Influence of bioceramic intracanal medication on the bond strength of bioceramic root canal sealer

To investigate the influence of the remaining volume of a new intracanal medication based on bioceramic compounds on the bond strength (BS) and formation of an adhesive interface between calcium silicate-based and epoxy resin-based root canal sealers. For this purpose, the specimens were distributed according to the intracanal medication (n = 26): Bio-C Temp (BCT) and Ultracal XS (UXS). The roots were scanned in microCT, and after 7 days, the medication was removed. Then a new scan was performed to evaluate the volume of medication remaining. Subsequently, 40 specimens were redistributed into 2 subgroups (n = 10) and filled according to the sealer used: AH Plus (AHP) and Bio-C Sealer (BCS), to assess the bond strength by using the push-out test, and the adhesive interface by confocal laser fluorescence microscopy (CLSM) and scanning electron microscopy (SEM). The t test showed a smaller remainder of BCT (1.77 ± 0.86) compared with UXS (10.47 ± 5.78), irrespective of the root third evaluated. The BS showed that teeth with BCT + BCS had higher bond strength values (3.70 ± 1.22) when compared to the other groups: BCT + AHP (2.15 ± 1.07), UXS + BCS (3.18 ± 1.09) and UXS + AHP (2.11 ± 1.02) (p<0.001). The cervical third had higher BS when compared with the middle and apical thirds (p < 0.001), and higher number of adhesive failures. The adhesive interface in SEM and CLSM images showed better adaptation for the association between BCT + BCS. Intracanal medication and silicate-based endodontic sealer appeared to interact chemically by forming a biomineralizing layer, allowing for an increase in the bond strength and forming an adhesive interface between the materials, with no or less gap formation.

Calcium-doped zinc oxide nanocrystals as an innovative intracanal medicament: a pilot study

Objectives

This study investigated the cytotoxicity, radiopacity, pH, and dentinal tubule penetration of a paste of 1.0% calcium-doped zinc oxide nanocrystals (ZnO:1.0Ca) combined with propylene glycol (PRG) or polyethylene glycol and propylene glycol (PEG-PRG).

Materials and Methods

The pastes were prepared by mixing calcium hydroxide [Ca(OH)2] or ZnO:1.0Ca with PRG or a PEG-PRG mixture. The pH was evaluated after 24 and 96 hours of storage in deionized water. Digital radiographs were acquired for radiopacity analysis and bubble counting of each material. The materials were labeled with 0.1% fluorescein and applied to root canals, and images of their dentinal tubule penetration were obtained using confocal laser scanning microscopy. RAW264.7 macrophages were placed in different dilutions of culture media previously exposed to the materials for 24 and 96 hours and tested for cell viability using the MTT assay. Analysis of variance and the Tukey test (α = 0.05) were performed.

Results

ZnO:1.0Ca materials showed lower viability at 1:1 and 1:2 dilutions than Ca(OH)2 materials (p < 0.0001). Ca(OH)2 had higher pH values than ZnO:1.0Ca at 24 and 96 hours, regardless of the vehicle (p < 0.05). ZnO:1.0Ca pastes showed higher radiopacity than Ca(OH)2 pastes (p < 0.01). No between-material differences were found in bubble counting (p = 0.0902). The ZnO:1.0Ca pastes had a greater penetration depth than Ca(OH)2 in the apical third (p < 0.0001).

Conclusions

ZnO:1.0Ca medicaments presented higher penetrability, cell viability, and radiopacity than Ca(OH)2. Higher values of cell viability and pH were present in Ca(OH)2 than in ZnO:1.0Ca.

Influence of different calcium hydroxide removal protocols on the bond strength of epoxy resin-based sealer in long oval root canals

This study evaluated the effect of different protocols for Ca(OH)₂ removal on the bond strength (BS) of epoxy resin-based sealer in long oval root canals. Forty-eight mandibular incisors with long oval root canals were selected by CBCT. Biomechanical preparation was performed, the samples were filled with Ca(OH)₂ paste and distributed in four groups (n = 12): G-without Ca(OH)₂ paste (C); G2-syringe/needle (SN); G3-SN + XP-Endo® Finisher (XPF); G4-SN + passive ultrasonic irrigation (PUI). After 7 days, Ca(OH)₂ was removed and teeth were filled using AHPlus and guttapercha. In four samples from each group, the sealer was manipulated with 0.1% rhodamine to assess sealer penetration by fluorescent laser confocal microscopy (FLCM). Samples were sectioned in slices for BS, scanning electron microscopy, and FLCM analysis. The BS data were analyzed by ANOVA and Tukey tests (α = 0.05). The lowest BS values were found for the SN group (12.89 ± 4.36) compared to C (35.55 ± 10.05), while PUI group presented intermediate values (28.57 ± 9.35) and the XPF group (31.34 ± 9.8) showed values that were sometimes similar to C group and sometimes similar to PUI group (p > .05). The analysis of the adhesive interface showed evident gaps, with the presence of residues between the dentin and the filling material for the SN group, and for C, XPF and PUI groups juxtaposed adhesive interface. FLCM images showed sealer penetration in the dentinal tubules along the entire perimeter for C, XPF, and PUI groups. Ca(OH)₂ removal with XPF and PUI from long oval root canals resulted in higher bond strength values compared to SN, besides better sealer penetration on dentinal tubules and juxtaposed adhesive interface.

Intra-canal calcium hydroxide removal by two rotary systems: A comparative study

Aim:

The presence of calcium hydroxide (Ca(OH)₂) in the root canal interferes with the apical root canal sealing and may result in periapical lesions in the long run. The present study was aimed to compare the efficacy of two rotary systems of Race and Mtwo in the removal of Ca (OH)₂ aqueous-based from distobuccal canals of human maxillary molars.

Materials and Methods:

A total of 44 distobuccal root canals of human maxillary molars were randomly distributed into two groups of 20 canals each and two control groups. Specimens in each group were instrumented with similar master apical rotary (MAR) and flexible files according to the manufacture's guidelines. The Ca (OH)₂ paste was placed in canals using # 20 lentulo and radiographs were taken from the two dimensions. The roots were incubated for 1 week at 37°C and 100% humidity and Ca (OH)₂ was removed from canals by MAR, afterward. Then, the roots were longitudinally split in halves by diamond disk and chisel without entering the root canals. Photos were taken from the canals’ walls by a stereomicroscope with × 10 magnification. Next, according to a defined scoring system, photos were scored by four endodontists, so that scores 1 and 2 (nonvisible remnants or scattered remnants of Ca(OH)₂) were considered as acceptable and scores 3 and 4 (distinct mass or densely-packed mass of Ca(OH)₂) were regarded as nonacceptable.

Results:

The obtained findings indicated that in coronal, middle, and apical portions of the root canal, 45, 60, and 65% of Mtwo specimens and 40, 50, and 55% of specimens prepared by the Race system acquired an acceptable score (1 and 2), respectively. Moreover, the results showed no significant difference between the two groups (P > 0.05).

Conclusions:

Both Mtwo and Race rotary systems with acceptable removal efficiency (score 1 and 2) were similarly able to remove Ca(OH)₂

Efeitos da dentina sobre o pH e atividade antimicrobiana de diversas formulações com hidróxido de cálcio

Objetivo Avaliar o efeito da dentina sobre o pH e a atividade antimicrobiana de formulações com hidróxido de cálcio. Material e método O pH e a atividade antimicrobiana das formulações (G1- polietilenoglicol, G2- glicerina e paramonoclorofenol canforado ou G3- clorexidina) foram analisados nas formulações puras (G1A, G2A e G3A) ou acrescidas de dentina em pó (G1B, G2B e G3B). Tubos de polietileno foram preenchidos com uma das formulações e imersos em água destilada. O pH foi analisado após 24 horas, 7, 14 e 21 dias. A atividade antimicrobiana foi avaliada sobre Enterococcus faecalis (ATCC 29212), através do teste de difusão em ágar. Os resultados foram submetidos aos testes de ANOVA e Tukey (p=0,05). Resultado A dentina não exerceu efeito sobre o pH das formulações, exceto ocasionando a redução em G1, no período de 24 horas (p<0,05). Nas demais formulações, não houve interferência da dentina sobre o pH (p>0,05). Quando comparados entre os grupos, em 24 horas e 7 dias, G1A e G1B apresentaram menor pH (p<0,05). Em 14 dias, G2A, G2B, G3A e G3B demonstraram similar pH (p>0,05), assim como entre G3B e G1A (p>0,05). Em 21 dias, todas as formulações demonstram semelhante pH (p>0,05). Os resultados em ordem decrescente da atividade antimicrobiana foram G2A=G2B>G3A=G3B>G1A=G1B (p<0,05). Conclusão A dentina não interferiu no pH e na atividade antimicrobiana das diferentes formulações com hidróxido de cálcio, exceto na associação com o polietilenoglicol, em que ocasionou a redução do pH apenas no período de 24 horas. A formulação com paramonoclorofenol canforado apresentou maior atividade antimicrobiana, seguida da clorexidina e do polietilenoglicol.

Retrievabilty of calcium hydroxide intracanal medicament with Chitosan from root canals: An in vitro CBCT volumetric analysis

AIM

This study compared the amount of aqueous-based and oil-based calcium hydroxide [Ca(OH)2 ] remaining in the canal, after removal with two different chelators 17% EDTA and 0.2% Chitosan in combination with ultrasonic agitation.

MATERIALS AND METHODS

Cleaning and shaping of root canals of 28 mandibular premolar was done and canals were filled either with Metapex or Ca(OH)2 mixed with distilled water. Volumetric analysis was performed utilizing cone beam-computed tomography (CBCT) after 7 days of incubation. Ca(OH)2 was removed using either 17% EDTA or 0.2% Chitosan in combination with ultrasonic agitation. Volumetric analysis was repeated and percentage difference was calculated and statistically analysed using Kruskal-Wallis and Mann-Whitney U test.

RESULTS

Both the chelators failed to remove aqueous-based as well as oil-based Ca(OH)2 completely from the root canal. Aqueous-based Ca(OH)2 was easier to be removed than oil-based Ca(OH)2. 0.2% Chitosan was significantly more effective for removal of oil-based Ca(OH)2 (P < 0.01) while both 17% EDTA and 0.2% Chitosan were equally effective in removing aqueous-based Ca(OH)2 .

CONCLUSION

Combination of 0.2% Chitosan and ultrasonic agitation results in lower amount of Ca(OH)2 remnants than 17% EDTA irrespective of type of vehicle present in the mix.

Efficacy of ethylene-diamine-tetra-acetic acid associated with chlorhexidine on intracanal medication removal: a scanning electron microscopy study

The aim of this study was to evaluate the effectiveness of 17% ethylene-diamine-tetra-acetic acid (EDTA) used alone or associated with 2% chlorhexidine gel (CHX) on intracanal medications (ICM) removal. Sixty single-rooted human teeth with fully formed apex were selected. The cervical and middle thirds of each canal were prepared with Gates Glidden drills and rotary files. The apical third was shaped with hand files. The specimens were randomly divided into two groups depending on the ICM used after instrumentation: calcium hydroxide Ca(OH)(2) +CHX or Ca(OH)(2) +sterile saline (SS). After seven days, each group was divided into subgroups according to the protocol used for ICM removal: instrumentation and irrigation either with EDTA, CHX+EDTA, or SS (control groups). All specimens were sectioned and processed for observation of the apical thirds by using scanning electron microscopy. Two calibrated evaluators attributed scores to each specimen. The differences between the protocols for ICM removal were analyzed with Kruskal-Wallis and Mann-Whitney U tests. Friedman and Wilcoxon signed rank tests were used for comparison between the score of debris obtained in each root canal third. Remains of Ca(OH)(2) were found in all specimens independently of the protocol and ICM used (P > 0.05). Seventeen percent EDTA showed the best results in removing ICM when used alone (P < 0.05), particularly in those associated with CHX. It was concluded that the chelating agent 17% EDTA significantly improved the removal of ICM when used alone. Furthermore, the type of the vehicle associated with Ca(OH)(2) also plays a role in the ICM removal.