Evaluation of the interaction between sodium hypochlorite and several formulations containing chlorhexidine and its effect on the radicular dentin—SEM and push‐out bond strength analysis

The aim of the current study was to evaluate the presence of debris and smear layer after endodontic irrigation with different formulations of 2% chlorhexidine gluconate (CHX) and its effects on the push‐out bond strength of an epoxy‐based sealer on the radicular dentin. One hundred extracted human canines were prepared to F5 instrument and irrigated with 2.5% sodium hypochlorite and 17% ethylenediaminetetraacetic acid. Fifty teeth were divided into five groups (n = 10), according to the final irrigation protocol with different 2% CHX formulations: G1 (control, no final rinse irrigation), G2 (CHX solution), G3 (CHX gel), G4 (Concepsis), and G5 (CHX Plus). In sequence, the specimens were submitted to scanning electron microscopy (SEM) analysis, in the cervical‐medium and medium‐apical segments, to evaluate the presence of debris and smear layer. The other 50 teeth were treated equally to a SEM study, but with the root canals filled with an epoxy‐based endodontic sealer and submitted to a push‐out bond strength test, in the cervical, middle, and apical thirds. G2, G3, G4, and G5 provided higher precipitation of the debris and smear layer than G1 (P < 0.05), but these groups were similar to each other (P > 0.05), in both segments. The values obtained in the push out test did not differ between groups, independent of the radicular third (P > 0.05). The CHXs formulations caused precipitation of the debris and smear layer on the radicular dentin, but these residues did not interfere in the push‐out bond strength of the epoxy‐based sealer. Microsc. Res. Tech. 77:17–22, 2014. © 2013 Wiley Periodicals, Inc.     

Long-term microleakage trends in access cavities conditioned with phosphoric acid and deproteinizing agent for root-canal-treated teeth: an investigation of fluid filtration and microscopy analysis

This study evaluated the long-term microleakage of access cavities conditioned with phosphoric acid and deproteinizing agents for root-canal-treated teeth using fluid filtration and microscopical analysis. Occlusal surfaces of extracted human mandibular premolars (N = 90) were removed leaving a 4 mm coronal length from the cemento-enamel junction. After root canal treatment, the specimens were randomly divided into four experimental groups (n = 21) and the remaining teeth were used for positive control group (n = 6): SB: 35% H₃PO₄ + Adper Single Bond 2; SSB: 35% H₃PO₄ + 5.25% NaOCl + 10% Sodium ascorbate (C₆H₇NaO₆) + Adper Single Bond 2; XP: 35% H₃PO₄₊XP Bond; SXP: 35% H₃PO₄₊5.25% NaOCl + 10% Sodium ascorbate + XP Bond. All cavities were restored with a resin composite (Filtek Z250). After removing the root filling from the apical side, teeth were subjected to fluid filtration test for 1 week, 6 and 12 months followed by ×2500 thermocycling after 1st week and 6th months each. Data were analyzed using one-way ANOVA and Dunnet T3 tests (α = 0.05). SEM analyses were carried out after each microleakage evaluation in two random teeth from all groups. Microleakage values in groups SB and XP presented no significant difference in any of the evaluated period (p > 0.05). Microleakage results of SXP (0.01665) group showed significant difference compared to XP (0.03377) and SB (0.03049) groups after 12 months. SSB group (0.00901) showed significantly less microleakage among all other groups (0.01665–0.03377) (p < 0.05). Prior to endodontic treatment, in access cavities, acid etching with 35% H₃PO₄ followed by the application of NaOCl and sodium ascorbate completely destroyed the collagen layer, reducing the microleakage and resin–dentin interface degradation up to 12 months.     

Residues of different gel formulations on dentinal walls: A SEM/EDS analysis

The aim of this study was to evaluate the presence of residues of sodium hypochlorite gel, chlorhexidine gel, and EDTA gel on dentinal walls after canal preparation through chemical SEM‐ elemental chemical microanalysis (EDS) analysis. Forty‐eight single‐rooted teeth were selected. They had their crowns sectioned and were instrumented with a reciprocating system. The canals were irrigated with 5 mL of saline solution during root canal preparation. After instrumentation, the root canals were irrigated with 3 mL 17% EDTA followed by 1 min of ultrasonic passive activation (3× 20 sec) to remove the smear layer, and then irrigated with 3 mL of saline solution. The specimens were randomized into three groups (n = 12) according to the chemical substance that filled the root canal for 30 min: GI: 5.5% sodium hypochlorite gel; GII: 2% chlorhexidine gel; GIII: 24% EDTA gel; Negative control group: no substance was used. Then, the root canals were irrigated with 6 mL of saline solution followed by 1 min of ultrasonic passive activation (3× 20 sec). After ultrasonic activation, the canals were irrigated with 2 mL saline. The roots were sectioned, and the percentage of each chemical element present in the samples was analyzed through chemical SEM‐EDS microanalysis. All experimental groups showed a significantly higher percentage of chemical elements (Na and/or Cl) than the control group (P < 0.03). This in vitro study has shown that, regardless of chemical solutions used even after the final irrigation protocol, chemical residues of different substances remained attached to the root canal walls. Microsc. Res. Tech. 78:495–499, 2015. © 2015 Wiley Periodicals, Inc.     

Effect of the root canal final rinse protocols on the debris and smear layer removal and on the push‐out strength of an epoxy‐based sealer

The aim of the present study was to evaluate the efficacy of QMiX, SmearClear, and 17% EDTA for the debris and smear layer removal from the root canal and its effects on the push‐out bond strength of an epoxy‐based sealer by scanning electron microscopy (SEM). Forty extracted human canines (n = 10) were assigned to the following final rinse protocols: G1‐distilled water (control), G2–17% EDTA, G3‐SmearClear, and G4‐QMiX. The specimens were submitted to a SEM analysis to evaluate the presence of debris and smear layer, respectively, in the apical or cervical segments. In sequence, forty extracted human maxillary canines with the root canals instrumented were divided into four groups (n = 10) similar to the SEM analysis study. After the filling with AH Plus, the roots were transversally sectioned to obtain dentinal slices. The specimens were submitted to a push‐out bond strength test using an electromechanical testing machine. The statistical analysis for the SEM and push‐out bond strength studies were performed using the Kruskal–Wallis and Dunn tests (α = 5%). There was no difference among the G2, G3, and G4 efficacy in removing the debris and smear layer (P > 0.05). The efficacy of these groups was superior to the control group. The push‐out bond strength values of G2, G3, and G4 were superior to the control group. The ability to remove the debris and smear layer by SmearClear and QMiX was as effective as the 17% EDTA. The final rinse with these solutions promoted similar push‐out bond strength values. Microsc. Res. Tech. 76:533–537, 2013. © 2013 Wiley Periodicals, Inc.     

Electrospun Azithromycin-Laden Gelatin Methacryloyl Fibers for Endodontic Infection Control

This study was aimed at engineering photocrosslinkable azithromycin (AZ)-laden gelatin methacryloyl fibers via electrospinning to serve as a localized and biodegradable drug delivery system for endodontic infection control. AZ at three distinct amounts was mixed with solubilized gelatin methacryloyl and the photoinitiator to obtain the following fibers: GelMA+5%AZ, GelMA+10%AZ, and GelMA+15%AZ. Fiber morphology, diameter, AZ incorporation, mechanical properties, degradation profile, and antimicrobial action against Aggregatibacter actinomycetemcomitans and Actinomyces naeslundii were also studied. In vitro compatibility with human-derived dental pulp stem cells and inflammatory response in vivo using a subcutaneous rat model were also determined. A bead-free fibrous microstructure with interconnected pores was observed for all groups. GelMA and GelMA+10%AZ had the highest fiber diameter means. The tensile strength of the GelMA-based fibers was reduced upon AZ addition. A similar pattern was observed for the degradation profile in vitro. GelMA+15%AZ fibers led to the highest bacterial inhibition. The presence of AZ, regardless of the concentration, did not pose significant toxicity. In vivo findings indicated higher blood vessel formation, mild inflammation, and mature and thick well-oriented collagen fibers interweaving with the engineered fibers. Altogether, AZ-laden photocrosslinkable GelMA fibers had adequate mechanical and degradation properties, with 15%AZ displaying significant antimicrobial activity without compromising biocompatibility.     

Tissue Characteristics in Endodontic Regeneration: A Systematic Review

The regenerative endodontic procedure (REP) represents a treatment option for immature necrotic teeth with a periapical lesion. Currently, this therapy has a wide field of pre-clinical and clinical applications, but no standardization exists regarding successful criteria. Thus, by analysis of animal and human studies, the aim of this systematic review was to highlight the main characteristics of the tissue generated by REP. A customized search of PubMed, EMBASE, Scopus, and Web of Science databases from January 2000 to January 2022 was conducted. Seventy-five human and forty-nine animal studies were selected. In humans, the evaluation criteria were clinical 2D and 3D radiographic examinations. Most of the studies identified a successful REP with an asymptomatic tooth, apical lesion healing, and increased root thickness and length. In animals, histological and radiological criteria were considered. Newly formed tissues in the canals were fibrous, cementum, or bone-like tissues along the dentine walls depending on the area of the root. REP assured tooth development and viability. However, further studies are needed to identify procedures to successfully reproduce the physiological structure and function of the dentin–pulp complex.     

Computed microtomography evaluation of calcium hydroxide‐based root canal dressing removal from oval root canals by different methods of irrigation

The aim of this study was to evaluate the capacity of conventional irrigation, passive ultrasonic irrigation (PUI), and Easy Clean for removing calcium hydroxide‐based root canal dressing from oval root canals. Thirty mandibular uniradicular incisors with oval canals were used, and subjected to chemical–mechanical preparation with Reciproc R40 instruments. The main canal was filled with a paste based on Ca(OH)₂ P.A., iodoform and propylene glycol in the ratio of 3:1:1. The teeth were stored in 100% humidity at a temperature of 37°C for 14 days. Afterwards, the teeth were divided into three groups (n = 10) according to the method of irrigation used (conventional irrigation, PUI, and Easy Clean). The specimens were analyzed by computed microtomography at three time intervals: before placing the root canal dressing, with the root canal dressing in place, and after application of the irrigation methods for removing it. The data were submitted to Kruskal–Wallis and Dunn tests for analyzing the canal as a whole, and Friedman and Dunn for analyzing the root thirds. The results showed that conventional irrigation was less efficient for removing the root canal dressing in comparison with the methods that agitated the irrigant solution (p < .05). When the root canal was analyzed as a whole, Easy Clean, and PUI were similar (p > .05). In analysis of the thirds, Easy Clean was more efficient than conventional irrigation in all the thirds, while PUI showed this behavior only in the cervical third (p < .05). The authors concluded that in oval canals, none of the irrigation methods were capable of removing all the root canal dressing, however, the methods that agitated the irrigant solution were more efficient than conventional irrigation.     

Evaluation of surface topography changes in three NiTi file systems using rotary and reciprocal motion: An atomic force microscopy study

Aim: To evaluate the surface topography changes in three nickel‐titanium (NiTi) file systems using either rotary or reciprocal motion using atomic force microscopy (AFM), and to determine the effect of scanning area on the AFM results in this study. Methodology: Five points on a F2 Protaper file, R25 Reciproc file, and a Primary file from WaveOne systems were scanned preoperatively in 1 × 1 and 5 × 5 µm² with an AFM device that can scan an intact (not sectioned) file. One standardized resin block was used for each instrument, according to the manufacturer's recommendations. Points were re‐scanned postoperatively using the same AFM and settings. Root‐mean‐square (RMS) and roughness average (Ra) values were obtained. The preoperative and postoperative surface topographies were compared separately in terms of RMS and Ra values. The surface topography change scores were analyzed using Kruskal–Wallis and Mann–Whitney U tests using a 0.10 significance level. Results: There were no significant differences preoperatively among the NiTi file systems in 1 × 1 or 5 × 5 µm² areas. Postoperatively, the WaveOne Primary had more surface irregularities (significant for 5 × 5 µm² scan in Ra evaluation). Conclusions: Three‐dimensional AFM images of instrument surfaces showed topographic irregularities preoperatively and postoperatively. AFM results differ depending on the scanning area and file used. Microsc. Res. Tech. 77:177–182, 2014. © 2013 Wiley Periodicals, Inc.     

Qualitative analysis of files of four different rotary systems,before and after being used for the twelfth time

The aim of this study was to make a comparative evaluation of the surface topography of the cervical third and tip of four different rotary systems, before and after being used 12 times, in resin blocks with simulated root canals with standardized 45° curvatures, and analyzed by scanning electronic microscopy (SEM). A total of 1,440 resin blocks with simulated root canals and standardized curvatures were used. The blocks were divided into four groups and prepared by the crown down technique according to the manufacturers' recommendations: Group 1 (G1)—K3®, Group 2 (G2)—Protaper Universal®, Group 3 (G3)—Twisted Files®, and Group 4 (G4)—Biorace®. After each preparation, the instruments were washed and autoclaved. A total of 24 instruments were selected, being three new instruments and three after having been used for the 12th time, from each group. These instruments were analyzed by SEM. To perform the evaluation, 24 micrographs were observed by 12 evaluators who attributed a score to the images according to a template. In the qualitative analysis of the cervical region and tip of new instruments, it was observe that the files of Groups G4 and G2 were the least rough and those of G1, the roughest. In the same manner, the cervical region of the instruments was qualitatively analyzed after the 12th time of using them, and there was no statistically significant difference at a level of 1% (ANOVA P < 0.01) between G2 and G4 as well as between G1 and G3. As regards the tip, it was observed that there was no statistically significant difference, at a level of 1%, between the groups: G1 and G3, G1 and G4, and between G3 and G4, and there was statistically significant difference at a level of 1%, between group G2 and the other groups, with G3 having the greatest roughness (ANOVA P < 0.01). Microsc. Res. Tech., 2013. © 2012 Wiley Periodicals, Inc.