Publications by authors named "Adriana de-Jesus-Soares"

34 Publications

Clinical and Radiographic Outcomes of Regenerative Endodontic Procedures in Traumatized Immature Permanent Teeth: Inter-appointment dressing or Single-Visit?

J Endod 2021 Jul 23. Epub 2021 Jul 23.

Department of Restorative Dentistry - Endodontic Division, State University of Campinas - Piracicaba Dental School (FOP-UNICAMP). Piracicaba, SP, Brazil. Electronic address:

Introduction: More data are needed before affirming that single-visit approaches are effective and safe for regenerative endodontic procedures (REPs). This study compared clinical and radiographic outcomes of REPs between inter-appointment dressing or single-visit protocols.

Methods: Twenty young patients presenting traumatized immature teeth with pulp necrosis were divided into 2 groups. Teeth were submitted to 6% NaOCl and 2% chlorhexidine irrigation and to 17% EDTA use prior to blood clot induction. In the inter-appointment dressing group (n=11), calcium hydroxide was used with 2% chlorhexidine gel for 21 days before scaffold induction. In the single-visit group (n=9), the scaffold was induced during the only appointment. Patients were followed-up for 24 months. Primary, secondary and tertiary outcomes were assessed by 3 independent evaluators. Preoperative and follow-up radiographs were assessed for quantitative measurements of apical diameter, root width, root length, and cervical barrier placement and compared between groups by t test or Mann-Whitney test. Categorical variables were assessed with G test and Fisher exact test, and continuous variables with Mann-Whitney test. Statistical significance was set at 5%.

Results: One tooth showed persistence of infection. No difference was observed in cervical barrier placement (p>0.05), and between groups regarding primary, secondary, and tertiary outcomes (p>0.05) and in parameters of quantitative radiographic outcomes (p>0.05).

Conclusion: Completing REPs with an inter-appointment dressing or in a single-visit protocol presented similar clinical and radiographic outcomes. Single-visit protocol of REPs using 6% NaOCl, 2% chlorhexidine and 17% EDTA permitted satisfactory outcomes in necrotic immature permanent teeth.
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http://dx.doi.org/10.1016/j.joen.2021.07.013DOI Listing
July 2021

The association of inadequate lip coverage and malocclusion with dental trauma in Brazilian children and adolescents - A systematic review and meta-analysis.

Dent Traumatol 2021 Jul 18. Epub 2021 Jul 18.

Endodontics Division, Department of Restorative Dentistry, School of Dentistry of Piracicaba, State University of Campinas, UNICAMP, Piracicaba, Brazil.

Background/aim: Dental trauma (DT) occurs frequently in children and adolescents. Therefore, understanding the factors associated with its occurrence in these age groups is important to establish specific preventive measures. The aim of this study was to investigate the relationships of lip coverage, overjet, and open bite to dental trauma in Brazilian children and adolescents.

Material And Methods: The review protocol was registered in the PROSPERO database (CRD42020156290) and the bibliographic search was performed in nine electronic databases until July 2020. The studies included were observational, performed in Brazil, with healthy children and adolescents (0-19 years old), and without the restriction of date or language. Two reviewers assessed the individual risk of bias of the eligible studies with a standardized checklist. The meta-analyses were stratified by dentition stage and age range using fixed or random effects, odds ratio (OR) as the effect measure, and 95% confidence interval. The heterogeneity across studies was assessed with the I² test and the GRADE approach assessed the certainty of evidence.

Results: The search presented 2493 initial results, from which 55 met the eligibility criteria and were included. Most studies (67%) presented a low risk of bias and were published between 2000 and 2019. Children and adolescents with inadequate lip coverage are 1.86-2.36 times more likely to suffer from DT, while those with increased overjet are 1.94-3.11 times more likely. Children with primary dentitions and anterior open bites are 1.76 (95% CI: 1.20-2.59) times more likely to suffer from DT. The certainty of evidence varied from very low to moderate.

Conclusions: Inadequate lip coverage, increased overjet, and anterior open bite are associated with the occurrence of dental trauma in Brazilian children and adolescents.
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http://dx.doi.org/10.1111/edt.12707DOI Listing
July 2021

Comparative analysis of bacterial content, levels of lipopolysaccharides and lipoteichoic acid in symptomatic and asymptomatic endodontic infections at different stages of endodontic treatment.

Clin Oral Investig 2021 Jun 11. Epub 2021 Jun 11.

Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School - State University of Campinas, UNICAMP, Av Limeira 901, Piracicaba, São Paulo, Brazil.

Objectives: This study aimed to detect the presence of specific bacteria and to evaluate the levels of lipopolysaccharides (LPS) and lipoteichoic acid (LTA) in symptomatic necrotic root canals associated with acute apical abscess (symptomatic group - GI). It also aimed to compare the findings with those presented by asymptomatic necrotic root canals (asymptomatic group - GII) in the different stages of the endodontic treatment.

Materials And Methods: Microbiological samples were collected from 20 root canals, including purulent collection from acute apical abscesses, before and after chemo-mechanical preparation (CMP) preparation (CMP) with chlorhexidine gel 2% and after 30 days of intracanal medication (ICM) with (Ca[OH]) + chlorhexidine. The culture method was used to evaluate the efficacy of CMP and ICM. Nested PCR was used to detect the presence of 17 specific bacteria. Levels of LPS were measured by using limulus amebocyte lysate, whereas enzyme-linked immunosorbent assay was used for the quantification of LTA.

Results: CMP was effective in reducing the microbial load in both groups (P < 0.05). LPS levels were higher in GI than in GII (P < 0.05). There was a significant reduction in the LPS levels after CMP and ICM (P < 0.05) in GI and GII. LTA levels were significantly reduced in GI after ICM and in GII after CMP and ICM (both P < 0.05). Fusobacterium nucleatum and Enterococcus faecalis were frequently identified in both groups, alone or in combination with each other.

Conclusion: Different species were detected in all stages of the endodontic treatment. CMP was able to reduce bacterial content and the levels of LPS, but not of LTA in the symptomatic group. High levels of LPS were correlated with spontaneous pain and pain to percussion in the symptomatic group.

Clinical Relevance: This clinical study showed that chemo-mechanical preparation was able to reduce bacterial load and levels of LPS, but not of LTA in the symptomatic group. Elevated levels of LPS were correlated with the presence of symptomatology.
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http://dx.doi.org/10.1007/s00784-021-03998-2DOI Listing
June 2021

Comparison of Postobturation Pain Experience after Apical Extrusion of Calcium Silicate- and Resin-Based Root Canal Sealers.

J Endod 2021 Aug 29;47(8):1278-1284. Epub 2021 May 29.

Department of Restorative Dentistry, Division of Endodontics, São Leopoldo Mandic Dental School, Campinas, São Paulo, Brazil.

Introduction: This study compared the intensity of postobturation pain after unintentional apical extrusion of calcium silicate-based root canal sealers (EndoSequence BC Sealer [Brasseler USA, Savannah, GA] and Bio-C Sealer [Angelus, Londrina, PR, Brazil]) with a resin-based sealer (AH Plus; Dentsply Sirona, York, PA).

Methods: A total of 330 patients referred for root canal treatment on molar teeth with asymptomatic irreversible pulpitis were recruited. Root canals were prepared using WaveOne Gold instruments (Dentsply Sirona) in a crown-down technique and irrigated with 2% chlorhexidine gel and saline solution. Next, patients were randomly distributed into 3 groups according to the root canal sealer used (n = 110): AH Plus, BC Sealer, and Bio-C Sealer. Root canal filling was then accomplished with a vertical compaction technique. Patients presenting with an unintentional extrusion of sealers (n = 13/group) were assessed for postobturation pain experience using a visual descriptor scale ranging from 0-10 at 6-, 12-, 24-, and 48-hour and 1-week intervals after treatment. Mixed analysis of variance repeated measures were used to assess the results (α = 0.05).

Results: The extrusion rate was similar for all sealers (~12%). There was no significant difference in the postobturation pain results between the root canal sealers evaluated (P > .05). However, after the time interval of 12 hours, AH Plus (P = .04073) and Bio-C Sealer (P = .04327) demonstrated a significant reduction in pain, whereas BC Sealer did not show differences in pain intensity, even in the maximum period evaluated of 1 week (P > .05).

Conclusions: The occurrence of unintentional apical extrusion of calcium silicate-based root canal sealers presents similar postoperative pain results compared with resin-based sealers with low-intensity pain.
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http://dx.doi.org/10.1016/j.joen.2021.05.008DOI Listing
August 2021

Calcium Silicate-Based Sealers Do Not Reduce the Risk and Intensity of Postoperative Pain after Root Canal Treatment when Compared with Epoxy Resin-Based Sealers: A Systematic Review and Meta-Analysis.

Eur J Dent 2021 May 23;15(2):347-359. Epub 2021 Mar 23.

Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil.

This review aims to evaluate whether root canal obturation with calcium silicate-based (CSB) sealers reduces the risk and intensity of endodontic postoperative pain when compared to epoxy resin-based (ERB) sealers. The review was registered at PROSPERO (CRD42020169255). Two independent reviewers conducted an electronic search in PubMed, Scopus, EMBASE, Web of Science, Cochrane Library and LILACS until November 2020 and included only randomized clinical trials with adult health participants undergoing root canal treatment. After selection, the JBI Critical Appraisal tool was used to assess the risk of bias. A fixed-effect meta-analysis was performed to summarize the results of pain risk and pain intensity at time intervals of 24 and 48 hours. Finally, the certainty of evidence was assessed using the GRADE approach. The search resulted in 1,206 records, of which five studies ( = 421 patients) met the eligibility criteria and presented moderate to low risk of bias. There was no significant difference between groups in the risk of pain in the first 24 hours (relative risk or RR = 0.83, 95% confidence interval or CI: 0.60, 1.16, =) or 48 hours (RR = 0.56, 95% CI: 0.26, 1.21, =). Silicate-based sealers led to lower pain intensity only at 48 hours (mean and standard deviation = 0.37, 95% CI: 0.69, 0.05). All analyses revealed low heterogeneity ( < 25%). The evidence presented moderate level of certainty. Currently available evidence has shown that there is no difference between CSB and ERB sealers in the risk or intensity of postoperative pain.
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http://dx.doi.org/10.1055/s-0041-1724157DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8184314PMC
May 2021

The antimicrobial effect of different ozone protocols applied in severe curved canals contaminated with Enterococcus faecalis: ex vivo study.

Odontology 2021 Jul 28;109(3):696-700. Epub 2021 Jan 28.

Endodontic Department São Leopoldo Mandic School of Dentistry, Rua José Rocha Junqueira 13, Campinas, SP, Brazil.

The aim of this study was to evaluate 3 different irrigation protocols using ozone on monoculture biofilm of Enterococcus faecalis. Fifty disto-buccal roots of maxillary first molars were instrumented up to the size 25.08, sterilized and then incubated with Enterococcus faecalis for 21 days for biofilm maturation in the root canal walls. After contamination, the initial collection (S1) was performed and the 50 samples were divided in 3 experimental groups (n = 15) and 1 positive control group (n = 5) as follows: Group1: Ozonated water (40 µg/ml); Group2: gaseous ozone (40 µg/ml); Group3: Ozonated water (40 µg/ml) under continuous ultrasonic irrigation (CUI) and, Group 4: 2.5% sodium hypochlorite (positive control). The final collection (S2) was performed using hedstroem files # 25 by scraping the root canal wall and absorbed paper cone. The collected samples were analyzed by CFU/ml count and qPCR. To compare the effect of irrigation methods and to investigate E. faecalis count data, Kruskal-Wallis and Wilcoxon nonparametric tests were used at p < 05. The values of the differences between the S1 values and the S2 values revealed that the groups did not differ significantly for either E. faecalis CFU count data (p = 0.713) or q-PCR (p = 0.185), however, it is observed that for all groups, the CFU count of E. faecalis decreased over 99%. For the q-PCR assay, the reduction was on the order of 74-95%. Only the NaOCl positive control group presented total elimination of CFU/mL bacterial counting. The ozone protocols assessed were similar in regard to Enterococcus faecalis reduction.
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http://dx.doi.org/10.1007/s10266-021-00592-6DOI Listing
July 2021

Microbiological Investigation in Teeth with Persistent/Secondary Endodontic Infection in Different Stages of Root Canal Retreatment.

Eur Endod J 2020 12;5(3):219-225

Department of Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas-UNICAMP, Piracicaba, SP, Brazil.

Objective: The present clinical study investigated the microbiota of teeth with persistent secondary endodontic infection in the different phases of root canal retreatment.

Methods: Twenty filled single-rooted teeth with apical periodontitis were included. Samples were collected with sterile paper points before chemo-mechanical preparation (CMP) (S1), after CMP (S2) and after 30 days of calcium hydroxide-based intracanal medication (ICM) (S3). Cultivable bacteria were assessed by colony forming units count (CFU/mL). DNA was extracted and assessed by using nested PCR. Paired t-test and repeated measures ANOVA were applied for intragroup analysis in the stages of endodontic therapy at a significance level of 5%.

Results: Cultivable bacteria were detected in all initial samples. CMP reduced bacteria by 99.4% and ICM by 99.5%. The most prevalent species found in the initial samples were E. faecalis (20/20), P. gingivalis (20/20), F. nucleatum (17/20) and A. actinomycetemcomitans (10/20), whereas D. pneumosintes, F. alocis, P. nigrescens and T. socranskii were not detected. After CMP, A. israelii, A. naeslundii, G. morbillorum, T. forsythia and T. denticola were not detected (P<0.05) either. E. faecalis and P. gingivalis had a low reduction (P>0.05) and F. nucleatum had its DNA significantly reduced after CMP (P<0.05). ICM had no additional effect on microbial reduction.

Conclusion: The microbiota of teeth with persistent/secondary endodontic infection consists of a polymicrobial community with Gram-positive and Gram-negative species, bacillus and cocci, facultative and strict anaerobes. E. faecalis and P. gingivalis were frequently detected in all stages of root canal retreatment, evidencing their great resistance to endodontic procedures. The endodontic procedures were effective in reducing the levels of bacteria from teeth presenting with persistent/secondary endodontic infection.
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http://dx.doi.org/10.14744/eej.2020.73626DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7881382PMC
December 2020

Success, Survival Rate, and Soft Tissue Esthetic of Tooth Autotransplantation.

J Endod 2021 Mar 24;47(3):391-396. Epub 2020 Nov 24.

São Leopoldo Mandic School of Dentistry, Campinas, São Paulo, Brazil.

Introduction: The aim of this retrospective study was to assess the success, survival rate, and soft tissue esthetic of autotransplanted teeth.

Methods: This study included patients with at least 1 tooth autotransplanted to the maxilla during childhood or adolescence. The autotransplantation technique included the removal of an immature tooth from a donor site and its placement in the maxilla as a replacement for a missing or extremely compromised tooth. The cases were properly restored to ensure function and esthetic. To be considered successful, the tooth should be asymptomatic at the time of assessment, no pain to palpation and percussion, have no signs of apical periodontitis or a sinus tract, have a periodontal probe ≤3, and have an absence of root resorption and development of at least 70% of the normal root. The esthetic evaluation of the soft tissue was based on the pink esthetic score and graded as very unsatisfactory, unsatisfactory, poor, fair, good, or excellent. Data were statistically analyzed at a significance level of 5%.

Results: Thirty-five patients (23 males and 12 females) had 43 anterior teeth replaced, including 42 central incisors and 1 lateral incisor. The follow-up period ranged from 1-25 years. In regard to success and the survival rate, 43 teeth were assessed; 34 cases (79.07%) were considered successful and 9 (20.93%) unsuccessful. Only 1 tooth was lost, and 42 teeth remained functional (survival rate = 97.67%). In regard to the esthetic, 40 teeth could be assessed and were considered as excellent (30%), good (35%), fair (27.5%), and poor (7.5%); there were no reports of unsatisfactory or very unsatisfactory cases.

Conclusions: Tooth autotransplantation can be considered a valid procedure to replace lost teeth in the maxilla, presenting high survival and success rates. The overall esthetic of the patients was considered as satisfactory.
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http://dx.doi.org/10.1016/j.joen.2020.11.013DOI Listing
March 2021

Outcomes of traumatised immature teeth treated with apexification or regenerative endodontic procedure: a retrospective study.

Aust Endod J 2020 Oct 22. Epub 2020 Oct 22.

Endodontics Division, Department of Restorative Dentistry, Piracicaba Dental School, State University of Campinas - UNICAMP, Piracicaba, SP, Brazil.

This study compares the clinical success rate and continued radiographic root development of apexification and regenerative endodontic procedure in traumatised immature permanent teeth, and proposes a method to evaluate apical convergence, namely apical angle. Clinical and radiological data were collected from 44 treated teeth (22 with apexification and 22 with regenerative endodontic procedure). The preoperative and follow-up periapical radiographs were analysed to calculate the percentage changes in root length, root width, apical diameter and apical angle. The success rates for complete healing with apexification and regenerative endodontic procedure were 86.36% and 95.45%, respectively. Radiographically, regenerative endodontic procedure showed significantly greater percentage changes in root width only (P < 0.05). Apexification and regenerative endodontic procedure provide satisfactory outcomes concerning clinical success rates. Continued root development in regenerative endodontic procedure was similar to apexification, except for root width. Apical angle allowed us to assess the convergence of the root canal walls.
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http://dx.doi.org/10.1111/aej.12447DOI Listing
October 2020

Treatment outcomes of pulp revascularization in traumatized immature teeth using calcium hydroxide and 2% chlorhexidine gel as intracanal medication.

J Appl Oral Sci 2020 25;28:e20200217. Epub 2020 Sep 25.

Universidade Estadual Campinas - UNICAMP. Faculdade de Odontologia de Piracicaba. Departamento de Odontologia Restauradora, área de Endodontia. Piracicaba, SP, Brasil.

Objective: Pulp revascularization is an effective treatment for immature necrotic teeth. Calcium hydroxide has been used in pulp revascularization as an intracanal medication due to its antimicrobial action and the non-exhibition of crown discoloration and cytotoxicity for stem cells from the apical papilla. Our study aimed to investigate the clinical success and quantitative radiographic changes of root development in immature traumatized teeth using calcium hydroxide plus 2% chlorhexidine gel as intracanal medication.

Methodology: In this retrospective study, 16 patients were treated with a standardized pulp revascularization protocol. Calcium hydroxide and 2% chlorhexidine gel were manipulated in a 1:1 (v/v) ratio and inserted into root canals with Lentulo spirals (Dentsply Maillefer, Baillaigues, Switzerland). Patients were followed up for a period from 9 to 36 months for the evaluation of clinical and radiological data. Radiographic measurements of root length, root width, apical diameter, and MTA placement from the apex were quantified using software ImageJ. Wilcoxon test and t-test were used, according to nonparametric or parametric data, respectively, for changes over time in root length, root width, and apical diameter.

Results: Fifteen teeth survived during the follow-up period (93.75%) and met the criteria for clinical success. Although the changes seem to be very small in many cases, significant increases in the average root length (14.28%, p<0.0001), root width (8.12%, p=0.0196), and decrease in apical diameter (48.37%, p=0.0007) were observed. MTA placement from the apex and age at the time of treatment was not significantly associated with the quantitative radiographic outcomes.

Conclusions: Pulp revascularization in traumatized immature teeth treated with calcium hydroxide plus 2% chlorhexidine gel as intracanal medication had high success and survival rates, showing periodontal healing and resolution of signs and symptoms. However, concerning the continued root development, the outcomes can still be considered unpredictable.
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http://dx.doi.org/10.1590/1678-7757-2020-0217DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7518246PMC
November 2020

Dental discoloration caused by Grey-MTAFlow cement: analysis of its physicochemical, biological and antimicrobial properties.

J Appl Oral Sci 2020 5;28:e20200269. Epub 2020 Aug 5.

Faculdade de Odontologia de Piracicaba, Universidade de Campinas, Piracicaba, São Paulo, Brasil.

Tricalcium silicate-based cement are materials used in reparative and regenerative procedures in endodontics. A recently proposed formulation aimed to enhance handling during clinical use with a versatile material applicable by syringe. Although, the use of bismuth oxide as radiopacifier and grey raw powder are drawbacks considering aesthetics. Objectives Evaluate physicochemical, biological, and antimicrobial properties of Grey-MTAFlow (Ultradent) and assess whether the addition of zinc oxide (ZnO) prevents dentinal discoloration caused by bismuth oxide. Methodology Grey-MTAFlow was manipulated in 'thin' consistency for all tests. Luminosity, color change, ion migration to dentine, radiopacity, setting time, ISO 6876:2012 linear flow, volumetric lateral flow and central filling of simulated grooves scanned using micro-computed tomography (μCT), pH, calcium release, volumetric change using μCT, chemical characterisation, cytotoxicity, and antimicrobial activity were assessed. Addition of 5% ZnO to Grey-MTAFlow and a bismuth-containing experimental composition were comparatively tested. Statistical analyses used Shapiro-Wilk, T-test, ANOVA, and Kolmogorov-Smirnov (p<0.05). Results The addition of ZnO to Grey-MTAFlow prevented dentine darkening after 90 days due to bismuth migration reduction, although no statistical difference was found (p=0.863). ZnO addition significantly enhanced Grey-MTAFlow radiopacity without differences in initial setting time. Grey-MTAFlow presented an ISO linear flow of 10.9 mm and a balanced volumetric lateral flow with central filling in μCT evaluation. All compositions presented an alkaline pH after immersion. Grey-MTAFlow had a significantly higher calcium ion release after 28 days in comparison to 24 hours (p=0.011) and volumetric expansion of 0.4±1.8% after immersion. ZnO addition altered the hydrated cement matrix once calcium hydroxide (portlandite) could not be detected in characterisation. Neither of the materials produced inhibition halos nor reduced bacterial turbidity, but all presented cytocompatibility above 100%. Conclusion Grey-MTAFlow expanded after immersion and exhibited higher luminosity values after the evaluation period when ZnO was added, but chemical modifications after this addition occurred.
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http://dx.doi.org/10.1590/1678-7757-2020-0269DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7406195PMC
October 2020

Clinical and Molecular Microbiological Evaluation of Regenerative Endodontic Procedures in Immature Permanent Teeth.

J Endod 2020 Oct 16;46(10):1448-1454. Epub 2020 Jul 16.

Department of Dentistry, Discipline of Endodontics, School of Dentistry, University of São Paulo, São Paulo, São Paulo, Brazil. Electronic address:

Introduction: This study evaluated the bacterial levels after regenerative endodontic procedures and their correlation with the treatment outcome using molecular microbiology methods.

Methods: Root canal samples of 15 necrotic immature teeth were analyzed by quantitative polymerase chain reaction. Bacteria were counted before treatment (S1), after irrigation with 6% sodium hypochlorite (S2), and after intracanal dressing (S3) using either triple antibiotic paste (n = 7) or calcium hydroxide with chlorhexidine (n = 8). The Wilcoxon test for related samples and the Mann-Whitney test were used for statistical analysis (P < .05). After a follow-up period of 12-48 months, clinical and radiographic findings were correlated with microbiological data using a linear regression model (P < .05).

Results: All S1 and S2 samples were positive for bacteria, but the number of positive S3 samples decreased to 53.3% (P = .001). Overall, there was a significant reduction of bacterial levels after each treatment step (S1-S2, P = .001; S2-S3, P = .02). In the triple antibiotic paste and chlorhexidine groups, 57.1% and 50% of S3 samples were positive with median numbers of 6.97 × 10 and 3.59 × 10 bacterial cells, respectively. No significant differences were found between the groups. Periapical healing occurred in all cases despite the presence of low levels of residual bacteria. However, the latter had a negative impact on the thickness of dentinal walls (R = 0.0043).

Conclusions: Although the bacterial levels were drastically reduced after the regenerative endodontic procedures, the residual bacteria influenced the thickness of the dentinal walls.
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http://dx.doi.org/10.1016/j.joen.2020.07.005DOI Listing
October 2020

Evaluation of the presence of microorganisms from root canal of teeth submitted to retreatment due to prosthetic reasons and without evidence of apical periodontitis.

Clin Oral Investig 2020 Sep 20;24(9):3243-3254. Epub 2020 Jan 20.

Department of Restorative Dentistry, Endodontics Division, Piracicaba Dental School, State University of Campinas-UNICAMP, Piracicaba, SP, Brazil.

Aim: The objective of this study was to evaluate the presence of microorganisms in the root canals (RC) of teeth submitted to endodontic retreatment due to prosthetic reasons and without evidence of apical periodontitis.

Material And Methods: Twenty teeth referred to endodontic retreatment due to prosthetic reasons and without evidence of apical periodontitis were included in this study. Gutta-percha (GP) was collected from each third of the RC. After GP removal, microbial samples were also collected from the full extension of RC using paper points and files. The samples were cultivated in Fastidious Anaerobe Agar and the colony-forming units (CFU/mL) were counted. They were also semi-quantitatively analyzed by checkerboard DNA-DNA hybridization using 40 DNA bacterial probes.

Results: Microorganisms were found in all samples. The coronal third of GP was more contaminated than the apical third (p ≤ 0.05). There was prevalence of Enterococcus hirae and Enterococcus faecalis in all RC thirds and also in the samples collected from the full extension of RCs.

Conclusion: Microorganisms were found in all cases referred to endodontic retreatment due to prosthetic reasons and without evidence of apical periodontitis. Enterococcus was the genus most frequently detected.

Clinical Significance: An endodontic retreatment should be considered before replacing a prosthesis.
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http://dx.doi.org/10.1007/s00784-020-03200-zDOI Listing
September 2020

Contribution of Bone Marrow-derived Cells to Reparative Dentinogenesis Using Bone Marrow Transplantation Model.

J Endod 2020 Mar 11;46(3):404-412. Epub 2020 Jan 11.

Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil.

Introduction: The aim of this study was to analyze the contribution of bone marrow-derived cells (BMDCs) to reparative dentinogenesis using bone marrow transplantation (BMT) and pulp capping as an in vivo model.

Methods: A chimeric mouse model was created through the injection of BMDCs expressing green fluorescent protein (GFP+ BMDCs) from C57BL/6 GFP+ transgenic donor mice into irradiated C57BL/6 wild-type recipient mice (GFP- mice). These GFP- chimeric mice (containing transplanted GFP+ BMDCs) were subjected to microscopic pulp exposure and capping with white mineral trioxide aggregate (n = 18) or Biodentine (Septodont, St Maur-des-Fossés, France) (n = 18) in the maxillary first molar. Maxillary arches from GFP- chimeric mice (with the capped tooth) were isolated and histologically processed 5 (n = 9) and 7 (n = 9) weeks after BMT. Confocal laser microscopy and immunohistochemical analysis were performed to assess the presence of GFP+ BMDCs and the expression of dentin sialoprotein, an odontoblast marker, for those cells contributing to reparative dentinogenesis in the dental pulp.

Results: Confocal laser microscopic analyses evidenced the presence of GFP+ BMDCs in close association with reparative dentin synthesized at the site of pulp exposure in GFP- mice 5 and 7 weeks after BMT. Immunohistochemical analysis revealed that GFP+ BMDCs in close association with reparative dentin expressed DSP, suggesting the contribution of nonresident GFP+ BMDCs to reparative dentinogenesis.

Conclusions: These data suggest the presence of nonresident BMDCs in reparative dentinogenesis and its contribution to dental pulp regeneration in the pulp healing process.
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http://dx.doi.org/10.1016/j.joen.2019.12.003DOI Listing
March 2020

Root Anatomy and Canal Configuration of Maxillary Molars in a Brazilian Subpopulation: A 125-μm Cone-Beam Computed Tomographic Study.

Eur J Dent 2019 Feb 6;13(1):82-87. Epub 2019 Jun 6.

Department of Endodontics, São Leopoldo Mandic School of Dentistry, Campinas, SP, Brazil.

Objective: Knowledge of internal anatomy of the teeth is of great importance in endodontics, leading to success in root canal therapy (RCT). The aim of this study was to assess the root anatomy and canal configuration of maxillary molars in a Brazilian subpopulation using tomographic images using a voxel size of 125 μm.

Materials And Methods: This in vivo retrospective study assessed 651 cone-beam computed tomographic scans from 328 maxillary first molars and 323 maxillary second molars. The images were assessed by two endodontists and an oral radiologist. Only permanent molars with fully developed roots and with no signs of RCT were included.

Results: Maxillary first and second molars presented three separated roots in 99.39 and 90.09% of the cases, respectively. The presence of mesiolingual canals in the mesiobuccal roots was 64.22% for maxillary first molars and 33.56% for maxillary second molars. Distobuccal canals in the maxillary first and second molars presented Vertucci's Type I configuration in 99.39 and 99.66%, respectively, and palatal canals in the maxillary first and second molars presented Vertucci's Type I configuration in 99.69 and 99.68%, respectively. Maxillary second molars were more subjected to anatomical variations than first molars. Female patients presented higher prevalence of mesiolingual canals in the maxillary second molars.

Conclusions: The most prevalent morphology in the maxillary first and second molars was three root canals. The presence of only one or two roots is more likely to occur in the maxillary second molars than in the maxillary first molars. Mesiolingual canals in mesiobuccal roots are more frequent in the maxillary first molars than in the maxillary second molars, and the occurrence of two distobuccal or two palatal canals is rare.
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http://dx.doi.org/10.1055/s-0039-1688736DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6635971PMC
February 2019

Effect of intracanal medications on the interfacial properties of reparative cements.

Restor Dent Endod 2019 May 9;44(2):e21. Epub 2019 May 9.

Department of Restorative Dentistry, Endodontics Area, Piracicaba Dental School, State University of Campinas - UNICAMP, Piracicaba, SP, Brazil.

Objectives: The purpose of the present study was to evaluate the effect of calcium hydroxide with 2% chlorhexidine gel (HCX) or distilled water (HCA) compared to triple antibiotic paste (TAP) on push-out bond strength and the cement/dentin interface in canals sealed with White MTA Angelus (WMTA) or Biodentine (BD).

Materials And Methods: A total of 70 extracted human lower premolars were endodontically prepared and randomly divided into 4 groups according to the intracanal medication, as follows: group 1, HCX; group 2, TAP; group 3, HCA; and group 4, control (without intracanal medication). After 7 days, the medications were removed and the cervical third of the specimens was sectioned into five 1-mm sections. The sections were then sealed with WMTA or BD as a reparative material. After 7 days in 100% humidity, a push-out bond strength test was performed. Elemental analysis was performed at the interface, using energy-dispersive spectroscopy. The data were statistically analyzed using analysis of variance and the Tukey test ( < 0.05).

Results: BD presented a higher bond strength than WMTA ( < 0.05). BD or WMTA in canals treated with calcium hydroxide intracanal medications had the highest bond strength values, with a statistically significant difference compared to TAP in the WMTA group ( < 0.05). There were small amounts of phosphorus in samples exposed to triple antibiotic paste, regardless of the coronal sealing.

Conclusions: The use of intracanal medications did not affect the bond strength of WMTA and BD, except when TAP was used with WMTA.
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http://dx.doi.org/10.5395/rde.2019.44.e21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6529794PMC
May 2019

The impact of a dental operating microscope on the identification of mesiolingual canals in maxillary first molars.

Gen Dent 2019 Mar-Apr;67(2):73-75

The aim of this study was to clinically assess the impact of a dental operating microscope (DOM) on the clinician's ability to locate a second canal in the mesiobuccal root (MB2), also known as the mesiolingual canal. An endodontic specialist treated 180 maxillary first molars using the same protocol for all teeth except for the use of the DOM (n = 90 per group). In the teeth treated without the use of a DOM, a mesiolingual canal was located in 26.67% of the cases; when a DOM was used, a mesiolingual canal was located in 77.78% of the cases. Analysis with the Fisher exact test revealed that the magnification provided by a DOM significantly (P < 0.05) improved the identification of MB2 canals in maxillary first molars.
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November 2019

Influence of chlorhexidine and zinc oxide in calcium hydroxide pastes on pH changes in external root surface.

Braz Oral Res 2019 Feb 11;33:e005. Epub 2019 Feb 11.

Universidade Estadual de Campinas - Unicamp, School of Dentistry of Piracicaba, Department of Restorative Dentistry, Piracicaba, SP, Brazil.

The objective of this study was to assess the influence of chlorhexidine (liquid and gel) and zinc oxide in calcium hydroxide (CH) pastes on root pH in simulated external resorption. One hundred human anterior teeth with a single root canal were selected. After decoronation and root canal instrumentation, the specimens were divided into 4 experimental groups and 1 control group (without intracanal paste): CH + saline (CH+S), CH + 2% chlorhexidine liquid (CH+ CHX), CH + 2% chlorhexidine gel (CH+ CHXg), and CH + 2% chlorhexidine gel + zinc oxide (CH+ CHXg+ZnO). pH was measured using a microelectrode at 3 and 24 h, and 1, 2, 3, and 4 weeks after inserting intracanal pastes. Data were analyzed statistically using an ANOVA and Tukey's test (p < 0.05). The CH+CHXg+ZnO group had the highest pH values throughout (p<0.05). The CH+S and CH+ CHX groups had the highest pH values after 1 week and the CH+ CHXg group after 2 weeks. CH+ CHXg maintained the highest pH until the fourth week compared with CH+ CHX (p < 0.05). The control group remained at a neutral pH at all evaluated times. It can be concluded that chlorhexidine solution or gel maintained the alkaline pH of CH, and chlorhexidine gel allowed a slower decrease in pH over time. CH+ CHXg+ZnO showed the highest pH values and was an effective intracanal medication for maintaining alkaline root pH in the area of resorption.
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http://dx.doi.org/10.1590/1807-3107bor-2019.vol33.0005DOI Listing
February 2019

Effectiveness of calcium hydroxide-based intracanal medication on infectious/inflammatory contents in teeth with post-treatment apical periodontitis.

Clin Oral Investig 2019 Jun 26;23(6):2759-2766. Epub 2018 Oct 26.

Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School - State University of Campinas - UNICAMP, Av. Limeira 901. Bairro Areião, Piracicaba, São Paulo, Brazil.

Objective: The objective of this work was to investigate in vivo the effects of calcium hydroxide-based intracanal medication (ICM) on the levels of bacteria, pro-inflammatory cytokines (PICs), and matrix metalloproteinases (MMPs) in root canals and periradicular tissues of teeth with failure of the root canal treatment and apical periodontitis.

Materials And Methods: Twenty infected root canals of single-rooted teeth were randomly assigned into two groups according to the irrigant used for chemomechanical preparation (CMP) (n = 10 per group): G1 - 2% chlorhexidine (CHX) gel and G2 - 6% sodium hypochlorite (NaOCl). Root canal contents were taken by using paper points before CMP (S1) and after 30 days of calcium hydroxide-based ICM (S2). Microbial reduction was calculated by means of colony-forming unit count (CFU/mL), with PICs and MMPs (pg/mL) being measured by using enzyme-linked immunosorbent assay (ELISA).

Results: Culturable bacteria (101.2 ± 79.2), PICs (IL-1β 1.2 ± 0.4 and TNF-α 8.8 ± 4.7), MMP-2 (803.7 ± 96.4), MMP-3 (453.9 ± 229.3), MMP-8 (245.9 ± 122.4), MMP-9 (129.4 ± 29.6), and MMP-13 (70.8 ± 12.8) were present in all S1 samples. After 30 days of ICM (S2), a 99.5% microbial reduction was observed, together with a significant reduction of PICs in all groups. Overall, it was observed a decrease in the levels of MMPs (S2), except MMP-13, which was found in increased levels after ICM (P < .05), independently of the groups.

Conclusions: Calcium hydroxide-based intracanal medications have had a positive effect on the microbial reduction by decreasing the levels of PICs and MMPs. Both auxiliary chemical substances (i.e., 2% CHX and 6% NaOCl) presented similar effects when calcium hydroxide was used as intracanal medication.

Clinical Relevance: Teeth with failure of the root canal treatment and apical periodontitis, and consequently with high levels of bacteria, PIC, and MMP, may present a better prognosis after a 30 days of a calcium hydroxide-based ICM.
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http://dx.doi.org/10.1007/s00784-018-2719-0DOI Listing
June 2019

Influence of ethanol on dentin roughness, surface free energy, and interaction between AH Plus and root dentin.

Braz Oral Res 2018 3;32:e33. Epub 2018 May 3.

Department of Restorative Dentistry, Piracicaba Dental School, Universidade Estadual de Campinas - Unicamp, Piracicaba, SP, Brazil.

This study aimed to evaluate the influence of different ethanol concentrations on dentin roughness, surface free energy, and contact angle between AH Plus and the root canal dentin. One hundred human maxillary anterior teeth were split longitudinally and 200 dentin specimens were polished to make the surface flatter and smoother. An acrylic bar was positioned between two dentin specimens and impression material was added to create a block, simulating an instrumented root canal space. Specimens were removed from the mold and cleaned in an ultrasonic bath for 10 min. Thereafter, dentin specimens were divided into four groups (n = 50) according to the drying methods used: a) wet: vacuum only, b) paper points: vacuum + absorbent paper points, c) 70% alcohol: 70% alcohol (1 min) + vacuum + absorbent paper points, and d) 100% alcohol: 100% alcohol (1 min) + vacuum + absorbent paper points. A rugosimeter and a goniometer were used to verify the roughness (Ra) and to measure the surface free energy and the contact angle between the AH Plus sealer and the root canal dentin. ANOVA and Tukey tests (α = 0.05) were used for statistical analysis. The 70% and 100% ethanol groups showed significantly decreased roughness as well as increased surface free energy in the root canal dentin when compared to the wet and paper point groups. In addition, ethanol significantly reduced the contact angle between the AH Plus sealer and the root canal dentin. Ethanol solutions (70% and 100%) provide better wettability of AH Plus sealer on dentin surfaces.
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http://dx.doi.org/10.1590/1807-3107bor-2018.vol32.0033DOI Listing
May 2018

Required Time for Migration of Bone Marrow-derived Cells to Dental Pulp after Bone Marrow Transplantation.

J Endod 2018 Mar 21;44(3):438-445. Epub 2017 Dec 21.

Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil.

Introduction: This study aimed to evaluate the time required for bone marrow-derived cells (BMDCs) from transgenic green fluorescent protein (GFP)+ donor mice (GFP+ mice) to migrate into the dental pulp of wild-type GFP- recipient mice (GFP- mice) by using bone marrow transplantation (BMT) as an in vivo model for tracking BMDCs from GFP+ mice (GFP+ BMDCs).

Methods: GFP+ BMDCs were injected into irradiated GFP- mice. Maxillary arches, tibiae, and femora from GFP- mice were isolated and processed at 24 hours, 48 hours, 4, 7, and 14 days, and 7 weeks after BMT. Confocal laser microscopy analyses were performed to assess the presence of GFP+ BMDCs in the dental pulp, and flow cytometry of BM was performed to confirm the efficiency of engraftment of GFP+ BMDCs.

Results: Confocal laser microscopy analyses evidenced the presence of GFP+ BMDCs in the dental pulp of GFP- mice from 14 days to 7 weeks after BMT. There was no presence of GFP+ BMDCs at 24 hours, 48 hours, 4 days, and 7 days. Flow cytometry of the BM of GFP- mice demonstrated a constant increase in the presence of GFP+ BMDCs at 24 hours, 48 hours, and 4 days after BMT, which stabilized from 7 days to 7 weeks.

Conclusions: The study demonstrated the presence of GFP+ BMDCs in the dental pulp from 14 days to 7 weeks after BMT and the feasibility of using GFP+ animals and BMT as an in vivo model for tracking GFP+ BMDCs.
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http://dx.doi.org/10.1016/j.joen.2017.10.006DOI Listing
March 2018

Multidisciplinary approach for replacement 
root resorption following severe intrusive luxation: 
A case report of decoronation.

Quintessence Int 2017 ;48(7):555-561

Intrusive luxation is a severe trauma-related event with a high frequency of pulp necrosis and root resorption. A common complication following intrusion is tooth ankylosis, which can extend to progressive replacement root resorption. An increasing infraposition in growing individuals can also occur. Decoronation is a new conservative treatment for cases of tooth ankylosis in young patients who have not finished growing. In this surgical technique, the tooth crown is removed and the root with replacement resorption process remains inside the alveolus. This treatment allows the alveolar bone to continue to develop, thus preserving bone dimensions. The purpose of this article is to report a multidisciplinary case of a young patient with anterior open bite, dental ankylosis, and tooth infraposition affected by intrusive luxation. Decoronation was the treatment of choice for this patient. The patient was then referred to orthodontic treatment to maintain the space of the maxillary right central incisor and open bite correction. After 5 years of follow-up, good clinical and radiologic results were obtained.
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http://dx.doi.org/10.3290/j.qi.a38334DOI Listing
October 2018

Relationship between Initial Attendance after Dental Trauma and Development of External Inflammatory Root Resorption.

Braz Dent J 2017 Jan-Apr;28(2):201-205

Department of Restorative Dentistry, Endodontics Area, Piracicaba Dental School, UNICAMP - Universidade Estadual de Campinas, Piracicaba, SP, Brazil.

This clinical study aimed to evaluate the relationship of the delay between dental trauma and the initial attendance to the development of external inflammatory root resorption in permanent teeth affected by severe luxation. Sixty-seven patients, aged between 11 and 56 years, presenting 133 injured teeth with closed apex (56 extrusive luxation, 69 lateral luxation and 8 intrusive luxation) were followed up for a minimum of 24 months. The time elapsed between dental trauma and the initial attendance was recorded. The presence of necrotic pulp and external inflammatory resorption for each type of trauma was verified. Fisher's exact test was used to verify the influence of the initial attendance date at the Dental Trauma Center and the development of inflammatory resorption (p<0.05). The odds ratio was used to check the risk of developing external inflammatory resorption due to delay in seeking treatment. Pulp necrosis was observed in 105 teeth (78.9%) and external inflammatory resorption was detected in 17.8% cases of extrusive luxation (10 teeth), 15.9% of lateral luxation (11 teeth) and 25% of intrusive luxation (2 teeth). For lateral luxation, extended delay between the date of injury and initial attendance influenced the occurrence of external inflammatory resorption (p=0.0174). Patients who began treatment 45 days after the injury were 3.4 times more likely to develop external inflammatory resorption than patients who sought treatment after the trauma. Treatment late after the occurrence of dental trauma can impair the prognosis and result in the development of external inflammatory resorption in luxated teeth.
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http://dx.doi.org/10.1590/0103-6440201701299DOI Listing
March 2018

Antimicrobial Susceptibility and Characterization of Virulence Genes of Enterococcus faecalis Isolates from Teeth with Failure of the Endodontic Treatment.

J Endod 2016 Jul 21;42(7):1022-8. Epub 2016 May 21.

Department of Restorative Dentistry, Endodontic Division, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil. Electronic address:

Introduction: The aim of this study was to investigate the prevalence of virulence factors and the antimicrobial resistance of Enterococcus faecalis isolates of teeth with failure of the endodontic treatment.

Methods: Twenty root canal samples were collected from teeth with apical periodontitis. E. faecalis was firstly identified based on phenotypic features and then by 16S ribosomal RNA gene sequencing. The antimicrobial susceptibility was determined by the minimum inhibitory concentration (MIC) of amoxicillin, amoxicillin + clavulanate, azithromycin, benzylpenicillin, ciprofloxacin, clindamycin, chloramphenicol, doxycycline, erythromycin, gentamicin, metronidazole, moxifloxacin, rifampicin, tetracycline, and vancomycin using the E test method. Virulence factors (ace, asa, asa373, cylA, efaA, esp, and gelE) were detected by polymerase chain reaction assay.

Results: Amoxicillin + clavulanate was effective against all strains. Intermediate and total resistance was found against the majority of the tested antimicrobials. The susceptibility of some microorganisms to some antimicrobial agents changed according to the evaluation time. MIC50 and MIC90 also varied according to the evaluation time. In relation to the virulence factors of the E faecalis isolates, ace was detected in 100% of the strains, asa (60%), asa373 (15%), efaA (95%), esp (70%), and gelE (75%), whereas cylA was not detected.

Conclusions: It was concluded that E. faecalis isolates from persistent endodontic infections showed varied degrees of intermediate/total resistance to several antimicrobial agents, with amoxicillin + clavulanate being the most effective agent. Moreover, the strains showed different patterns for virulence gene detection.
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http://dx.doi.org/10.1016/j.joen.2016.03.015DOI Listing
July 2016

Quantification of Lipoteichoic Acid Contents and Cultivable Bacteria at the Different Phases of the Endodontic Retreatment.

J Endod 2016 Apr;42(4):552-6

Endodontic Division, Department of Restorative Dentistry, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil. Electronic address:

Introduction: The infectious content of root canals, including bacteria and lipoteichoic acid (LTA), cause injuries to the periapical tissues. The purpose of this clinical study was to quantify the levels of both LTA and cultivable bacteria at the different phases of endodontic retreatment (ER) of teeth with post-treatment apical periodontitis. It also aimed to investigate the presence of gram-positive microorganisms before and after chemomechanical preparation (CMP) and intracanal medication (ICM).

Methods: Twenty infected root canals of single-rooted teeth were randomly assigned into 2 groups according to the chemical substance used for CMP (n = 10 per group): chlorhexidine (CHX) group, 2% CHX gel, and the sodium hypochlorite (NaOCl) group, 6% NaOCl. Root canal samples were taken using paper points before (S1) and after CMP (S2) and after 30 days of ICM with calcium hydroxide + 2% CHX gel (S3). Microorganisms were identified by the culture technique using biochemical tests. Cultivable bacteria were determined by counting the colony-forming unit. LTA levels were measured using the enzyme-linked immunosorbent assay (pg/mL).

Results: A total of 70 gram-positive species, out of 102 species isolated, were found in the root canals (54 in S1, 4 in S2, and 12 in S3). Enterococcus faecalis was the most frequent isolated taxon in all phases of the ER. LTA (574.0 ± 94.7) and cultivable bacteria (101.2 ± 79.2) were present in all S1 samples. CMP decreased the overall levels of cultivable bacteria by 99.4% and LTA by 24.8% (P < .05), whereas the total overall reduction level of ICM on viable bacteria was 99.5% and on LTA it was 38.6% (P < .05). CMP with 2% CHX gel (CHX group, 99.3%) was more effective (P < .05) than 6% NaOCl (NaOCl group, 92.1%) on bacterial reduction. Likewise, ICM showed a 100% reduction in the CHX group and 98.5% in the NaOCl group. Regarding the reduction of LTA, CMP with 2% CHX gel (CHX group, 26.9%) was more effective (P < .05) than 6% NaOCl (NaOCl group, 22.6%). In addition, ICM showed a 43.2% reduction in the CHX group and 36.2% in the NaOCl group (P > .05).

Conclusions: The reduction rates of bacteria were higher than the LTA. Moreover, gram-positive microorganisms were present in all phases of the endodontic retreatment.
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http://dx.doi.org/10.1016/j.joen.2016.01.002DOI Listing
April 2016

Influence of Using Clinical Microscope as Auxiliary to Perform Mechanical Cleaning of Post Space: A Bond Strength Analysis.

J Endod 2015 Aug;41(8):1311-6

Division of Endodontics, Department of Restorative Dentistry, State University of Campinas-UNICAMP, Piracicaba, São Paulo, Brazil.

Introduction: The aim of the present study was to evaluate the influence of using a clinical microscope while performing mechanical cleaning of post space walls on the bond strength of a fiberglass post to dentin.

Methods: Forty-five bovine roots were used. After preparation, roots were filled using gutta-percha and Pulp Canal Sealer (SybronEndo, Orange, CA). Subsequently, for post space preparation, the roots were divided into 3 groups: control (only heat condenser + specific bur of the post system); cleaning without a microscope, mechanical cleaning (after the procedure described in the control group, round burs were used to improve cleaning); and cleaning with a microscope, mechanical cleaning performed with round burs visualized under a clinical microscope. Then, fiberglass posts were cemented. The roots were prepared and evaluated by the push-out test. Data were analyzed using Kruskal-Wallis and Student-Newman-Keuls tests (P < .05). The failure pattern was classified as follows: adhesive between the cement and dentin, adhesive dentin/cement/post, mixed cohesive within dentin, mixed cohesive post, and mixed cohesive post/dentin.

Results: The bond strength values (mean ± standard deviation) were control (cervical 1.17 ± 1.1, middle 0.40 ± 0.3, apical 0.52 ± 0.3, and total 0.95 ± 1.9), cleaning without a microscope (cervical 1.66 ± 2.3, middle 0.65 ± 1.1, apical 0.79 ± 1.2, and total1.04 ± 1.7), and cleaning with a microscope (cervical 3.26 ± 2.8, middle 1.97 ± 3.5, apical 1.85 ± 4.1, and total 2.37 ± 3.5). In the cleaning with a microscope group, the bond strength values were significantly higher than those in the other groups. In all groups, the main failure pattern was adhesive between cement and dentin.

Conclusions: The use of a clinical microscope while performing mechanical cleaning during post space preparation improved the bond strength of a fiberglass post to dentin.
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http://dx.doi.org/10.1016/j.joen.2015.05.003DOI Listing
August 2015

Post-traumatic complications of severe luxations and replanted teeth.

J Contemp Dent Pract 2015 01 1;16(1):13-9. Epub 2015 Jan 1.

Department of Restorative Dentistry, Endodontics Area Piracicaba Dental School, State University of Campinas Piracicaba, Brazil.

Aim: The aim of this study was to evaluate the main post-traumatic complications of severe luxation and replanted teeth using clinical and radiographic analyses.

Materials And Methods: Eighty-three patients aged between 7 and 55 years old presenting 180 traumatized teeth that suffered extrusive luxation (n=67), lateral luxation (n=69), intrusive luxation (n=10) and tooth avulsion (n=34) followed by replantation were evaluated. The follow-up period was 24 months. The complications examined were: pulp canal obliteration, pulp necrosis and root resorption (infammatory and replacement). Furthermore, the relationship between time elapsed before receiving dental attendance and development of infammatory resorption was observed.

Results: Pulp necrosis was the main complication, occurring in 147 teeth (82.7%). All of the teeth that suffered intrusive luxation and tooth avulsion were diagnosed with pulp necrosis, with significant difference in comparison with another traumas (p<0.001/Fisher's exact test). Infammatory root resorption was observed in 20.5% of the cases and replacement resorption was more related to tooth replantation (94.1%), showing significant prevalence among tooth luxations (p<0.001/Fisher's exact test). In addition, it was noted that patients who seek treatment 9 weeks after the trauma episode presented 10 times more chance of developing infammatory resorption when compared with patients who seek treatment soon after dental trauma (Odds ratio test).

Conclusion: It may be concluded that pulp necrosis was the main post-traumatic complication observed in traumatized teeth and that delay in seeking treatment may damage the prognosis of severe luxation and replanted teeth.

Clinical Significance: Clinical studies describing the main complications that may affect traumatized teeth present great relevance to make the population aware of the importance of seeking immediate treatment and to alert the professional to the need for follow-up. When traumatic injuries are diagnosed and treated early, post-traumatic complications may be controlled, allowing conservation of the tooth in oral cavity.
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http://dx.doi.org/10.5005/jp-journals-10024-1628DOI Listing
January 2015

Traumatized immature teeth treated with 2 protocols of pulp revascularization.

J Endod 2014 May 6;40(5):606-12. Epub 2014 Mar 6.

Department of Restorative Dentistry, Endodontics Area, State University of Campinas-UNICAMP, Piracicaba, São Paulo, Brazil. Electronic address:

Introduction: Pulp revascularization may be considered a promising alternative for traumatized necrotic immature teeth. The aim of this study was to evaluate traumatized immature teeth treated with 2 protocols of pulp revascularization.

Methods: Twenty-three teeth of young patients (7-17 years old) with necrotic upper incisors caused by dental trauma were divided into 2 groups; one group was treated with triple antibiotic paste (metronidazole, ciprofloxacin, and minocycline) (TAP) (n = 12), and the other was medicated with combination of calcium hydroxide and 2% chlorhexidine gel (CHP) (n = 11). Patients were treated and followed up for a period from 9-19 months in 2 dental institutions for evaluation of clinical and radiographic data.

Results: Most of the teeth were affected by lateral luxation (47.8%). Clinical evaluation in group TAP showed significant reduction in spontaneous pain (P = .01), pain on horizontal percussion (P = .007), and pain on palpation (P = .03), whereas group CHP showed significant reduction in pain on vertical percussion (P = .03). Crown discoloration was observed significantly more in teeth of group TAP (83.3%) (P < .002). On radiographic exam, periapical repair was found in all TAP-treated teeth (P = .03). Similarly, the same findings were found for all teeth treated with CHP with exception of 1 tooth (P = .21). Apical closure was significantly observed in both groups (P < .05). Increase in root length was demonstrated in 5 teeth (41.7%) and 3 teeth (27.3%) of groups TAP and CHP, respectively. Thickening of lateral dentinal walls was observed in 5 teeth of each group.

Conclusions: Revascularization outcomes for traumatized patients treated with the tested protocols presented similar clinical and radiographic data. However, TAP caused esthetic problem leading to tooth discoloration, which can be considered a disadvantage when compared with CHP.
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http://dx.doi.org/10.1016/j.joen.2014.01.032DOI Listing
May 2014

Prevalence of traumatic dental injuries and associated factors among Brazilian schoolchildren.

Oral Health Prev Dent 2013 ;11(1):31-8

School of Dentistry, Faculdade Leao Sampaio, Juazaeiro do Norte, Brazil.

Purpose: To assess the prevalence of traumatic dental injuries to permanent anterior teeth in 9- to 14-year-old schoolchildren attending public schools in Anápolis, Brazil, and to investigate the association between the occurrence of these injuries and the size of incisal overjet and type of lip coverage.

Materials And Methods: A cross-sectional survey and a two-stage cluster sampling technique were used. The sample size included 765 9- to 14-year-old schoolchildren. Data were collected through clinical examinations and interviews carried out by a trained, calibrated dentist. Oral examinations dealt with the type of traumatic dental injury (TDI), the treatment received, the size of incisal overjet and the type of lip coverage. The teeth examined were maxillary and mandibular incisors.

Results: A 16.5% prevalence of dental trauma was found. Boys experienced double the number of girls' injuries. The maxillary central incisors were the teeth most affected, totaling 84.8%. The most frequent type of injury found was enamel fracture (66%), followed by enamel-dentin fracture (27%) and enamel cracks (5%). Only 26% of traumatised teeth were restored. Children with an overjet size > 3 mm were 1.78 times (CI= 1.18 - 2.69) more likely to have a dental injury than children with an overjet size <= 3 mm. Children with inadequate lip coverage were 2.18 times (CI= 1.27 - 3.76) more likely to experience dental trauma than children whose lip coverage was adequate.

Conclusion: This study shows that the prevalence of traumatic dental injuries among schoolchildren in Anápolis, Brazil is similar to that of other regions in Brazil. The teeth most affected by dental trauma are the maxillary central incisors. Boys run a 2.03-times higher risk of crown fracture than girls, and children with an overjet size > 3 mm are 1.78 times more likely to have dental injuries. In addition, children with inadequate lip coverage are 2.18 times more likely to present traumatic dental injuries than children with adequate lip coverage.
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http://dx.doi.org/10.3290/j.ohpd.a29373DOI Listing
July 2013

Pulp revascularization after root canal decontamination with calcium hydroxide and 2% chlorhexidine gel.

J Endod 2013 Mar 10;39(3):417-20. Epub 2012 Nov 10.

Department of Restorative Dentistry, Endodontics Area, State University of Campinas-UNICAMP, Piracicaba, São Paulo, Brazil.

Introduction: Pulp revascularization may be considered a promising alternative for necrotic immature teeth. Many studies have accomplished passive decontamination associated with an antibiotic paste. To date, there is no report evaluating calcium hydroxide associated with 2% chlorhexidine gel for revascularization therapy. The aim of this case report was to describe a new proposal for pulp revascularization with mechanical decontamination and intracanal medication composed of calcium hydroxide and 2% chlorhexidine gel.

Methods: The patient, a 9-year-old girl, suffered an intrusion associated with pulp exposure caused by an enamel-dentin fracture in her maxillary left central incisor. After diagnosis, treatment consisted of revascularization therapy with gentle manual instrumentation of the cervical and medium thirds of the root in addition to intracanal medication with calcium hydroxide and 2% chlorhexidine gel for 21 days. In the second session, a blood clot was stimulated up to the cervical third of the root canal. Mineral trioxide aggregate (MTA; Angelus, Londrina, Paraná, Brazil) was used for cervical sealing of the canal. Coronal sealing was performed with temporary filling material and composite resin.

Results: During the follow-up period, the root canal space showed a progressive decrease in width, mineralized tissue deposition on root canal walls, and apical closure. A cone-beam computed tomography scan taken at the 2-year follow-up confirmed these findings and did not show complete root canal calcification.

Conclusions: This new proposal for revascularization therapy with 2% chlorhexidine gel may be used for the treatment of necrotic immature root canals.
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http://dx.doi.org/10.1016/j.joen.2012.10.005DOI Listing
March 2013
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