A terapia laser é um excelente procedimento clínico coadjuvante no tratamento endodôntico pela sua capacidade de promoção e melhoria da limpeza e da desinfecção do sistema endodôntico, porém existem poucos estudos sobre a possível utilização desta nova tecnologia nas situações clínicas de desobturação. O objetivo deste estudo foi avaliar in vitro o uso do laser de diodo (810nm, no modo contínuo) na desobturação da guta percha e do cimento AH Plus, utilizando ou não solvente químico (eucaliptol). Canais radiculares obturados tiveram o seu material obturador irradiado pelo laser de diodo de 810 nm (ZAP SOFTLASE, ZAP LASERS). A temperatura externa radicular durante a irradiação foi verificada no terço apical de 12 amostras utilizando o sistema de medida de temperatura. Observou-se um aumento de temperatura que variou de 2,47 a 9,35 ºC. Raízes foram divididas aleatoriamente em 4 grupos com 10 espécimes, variando o parâmetro de irradiação laser e a utilização do eucaliptol. Os grupos foram: Grupo I = irradiação (1,0 W) sem a utilização de solvente, Grupo II = irradiação (1,5 W) sem o uso de solvente, Grupo III = irradiação (1,0 W) + solvente, Grupo IV = (1,5 W) + solvente. As amostras foram radiografadas no sentido V-L e M-D, antes e após o retratamento, digitalizadas, e as áreas remanescentes de guta percha foram calculadas com o auxílio de programas de computador: Adobe Photoshop e ImageLab. Os resultados dos espécimes dos grupos: G1xG3; G1xG4; G2xG4 apresentaram diferença estatística. O modelo experimental selecionado permitiu verificar que a propagação da temperatura durante o procedimento não excedeu 10ºC e que a presença do solvente possibilitou a remoção de maior quantidade de material obturador auxiliando o processo de desobturação quando do emprego da irradiação com laser de diodo. / The laser therapy is an excellent adjunct clinical procedure in endodontic treatment in order to improve the cleaning and disinfection of the root canal system; however few studies in the literature investigated the possible use of this new technology in the clinical situations of retreatment. The objective of this study was to evaluate in vitro the use of the diode laser (810nm, continuous mode) in the removal of gutta-percha and AH Plus sealer from the root canal, with or without the use of a chemical solvent (eucalyptol). Root canal filling materials were irradiated by 810 nm diode laser (ZAP SOFTLASE, ZAP LASERS). The temperature changes at the outer root surface were verified in the apical third of 12 samples during the irradiation. Temperature increase from 2.47 to 9.35 ºC was observed. The specimens were randomly divided in 4 groups of 10 roots each, varying the parameter of laser irradiation and the use of eucalyptol. The groups were assigned as follow: Group I = irradiation (1.0 W) without the solvent use, Group II = irradiation (1.5 W) without the solvent use, Group III = irradiation (1.0 W) + solvent, Group IV = (1.5 W) + solvent. Mesio-distal and buccolingual radiographs were taken before and after retreatment and the area of remaining gutta-percha in the root canals was determined with the aid of: Adobe Photoshop and ImageLab softwares. The groups: G1xG3; G1xG4; G2xG4 presented statistical differences.Based on the methodology used, it was verified that the temperature did not exceed 10ºC and that the presence of the solvent made it possible to remove large amounts of root canal filing material, aiding the desobturation process when used in association to the diode laser.

O emprego da solução de hipoclorito de sódio em Endodontia data de 1936 quando Walker a introduziu na forma de soda clorada. Desde então, essa veio a se constituir na solução mais bem aceita como irrigante para fins endodônticos. Nos últimos anos, atribuições de grande importância relativas ao desempenho das soluções de hipoclorito de sódio, têm sido referidas ao controle do seu pH. Este trabalho tem por objetivo avaliar a resposta inflamatória do tecido conjuntivo do dorso de ratos frente ao emprego de soluções de hipoclorito de sódio em diferentes concentrações e valores de pH. Para tanto, 36 ratos receberam quatro feridas circulares confeccionadas por um punch. Sobre cada três dessas feridas foi gotejada uma solução diferente, enquanto que a última foi utilizada para controle. Os tratamentos foram realizados em triplicata. Após a irrigação das feridas, os ratos foram sacrificados em 3, 7 e 14 dias. Os fragmentos foram fixados e corados com hematoxilina e eosina para análise histológica. A análise histológica mostrou que aos 14 dias quase todos os espécimes encontravam-se totalmente epitelizados, com fenômenos inflamatórios somente no tecido conjuntivo subjacente, com exceção do grupo no qual foi utilizado a solução de hipoclorito de sódio 5% pH 11. / Sodium hypochlorite has been used as an endodontic irrigant since 1936, when Walker used it as Sodium Chlorine. Since then it has became the most well acceptable endodontic irrigant. During the last few years many studies have reported the importance of pH control. This study evaluates the inflammatory response of some endodontic irrigations solutions in the subcutaneous connective tissue of mice. Thirty six mice were obtained from the Biomedical Sciences Institute at the University of São Paulo. Their backs were divided in four quadrants and each quadrant was injured with an 8 mm punch. Three of these wounds were submitted to differents solutions, while the fourth was used as a control. This experiment was done in triplicate. After wounds irrigation mice were sacrificed at 3, 7 and 14 days. The samples were fixed on formol 10% and histologically analyzed after hematoxylin and eosin staining. At 14 days all wounds were covered with epithelium with a mild inflammatory infiltrate in the subjacent connective tissue, excepted the group that sodium hypochlorite 5% pH 11 was used. Endodontic; Sodium Hypochlorite; Inflamation.

O objetivo do estudo foi desenvolver um cimento endodôntico com microesferas contendo amoxicilina e avaliar suas propriedades. As microesferas foram produzidas por secagem e caracterizadas por Microscopia eletrônica de varredura (MEV) e difração a laser. A formulação da resina base para um cimento endodôntico dual foi obtida pela mistura, em massa, de 70% de UDMA, 15% de GDMA e 15% de BISEMA. Como sistema iniciador/ativador, foram incorporados canforoquinona, DHEPT e peróxido de benzoíla, a 1% em mol e BHT em 0,01% em massa. Foram adicionados à resina base, em massa, 10 e 15% de microesferas de amoxicilina, além de um grupo sem microesferas (controle). Em todos os grupos foi adicionado trifluoreto de itérbio (10% em massa) como agente radiopacificante. Os cimentos foram avaliados quanto ao grau de conversão (GC) por Raman (n=3) imediatamente e após 24 horas de armazenamento, degradação em solvente (n=3) após 1 hora de imersão em álcool 70%, perfil de liberação do fármaco (n=3), atividade antimicrobiana contra Enterococcus Faecallis (n= 3), escoamento (n=3) e espessura de película (n=3)e citotoxicidade (n=3). Os dados foram analisados por ANOVA e Tukey com nível de significância de 5%. As microesferas apresentaram diâmetro médio de 2,664 μm. O grau de conversão imediato variou entre 51,73% e 55,13% e em 24h variou entre 60,79% e 73,80% sem apresentar diferença estatística entre os grupos. O percentual de degradação em solvente apresentou diferença significativa entre o grupo controle e o grupo com 15% de microesferas, variando entre 54,44% e 56,21% de redução. O perfil de liberação do fármaco mostrou que em 96h ocorreu uma liberação média de 73,76% do fármaco. A atividade antimicrobiana apresentou redução significativa dos grupos experimentais em 24 e 48h. Em 96h o grupo com 15% não apresentou diferença estatística quando comparado ao grupo controle (p>0,05). O escoamento apresentou uma redução significativa nos grupos experimentais comparados ao grupo controle (p<0,05). A espessura de película variou, mas não apresentou diferença estatística entre os grupos (p=0,63). A citotoxicidade apresentou alta viabilidade celular no tempos avaliados. Com base nesses resultados, pode-se concluir que a adição de até 10% de microesferas contendo amoxicilina apresentou característica antimicrobiana e não alterou as propriedades do cimento endodôntico experimental. / The objective of the study was to develop an endodontic sealer with amoxicillin-loaded microsphere and to evaluate its properties. The microspheres were produced by drying and characterized by Scanning Electron Microscopy (SEM) and laser diffraction. The formulation of the base resin dual cure endodontic cement was obtained by mixing, by weight, 70% UDMA, 15% GDMA and 15% BISEMA. As initiator / activator system, camphorquinone, DHEPT and benzoyl peroxide, 1 mol% and BHT were incorporated in 0.01% by weight. 10 and 15% of amoxicillin microspheres were added to the base resin, in addition to a group without microspheres (control). Ytterbium trifluoride (10% by weight) as radiopacifier was added in all groups. The cements were evaluated for Raman (n=3) conversion grade immediately after 24 hours storage, solvent degradation (n=3) after 1 hour immersion in 70% alcohol, drug release profile (n=3), antimicrobial activity against E. faecallis (n=3), flow (n=3) and film thickness (n=3) and cytotoxicity (n=3). Data were analyzed by ANOVA and Tukey with significance level of 5%. The microspheres had an average diameter of 2,664 μm. The degree of immediate conversion ranged from 51.73% to 55.13%, and in 24h conversion ranged from 60.79% to 73.80%, with no statistical difference between the groups. The percentage of degradation in solvent showed a significant difference between the control group and the group with 15% of microspheres, varying between 54.44% and 56.21% reduction. The drug release profile showed that a mean release of 73.76% of the drug occurred in 96h. The antimicrobial activity showed a significant reduction of the experimental groups in 24 and 48h. In 96h the group with 15% presented no statistical difference when compared to the control group (p> 0.05). The flow showed a significant reduction in the experimental groups compared to the control group (p <0.05). The film thickness varied, but did not present statistical difference between the groups (p = 0.63). Cytotoxicity showed high cellular viability at the determined times. Based on these results, it can be concluded that the addition of up to 10% of microspheres containing amoxicillin showed antimicrobial characteristics and did not alter the properties of the experimental endodontic cement.

Analisou-se, por meio de espectrofotometria, a liberação de formaldeído de cimentos endodônticos à base de óxido de zinco e eugenol, resinas epóxica e polimetacrilato, hidróxido de cálcio e biocerâmico, estudados em diferentes oportunidades: durante a espatulação; decorrido três vezes o tempo de endurecimento e, por fim, na extração de sua massa endurecida. As amostras foram adquiridas pela coleta do volume da água utilizada em cada período e, determinada a curva de calibração da liberação do formaldeído e análise controle com água, foram submetidas à análise colorimétrica com adição dos reagentes: 5,0 mL de solução tampão, 0,5 mL de solução de parafenilenodiamina e 2,5 mL de peróxido de hidrogênio em balões volumétricos de 50,0 mL mantendo-os em repouso por 20 minutos. Após, foi realizada leitura em espectrofotômetro duplo feixe nos comprimentos de onda 326, 334 e 462 nm. Detectou-se formaldeído em todos os cimentos à base de resina epóxica, no EndoREZ® e no Endomèthasone N, quantificado apenas no Sealer 26 (7.40 mg.L-1) e Endomèthasone N (9.13 mg.L-1) durante a espatulação; no AH Plus® (4.44 mg.L-1) e no Endomèthasone N (18.14 mg.L-1) durante o endurecimento, e somente no Endomèthasone N depois de endurecido (9.43 mg.L- 1). Concluiu-se que, durante a espatulação, todos os cimentos de resina epóxica liberaram formaldeído, com quantificação apenas para o Sealer 26, o Endomèthasone N apresentou a maior quantidade, e o Endorez liberou a substância em quantidade insuficiente para quantificação. Após a espatulação, todos os de resina epóxica liberaram formaldeído, com quantificação no AH Plus e o Endomèthasone N apresentou a maior quantidade da substância, que também foi encontrada no Endorez, sem quantificação. Endurecidos, todos os cimentos de resina epóxica e o Endorez liberaram formaldeído em quantidade insuficiente para quantificação, e o cimento Endomèthasone N liberou a maior quantidade dessa substância. / This study evaluated, by means of spectrophotometry, the release of formaldehyde in zinc oxide, epoxy resins and polymethylmethacrylate, calcium hydroxide and bioceramic based endodontic sealers in different situations: during mixing; after 3 time the setting time and, at extraction of its hardened mass. The samples were acquired by means of collection of the volume of water used in each period and - after determining the calibration curve of formaldehyde release and analyzing the control with water - were submitted to colorimetric analysis with the addition of the following reagents: 5.0mL of buffered solution, 0.5mL of paraphenylenediamine and 2.5mL of hydrogen peroxide to a 50.0mL volumetric flask, which was kept at rest for 20 minutes. Double-beam spectrophotometer readings were performed at 326, 334 and 462nm wavelengths. Formaldehyde was detected in all epoxy resin based sealers, in EndoREZ and in Endomèthasone N, quantified only in Sealer 26 (7.40 mg.L-1) and Endomèthasone N (9.13 mg.L-1) during mixing, and in AH Plus (4.44 mg.L-1) and Endomèthasone N (18.14 mg.L-1) during the setting time, and only in Endomèthasone N after setting (9.43 mg.L-1). It can be concluded that during mixing all epoxy resin based sealers released formaldehyde, with quantification being possible only for Sealer 26, Endomèthasone N showed higher quantities, and Endorez released the substance in insufficient quantity for detection. After mixing, all epoxy resin based sealers released formaldehyde, whereas quantification was possible for AH Plus and Endomèthasone N presented the highest quantity of the substance, that was also found in Endorez, but could not be quantified. When set, all epoxy resin sealers and Endorez released formaldehyde in insufficient quantity for quantification, and Endomèthasone N released the greater amount of this substance.

O objetivo deste estudo foi avaliar, in vitro, a influência da radioterapia na resistência de união (RU) do material obturador à dentina e na interface adesiva de caninos superiores obturados com cimento AH Plus e MTA Fillapex, por meio de teste de cisalhamento por extrusão (push-out) e microscopia eletrônica de varredura (MEV). Trinta e dois caninos superiores foram selecionados e distribuídos em 2 grupos (n=16) de acordo com a irradiação: Grupo I - Não irradiados e Grupo II - Irradiados, submetidos à radioterapia com raios-X com 6 MV em frações de 2 Gy, por 5 dias consecutivos, com 30 ciclos, durante 6 semanas, perfazendo 60 Gy. Após a irradiação, o preparo biomecânico dos dentes foi realizado utilizando o sistema Reciproc (R50) e irrigação com hipoclorito de sódio a 1%. Cada grupo foi subdividido de acordo com o cimento endodôntico utilizado (n=8): Subgrupo A - AH Plus; e Subgrupo B - MTA Fillapex e obturados com a técnica do cone único. Decorrido o tempo de endurecimento dos cimentos, os dentes foram transversalmente seccionados em slices de 1 mm de espessura, obtendo-se 3 slices de cada terço da raiz. O primeiro slice no sentido coroa-ápice de cada terço foi selecionado para avaliar a RU por meio do teste de push-out com velocidade de 0,5 mm/min e posterior análise do padrão de falhas por meio de estereomicroscópio. Para análise por MEV, foram selecionados aleatoriamente dois dentes de cada grupo, cujos slices (um de cada terço) foram preparados utilizando-se dois protocolos previamente à metalização. Para a análise da interface dentina/material obturador foi utilizado o protocolo de desidratação e para análise da penetrabilidade do cimento foi utilizado o protocolo de descalcificação superficial. Após metalização, os slices foram avaliados qualitativamente com aumentos de 75, 100 e 500x. Os dados (MPa) foram submetidos à análise estatística pelos testes de ANOVA e Tukey (p<0,0001). Os espécimes irradiados (0,71±0,20) apresentaram os menos valores de RU (p<0,0001) independente do cimento utilizado, e, quando comparados os cimentos, os espécimes obturados com MTA Fillapex (0,70±0,18) apresentaram valores menores que os obtidos com o AH Plus (1,00±0,27) (p<0,0001). O terço cervical apresentou valores superiores entre os terços das regiões analisadas dentro de cada grupo diminuindo em direção apical (p<0,0001). Houve maior ocorrência de falhas adesivas para o cimento AH Plus em todos os terços avaliados nos espécimes irradiados. Na análise qualitativa em MEV, observou-se maior quantidade de gaps na interface cimento/dentina nos espécimes irradiados quando comparados aos não irradiados. De modo geral, para os espécimes obturados com cimento AH Plus, foi possível observar a presença de densas áreas de tags resinosos, longos, contínuos e regularmente distribuídos, diferentemente dos obturados com MTA Fillapex que se apresentaram menores, menos numerosos e dispostos de forma irregular. Concluiu-se que a radioterapia diminuiu a RU dos cimentos à dentina, independente do cimento obturador utilizado, sendo que o MTA Fillapex propiciou RU menor que o AH Plus, tanto nos dentes irradiados como nos não irradiados, com formação de gaps na interface cimento/dentina e menor formação de tags resinosos / The purpose of this in vitro study was to evaluate the influence of the radiotherapy on the bond strength (BS) of the filling material to dentin and the adhesive interface of superior canines filled with AH Plus and MTA Fillapex using the bond strength test (push-out) and the scanning electron microscopy (SEM). Thirty-two superior canines were selected and divided into 2 groups (n=16) according to the irradiation: Group I - Non-irradiated and Group II - Irradiated, submitted to a X-Ray of 6 MV regimen in fractions of 2 Gy, for 5 consecutive days, 30 cycles during 6 weeks, totalizing 60 Gy. After the irradiation, biomechanical preparation of the teeth was performed with the Reciproc system (R50) irrigated with 1% sodium hypochlorite. Each group was then subdivided according the sealer (n=8): Subgroup A - AH Plus; and Subgroup B - MTA Fillapex and the single-cone technique was used. Elapsed the setting time of the sealers, the teeth were transversally sectioned in slices of ±1 mm thickness, obtaining 3 slices from each root third. The first slice in the crown-apex direction of each third was selected for the BS evaluation at a speed of 0.5 mm/min and the posterior analysis of the pattern failure with a stereomicroscope was performed. For the SEM analysis, two teeth of each group were randomly selected, in which, a slice of each third was prepared using two different protocols prior the metallization. For the dentin/filling material interface analysis a protocol of dehydration was used and for the sealer penetrability a superficial decalcification protocol was performed. After the metallization, the slices were qualitatively evaluated at 75, 100 and 500x magnifications. Data (MPa) was submitted to the statistical analysis by the ANOVA and Tukey tests (p<0.0001). The irradiated specimens (0.71±0.20) had lower BS values (p<0.0001) independently of the used sealer, and when compared, the sealers of the specimens filled with MTA Fillapex (0.70±0.18) showed lower values than the ones filled with AH Plus (1.00±0.27) (p<0.0001).The cervical third had higher values between the analysed regions of the thirds in each group, decreasing towards apical direction (P<0.0001). There was a higher occurrence of adhesive failures for the AH Plus sealer in every evaluated third of the irradiated specimens. In the qualitative analysis of the SEM, a higher amount of gaps was observed in the dentin/filling material interface of the irradiated specimens compared to the non-irradiated specimens. In general, for the specimens filled with AH Plus, it was possible to notice the presence of extensive areas with long and regularly distributed resin tags, them being, different from the specimens filled with MTA Fillapex, which were less frequent and irregularly disposed. It can be concluded that radiotherapy decreased the BS values of the sealers to the dentin, independently of the sealer, with lower values in the teeth filled with MTA Fillapex compared to AH Plus, both for the irradiated as well as for the non-irradiated teeth with formation of gaps in the interface sealer/dentin and the decrease formation of resin tags

<p> <p>&nbsp / </p> </p> <p><font face="Times New Roman" size="3">The aim of this study was to compare the sealing ability of AH Plus sealer to the canal wall in the presence and absence of the smear layer.</font></p>

This study characterized maxillary sinus mucositis (SIMS) adjacent to teeth with apical periodontitis (AP), and assessed its resolution three months after endodontic treatment. 29 subjects who maxillary posterior teeth with AP were imaged with cone-beam computed tomography (CBCT). Resolution of SIMS was assessed with CBCT three months after treatment, and periapical healing was assessed using the PAI after six months. Four non-compliant subjects were discontinued and SIMS was identified in 14/25 subjects (56%). Three months post-treatment, SIMS was resolved fully in 3/10 subjects (30%), and partially in 3/10 subjects (30%). Six months post-treatment, 6/10 subjects (60%) were classified as healed or healing. CBCT revealed a lower-than-expected prevalence of SIMS adjacent to teeth with AP. In specific cases SIMS might linger beyond three months after the elimination of the endodontic infection. Due to the low statistical power, association between the resolution of SIMS and periapical healing could not be explored.

Conservative endodontic cavity (CEC) may improve fracture resistance of teeth but compromise instrumentation of canals. Extracted human intact maxillary incisors, mandibular premolars and molars were imaged with micro-CT and assigned to CEC or traditional endodontic cavity (TEC) groups (n=10/group/type). Canals were prepared and post-treatment micro-CT images obtained. These teeth along with the negative controls were then loaded to fracture. Mean proportion of untouched canal-wall was significantly higher only in distal canals of molars with CEC compared to TEC. Mean dentin volume removed was significantly smaller for CEC in all tooth types. Mean load-at-fracture for CEC was significantly higher in premolars and molars without differing significantly from the negative controls. While CEC was associated with compromised canal instrumentation only in the distal canals of molars, it conserved coronal dentin in all three tooth types and increased resistance to fracture in the mandibular molars and premolars.

This study characterized maxillary sinus mucositis (SIMS) adjacent to teeth with apical periodontitis (AP), and assessed its resolution three months after endodontic treatment. 29 subjects who maxillary posterior teeth with AP were imaged with cone-beam computed tomography (CBCT). Resolution of SIMS was assessed with CBCT three months after treatment, and periapical healing was assessed using the PAI after six months. Four non-compliant subjects were discontinued and SIMS was identified in 14/25 subjects (56%). Three months post-treatment, SIMS was resolved fully in 3/10 subjects (30%), and partially in 3/10 subjects (30%). Six months post-treatment, 6/10 subjects (60%) were classified as healed or healing. CBCT revealed a lower-than-expected prevalence of SIMS adjacent to teeth with AP. In specific cases SIMS might linger beyond three months after the elimination of the endodontic infection. Due to the low statistical power, association between the resolution of SIMS and periapical healing could not be explored.

Conservative endodontic cavity (CEC) may improve fracture resistance of teeth but compromise instrumentation of canals. Extracted human intact maxillary incisors, mandibular premolars and molars were imaged with micro-CT and assigned to CEC or traditional endodontic cavity (TEC) groups (n=10/group/type). Canals were prepared and post-treatment micro-CT images obtained. These teeth along with the negative controls were then loaded to fracture. Mean proportion of untouched canal-wall was significantly higher only in distal canals of molars with CEC compared to TEC. Mean dentin volume removed was significantly smaller for CEC in all tooth types. Mean load-at-fracture for CEC was significantly higher in premolars and molars without differing significantly from the negative controls. While CEC was associated with compromised canal instrumentation only in the distal canals of molars, it conserved coronal dentin in all three tooth types and increased resistance to fracture in the mandibular molars and premolars.