Diabetes mellitus (DM) is one of the most common metabolic disorders. DM is characterized by hyperglycaemia, resulting in wound healing difficulties and systemic and oral manifestations, which have a direct effect on dental pulp integrity. Experimental and clinical studies have demonstrated a higher prevalence of periapical lesions in patients with uncontrolled diabetes. The influence of DM on periapical bone resorption and its impact on dental intervention of such patients are reviewed, and its aetiology and pathogenesis are analysed at molecular level. Pulps from patients with diabetes have the tendency to present limited dental collateral circulation, impaired immune response, increased risk of acquiring pulp infection (especially anaerobic ones) or necrosis, besides toothache and occasional tendency towards pulp necrosis caused by ischaemia. In regard to molecular pathology, hyperglycaemia is a stimulus for bone resorption, inhibiting osteoblastic differentiation and reducing bone recovery. The relationship between poorly controlled diabetes and bone metabolism is not clearly understood. Molecular knowledge about pulp alterations in patients with diabetes could offer new therapeutic directions. Knowledge about how diabetes affects systemic and oral health has an enduring importance, because it may imply not only systemic complications but also a higher risk of oral diseases with a significant effect on pulp and periapical tissue.

Variations in the internal anatomy of root canals may interfere with the success of root canal because tissue remnants may remain in the isthmus, re-entrances and ramifications of flattened root canals making instrumentation more difficult. Successful root canal treatment depends fundamentally on shaping, cleaning, disinfection and obturation. This study verified the quality of cleaning of ProFile .04 rotary technique associated with different irrigating solutions: 0.5% sodium hypochlorite, calcium hydroxide + Tergentol and 2% chlorhexidine in canals with mesio-distal flattening. Twelve human mandibular central incisors were randomly divided into 3 groups and instrumented up to ProFile 0.4 #35 file after cervical preparation, and processed histologically. After optical microscopic evaluation, statistical analysis showed that the percentage of cleaning of the three irrigating solutions was statistically different. Two-by-two comparisons classified the irrigating solutions in increasing order of cleaning: calcium hydroxide + Tergentol < chlorhexidine < 0.5% sodium hypochlorite.

The present study aimed to identify students' perceptions of endodontic treatment at a Brazilian university through a survey, which analysed student profiles and their difficulties in 2016. One hundred and two students who had experienced endodontic, laboratory or clinical procedures answered a survey based on their experiences, regarding their perceptions, experience and self-confidence levels. Results demonstrated that there was no significant difficulty among students regarding anaesthesia, rubber dam use, chamber access, working length determination, instrumentation, root filling and temporary restoration procedures during endodontic treatment. However, problems were observed regarding radiographic examination (mainly in separating root canals) and the choice of intracanal medication. The present study also raised a question regarding dental education: how can endodontic education be improved by addressing students' perceived difficulties? Evaluating the major student difficulties during root canal therapy can help the improvement of teaching strategies during preclinical and clinical teaching.

This study evaluated, histologically and morphometrically, the cleaning capacity of rotary instrumentation in root canals using the Profile system with ultrasonic irrigation. Twelve single-rooted mandibular incisors were divided randomly into three groups according to the irrigation method tested. The canals in the teeth were instrumented using Orifice Shapers, taper 0.6 and 0.4 in the cervical third, and up to a #35 file in the apical third. One per cent sodium hypochlorite was used as the irrigating solution. Group I: canals were irrigated with 5 ml of solution, using a Luer-Lok syringe, between each file. Group 2: canals were irrigated with the solution and instrumented using ultrasound for I min between each file. Group 3: canals were irrigated with 5 ml of solution with Luer-Lok syringe, between each file, and final irrigation using ultrasound for 3 min. After chemo-mechanical preparation, the apical thirds of the teeth were submitted for histological processing. Morphometric analysis was performed using an optical microscope with 40x magnification and a grid. The results showed statistical difference at the 5% level between the methods used for irrigation. Rotary instrumentation with Profile system NiTi files and ultrasonic irrigation for 3 min was more effective in cleaning root canals when the different methods were compared.

The aim of this study was to evaluate the cleaning capacity of Profile .04 files combined with different irrigating solutions in flattened root canals using histological, morphometrical and SEM analyses. Eighty human mandibular incisors were prepared with Profile .04 instruments and randomly divided into 4 groups according to the irrigating solutions used (n=20): G1: distilled water (control); G2: 1% sodium hypochlorite (NaOCl); G3: 1% NaOCl alternated with 17% EDTA, and G4: 1% NaOCl with RCPrep cream. Ten teeth of each group were evaluated with an optical microscope to determine the percentage of root canal debris. The remaining teeth were evaluated under scanning electron microscopy (SEM). Data were analyzed statistically by ANOVA and Tukey's test (alpha=0.01).There was a significant difference (p<0.001) among the groups regarding the percentage of debris left in the canals (distilled water: 18.82 +/- 5.55; 1% NaOCl: 6.29 +/- 5.55; 1% NaOCl + 17% EDTA: 12.47 +/- 6.92; 1% NaOCl + RCPrep: 7.82 +/- 1.91). The SEM analysis showed the best results for 1% NaOCl + 17% EDTA on smear layer removal. It may be concluded that the combination of Profile .04 rotary instrumentation and the tested solutions was not able to totally remove debris and smear layer from flattened root canals.