Removal of calcium hydroxide from Weine Type II systems using photon-induced photoacoustic streaming, passive ultrasonic, and needle irrigation: a microcomputed tomography study

Objective

This study compared the effectiveness of Er:YAG laser-activated irrigation (PIPS), passive ultrasonic irrigation (PUI) with EndoUltra and standard needle irrigation (SNI) in the removal of calcium hydroxide [Ca(OH)2] from the mesial roots of Weine Type II mandibular molars.

Material and Methods

Thirty mandibular molars were screened by µCT for the presence of mesial roots with complex intra-canal anatomy and a common apical foramen. The teeth were enlarged to a standardized 25/.06 preparation and filled with Ca(OH)2 paste. Specimens were divided into three groups (n=10) according to the technique used for Ca(OH)2 removal: PIPS, at 15 Hz and 20 mJ using a 9 mm long, 600 µm diameter tip; PUI using a 15/.02 tip; and SNI (30 Ga. side-vented needle). Equal volumes of 8.25% NaOCl and 17% EDTA were used in all groups. µCT was used to measure the initial amount of Ca(OH)2 present and to assess the residual volume of Ca(OH)2 following each irrigation protocol. Data were analyzed using Tukey HSD and Kruskal-Wallis tests (α=5%).

Results

The mean volume of Ca(OH)2 before removal was significantly higher in the coronal third than in the middle and apical third (p<0.001). Ca(OH)2 was similarly removed from the coronal and middle thirds with the three methods used (p>0.05). PIPS (median 0%; IQR: 0-0) showed significant higher Ca(OH)2 removal in the apical third than PUI (median 100%, IQR: 85-100) and SNI (median 47%; IQR: 16-72) (p<0.001).

Conclusions

PIPS laser-activation was more effective for the removal of Ca(OH)2 from mesial roots of mandibular molars with Weine Type II canal configurations than PUI with EndoUltra and SNI.

Dentin permeability of the apical third in different groups of teeth

This ex vivo study evaluated dentin permeability of the root canal in the apical third of different human groups of teeth. Eighty teeth were used, 8 from each dental group: maxillary and mandibular central incisors, lateral incisors and canines, maxillary first premolars (buccal and palatal roots), mandibular first premolars, and maxillary and mandibular second premolars, totalizing 88 roots that were distributed in 11 groups. The root canals were instrumented, irrigated with 1% NaOCl and 15% EDTA. Roots were immersed in 10% copper sulfate for 30 min and then in 1% rubeanic acid alcohol solution for the same period; this chemical reaction reveals dentin permeability by the formation of copper rubeanate, which is a dark-colored compound. Semi-serial 100-µm-thick cross-sections were obtained from the apical third of the roots. Five sections of each apical third were washed, dehydrated, cleared and mounted on glass slides for examination under optical microscopy. The percentage of copper ion infiltration and the amount of tubular dentin were quantified by morphometric analysis. The penetration of copper ions in the apical third ranged from 4.60 to 16.66%. The mandibular central and lateral incisors presented the highest dentin permeability (16.66%), while the maxillary canines and mandibular second and first premolars presented the lowest dentin permeability (4.60%, 4.80% and 5.71%, respectively; p<0.001). The other teeth presented intermediate permeability. In conclusion, dye penetration into dentin tubules at the apical region is strongly dependent on the group of teeth evaluated.

Morphologic and morphometric analysis of the root canal apical third cleaning after biomechanical preparation using 3.3% Ricinus communis detergent and 1% NaOCl as irrigating solutions

This study evaluated, by morphologic and morphometric analyses, the cleaning of apical third of root canals instrumented with nickel-titanium rotary files using different irrigating solutions. Twenty-seven single-rooted mandibular premolars were assigned to three groups (n=9), according to the irrigating solution used: Group I, distilled and deionized water; Group II, 1% NaOCl; and Group III, 3.3% Ricinus communis detergent. Biomechanical preparation was performed with Protaper Plusâ nickel-titanium files as follows: S1, SX and S2 at the cervical and middle thirds, and 25/02, 25/04, 25/06, 30/02, 30/04 and 30/06 to complete the instrumentation, operating at 1 mm from the root apex. Irrigation was done at each file change with 2 mL of irrigating solution, totalizing 20 mL for each tooth. After biomechanical preparation, the apical thirds were serially sectioned and histologically processed. The cross-sections were examined by an optical microscope (X40) connected to a computer. The images were captured and analyzed using a computer software and submitted to morphometric analysis with aid of a grid. The percentage of debris remaining at the apical third was calculated. Data were submitted to statistical analysis by ANOVA and Tukey test. The results showed no statistically significant difference (p>0.01) between the groups irrigated with 1% NaOCl and 3.3% Ricinus communis detergent, which presented the lowest percentage of debris at the apical third, 8.49% and 10.11%, respectively. The group irrigated with distilled and deionized water had the highest percentage of debris (15.58%) and was statistically different from the other groups (p<0.01). It may be concluded that 3.3% Ricinus communis detergent and 1% NaOCl had similar cleaning effectiveness on removal of debris from root canals.

Ultrastructural evaluation of radicular dentin after Nd:YAG laser irradiation combined with different chemical substances

This aticle sought to evaluate the dentin morphology after irradiation by a Neodymium:Yttrium-Aluminum-Garnet (Nd:YAG) laser, using different chemical substances to irrigate radicular canals: distilled water, 17% ethylenediaminetetraacetic acid plus Cetavlon (EDTAC), 1% sodium hypochlorite, and 2% chlorhexidine. Groups were subdivided according to the protocol of laser application (n=9). The specimens were analyzed by scanning electron microscopy (SEM). No differences were found in dentin morphology when different root thirds were examined. Regardless of the chemical substance used, alterations were more evident in groups in which the surfaces were dried before laser irradiation. Fusion areas, craters, carbonization, and partially exposed tubules were verified. When the irradiation was performed in water, the smear layer was incorporated into the laser-modified surface. Among the specimens irrigated with EDTAC and laser-treated, partial obliteration of dentin tubules due to the laser action was verified; in addition, there was no remaining smear layer on the surfaces. Samples irrigated with sodium hypochlorite followed by laser irradiation demonstrated similar morphology to the samples in the chlorhexidine group, with some fusion areas present and no exposed dentin tubules or fissures. The irradiation from an Nd:YAG laser in the presence of EDTAC solution provided a more favorable surface pattern compared to the other experimental conditions, due to the removal of the contaminated layer and the posterior sealing of dentin tubules.

Effectiveness of root canal debris removal using passive ultrasound irrigation with chlorhexidine digluconate or sodium hypochlorite individually or in combination as irrigants

AIM

The aim of this in vitro study was to evaluate the cleaning capacity of different auxiliary chemical substances energized with ultrasound in radicular dentin using morphologic analysis.

METHODS AND MATERIALS

Twenty-eight single-canal, mandibular incisors were prepared with the Hero 642 canal preparation system following the sequence: 25/12, 30/06, 35/02, and 40/02, 1 mm from the apex. The specimens were then divided into four groups of seven teeth. During biomechanical preparation the teeth were irrigated with 2 ml of distilled water between files. Each group of specimens (n=7) received a final irrigation with 100 ml of the following irrigants that were activated with ultrasound for 3 minutes: Group 1- distilled water; Group 2- 0.2% chlorhexidine digluconate (CHX); Group 3- 2.5% sodium hypochlorite (NaOCl); and Group 4-the filtrate obtained after combining 0.2% CHX and 2.5% NaOCl. The apical portions of the root canals from each group were then submitted to histological processing and analyzed using optical microscopy.

RESULTS

Results showed statistical differences between the groups (p<0.01). Groups 1 and 2 (distilled water and 0.2% CHX respectively) were statistically similar in terms of a greater amount of debris, whereas 2.5% NaOCl and the filtrate were more efficient in removal of debris.

CONCLUSION

There is no additional benefit in terms of debris removal from root canal walls by irrigating with the filtrate obtained from the combination of NaOCl and CHX when compared to using NaOCl alone.

CLINICAL SIGNIFICANCE

The findings of this study suggest the time and expense of preparing and using a combination of NaOCl and CHX is not warranted compared to using NaOCl alone for root canal irrigation.

Oral undifferentiated high-grade pleomorphic sarcoma: report of a case

The current World Health Organization classification considers the existence of an undifferentiated unclassifiable category of pleomorphic sarcomas, defined as a group of pleomorphic high-grade sarcomas. Undifferentiated high-grade pleomorphic sarcoma represents about 5% of all soft tissue sarcomas in adults and occurs more commonly in the extremities. In the oral cavity, undifferentiated pleomorphic sarcoma is extremely rare. We report a case of undifferentiated high-grade pleomorphic sarcoma located in the floor of the mouth in a man 56 years old. Microscopically, spindle-shaped cells with accented pleomorphism arranged in a storiform pattern, several bizarre giant cells, and frequent atypical mitoses were observed. The tumor cells were positive only for vimentin, with focal positivity for CD68. The patient was treated by surgery and postoperative radiation therapy, and after 25 months, no recurrence was observed.

Ex vivo study of the adhesion of an epoxy-based sealer to human dentine submitted to irradiation with Er : YAG and Nd : YAG lasers

AIM

To evaluate the adhesion of an epoxy-based sealer to human dentine submitted to irradiation with Er : YAG or Nd : YAG laser at various parameters.

METHODOLOGY

Ninety maxillary canine teeth were sectioned transversely at the cemento-enamel junction and at the root tip to leave an 8-mm-long cylinder. The tooth specimen was centred in a metallic ring (16 mm diameter and 8 mm height) and embedded in acrylic resin. The root canals were prepared using a low-speed handpiece and a conical diamond bur, which was attached to a paralleling device. This bur was lowered to a depth previously determined by a silicone stop. Specimens were divided into nine groups: group I, dentine was treated with 2 mL of 17% EDTAC for 5 min. Groups II-V were irradiated with Er : YAG laser at the following parameters: group II - 8 Hz and 200 mJ input (120 mJ output); group III - 8 Hz and 400 mJ input (240 mJ output); group IV - 16 Hz and 200 mJ input (120 mJ output); group V - 16 Hz and 400 mJ input (240 mJ output). Groups VI-IX were irradiated with Nd : YAG laser at the following parameters: group VI - 10 Hz and 1 W input (0.4 W output); group VII - 10 Hz and 2 W input (0.8 W output); group VIII - 15 Hz and 1 W input (0.4 W output); group IX - 15 Hz and 2 W input (0.8 W output). The root canals were filled with an epoxy-based root canal sealer and submitted to a push-out test.

RESULTS

Statistical analysis showed significant differences (P < 0.01) between Er : YAG and Nd : YAG laser treatments at the higher frequencies compared with 17% EDTAC. Greater adhesion values were obtained for groups IV and V (Er : YAG laser) and groups VIII and IX (Nd : YAG laser), which were statistically different from groups II and III (Er : YAG laser) and groups VI and VII (Nd : YAG laser). Treatment with only 17% EDTAC had the lowest adhesion values.

CONCLUSIONS

An increase in frequency, independent of power settings, of the lasers used in this study increased adhesion of an epoxy-based root canal sealer.

Evaluation of smear layer removal by EDTAC and sodium hypochlorite with ultrasonic agitation

AIM

To evaluate smear layer removal by different irrigating solutions under ultrasonic agitation.

METHODOLOGY

Twenty recently extracted mandibular incisors with a single root canal were divided into four equal groups. Three groups were instrumented using the modified double-flared technique, the fourth remained unprepared. Each group was irrigated with either distilled water, 1.0% sodium hypochlorite alone or associated with 15% EDTAC between each file size. The final group was not instrumented but irrigated with 1.0% sodium hypochlorite and 15% EDTAC. A size 15 file energised by ultrasound was used with small amplitude filing movements against the canal walls in all groups. The teeth were split longitudinally and the roots measured to provide three sections of the same size (cervical, middle and apical). Samples were examined under the scanning electron microscope and assessed for the amount of smear layer by three independent and calibrated examiners. The scoring system ranged from 1 (no smear layer) to 4 (all areas covered by smear layer). Due to the non-parametric nature of the data, Friedman's test was used for statistical analysis.

RESULTS

Canal walls were covered with smear layer in the group irrigated with 1% sodium hypochlorite alone and the group irrigated with distilled water. Canals irrigated with 1.0% sodium hypochlorite associated with 15% EDTAC had less smear layer throughout the canal (P < 0.001). There were no statistical differences for the amount of smear layer found on the cervical, middle and apical thirds when each group was analysed separately.

CONCLUSIONS

Under ultrasonic agitation, sodium hypochlorite associated with EDTAC removed the smear layer from root canal walls, whereas irrigation with distilled water or 1.0% sodium hypochlorite alone did not remove smear layer.

Evaluation of Er:YAG laser and EDTAC on dentin adhesion of six endodontic sealers

The effect of Er:YAG laser application and EDTAC on the adhesion of epoxy resin-based endodontic sealers to human dentin was evaluated in vitro. A total of 99 extracted human maxillary molars with their crowns worn flat were used. The teeth were divided into 3 groups: group 1, the dentin surface received no treatment; group 2, EDTAC was applied to the dentin surface for 5 min; group 3, the dentin surface received Er:YAG laser application (2.25 W potency; 11 mm focal distance; 4 Hz frequency; 200 mJ energy; 62 J total energy; 313 mean impulse). Three teeth from each group were analyzed by scanning electron microscopy for changes in dentin surface. The epoxy resin root canal sealers used were: AH Plus, Topseal, Sealer 26, AH 26, and Sealer Plus. The zinc oxide eugenol-based sealer Fillcanal was used as control. Adhesion was measured with a Universal testing machine. The results showed a statistically significant difference at the level of 1% among the dentin treatments. The dentin treated with Er:YAG laser showed greater adhesion with the sealers than dentin treated with EDTAC which was greater than dentin that received no treatment. The Tukey test showed the formation of 5 groups in decreasing order of adhesion: AH Plus, Topseal and Sealer 26, AH 26, Sealer Plus, and Fillcanal (Grossman cement).