Publications by authors named "Liviu Steier"

36 Publications

Fluorescence-Enhanced Theragnosis: A Novel Approach to Visualize, Detect, and Remove Caries.

Compend Contin Educ Dent 2021 Sep;42(8):460-465

Professor of Restorative Dentistry and Chairman, Department of Preventive and Restorative Sciences, Assistant Dean for Digital Innovation and Professional Development, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania.

Fluorescence tools have shown to be highly valuable for precise diagnosis of caries and other lesions in dentistry. In the form of ultraviolet (UV) headlights and special loupes with high levels of magnification and observational capacity, these instruments can even be used during treatment for a more preventive and minimally invasive treatment strategy. Fluorescence, a type of luminescence, absorbs light of shorter wavelength and re-emits it as longer-wavelength light. This changes the color, for example from blue to red. The fluorescence spectra of carious lesions are typical for fluorescent porphyrins, mainly protoporphyrin IX. A possible source of these porphyrins within carious tissues is bacterial biosynthesis. Streptococcus mutans induces enamel and dentin lesions and modifies the fluorescence in the red and green spectral regions, with a stronger signal in the red region, due to porphyrin gradient signals. This article describes the concept of fluorescence-enhanced theragnosis for removal of caries and preservation of sound dental tissues.
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September 2021

Benefits of Using Fluorescence Induced Theragnosis in Fixed Orthodontic Therapy: Status, Technology and Future Trends.

Dent J (Basel) 2021 Aug 5;9(8). Epub 2021 Aug 5.

Department of Orthodontics, Saveetha Institute of Medical and Technical Sciences, Saveetha Dental College, Saveetha University, Chennai 600077, India.

Dental biofilm is often found to be the source of bacteria that releases toxins, peptides, lipopolysaccharides as well as organic acids, which lead to gingival inflammation and tooth caries. Further, the persistent plaque may result in the continued destruction of the surrounding soft and hard tissues. During fixed orthodontic therapy, arch-wires, brackets, and elastic modules have been shown to be sites of significant plaque accumulation, making it difficult for a patient to maintain proper oral hygiene. The problem most dentists face is that they cannot visualize this biofilm completely to be able to carry out efficient plaque removal. Visual assessment is, to date, the most common method for plaque visualization, and various indexes have been demonstrated to be sufficient for quantification of the amount of plaque present. However, the problem is that visual assessments are inconsistent, operator dependent and often subjective, which can lead to inconsistency in results. Fluorescence is one such method that can be explored for its use in effective plaque identification and removal. Literature has it that dentists and patients find it particularly useful for monitoring oral hygiene status during treatment. Fluorescence has the capability of offering clinical orthodontists and researchers a new method of detection of demineralization during orthodontic treatment, furthermore, for efficient removal of orthodontic adhesive cements, fluorescent light may be used in conjunction with high-speed burs to deliver fast, less time consuming, and safer results. The benefit of direct visual treatment using fluorescence enhanced theragnosis is that the patient receives controlled and guided therapy. It has multiple benefits, such as early diagnosis of caries, biofilm identification, and even helps to achieve improved treatment outcomes by better resin selection for esthetic procedures.
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http://dx.doi.org/10.3390/dj9080090DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8393472PMC
August 2021

Diagnosis of Biofilm-Associated Peri-Implant Disease Using a Fluorescence-Based Approach.

Dent J (Basel) 2021 Feb 27;9(3). Epub 2021 Feb 27.

Department of Preventive and Restorative Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.

Dental implants have become a routine component of daily dental practice and the demand for dental implants is expected to increase significantly in the future. Despite the high success rates of dental implants, failures do occur, resulting in discomfort, rampant destruction of the oral health, or painful and costly surgical replacement of a failed implant. Peri-implant diseases are inflammatory conditions affecting the soft/hard tissues surrounding a functional dental implant. Plenty of experimental evidence indicates that the accumulation of dental plaque at the soft tissue-implant interface and the subsequent local inflammatory response seems to be key in the pathogenesis of the peri-implant mucositis. Such peri-implant-soft tissue interface is less effective than natural teeth in resisting bacterial invasion, enhancing vulnerability to subsequent peri-implant disease. Furthermore, in certain individuals, it will progress to peri-implantitis, resulting in alveolar bone loss and implant failure. Although early diagnosis and accurate identification of risk factors are extremely important to effectively prevent peri-implant diseases, current systematic reviews revealed that a uniform classification and diagnostic methodology for peri-implantitis are lacking. Recent progress on fluorescence-based technology enabled rapid diagnosis of the disease and effective removal of plaques. Here, we briefly review biofilm-associated peri-implant diseases and propose a fluorescence-based approach for more accurate and objective diagnoses. A fluorescence-based diagnosis tool through headlights combined with special-filtered dental loupes may serve as a hands-free solution for both precise diagnosis and effective removal of plaque-biofilms.
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http://dx.doi.org/10.3390/dj9030024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7996852PMC
February 2021

Use of autofluorescence and fluorescent probes as a potential diagnostic tool for oral cancer: A systematic review.

Photodiagnosis Photodyn Ther 2021 Mar 21;33:102073. Epub 2020 Nov 21.

Department of Morphological Sciences, Institute of Basic Health Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil. Electronic address:

Introduction: The prognosis of patients with Oral squamous cell carcinoma (OSCC) are directly related to the stage of development of the tumor at the time of diagnosis, but it is estimated an average delay in diagnosis of 2-5 months. New non-invasive techniques for the early diagnosis of OSCC are being developed, such as methodologies to detect spectral changes of tumor cells. We conducted a systematic review to analyze the potential use of autofluorescence and/or fluorescent probes for OSCC diagnosis.

Material And Methods: Four databases (PubMed, Scopus, Embase and Web of Science) were used as research sources. Protocol was registered with PROSPERO. It was included studies that evaluated tissue autofluorescence and/or used fluorescent probes as a method of diagnosing and/or treatment of oral cancer in humans.

Results: Forty-five studies were selected for this systematic review, of which 28 dealt only with autofluorescence, 18 on fluorescent probes and 1 evaluated both methods. The VELscope® was the most used device for autofluorescence, exhibiting sensitivity (33%-100%) and specificity (12%-88.6%). 5-Aminolevulinic acid (5-ALA) was the most used fluorescent probe, exhibiting high sensitivity (90%-100%) and specificity (51.3%-96%). Hypericin, rhodamine 6 G, rhodamine 610, porphyrin and γ-glutamyl hydroxymethyl rhodamine green have also been reported.

Conclusion: Thus, the autofluorescence and fluorescent probes can provide an accurate diagnosis of oral cancer, assisting the dentist during daily clinical activity, but it is not yet possible to suggest that this method may replace histopathological examination.
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http://dx.doi.org/10.1016/j.pdpdt.2020.102073DOI Listing
March 2021

Antimicrobial effect of photodynamic therapy on intracanal biofilm: A systematic review of in vitro studies.

Photodiagnosis Photodyn Ther 2020 Dec 25;32:102025. Epub 2020 Sep 25.

Brazilian Lutheran University, ULBRA, Dental School, Av. Farroupila, 8001 Bairro São José, Canoas, RS, CEP 92425-020, Brazil.

Background: Antimicrobial photodynamic therapy (A-PDT), is one of the adjunctive therapies developed to improve the effectiveness of root canal disinfection.. The aim of this study was to analyze the antimicrobial effect of PDT on intracanal biofilm.

Methods: Two reviewers conducted a literature search in PubMed, MEDLINE, Lilacs, SciELO, EMBASE and Google Scholar using the following search strategy: photochemotherapy "[Mesh] OR (photodynamic therapy) AND" dental plaque "[Mesh] OR (dental biofilm) AND (root canal). The following data were collected: publication year, author's name, study site, type of study, participant number, type of photosensitizer, type of laser, method of data collection, application time and results. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS).

Results: After selection based on title, abstract and full text, 27 studies were included in this systematic review. PDT reduced bacterial viability in most studies when combined with conventional endodontic techniques.

Conclusion: PDT reduced bacterial counts in most studies, especially when used as an adjunct to the conventional endodontic technique to treat refractory infection. However, PDT effects on in vitro bacterial biofilm were not accurately quantified because of the numerous biases in the studies reviewed.
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http://dx.doi.org/10.1016/j.pdpdt.2020.102025DOI Listing
December 2020

New antimicrobial and collagen crosslinking formulated dentin adhesive with improved bond durability.

J Mech Behav Biomed Mater 2020 10 3;110:103927. Epub 2020 Jul 3.

UWA Dental School, University of Western Australia, 17 Monash Avenue, Nedlands WA 6009, Australia. Electronic address:

Objective: Here we describe a novel formulation, based on quaternary ammonium (QA) and riboflavin (RF), which combines antimicrobial activities and protease inhibitory properties with collagen crosslinking without interference to bonding capabilities, was investigated.

Methods: Experimental adhesives modified with different fractions of dioctadecyldimethyl ammonium bromide quaternary ammonium and riboflavin (QARF) were formulated. Dentine specimens were bonded to resincomposites with control or the experimental adhesives to be evaluated for bond strength, interfacial morphology, micro-Raman analysis, nano-CT and nano-leakage expression. In addition, the antibacterial and biocompatibilities of the experimental adhesives were investigated. The endogenous proteases activities and their molecular binding-sites were studied.

Results: Modifying the experimental adhesives with QARF did not adversely affect micro-tensile bond strength or the degree of conversion along with the demonstration of anti-proteases and antibacterial abilities with acceptable biocompatibilities. In general, all experimental adhesives demonstrated favourable bond strength with increased and improved values in 1% QARF adhesive at 24 h (39.2 ± 3.0 MPa) and following thermocycling (34.8 ± 4.3 MPa).

Significance: It is possible to conclude that the use of QARF with defined concentration can maintain bond strength values when an appropriate protocol is used and have contributed in ensuring a significant decrease in microbial growth of biofilms. Incorporation of 1% QARF in the experimental adhesive lead to simultaneous antimicrobial and anti-proteolytic effects with low cytotoxic effects, acceptable bond strength and interfacial morphology.
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http://dx.doi.org/10.1016/j.jmbbm.2020.103927DOI Listing
October 2020

The COVID-19 Pandemic and Planetary Health. A Critical Review of Epidemiology, Prevention, Clinical Characteristics and Treatments for Oral, Head and Neck Health Professionals. Do We Have a Roadmap?

Int Arch Otorhinolaryngol 2020 Jul 31;24(3):e351-e358. Epub 2020 Jul 31.

School of Public Health, Columbia University, Columbia, NY, United States of America.

 Coronavirus disease 19 (COVID-19) is potentially the greatest global public health crisis of this century. This disease emerged as an outbreak of pneumonia of unknown cause in Wuhan, the capital city of the Hubei province in China, in December 2019. Otolaryngologists, head and neck surgeons and dentists are at an increased risk of occupational disease.  The present review summarizes currently published evidence of Covid-19 epidemiology, clinical characteristics, treatment and prevention. No proven effective treatments for this disease currently exist.  COVID-19 started from a zoonotic transmission event associated with a large seafood market that also traded in live wild animals, and it soon became clear that efficient person-to-person transmission was also occurring. Symptoms are varied, and not all patients develop all of them.  Social distancing seems to have been successful in several places in the world. However, this recommendation alone is not enough to contain the disease, and it is not a long-term solution. Large-scale testing by health professionals of representative samples of the population may give an estimate of the progression of the disease. Different treatments are under test and bring hope of a cure to the population. However, no current treatments (April 27, 2020) have been proven to be the key to success in the treatment of patients with COVID-19. Planetary health is a useful concept to understand the current drivers of this pandemic and to draw a roadmap for science and healthcare that may guide actions to fight economic depression and ensure a healthy recovery.
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http://dx.doi.org/10.1055/s-0040-1714143DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7394647PMC
July 2020

A micro-CT evaluation of the performance of rotary and reciprocating single-file systems in shaping ability of curved root canals.

Braz Oral Res 2020 30;34:e039. Epub 2020 Apr 30.

Universidade de Ribeirão Preto - UNAERP, Faculty of Dentistry , Ribeirão Preto , SP , Brazil .

To compare the shaping ability of different single-file systems in the preparation of mesial curved canals of mandibular molars using micro-CT technology. Fifteen mesial roots of mandibular molars with two independent and curved canals (n = 30) were selected, scanned at a resolution of 26.7 μm anatomically matched, and distributed into three groups (n = 10), according to the preparation system: WaveOne 25.08, Reciproc 25.08, and OneShape 25.06. A final micro-CT scanning was performed, data sets were registered with their respective counterparts, and compared regarding the three-dimensional (volume, surface area, and structure model index - SMI) and two-dimensional (perimeter, area, roundness, major and minor diameters) parameters, as well as, canal transportation, using ANOVA and post hoc Tukey tests (α = 5%). Overall, no difference was observed between groups regarding area, perimeter, volume, surface area, and canal transportation (p > 0.05). Within group, no canal transportation was significantly higherobserved in the apical third (0.10 ± 0.05 mm) compared to coronal (0.08±0.040 mm) and middle (0.07 ± 0.03 mm) thirds (p < 0.05). Structure model index (SMI) was statistically higher after preparation with OneShape instrument (0.36 ± 0.26) compared to other systems (p < 0.05). Within the parameters of this study, similar shaping ability was observed in the preparation of mesial curved root canals of mandibular molars with Reciproc, OneShape and WaveOne systems.
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http://dx.doi.org/10.1590/1807-3107bor-2020.vol34.0039DOI Listing
May 2020

Reveal: Fluorescence Enhanced Theragnosis by Designs for Vision.

Authors:
Liviu Steier

Eur J Dent 2020 Feb 13;14(1):186-188. Epub 2020 Mar 13.

University of Pennsylvania, Pennsylvania, United States.

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http://dx.doi.org/10.1055/s-0040-1705076DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7069761PMC
February 2020

Effect of a chitosan final rinse on the bond strength of root canal fillings.

Gen Dent 2019 Sep-Oct;67(5):54-57

This study was designed to evaluate the effect of a final rinse with 0.2% chitosan solution on the adhesion in roots filled with gutta percha and an epoxy resin based sealer. Thirty extracted human maxillary canines selected to ensure specimen standardization were used in the study. After the coronal portion of each tooth was removed, the roots were instrumented and irrigated with 1% sodium hypochlorite (NaOCl). Roots were distributed into 3 groups according to the final rinsing solution (n = 10): 0.2% chitosan, 17% ethylenediaminetetraacetic acid (EDTA), or 1% NaOCl. The canals were irrigated with 5 mL of each solution for 5 minutes and then filled with gutta percha cones and the resin based sealer. Ten roots in each group were prepared, sectioned, and submitted to push-out testing. Data were analyzed with analysis of variance and Tukey test (P < 0.05). In the push-out test, final irrigation with chitosan (mean, 0.37 [SD, 0.12] MPa) or EDTA (0.38 [0.11] MPa) resulted in significantly greater bond strength of the sealer to the root canal (P < 0.05) than did irrigation with 1% NaOCl (0.13 [0.04] MPa). The cervical third had greater bond strength than the other thirds (P < 0.05). Adhesive failure was the most frequent type in all groups. A final rinse with 0.2% chitosan or 17% EDTA resulted in greater bond strength of root fillings to the root canal than did 1% NaOCl.
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December 2019

Periradicular inflammatory response, bone resorption, and cementum repair after sealing of furcation perforation with mineral trioxide aggregate (MTA Angelus™) or Biodentine™.

Clin Oral Investig 2019 Nov 12;23(11):4019-4027. Epub 2019 Mar 12.

Department of Oral Biology, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.

Objective: This study assessed tissue responses after furcation perforation and immediate sealing with either Biodentine™ or MTA Angelus™.

Material And Methods: Sixty male Wistar rats were used (n = 6 per group/period). The mandibular first molars had the furcation mechanically exposed and sealed with either MTA or Biodentine™ and restored with silver amalgam. In an additional test group, teeth were sealed only with Biodentine™. Furcation sealing with gutta-percha and silver amalgam restoration served as positive control, and healthy untreated teeth were the negative control. Histological evaluation was performed after 14 or 21 days. Kruskal-Wallis and Dunn's post hoc tests were performed to analyze the extent and intensity of tissue inflammation, bone resorption, and cementum repair (p < 0.05).

Results: Biodentine™ and MTA presented satisfactory results, showing a milder inflammatory response when compared to the control, regardless of the material used for coronal sealing and of the experimental period evaluated (p < 0.0001). All test groups showed less bone resorption than the positive control after 21 days (p < 0.05), and such differences were more pronounced in teeth restored with silver amalgam. Cementum repair was performed in 30% of MTA and Biodentine™ samples but not carried out in any positive control specimen.

Conclusions: Biodentine™ and MTA promoted similar responses when used to seal furcation perforations and should therefore be regarded as a promising alternative.

Clinical Relevance: Knowledge about tissue responses to restorative materials is essential for improving root perforation sealing protocols. The present results showed that both Biodentine™ and MTA promoted appropriate periradicular tissue reactions in a preclinical test for evaluating furcation perforation treatments.
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http://dx.doi.org/10.1007/s00784-019-02833-zDOI Listing
November 2019

Bacteriophages in Dentistry-State of the Art and Perspectives.

Dent J (Basel) 2019 Jan 9;7(1). Epub 2019 Jan 9.

Department of Morphological Sciences, Federal University of Rio Grande do Sul-UFRGS, Porto Alegre 90040-060, Brazil.

Bacteriophages, viruses capable of killing bacteria, were discovered in 1915, but the interest in their study has been limited since the advent of antibiotics. Their use in dentistry is still very limited. The authors reviewed studies about bacteriophage structure, mode of action, uses in oral health, and possible future uses in dentistry associated with their possible action over biofilm, as well as the advantages and limitations of phage therapy.
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http://dx.doi.org/10.3390/dj7010006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6473837PMC
January 2019

Physicochemical Properties and Volumetric Change of Silicone/Bioactive Glass and Calcium Silicate-based Endodontic Sealers.

J Endod 2017 Dec 9;43(12):2097-2101. Epub 2017 Oct 9.

Department of Restorative Dentistry, Araraquara Dental School, São Paulo State University, Araraquara, São Paulo, Brazil.

Introduction: This study evaluated setting time (ST), radiopacity, pH, flow, solubility, and volumetric change (VC) of a silicone, gutta-percha, and bioactive glass-based sealer, GuttaFlow Bioseal (GFB), and a calcium silicate-based sealer, TotalFill BC Sealer (TFBC), in comparison with AH Plus.

Methods: ST and flow were evaluated in accordance with the ISO 6876 Standard. pH was evaluated after different time intervals (1, 3, 7, 14, 21, and 28 days). Radiopacity was evaluated by radiographic analysis in millimeters of aluminum. Solubility was evaluated by means of mass loss (%) after 7 and 30 days of immersion in distilled water. VC was evaluated by micro-computed tomography, by using cavities 3 mm deep and 1 mm in diameter in acrylic resin, filled with the materials. The materials were evaluated after setting and after 7 and 30 days of immersion in distilled water. The data were submitted to analysis of variance and Tukey statistical tests (P < .05).

Results: TFBC demonstrated the highest pH and solubility. GFB had the shortest ST, and lowest radiopacity and flow values. VC was similar for the sealers in both time intervals.

Conclusions: TFBC presented the highest pH and solubility, but showed similar VC to GFB and AH Plus. GFB showed proper physicochemical properties. Micro-computed tomography complements the physicochemical analysis of endodontic sealers.
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http://dx.doi.org/10.1016/j.joen.2017.07.005DOI Listing
December 2017

Uncertain Decision-Making in Primary Root Canal Treatment.

J Evid Based Dent Pract 2017 Sep 28;17(3):205-215. Epub 2017 Jan 28.

Warwick Medical School, University of Warwick, Coventry, West Midlands, United Kingdom.

Objectives: A systematic review of literature was conducted to compare the success and survivability of primary root canal interventions.

Methods: The Preferred Reporting Items for Systematic Reviews and Meta Analyses protocol was adopted in this study to systematically assess and report systematic reviews related to success or survival or failure rates of primary root canal interventions. MEDLINE and Cochrane Oral Health Library were both searched by using specific search terms to identify relevant literature, until June 2016. The search was augmented by handsearching. Then, the quality of the included systematic reviews was assessed by using the Revised Assessment of Multiple Systematic Reviews (RAMSTAR) protocol.

Results: Only 9 systematic reviews were identified. The RAMSTAR scores of the included reviews ranged from 43/44 to 29/44. Nevertheless, the later reviews did not provide sufficient evidence or statistically significant evidence to support any of the interventions used during primary root canal treatment. In addition, a number of key steps during primary root canal treatment, such as types of dental files, root canal instrumentation techniques, orthograde obturation materials, and techniques, were not assessed by systematic reviews.

Conclusion: The current status of evidence related to the success and survivability of primary root canal interventions is lacking. This puts dentists under marked degrees of uncertainty. Consequently, patients are potentially exposed to health care risks. It is then essential to develop tailored methods and tools for decision-making under uncertainty to aid both dentists and patients engaged in primary root canal treatment.
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http://dx.doi.org/10.1016/j.jebdp.2017.01.001DOI Listing
September 2017

Evaluation of the physicochemical properties of silicone- and epoxy resin-based root canal sealers.

Braz Oral Res 2017 Aug 21;31:e72. Epub 2017 Aug 21.

Universidade de São Paulo - USP, School of Dentistry of Ribeirão Preto, Department of Restorative Dentistry, Ribeirão Preto, SP, Brazil.

To assess the physicochemical properties of AH Plus, GuttaFlow 2, GuttaFlow BioSeal, and MM Seal, five samples of each root canal sealer were evaluated to determine their setting time (ST), dimensional change (DC), solubility (SL), flow (FL), and radiopacity (RD) according to American National Standards Institute/American Dental Association (ANSI/ADA) Specification 57. The distilled and deionized water obtained from the SL test were subjected to atomic absorption spectrometry to observe the presence of Ca2+, K+, and Na+ ions. Statistical analysis was performed by using one-way ANOVA and Tukey-Kramer tests (p < 0.05). The following results were obtained: ST (min) (AH Plus 463.6 ± 13.22; GuttaFlow 2 24.35 ± 2.78; GuttaFlow Bioseal 17.4 ± 0.55; MM Seal 47.60 ± 4.39), DC (%) (AH Plus 0.06 ± 0.12; GuttaFlow 2 -26.06 ± 1.24; GuttaFlow Bioseal 2.10 ± 1.47; MM Seal 8.47 ± 2.41), SL (%) (AH Plus 0.41 ± 0.21; GuttaFlow 2 5.13 ± 4.11; GuttaFlow Bioseal 3.03 ± 1.05; MM Seal 0.94 ± 0.17), FL (mm) (AH Plus 36.42 ± 0.40; GuttaFlow 2 36.44 ± 0.05; GuttaFlow Bioseal 35.4 ± 0.03; MM Seal 52.75 ± 0.60), and RD (mmAl) (AH Plus 7.52 ± 1.59; GuttaFlow 2 6.85 ± 0.14; GuttaFlow Bioseal 7.02 ± 0.18; MM Seal 3.32 ± 0.90). ST, DC, SL, FL, and RD showed statistical differences among the root canal sealers (p < 0.05). As AH Plus showed the lowest DC and SL values (p < 0.05), the findings indicate that this sample is the only sealer conforming to ANSI/ADA standards.
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http://dx.doi.org/10.1590/1807-3107BOR-2017.vol31.0072DOI Listing
August 2017

Histopathological, Microbiological, and Radiographic Analysis of Antimicrobial Photodynamic Therapy for the Treatment of Teeth with Apical Periodontitis: A Study in Rats' Molars.

Photomed Laser Surg 2017 Jul 9;35(7):364-371. Epub 2017 Mar 9.

1 Postgraduate Program in Dentistry, Pontifical Catholic University of Rio Grande do Sul (PUCRS) , Porto Alegre, RS, Brazil .

Objective: The aim of this study was to evaluate in vivo, by histological and radiographic analysis, the response of apical tissues of rats' teeth with experimentally induced apical periodontitis, after one- and two-session endodontic treatment with and without photodynamic therapy (PDT). A microbiological analysis was also performed to verify bacterial reduction after each treatment.

Background Data: Studies carried out in recent years highlighted the antibacterial potential of PDT when associated with conventional endodontic therapy in vitro. Although the antimicrobial effect of PDT is well-established, tissue response to PDT in teeth with apical periodontitis lacks studies.

Methods: Thirty-two rats' root canals were assigned to four groups: one session/PDT-[chemomechanical preparation (CMP)+root canal filling (RCF)]; two sessions/PDT- [CMP+calcium hydroxide (CH) for 14 days+RCF]; one session/PDT+ [CMP+PDT+RCF], and two sessions/PDT+ [CMP+PDT+CH for 14 days+RCF]. For microbiological evaluation, samples were collected before and after proposed treatments. For radiographic and histological analysis, the animals were euthanized after 28 days and the mandibles surgically removed.

Results: PDT associated with conventional endodontic therapy was able to promote significant bacterial reduction in root canals with induced apical periodontitis, but this reduction was not significantly different to conventional endodontic therapy alone. Although radiographic evaluation showed no significant differences, histological analysis showed lower scores for neutrophils/eosinophils in PDT-treated groups and macrophages/giant cells in CH groups.

Conclusions: The use of low-level laser as light source did not promote major improvement on radiographic and histological repair, but since the number of inflammatory cells slightly decreased, it may optimize repair by modulating inflammatory process. PDT may be indicated as an adjunct to conventional endodontic therapy for teeth with apical periodontitis, in association with an interappointment dressing with CH, in an attempt to produce better conditions to stimulate repair.
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http://dx.doi.org/10.1089/pho.2016.4102DOI Listing
July 2017

Biological Tissue Response to a New Formulation of a Silicone Based Endodontic Sealer.

Braz Dent J 2016 Oct-Dec;27(6):657-663

Department of Conservative Dentistry, Dental School, UFRS - Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.

Satisfactory biological behavior is a necessary requirement for clinical application of endodontic materials. In this study, the connective tissue responses to silicone (GuttaFlow 2), epoxy resin (AH Plus) and zinc oxide and eugenol (Endofill) based sealers were compared. Twelve Wistar rats had polyethylene tubes (four per animal) containing one of the tested sealers and empty tubes (negative control) implanted in their subcutaneous tissue. The tubes were randomly placed 2 cm from the spine and at least 2 cm apart from one another. Tissue samples with implants were processed for histological analysis after 7 or 60 days (n=6 animals per period). Inflammatory cells, fibrous condensation and abscess were scored according to their intensity. Friedman, followed by Dunn's post hoc, was used to compare sealers. Differences between the two experimental periods were verified using Mann-Witney U test (p<0.05). At 7 days, most of the histological parameters showed no significant differences amongst groups. Endofill group scored higher than the others for giant cells (o<0.05) and promoted a greater number of samples presenting abscess formation. GuttaFlow 2 tended to show a less intense inflammatory infiltrate compared to the other materials. At 60 days, there were no significant differences between groups in most of the histological parameters evaluated. However, it was observed that Endofill scored higher for macrophages (p<0.05) compared to the control group, and GuttaFlow 2 tended to present lower scores than the others for neutrophils and abscess. GuttaFlow 2 showed proper biological behavior and should be considered adequate for clinical practice.
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http://dx.doi.org/10.1590/0103-6440201600719DOI Listing
April 2017

Longevity of Self-etch Dentin Bonding Adhesives Compared to Etch-and-rinse Dentin Bonding Adhesives: A Systematic Review.

J Evid Based Dent Pract 2016 Jun 29;16(2):96-106. Epub 2016 Mar 29.

University of Warwick, Coventry, UK.

Objectives: A systematic review and meta-analysis were performed to compare longevity of Self-Etch Dentin Bonding Adhesives to Etch-and-Rinse Dentin Bonding Adhesives.

Material And Methods: The following databases were searched for PubMed, MEDLINE, Web of Science, CINAHL, the Cochrane Library complemented by a manual search of the Journal of Adhesive Dentistry. The MESH keywords used were: "etch and rinse," "total etch," "self-etch," "dentin bonding agent," "bond durability," and "bond degradation." Included were in-vitro experimental studies performed on human dental tissues of sound tooth structure origin. The examined Self-Etch Bonds were of two subtypes; Two Steps and One Step Self-Etch Bonds, while Etch-and-Rinse Bonds were of two subtypes; Two Steps and Three Steps. The included studies measured micro tensile bond strength (μTBs) to evaluate bond strength and possible longevity of both types of dental adhesives at different times. The selected studies depended on water storage as the aging technique. Statistical analysis was performed for outcome measurements compared at 24 h, 3 months, 6 months and 12 months of water storage.

Results: After 24 hours (p-value = 0.051), 3 months (p-value = 0.756), 6 months (p-value=0.267), 12 months (p-value=0.785) of water storage self-etch adhesives showed lower μTBs when compared to the etch-and-rinse adhesives, but the comparisons were statistically insignificant.

Conclusion: In this study, longevity of Dentin Bonds was related to the measured μTBs. Although Etch-and-Rinse bonds showed higher values at all times, the meta-analysis found no difference in longevity of the two types of bonds at the examined aging times.
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http://dx.doi.org/10.1016/j.jebdp.2016.03.003DOI Listing
June 2016

LPS levels in root canals after the use of ozone gas and high frequency electrical pulses.

Braz Oral Res 2016 15;30. Epub 2016 Mar 15.

Clinical Department, School of Dentistry, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil.

The present study aims to verify the effect of ozone gas (OZY® System) and high frequency electric pulse (Endox® System) systems on human root canals previously contaminated with Escherichia colilipopolysaccharide (LPS). Fifty single-rooted teeth had their dental crowns removed and root lengths standardized to 16 mm. The root canals were prepared up to #60 hand K-files and sterilized using gamma radiation with cobalt 60. The specimens were divided into the following five groups (n = 10) based on the disinfection protocol used: OZY® System, one 120-second-pulse (OZY 1p); OZY® System, four 24-second-pulses (OZY 4p); and Endox® System (ENDOX). Contaminated and non-contaminated canals were exposed only to apyrogenic water and used as positive (C+) and negative (C-) controls, respectively. LPS (O55:B55) was administered in all root canals except those belonging to group C-. After performing disinfection, LPS samples were collected from the canals using apyrogenic paper tips. Limulus Amoebocyte Lysate (LAL) was used to quantify the LPS levels, and the data obtained was analyzed using one-way ANOVA. The disinfection protocols used were unable to reduce the LPS levels significantly (p = 0.019). The use of ozone gas and high frequency electric pulses was not effective in eliminating LPS from the root canals.
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http://dx.doi.org/10.1590/1807-3107BOR-2016.vol30.0019DOI Listing
May 2016

In vitro antibacterial activity of a silicone-based endodontic sealer and two conventional sealers.

Braz Oral Res 2016 23;30. Epub 2016 Feb 23.

Laboratory of Immunology and Microbiology, School of Biosciences, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil.

The aim of this study was to evaluate whether the modification in the silver component is capable of providing GuttaFlow 2 with antibacterial activity against Enterococcus faecalis compared with epoxy resin-based (AH Plus) and zinc oxide and eugenol-based (Endofill) sealers. The antibacterial activity was evaluated using a reference strain of E. faecalis (ATCC 29212). Freshly mixed sealers were subjected to the agar diffusion test (ADT), while the direct contact test (DCT) was performed after materials setting. ADT results were obtained through measurements, in millimeters, of the inhibition zones promoted by the materials, using a digital caliper. In DCT, values of CFU/mL promoted by the three sealers were compared in three experimental periods (1 min, 1 h, and 24 h). The data were analyzed using Kruskal-Wallis and Dunn post-hoc tests (p < 0.05). In both ADT and DCT, GuttaFlow 2 presented no effect against E. faecalis, while Endofill and AH Plus showed similar inhibition zones. Endofill was the only material capable of reducing bacterial growth in DCT. In conclusion, modifications in the silver particle of GuttaFlow 2 did not result in a sealer with antibacterial effect against E. faecalis.
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http://dx.doi.org/10.1590/1807-3107BOR-2016.vol30.0018DOI Listing
May 2016

Polytetrafluoroetylene tape as temporary restorative material: a fluid filtration study.

J Istanb Univ Fac Dent 2015 21;49(3):17-22. Epub 2015 Oct 21.

Department of Endodontics, Faculty of Dentistry, Selçuk University, Turkey.

Purpose: The purpose of this study was to compare the sealing ability of temporary restorative materials at 24 hrs and 1 week.

Materials And Methods: Endodontic access cavities were prepared in 56 extracted lower incisor-teeth and divided into 5 groups (n=10). Standard 5 mm deep access preparations were completed and root canals were prepared to size ISO #30 file. The access cavities were restored as follows: Group 1: temporary restorative material (Ceivitron); Group 2: glass ionomer cement (Fuji II); Group 3: zinc oxide-eugenol cement (IRM); Group 4: zinc phosphate cement (Adhesor); Group 5: polytetrafluoroetylene tape (PTFE). The quality of the coronal sealing of each specimen was measured (24 hrs and 1 week) using fluid transport model. The data was analyzed with repeated measurements ANOVA, Tukey' HSD and Paired samples T-Tests.

Results: A significant difference was found among the groups at all time-periods (p<0.05). At 24 hrs, PTFE showed similar leakage with Ceivitron, IRM, and Fuji II but it showed higher leakage than Adhesor. At 1 week, Ceivitron showed higher leakage than PTFE, meanwhile PTFE showed similar leakage with IRM, Fuji II, and Adhesor (p>0.05). Sealing ability of IRM and PTFE groups significantly increased by time (p<0.05 and p<0.001 respectively).

Conclusion: Within the limitations of this study, PTFE showed an acceptable short-term sealing capability when compared to the other commonly used temporary restorative materials at 1 week measurements.
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http://dx.doi.org/10.17096/jiufd.08659DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573500PMC
October 2015

New methodology to evaluate bond strength of root-end filling materials.

Braz Dent J 2015 May-Jun;26(3):288-91

School of Dentistry of Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil.

This study evaluated the bond strength of root-end filling materials to root-end cavities using a new methodology. Twenty maxillary central incisors were subjected to biomechanical preparation (#80 hand file) and sectioned transversally 2 mm short of the apex and 4 mm coronally to this point. The root cylinders were embedded in acrylic resin and positioned at 45° to the horizontal plane for preparation of root-end cavities with a diamond ultrasonic retrotip. Two groups (n=10) were formed according to the root-end filling material: MTA and Super EBA. A gutta-percha cone (#80) was tug-backed at the limit between the canal and the root-end cavity. The cavity was filled and the gutta-percha cone was removed after complete setting of the sealer. The specimens were placed in an Instron machine with the root-end filling turned downwards. The push-out shaft was inserted in the space previously occupied by the gutta-percha cone and run at a crosshead speed of 1.0 mm/min for pushing out the root-end filling material. Data were analyzed by ANOVA (α=5%). Super EBA (6.03±1.31) presented higher bond strength (MPa) than MTA (1.81±0.45) (p>0.05). There was a predominance of cohesive failures for Super EBA and mixed for MTA. The protocol of specimen preparation is effective and introduces a specific methodology for assessing bond strength of root-end filling materials to dentin. Among the materials, Super EBA presented the highest bond strength.
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http://dx.doi.org/10.1590/0103-6440201300189DOI Listing
January 2017

Effect of different irrigating solutions and photo-activated therapy for in vivo root canal treatment.

Braz Dent J 2015 May-Jun;26(3):228-33

Post-Graduate Program in Dentistry, Dental School, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil.

This study aimed to evaluate histologically the effect of irrigation with 400 ppm Sterilox, 2% and 5% sodium hypochlorite (NaOCl), with and without photo-activated therapy (PAD), in a single-visit root canal treatment of dog's teeth with apical periodontitis (AP). Ten dogs were randomly divided into two groups (n=5): with and without PAD, and the root canals into four subgroups, according to the irrigating solution: SX (400 ppm Sterilox), SH2 (2% NaOCl), SH5 (5% NaOCl) and SS (saline solution) as positive control. A total of 134 root canals were opened and left exposed to the oral environment for 14 days and then sealed for 60 days for AP induction. Then, root canals were treated according to each proposed disinfecting protocol and filled in the same session. After 120 days, the dogs were euthanized and the periapical inflammatory events were evaluated under light microscopy. Qualitative data were submitted to Kruskal-Wallis and Mann-Whitney tests (α=0.05). PAD did not produce significant differences in the scores for apical inflammation when used after chemo-mechanical preparation (p>0.05). The irrigating solutions SX, SH2 and SH5 without PAD were statistically different from SS (p<0.05) that presented the greatest scores for apical inflammation. PAD did not show any additional effect for the treatment of root canals with pulp necrosis and AP in a single visit and 400 ppm Sterilox may be considered an alternative to NaOCl in root canal treatment.
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http://dx.doi.org/10.1590/0103-6440201300154DOI Listing
January 2017

Effect of superoxidized water and sodium hypochlorite, associated or not with EDTA, on organic and inorganic components of bovine root dentin.

J Endod 2015 Jun 17;41(6):925-30. Epub 2015 Mar 17.

Department of Endodontics, School of Dentistry, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.

Introduction: This study aimed to evaluate the effects of Sterilox (Sx), a superoxidized water, 5% and 2% sodium hypochlorite (5NaOCl and 2NaOCl), and 17% EDTA (E) on the organic and inorganic components of bovine dentin.

Methods: Eighty bovine incisors were randomly divided into 8 groups (n = 10): 5NaOCl, 5NaOCl + E, 2NaOCl, 2NaOCl + E, Sx, Sx + E, E alone, and distilled water (H2O). Root canal instrumentation was performed by using the corresponding irrigant. The apical 15 mm was longitudinally sectioned into 2 fragments, one for light microscopy analysis in slides stained with picrosirius red (organic component) and the other for scanning electron microscopy analysis (inorganic component). Scores data obtained in the light microscopy analysis were submitted to the Kruskal-Wallis test, followed by multiple comparisons test (P < .05). Scanning electron microscopy images were analyzed descriptively.

Results: The chemical solution 5NaOCl had a greater effect on the organic component of dentin in area and depth than 2NaOCl. The chemical solutions 5NaOCl + E, 5NaOCl and 2NaOCl + E caused the greatest change in the collagenous organic matrix near the root canal lumen. The chemical solution 2NaOCl showed similar behavior to Sx, associated or not with E, promoting more superficial disorganization of collagen in a smaller area. Demineralization was observed in all groups in which E was used. However, areas of erosion and open dentinal tubules were detected only when it was combined with NaOCl.

Conclusions: Five percent NaOCl promoted the most extensive damage to the organic component of dentin, and when associated to EDTA, dentinal erosion could be seen. Considering these specific aspects, 2% NaOCl and Sx had milder effects on bovine root dentin.
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http://dx.doi.org/10.1016/j.joen.2015.01.039DOI Listing
June 2015

Photodynamic therapy in endodontics: a literature review.

Photomed Laser Surg 2015 Mar 26;33(3):175-82. Epub 2015 Feb 26.

1 Postgraduate Program in Dentistry, Pontifical Catholic University of Rio Grande do Sul , Porto Alegre, Rio Grande do Sul, Brazil .

Recently, several in vitro and in vivo studies demonstrated promising results about the use of photodynamic therapy during root canal system disinfection. However, there is no consensus on a standard protocol for its incorporation during root canal treatment. The purpose of this study was to summarize the results of research on photodynamic therapy in endodontics published in peer-reviewed journals. A review of pertinent literature was conducted using the PubMed database, and data obtained were categorized into sections in terms of relevant topics. Studies conducted in recent years highlighted the antimicrobial potential of photodynamic therapy in endodontics. However, most of these studies were not able to confirm a significant improvement in root canal disinfection for photodynamic therapy as a substitute for current disinfection methods. Its indication as an excellent adjunct to conventional endodontic therapy is well documented, however. Data suggest the need for protocol adjustments or new photosensitizer formulations to enhance photodynamic therapy predictability in endodontics.
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http://dx.doi.org/10.1089/pho.2014.3776DOI Listing
March 2015

Effect of super-oxidized water, sodium hypochlorite and EDTA on dentin microhardness.

Braz Dent J 2014 Sep-Oct;25(5):420-4

Department of Endodontics, School of Dentistry, PUCRS - Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.

The present study aimed to evaluate the influence of the following irrigating solutions on the microhardness of root canal dentin: 2% sodium hypochlorite (2NaOCl), 5% sodium hypochlorite (5NaOCl), super-oxidized water (400 ppm Sterilox - Sx) and 17% EDTA (E). Eighty roots from bovine incisors were randomly divided into 8 groups (n=10): 2NaOCl, 5NaOCl, Sx, and 2NaOCl + E, 5NaOCl + E, Sx + E (associated with E as final irrigant for 5 min), E solely and distilled water (dH2O) as the negative control. Root canal preparation was performed by hand instruments, using one of the irrigation protocols for 30 min. Then, 5 mm of the cervical root third were cut out from each sample and subjected to the Vickers microhardness test, at two points, one at approximately 500-1000 µm from the root canal lumen (distance 1), and the other at approximately 500-1000 µm from the external root surface (distance 2). Data were analyzed by Wilcoxon and Kruskal-Wallis tests at 5% significance level. Microhardness values at distance 1 were significantly lower than those at distance 2 for all groups, except 5NaOCl and 5NaOCl + E groups (p>0.05). EDTA showed the lowest microhardness values. However, no statistically significant difference was detected among groups at distance 1 and EDTA was significantly different only from Sx at distance 2. In conclusion, all tested solutions showed lower microhardness at the most superficial root canal dentin layer compared to the one found near the external root surface, except 5NaOCl and 5NaOCl + E; EDTA promoted lower microhardness values in comparison to Sterilox at this site.
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http://dx.doi.org/10.1590/0103-6440201300129DOI Listing
November 2016

3D mapping of the irrigated areas of the root canal space using micro-computed tomography.

Clin Oral Investig 2015 May 4;19(4):859-66. Epub 2014 Sep 4.

Department of Endodontics, Dental School of Ribeirão Preto, University of São Paulo, Av. Do Café s/n, Bairro Monte Alegre, Ribeirão, Preto-SP, CEP 14.040-904, Brazil,

Objectives: The aim of this study was to introduce a methodology to map irrigant spreadability within the root canal space using micro-computed tomography (micro-CT).

Materials And Methods: Mandibular molars presenting Vertucci's types I and II canal configurations were selected, and four scans using isotropic resolution of 19.5 μm were accomplished per tooth: prior to treatment (S1), after glide path (S2) and after root canal preparation (S3 and S4). A contrast solution (CS) was used to irrigate the canals at stages S2 and S4. The touched and untouched surface areas of the canals, the volume of irrigant-free areas and the percentage volume occupied by the CS were calculated. Density, surface tension and the spread pattern of the CS and 2.5% NaOCl were also evaluated.

Results: In the type I mesial root, there was an increase in the percentage volume of free-irrigated areas from S2 to S4 preparation steps, whilst in the distal roots and type II mesial root, a decrease of irrigant-free areas was observed. The use of CS allowed the quantification of the touched surface area and the volume of the root canal occupied by the irrigating solution. Density (g/mL) and surface tension (mN/m) of the CS and 2.5% NaOCl were 1.39 and 47.5, and 1.03 and 56.2, respectively. Besides, a similar spread pattern of the CS and 2.5% NaOCl in a simulated root canal environment was observed.

Conclusions: This study introduced a new methodology for mapping the irrigating solution in the different stages of the root canal preparation and proved useful for in situ volumetric quantification and qualitative evaluation of irrigation spreading and irrigant-free areas.

Clinical Relevance: Micro-computed tomographic technology may provide a comprehensive knowledge of the flush effectiveness by different irrigants and delivery systems in order to predict the optimal cleaning and disinfection conditions of the root canal space.
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http://dx.doi.org/10.1007/s00784-014-1311-5DOI Listing
May 2015

Influence of drying protocol with isopropyl alcohol on the bond strength of resin-based sealers to the root dentin.

J Endod 2014 Sep 13;40(9):1454-8. Epub 2014 Apr 13.

Department of Restorative Dentistry, Dental School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil. Electronic address:

Introduction: This study compared the bond strength, interfacial ultrastructure, and tag penetration of resin-based sealers applied to smear-free radicular dentin using 70% isopropyl alcohol as the active final rinse.

Methods: Eighty root canals were prepared and assigned to 2 groups (n = 40) according to the drying protocol: paper points or 70% isopropyl alcohol. Then, roots were divided into 4 subgroups (n = 10) with respect to the sealer and obturation material: AH Plus (Dentsply De Trey GmbH, Konstanz, Germany) and gutta-percha (AH/GP), Hybrid Root SEAL (Sun Medical, Tokyo, Japan) and gutta-percha (HR/GP), Epiphany SE (Pentron Clinical Technologies, Wallingford, CT) and gutta-percha (EP/GP), and Epiphany SE and Resilon (EP/RS). Roots were sectioned, and the push-out test was performed. Failure modes were examined under stereomicroscopy and sealer penetration into the dentinal tubules under scanning electron microscopy. Data were statistically analyzed by 2-way analysis of variance post hoc Tukey tests with a significant level of 5%.

Results: Overall, canals dried with isopropyl alcohol showed significantly higher bond strength values (2.11 ± 1.74 MPa) than with paper points (1.81 ± 1.73 MPa) (P < .05). The HR/GP group showed lower bond strength than the AH/GP group (P < .05) but higher than the EP/GP and EP/RS groups (P < .05). The most frequent type of failure was cohesive in the AH/GP and HR/GP groups and adhesive in the EP/GP and EP/RS groups. Scanning electron microscopic evaluation revealed better adaptation of the adhesive interface in the AH/GP and HR/GP groups in comparison with the EP/GP and EP/RS groups.

Conclusions: A final rinse with EDTA and 70% isopropyl alcohol improved the bond strength and penetration of the sealers into dentinal tubules of the root.
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http://dx.doi.org/10.1016/j.joen.2014.02.021DOI Listing
September 2014

Maxillary sinus unilateral aplasia as an incidental finding following cone-beam computed (volumetric) tomography.

Aust Endod J 2014 Apr 15;40(1):26-31. Epub 2012 Nov 15.

Postgraduate Dental Education Unit, Institute of Clinical Education, Warwick Medical School, University of Warwick, Coventry, UK.

This paper presents a case of maxillary sinus unilateral aplasia, an uncommon condition in adults, diagnosed as an incidental finding during cone-beam computed tomography (CBCT) examination for an endodontic case analysis. The patient was referred to a specialist endodontic practice for management of an upper right central incisor tooth. A CBCT scan was performed. The images of the left maxillary sinus showed a total lack of pneumatisation, prompting the diagnosis of aplasia. The patient's otolaryngologist was made aware of the findings. Clinical evaluation of volumetric images should be performed by an adequately trained dentist or radiologist so the maximum amount of information is gathered for the patient. This requires a systematic approach to ensure that no relevant information is missed and should include the paranasal sinuses and other surrounding structures as incidental findings can be observed during CBCT analysis.
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http://dx.doi.org/10.1111/aej.12001DOI Listing
April 2014

Bovine pulp tissue dissolution ability of HealOzone®, Aquatine Alpha Electrolyte® and sodium hypochlorite.

Aust Endod J 2013 Aug 5;39(2):57-61. Epub 2010 Nov 5.

Postgraduate Dental Education Unit, Institute of Clinical Education, Warwick Medical School, University of Warwick, Coventry, UK.

The aim of this study was to evaluate the bovine pulp tissue dissolution ability of HealOzone, Aquatine Alpha Electrolyte® and 0.5% sodium hypochlorite, used alone or in combination. Thirty bovine pulp fragments were weighed, divided into six groups and placed individually in Eppendorf tubes containing the tested solution until total dissolution occurred. The groups were: G1: saline (negative control), G2: Aquatine Alpha Electrolyte®, G3: 0.5% NaOCl (positive control), G4: Saline + HealOzone, G5: 0.5% NaOCl + HealOzone, G6: Aquatine Alpha Electrolyte® + HealOzone. HealOzone was activated for 2 min with a #6 cup covering the test tube opening on a fixed platform. Two blinded observers using 2× loupes magnification assessed the samples continuously for the first 2 h, and then every hour for the next 8 h. Dissolution speed was calculated by dividing pulp weight by dissolution time (mg min(-1) ). G3 (NaOCl) and G5 (NaOCl + HealOzone) dissolved the pulp tissue completely. The mean dissolution speed for G3 was 0.396 mg min(-1) (SD 0.032) and for G5 was 0.775 mg min(-1) (SD 0.2). Student's t-test showed that G5 dissolved bovine pulp tissue faster than G3 (P = 0.01). Only groups containing sodium hypochlorite dissolved pulp tissue, whilst HealOzone enhanced speed of dissolution.
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http://dx.doi.org/10.1111/j.1747-4477.2010.00287.xDOI Listing
August 2013
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