROFILE&reg / and HERO System, but once again this was not statistically significant. It was concluded that more aggressive cutting features such as a positive rake<br /> angle, pyramidal shaped tip, progressive taper and absence of radial lands, if present, could have enabled K3&trade / , HERO System and PROTAPER&reg / to have faster times, and in addition these features did not compromise these systems with regard to apical foramina transportation and breakage.

Thesis (M.Sc. (Odontology)) -- University of Pretoria, 2007. / Includes bibliographical references.