This study evaluated the time required for recontamination of root canals medicated with calcium hydroxide (Ca(OH)2), 2% chlorhexidine gel (CG), or their combination, with or without coronal sealing. 75 teeth were prepared and divided into groups based on intracanal medication and coronal sealing. Without sealing, recontamination occurred within days for all groups. With sealing, recontamination was delayed up to 17 days depending on the medication. The coronal seal delayed but did not prevent recontamination, and there was no difference between medication types.
This case report describes a patient who developed a gingival swelling after undergoing endodontic treatment of his lower left canine tooth. During the treatment, an intracanal medication (Calcipex II) was overfilled into the periapical area. A biopsy of the swelling revealed a foreign body granuloma containing macrophages that had engulfed fine granules of the Calcipex II material. The granules had dispersed widely into the surrounding tissues rather than remaining localized. Immunohistochemistry showed the granule-laden cells were macrophages, not neutrophils, and they appeared to be undergoing apoptosis. This represents the first reported case of a foreign body reaction induced by overfilling of the Calcipex II calcium hydrox
Comparative evaluation of natural and artificial scaffolds inRana Rana
This document summarizes a study on regenerative endodontic procedures using different scaffold materials. It provides background on regenerative endodontics and recommendations. The study compared the outcomes of using blood clots, platelet-rich fibrin (PRF), collagen, and poly-lactic-co-glycolic acid (PLGA) polymer as scaffolds in 16 immature teeth with necrotic pulps. Results found that PRF and collagen scaffolds showed better periapical healing, apical closure, root lengthening and dentin wall thickening compared to blood clots and PLGA. The conclusion is that PRF and collagen are better scaffolds than blood clots or PLGA for regenerative procedures in immature necro
This document summarizes a study evaluating the use of carbon fiber post systems for restoring teeth defects in children. 106 children with anterior tooth defects from trauma or decay were restored with carbon fiber posts, resin cores, and jacket crowns and observed for 3-5 years on average. The restorations were deemed successful in 121 cases (96.2%), with only 4 crowns lost. The study concluded that carbon fiber post systems can satisfactorily restore anterior teeth in children, with good esthetic and functional outcomes and ease of use for dentists.
This document discusses guided tissue regeneration (GTR) for treating endodontic-periodontal lesions. It describes that GTR involves placing a barrier membrane to prevent non-bone cells from migrating first to the root surface. The success rate of treating these lesions without GTR is only 27-37%, but increases to 95% with GTR. A case example is provided of a patient with a deep periodontal pocket and bone loss treated with root canal therapy, scaling and root planing, and later GTR using an autogenous bone graft and membrane. Radiographs alone are not reliable for assessing bone fill after surgery.
Objective: In order to reduce complications accompanied with dental implant restoration, this study strives to prepare a novel sealant and lubricant that can be used in dental implant systems as well as to evaluate its characteristics.
Study Design: Chitosan (CS), β-glycerophosphate pentahydrate (β-GP), and nano silver (nAg) were used to prepare thermosensitive hydrogel. According to the different volume ratios of CS to β-GP, 3 experimental groups were established, namely 16/4, 13/7, and 10/10 groups. Their morphology, composition, and chemical properties were analyzed via SEM, EDS, and FTIR. In addition, the effect of the hydrogel on the stability of dental implant-abutment connection was investigated by removal torque test combined with dynamic cyclic loading experiment. The maximum fracture load was measured under different lubricating conditions by electronic universal testing machine. The cytotoxicity and in vitro antibacterial effect of the hydrogel were examined respectively by CCK-8 test and the spread plate method.
Results: The CS/β-GP/nAg thermosensitive hydro-gel was successfully prepared in this study, which was found to be a porous structure through SEM. The removal torque test and the dynamic cyclic loading experiment showed that the removal torque of the experimental group was greater than that of the control group. Furthermore, the single load-to-fracture test indicated that the 16/4 group had the greatest maximum bearing load. The in vitro cytotoxicity test using rat bone marrow stromal cells (rBMSCs) and human gingival fibroblast cells (hGFCs) showed no cytotoxicity in all 3 groups. The 3 experimental groups had obvious antibacterial effects against E. coli, S. aureus, and P. gingivalis.
Conclusion: A nontoxic antibacterial CS/β-GP/nAg thermosensitive hydrogel for lubricating purpose was successfully fabricated. When the volume ratio of CS to β-GP was 16/4, this thermosensitive hydrogel demonstrated better sealing and lubricating abilities and had a positive influence on the reliability of dental implant-abutment connection.
Keywords: abutment, dental implant, dental implant restoration, dental sealant, lubrication, thermosensitive hydrogel
JOURNAL CLUB: The effect of two types chewing gum containingcasein phosphope...Urvashi Sodvadiya
Daily chewing of gum containing casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) or xylitol can significantly reduce the level of Streptococcus mutans bacteria in saliva. A study of 60 participants who chewed gum containing either CPP-ACP or xylitol for 3 weeks found that both reduced S. mutans, but CPP-ACP gum reduced levels more than xylitol gum. CPP-ACP and xylitol have properties that inhibit the growth and attachment of S. mutans to teeth, thereby reducing the risk of dental caries.
This document summarizes regenerative endodontic procedures. It discusses the history of revascularization and defines related terms. The principle that dental pulp has the ability to self-revascularize after trauma or infection is explained. The typical two-appointment procedure is outlined, including disinfection in the first appointment and inducing bleeding in the second. The mechanisms of early cell mobilization and late cell differentiation are described. Limitations and a case report demonstrating apical closure after 6 months are provided. Recent concepts and references on the topic are listed at the end.
LSTR is a new pulp therapy technique used in pediatric dentistry.
This presentation illustrated some studies which ensures the high success probability of the new technique
This case report describes a patient who developed a gingival swelling after undergoing endodontic treatment of his lower left canine tooth. During the treatment, an intracanal medication (Calcipex II) was overfilled into the periapical area. A biopsy of the swelling revealed a foreign body granuloma containing macrophages that had engulfed fine granules of the Calcipex II material. The granules had dispersed widely into the surrounding tissues rather than remaining localized. Immunohistochemistry showed the granule-laden cells were macrophages, not neutrophils, and they appeared to be undergoing apoptosis. This represents the first reported case of a foreign body reaction induced by overfilling of the Calcipex II calcium hydrox
Comparative evaluation of natural and artificial scaffolds inRana Rana
This document summarizes a study on regenerative endodontic procedures using different scaffold materials. It provides background on regenerative endodontics and recommendations. The study compared the outcomes of using blood clots, platelet-rich fibrin (PRF), collagen, and poly-lactic-co-glycolic acid (PLGA) polymer as scaffolds in 16 immature teeth with necrotic pulps. Results found that PRF and collagen scaffolds showed better periapical healing, apical closure, root lengthening and dentin wall thickening compared to blood clots and PLGA. The conclusion is that PRF and collagen are better scaffolds than blood clots or PLGA for regenerative procedures in immature necro
This document summarizes a study evaluating the use of carbon fiber post systems for restoring teeth defects in children. 106 children with anterior tooth defects from trauma or decay were restored with carbon fiber posts, resin cores, and jacket crowns and observed for 3-5 years on average. The restorations were deemed successful in 121 cases (96.2%), with only 4 crowns lost. The study concluded that carbon fiber post systems can satisfactorily restore anterior teeth in children, with good esthetic and functional outcomes and ease of use for dentists.
This document discusses guided tissue regeneration (GTR) for treating endodontic-periodontal lesions. It describes that GTR involves placing a barrier membrane to prevent non-bone cells from migrating first to the root surface. The success rate of treating these lesions without GTR is only 27-37%, but increases to 95% with GTR. A case example is provided of a patient with a deep periodontal pocket and bone loss treated with root canal therapy, scaling and root planing, and later GTR using an autogenous bone graft and membrane. Radiographs alone are not reliable for assessing bone fill after surgery.
Objective: In order to reduce complications accompanied with dental implant restoration, this study strives to prepare a novel sealant and lubricant that can be used in dental implant systems as well as to evaluate its characteristics.
Study Design: Chitosan (CS), β-glycerophosphate pentahydrate (β-GP), and nano silver (nAg) were used to prepare thermosensitive hydrogel. According to the different volume ratios of CS to β-GP, 3 experimental groups were established, namely 16/4, 13/7, and 10/10 groups. Their morphology, composition, and chemical properties were analyzed via SEM, EDS, and FTIR. In addition, the effect of the hydrogel on the stability of dental implant-abutment connection was investigated by removal torque test combined with dynamic cyclic loading experiment. The maximum fracture load was measured under different lubricating conditions by electronic universal testing machine. The cytotoxicity and in vitro antibacterial effect of the hydrogel were examined respectively by CCK-8 test and the spread plate method.
Results: The CS/β-GP/nAg thermosensitive hydro-gel was successfully prepared in this study, which was found to be a porous structure through SEM. The removal torque test and the dynamic cyclic loading experiment showed that the removal torque of the experimental group was greater than that of the control group. Furthermore, the single load-to-fracture test indicated that the 16/4 group had the greatest maximum bearing load. The in vitro cytotoxicity test using rat bone marrow stromal cells (rBMSCs) and human gingival fibroblast cells (hGFCs) showed no cytotoxicity in all 3 groups. The 3 experimental groups had obvious antibacterial effects against E. coli, S. aureus, and P. gingivalis.
Conclusion: A nontoxic antibacterial CS/β-GP/nAg thermosensitive hydrogel for lubricating purpose was successfully fabricated. When the volume ratio of CS to β-GP was 16/4, this thermosensitive hydrogel demonstrated better sealing and lubricating abilities and had a positive influence on the reliability of dental implant-abutment connection.
Keywords: abutment, dental implant, dental implant restoration, dental sealant, lubrication, thermosensitive hydrogel
JOURNAL CLUB: The effect of two types chewing gum containingcasein phosphope...Urvashi Sodvadiya
Daily chewing of gum containing casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) or xylitol can significantly reduce the level of Streptococcus mutans bacteria in saliva. A study of 60 participants who chewed gum containing either CPP-ACP or xylitol for 3 weeks found that both reduced S. mutans, but CPP-ACP gum reduced levels more than xylitol gum. CPP-ACP and xylitol have properties that inhibit the growth and attachment of S. mutans to teeth, thereby reducing the risk of dental caries.
This document summarizes regenerative endodontic procedures. It discusses the history of revascularization and defines related terms. The principle that dental pulp has the ability to self-revascularize after trauma or infection is explained. The typical two-appointment procedure is outlined, including disinfection in the first appointment and inducing bleeding in the second. The mechanisms of early cell mobilization and late cell differentiation are described. Limitations and a case report demonstrating apical closure after 6 months are provided. Recent concepts and references on the topic are listed at the end.
LSTR is a new pulp therapy technique used in pediatric dentistry.
This presentation illustrated some studies which ensures the high success probability of the new technique
Mix powders together in 1:1:1 ratio.
Add small amount of carrier (MP) and mix to a thick paste consistency.
Add remaining carrier and mix thoroughly.
Store in sealed container at room temperature.
Use within 1 month.
6/1/2017 39
Placement of intracanal medicament
Antibiotic paste is placed into the canal with a hand plugger or
lentulo spiral to the full working length.
Excess paste is removed from the canal orifice with a small
paper point.
Temporary restoration is placed.
Medicament is left in place for 1-
Effects of the association between a calcium hydroxideCharles Pereira
This document summarizes a study that evaluated whether the association between calcium hydroxide paste (Calen paste) and 0.4% chlorhexidine (CHX) affects the development of osteogenic phenotype in vitro. Rat calvarial osteogenic cell cultures were used to analyze cell morphology, viability, alkaline phosphatase activity, protein content, bone sialoprotein localization, and mineralized nodule formation under control conditions and with Calen paste or Calen paste combined with CHX. The results showed that the association between Calen paste and 0.4% CHX did not significantly affect any of the osteoblastic cell parameters analyzed.
This document discusses the history, mechanisms, and effects of dental bleaching. It begins with a brief history of bleaching, noting the introduction of chloride lime in 1848 and hydrogen peroxide in 1910. The most common bleaching agents are hydrogen peroxide, sodium perborate, and carbamide peroxide. Bleaching works via an oxidation reaction where reactive oxygen radicals interact with colored molecules in enamel and dentin. The document then discusses various bleaching techniques and their effects on tooth structure and restorations. Specifically, bleaching can cause decreased microhardness and changes to the bonding interface that impact restoration durability.
This document discusses revascularization/regeneration procedures performed on immature molars. It defines regenerative endodontics as biologically based procedures to replace damaged pulp and root structures. The objectives of regenerative endodontics are to regenerate pulp-like tissue, dentin, and root structures. Stem cells, scaffolds, and growth factors are key elements in dental tissue engineering and regeneration procedures. The document also discusses the use of triantibiotic pastes containing ciprofloxacin, metronidazole, and minocycline to disinfect immature teeth and enable revascularization.
3D reconstruction revealed features of carious hard tissues and soft tissues. Specifically, it showed strongly expressed amelogenin proteins in dentin tubules of carious teeth and increased glial markers GFAP and S100B in pulp components of carious teeth. 4D live cell imaging showed the diffusion patterns of fluorescent molecules in response to bacterial virulence factors and uptake of an antibiotic into epithelial cells to kill intracellular oral pathogens. 3D/4D imaging using confocal microscopy provides benefits for analyzing clinical dental specimens and studying drug development.
This document summarizes a study on the effects of hyaluronic acid as an adjunct to scaling and root planing in the treatment of chronic periodontitis. 42 subjects with moderate to severe chronic periodontitis were divided into a test group that received subgingival hyaluronic acid gel application and a control group. Both groups received scaling and root planing. Clinical parameters like probing depth and attachment level significantly improved in both groups but were greater in the test group. Microbiological analysis found greater reductions in pathogenic bacteria in the test group. The study concludes that hyaluronic acid has positive adjunctive effects in reducing probing depths and preventing recolonization of periodontopathogens.
This document discusses revascularization procedures for immature permanent teeth with necrotic pulps. It begins by introducing the challenges of treating such teeth and the potential for revascularization to encourage continued root development. The history of revascularization is then reviewed, from early case studies in the 1960s demonstrating new tissue formation in root canals, to more recent definitions and understanding of the process. Key aspects of revascularization techniques using calcium hydroxide, triple antibiotic paste, and their two-step protocols are then outlined. Considerations for instrumentation, irrigation, and medication of the root canal are also presented.
This document provides an overview of regenerative endodontics and tissue engineering. It discusses definitions of key terms like regeneration, repair, and the regenerative triad of stem cells, growth factors, and scaffolds. The history and objectives of regenerative endodontics are described. Regenerative endodontic procedures aim to physiologically replace damaged tooth structures using principles of tissue engineering. This involves stimulating regeneration of the pulp-dentin complex using the building blocks of stem cells, signaling molecules, and matrices.
This document provides an overview of regenerative endodontics, which aims to regenerate dental tissues through biologically-based procedures using stem cells, growth factors, and scaffolds. Key elements for pulp regeneration include reliable stem cell sources, such as dental pulp stem cells, growth factors to stimulate cell proliferation and differentiation, and appropriate scaffolds. Potential regenerative therapies include revascularization, stem cell therapy, scaffold implantation, and gene delivery. Measuring clinical outcomes and further applications are areas of future focus to develop regenerative endodontic therapies.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
JOURNAL CLUB: “Matching the Dimensions of Currently AvailableInstruments wit...Urvashi Sodvadiya
This micro-CT study investigated the largest original diameters of Vertucci type IV mandibular molar mesial root canals at 1-, 2-, 3-, and 4-mm levels short of the apical foramen. The diameters were then matched to currently available instrument sizes recommended for apical preparation. The study found that the original canal diameters were usually larger than recommended instrument sizes, making it impossible to fully shape most canals without risk of deviation, perforation, or root weakening. Approaches are needed to better determine optimal apical preparation size and address the problem of unprepared canal walls.
A detailed description of regenerative endodontics with illustrated journals right from its history,, needs, till its future advancements and challenges...
This document summarizes the outcomes of regenerative endodontic procedures. It finds that regenerative endodontic procedures (REPs) are generally more successful at resolving symptoms of apical periodontitis compared to apexification. REPs also typically result in greater increases in root length and thickness compared to apexification. However, the degree of additional root development from REPs can vary significantly depending on factors like the cause of pulp necrosis. Long-term survival rates of teeth treated with REPs or apexification are still unclear due to a lack of large, long-term studies. Return of pulp vitality is achieved in around half of REP cases.
Regenerative endodontics aims to regenerate damaged pulp and root structures through biologically-based procedures. Historically, studies in the 1960s-70s showed blood clots could induce tissue formation in root canals. Current methods include placing stem cells on scaffolds with growth factors in the root canal to regenerate the pulp-dentin complex. Triple antibiotic paste, calcium hydroxide, and MTA are used as antimicrobial medicaments. The protocol involves inducing bleeding into the root canal to form a blood clot which triggers regeneration. The goal is periradicular health and evidence of vital regenerated tissue through radiographic and clinical measures.
This document summarizes research from several studies on orthodontics and craniofacial research. It discusses tolerance for deviations in eye and mouth position, using 3D imaging to track facial changes in identical twins over time, examining differences in palate length in fetuses with Down syndrome, measuring friction of different archwire and bracket combinations, evidence of temporary loss of cell membrane integrity during orthodontic tooth movement, identifying growth patterns of the mandibular condyle through molecular and biochemical analysis, and investigating the use of stem cells for craniofacial and dental tissue engineering applications like periodontal and orthognathic surgery.
Simultaneous vertical guided bone regeneration and guided tissue regeneration...threea3a
This clinical case report describes using recombinant human platelet-derived growth factor (rhPDGF-BB) along with autogenous bone and barrier membranes to reconstruct severe alveolar bone defects in the posterior maxilla through simultaneous vertical ridge augmentation and sinus floor elevation. Over 9 months of healing, complete vertical bone regeneration and new attachment to a previously denuded root surface were observed. Three implants were successfully placed and a fixed restoration was provided, demonstrating the potential for rhPDGF-BB to enhance regeneration when combined with standard bone grafting techniques and membranes. However, further controlled studies are needed to fully evaluate the benefits of using rhPDGF-BB for complex reconstruction procedures.
Dr. Tinet Mary Augustine presents information on regenerative endodontics, including its history, goals, mechanisms, and a case study. Regenerative endodontics aims to revascularize and regenerate dental pulp through disinfection and inducing bleeding to transport stem cells. The procedure involves chemically debriding the root canal, inducing bleeding to introduce stem cells, and sealing with MTA or biodentin. Over 6 months, the case study showed resolution of an apical radiolucency and root lengthening, indicating regeneration of the pulp-dentin complex. Long-term follow-up of 1-3 years is recommended to monitor regeneration.
Human Dental Pulp Stem Cells Cryopreservation
This study evaluated the effect of two cryopreservation methods on the viability and phenotype of human dental pulp stem cells (DPSCs). DPSCs were isolated from teeth extracted from patients, cryopreserved using two different methods, and then analyzed for viability and phenotype markers after 24 hours and 7 days. The results showed that both cryopreservation methods maintained high viability of DPSCs short-term, though one method resulted in slightly higher viability. Both methods also maintained the stem cell phenotype after cryopreservation. However, longer-term studies are still needed to fully evaluate the effects of cryopreservation methods on DPSCs.
This document discusses various materials used for vital pulp therapy (VPT). It begins by outlining the ideal properties of a pulp capping agent, such as maintaining pulp vitality and stimulating reparative dentin formation. Classic materials like calcium hydroxide, zinc oxide-eugenol, and polycarboxylate cement are described along with their disadvantages. More recent bioactive bioceramic materials like mineral trioxide aggregate (MTA), Biodentine, and Endosequence are then discussed and compared to calcium hydroxide, with studies showing higher success rates for reparative dentin formation and less inflammation with bioceramics. The document concludes by mentioning recent advances in VPT including the
Mix powders together in 1:1:1 ratio.
Add small amount of carrier (MP) and mix to a thick paste consistency.
Add remaining carrier and mix thoroughly.
Store in sealed container at room temperature.
Use within 1 month.
6/1/2017 39
Placement of intracanal medicament
Antibiotic paste is placed into the canal with a hand plugger or
lentulo spiral to the full working length.
Excess paste is removed from the canal orifice with a small
paper point.
Temporary restoration is placed.
Medicament is left in place for 1-
Effects of the association between a calcium hydroxideCharles Pereira
This document summarizes a study that evaluated whether the association between calcium hydroxide paste (Calen paste) and 0.4% chlorhexidine (CHX) affects the development of osteogenic phenotype in vitro. Rat calvarial osteogenic cell cultures were used to analyze cell morphology, viability, alkaline phosphatase activity, protein content, bone sialoprotein localization, and mineralized nodule formation under control conditions and with Calen paste or Calen paste combined with CHX. The results showed that the association between Calen paste and 0.4% CHX did not significantly affect any of the osteoblastic cell parameters analyzed.
This document discusses the history, mechanisms, and effects of dental bleaching. It begins with a brief history of bleaching, noting the introduction of chloride lime in 1848 and hydrogen peroxide in 1910. The most common bleaching agents are hydrogen peroxide, sodium perborate, and carbamide peroxide. Bleaching works via an oxidation reaction where reactive oxygen radicals interact with colored molecules in enamel and dentin. The document then discusses various bleaching techniques and their effects on tooth structure and restorations. Specifically, bleaching can cause decreased microhardness and changes to the bonding interface that impact restoration durability.
This document discusses revascularization/regeneration procedures performed on immature molars. It defines regenerative endodontics as biologically based procedures to replace damaged pulp and root structures. The objectives of regenerative endodontics are to regenerate pulp-like tissue, dentin, and root structures. Stem cells, scaffolds, and growth factors are key elements in dental tissue engineering and regeneration procedures. The document also discusses the use of triantibiotic pastes containing ciprofloxacin, metronidazole, and minocycline to disinfect immature teeth and enable revascularization.
3D reconstruction revealed features of carious hard tissues and soft tissues. Specifically, it showed strongly expressed amelogenin proteins in dentin tubules of carious teeth and increased glial markers GFAP and S100B in pulp components of carious teeth. 4D live cell imaging showed the diffusion patterns of fluorescent molecules in response to bacterial virulence factors and uptake of an antibiotic into epithelial cells to kill intracellular oral pathogens. 3D/4D imaging using confocal microscopy provides benefits for analyzing clinical dental specimens and studying drug development.
This document summarizes a study on the effects of hyaluronic acid as an adjunct to scaling and root planing in the treatment of chronic periodontitis. 42 subjects with moderate to severe chronic periodontitis were divided into a test group that received subgingival hyaluronic acid gel application and a control group. Both groups received scaling and root planing. Clinical parameters like probing depth and attachment level significantly improved in both groups but were greater in the test group. Microbiological analysis found greater reductions in pathogenic bacteria in the test group. The study concludes that hyaluronic acid has positive adjunctive effects in reducing probing depths and preventing recolonization of periodontopathogens.
This document discusses revascularization procedures for immature permanent teeth with necrotic pulps. It begins by introducing the challenges of treating such teeth and the potential for revascularization to encourage continued root development. The history of revascularization is then reviewed, from early case studies in the 1960s demonstrating new tissue formation in root canals, to more recent definitions and understanding of the process. Key aspects of revascularization techniques using calcium hydroxide, triple antibiotic paste, and their two-step protocols are then outlined. Considerations for instrumentation, irrigation, and medication of the root canal are also presented.
This document provides an overview of regenerative endodontics and tissue engineering. It discusses definitions of key terms like regeneration, repair, and the regenerative triad of stem cells, growth factors, and scaffolds. The history and objectives of regenerative endodontics are described. Regenerative endodontic procedures aim to physiologically replace damaged tooth structures using principles of tissue engineering. This involves stimulating regeneration of the pulp-dentin complex using the building blocks of stem cells, signaling molecules, and matrices.
This document provides an overview of regenerative endodontics, which aims to regenerate dental tissues through biologically-based procedures using stem cells, growth factors, and scaffolds. Key elements for pulp regeneration include reliable stem cell sources, such as dental pulp stem cells, growth factors to stimulate cell proliferation and differentiation, and appropriate scaffolds. Potential regenerative therapies include revascularization, stem cell therapy, scaffold implantation, and gene delivery. Measuring clinical outcomes and further applications are areas of future focus to develop regenerative endodontic therapies.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
JOURNAL CLUB: “Matching the Dimensions of Currently AvailableInstruments wit...Urvashi Sodvadiya
This micro-CT study investigated the largest original diameters of Vertucci type IV mandibular molar mesial root canals at 1-, 2-, 3-, and 4-mm levels short of the apical foramen. The diameters were then matched to currently available instrument sizes recommended for apical preparation. The study found that the original canal diameters were usually larger than recommended instrument sizes, making it impossible to fully shape most canals without risk of deviation, perforation, or root weakening. Approaches are needed to better determine optimal apical preparation size and address the problem of unprepared canal walls.
A detailed description of regenerative endodontics with illustrated journals right from its history,, needs, till its future advancements and challenges...
This document summarizes the outcomes of regenerative endodontic procedures. It finds that regenerative endodontic procedures (REPs) are generally more successful at resolving symptoms of apical periodontitis compared to apexification. REPs also typically result in greater increases in root length and thickness compared to apexification. However, the degree of additional root development from REPs can vary significantly depending on factors like the cause of pulp necrosis. Long-term survival rates of teeth treated with REPs or apexification are still unclear due to a lack of large, long-term studies. Return of pulp vitality is achieved in around half of REP cases.
Regenerative endodontics aims to regenerate damaged pulp and root structures through biologically-based procedures. Historically, studies in the 1960s-70s showed blood clots could induce tissue formation in root canals. Current methods include placing stem cells on scaffolds with growth factors in the root canal to regenerate the pulp-dentin complex. Triple antibiotic paste, calcium hydroxide, and MTA are used as antimicrobial medicaments. The protocol involves inducing bleeding into the root canal to form a blood clot which triggers regeneration. The goal is periradicular health and evidence of vital regenerated tissue through radiographic and clinical measures.
This document summarizes research from several studies on orthodontics and craniofacial research. It discusses tolerance for deviations in eye and mouth position, using 3D imaging to track facial changes in identical twins over time, examining differences in palate length in fetuses with Down syndrome, measuring friction of different archwire and bracket combinations, evidence of temporary loss of cell membrane integrity during orthodontic tooth movement, identifying growth patterns of the mandibular condyle through molecular and biochemical analysis, and investigating the use of stem cells for craniofacial and dental tissue engineering applications like periodontal and orthognathic surgery.
Simultaneous vertical guided bone regeneration and guided tissue regeneration...threea3a
This clinical case report describes using recombinant human platelet-derived growth factor (rhPDGF-BB) along with autogenous bone and barrier membranes to reconstruct severe alveolar bone defects in the posterior maxilla through simultaneous vertical ridge augmentation and sinus floor elevation. Over 9 months of healing, complete vertical bone regeneration and new attachment to a previously denuded root surface were observed. Three implants were successfully placed and a fixed restoration was provided, demonstrating the potential for rhPDGF-BB to enhance regeneration when combined with standard bone grafting techniques and membranes. However, further controlled studies are needed to fully evaluate the benefits of using rhPDGF-BB for complex reconstruction procedures.
Dr. Tinet Mary Augustine presents information on regenerative endodontics, including its history, goals, mechanisms, and a case study. Regenerative endodontics aims to revascularize and regenerate dental pulp through disinfection and inducing bleeding to transport stem cells. The procedure involves chemically debriding the root canal, inducing bleeding to introduce stem cells, and sealing with MTA or biodentin. Over 6 months, the case study showed resolution of an apical radiolucency and root lengthening, indicating regeneration of the pulp-dentin complex. Long-term follow-up of 1-3 years is recommended to monitor regeneration.
Human Dental Pulp Stem Cells Cryopreservation
This study evaluated the effect of two cryopreservation methods on the viability and phenotype of human dental pulp stem cells (DPSCs). DPSCs were isolated from teeth extracted from patients, cryopreserved using two different methods, and then analyzed for viability and phenotype markers after 24 hours and 7 days. The results showed that both cryopreservation methods maintained high viability of DPSCs short-term, though one method resulted in slightly higher viability. Both methods also maintained the stem cell phenotype after cryopreservation. However, longer-term studies are still needed to fully evaluate the effects of cryopreservation methods on DPSCs.
This document discusses various materials used for vital pulp therapy (VPT). It begins by outlining the ideal properties of a pulp capping agent, such as maintaining pulp vitality and stimulating reparative dentin formation. Classic materials like calcium hydroxide, zinc oxide-eugenol, and polycarboxylate cement are described along with their disadvantages. More recent bioactive bioceramic materials like mineral trioxide aggregate (MTA), Biodentine, and Endosequence are then discussed and compared to calcium hydroxide, with studies showing higher success rates for reparative dentin formation and less inflammation with bioceramics. The document concludes by mentioning recent advances in VPT including the
As an intracanal medicament
Definition
Clinical application
Mechanism of action
Vehicles
Placement of Calcium hydroxide paste
Dentin and Calcium hydroxide
Effect of Calcium hydroxide on clinical outcome
Calcium hydroxide and Chlorhexidine
Calcium hydroxide and Sodium Hypochlorite
Removal of Calcium hydroxide from the canal
When to replace Calcium hydroxide dressing?
Calcium hydroxide and CO2
Toxicity
As a Root canal Sealer
Clinical significance
Classification
Composition
Properties
Leakage
Solubility
- In tissue fluids
- In chemical solvent
Biocompatibility
Antimicrobial
Toxicity
Conclusion
References
This document summarizes a study that compared the sealing ability of three endodontic sealers (RoekoSeal, AH Plus, and EndoRez) in dog teeth after post-space preparation and exposure to the oral environment. 74 root canals in dog premolars were instrumented, filled with gutta-percha and one of the three sealers, and had post spaces prepared, leaving 4 mm of filling at the apex. Teeth were exposed to the oral environment for 45 days, then soaked in dye and cleared to measure leakage. EndoRez showed significantly less leakage than RoekoSeal, while AH Plus did not differ significantly from the other sealers.
This document discusses various aspects of vital pulp therapy (VPT), including indirect pulp capping (IPC), direct pulp capping (DPC), and pulpotomy procedures. It provides the history and objectives of these procedures, as well as guidelines for when each is appropriate based on factors like the size of a pulp exposure and presence of symptoms. Materials commonly used for VPT are also reviewed, including calcium hydroxide, MTA, and others. Success rates from studies on IPC and factors influencing the outcome of VPT are presented.
This study compared the residual antibacterial activity of chlorhexidine (CHX), MTAD, and sodium hypochlorite (NaOCl) in human root dentin infected with Enterococcus faecalis. Dentin tubes were infected for 14 days then treated and sampled over 28 days. MTAD showed the highest residual antibacterial activity, followed by CHX then NaOCl, with increasing colony forming units over time for all groups. MTAD demonstrated significantly greater substantivity than CHX and NaOCl against E. faecalis in human root dentin in vitro.
This case report describes the use of mineral trioxide aggregate (MTA) in apexification of two immature permanent teeth with open apices and periapical lesions in a 14-year old patient. After cleaning and shaping the root canals, MTA was used to create an apical plug in each canal. Follow up radiographs at 6 and 12 months showed periapical healing and apical closure of the teeth. MTA is described as a promising alternative to traditional calcium hydroxide treatment for apexification due to its superior biocompatibility and ability to stimulate hard tissue formation.
PULP REVASCULARIZATION OF A NECROTIC INFECTED IMMATURE PERMANENT TOOTH: A CAS...Abu-Hussein Muhamad
This document summarizes a case report of regenerative endodontic treatment (revascularization) of a necrotic, immature permanent tooth. Specifically:
- An 11-year-old patient presented with a necrotic tooth that had undergone previous calcium hydroxide treatment but remained immature.
- The tooth underwent cleaning and disinfection, followed by a bleeding induction technique to form a blood clot and promote revascularization. MTA was then used to seal the canal.
- Follow up radiographs at 10 and 12 months showed continued root development, thickening of root walls, and periapical healing, indicating success of the revascularization procedure.
- Revascularization represents a
This document provides information on various materials used for obturation in primary teeth pulpectomy procedures. It discusses the properties, advantages and disadvantages of commonly used materials like zinc oxide eugenol, iodoform-based pastes (Walcoff paste, KRI paste, Maisto paste), Vitapex, and calcium hydroxide mixtures. It summarizes studies comparing the success rates, resorption rates, and antibacterial effects of these materials. The goal of obturation is to disinfect the root canal system and create an effective seal, while using a material that will resorb at a rate similar to root resorption in primary teeth. No single material meets all ideal criteria.
Non Surgical Root Canal Treatment of Calcified CanalZiad Abdul Majid
This case report is presented to illustrate the successful non - surgical management of canal calcification in a maxillary first premolar in a 17 years old female.
Published By the International Journal of Health and Dental Sciences, Second Volume 2015.
This randomized double-blinded clinical trial compared the antibacterial efficacy of a final rinse with MTAD (BioPure MTAD) and intracanal medication with 2% chlorhexidine gel (CHX) to a saline rinse in teeth with apical periodontitis. Bacterial samples were taken from the root canals at several time points and analyzed using epifluorescence microscopy and colony-forming unit counts. The results showed that bacterial counts were significantly reduced after canal preparation with NaOCl. However, the final rinse with MTAD and medication with CHX did not further reduce bacterial counts beyond the levels achieved with canal preparation alone.
Endodontic Management of Maxillary Molars with Two Palatal Canals – Case Reportiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Disinfection of dentinal tubules with 2% chlorhexidine,Charles Pereira
2. Chlorhexidine gel was the most effective at inhibiting the growth of Enterococcus faecalis, eliminating bacterial growth at both 200 and 400 micrometer depths over 5 days. Metronidazole gel showed moderate inhibition of 86.5%, followed by bioactive glass at 62.8% and calcium hydroxide at 58.5%. Chlorhexidine gel completely inhibited bacterial growth at all time intervals tested, demonstrating its strong antibacterial properties compared to the other medicaments.
Dens evaginatus- a problem based approachAshok Ayer
Dens evaginatus is an uncommon developmental anomaly of human dentition characterized by the presence of tubercle on the occlusal surface of mandibular premolars and lingual surface of anterior teeth.Due to occlusal trauma, this tubercle tends to fracture thus exposing the pathway to the pulp chamber of teeth. This case report is about the presentation of dens evaginatus in mandibular premolars bilaterally; among them, tooth 44 was associated with chronic apical periodontitis. Fractured tubercle of three premolars was sealed with composite resin. Root canal treatment was performed with tooth 44. Routine endodontic treatment did not result in remission of infection.Therefore, culture and sensitivity tests were performed to identify the cause and modify treatment plan accordingly. The triple antibiotic paste was used as an intracanal medicament to disinfect the root canal that resulted in remission of infection.
Intentional replantation of maxillary second molar; case report and 15-year f...Abu-Hussein Muhamad
Abstract: Intentional reimplantation is a procedure in which tooth extraction is performed followed by reinsertion of the extracted tooth into its own socket after performing the desired procedure. In this article, intentional reimplantation is described and discussed as a treatment approach for aperiapical lesion that is in maxillary second molar. After 15 years, the patient was asymptomatic, the tooth was still functional and a recall intraoral periapical radiograph showed an intact periodontal ligament space and lamina dura with no evidence of gross root resorption or ankylosis.
Keywords: Intentional replantation, calcified canals, mineral trioxide aggregate
A detailed presentation on Endodontic failures starting from the basics in case selection to final prosthesis. Good for Post Graduates and Under Graduates.
DENTAL AVULSION- IMMEDIATE REPLANTATION: 8- YEAR FOLLOW UP CASEAbu-Hussein Muhamad
Avulsion of permanent front teeth is a rare accident , mostly affecting children between seven and nine year s of age.
Replanted and splinted, these teeth often develop inflammat ion, severe resorption or ankylosis affect ing alveolar bone
development and have to be extracted sooner or later . This repor t proposes a discussion on the var ious pecul iar ities of a
tooth avulsion case with immediate replantation, such as a long retent ion per iod, root canal fil ling with MTA, or thodontic
treatment.
Temporal relationship between sucrose –associated changes inDr. Roshni Maurya
The study evaluated the timing of effects of sucrose on the biochemical and microbiological composition of dental biofilm and its relationship to enamel demineralization. The findings showed that dental biofilm exposed 8 times per day to 20% sucrose solution significantly increased enamel mineral loss over time compared to the negative control. Sucrose increased levels of mutans streptococci and lactobacilli in dental biofilm and the concentration of insoluble extracellular polymeric substances compared to the negative control and glucose+fructose solution. While changes in biofilm composition occurred earlier, significant enamel demineralization only occurred after 7 days of biofilm accumulation.
This case report describes the endodontic treatment of a maxillary first molar with an unusual root canal morphology - 7 root canals. During treatment using an operating microscope, 3 canals were identified in the mesiobuccal root, 2 in the distobuccal root, and 2 in the palatal root. All canals were instrumented and obturated. While most maxillary first molars have 3 canals, additional canals are common. Careful examination with magnification is important to locate all canals for successful treatment.
Este documento descreve o plano de ensino-aprendizagem para a disciplina de Técnicas e Materiais em Endodontia no curso de Odontologia da Universidade Luterana do Brasil. O objetivo geral é formar cirurgiões-dentistas habilitados a resolver problemas de saúde bucal usando princípios biológicos, técnicos e éticos. As aulas serão expositivas e práticas em laboratório para ensinar procedimentos endodônticos como acesso aos canais, preparo químico-mecânico
A disciplina de Clínica Integral II ensina estudantes de odontologia a realizar tratamentos odontológicos de complexidade moderada em pacientes, com foco em abordagens preventivas e interdisciplinares. Os alunos aprenderão a diagnosticar problemas, desenvolver planos de tratamento e tratar doenças, incluindo próteses simples. A metodologia inclui aulas teóricas, seminários, discussões de casos e atendimento prático de pacientes sob supervisão.
[1] O documento descreve as técnicas e materiais utilizados no preparo do canal radicular em endodontia, incluindo meios mecânicos, físicos e químicos. [2] Os principais meios químicos discutidos são o hipoclorito de sódio e o EDTA, com foco em suas propriedades, ações e protocolos de uso. [3] O hipoclorito de sódio possui ação antibacteriana e de dissolução de tecidos, enquanto o EDTA é utilizado para remover a cam
Este documento apresenta o plano de ensino-aprendizagem para a disciplina de Técnicas e Materiais em Endodontia no curso de Odontologia da Universidade Luterana do Brasil. O plano descreve os objetivos da disciplina, abordagens temáticas, metodologia de ensino, cronograma de aulas, processos avaliativos e recursos de apoio.
Este documento apresenta o plano de ensino-aprendizagem da disciplina de Clínica Integral II ministrada na Universidade Luterana do Brasil. O objetivo geral é formar cirurgiões-dentistas aptos a tratar problemas odontológicos de forma integrada e preventiva. As aulas combinam teoria e prática clínica, com avaliações baseadas no desempenho teórico e no atendimento de pacientes.
O documento apresenta o plano de ensino-aprendizagem de uma disciplina de Técnicas e Materiais em Endodontia ministrada na Universidade Luterana do Brasil. O plano descreve os objetivos gerais da disciplina, abordagens temáticas, metodologia de ensino, cronograma de aulas, processos avaliativos e recursos de apoio.
Este documento fornece o plano de ensino-aprendizagem para a disciplina de Clínica Integral II do curso de Odontologia da Universidade Luterana do Brasil. O objetivo geral é formar cirurgiões-dentistas capazes de tratar problemas odontológicos de maior complexidade de forma integrada e com enfoque preventivo. As aulas combinam teoria e prática clínica com pacientes. Os alunos serão avaliados por meio de testes, seminários e seu desempenho no atendimento clínico.
O documento discute técnicas e materiais para obturar canais radiculares. Apresenta as técnicas de condensação lateral e vertical e obturação termoplástica, além de materiais como guta-percha, cimentos à base de óxido de zinco e eugenol ou resinas epóxi. Realiza estudos comparativos entre marcas de cones de guta-percha e cimentos, avaliando diâmetros, radiopacidade e selamento dos canais. Conclui que a qualidade da obturação é fator importante para o sucess
Esta lista de instrumental contém os itens necessários para o módulo de técnicas e materiais em endodontia, incluindo consumíveis como guta-percha, alginato e papel absorvente, além de instrumentos como brocas endodônticas, limas manual e motoraizadas e materiais como cimento endodôntico. A lista especifica a quantidade solicitada de cada item para uso em laboratório pelos alunos do curso de odontologia.
O documento descreve o plano de ensino-aprendizagem da disciplina de Clínica Integral II do curso de Odontologia da Universidade Luterana do Brasil. O objetivo é instruir os alunos no planejamento e tratamento de pacientes com diferentes problemas odontológicos de maior complexidade, utilizando uma abordagem interdisciplinar. As aulas combinam teoria e prática clínica com pacientes. Os alunos serão avaliados por meio de testes, seminários e atendimento de pacientes.
Este documento apresenta o plano de ensino-aprendizagem para a disciplina de Técnicas e Materiais em Endodontia no curso de Odontologia da Universidade Luterana do Brasil. O plano descreve os objetivos da disciplina, abordagens temáticas, metodologia de ensino, cronograma de aulas, processos avaliativos e recursos de apoio.
O documento descreve o plano de ensino-aprendizagem da disciplina de Clínica Integral II do curso de Odontologia da Universidade Luterana do Brasil. O objetivo é instruir os alunos no planejamento e tratamento de pacientes com diferentes problemas odontológicos de maior complexidade, utilizando uma abordagem interdisciplinar. As aulas combinam teoria e prática clínica com pacientes. Os alunos serão avaliados por meio de testes, seminários e atendimento de pacientes.
Este documento descreve vários tipos de acidentes que podem ocorrer durante tratamentos endodônticos, incluindo perfurações durante a abertura coronária, compactação de dentina durante o preparo do canal radicular, fraturas de instrumentos e sobreobturações durante a obturação do canal. Ele fornece causas, condutas e formas de prevenção para cada um desses acidentes.
O documento discute princípios da endodontia e prótese, incluindo a triade endodôntica, meios químicos como hipoclorito de sódio, estudos sobre tratamento endodôntico de um ou dois passos, limitações da ação antibacteriana de medicamentos, avaliação radiográfica da qualidade de obturações, importância do selamento coronário, estudos comparativos de cimentos endodônticos, pinos intra-radiculares e técnicas de remoção, além de tomografias computadorizadas para diagnóstico
Aula clinica integral ii remoção pinos (blog)pptCharles Pereira
Este documento discute as considerações e técnicas para a remoção de coroas e pinos intra-radiculares. Ao remover coroas, é importante cortá-las sem traumatizar a raiz ou pino existente. Para remover pinos, deve-se primeiro remover o agente cimentante circundante usando brocas ou ultra-som, e evitar forçar o pino com movimentos pendulares. A remoção do pino envolve perfurar o núcleo para inserir a ponta de ultra-som e quebrar o cimento até sua remoção.
O documento discute as considerações e técnicas para troca de restaurações protésicas, remoção de pinos intra-radiculares e uso do ultrassom nesse processo. Deve-se questionar os motivos para troca, como fratura do material, infiltração cariosa ou pino curto/sem retenção. As técnicas variam de acordo com o tipo de restauração, mas sempre removendo primeiro o agente cimentante ao redor do pino antes de sua remoção, evitando movimentos pendulares para não traumatizar os tecidos
Aula clinica integral ii remoção pinos (blog)pptCharles Pereira
O documento discute as considerações e técnicas para a remoção de coroas e pinos intra-radiculares. É importante avaliar por que trocar, o que trocar e os riscos envolvidos antes de realizar a troca. Para remover coroas, deve-se usar pontas diamantadas e brocas para separá-las ao longo do eixo do dente. Para remover pinos, deve-se expor a linha de cimentação, remover o máximo de cimento possível e perfurar o pino para removê-lo com ultra-som.
O documento descreve as vantagens e técnicas de isolamento do campo operatório odontológico com lençol de borracha. As vantagens incluem manter o campo seco e asséptico, reduzir infecções e proteger tecidos. A técnica envolve montar o lençol no arco, perfurar, levar em conjunto com o grampo para isolar apenas o dente a ser tratado.
O documento discute técnicas de obturação dos canais radiculares, incluindo a técnica da condensação lateral. Ele descreve os objetivos da obturação, materiais como cones de guta-percha e cimento endodôntico, e as etapas da técnica da condensação lateral, como seleção do cone principal e condensação lateral e vertical do material obturador.
“An Outlook of the Ongoing and Future Relationship between Blockchain Technologies and Process-aware Information Systems.” Invited talk at the joint workshop on Blockchain for Information Systems (BC4IS) and Blockchain for Trusted Data Sharing (B4TDS), co-located with with the 36th International Conference on Advanced Information Systems Engineering (CAiSE), 3 June 2024, Limassol, Cyprus.
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Generative AI Deep Dive: Advancing from Proof of Concept to ProductionAggregage
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The modern software delivery process (or the CI/CD process) includes many tools, distributed teams, open-source code, and cloud platforms. Constant focus on speed to release software to market, along with the traditional slow and manual security checks has caused gaps in continuous security as an important piece in the software supply chain. Today organizations feel more susceptible to external and internal cyber threats due to the vast attack surface in their applications supply chain and the lack of end-to-end governance and risk management.
The software team must secure its software delivery process to avoid vulnerability and security breaches. This needs to be achieved with existing tool chains and without extensive rework of the delivery processes. This talk will present strategies and techniques for providing visibility into the true risk of the existing vulnerabilities, preventing the introduction of security issues in the software, resolving vulnerabilities in production environments quickly, and capturing the deployment bill of materials (DBOM).
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Bob Boule
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One such alternative that has garnered significant attention and acclaim is Nitrux Linux 3.5.0, a sleek, powerful, and user-friendly Linux distribution that promises to redefine the way we interact with our devices. With its focus on performance, security, and customization, Nitrux Linux presents a compelling case for those seeking to break free from the constraints of proprietary software and embrace the freedom and flexibility of open-source computing.
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Elizabeth Buie - Older adults: Are we really designing for our future selves?
Brenda
1. Evaluation of time required for recontamination of
coronally sealed canals medicated with calcium
hydroxide and chlorhexidine
B. P. F. A. Gomes, E. Sato, C. C. R. Ferraz, F. B. Teixeira, A. A. Zaia & F. J. Souza-Filho
Department of Restorative Dentistry, EndodonticUnit, Dental School of Piracicaba, State Universityof Campinas, Piracicaba, SP, Brazil
Abstract Brain Heart Infusion broth (BHI), so that only the root
apex was in contact with the broth, while the crown
Gomes BPFA, Sato E, Ferraz CCR,Teixeira FB, Zaia AA,
was immersed in human saliva ‡ BHI (3 : 1). The £asks
Souza-Filho FJ. Evaluation of time required for recontamination
were then incubated at 37 8C in an atmosphere of 10%
of coronally sealed canals medicated with calcium hydroxide and
CO2, and microbial growth was checked daily.
chlorhexidine. International Endodontic Journal, 36, 604^609, 2003.
Results All specimens of the PC showed contamination
Aim To determine in vitro the time required for reconta- within 1 day of incubation, while the NC showed no evi-
mination of coronally sealed canals medicated with dence of broth turbidity. Recontamination was detected
either calcium hydroxide (Ca(OH)2), 2% chlorhexidine after an average time of 3.7 days in the unsealed canals
gel (CG) or with a combination of both. medicated with CG,1.8 days in the group medicated with
Methodology Eighty intact, caries-free, premolar Ca(OH)2 and 2.6 days in the group medicated with
teeth with straight roots and mature apices were selected Ca(OH)2 ‡ CG.When the crowns were sealed with IRM,
for the study. After biomechanical preparation of 75 recontamination was detected within 13.5 days in the
teeth, they were randomly divided into nine groups canals medicated with CG, after 17.2 days in the group
according to the intracanal medicament and the coronal medicated with Ca(OH)2 and after11.9 days in the group
seal with`Intermediate Restorative Material' (IRM) as fol- medicatedwithCG ‡ Ca(OH)2.Thegroupwithnomedica-
lows: (i) 10 teeth medicated with CG, coronally unsealed; tion, but sealed with IRM, showed recontamination after
(ii) 10 teeth medicated with Ca(OH)2, coronally unsealed; 8.7 days. There were statistically signi¢cant di¡erences
(iii) 10 teeth medicated with Ca(OH)2 ‡ CG, coronally betweenthe teethwith or without coronal seal (P < 0.05).
unsealed; (iv) 10 teeth medicated with CG ‡ coronal seal; Conclusion The coronal seal delayed but did not pre-
(v) 10 teeth medicated with Ca(OH)2 ‡ coronal seal; (vi) vent leakage of microorganisms.There was no di¡erence
10 teeth medicated with CG ‡ Ca(OH)2 ‡ coronal seal; between the various medicaments.
(vii) 10 teeth without intracanal medicament and coron-
Keywords: antimicrobial activity, calcium hydro-
ally sealed; (viii) 5 teeth without intracanal medicament
xide, chlorhexidine, endodontics, intracanal medica-
and coronally unsealed, used as the positive control
ment, IRM.
group (PC); (ix) 5 teeth with intact crowns used as the
negative control group (NC). Glass £asks were ¢lled with Received 9 January 2002; accepted 30 April 2003
come of root canal treatment depends on the reduction
Introduction
or elimination of bacteria present within the tooth and
Bacteria and their by-products are the main causes of thus on the e¡ectiveness of chemomechanical prepara-
pulpitis and apical periodontitis (Kakehashi et al. 1965, tion (Siqueira & Uzeda 1997).
Gomes et al. 1994, 1996a,b,c, Estrela et al. 1998). The out- The complex anatomy of root canals provides a sup-
portive environment for growth, multiplication and
interaction of microorganisms in pulpal infections (Bi¤
Correspondence: Dr Brenda P. F. A. Gomes, Faculdade de Odon-
tologia de Piracicaba, UNICAMP, Endodontia, Avenida Limeira,
& Rodrigues 1989). Di¤culties in antimicrobial control
901 Piracicaba, SP 13414-018, Brazil (Tel.: ‡55 19 3412 5215; require the use of intracanal dressings that comple-
fax: ‡55 19 3412 5218; e-mail: bpgomes@fop.unicamp.br). ment chemomechanical preparation, especially in the
604 International Endodontic Journal, 36, 604^609, 2003 ß 2003 Blackwell Publishing Ltd
2. Gomes et al. Recontamination of canals medicated with calcium hydroxide and chlorhexidine
presence of pain and/or persistent exudate (Estrela et al. cularly against resistant microorganisms such as Enter-
1998). ococcus faecalis that are implicated in the failure of root
Intracanal medicaments should have a broad antibac- canal treatment (Engstrom 1964, Cavalleri et al. 1989,
«
terial spectrum, no cytotoxicity, and should possess phy- Gomes et al. 1996b, Molander et al. 1998, Peciuliene et al.
sicochemical properties that permit di¡usion through 2000, Pinheiro et al. 2003). The association of CG and
the dentinal tubules and lateral rami¢cations of the root Ca(OH)2 has been tested against E. faecalis in infected
canal system (Alencar et al. 1997). bovine root dentine, demonstrating that the combined
Calcium hydroxide (Ca(OH)2) is considered to possess medicaments were e¡ective (Almyroud et al. 2002,
many properties of an ideal root canal dressing (Beltes Gomes et al. 2003).
et al. 1997), and has become popular because of its anti- The objective of this study was to determine in vitro
microbial and biological properties (Estrela et al. 1998). the time required for recontamination of canals medi-
The antimicrobial action of Ca(OH)2 is related to its ionic cated with either Ca(OH)2, CG or a combination of both.
dissociation into calcium and hydroxyl ions and their
toxic e¡ects on bacteria, by inhibiting cytoplasmic mem-
Materials and methods
brane enzymes with consequent changes in the organic
components and in nutrient transport (Estrela etal.1998). Eighty intact, caries-free, human premolar teeth with
Calcium hydroxide-containing materials have been straight roots were selected for the study. The teeth were
used widely in endodontic therapy to stimulate apexi¢- autoclaved and kept in 0.5% sodium hypochlorite
cation, repair perforations, promote healing by hard tis- (NaOCl) for no longer than 7 days. Conventional access
sue formation in horizontal and vertical root fractures preparations were made in 75 teeth, and the cervical
and control external and internal in£ammatory root two-thirds of the canals were prepared initially using
resorption (Beltes et al. 1997). Ca(OH)2 also mediates the ¢les up to size 35. They were then £ared with a size 2
neutralisation of lipopolysaccharides (Safavi & Nichols Gates-Glidden bur (GG), followed by a size 3 bur, 1 mm
1994), and thus helps in cleansing the root canal (Hassel- shorter. A size 10 K-¢le was introduced into each canal
gren et al.1988). However, Ca(OH)2 cannot be considered until it appeared at the apical foramen. The working
as a universal intracanal medicament, as it is not equally length was established by subtracting 1 mm from this
e¡ective against all bacteria found in the root canal measurement. The same K-¢le was used to recapitulate
(Gomes et al.2002). Indeed, several studies have reported the canal 1 mm beyond its length between each ¢le in
the failure of Ca(OH) 2 to eliminate enterococci e¡ec- order to preserve patency. The root canals were prepared
tively (Engstrom 1964, Cavalleri et al. 1989, Gomes et al.
« using the step-back technique with K-¢les manipu-
1996c, Molander et al.1998, Pinheiro et al. 2003), as they lated in a reaming motion. To standardise the diameter,
tolerate high pH values, varying from 9 to 11. the apical foramen was enlarged to a size 20 K-¢le.
Chlorhexidine gluconate has been widely used in per- Apical preparation was performed at the working
iodontics because of its antibacterial activity (Gjermo length up to a size 35 K-¢le and completed by stepping
1974, Lindskog et al. 1998). Its use in endodontics has back at 1-mm increments. Irrigation was carried out
been proposed as both an irrigant and an intracanal using1 mL of a 2.5% NaOCl solution between ¢les. After
medicament (Delany et al.1982,Vahdaty et al.1993, Jean- preparation, the root canal was irrigated with 5 mL
sonne & White 1994, Siqueira & Uzeda 1997, Ferraz et al. 17% EDTA for 3 min to remove the smear layer, and
2001, Gomes et al. 2001). It has been demonstrated that then with 1 mL 5.25% NaOCl. Five millilitres of sterile
chlorhexidine has inhibitory e¡ects on bacteria com- saline was used as a ¢nal rinse to remove debris and
monly found in endodontic infections (Cervone et al. the irrigants.
1990). Chlorhexidine has antimicrobial activity against The teeth were divided randomly according to the
Gram-positive and Gram-negative microorganisms intracanal medicament and coronal seal with `Inter-
(Waaler 1990). Its e¤cacy is based on the interaction mediate Restorative Material' (IRM; LD Caulk Division,
between the positive charge of the molecule and nega- Milford, DE, USA), as follows:
tively charged phosphate groups on the bacterial cell Group 1:10 teeth with CG, unsealed coronally;
wall, which allows the chlorhexidine molecule to pene- Group 2:10 teeth with Ca(OH)2, unsealed coronally;
trate the bacteria with intracellular toxic e¡ects (Hugo Group 3:10 teeth with CG ‡ Ca(OH)2, unsealed coro-
Longworth 1964, Lindskog et al. 1998). nally;
The aim of combining Ca(OH)2 and 2% chlorhexidine Group 4:10 teeth with CG ‡ coronal seal;
gel (CG) is to enhance antimicrobial e¡ectiveness, parti- Group 5:10 teeth with Ca(OH)2 ‡ coronal seal;
ß 2003 Blackwell Publishing Ltd International Endodontic Journal, 36, 604^609, 2003 605
3. Recontamination of canals medicated with calcium hydroxide and chlorhexidine Gomes et al.
Group 6:10 teeth with CG ‡ Ca(OH) 2 (1 : 1) ‡ coronal
seal;
Group 7: 10 teeth without intracanal medica-
tion ‡ coronal seal;
Group 8:5 teethused as the positive control group (PC),
without intracanal medication and coronally unsealed;
Group 9: 5 teeth used as the negative control group
(NC), with intact crowns.
The chlorhexidine gel consisted of gel base (1% natro-
sol) and chlorhexidine gluconate, and was prepared in
¨
a standard way (Drogal Farmacia de Manipulac ¬ o Ltda.,
Ëa
Piracicaba, SP, Brazil). The natrosol gel (hydroxyethyl
cellulose, pH 5.5), used as the base, is soluble in water
and widely used to thicken shampoos, gels and soaps.
The gel formulation may keep the `active principle' of
chlorhexidine gluconate in contact with the microor-
ganisms for inhibiting growth for a longer period
(Gomes et al. 2001).
The Ca(OH)2 paste was prepared from Ca(OH)2 pow-
der (Quimis Mallinkrodt, Inc., Phillipsburg, NJ, USA),
using polyethyleneglycol (Merck, Darmstadt, Germany)
as a vehicle (2 : 1), in order to facilitate its placement with
a syringe inside the root canals. The consistency of the
Figure 1 Apparatus used to assess the root canal
paste was similar to that of a toothpaste with a viscosity system reinfection. (a) Syringe (saliva reservoir); (b) size1
of 3501 cP at 0.1 r.p.m. (Brook¢eld Digital Reometer, rubber stopper; (c) tooth; (d) 10-mL vial; (e) Brain Heart
model DV-III-IV Sao Paulo, SP, Brazil).
, ¬ Infusion (BHI) medium.
The pH of the chlorhexidine and the Ca(OH)2 pastes,
alone and combined, was also tested (Procyon, digital The £asks containing BHI, the stoppers with the
pH meter model AS 720, electrode A11489, Procy Instru- teeth and the syringes were separately autoclaved at
mental Cient|¨ ¢ca, Sao Paulo, SP, Brazil).
¬ 121 8C for15 min, and then adapted to the £asks ‡ stop-
The apparatus used to evaluate leakage was prepared pers under a laminar £ow hood. Cyanocrylate was then
as previously described by Siqueira et al. (1999) (Fig. 1). applied to the interface between the tooth and the stop-
Glass vials with rubber stoppers were adjusted for use. per to avoid saliva penetration into the BHI broth (Imura
Using a high-speed handpiece, a hole was made through et al.1997). In order to ensure the e¤ciency of the cyano-
the centre of each rubber stopper (Torabinejad et al. crylate seal, 2 mL of 1% sterile methylene blue dye
1990) in which each tooth was inserted under pressure was placed into the tube leading to the coronal portion
up to its cemento-enamel junction, so that its crown of each sample (Malone Donnelly1997). If the medium
was outside the vial and its root was within. became blue, this meant the seal was defective and
Cylinders prepared from 10-mL plastic syringes were the specimen was discarded. Para¢lm1 (American
adapted to the outer surface of the stoppers to create a National CanTM, Menasha, WI, USA) was used to block
chamber around the crown of the tooth. the interface between £asks and stopper. The £asks were
The glass £asks were then ¢lled with Brain Heart then incubated at 37 8C for 4 days to ensure sterilisation.
Infusion broth (BHI; Oxoid, Basingstoke, UK) plus After the fourth day, the syringe chambers were
neutralisers so that a 2-mm length of root apex was removed so that the methylene blue could be removed
immersed in the broth. The neutralisers were used to with plastic pipettes. The medicaments were prepared
prevent continued action of the medication if it reached and injected into the root canals with sterile plastic syr-
the BHI medium through the apical foramen. The inges. In order to check the correct placement of the med-
neutraliser for Ca(OH)2 was 0.5% citric acid, while ication inside the canals, buccal^lingual and mesial^
0.5% Tween 80 ‡ 0.07% lecithin was used for chlorhex- distal radiographs were taken, and the passage of a small
idine alone or combined with Ca(OH)2 (Siqueira et al. amount of medication through the apical foramen was
1998). permitted.
606 International Endodontic Journal, 36, 604^609, 2003 ß 2003 Blackwell Publishing Ltd
4. Gomes et al. Recontamination of canals medicated with calcium hydroxide and chlorhexidine
The teeth from groups 4^7 had their coronal access analysis, with the level of signi¢cance set at 5%
¢lled with IRM, a reinforced zinc oxide^eugenol-based (P 0.05).
temporary restorative material, in order to avoid saliva
penetration into the canals.
Results
The depth of the cavity was measured from the
canal ori¢ce to the cavosurface margin with a periodon- The average time for the complete reinfection of the root
tal probe. All samples allowed for approximately 4 mm canal system is shown in Table 1. All specimens of the
of the restorative material to comply with the recom- PC showed broth turbidity within 1 day of incubation.
mendation of Webber et al. (1978). To verify the unifor- On the other hand, there was no evidence of broth tur-
mity and density, all teeth were radiographed buccal^ bidity in the NC throughout the experiment.
lingually and mesial^distally after the placement of The canals without coronal seal, but medicated with
IRM. CG, showed recontamination after an average time of
Human whole saliva (30 mL) was collected from one 3.7 days; the group with Ca(OH)2 after 1.8 days and the
individual at 8 AM on each day of exposure or solution group with CG ‡ Ca(OH)2 after 2.6 days.
change. The volunteer did not brush or £oss for at least The canals medicated with CG ‡ IRM showed recon-
12 h before collection. Chewing a 1-g piece of Para¢lm1 tamination within 13.5 days; the group with Ca(OH)2 ‡
(American National CanTM, Menasha,WI, USA) was used IRM after17.2 days and the group with CG ‡ Ca(OH)2 ‡
to stimulate salivary £ow. The saliva was stored in a IRM after 11.9 days.
brown glass, 100 mL screw-top container, according to The group with no medication, but sealed with IRM,
Magura et al. (1991). The chamber of each whole appara- showed recontamination after an average time of
tus was put in place again and ¢lled with 3 mL of human 8.7 days.
saliva and BHI broth in a 3 : 1 proportion. The mixture There were statistically signi¢cant di¡erences
was replaced every 3 days. between the groups (P 0.05). All groups without coro-
The whole apparatus was incubated at 37 8C and nal seal were recontaminated signi¢cantly more quickly
checked daily for the appearance of turbidity in the than those sealed with IRM, except those teeth coronally
BHI broth. As the medium can evaporate, care was also sealed but without medicament. The groups with intra-
taken to ensure that the roots remained in contact with canal medication and sealed were not signi¢cantly dif-
the BHI medium throughout the experiment. ferent from each other. The pH of chlorhexidine was
All data were organised in a contingency table, 7.0, calcium hydroxide paste was 11.0 and chlorhexidi-
and the Kruskal^Wallis test was applied for statistical ne ‡ calcium hydroxide was 12.8.
Table 1 Number and average days to complete recontamination of root canals after saliva challenge
Samples CG Ca(OH)2 CG ‡ Ca(OH)2 CG ‡ IRM Ca(OH)2 ‡ IRM CG ‡ Ca(OH)2 ‡ IRM IRM PC NC
1 3 3 2 14 20 15 5 1 No bacterial
growth
2 3 1 2 11 3 15 6 1 No bacterial
growth
3 5 1 2 21 20 4 17 1 No bacterial
growth
4 4 1 3 22 20 13 15 1 No bacterial
growth
5 4 3 3 5 27 13 5 1 No bacterial
growth
6 1 1 3 21 3 20 7 ^ ^
7 4 2 3 5 27 4 7 ^ ^
8 4 1 3 14 20 10 15 ^ ^
9 5 2 2 11 7 18 5 ^ ^
10 4 3 3 11 25 7 5 ^ ^
Average 3.7 Æ 1.16a 1.8 Æ 0.92a 2.6 Æ 0.52a 13.5 Æ 6.22b,c 17.2 Æ 9.38c 11.9 Æ 5.55b,c 8.7 Æ 4.9a,b 1 Æ 0.0a ^
days Æ SD
CG: 2% chlorhexidine gel; PC: positive control group; NC: negative control group.
SD: Standard deviation.
Different letters mean significant statistical difference (P 0.05).
ß 2003 Blackwell Publishing Ltd International Endodontic Journal, 36, 604^609, 2003 607
5. Recontamination of canals medicated with calcium hydroxide and chlorhexidine Gomes et al.
in this study was to act as a barrier against coronal
Discussion
microleakage, as the samples had been previously auto-
One of the objectives of using an intracanal medicament claved. On the other hand, in infected root canals, a med-
is to reduce the number of microorganisms. Ideally, it icament should also reach and be e¡ective against
should penetrate areas not reached by the instruments selected endodontic microorganisms inside the dentinal
or irrigating solution during root canal preparation (Bar- tubules and rami¢cations of the root canal system. In
bosa et al. 1997). this context, the tested medicaments may present di¡er-
The methodology used inthis study was similar to that ent behaviour, as they will also depend upon the vulner-
reported previously (Imura et al. 1997, Malone Don- ability of the involved species, which may not be
nelly1997, Siqueira et al.1999).The placement of medica- uniform (Gomes et al. 1996c).
ments inside the canals and the coronal seal was
checked radiographically (except those with chlorhexi-
Conclusion
dine as this medication is radiolucent). Pilot studies
demonstrated that the presence of neutralisers in 8-mL The coronal seal delays coronal microleakage, as does
BHI broth allowed bacterial growth, even when 200 mL the use of an intracanal medicament.
of the medicaments was added. Furthermore, undesir-
able saline penetration into the BHI broth (Imura et al.
Acknowledgements
1997) as a result of a leakage along the interface between
the tooth and the stopper was visuallychecked by means This work was supported by the Brazilian agencies
of sterile 1% methylene blue dye. Care was also taken FAPESP (00/13689^7, 96/5584^3) and CNPq (520277/
to ensure that the roots were in contact with the BHI 99^6, PIBIC).
medium throughout the experiment, in order to avoid
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