Volume 11 Issue 3 - 2020
Rúbia Moura Leite Boczar,1 Daniela Francescato Veiga,1 Yara Juliano,2 Taylor Brandão Schnaider,1 José Dias da Silva Neto1
1Student of Professional Master’s Program in Science Applied of Health, University of Vale do Sapucaí, Brazil - 2Department of Biostatistics, University of Vale do Sapucaí,Brazil
Correspondence: Jose Dias da Silva Neto, Professional Master’s Program in science Applied of Health, Universidade do Vale do Sapucaí, Pouso Alegre-MG, Av. Prefeito Tuany Toledo 470, Fátima I, CEP 37550-000, Brazil, Tel 5535-344-99248, 5535984321520, Email
Received: May 07, 2020 | Published: June 17, 2020
Abstract
Statement of the problem: The bioceramic cements have properties that provide periradicular and root regeneration. Attributes that determine regenerative dentistry.
Purpose: the objective of this study was to evaluate endodontic treatments of necrotic teeth performed with PBS HP CIMMO® cement (without gutta-percha), compared to conventional treatments, filled with gutta-percha.
Materials and method: A two-arm, double-blind, single-center, randomized, and prospective clinical trial was designed (NCT03514264). CONSORT guidelines were followed. Eighty-six patients aged 18-60 years were enrolled; only one tooth per patient was treated. Patients were treated in two sessions in Group A (gutta-percha thermoplasticization and vertical hydraulic compresssion and AH Plus® n=43) and one session in Group B (PBS HP CIMMO® n=43). The evaluation was performed one year after the treatment. Two examiners performed clinical examinations and evaluated CT images for the presence or absence of periradicular lesion. Intention-to-treat analysis was used.
Results: Tomographic analyzes showed differences between the groups: group B (PBS HP CIMMO®) presented a higher number of cases with periradicular regeneration (p=0.0004).
Conclusion: The results of the present study indicated the possibility of rehabilitation of necrotic teeth through endodontic filling with bioceramic (PBS HP CIMMO®), without gutta-percha, in a single session.
Keywords: endodontic canal system, biomaterials, endodontic dentin system, periapical periodontitis, dental materials
Abbreviations: GP, guttapercha; BECs, bioactive endodontic cements; PUI, passive ultrasound irrigation; CT, computed tomography; Univás, university of vale do sapucaí; ASA, american society of anesthesiologists; physical fitness classification; X2, Chi square test;p, statistical hypothesis testing
Introduction
The pathogenesis of the infection endodontic is complex and requires treatment that rehabilitates the root with hermetic sealing, determine to regression of the lesion, and ensures tooth regeneration while avoiding re-infection.1–5
There are two methods of endodontic treatment of necrotic teeth: single session and double session. Double session treatment involves introducing intra-canal medication into the root canals and temporary tooth restoration for 4 weeks, after which, endodontic obturation is performed in the second session. The most commonly used intra-canal medication in endodontics is calcium hydroxide.6–9
The obtaining airtight obturation of root canals is the goal of endodontic treatment, promoting proper rehabilitation that prevents re-infection and provide regression of alveolar lesions.1 The most common technique for endodontic filling is using guttapercha (GP) cones (a thermoplastic material containing 70% zinc oxide) along with cement.10 This material occupies approximately 75% of the canal volume, while the remaining 25% is filled with cement.11
Gutta-percha is a biocompatible element; however, there is evidence of its longterm degradation, a situation that favors reinfection.12 For this reason, there is controversy regarding the execution of this technique (gutta percha and cement) in a single session. Thus, it is recommended to perform the procedure for necrotic teeth in two sessions. In the initial session, after instrumentation, the intra-canal medication is installed for a period of four weeks, which determines alkalinization and degradation of microbiota in the dentinal canaliculi.13
There are several types of cement available on the market, routinely incorporated to GP cones in endodontic filling. The most commonly used cements are resin cements such as AHPlus Dentsply®10 and ready-to-usebioceramic cements such as BC Sealer EndoSequence®.14 Resin cements have favorable properties such as biocompatibility, flowability and channel adhesion and GP, but are not bioactive.10
Ready-to-use bioceramics show bioactivity, but their longevity after obturation and degree of adhesion are controversial because they are ready for use and do not require mixing or the use of activators. This hydrophilic material is derived from calcium silicate and is incorporated into polymers for increased flow, but requires water to harden. These bio-cements make up less than a third of the total filling material used during obturation because most of the canal is filled with GP.10–15
Bioactive calcium silicate cements provide an innovative perspective on endodontic treatment because of their property of volumetric expansion and their ability to trigger the nucleation
of hydroxyapatite deposits to reduce marginal porosities and seal discrepancies between the dentin and the obturation material.16,17 These bioactive endodontic cements (BECs) are considered synthetic dentin because they facilitate root and periradicular regeneration and establish definitive alkalinization of the root, rendering the environment inhospitable to microbial proliferation.18 The regeneration is established on two root surfaces: external
(periodontal ligament and alveolar bone) and internal (cement and dentinal wall).18–21
Recent studies have developed a bioactive cement with the addition of adjunctive materials, which are important to create a strong material that can resist masticatory forces. This cement is called PBS HP CIMMO®. Composed of mineral oxides in the form of fine hydrophilic particles. It has excellent marginal sealing capacity and alkaline pH that prevent the migration of microorganisms and fluids into the root canal. Composition: SiO2, K2O, Al2O3, Na2O, Fe2O3, SO3, BaSO4, CaO, MgO. A national patent application has been filed in the National Intellectual Property Institute (registration number: BR 102017 022748). Experimental studies have been performed to define the regenerative capacity of PBS HP CIMMO® cement in
furcation lesions.22,23 Clinical studies with PBS HP CIMMO® cement have been carried
out to evaluate the regeneration of teeth subjected to parendodontic surgery.24,25 The results of these studies have demonstrated that the clinical use of PBS HP CIMMO® cement is feasible because it facilitates regeneration of bone and periodontal ligament structures
in the long-term and is more resistant to masticatory forces due to the presence of additives.24,25 Therefore, the objective of this study was to evaluate endodontic treatments of necrotic teeth performed with PBS HP CIMMO® cement (without gutta-percha), compared to conventional treatments, filled with gutta-percha.20,21,24–25
Artigo completo => Bioceramic cement
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