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BACKGROUND: Evaluate the fracture resistance of endodontically treated teeth after cervical preflaring and root canal preparation and to assess the volume of the root canal and the amount of remaining root dentin before and after cervical preflaring. METHODS: Forty-four mandibular incisors were selected using micro-CT scanning and distributed into 4 groups (n = 11) according to the instrument used for cervical preflaring: control group - no cervical preflaring; Gates Glidden - burs size #2 and #3; WXN - 25.07 Navigator instrument; and Easy - 25.08 ProDesign S instrument. Coronal opening was performed, and the canals were prepared with Wave One Gold Primary and filled with an epoxy-resin based sealer and gutta-percha cones. Micro-CT scans were performed before and after root canal instrumentation. All images were reconstructed and assessed for the thickness of mesial and distal root dentin at 3 mm and 5 mm from the cement -enamel junction and for the volume of cervical portion of the canal after preparation. Fracture resistance test was performed applying compressive loads at a crosshead speed of 0.5 mm/min, applied on the palatal aspect of specimens at 135° along the long axis of the tooth. The data were analyzed using ANOVA and Tukey's test (P = .05). RESULTS: Cervical preflaring and canal preparation reduced the dentin thickness (P < .05) and increased the canal volume (P < .05) in all groups at 3 mm an 5 mm. Cervical preflaring with Gates Gliden burs reduced the fracture resistance of endodontically treated teeth (P < .05). CONCLUSIONS: All instruments reduced the dentin thickness and increased the canal volume in the cervical at 3 mm and 5 mm. Gates Glidden reduced fracture resistance of mandibular incisors submitted to cervical preflaring, whereas NiTi instruments did not. CLINICAL RELEVANCE: Cervical preflaring assumes particular importance previously to the root canal preparation because it minimizes the occurrence of operative accidents, and permits more accurate determination of working length and the apical diameter.

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This study aimed to systematically review the literature to address the question regarding the influence of different materials in the clinical and radiographic success of indirect pulp treatment in primary teeth. A literature search was carried out for articles published prior to January 2017 in PubMed/MEDLINE, CENTRAL, Scopus, TRIP and ClinicalTrials databases; relevant articles included randomized clinical trials that compared materials used for indirect pulp treatment in primary teeth. Two reviewers independently selected the studies and extracted the data. The effects of each material on the outcome (clinical and radiographic failures) were analyzed using a mixed treatment comparisons meta-analysis. The ranking of treatments according to their probability of being the best choice was also calculated. From 1,088 potentially eligible studies, 11 were selected for full-text analysis, and 4 were included in the meta-analysis. In all papers, calcium hydroxide liner was used as the control group versus an adhesive system, resin-modified glass ionomer cement or placebo. The follow-up period ranged from 24 to 48 months, with dropout rates of 0-25.7%. The material type did not significantly affect the risk of failure of the indirect pulp treatment. However, calcium hydroxide presented a higher probability of failure. In conclusion, there is no scientific evidence showing the superiority of any material used for indirect pulp treatment in primary teeth.

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Objetivo: o objetivo deste estudo foi avaliar a influência dos cimentos AH Plus e Endofill na radiopacidade de obturações em canais simulados, usando-se a técnica do cone único. Métodos: vinte blocos de resina com canais curvos simulados foram preparados até o instrumento rotatório ProTaper Universal F3. Após a irrigação final, os canais foram secos com cones de papel, e um cone de guta-percha F3 foi inserido no canal; em seguida, uma radiografia digital foi realizada para cada espécime. Os espécimes foram distribuídos aleatoriamente em dois grupos experimentais (n = 10), de acordo com cimento empregado. AH Plus e Endofill foram os cimentos associados à guta-percha para obturação dos canais. Após a presa final dos cimentos, novas imagens digitais foram realizadas, da mesma forma que as radiografias pré-operatórias. As imagens das radiografias antes e após a associação da guta-percha com o cimento foram sobrepostas e analisadas, para se registrar o número de pixels das imagens. A análise estatística foi realizada utilizando-se os testes t de Student e Wilcoxon, com nível de significância de 5%. Resultados: ambos os grupos apresentaram radiopacidade semelhante para a guta-percha (p > 0,05). No entanto, a adição do cimento aumentou significativamente (p < 0,05) a radiopacidade das imagens radiográficas. A radiopacidade foi aumentada em 68,10% com o cimento AH Plus e em 46,02% com o cimento Endofill, com diferença estatisticamente significativa entre os cimentos. Conclusões: os cimentos aumentaram significativamente a radiopacidade da obturação com a técnica do cone único. O cimento AH Plus foi mais radiopaco do que o cimento Endofill.

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Abstract: This study aimed to systematically review the literature to address the question regarding the influence of different materials in the clinical and radiographic success of indirect pulp treatment in primary teeth. A literature search was carried out for articles published prior to January 2017 in PubMed/MEDLINE, CENTRAL, Scopus, TRIP and ClinicalTrials databases; relevant articles included randomized clinical trials that compared materials used for indirect pulp treatment in primary teeth. Two reviewers independently selected the studies and extracted the data. The effects of each material on the outcome (clinical and radiographic failures) were analyzed using a mixed treatment comparisons meta-analysis. The ranking of treatments according to their probability of being the best choice was also calculated. From 1,088 potentially eligible studies, 11 were selected for full-text analysis, and 4 were included in the meta-analysis. In all papers, calcium hydroxide liner was used as the control group versus an adhesive system, resin-modified glass ionomer cement or placebo. The follow-up period ranged from 24 to 48 months, with dropout rates of 0-25.7%. The material type did not significantly affect the risk of failure of the indirect pulp treatment. However, calcium hydroxide presented a higher probability of failure. In conclusion, there is no scientific evidence showing the superiority of any material used for indirect pulp treatment in primary teeth.

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Objective: This study aimed to compare the fracture resistance of endodontically treated roots filled by different obturation systems. Material and methods: Ninety-six maxillary central incisors were used and decoronated, retaining 12 mm of the roots. On the basis of obturation systems, the roots were randomly divided into 4 groups (n=24): Group1 (COGR): control group (unprepared, unfilled), Group 2 (AVGR): ActiV GP points/ActiV GP sealer, Group 3 (GPGR): Gutta percha points / AH plus sealer, and Group4 (GAGR): Gutta percha points/ActiV GP sealer. The last three groups were obturated with the single cone technique. The roots were then stored in 100% relative humidity at 37 °C for 2 weeks. A vertical compressive force was exerted in a universal testing machine until fracture occurred. Data were statistically analyzed using one-way ANOVA. Results: Mean (SD) failure loads for groups ranged from 920.51 ± 210.37 to 1113.44 ± 489.42 N. The fracture resistance between the different study groups indicated no statistical difference (p>0.05). Conclusions: ActiV GP system did not exert a significant effect on the fracture resistance of endodontically treated teeth.(AU)

Objective: Comparar a resistência à fratura de raízes tratadas endodonticamente obturadas através de diferentes sistemas. Materiais e Métodos: Noventa e seis incisivos centrais superiores foram utilizados, tiveram as coroas removidas, restando 12 mm de raíz. De acordo com o sistema de obturação, as raízes foram divididas em 4 grupos (n=24): Grupo1 (COGR): grupo controle (sem preparo, sem preenchimento), Grupo2 (AVGR): cones ActiV GP / cimento ActiV GP, Grupo3 (GPGR): cones de guta percha / cimento AH plus, e Grupo4 (GAGR): cones de guta percha / cimento ActiV GP. Os últimos três grupos foram obturados através da técnica de cone único. As raízes foram armazenadas em 100% de umidade relativa a 37 °C durante 2 semanas. Uma força compressiva vertical foi aplicada através de uma máquina de ensaio universal até ocorrer fratura. Os dados foram analisados estatisticamente através de ANOVA ­ 1 fator. Resultados: A carga média (SD) obtida no momento da falha variou entre 920.51 ± 210.37 até 1113.44 ± 489.42 N. A resistência à fratura entre os diferentes grupos estudados não indicaram diferença estatística. Conclusão: O sistema ActiV GP não exerceu um efeito significante na resistência à fratura em dentes tratados endodonticamente.(AU)

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Cyst-like periapical lesions should be treated initially with conservative nonsurgical procedures. In this case series, we describe the clinical and radiographic outcomes of large cyst-like lesions that were treated by orthograde decompression and long-term intracanal use of calcium hydroxide [Ca(OH)2] mixed with 2% chlorhexidine digluconate. Ten cases of cyst-like periapical lesions involving 15 teeth from 10 patients were selected. Maximal radiographic diameters of the lesions ranged from 11 to 28 mm. Nonsurgical procedures were performed, including apical patency, orthograde puncture of cyst-like exudates, chemomechanical preparation, and placement of intracanal Ca(OH)2/CHX dressings, which were periodically replaced during 6-10 months. The root canals were then filled with gutta-percha and sealer. The follow-up periods ranged from 6 to 24 months, and the outcome was classified as healed, healing, or failure. Nine lesions drained copious exudates after canal patency. One lesion only drained bloody serous exudate after periapical overinstrumentation. In 9 patients, intracanal exudation ceased in the first follow-up visit. At the 24-month follow-up, 6 lesions (60.0%) had healed, and 3 lesions (30.0%) were healing, with the corresponding patients being without clinical signs or symptoms. The case of treatment failure was submitted to surgical treatment. Microscopically, the lesion appeared to be an apical cyst with exuberant extraradicular bacterial biofilms attached to the sectioned root apex. This case series supports the use of nonsurgical methods to resolve larger cyst-like periapical lesions.

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The aim of this study was to evaluate the effects of different root canal filling techniques on the bond strength of epoxy resin-based sealers. Sixty single-rooted canines were prepared using ProTaper (F5) and divided into the following groups based on the root filling technique: Lateral Compaction (LC), Single Cone (SC), and Tagger Hybrid Technique (THT). The following subgroups (n = 10) were also created based on sealer material used: AH Plus and Sealer 26. Two-millimeter-thick slices were cut from all the root thirds and subjected to push-out test. Data (MPa) was analyzed using ANOVA and Tukey's test (α = 0.05). The push-out values were significantly affected by the sealer, filling technique, and root third (p < 0.05). AH Plus (1.37 ± 1.04) exhibited higher values than Sealer 26 (0.92 ± 0.51), while LC (1.80 ± 0.98) showed greater bond strength than THT (1.16 ± 0.50) and SC (0.92 ± 0.25). The cervical (1.45 ± 1.14) third exhibited higher bond strength, followed by the middle (1.20 ± 0.72) and apical (0.78 ± 0.33) thirds. AH Plus/LC (2.26 ± 1.15) exhibited the highest bond strength values, followed by AH Plus/THT (1.32 ± 0.61), Sealer 26/LC (1.34 ± 0.42), and Sealer 26/THT (1.00 ± 0.27). The lowest values were obtained with AH Plus/SC and Sealer 26/SC. Thus, it can be concluded that the filling technique affects the bond strength of sealers. LC was associated with higher bond strength between the material and intra-radicular dentine than THT and SC techniques.

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Abstract The aim of this study was to evaluate the effects of different root canal filling techniques on the bond strength of epoxy resin-based sealers. Sixty single-rooted canines were prepared using ProTaper (F5) and divided into the following groups based on the root filling technique: Lateral Compaction (LC), Single Cone (SC), and Tagger Hybrid Technique (THT). The following subgroups (n = 10) were also created based on sealer material used: AH Plus and Sealer 26. Two-millimeter-thick slices were cut from all the root thirds and subjected to push-out test. Data (MPa) was analyzed using ANOVA and Tukey's test (α = 0.05). The push-out values were significantly affected by the sealer, filling technique, and root third (p < 0.05). AH Plus (1.37 ± 1.04) exhibited higher values than Sealer 26 (0.92 ± 0.51), while LC (1.80 ± 0.98) showed greater bond strength than THT (1.16 ± 0.50) and SC (0.92 ± 0.25). The cervical (1.45 ± 1.14) third exhibited higher bond strength, followed by the middle (1.20 ± 0.72) and apical (0.78 ± 0.33) thirds. AH Plus/LC (2.26 ± 1.15) exhibited the highest bond strength values, followed by AH Plus/THT (1.32 ± 0.61), Sealer 26/LC (1.34 ± 0.42), and Sealer 26/THT (1.00 ± 0.27). The lowest values were obtained with AH Plus/SC and Sealer 26/SC. Thus, it can be concluded that the filling technique affects the bond strength of sealers. LC was associated with higher bond strength between the material and intra-radicular dentine than THT and SC techniques.

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AIM: To evaluate (i) the accuracy of three intra-oral digital systems in detecting vertical root fractures (VRFs); and (ii) the influence of different intracanal conditions (without filling, filled with Gutta-percha and metal or fibreglass post). METHODOLOGY: Forty single-rooted human teeth were decoronated and the root canals prepared. VRFs were induced using a universal testing machine on 20 teeth. Radiographic images were obtained using the paralleling technique with three different horizontal angulations on conventional E/F film, two storage phosphor plates (Digora Optime and VistaScan) and one sensor system (SnapShot). All teeth were radiographed with all intracanal conditions tested. All images were evaluated by five examiners. After 30 days, 25% of the images were reviewed. Areas under ROC curves, sensitivity, specificity, accuracy, positive predictive and negative predictive values were compared by anova. RESULTS: The weighted kappa values for intra- and interobserver reproducibility were 0.48-0.74 and 0.57-0.66, respectively. The sensitivity revealed a significant difference between imaging modalities, with higher values for SnapShot (0.53) and VistaScan (0.46), followed by the film (0.41) and Digora (0.38). The area under the ROC curve for SnapShot (0.82) was greater than for the other systems in the teeth with a fibreglass post (VistaScan: 0.70; Digora: 0.64; film: 0.60). CONCLUSION: All systems gave a similar performance for detecting VRFs; all gave a good performance in the absence of intracanal materials, but performed less well in the presence of a metal post or Gutta-percha. In teeth with a fibreglass post, digital systems with higher resolution should be used.

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Objetivo: o objetivo desse estudo foi comparar, in vivo,a eficácia de duas técnicas para remoção da guta-percha(limas manuais e o sistema MTwo R) na redução microbianaapós o preparo químico-mecânico em dentes tratadosendodonticamente e com lesão periapical crônica.Material: trinta dentes unirradiculares obturados, comlesão periapical crônica, foram divididos em dois grupos.Um grupo teve a remoção da guta-percha por meiode limas manuais (n = 15), enquanto o outro grupo utilizouas limas rotatórias MTwo R (n = 15). Após a remoçãoda guta-percha, a primeira amostra (S1) foi obtida.Em seguida, foi realizado o preparo químico-mecânico euma segunda coleta (S2). A carga bacteriana foi determinadapor meio da técnica de cultura. Aplicou-se ostestes estatísticos de Wilcoxon e de Mann-Whitney. Resultados:em S1, todos os canais mostraram a presençabacteriana nos grupos manual e MTwo R, com medianade 5,14 x 103 (variação 20-1,7 x 105) e 3,4 x 102 (variação20-3,14 x 103), respectivamente. Em S2, a redução bacterianafoi detectada nos dois grupos (p < 0,05). Conclusão:conclui-se que o MTwo R mostrou significativaredução bacteriana durante o retratamento endodôntico.

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