O objetivo deste estudo foi avaliar o pH e a liberação de íons cálcio dos cimentos AH Plus, MTA Fillapex e Sealapex, em diferentes períodos, quando empregados em obturações de canais radiculares, bem como, a qualidade das obturações, após 1 ano de realizadas. O pH e a liberação de íons cálcio foram avaliados por meio de um peagômetro e espectrofotômetro de absorção atômica, respectivamente. A qualidade das obturações foi avaliada por meio de um estereomicroscópio. Cento e vinte e quatro pré-molares inferiores humanos extraídos, unirradiculados, foram divididos em 01 grupo controle e 02 grupos experimentais, de acordo com a padronização do diâmetro do forame apical. Em seguida, os 02 grupos experimentais foram divididos em 4 subgrupos, considerando as técnicas de instrumentação e obturação empregadas. Após o preparo dos canais radiculares cada subgrupo teve o número de dentes divididos por dois, formando novos subgrupos, de acordo com os cimentos obturadores utilizados. Imediatamente após a obturação, a raiz de cada dente foi imersa em 15 mL de água ultrapura para avaliação do pH e liberação de íons cálcio nos seguintes períodos: 1 h, 1, 3, 7, 30, 180 e 365 dias, após a obturação. Após o período de 1 ano, os dentes foram seccionados transversalmente a 2, 4, 6 mm do forame apical para análise da qualidade das obturações, analisando-se a porcentagem de cimento, guta-percha e espaços vazios na massa obturadora. Os cimentos apresentaram pH neutro, porém, aos 180 dias, os valores mostraram um ligeiro aumento quando utilizados em canais com forames de diâmetro 0,25 mm. Quando utilizados em canais com forames de diâmetro 0,45 mm, o pH mostrou-se com valores maiores para todos os períodos sem distinção do cimento. Todos os cimentos liberaram íons cálcio, com menores valores para o AH Plus. Na estereomicroscopia, observaram-se variações nas porcentagens de cimento e guta-percha, considerando-se os diâmetros foraminais e técnicas obturadoras, e porcentagem insignificante de espaços vazios. / The objective of this study was to evaluate the pH and calcium ion release of AH Plus, MTA Fillapex and Sealapex cements at different time periods when used in root canal obturations, as well as the quality of the obturations one year after being performed. The pH and calcium ion release were evaluated by means of a pH meter and an atomic absorption spectrophotometer, respectively. The quality of the obturations was evaluated using a stereomicroscope. One hundred and twenty-four extracted human uniradicular mandibular premolars were divided into 1 control and 2 experimental groups, according to the standardization of the apical foramen diameter. Next, the 2 experimental groups were divided into 4 subgroups, considering the instrumentation techniques and obturations employed. After the preparation of the root canals, each subgroup had the number of teeth divided by two, forming new subgroups, according to the sealers used. Immediately after the obturation, the root of each tooth was immersed in 15 mL of ultrapure water for the evaluation of the pH and calcium ion release in the following time periods: 1 hr, 1, 3, 7, 30, 180 and 365 days after the obturation. After the period of one year, the teeth were transversely sectioned at 2, 4 and 6 mm from the root apex to examine the quality of the obturations, analyzing the percentage of cement, gutta-percha and voids in the obturator mass. The cements presented a neutral pH, which showed slightly increase as of 180 days when used in canals with foramens of 0.25 mm diameters. When used in canals with foramens with diameters of 0.45 mm, the pH presented higher values in all periods for all cements. All cements released calcium ions, with lower values for the AH Plus. In the stereomicroscopy, there were variations in the percentages of cement and gutta-percha, considering the foraminal diameters and obturation techniques and an insignificant percentage of voids.

O presente estudo teve por objetivo avaliar comparativamente o emprego de tomografias e cortes transversais na quantificação de material obturador endodôntico remanescente à desobturação e repreparo dos canais radiculares. Para tal, 32 dentes preparados, obturados e após periodo necessário para o ennvelhecimento do cimento obturador foram desobturados e repreparados. Os espécimes tiveram o conteúdo de material obturador remanescente avaliado por diferentes métodos: aferição em tomógrafo computadorizado de múltiplos detectores e aferição em software Leica Qwin. Inicialmente foram medidos os volumes de material obturador remanescente no tomógrafo computadorizado com os espécimes ainda íntegros. Em seqüência, realizou-se nos mesmos cortes transversais com espessura de 1mm permitindo assim aferição: do volume em tomógrafo computadorizado após o corte; das áreas de material remanescente em cada corte com auxílio do software Leica Qwin. Para que fosse possível a comparação dos métodos, os valores de área foram utilizados para cálculo do volume de material remanescente em cada espécime através da fórmula do volume do cone truncado. Os resultados obtidos foram submetidos a análise pelo teste t de Student para dados vinculados, o qual identificou diferença estatisticamente significante em nível de 5% na quantificação de material obturador remanescente quando da comparação dos volumes obtidos com a análise do software Leica Qwin e aplicação da fórmula do volume do cone 11 truncado aos volumes obtidos pelas aferições tomográficas, sendo que a análise dos cortes pelo software Leica Qwin permitiu maior quantificação de material, mostrandose método adequado para análise. Em relação ao método tomográfico não houve diferença estatística significante entre a avaliação do remanescente de material obturador nos cortes ou nos espécimes íntegros. / The aim of the present study was to evaluate the effectiveness of computed tomography and cross section in quantifying the remaining filling material during retreatment. For that, 32 teeth were prepared, filled and after the period necessary to the sealer set, the specimens had their filling material removed and were reprepared. The amount of filling material were evaluate for different methods: computed tomography and Leica Qwin software. First, the volumes of filling material remaining were measured through the computed tomography with the specimens still entire. After, they were cross sectioned with a thickness of 1mm allowing measure of: the volume through computed tomography and the areas of remaining material in which section through the Leica Qwin software. To allow a comparative analysis among methods, the area values were used to calculate the filling material remaining volume using the truncated cone formula. The results were submitted to the t Student test for linked data which identify a significant difference to the level of 5% in the quantification of remaining material when the comparison of the volumes obtained after Leica Qwin analysis and application of truncated cone formula in relation to the results obtained from computed tomography, being the first method that allow the bigger quantification, therefore, most efficient. In relation the tomographic method there was no significant difference between the measured made in the intact specimen or after they were cross-sectioned.

O presente estudo teve como objetivo avaliar a influência do protocolo de secagem com álcool isopropílico à adesividade dos cimentos AH Plus, Hybrid Root Seal e Epiphany SE à dentina radicular. Oitenta raízes de caninos foram submetidas ao preparo biomecânico e distribuídas em 2 grupos de acordo com a secagem, previamente a obturação: I- Secagem cone de papel absorvente e II- Secagem com álcool isopropílico 70%,e posteriormente distribuídas em 8 grupos (n=10): IA e IIA cimento AH Plus; IB e IIB - cimento Hybrid Root Seal; IC e IIC- cimento Epiphany SE com guta percha e ID e IID cimento Epiphany SE com Resilon. Após a obturação, 80 raízes foram seccionadas transversalmente obtendo-se 3 slices de 1,0 mm de espessura para cada terço radicular. Um slice de cada terço foi submetido ao teste de push out e tipo de falha analisado por meio de lupa estereoscópica. Os dois slices restantes foram submetidos à MEV para análise da interface adesiva e superfície do material obturador. A análise de variância evidenciou haver diferença estatisticamente significante (p<0,05) entre os materiais obturadores, o protocolo de secagem do canal radicular e a interação destes fatores. AH Plus/ guta percha obteve os maiores valores médios de resistência de união (3,83 ± 0,45 MPa), sendo estatisticamente diferente (p<0,05) dos demais. O Hybrid Root SEAL/ guta percha (3,24 ± 0,46 MPa) obteve valores intermediários, sendo estatisticamente diferente dos demais (p<0,05). O cimento obturador Epiphany SE quando associado à guta percha (0,45 ± 0,10 MPa) ou ao Resilon (0,31 ± 0,09 MPa) obteve os menores valores de adesividade, sendo estatisticamente semelhantes entre si (p>0,05) e diferentes dos demais (p<0,05). O cimento AH Plus obteve os maiores valores de adesividade independente do protocolo de secagem utilizado. Na comparação entre os protocolos, o protocolo que utilizou álcool isopropílico 70% obteve maiores valores médios de adesividade. / The purpose of the present study was to evaluate the influence of the drying protocol with isopropyl alcohol on the adhesion of the sealers AH Plus, Hybrid Root Seal and Epiphany SE to intraradicular dentin. Eighty root canals of canines were subjected to biomechanical preparation and were allocated to receive one of the following drying protocols (n=40) prior to root canal filling: I- Drying with absorbent paper point and II- Drying with 70% isopropyl alcohol. Thereafter, 8 groups (n=10) were formed according to the filling material: IA and IIA AH Plus sealer; IB and IIB - Hybrid Root Seal sealer; IC and IIC- Epiphany SE sealer with gutta-percha; and ID and IID Epiphany SE sealer with Resilon. After filling, the 80 roots were sectioned transversally to obtain three 1.0-mm-thick slices from each root third. The first slice of each third was subjected to a push-out test and the failure mode was determined with a stereoscopic lens. The other two slices were prepared for SEM to examine adhesive interface and the surface of the filling materials. Analysis of variance revealed statistically significant difference (p<0.05) among the filling materials, between the root canal drying protocols as well as for the interaction of these factors. AH Plus/gutta-percha had significantly higher (p<0.05) bond strengths (3.83 ± 0.45 MPa) than the other materials. Hybrid Root SEAL/gutta-percha (3.24 ± 0.46 MPa) had intermediate values and differed significantly from the other materials (p<0.05). Epiphany SE combined with either gutta-percha (0.45 ± 0.10 MPa) or Resilon (0.31 ± 0.09 MPa) presented the lowest bond strengths without statistically significant difference (p>0.05) from each other, but with significant difference (p<0.05) from the other materials. AH Plus present the highest bond strengths regardless of the drying protocol. Comparing the two protocols, drying of root canals with 70% isopropyl alcohol was associated with the highest bond strength values to intraradicular dentin.

POTENTIAL ANTIMICROBIAL METHODS FOR PROVISIONALIZING TEETH AFTER ENDODONTIC TREATMENT By Laura T. Garden, DDS A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science in Dentistry at Virginia Commonwealth University. Virginia Commonwealth University, 2018 Thesis Advisor: Garry Myers, DDS Department of Endodontics Objective:To evaluate the effectiveness of a Chlorhexidine soaked cotton pellet on bacterial leakage. Methods: Fifty-one extracted teeth, including six controls, were instrumented, obturated, and sealed with either a cotton pellet (CP), 2% Chlorhexidine soaked cotton pellet (CHX), or a Permaflo orifice barrier (OB). Each root was suspended between two chambers: the coronal chamber inoculated with brain heart infusion broth and colony-forming units of Enterococcus faecalis, the apical chamber with brain heart infusion broth and phenol red. The latter was checked daily for turbidity, indicating bacterial leakage. Results: All open and closed control groups had leaked by day 7. The average CP tooth survived for 13.1 days whereas the CHX and OB teeth leaked by an average of 5.8 days. Conclusion:There is insufficient evidence to support the use of a Chlorhexidine soaked cotton pellet. The results were not as expected and the study design should be re-evaluated.

Orientador: Rogério de Castilho Jacinto / Coorientadora: Carolina Simonetti Lodi / Banca: Luciano Tavares Angelo Cintra / Banca: João Eduardo Gomes Filho / Banca: Francisco Montagner / Resumo: O presente estudo teve como objetivo avaliar a atividade antimicrobiana dos cimentos endodônticos, com ou sem associação do uso prévio de hidróxido de cálcio em um modelo "in vitro" de biofilme. Espécimes de dentina bovina (240) foram colocadas e deixas em contato direto com inoculo de E. faecalis (ATCC 51299) por 14 dias, para induzir a formação do biofilme. Em seguida, metade das espécimes foram incubadas (37⁰C e 5% CO2) em contato com um dos seguintes cimentos: AH Plus, Acroseal e Sealapex por 2, 7 e 14 dias, e a outra metade foi tratada com solução de hidróxido de cálcio por 14 dias e incubada em contato com os cimentos AH Plus, Acroseal e Sealapex por 2, 7 e 14 dias. Cada grupo continha um n = 8. Após cada período experimental, as amostras foram agitadas e as suspensões formadas foram diluídas em série e triplamente plaqueadas em ágar m-Enterococcus. As unidades formadoras de colônias foram contadas, e os dados foram analisados estatisticamente usando os testes one-way ANOVA, Shapiro-Wilk e Kruskal-Wallis (p <0,05) para determinar o potencial antimicrobiano. Foi observada diferença estatisticamente significante entre os grupos com e sem o tratamento com Hidróxido de Cálcio, para todos os cimentos avaliados. Entretanto, nenhum dos cimentos testados foi capaz de eliminar completamente o biofilme. Ao comparar os cimentos, Sealapex reduziu E. faecalis após 7 dias, enquanto AH Plus e Acroseal mostraram atividade antimicrobiana apenas no 14º dia experimental. Em conclusão, o u... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The present study aimed at evaluating the antimicrobial activity of endodontic sealers, with or without prior use associationof calcium hydroxide in an in vitro biofilm model. Bovine dentin specimens (240) were placed and left in contact with inoculum of E. faecalis(ATCC 51299) for 14 days, to induce biofilm formation. Then, half of the specimens were incubated (37⁰C and 5% CO2) in contact with one of the following sealers AH Plus, Acroseal and Sealapex for 2, 7 and 14 days, and the other half were treated with calcium hydroxide solution for 14 days, and then incubated in contact with the sealers AH Plus, Acroseal and Sealapex for 2, 7 and 14 days. Each group comprised a n=8. After each experimental time the samples were agitated, and the suspensions formed were serially diluted, and triple plated onto m-Enterococcus agar. Colony forming units were counted, and the data were statistically analyzed using ANOVA, Shapiro-Wilk and Kruskal-Wallis one-way tests (p<0.05) to determine antimicrobial potential. A statistically significant difference was observed between the groups with and without the treatment with Calcium Hydroxide, for all sealers evaluated. However, neither of the sealers tested were able to completely eliminate the biofilm.When comparing the sealers, Sealapex reduced E. faecalisafter 7 days, while AH Plus and Acroseal showed antimicrobial activity only on the 14th experimental day. In conclusion, previous use of calcium hydroxide helped to decrease Enterococcus faecalisbiofilm of the sealers studied in all experimental times. (Complete abstract electronic access below) / Doutor

Root canal preparation in narrow, curved canals is a challenge even for experienced endodontists. Recently nickel-titanium (NiTi) hand files have played an important role in root canal preparation, particularly in curved root canals. Nickel-titanium endodontic instruments were first investigated in 1988 by Walia et al. who found that NiTi files have two to three times more elastic flexibility in bending and torsion, as well as superior resistance to torsional fracture compared with similar stainless steel files.

Root canal preparation in narrow, curved canals is a challenge even for experienced endodontists. Recently nickel-titanium (NiTi) hand files have played an important role in root canal preparation, particularly in curved root canals. Nickel-titanium endodontic instruments were first investigated in 1988 by Walia et al. who found that NiTi files have two to three times more elastic flexibility in bending and torsion, as well as superior resistance to torsional fracture compared with similar stainless steel files.

Objective: To assess biofilm proliferation within the sealer-dentin interfaces of methacrylate resin-based sealers, self-etch (SE) and total-etch (TE), and an epoxy resin-based sealer (EP). Methods: Standardized human root specimens were filled with the test materials and were aged for 1 week, 1, 3 or 6 months in saline (n=3/group). Monoclonal biofilms of Enterococcus faecalis were grown on the specimens for 7 days in continuous media reactor. The extent of biofilm proliferation of E. faecalis within the sealer-dentin interface for each material at each incubation period was assessed using fluorescence microscopy of dihydroethidium-stained specimens. Results: TE had less biofilm proliferation than EP and SE (p<0.01). Deeper biofilm proliferation was detected in SE and EP specimens aged for 1 and 3 months than those aged for 1 week or 6 months (p<0.05). Conclusion: Self-etch and epoxy resin-based sealers were more susceptible to interfacial biofilm proliferation than total-etch system at shorter incubation periods.

Objective: To assess biofilm proliferation within the sealer-dentin interfaces of methacrylate resin-based sealers, self-etch (SE) and total-etch (TE), and an epoxy resin-based sealer (EP). Methods: Standardized human root specimens were filled with the test materials and were aged for 1 week, 1, 3 or 6 months in saline (n=3/group). Monoclonal biofilms of Enterococcus faecalis were grown on the specimens for 7 days in continuous media reactor. The extent of biofilm proliferation of E. faecalis within the sealer-dentin interface for each material at each incubation period was assessed using fluorescence microscopy of dihydroethidium-stained specimens. Results: TE had less biofilm proliferation than EP and SE (p<0.01). Deeper biofilm proliferation was detected in SE and EP specimens aged for 1 and 3 months than those aged for 1 week or 6 months (p<0.05). Conclusion: Self-etch and epoxy resin-based sealers were more susceptible to interfacial biofilm proliferation than total-etch system at shorter incubation periods.

O presente estudo avaliou a eficáciado instrumento Reciproc#25 em atingir o forame de canais de molares inferiores sem um glide path manual prévio. Para isso, uma amostra geral de 300 molares inferiores foi radiografada e previamente selecionada quanto ao grau de curvatura segundo critério de Schneider sendo divididos em classes I e II. Após a aplicação dos critérios de inclusão e exclusão, uma amostragem total de 502 canais radiculares foi incluída para formar os grupos experimentais: 253 canais no grupo de molares inferiores classe I e 249 no grupo de molares classe II. Todos os canais foram instrumentados diretamente com a lima 25, sem nenhum glide path prévio, seguindo criteriosamente as diretrizes do fabricante. Os dados foram descritos como a frequência da distribuição do número de canais (%) nos quais foi possível chegar ao forame apical sem a necessidade de glide path, assim como o número de fraturas em cada grupo. Os resultados compilados dos 2 grupos experimentais mostraram que em 93,4% do total dos canais instrumentados, o instrumento R25 foi capaz de ir até o forame apical sem a necessidade de glide path. Em 6,4% do total dos canais, o instrumento R25 não chegou até o forame apical e em somente 0,2% dos casos ocorreu fratura da lima (um caso no grupo classe I, enquanto no grupo classe II não houve nenhuma ocorrência de fratura). O teste Qui-quadrado foi realizado para verificar se uma determinada classe de canais encontra-se mais associada ou não a necessidade de glide path quando o sistema Reciproc é usado. No grupo de molares classe II houve maior número de canais (23) que o instrumento R25 não foi capaz de ir até o forame apical do que no grupo de molares classe I (9), sendo essa diferença estatisticamente significante (Qui-quadrado, p=0,020, X2=5,452). Dentro das condições experimentais do presente estudo, pode-se concluir então quea lima R25 mostrou uma alta eficácia em instrumentar toda a extensão dos canais de molares inferiores classe I e II sem a necessidade de glide path prévio. Além disso, o sistema de instrumentação proposto mostrou-se altamente seguro quanto ao índice de fratura. / The aim of the present studywas to evaluate the effectiveness of the Reciproc #25 instrument in reaching the apical foramen of mandibular molars root canals without any manual glide path. For this, a general sample of 300 mandibular molars was radiographed and graded accordantly the degree of curvature (Schneiders criteria) classes I and II. After applying the inclusion and exclusion criteria, a total of 502 root canals were included to form the two experimental groups: 253 canals in the class Igroupand 249 in the class II group. All canals were instrumented directly with R25 file, without any manual glide path, carefully following the manufactures guidelines. The pooled results of two experimental groups showed that the R25 instrument was able to reach the apical foramen without glide path in 93.4% of the cases. In 6.4%, the instrument R25 was unable to reach the apical foramen and in only 0.2% of the cases occurredinstrument fracture (one fracture in the class I group andnone in the class II group). The chi-square test was accomplished to verify that a certain class of channels is more associated with or without the need for glide path when the Reciproc system is used. . In the group of class II molar higher number of channels (23) that the instrument was not able to go to the apical foramen than in the molar class I (9), and this difference was statistically significant (Chi-square test, p = 0.020, X2 = 5.452) Within the experimental conditions of this study, it can be concluded that the file R 25 showed to be a highly effective instrument in the instrumentation of the entire length of the canals of mandibular molars class I and II without prior glide path. In addition, the instrumentation system was shown to be highly safe in the rate of fracture.