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Orientador: Angela Cristina Cilense Zuanon / Resumo: Avaliou-se a dureza superficial, rugosidade, porosidade, resistência a compressão, atividade antibiofilme, atividade metabólica do biofilme (XTT) e observou-se a aderência e formação do biofilme em microscopia eletrônica de varredura (MEV) de um cimento de ionômero de vidro (CIV) de alta viscosidade (Ketac Molar Easy Mix), associado a nanopartículas de óxido de zinco (NPZnO) a 2% ou ao diacetato de clorexidina (CLX) nas concentrações de 0,5%, 1% e 2%. Como grupo controle utilizou-se o próprio CIV. Para os testes físicos, mecânicos e atividade antibiofilme foram confeccionados 10 corpos de prova por grupo, para o teste de XTT e MEV, foram utilizados 5 e 2 corpos de prova por grupo respectivamente. A atividade antibiofilme foi avaliada para biofilme monoespécie de Streptococus mutans, no período de incubação de 1, 7, 14 e 21 dias. Realizou-se contagem das unidades formadoras de colônia por mililitro (UFC/mL) e a atividade metabólica do biofilme, assim como a observação em MEV foram avaliadas nos os períodos de 1 e 7 dias . Os dados foram analisados estatisticamente e atenderam quanto à normalidade e a homogeneidade de variâncias. Realizou-se análise paramétrica de variância (ANOVA) para verificar diferença estatística seguida pelo teste de Tukey. Todos os testes foram realizados com um nível de significância de 5%. Avaliação qualitativa em MEV foi realizada para a observação da aderência e formação de biofilme. No teste de dureza superficial todos os grupos apresentaram diminui... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: It was evaluated the surface hardness, roughness, porosity, compressive strength, antibiofilm activity, metabolic activity of the biofilm (XTT) and the adherence and formation of the biofilm in Scanning Electron Microscopy (SEM) of a glass ionomer cement (GIC) of high viscosity (Ketac Molar Easy Mix), associated with 2% zinc oxide (NPZnO) nanoparticles or chlorhexidine diacetate (CLX) at concentrations of 0.5%, 1% and 2%. As a control group, the GIC itself was used. For the physical, mechanical and antibiofilm activity tests, 10 specimens were prepared per group, for the XTT and MEV test, 5 and 2 specimens were used per group, respectively. The antibiofilm activity was evaluated for monospecific biofilm of Streptococus mutans, during the incubation period of 1, 7, 14 and 21 days. The colony forming units were counted per milliliter (CFU / mL) and the metabolic activity of the biofilm, as well as the SEM observation, were evaluated in the 1 and 7 day periods. The data were analyzed statistically and attended to the normality and homogeneity of variances. We performed a parametric analysis of variance (ANOVA) to verify statistical difference followed by the Tukey test. All tests were performed with a significance level of 5%. Qualitative evaluation in SEM was performed for the observation of adhesion and biofilm formation. In the superficial hardness test, all groups showed decreased values, being the lowest values of the CLX groups. For the surface roughness, only the group wi... (Complete abstract click electronic access below) / Doutor

Aim: The study aimed to investigate the effect of a customary fluoride solution, containing sodium fluoride and amine fluoride, on initial biofilm formation on enamel and dentin in situ compared directly to chlorhexidine. Methods: Bovine enamel and dentin specimens were mounted on maxillary splints carried by 9 subjects. After 1 min of pellicle formation, rinses with tap water (control), chlorhexidine (meridol med CHX 0.2%, GABA) and a fluoride mouthrinse (elmex, GABA) were performed for 1 min. Subsequently, the slabs were carried for another 8 h. The adherent bacteria were determined by DAPI staining, live-dead staining and determination of colony-forming units after desorption; glucan formation was visualized with concanavalin A. Additionally, energy-dispersive X-ray spectroscopy (EDX) analysis of the in situ biofilm layers was conducted, and contact angle measurements were performed. Statistical evaluation was performed by means of the Kruskal-Wallis test followed by the Mann-Whitney U test (p < 0.05). Results: In the control group, significantly higher amounts of adherent bacteria were detected on dentin (4.8 x 10⁶ ± 5.4 x 10⁶ bacteria/cm²) than on enamel (1.2 x 10⁶ ± 1.5 x 10⁶ bacteria/cm² , DAPI). Chlorhexidine significantly reduced the amount of adherent bacteria (dentin: 2.8 x 10⁵ ± 3.4 x 10⁵ bacteria/cm² ; enamel: 4.2 x 10⁵ ± 8.7 x 10⁵ bacteria/cm²). Rinses with the fluoride solution also significantly reduced bacterial adherence to dentin (8.1 x 10⁵ ± 1.5 x 10⁶ bacteria/cm²). Fluoride could not be detected by EDX analysis of the biofilms. Fluoride mouthrinsing did not influence the wettability of the pellicle-covered enamel surface. Conclusion: In addition to the reduction of demineralization and antibacterial effects, fluorides inhibit initial biofilm formation on dental hard tissues considerably, especially on dentin.

In der vorliegenden Arbeit wurden vier Studien vorgestellt, die sich mit der Notwendigkeit und Art medikamentöser Einlagen im Rahmen von Wurzelkanalbehandlungen beschäftigen. In Studie 1 wurde in vitro untersucht, in wieweit Kalziumhydroxid in der Lage ist, bakterielle Endotoxine zu neutralisieren. Hierzu wurde die TNFalpha-Ausschüttung menschlicher Monozyten als Indikator für die biologische Aktivität von Escherichia coli LPS bestimmt. Aus der Studie konnte geschlossen werden, E. coli LPS durch Kalziumhydroxid neutralisiert werden kann. In Studie 2 wurde die Keimreduktion durch Kalziumhydroxid und Chlorhexidin (CHX) in einem In-situ-Modell untersucht. Die Wurzeln extrahierter menschlicher Zähne wurden in intraoral zu tragende herausnehmbare Apparaturen einpolymerisiert und von zwei Freiwilligen jeweils für eine Woche getragen. So konnte eine Besiedlung der Wurzelkanäle durch orale Mikroorganismen stattfinden. Vor und nach Applikation von Kalziumhydroxid und CHX in verschiedenen Darreichungsformen wurde die Keimzahl im Wurzelkanal bestimmt. Kalziumhydroxid-Paste und 5%iges CHX-Gel führten zu einer signifikant besseren Keimreduktion als in Guttaperchaspitzen integriertes Kalziumhydroxid oder CHX. In Studie 3 wurde die Re-Infektion des Wurzelkanals nach Füllung in vitro untersucht. Hierbei wurden adhäsive (Clearfil, CoreRestore) und nichtadhäsive provisorische Füllungsmatierialien (Ketac-Fil, IRM) als Deckfüllungen appliziert und die bakterielle Passage über einen Zeitraum von einem Jahr bestimmt. Nach diesem Zeitraum war in allen Gruppen eine ähnliche Anzahl undichter Proben zu finden. Es wurde die Schlußfolgerung gezogen, dass wurzelkanalgefüllte Zähne möglichst innerhalb der ersten drei Monate nach Obturation eine definitive Versorgung erhalten sollten. In Studie 4 wurde die Re-Infektion gefüllter Wurzelkanäle nach vorheriger medikamentöser Einlage mit Kalziumhydroxid, CHX oder Ledermix in vitro untersucht. Ab dem achten Monat zeigten die mit Kalziumhydroxid behandelten Zähne bis zum Ende des Experimentes nach 12 Monaten signifikant weniger undichte Proben als die Zähne aller anderen Gruppen. Kalziumhydroxid ist unter dem in dieser Studie beleuchteten Aspekt als günstigste Zwischeneinlage zu sehen. Unter Berücksichtigung aller vorgestellten Studien darf die Empfehlung ausgesprochen werden, im Falle der Behandlung eines infizierten Wurzelkanals eine mindestens einwöchige medikamentöse Einlage mit Kalziumhydroxid vorzunehmen, da hierdurch bakterielle Endotoxine neutralisiert werden, die Zahl der Mikroorganismen im Wurzelkanal signifikant reduziert und ein prolongierter Schutz vor Re-Infektion des nachfolgend obturierten Wurzelkanals erreicht wird. Nach Wurzelkanalfüllung sollte möglichst schnell eine dichte, adhäsiv befestigte provisorische oder definitive Deckfüllung appliziert werden, um Schutz vor einer Re-Infektion des Wurzelkanalsystems zu gewährleisten. / This work presents four studies dealing with endodontic treatment and microorganisms or microbial cell wall components, respectively. The first study examined the effect of calcium hydroxide on Escherichia coli LPS. TNF-alpha production in human monocytes was used as indicator for the biological activity of LPS. Results showed that calcium hydroxide is able to eliminate the ability of E. coli LPS to stimulate TNF-alpha production in peripheral blood monocytes. The second study determined the antibacterial effectiveness of either chlorhexidine or calcium hydroxide integrated in gutta-percha points or chlorhexidine or calcium hydroxide delivered as gel or paste. Roots from extracted human teeth were carried with open accesses for one week in the oral cavities of two volunteers. The number of CFU's was determined before and after medication of the contaminated root canals. The chlorhexidine-gel and the calcium hydroxide paste resulted in significantly more samples without microbial colonization as compared to gutta-percha point groups. The third study examined whether obturated roots combined with several adhesive and temporary filling materials can be bypassed by bacteria. After one year of observation, there was no significant difference in number of leaking samples among the groups. It could be concluded that root-filled teeth should receive definitive restoration within three months after obturation. The aim of the fourth study was to examine whether intracanal medication prior to root canal obturation has an inhibitory effect on corono-apical penetration of bacteria. After one year of observation, the group pre-treated with calcium hydroxide paste showed significantly less leaking samples as compared to the groups pretreated with chlorhexidine, Ledermix or no medication. Reconsidering the results of all four studies it may be recommended to perform multi-visit treatment in case of an infected root canal. A one week intermediate dressing with calcium hydroxide will not only neutralize bacterial LPS, but also reduce bacteria significantly and provide prolonged protection against bacterial penetration after root canal filling. After obturation of the root canal system, it is recommended to quickly provide the tooth with a tight adhesively inserted temporary filling or a definitve restoration to achieve additional protection against bacterial ingress.

Die systemische Verabreichung von Amoxizillin/Metronidazol (AM) als Zusatz zu Scaling/Root planing (SRP) in der Behandlung der generalisierten Aggressiven Parodontitis (gAP) führt zu guten klinischen und mikrobiologischen Ergebnissen. Die lokale antiseptische Zusatzmedikation mit Chlorhexidin in einem Controlled-Delivery-Device (PerioChip, PC) verbessert das Ergebnis von SRP in der Behandlung der Chronischen Parodontitis. Die Anwendung in der Behandlung der gAP ist bisher noch nicht untersucht worden. Ziele: Der Effekt von PC als Zusatz zu SRP in der Therapie der gAP wurde untersucht. Die Wirksamkeit wurde mit der Standardmedikation AM verglichen. Neben klinischen Parametern wurde die Konzentration des Entzündungsmarkers Calprotectin in der Sulkusflüssigkeit (SF) bestimmt. Material/Methode: 36 gAP-Patienten (18/Gruppe, 35+/-4 Jahre) wurden mit SRP und randomisiert entweder mit AM oder PC behandelt. Zur Baseline, 3 und 6 Monate nach SRP wurden die klinischen Parameter PD, CAL, BoP, Pus erhoben sowie SF-Proben tiefer und flacher Referenzstellen entnommen. Die Calprotectin-Konzentration in der SF wurde mittels ELISA bestimmt. Ergebnisse: 3 Monate nach SRP zeigten beide Gruppen signifikante Verbesserungen der klinischen Parameter, wobei noch keine Unterschiede zwischen den Gruppen bestanden. Während die AM-Gruppe stabil blieb, verschlechterten sich mehrwurzelige Zähne und tiefe Referenzstellen der PC-Gruppe wieder signifikant. Nach 6 Monaten wies die AM-Gruppe signifikant mehr CAL-Gewinn und PD-Reduktion auf. Pus war nur noch in der PC-Gruppe nachweisbar. Die Calprotectin-Konzentration war zwar in beiden Gruppen signifikant gesunken, Unterschiede zwischen den Gruppen bestanden jedoch aufgrund hoher Standardabweichungen nicht. Schlussfolgerung: AM zeigte eine bessere klinische Wirksamkeit und Langzeitstabilität als PC. Aufgrund großer interindividueller Variabilität spiegelte die SF-Konzentration von Calprotectin die klinischen Unterschiede nicht wider. / Adjunctive systemic administration of amoxicillin/metronidazole (AM) in generalized aggressive periodontitis (gAP) therapy results in good clinical and microbiological outcome. Adjunctive use of chlorhexidine within a controlled-delivery-device (PerioChip, PC) improves the outcome of scaling/root planing (SRP) in chronic periodontitis therapy. Its effect in the treatment of gAP has not been evaluated. Aims: The effect of adjunctive use of PC in the treatment of gAP was investigated. Efficacy of PC was compared to the standard treatment with AM. Clinical parameters and the concentration of the inflammation marker calprotectin within gingival crevice fluid (GCF) were measured. Material/methods: 36 gAP patients (18/group, 35+/-4 years) were treated by SRP either AM or PC. Clinical parameters PD, CAL, BoP and Pus were recorded at baseline, 3 and 6 months after therapy. GCF was sampled at deep and shallow reference sites and the concentration of calprotectin was measured by ELISA. Results: Both groups showed significant improvements of clinical parameters 3 months after SRP, however differences between groups were not significant. While the AM-group remained clinically stable, multirooted teeth and deep reference sites of the PC-group showed significant deterioration again. 6 months after SRP, the AM-group showed significant more CAL gain and PD reduction. Pus was detectable in the PC group only. The concentration of calprotectin in GCF had significantly decreased in both groups; however differences between groups were not significant due to high standard deviations. Conclusion: AM showed higher efficacy in terms of clinical treatment outcome and long-term stability than PC. Due to high interindividual variability, GCF-concentrations of calprotectin failed to reflect clinical differences.