RESUMO
Immature avulsed teeth are not usually treated with pulp revascularization because of the possibility of complications. However, this therapy has shown success in the treatment of immature teeth with periapical lesions. This report describes the case of an immature replanted tooth that was successfully treated by pulp revascularization. An 8-year-old boy suffered avulsion on his maxillary left lateral incisor. The tooth showed incomplete root development and was replanted after 30 minutes. After diagnosis, revascularization therapy was performed by irrigating the root canal and applying a calcium hydroxide paste and 2% chlorhexidine gel for 21 days. In the second session, the intracanal dressing was removed and a blood clot was stimulated up to the cervical third of the root canal. Mineral trioxide aggregate was placed as a cervical barrier at the entrance of the root canal and the crown was restored. During the follow-up period, periapical repair, apical closure and calcification in the apical 4 mm of the root canal was observed. An avulsed immature tooth replanted after a brief extra-alveolar period and maintained in a viable storage medium may be treated with revascularization.
Assuntos
Apexificação/métodos , Incisivo/lesões , Avulsão Dentária/terapia , Reimplante Dentário/métodos , Compostos de Alumínio/uso terapêutico , Compostos de Cálcio/uso terapêutico , Hidróxido de Cálcio/uso terapêutico , Criança , Clorexidina/uso terapêutico , Polpa Dentária/irrigação sanguínea , Polpa Dentária/efeitos dos fármacos , Cavidade Pulpar/efeitos dos fármacos , Combinação de Medicamentos , Seguimentos , Humanos , Masculino , Óxidos/uso terapêutico , Materiais Restauradores do Canal Radicular/uso terapêutico , Irrigantes do Canal Radicular/uso terapêutico , Preparo de Canal Radicular/métodos , Silicatos/uso terapêutico , Ápice Dentário/efeitos dos fármacos , Calcificação de Dente/efeitos dos fármacosRESUMO
AIM: To measure the minimum thickness of the distal (furcal) root dentine associated with the buccal and lingual canals of the mesial roots of mandibular first molars with different lengths. METHODOLOGY: The mesial roots of 285 mandibular first molars were allocated into three groups according to their length: group I - long (24.14 mm +/- 0.85), group II - medium (22.10 mm +/- 0.65) and group III - short (19.97 mm +/- 0.75). The minimum thickness of the distal (furcal) root dentine associated with the buccal and lingual canals of the mesial roots 2 mm below the furcation was measured. The distance between the buccal and lingual canals, and the depth of concavity in the distal surface of the mesial roots were also measured. anova and Tukey-Kramer were used to test for significant differences among the groups. RESULTS: The minimum thickness of the distal wall of the mesiobuccal canal was significantly different (P < 0.05) between group I (long) and III (short), with long teeth having the smallest mean values. No significant difference was found in the thickness of the distal wall of the mesiolingual canal among the groups studied (P > 0.05). The shortest distance between the mesiobuccal and the mesiolingual canals was observed in group III (P < 0.05). The distal (furcal) concavity was deeper in group I (P < 0.05) when compared with the other groups. CONCLUSION: There was a significant difference in the minimum thickness of the distal (furcal) root wall of the mesiobuccal canal of mandibular first molars 2 mm below the furcation between group I (long) and group III (short) teeth. The thinnest walls were found in the longest teeth. The deepest concavities in the distal (furcal) walls of the mesial roots were found in the longest roots.
Assuntos
Cavidade Pulpar/anatomia & histologia , Dentina/anatomia & histologia , Dente Molar/anatomia & histologia , Raiz Dentária/anatomia & histologia , Análise de Variância , Humanos , Mandíbula , Odontometria , Valores de Referência , Estatísticas não ParamétricasRESUMO
AIM: To evaluate ex vivo degradation of gutta-percha following six thermoplastic obturation techniques. METHODOLOGY: Ninety human-extracted mandibular premolars were selected and divided randomly into nine groups for filling. Group 1: thermomechanical compaction for 3 s with Konne gutta-percha points (Konne Ind. e Com. de Mat. Odontol., Belo Horizonte, MG, Brazil); Group 2: thermomechanical compaction for 3 s with Dentsply TP gutta-percha points (Dentsply Indústria e Comércio Ltda, Petrópolis, R.J. Brazil); Group 3: thermomechanical compaction for 10 s with Konne; Group 4: thermomechanical compaction for 10 s with Dentsply TP; Group 5: warm vertical condensation using System B (EIE/Analytic, Richmond, WA, USA) with Konne; Group 6: warm vertical condensation using System B with Dentsply TP; Group 7: vertical condensation with Konne; Group 8: vertical condensation with Dentsply TP; Group 9: Microseal cone (Analytic Endodontics, Glendora, CA, USA). A further four groups were assessed without using teeth, Group 10: Microseal microflow (Analytic Endodontics); Group 11: Obtura (Obtura Corporation, Penton, MO, USA); Group 12: Obtura flow (Obtura Corporation); Group 13: Thermafil (Dentsply Maillefer, Tulsa, OK, USA). The filling material was removed from the root canal and trans-1,4-polyisoprene isolated by solubilization of the root filling remnants in chloroform followed by filtration and centrifugation. By gel permeation chromatography and infrared spectroscopy, the occurrence and degree of degradation were assessed. The results were analysed statistically using the Kruskal-Wallis test. With differential scanning calorimetry, the thermal behaviour of the gutta-percha was determined. RESULTS: A significant decrease in polymer molar mass and the production of carboxyl and hydroxyl groups in the polymer were observed with thermomechanical compaction used for 10 s and vertical condensation filling techniques (P = 0.0001 and P = 0.0005, respectively). Other techniques caused no polymer degradation. CONCLUSION: Polyisoprene degrades with high temperature. Thermomechanical compaction for 10 s and vertical condensation were associated with the greatest degradative process.
Assuntos
Guta-Percha/química , Materiais Restauradores do Canal Radicular/química , Dente Pré-Molar , Varredura Diferencial de Calorimetria , Cromatografia em Gel , Hemiterpenos/química , Temperatura Alta , Humanos , Teste de Materiais , Peso Molecular , Obturação do Canal Radicular , Espectroscopia de Infravermelho com Transformada de Fourier , Estatísticas não ParamétricasRESUMO
AIM: To investigate ex vivo the antimicrobial activity of a paste of sodium perborate associated with various vehicles comparing it with 37% carbamide peroxide and 35% hydrogen peroxide. METHODOLOGY: The antimicrobial activity of these agents was evaluated against three microorganisms: Enterococcus faecalis, Streptococcus mutans and Candida albicans. One millilitre of each tested substance was placed on the bottom of wells of 24-well cell culture plates. Six wells were used for each time period and group. Two millilitres of the microbial suspension was ultrasonically mixed for 10 s with the bleaching pastes and placed in contact with them for 10, 30, 45 s; 1, 3, 5, 10, 20, 30 min; and 1 and 2 h. After each period of time, 1 mL from each well was transferred to tubes containing 2 mL of freshly prepared brain heart infusion agar + neutralizers. Agar plates were inoculated in appropriate gaseous conditions. Data were analysed statistically by the Kruskal-Wallis test with the level of significance set at P < 0.05. RESULTS: In all groups containing chlorhexidine (groups 3, 5 and 7), the antimicrobial activity of the bleaching paste was significantly increased when compared with groups with other kinds of vehicle (groups 1, 2, 4, 6 and 8). For all tested groups, the most resistant microorganism was E. faecalis. CONCLUSIONS: Chlorhexidine when used as a vehicle for sodium perborate enhanced its antimicrobial activity.
Assuntos
Anti-Infecciosos/farmacologia , Boratos/farmacologia , Peróxido de Hidrogênio/farmacologia , Oxidantes/farmacologia , Peróxidos/farmacologia , Clareamento Dental/métodos , Ureia/análogos & derivados , Anti-Infecciosos Locais/farmacologia , Candida albicans/efeitos dos fármacos , Peróxido de Carbamida , Clorexidina/farmacologia , Combinação de Medicamentos , Farmacorresistência Bacteriana , Enterococcus faecalis/efeitos dos fármacos , Humanos , Teste de Materiais , Veículos Farmacêuticos , Streptococcus mutans/efeitos dos fármacos , Fatores de Tempo , Ureia/farmacologiaRESUMO
BACKGROUND/AIMS: The purpose of this study was to determine the amount of endotoxin (lipopolysaccharide) and cultivable bacteria in human necrotic root canals before (S1) and after chemo-mechanical preparation using chlorhexidine (CHX) gel as auxiliary chemical substance (S2), and after 7 days of intracanal dressing (S3) in order to evaluate the anti-endotoxin and antimicrobial effects of endodontic procedures. METHOD: Twenty-four teeth were selected for the present study. Chemo-mechanical preparation was performed using 2% CHX gel and three different intracanal medicaments [CaOH2 paste; 2% CHX gel; and CaOH2 + 2% CHX gel]. A quantitative chromogenic Limulus amoebocyte lysate assay was used to measure the amount of endotoxin. Aerobic and anaerobic techniques were used to isolate and identify bacteria, and to determine the bacterial reduction by counting colony-forming units (CFU). RESULTS: Endotoxins and bacteria were present in 100% of the initial samples, with endotoxin concentration ranging from 62.93 to 214.56 UE/ml and CFU ranging from 4 x 10(5) to 2.6 x 10(6). After chemo-mechanical preparation a mean endotoxin reduction of 44.4% was found. Eight (33.3%) root canals were still positive by culture analysis with a mean reduction of bacteria (CFU) of 99.96%. After 7 days of intracanal dressing, endotoxin concentration decreased by only 1.4% compared with S2, and residual bacteria were recovered by culture analysis in 13 cases (54.1%). No significant difference was found among different intracanal medicaments. CONCLUSION: Relatively high values of endotoxin were still present in the root canal after chemo-mechanical preparation although the majority of bacteria were eliminated. No improvement was achieved by 7 days of intracanal dressing.
Assuntos
Bactérias/classificação , Cavidade Pulpar/patologia , Necrose da Polpa Dentária/microbiologia , Endotoxinas/análise , Tratamento do Canal Radicular/métodos , Adolescente , Adulto , Idoso , Anti-Infecciosos Locais/uso terapêutico , Bactérias Aeróbias/classificação , Bactérias Anaeróbias/classificação , Técnicas de Tipagem Bacteriana , Hidróxido de Cálcio/uso terapêutico , Clorexidina/uso terapêutico , Compostos Cromogênicos , Contagem de Colônia Microbiana , Necrose da Polpa Dentária/terapia , Bactérias Gram-Negativas/classificação , Bactérias Gram-Positivas/classificação , Humanos , Lipopolissacarídeos/análise , Pessoa de Meia-Idade , Irrigantes do Canal Radicular/uso terapêuticoRESUMO
AIM: To evaluate the flow characteristics of AH Plus, Epiphany Root Canal Sealant, Endométhasone, Pulp Canal Sealer (EWT) and Sealapex and their ability to fill artificial lateral canals and prevent microleakage. METHODOLOGY: Flow of the sealers was analysed using the American Dental Association (ADA) 57 and the International Standards Organization (ISO) 6,876 specifications. Two lateral canals were produced in the middle and apical third of 64 roots using 0.1 mm cylindrical drills. Lateral condensation of gutta-percha or Resilon and one or other of the sealers were used to fill the root canals. Buccal-lingual digital radiographs were exposed. After the sealer had set, the roots were immersed in Indian ink and cleared in methyl salicylate. The extent of filling and dye penetration were measured on the buccal and lingual root surfaces under 30 x magnification with a stereoscope. RESULTS: AH Plus, Epiphany and Pulp Canal Sealer (EWT) complied with ADA 57 and ISO 6,876 specifications. Sealapex complied with the ADA 57 specification but not with ISO 6,876. Endométhasone did not comply with either specification. Filling of lateral canals was similar for the five sealers tested. Dye leakage demonstrated that AH Plus, Epiphany and Sealapex permitted less leakage than Pulp Canal Sealer (EWT) (P < 0.05). CONCLUSIONS: All the sealers flowed into the 0.1 mm artificial lateral canals. AH Plus, Epiphany and Sealapex allowed less linear leakage than Pulp Canal Sealer (EWT). The flow of Endométhasone did not comply with either ADA 57 or ISO 6,876 specifications and Sealapex did not comply with ISO 6,876.
Assuntos
Infiltração Dentária/prevenção & controle , Cavidade Pulpar/cirurgia , Materiais Restauradores do Canal Radicular/química , Cavidade Pulpar/anatomia & histologia , Humanos , Materiais Restauradores do Canal Radicular/uso terapêutico , Estatísticas não ParamétricasRESUMO
AIM: To evaluate in vivo degradation of root filling materials over time. METHODOLOGY: Thirty-six root filled teeth with or without periapical lesions were selected. Teeth with poor coronal restoration were not included. The teeth had been root filled 3-30 years previous and were scheduled for conventional retreatment. The association of root canal treatment, age, periapical lesion and root filling degradation was investigated. The filling material was removed from the root canal using files and no solvent. Trans-1,4-polyisoprene was isolated through solubilization of root filling remnants in chloroform followed by filtration and centrifugation. Gel permeation chromatography (GPC) and infrared spectroscopy (FT-IR) were utilized to study the occurrence and degree of degradation. The GPC and FT-IR data were collected for each sample and analysed statistically using the Kruskal-Wallis test. RESULTS: Degradation of trans-1,4-polyisoprene was a slow process. The process was identified as an oxidation reaction through the production of carboxyl and hydroxyl groups. Compared with the control group, significant molar mass decrease was noted after 15 years (P = 0.0146) in teeth with no periapical lesions. However, in teeth associated with periapical lesions the number of years for significant degradation was reduced to 5 (P = 0.0009). CONCLUSION: Polyisoprene degrades inside root canals as an oxidative process. The presence of periapical lesions was associated with a more rapid onset of degradation.
Assuntos
Butadienos/química , Guta-Percha/química , Hemiterpenos/química , Pentanos/química , Materiais Restauradores do Canal Radicular/química , Biotransformação , Cromatografia em Gel , Falha de Restauração Dentária , Humanos , Oxirredução , Periodontite Periapical/terapia , Retratamento , Obturação do Canal Radicular , Espectroscopia de Infravermelho com Transformada de Fourier , Estatísticas não Paramétricas , Fatores de TempoRESUMO
AIM: To investigate the antimicrobial activity of 2.5% and 5.25% sodium hypochlorite and 2.0% chlorhexidine gel and liquid as endodontic-irrigating substances against selected single-species biofilms. METHODS: Single-species biofilms of Enterococcus faecalis, Staphylococcus aureus, Candida albicans, Prevotella intermedia, Porphyromonas gingivalis, Porphyromonas endodontalis and Fusobacterium nucleatum were generated on a cellulose nitrate membrane placed on agar medium. The biofilms were then immersed in the endodontic-irrigating substances for 30 s and also for 5, 10, 15, 30 and 60 min, with and without mechanical agitation. Sterile saline was used as control. After each time period, the membrane filters were then transferred to tubes containing 2 mL of fresh broth medium plus neutralizers (in order to prevent the residual action of the tested substances). The micro-organisms were suspended using a vortex, and the inoculum was serially diluted 10-fold. Aliquots of the dilutions were plated on 5% sheep blood agar medium, and incubated under adequate gaseous conditions. Colony-forming units were calculated. The samples were compared using the Friedman and Tukey test, when necessary, at a significance level of P < 0.05. RESULTS: Mechanical agitation promoted the effectiveness of the antimicrobial agents, resulting in less time to eliminate the same micro-organisms, except for S. aureus with 2.5% NaOCl. Antimicrobial agents in liquid presentation, especially 5.25% NaOCl and 2% chlorhexidine, killed the tested micro-organisms more rapidly. Saline did not inhibit the growth of any of the tested micro-organisms, with or without agitation, being statistically different (P < 0.05) from NaOCl and chlorhexidine. P. intermedia, P. gingivalis, P. endodontalis and F. nucleatum were eliminated in 30 s by all antimicrobial agents, with our without agitation, in contrast with the facultative and aerobe strains. CONCLUSIONS: Mechanical agitation improved the antimicrobial properties of the chemical substances tested using a biofilm model, favouring the agents in liquid presentation, especially 5.25% NaOCl and 2% chlorhexidine.
Assuntos
Anti-Infecciosos Locais/farmacologia , Biofilmes/efeitos dos fármacos , Clorexidina/farmacologia , Desinfetantes/farmacologia , Irrigantes do Canal Radicular/farmacologia , Hipoclorito de Sódio/farmacologia , Anti-Infecciosos Locais/administração & dosagem , Técnicas Bacteriológicas , Candida albicans/efeitos dos fármacos , Clorexidina/administração & dosagem , Contagem de Colônia Microbiana , Desinfetantes/administração & dosagem , Relação Dose-Resposta a Droga , Enterococcus faecalis/efeitos dos fármacos , Fusobacterium nucleatum/efeitos dos fármacos , Humanos , Teste de Materiais , Porphyromonas endodontalis/efeitos dos fármacos , Porphyromonas gingivalis/efeitos dos fármacos , Prevotella intermedia/efeitos dos fármacos , Irrigantes do Canal Radicular/administração & dosagem , Hipoclorito de Sódio/administração & dosagem , Staphylococcus aureus/efeitos dos fármacos , Fatores de TempoRESUMO
AIM: To compare the ability of five different commercially available gutta-percha points to fill simulated lateral canals when subjected to warm vertical compaction. METHODOLOGY: Fifty clear plastic teeth with a lateral canal in each third of the root were used. All teeth were filled using warm vertical compaction. Backfilling was completed with a sealer and the same gutta-percha point used during the apical condensation. After this, they were horizontally sectioned using a diamond disc adapted to a low-speed saw. The resulting sections were embedded in epoxy resin. The extent of gutta-percha and sealer filling were measured in each lateral canal using an IMAGE-PRO 4.0 software system. The voids in each canal were measured using the same system. Data were ranked and analysed using the Kruskal-Wallis statistical test. RESULTS: The mean percentage of the three lateral canals filled with gutta-percha and sealer were respectively: Konne (68.23% and 24.50%), Analytic (67.90% and 25.28%), Obtura (63.80% and 29.60%), Tanari (49.42% and 45.86%) and Dentsply (44.60% and 47.05%). There was significantly (P < 0.05) more gutta-percha in the lateral canal filled with Analytic, Obtura and Konne points than with Tanari and Dentsply points. CONCLUSIONS: The brand of gutta-percha cone had an influence on the length of filling within lateral canals. This may be a reflection of the chemical formulation of the gutta-percha points.
Assuntos
Cavidade Pulpar/anatomia & histologia , Guta-Percha/uso terapêutico , Materiais Restauradores do Canal Radicular/uso terapêutico , Guta-Percha/química , Humanos , Processamento de Imagem Assistida por Computador , Microscopia , Reologia , Materiais Restauradores do Canal Radicular/química , Obturação do Canal Radicular/métodos , Propriedades de SuperfícieRESUMO
AIM: To evaluate the efficacy of 0.5%, 2.5% and 5.25% sodium hypochlorite (NaOCl) as intracanal irrigants associated with hand and rotary instrumentation techniques against Enterococcus faecalis within root canals and dentinal tubules. METHODOLOGY: A total of 180 extracted human premolar teeth were infected for 21 days with E. faecalis. The specimens were divided into 12 groups, as follows: group 1: 5.25% NaOCl + Hybrid technique (Valdrighi et al. 1998); group 2: 5.25% NaOCl + nickel-titanium (NiTi) rotary technique 4 mm shorter than the apex (by FOP-UNICAMP); group 3: 5, 25% NaOCl + NiTi rotary technique (Hero 642); group 4: 2.5% NaOCl +Hybrid technique; group 5: 2.5% NaOCl + NiTi rotary technique 4 mm shorter than the apex; group 6: 2.5% NaOCl + NiTi rotary technique (Hero 642); group 7: 0.5% NaOCl + Hybrid technique; group 8: 0.5% NaOCl + NiTi rotary technique 4 mm shorter than the apex; group 9: 0.5% NaOCl + NiTi rotary technique (Hero 642); group 10: sterile saline solution + Hybrid technique; group 11: sterile saline solution + NiTi rotary technique 4 mm shorter than the apex; group 12: sterile saline solution + NiTi rotary technique (Hero 642). Canals were sampled before and after preparation. After serial dilution, samples were plated onto brain heart infusion (BHI) agar, and the colony forming units (CFU) that were grown were counted. The teeth were sectioned into three thirds and dentine chips were removed from the canals with conical burs. The samples obtained with each bur were immediately collected into test tubes containing BHI broth, and were incubated at 37 degrees C and plated onto BHI agar. The CFU were counted and analysed. RESULTS: At all depths and thirds of the root canals and for all techniques used, 5.25% NaOCl was shown to be the most effective irrigant solution tested when dentinal tubules were analysed, followed by 2.5% NaOCl. No differences among concentrations in cleaning the canals were found. CONCLUSIONS: Especially at higher concentrations, NaOCl, was able to disinfect the dentinal tubules, independent of the canal preparation technique used.