[Show abstract][Hide abstract] ABSTRACT: Florid cemento-osseous dysplasia (FCOD) belongs to the group of fibro-osseous lesions in which normal bone is replaced by fibrous connective tissue and calcified cementum tissue of the avascular type. Among the various types of fibro-osseous lesions, FCOD is 1 of the most commonly encountered diseases in clinical practice and may involve 3 or 4 of the quadrants. FCOD is located in the periapical regions of teeth, and the lesions are predominantly radiolucent (osteolytic phase), become mixed over time (cementoblast phase), and ultimately become radiopaque (osteogenic phase) with a thin radiolucent peripheral halo. The characteristics of FCOD in the initial stages are similar to those of periapical lesions of inflammatory origin, which may lead to misdiagnosis. A 38-year-old woman sought dental care because of complaints of pain on the right side of her face. A clinical examination revealed no marked alterations; a panoramic radiograph was therefore requested and revealed the presence of radiolucent lesions associated with the periapical regions of some of the lower teeth. Thus, the professional referred the patient for endodontic treatment of the associated teeth with the justification that the lesions were of endodontic origin. However, the endodontist found that the teeth responded positively to a sensitivity test. The initial diagnosis could have resulted in unnecessary root canal treatment, but after careful clinical, radiographic, and tomographic assessments by different professionals, FCOD was diagnosed, conservatively treated, and regularly monitored. It is important that dentists have a basic knowledge of the various injuries that affect the jaw bones to prevent errors in diagnosis and treatment and to promote oral health.
Journal of endodontics 09/2015; 41(11). DOI:10.1016/j.joen.2015.08.016 · 3.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study evaluated the influence of the exposure of mineral trioxide aggregate (MTA) - with and without calcium chloride (CaCl2) -to phosphate-buffered saline (PBS) on apical microleakage. Sixty root segments were divided into 4 experimental groups (n=15). Apical cavities were filled with MTA with or without CaCl2, and the root canals dressed with a moistened cotton pellet or PBS: 1) MTA/cotton pellet; 2) MTA/PBS; 3) MTA+ 10%CaCl2/cotton pellet; 4) MTA+10%CaCl2/PBS. After 2 months, E. faecalis penetration was analyzed along the apical plugs. Samples were observed weekly for 70 days, and leakage was detected by turbidity of the medium in contact with the root segment. Teeth in the control groups (n=2) were either made completely impermeable or kept without an apical plug. The Kaplan-Meier method was used to analyze survival and the Logrank test was used to compare the survival curves (p<0.05). All specimens in the positive control group showed evidence of leakage within 24h, while none in the negative control group showed leakage up to 70 days. There was no statistically significant difference among the experimental groups (p=0.102). The use of PBS as intracanal dressing may improve MTA sealing ability, but cannot prevent bacterial leakage. The addition of CaCl2 to the MTA did not improve MTA sealing ability.
[Show abstract][Hide abstract] ABSTRACT: Aim: To analyze the influence of exposure and time of exposure to phosphate buffered saline (PBS) on the push-out bond strength (BS) of Biodentine to dentine. Methods: Eighty 2-mm-thick dentin discs were obtained from transversal sections of human teeth roots. The space of the canal was enlarged using #2-#5 Gates-Glidden burs to obtain 1.3-mm-diameter standardized cavities. The discs were immersed in 17% EDTA followed by 1% NaOCl and dried. The spaces of the canals were filled with Biodentine and the samples were divided into 2 groups (n=40) according to the storage: G1: exposure to moistened cotton pellet; G2: exposure to PBS. After 30 min, 1, 3 and 28 days, 10 samples of each group were subjected to the push-out test. Data were analyzed using ANOVA and Tukey test (p < 0.05). Results: The specimens exposed to PBS had lower BS (p < 0.05), except for the 1-day period (p = 0.6017). In specimens of Group 1 the BS increased up to 3 days (p < 0.05). In specimens in Group 2, the BS increased from 30 min to 1 day (p < 0.0001) and remained stable up to 3 days (p = 0.9876). At 28 days, a significant decrease was observed in the BS values of both groups (p < 0.05). Conclusions: The exposure of Biodentine to PBS led to lower BS values. In general, the BS increased gradually up to 3 days and reduced at 28 days.
Brazilian Journal of Oral Sciences 06/2015; 14(2):126-129. DOI:10.1590/1677-3225v14n2a06
[Show abstract][Hide abstract] ABSTRACT: Introduction
In individuals with periodontal disease, dental pulp status should be determined before a treatment plan is made. Pulse oximeters are promising diagnostic tools to evaluate pulp vascularization. This study used pulse oximetry to determine the level of oxygen saturation in dental pulp of intact permanent teeth with periodontal attachment loss (PAL) and gingival recession (GR) and to evaluate the correlation between periodontal disease and level of oxygen saturation in the pulp.
This study included 67 anterior teeth of 35 patients; all teeth showed intact crowns, PAL, a periodontal pocket (PP), and GR. The teeth underwent periodontal examination, cold and electric pulp testing, and pulse oximetry measurements. The Pearson correlation coefficient and a linear regression coefficient were calculated to evaluate the degree of correlation between periodontal disease markers (PAL, PP, and GR) and the level of oxygen saturation in dental pulp. These tests also evaluated possible associations between oxygen saturation and cold and electric pulp testing.
PAL, PP, and GR had negative correlations with oxygen saturation in dental pulp. Conversely, no statistically significant association was found between oxygen saturation in dental pulp and the response to electric sensibility testing.
Oxygen saturation was lower in the pulp of permanent teeth with PAL, PP, and GR, indicating that periodontal disease correlates with the level of oxygen saturation in the pulp.
Journal of Endodontics 10/2014; 40(12). DOI:10.1016/j.joen.2014.08.009 · 3.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Introduction
Pulse oximetry is a noninvasive method for assessing vascular health based on oxygen saturation level. The method has recently also been used to assess dental pulp vitality, but a median oxygen saturation level suggestive of normal pulp physiology has not been determined. The objective of this study was to make a critical analysis of the published research to establish the median oxygen saturation for the diagnosis of normal dental pulps in maxillary anterior permanent teeth using pulse oximetry.
Studies reporting on the use of pulse oximeters to determine oxygen saturation in dental pulps were retrieved using the MEDLINE, Scientific Electronic Library Online, and Cochrane Central Register of Controlled Trials databases plus a manual search of relevant references cited by selected articles. Different combinations of the terms “oximetry,” “oximeter,” “pulp,” “dental,” and “dentistry” were used in the search. Statistical analysis was performed for each group of teeth (central incisors, lateral incisors, and canines) using R statistical software (US EPA ORD NHEERL, Corvallis, OR) and a random effects model (P < .0001) with an I2 of 99%.
Of the 295 articles found, only 6 met the inclusion criteria (472 teeth). Of these, the number of articles included in each analysis (according to tooth group) was as follows: all 6 studies (288 teeth) for central incisors at a median oxygen saturation of 87.73%, 3 studies (90 teeth) for lateral incisors at a median oxygen saturation of 87.24%, and 4 studies (94 teeth) for canines at a median oxygen saturation of 87.26%.
The median oxygen saturation in normal dental pulps of permanent central incisors, lateral incisors, and canines was higher than 87%.
Journal of Endodontics 08/2014; 40(8). DOI:10.1016/j.joen.2014.04.011 · 3.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: AimTo evaluate connective tissue reactions to iRoot SP (Innovative Bioceramics, Vancouver, BC, Canada), mineral trioxide aggregate (MTA) Fillapex (FLPX) (Angelus Soluções Odontológicas, Londrina, Brazil), DiaRoot Bioaggregate (DiaDent Group International, Burnaby, BC, Canada) and white MTA (Angelus, Londrina, Brazil) in Wistar rats. MethodologyA total of 128 dentine tubes filled with the materials and 32 empty tubes (control) were implanted into 32 rats. After 7, 15, 30 and 90 days (n = 8 per period), the animals were euthanized, and the tissues were processed for histological evaluation using haematoxylin-eosin (H&E) and Von Kossa (VK) staining. Observations were made for cellular inflammatory components and the presence of multinucleated giant cells (MNGC), macrophages and tissue necrosis. Data were analysed by Fisher's exact and Kruskal–Wallis tests (P < 0.05). ResultsIn all experimental periods, MTA FLPX and iRoot SP scored higher than the other groups for the variable macrophages (P < 0.05). After 30- and 90-day experimental periods, MTA FLPX scored higher than the other groups for the variable MNGC (P < 0.05). After 90 days, the only group that exhibited samples with severe inflammatory response was MTA FLPX. VK positivity was observed in areas of necrosis in all groups, except in the control group. Conclusions
The materials were considered biologically acceptable except MTA FLPX, which remained toxic to subcutaneous tissue even after 90 days.
International Endodontic Journal 11/2013; DOI:10.1111/iej.12203 · 2.97 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to evaluate the influence of exposure of the mineral trioxide aggregate (MTA) - with and without calcium chloride (CaCl2) - to phosphate-buffered saline (PBS) on the apical microleakage using a glucose leakage system.
Sixty root segments were randomly divided into 4 experimental groups (n=15). After resecting the apical segments and enlarging the canals with Gates-Glidden drills, the apical cavities were filled with MTA with or without CaCl2 and the root canals were dressed with a moistened cotton pellet or PBS, as follows: 1) MTA/cotton pellet; 2) MTA/PBS; 3) MTA+10%CaCl2/cotton pellet; 4) MTA+10%CaCl2/PBS. All root segments were introduced in floral foams moistened with PBS. After 2 months, all root segments were prepared to evaluate the glucose leakage along the apical plugs. The amount of glucose leakage was measured following an enzymatic reaction and quantified by a spectrophotometer. Four roots were used as controls. The data were analyzed using Kruskal-Wallis and Mann-Whitney tests (p<0.05).
There were no differences between groups 1 and 2 (p>0.05), and 3 and 4 (p>0.05). The addition of CaCl2 to the MTA significantly decreased its sealing ability (p<0.05).
The interaction with PBS did not improve the MTA sealing ability. The addition of CaCl2 to the MTA negatively influenced the apical seal.
Journal of applied oral science: revista FOB 08/2013; 21(4):341-5. DOI:10.1590/1678-775720130023 · 0.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To analyse the influence of exposure of mineral trioxide aggregate (MTA) with and without calcium chloride (CaCl2 ) to phosphate-buffered saline (PBS) on the push-out bond strength, over different experimental periods.
One hundred and twenty dentine discs with standardized cavities were filled with MTA with and without 10% CaCl2 . The specimens were randomly divided as follows (n = 30): (G1) MTA in contact with a moistened cotton pellet, (G2) MTA immersed in PBS, (G3) MTA + CaCl2 in contact with a moistened cotton pellet and (G4) MTA + CaCl2 immersed in PBS. The samples were stored for 3, 28 and 60 days. The bond strengths were measured with the Instron Testing machine. Data were analysed using the three-way anova and Tukey test (P < 0.05).
In general, the samples of MTA with and without CaCl2 , exposed to PBS, had higher bond strength values in all study periods (P < 0.05). Analysis of the influence of addition of CaCl2 to MTA (G1 × G3) evidenced significant differences in bond strength in the different periods (P < 0.05).
The exposure of MTA to PBS positively influenced the push-out bond strength, whereas the addition of CaCl2 had a negative influence.
International Endodontic Journal 07/2013; 47(5). DOI:10.1111/iej.12168 · 2.97 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Many articles demonstrated that Passive Ultrassonic Irrigation (PUI) improves the cleaning and the smear layer removal. However no article has yet shown if the PUI influences on hydroxil ions (OH-) diffusion on dentin. Objective: The aim of this study was to evaluate the PUI effect on OH- diffusion arising from calcium hydroxide paste among root dentin.
Methods: 50 humans teeth were endodontically prepared. The cement layer was removed and the root surface was washed with EDTA and NaOCl. The cementoenamel junction and the apical portion of each root was covered. 4 different protocols for final irrigation were employed (n=10): G1 - final irrigation with EDTA + NaOCl, G2 - final irrigation with EDTA + PUI + NaOCl, G3 – final irrigation with EDTA + NaOCl + PUI and G4 – final irrigation with EDTA + NaOCl both with PUI activation. 5 teeth received only distilled water as final solution (G5) and other five were irrigated with distilled water + PUI (G6) working was control groups. The root canal was then dried and filled with CH. The specimens were individually kept in plastic vials containing distilled water (10mL) with a known pH. After 7, 15, and 21 days the pH from the specimens distilled water was verified. This values were recorded and compared by using ANOVA and Tukey’s test was used to individuals comparisons (α=0.05).
Results: No statistically significant difference was observed between the groups (p=0.1224). But it was observed among the different periods (p<0.0001). In the 15 and 21 days period was more OH- diffusion when compared to the 7 days analysis.
Conclusion: PUI did not influence on OH- diffusion among radicular dentin. When CH is employed as an intracanal medication it is necessary at least 15 days for the paste to promote a proper alcalinization of the dentin.
IADR/AADR/CADR General Session and Exhibition 2013; 03/2013
[Show abstract][Hide abstract] ABSTRACT: Objective: : The aim of this ex vivo study was to evaluate the effects of NaOCl and EDTA solutions, prior to root canal dressing with calcium hydroxide, on compressive strength of root dentin.
Method: Forty-eight roots with single and straight canals were used. The endodontic treatment was conducted by the crown-down technique, and canals were irrigated with 2 ml of 0,9 % NaCl between each file or drill. Further, specimens were randomly divided into four groups (n = 12), according to the irrigating solution used: group 1 (control), 0.9% NaCl; group 2, 1% NaOCl; group 3, 17% EDTA; group 4, 1% NaOCl and 17% EDTA. The total time of irrigation in each group was 40 min, and every 10 min the tested solution was renewed. In group 4, the time was equally divided (alternating solutions every 10 min). Further, each root canal was dry and filled with calcium hydroxide paste. After X-rays to confirm the completion, each canal was sealed and stored at 37º C for 30 days. After this period, the roots were cut 1 mm below the cement-enamel junction and 6 mm apically from this cut, in order to obtain 6 mm-length cylinders. The compressive strength test was conducted in an Instron machine with a crosshead speed of 1mm/min.
Result: The data recorded at fracture (MPa) were analyzed by ANOVA and Tukey test (α = 5%) and it was found that there was statistically significant difference between group 2, irrigated with NaOCl, and group 4, irrigated with EDTA and NaOCl. Group 2 had a mean compressive strength superior to that of Group 4.
Conclusion: The root canal irrigation with 17% EDTA followed by 1% NaOCl promote a significant reduction of root dentin resistance observed after 30 days of calcium hydroxide dressing.
IADR/AADR/CADR General Session and Exhibition 2013; 03/2013
[Show abstract][Hide abstract] ABSTRACT: Objective: To evaluate ex vivo the effects of immersion in phosphate buffer solution (PBS) in bond strength (BS) and adhesive interface formation between endodontic sealers and root canal dentin.
Methods: Eighty 16-mm long roots had their canals submitted to biomechanical preparation. After the final irrigation with EDTA and NaOCl, the canals were randomly divided into four groups (n = 20) according to the sealer used in obturation: Endofill (G1), AH Plus (G2), Sealapex (G3) and MTA Fillapex (G4). Half of the specimens of each group was tested after 07 days of immersion in water (Period A) and the other half after 60 days in PBS (period B). Two cross-sections of 1 mm thickness for each region (coronal, middle and apical) of the root were obtained. One slice per region was used to push-out test and the other one was prepared for interface analysis in scanning electron microscopy (SEM).
Results: Three-way analysis of variance (α = 0.05) indicated statistically significant difference among the groups and the regions (p <0.0001), but not among periods. AH Plus (G1) had higher BS than the other sealers, regardless of the period analyzed (p <0.5). Adhesive failures were more commonly observed in the G1 Group (Endofill), and cohesive failures in the other groups. SEM analysis showed In both periods A and B, homogeneous adhesive interface and the presence of many tags when the AH Plus sealer was used. After 60 days of immersion in PBS it was observed greater depth of sealer penetration into dentinal tubules,only when Sealapex and MTA Fillapex were used.
Conclusion: The immersion in PBS did not increase the bond strength to dentin of the tested sealers, although after this period the SEM analysis showed more homogeneous adhesive interface.
[Show abstract][Hide abstract] ABSTRACT: Objective: Mineral Trioxide Aggregate (MTA) has as radiopacifier bismuth oxide (Bi2O3), which has received criticism for not taking part of the material setting and for make it more porous. Portland cement has similar composition and lower price as compared to MTA and because of that, Portland cement has replaced MTA in many researches. This study aimed to evaluate the solubility and the disintegration of Portland cement with different concentrations of Bi2O3 (0, 10, 15, 20 e 30%).
Method: Twelve teflon rings with 4 mm thickness and a 12 mm diameter were filled with cement. After setting, the samples were weighed (initial hidrated weight = PH0) and after 24 h in a dissecator, the samples were again weighed (initial dehydrated weight = PD0). Then the samples were divided and immersed in deionized water for 7 and 30 days. After those periods, the same procedures were performed and new weights were obtained (PH7d, PD7d, PH30d e PD30d). The solubility and disintegration of the cements was measured by the loss of mass identified by the weight of each sample, expressed as percentage of weight lost when compared to the original weight. For statistical analysis it was employed the two-way ANOVA test, in each period, and the Tukey HSD to indicate the significant differences (α=5%). It was not observed disintegration of the cements.
Result: There was a difference between the groups in the 7 days analysis (hidrated and dehydrated) and between the periods for pure Portland cement when weighed dehydrated (p<0,05).
Conclusion: Although there was statistical difference in the solubility of the groups at 7 days, all showed the same behavior after 30 days of storage in water.
[Show abstract][Hide abstract] ABSTRACT: Objective: The aim of this study was to evaluate the coronal leakage in root canals filled with gutta-percha and AH Plus and MTA FILLAPEX.
Method: After accessing, measuring and cleaning of the 36 single-rooted premolars root canals, the instrumentation was performed with the ProTaper system, until to instrument F4 under irrigation with 1%. sodium hypochlorite solution Thirty teeth were randomly divided in two experimental groups (n = 15) according to the sealer used: G1: MTA FILLAPEX and G2: AH Plus. After obturation, with ProTaper F4 cones, the teeth were kept at 37 °C for 07 days. Six teeth were used as positive control group (n = 3) and negative control group (n = 3). The infiltration test was realized with dye ink under a pressure of 60 kPa for 8 min. After diaphanization, the dye penetration was evaluated by root thirds.
Result: There was infiltration of 8 and 7 samples of G1 and G2, respectively. In any sample of the G2, the dye reached the apical third, being restricted to the cervical and middle thirds. In four samples of G1, the dye was visualized in the apical third. Evaluating the total infiltration, the χ² test and Fisher's exact test revealed no significant difference between groups 1 and 2. When the dye penetration was evaluated by thirds, the proportions test showed that, for the apical third, G12 were significantly different (p = 0.0317).
Conclusion: It was concluded that the two sealers allowed, similarly, the dye leakage in the cervical and middle thirds of the root. When considering infiltration to the apical third, the MTA FILLAPEX showed a lower quality of sealing.
[Show abstract][Hide abstract] ABSTRACT: Objectives: To evaluate the influence of two intensities of pressure (30KPa and 60KPa) in bacterial penetration in filled root canals, and to correlate the depth of penetration with the time of exposure to the oral environment (45 and 120 days).
Methods: One hundred-twenty-two root canals of dogs’ teeth were instrumented with ProTaper files and filled by single cone technique with gutta-percha and AH Plus sealer. After setting, root canal fillings were subjected to different pressures for 8 minutes according to groups: A-were not under pressure (n=34); B-30KPa (n=34); C-60KPa (n=34). Then, all root canal fillings were exposed to the oral environment in accordance with sub-groups (45 and 120 days). All sub-groups had positive (n=10) and negative controls (n=10). The animals were killed and jaws were removed and prepared for histobacteriological analysis. Histological sections were stained with Brown-Brenn to detect the presence of bacteria.
Results: Bacterial infiltration was higher in cervical 4mm. The Kruskal-Wallis test did not shown significant difference in bacterial penetration among groups A, B and C in both periods: 45 days (p=0.903) and 120 days (p=0.211). Comparing the exposure times (45 and 120 days), there was no significant difference in bacterial penetration (p=0.608), although greater infiltration was detected in 120 days.
Conclusions: The pressures of 30KPa and 60KPa did not induce alterations in root canal fillings to the point of influencing bacterial penetration in the different time periods. These pressures can be indicated to use in sealability assessment methodologies (ex vivo and in vitro) to facilitate the infiltration of fluid markers such as dyes, water and glucose.
[Show abstract][Hide abstract] ABSTRACT: Objective: The aim of this study was to analyze the interaction of the new cements MTA Fillapex, Diaroot Bioaggregate and iRoot SP with dentin in vivo.
Method: One hundred and sixty human dentin tubes were randomly divided in 4 experimental groups. After filling with the materials tubes were implanted subcutaneously in 32 rats at four sites equidistant from the dorsal area. Empty tubes were used as control and implanted in a fifth site. After 7, 15, 30 and 90 days the animals were euthanized and the dentin tubes retrieved for scanning electron microscope (SEM) analysis.
Result: In 7 and 30 days, the mineral deposition in the material-dentin interface was detected in all tubes filled with MTA Fillapex; and in 15 and 90 days it was detected in 7 of the 8 samples. Despite of the period, the mineral deposition was not detected in any of the control samples, neither in those filled with iRoot SP, Diaroot Bioaggregate and MTA Branco.
Conclusion: It was concluded that MTA FILLAPEX was the only cement which interacted with dentin and promoted the in vivo biomineralization, and that this process was not affected by the experimental period.