Intracanal Medication Research Articles

Comparison of the Antibacterial Efficacy of Ibuprofen Versus Triple Antibiotic Paste Against Enterococcus Faecalis in Single Rooted Teeth

Aim: The aim of the present study was to compare the antibacterial efficiency of the anti-inflammatory non-antibiotic ibuprofen versus triple antibiotic paste as an intra-canal medication against Enterococcus faecalis. Methodology: Forty four single rooted teeth were decoronated and instrumented up to F4 ProTaper rotary files. Apical foramen was sealed with acrylic resin, and all the external surfaces were made impermeable with nail varnish, except for the coronal access. Roots were autoclaved at 121°C for 20 minutes, placed in Eppendorf tubes and contaminated with E. faecalis for 14 days. Teeth were divided into two groups of 22 teeth; (Group1: ibuprofen, Group2: triple antibiotic paste (TAP). Colony forming unit (CFU) counts were taken before placing the intracanal medications by a paper point sampling (CFU1). The tested medicaments were mixed with distilled water (1:1 w/v), placed inside the root canals, then canals were temporarily sealed, and incubated at 37°C for 7 days. After intracanal medication removal, the second count (CFU2) was taken as (CFU1) and the antibacterial action of each medication was determined by calculating the percentage of bacterial reduction when comparing CFU2 to CFU1, and then the antibacterial action of the tested medications was compared with each other. Results: There was no statistically significant difference between (T.A.P) and (Ibuprofen) groups in the percentage of bacterial reduction where (p=0.073). Both medications caused a reduction in the bacterial count from CFU1 to CFU2. Conclusion: Ibuprofen proved to have an antibacterial effect comparable to that of TAP.

English

BACKGROUND The complex anatomy of root canal makes it very difficult to clean and shape to eliminate the bacteria in the canal. Multiple root canal medicaments and irrigants are used to eliminate the canal microbials. Many of the pathogens have undergone resistance to the medicaments and the irrigants used. Thus, antibacterial nanoparticles have been introduced to overcome this problem. Nano dentistry mainly infers the use of nanomaterials and dental nanorobots in the field of diagnosis and treatment, aiming improvement in complete oral health. The use of nanoparticles is extending in many oral health–related issues such as management of dentin hypersensitivity, elimination of bacterial biofilm, diagnosing as well as treating oral cancers, bone replacement and so on. It possesses a unique physical and chemical property. The usage of nanoparticles in different forms like solutions for irrigation, as intracanal medication, in conjunction with sealers or restorative materials aimed at evaluating and mainly improving the antimicrobial efficacy in endodontic and conservative treatments. These nanoparticles act on the bacteria through various mechanisms. The bactericidal effect of the nanoparticles has been investigated in many in vitro studies. In the field of endodontics, nanomaterials are inculcated mainly focusing on strategies improving antimicrobial efficacy, mechanical integrity of already diseased dentinal matrix, regeneration of the tissues and many more. Recently, many more new technologies are in process to be tested in the field, keeping an eye on overcoming the microbial challenge. This review intended to give a look on the literature available, uses, applications and advantages of the nanoparticles in endodontics. KEY WORDS Nanotechnology, Nanoparticles, Antibacterial Efficacy, Endodontics

Maxillary Canine with two roots and two canals: A case report

Introduction: Knowledge of the anatomy and root canal system is of fundamental importance for a successful endodontic treatment. Maxillary canines unusually possess two root canals. Aim: The present study aims to present a maxillary canine with two roots and two canals through a clinical case. Case report: A male patient was referred for the treatment of a root perforation of the tooth 23. Clinical examination revealed the presence of vestibular fistula and mild pain with vertical and horizontal percussion. Through a tomographic examination, the presence of two roots and two root canals was observed in addition to a radiolucent lesion at the middle third of the roots but without perforation in the middle third. Coronary opening and the localization of the vestibular and palatal canals were performed. The root canal length was performed with Romi Apex A-15® foraminal locator and instrumentation was conducted by using Protaper Next® system. Due to the presence of fistula, calcium hydroxide manipulated with propylene glycol was used as intracanal medication for 30 days. After this period, the root canals were filled with gutta-percha and AH Plus® cement and a new tomographic examination was undertaken, which confirmed the complete filling of the root canals and the absence of root perforation. Conclusion: Given the above, endodontic professionals shall be aware of possible anatomical variations and make use of auxiliary resources when appropriate, such as cone beam computed tomography (CBCT), to ensure correct diagnosis and, consequently, a successful root canal treatment.

Type IIIb dens in dente endodontic retreatment: a case report

Dens in dente is a developmental anomaly characterized by dental tissues invagination that varies from a slight increase of the cingulum´s fossa to a deep groove that can extend up to the dental apex. Objectives The aim of this study was to report a dens in dente endodontic retreatment case with the presence of fistula and periapical lesion. Case report: Non-surgical retreatment was performed from the removal of the filling endodontic material, use of Calcium Hydroxide as intracanal medication changed every two months for a one year and a half period, and later, apical closure with MTA and endodontic filling of the remaining thirds with thermoplastic gutta-percha. Results: Postoperative follow-ups were performed for a 4 years period where a reduction of the periapical lesion diameter and disappearance of the fistula were observed. Conclusion: These results demonstrate that the present non-surgical dens in dente endodontic retreatment protocol could be considered a viable option for success.

Chitosan-Based Biomaterial, Calcium Hydroxide and Chlorhexidine for Potential Use as Intracanal Medication.

The objective of this study was to develop a chitosan-based biomaterial with calcium hydroxide and 2% chlorhexidine for intracanal treatment application and, consequently, to diminish the number of microorganisms in the root canal system. The chitosan solution was prepared by dissolving it in 2% and 4% acetic acid (v/v) for 1 h at room temperature (25 °C) with magnetic agitation (430 rpm). Calcium hydroxide was obtained in two stages: the first was the synthesis of the calcium oxide—CaO, and the second was that of the calcium hydroxide—Ca(OH)2. The samples were developed using different concentrations of chitosan, calcium hydroxide, and chlorhexidine 2%. They were codified as Ca(OH)2 + Q2% (M1), Ca(OH)2 + Q4% (M2), Ca(OH)2 + Q2% + CLX (M3), Ca(OH)2 + Q4% + CLX (M4), Ca(OH)2 + Q2% + PEG (M5), and Ca(OH)2 + Q4% + PEG (M6). They were characterized through Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), and rheological measurement, and the antimicrobial activity was evaluated in vitro. Characteristic absorption bands of the source materials used in this research were observed in the FTIR spectra. The X-ray diffraction technique indicated that the material has a semi-crystalline structure and that the presence of calcium hydroxide made the biomaterial more crystalline. The viscosity measurement showed a pseudoplastic behavior of the studied samples. The microbiologic analysis was positive for all samples tested, with bigger inhibition zones for the samples M3 and M4. As a result, we conclude that the formulation developed based on chitosan is promising and has potential to be an intracanal medication.

Revascularization of an Immature Necrotic Mandibular Second Molar Using Calcium Hydroxide: A 3-year Follow Up

Endodontic intervention in necrotic immature permanent teeth is usually a clinical challenge. With appropriate case selection and optimal disinfection, regenerative endodontic procedure (REP) can be effective and a desirable result can be obtained. In this report, an immature necrotic mandibular second molar had been treated by REP in two visits. In the first visit, a nonsetting calcium hydroxide was used as intracanal medication after irrigation with 1.5% (NaOCl). In the second visit, blood clots were created in the root canals. MTA was placed over the blood clots and the tooth was restored with a composite filling and stainless-steel crown. A clinical and radiographic follow up was performed for three years where the tooth was deemed a symptomatic with a complete root formation.

Osteoclast formation, inflammation, and matrix metalloproteinase-9 are downregulated in bone repair following root canal treatment in dogs teeth.

The aim of this study was to investigate the inflammatory infiltrate, osteoclast formation, and expression of MMP-9 during the healing phase following root canal treatment in teeth with apical periodontitis. Apical periodontitis was induced in dogs teeth, and root canal treatment was performed in a single visit or using calcium hydroxide as intracanal medication. One hundred and eighty days following treatment the presence of inflammation was examined, and the tissues were stained to detect osteoclasts by means of a tartrate resistant alkaline phosphatase (TRAP) assay. Synthesis of MMP-9 was detected using Western blotting and immunohistochemistry. Teeth with apical periodontitis that had root canal therapy performed in a single visit presented a higher synthesis of MMP-9 compared with root canal treatment using calcium hydroxide. Treatment with calcium hydroxide resulted in a reduced amount of inflammatory cells and MMP-9 positive cells. Osteoclast formation, the number of MMP-9 positive osteoclasts and cementocytes, was reduced following root canal treatment, regardless of the root canal treatment protocol used. Root canal treatment reduced the amount of inflammatory cells and osteoclasts in periapical area. The use of calcium hydroxide as intracanal medication resulted in a lower synthesis of MMP-9, though the number of osteoclasts and MMP-9 positive osteoclasts were similar between the groups. Periapical bone repair following root canal treatment is impacted by therapy performed either in single visit or using calcium hydroxide dressing measured by inflammatory cell recruitment, osteoclast formation, and MMP-9 synthesis.

A novel plant based intra canal medicament: ease of removal and effect on radicular dentine microhardness

BackgroundThis study aimed to evaluate the remaining amount of intra canal medicament in the root canals and their effect on microhardness of radicular dentine. In this study, ninety straight single-rooted teeth were used. Teeth were decoronated at the cemento-enamel junction to ensure a uniform root length of 14 mm (± 1 mm). Root canals were prepared using ProTaper rotary files till size F5. The teeth were then randomly assigned to 3 treatment groups (n = 30); Group 1: Ca(OH)2 pastes (Metapex), Group 2: Moringa oleifera leaf powder mixed with Moringa oleifera extract liquid and Group 3: Moringa oleifera root powder mixed with Moringa oleifera extract liquid. The access openings of all teeth were sealed with Cavit and all teeth were kept in the incubator at 37 °C and 100% humidity for 1 week. After 1 week, the intra canal medicament paste was removed from all teeth. For examination of the ease of removal of the intracanal medicaments, root canals were sectioned longitudinally into buccal and lingual halves and were examined under stereomicroscope at 25× magnification. The remaining amount of intracanal medicaments was calculated using image analysis software (Image j). For microhardness evaluation, forty-five specimens were longitudinally sectioned in a bucco-lingual direction then the roots were split. The root segments were then horizontally embedded in autopolymerizing acrylic resin leaving their dentin surface exposed. The dentin surface of the mounted specimens was ground flat and smooth and polished to obtain a smooth surface. Microhardness measurement was recorded for each sample at baseline before and after application of the three intracanal medications using Vickers Microhardness Tester at magnification of 100× using a 25 g load for 10 s.ResultsRegarding the evaluation of the ease of removal of the intracanal medicaments after irrigation: apically, the Ca(OH)2 recorded the highest mean value of the residual remnants with a statistically significant difference with both Moringa oleifera leaf and root. The microhardness evaluation results showed that all groups showed increase in the microhardness after application of the intracanal medicament for 1 week with no statistically significant difference between them.ConclusionsMoringa oleifera could be removed easily from the root canals and showed increase in the microhardness of root canal dentin similar to the commonly used calcium hydroxide.

Do intracanal medications used in regenerative endodontics affect the bond strength of powder-to-liquid and ready-to-use cervical sealing materials?

Aim:This study evaluated the effect of four intracanal medications commonly used in regenerative endodontic procedures on the bond strength of four calcium silicate-based materials, in which two are powder-to-liquid products (MTA and MTA-HP) and the other are ready-to-use materials (EndoSequence Root Repair Material Fast Set Putty [ERRM] and Bioceramic Repair [BIO-C Repair]).Methods:Ten bovine central incisors were selected and 4 slices (1.0 ± 0.1 mm) were prepared from each root. Next, four 0.8-mm wide holes were drilled in each slice and specimens were filled with one of the following intracanal medications: triple antibiotic paste, double antibiotic paste, calcium hydroxide with distilled water, and calcium hydroxide with 2% chlorhexidine gel. After 21 days, holes were filled with one of the materials: MTA, MTA-HP, ERRM, or BIO-C Repair. After storage, push-out test and failure analysis were performed. Data were submitted to analysis of variance in a 4 × 4 factorial scheme. Tukey's test was used for multiple comparisons.Results:The use of different interappointment dressings did not influence the results (P > 0.05). ERRM and BIO-C Repair presented significantly higher values than MTA and MTA-HP (P < 0.0001). Specimens showed a 100% occurrence of adhesive failures.Conclusion:The use of different intracanal medications presented similar impact on bond strength of calcium silicate-based materials. Ready-to-use ERRM and BIO-C Repair materials presented the best push-out values to dentine, whereas powder-to-liquid MTA and MTA-HP cements showed the lowest results.

Vertical root fractures: A time-dependent clinical condition. A case-control study in two colombian populations.

BackgroundThis nested case-control study can be viewed as an efficient way to sample subjects from a large cohort study case-control study aimed to analyze the effect of different clinical factors on the appearance of vertical root fractures in endodontically-treated teeth (ETT) over time. Material and MethodsBy matching 90 cases and 270 controls nested in a cohort of 450 patients. Incident “cases” included those ETT in which a confirmed VRF. The “controls” were ETT with clinical and radiographic evidence of normality. When an “incident case” was detected, three random “controls” according to the evaluation time registered in years were selected. Time interval corresponded to the exposure time from the end of the endodontic treatment until the tooth was included in the study. Demographic and clinical parameters included: age, gender, type, and location of the tooth, type of endodontic treatment, number of appointments necessary to complete the endodontic treatment, use of intra-canal medication, the apical extension of the filling, type of coronal restoration, the role of the tooth in the rehabilitation treatment, presence of intra-radicular posts, and presence of an adjacent implant, were analyzed over time. Statistical analysis: univariate descriptive analysis, Pearson’s χ2 test, and a logistic regression model adjusted for the most significant variables with a 95% confidence interval. ResultsThe prevalence of vertical root fractures was 16.42%. The multivariate analysis confirmed that re-treatment (OR:12.19; OR:4.28;P<0.05) lasting five to ten years and intra-canal medication (OR:6.16;P=0.004) for more than eleven years significantly more associated with the risk of vertical root fracture. For teeth with intra-canal post or direct coronal restorations, the risk of vertical root fracture was three times lower. ConclusionsEndodontic re-treatment and the use of intracanal medication such as calcium hydroxide should be considered primary and secondary risk factors, respectively, according to the appearance of VRF over time. Key words:Apical surgery, endodontic re-treatment, endodontically-treated teeth, risk factors, vertical root fracture.

Structural characteristics of oral health services in Brazilian Primary Health Care.

This study aimed to describe the structure of oral health services in primary health care in Brazil with centers participating in the second cycle of the 'National Program for Improving Access and Quality of Primary Care' (PMAQ-AB), the largest health service evaluation program ever instituted in the country. This cross-sectional study evaluated 16,202 oral health services, regarding 22 pieces of dental equipment and 25 dental supplies. The presence of each piece of equipment/dental supply generated a score for services. The sum of these scores was compared among different regions in Brazil. Quantitative data were described by quartiles and categorical data by frequencies, using the SPSS, version 25. Most of the evaluated centers presented adequate equipment in good using conditions and sufficient dental supplies for primary oral health care. Data also showed a lack of some equipment, such as X-rays, bicarbonate jet, and ultrasound devices, while for dental supplies, a lack of amalgam (capsule and manual preparation), anesthesia without vasoconstrictors, and intracanal medication was found. The services presented a median of 14 pieces of equipment and 22 dental supplies. Of the Brazilian regions, the South presented the highest median, while the North and Northeast regions presented the lowest one. The oral health services presented dental offices with good availability of equipment and dental supplies to perform clinical activities. However, differences in the structure of services among the Brazilian regions was still observed.

Intracanal delivery of calcium hydroxide: A literature review

Introduction: Intracanal medication with calcium hydroxide is an important adjunct to disinfection after the chemomechanical preparation. A dense and homogeneous filling up to the working length positively influences the outcome of endodontic treatment in infected cases. The optimum placement of intracanal medicament can many times become a challenging task, owing to the lack of usage of the appropriate instruments and techniques. Aim: The aim is to gather and assess available literature on the rationale of calcium hydroxide placement, instruments, and techniques for effective delivery. Materials and Methodology: An electronic search was conducted using the PubMed Database from 1970 to 2019 using the keywords “delivery of calcium hydroxide,” “placement of calcium hydroxide,” “density of calcium hydroxide.” The articles pertaining to the comparison between the placement techniques of calcium hydroxide dressing were analyzed. Results: The search identified 433 articles, from which 419 articles that did not fulfill the inclusion criteria were excluded from the study and eventually 13 research articles were analyzed for the review. Conclusion: The density of calcium hydroxide and the technique of placement may affect the healing outcome especially in cases of pulp necrosis with apical periodontitis. The use of lentulo spirals at lower speeds seems effective in intracanal delivery of calcium hydroxide.

Comparative Evaluation Of Fracture Resistance Of Root Dentin To Different Intracanal Medicaments: In-Vitro Study

Intracanal medication reduces micro-organisms after cleaning &amp; shaping a root canal. Long-term exposure to some intra-canal medicament decreases fracture resistance of radicular dentin due to its strong alkalinity in long-term exposure. We studied the resistance of human root dentin to fracture following the application of intracanal medicament on the 7th and 10th days. Thirty-six human permanent extracted teeth with singleroot&nbsp; were collected. They were cleaned and shaped till Hand Pro

Effect of the several epoxy resin-based sealer compositions on adhesion interface in radicular dentin after calcium hydroxide intracanal medication removal.

BackgroundThis study evaluated the effects of several epoxy resin-based sealer compositions (AHP, AH Plus; ADS, Adseal; SPL, Sealer Plus) on bond strength and intratubular dentin penetration of the endodontic obturation, in root canal previously treated with calcium hydroxide intracanal medication (CH) and removed by continuous ultrasonic irrigation (CUI). Material and MethodsForty-five maxillary canines were prepared up to F5 (ProTaper system), filled with CH, coronally sealed, and stored at 37ºC. After 1 week, CH was removed using 2.5% sodium hypochlorite energized by CUI. The specimens were randomly distributed in three groups (n=15) and root canal obturated, according to epoxy-based resin sealer composition (AHP, ADS or SPL). The roots were transversally sectioned in cervical, middle, and apical thirds. In each radicular third, push out bond strength using universal machine and intratubular dentin using confocal laser scanning microscopy (CLSM) and Image J Program were evaluated. Bond strength and intratubular dentin penetration were statistically evaluated by ANOVA one-way and Tukey tests and Kruskal Wallis test, respectively (α = 0.05). ResultsIn middle and apical thirds, AHP showed higher bond strength values (p<0.05), and ADS and SPL were similar each other (p>0.05). All epoxy resin-based sealers presented similar intratubular dentin penetration, independently of the radicular thirds (p>0.05). Cohesive and mixed failures were predominant in the cervical thirds. In the middle and apical thirds, AHP showed more cohesive type failures, while ADS and SPL showed more adhesive-type failures. ConclusionsAHP has the highest bond strength in middle and apical radicular thirds, after calcium hydroxide intracanal medication removal using continuous ultrasonic irrigation, although intratubular dentin infiltration being similar among epoxy resin-based sealer with several chemical composition. Key words:Continuous ultrasonic irrigation, endodontic sealers, epoxy resin-based sealers, root canal obturation.

Medications for intracanal dressing used in the multivisit treatment of apical periodontitis

Introduction: Apical periodontitis is caused usually by bacterial infection in the root canal. Enterococcus faecalis is considered to be the main pathogen associated with periapical lesions. The main goal of endodontic treatment is to remove as many bacteria as possible from the root canal system and then create an environment in which other organisms cannot survive. Unfortunately, this cannot always be obtained with mechanical processing and proper irrigation of the root canal system only. Aim : The purpose of this article is to present and compare the main materials used to treat the root canal. Materials and Methods: In this review of the literature related articles and publications will be reviewed and the results of researches on the topic will be summarized. Results: The review of all the included related articles and publications shows that a significant number of intracanal medicaments can be used in order to treat existing inflammatory processes inside the root canals and reduce the number of pathogenic microorganisms. Some of them have a questionable effect on the health of the periapical tissues and therefore their use has been limited in modern endodontics. Conclusion: According to the available literature-based evidence, the two-visit treatment of teeth diagnosed with asymptomatic apical periodontitis, which includes a placement of an intracanal medication, provides good results in the reduction of the inflammatory process in the periapical tissues and the amount of pathogenic microorganisms.

Effect of calcium hydroxide alone or in combination with ibuprofen and ciprofloxacin on postoperative pain and periapical prostaglandin E2 level: A randomized clinical study

AimThe aim of the present study was to compare pure Ca(OH)2, Ca(OH)2 + ibuprofen and Ca(OH)2 + ciprofloxacin in terms of postoperative pain and prostaglandin E2 (PGE2) level in previously treated teeth with periapical lesions. Materials and methodsSixty-six patients were randomly assigned into 3 groups according to the intracanal medication (Ca(OH)2, Ca(OH)2 + ibuprofen and Ca(OH)2 + ciprofloxacin). After removing gutta-percha from the root canals, the PGE2 sample collection was obtained by introducing three sterile paper points into the root canals through the root apex (2 mm). Selected intracanal medicament was placed into the root canal and the participants were told to record postoperative pain levels at 24, 48, and 72 h and on 1 week after treatment using visual analog scale (VAS). At the second appointment, the medicaments were removed and second sampling was performed using the same method. The PGE2 levels measured by enzyme-linked immunosorbent assay kits, and the data were statistically analyzed. ResultsAll the tested Ca(OH)2 pastes were found to be significantly effective in lowering the preoperative PGE2 levels. However, intergroup analyses revealed that the Ca(OH)2 + ciprofloxacin group had the highest effectiveness in lowering PGE2 with a significant difference when compared with the pure Ca(OH)2 group. There was no statistically significant difference among the groups in terms of pre- and post-operative pain levels. ConclusionThe Ca(OH)2 + ciprofloxacin medication is more effective than the pure Ca(OH)2 medication in lowering periapical PGE2 level. However, addition of ibuprofen or ciprofloxacin to the Ca(OH)2 paste does not provide extra benefit in terms of post-operative pain relief.

A second attempt at pulp revascularisation on an immature traumatised anterior tooth: a case report with two‐year follow‐up

This report describes the second attempt at pulp revascularisation, using an association between 2% chlorhexidine (CHX) and calcium hydroxide (CH) as intracanal dressing, in an immature traumatised anterior tooth with pulp necrosis. A 21-year-old woman complained of pain and dental crown darkening of a permanent maxillary right central incisor. Her medical records presented a history of dental trauma, and at age 15, the first attempt at revascularisation was performed, using triple antibiotic paste (TAP) as the intracanal dressing. Recent radiographs then showed a periapical lesion associated with an immature root, which demonstrated the failure of the first attempt. The second pulp revascularisation was performed, using an association between CHX and CH as intracanal medication. The case was followed up for 24months. Observations showed evidence of root development, dentinal wall thickening and periapical healing. In this case, the association between CHX and CH showed favourable results as an intracanal medication.

Comparative Analysis of the Antimicrobial Potential of Different Intra-Canal Medication to Microorganisms Present in the Failure of the Endodontic Therapy: in Vitro Study

Microorganisms that infect the root canals system are the main etiologic factor of the periapical pathologies. Some microorganisms are resistant to the antimicrobial treatment and may survive in the root canal after the chemical mechanical preparation and intra-canal medication, characterizing a persistent infection. In cases of failure of the endodontic treatment, a new approach may be done using additional measures that involve this infectious process control through the elimination or maximum reduction of microorganisms. Therefore, this article aims to evaluate the antimicrobial potential of different formulations of intra-canal medication compared to strains of Enterococcus faecalis, Pseudomonas aeruginosa and Staphylococcus aureus in Petri plates. It was used diffusion test in agar where each Petri plate with the inoculated bacteria presented 5 wells that were filled with each medication. The diameters of the bacterial inhibition zones were measured and registered to each tested medication at the period of 24 hours, 48 hours, 1 week and 2 weeks. All the medications promoted inhibition halos; however, a higher elimination of micro-organisms can be significantly achieved through the association of different substances in the formulation of an intra-canal medication, with emphasis to HPG and Ca(OH)2 + CHX.

Protocolo de tratamento conservador em fraturas radiculares horizontais de terço cervical – Relato de caso

Os traumas dentais possuem uma significante ocorrência na odontologia. As fraturas radiculares podem ser consideradas como politraumatismos por envolverem diferentes tipos de tecido: dentina, cemento, polpa e periodonto. Objetivo: mostrar uma opção de protocolo terapêutico conservador no tratamento de fraturas radiculares horizontais a fim de preservar a estrutura dental levando em consideração a condição socioeconômica do paciente. Relato de caso: paciente do sexo masculino, 15 anos, procurou a clínica de Odontologia da Universidade Federal de Alagoas onde procurou atendimento após sofrer um trauma. Ao exame clínico, observou-se que o incisivo central superior (11) apresentava fratura radicular horizontal cervical e discreto deslocamento palatino. Optou-se pela instalação de contenção semirrígida como tratamento imediato. Posteriormente uma pulpectomia do segmento coronal até a linha de fratura foi realizada com medicação intracanal composta por hidróxido de cálcio e clorexidina gel a 2%. Após 2 semanas foi realizada obturação do canal com MTA. Conclusão: O tratamento endodôntico foi realizado com sucesso, seu prognóstico depende do tipo de reparo tecidual na linha de fratura e saúde dos tecidos periodontais.

Antibacterial potential of nano-particulate intracanal medications on a mature E. faecalis biofilm in an ex-vivo model

Aim: To investigate and compare the antibacterial and antibiofilm activity of Chlorhexidine Digluconate functionalized Hydroxyapatite Nanoparticles and silver Nanoparticles as intracanal medicaments on a mature E. faecalis biofilm model in root canals of extracted teeth. Methodology: Sixty-eight human maxillary central incisors were mechanically prepared, sterilized, infected with E. faecalis, and then incubated for 28 days under anaerobic conditions to develop a mature E. faecalis biofilm. Eight teeth were used to monitor biofilm formation and maturation over the incubation period with field emission scanning electron microscopy (Fe SEM), while the other 60 teeth were divided into two experimental groups (n=20) in which 2% chlorhexidine digluconate functionalized hydroxyapatite nanoparticles (Group A) and 0.02% silver nanoparticles (group B) were used as intra canal medications, and two control groups (n=10). The positive control group (Group C) was used to check for bacterial viability throughout the experiment, while the negative control group (Group D) was used to check for sterility of the procedures. Finally, bacterial samples were collected and analyzed quantitively by culture counts and qualitatively by real time PCR (RTQ-PCR). Results: RTQ-PCR detected E. faecalis DNA in all groups except for the negative control group. The mean values of E. faecalis DNA detected in groups A, B and C were 99.6 ng/mL, 67.1 ng/mL , 2797.4 ng/mL respectively. Statistical analysis of these results showed that both treatment groups presented statistically significantly lower mean values of E. faecalis DNA quantities compared to the positive control group. However, there was no statistically significant difference between them (P<.05). Conclusions: Chlorhexidine Digluconate functionalized Hydroxyapatite Nanoparticles and silver nanoparticles demonstrated an effective antimicrobial activity against mature E. faecalis biofilms.