Finite element evaluation of dentin stress changes following different endodontic surgical approaches.

The aim was to compare the effect of different endodontic surgical treatments on the stress distributions in dentin of a simulated first mandibular molar tooth using the finite element analysis method. Three surgical endodontic procedures (apical resection, root amputation, and hemisection) were simulated in a first mandibular molar. Biodentine or mineral-trioxide-aggregate was used to repair the surgery site in apical resection and root amputation models; the remaining root canal spaces were filled with gutta-percha. Access cavities were restored using resin composite. In hemisection model, root canal was filled with gutta-percha, and coronal restoration was finished with a monolithic zirconia crown. A sound tooth model was created as a control model. An oblique force of 300 N angled at 45° to the occlusal plane was simulated. Maximum von Mises stresses were evaluated in dentin near the surgery regions and the entire tooth. Apical resection/Biodentine and apical resection/mineral-trioxide-aggregate models generated maximum von Mises stresses of 39.001 MPa and 39.106 MPa, respectively. The recorded maximum von Mises stresses in root amputation models were 66.491 MPa for root amputation/Biodentine and 73.063 MPa for root amputation/mineral-trioxide-aggregate models. The highest maximum von Mises stress value among all models was observed in the hemisection model, measuring 138.87 MPa. Hemisection induced the highest von Mises stresses in dentin, followed by root amputation and apical resection. In apical resection, Biodentine and mineral-trioxide-aggregate did not show a significant difference in stress distribution. Biodentine in root amputation may lead to lower stresses compared to mineral-trioxide-aggregate.

Rational design of EDTA-incorporated nanoflowers as novel and effective endodontic disinfection against biofilms.

The ethylenediaminetetradiacetic acid (EDTA) is one of the most commonly used irrigation solutions. Although EDTA has a very low antimicrobial property, it is used to remove inorganic part of smear layer in areas of root canal system. Herein, we developed EDTA-incorporated nanoflowers (EDTA NFs), for the first time, as novel and effective irrigation solution with quite high antimicrobial property to provide complete disinfection in root canal system. We both systematically elucidated the formation of the EDTA NFs with various techniques, and their catalytic and antimicrobial activities in the presence of hydrogen peroxide (H2O2) were documented through intrinsic EDTA property and peroxidase-like activities.

Evaluation of Stress Distributions in Mandibular Molar Teeth with Different Iatrogenic Root Perforations Repaired with Biodentine or Mineral Trioxide Aggregate: A Finite Element Analysis Study.

INTRODUCTION: In this study, finite element analysis was used to evaluate the stress distributions in simulated mandibular molar teeth with various iatrogenic root perforation types after reparation with Biodentine (Septodont, Saint-Maur-des-Fossés, France) or mineral trioxide aggregate (MTA). METHODS: An extracted human mandibular molar tooth was scanned using a micro-computed tomographic device, and a 3-dimensional solid model was created. Then, 3 different iatrogenic perforation types (furcation perforation [FP], strip perforation [SP], and post drill perforation [PDP]) and 2 different repair materials (MTA and Biodentine [BD]) were simulated on the model. In addition, a sound tooth (ST) model (control) and a model left unrepaired for each type of perforation were created; then, access cavities were restored using resin composite, except for the sound tooth model. Consequently, a total of 10 experimental models were designed. An oblique force of 300 N angled at 45° to the occlusal plane was simulated. Evaluations of von Mises stress were performed in the perforated regions. RESULTS: Maximum von Mises stress values were 7.76 MPa for ST/corresponding to the FP region, 8.48 MPa for ST/corresponding to the SP region, 14.20 MPa for ST/corresponding to the PDP region, 10.89 MPa for FP /MTA, 7.65 MPa for FP/BD, 14.67 MPa for FP/unrepaired, 15.92 MPa for SP/MTA, 15.82 MPa for SP/BD, 21.95 MPa for SP/unrepaired, 10.20 MPa for PDP/MTA, 9.17 MPa for PDP/BD, and 17.86 MPa for PDP/unrepaired. CONCLUSIONS: The results of this finite element analysis indicated that BD models showed lower maximum von Mises stress values than the MTA models, and SPs exposed higher stress concentrations in root perforation regions than FPs and PDPs. The use of MTA and BD may reduce the risk of potentially harmful stress in root perforation regions.

Stress distributions in internal resorption cavities restored with different materials at different root levels: A finite element analysis study.

The aim of this study was to evaluate the stresses within simulated roots with internal resorption cavities at the apical, middle and coronal root levels, after obturation with gutta-percha and/or MTA utilising finite element analysis (FEA). Mandibular premolar teeth with internal resorption cavities at different root levels were modelled. Models were restored with gutta-percha and/or MTA. An oblique force of 300 N was applied and stress evaluations were carried out. In the MTA-filled resorption models, the stresses were distributed more homogeneously than the gutta-percha filled models, and the stress concentrations were lower in the remaining dentinal tissues. If the whole root is considered, the fully gutta-percha-filled models generated the highest stress values. Differences between the fully MTA-filled models and hybrid techniques were present only in the apical resorption models. Both the MTA and combination of MTA and gutta-percha can be suggested for use in clinical practice, in cases of internal root resorption cavity obturation.

Evaluation of dentinal defects during root canal preparation using thermomechanically processed nickel-titanium files.

OBJECTIVE: The aim of this study was to compare the incidence of root cracks after root canal instrumentation with thermomechanically processed nickel-titanium (Ni-Ti) files with different instrumentation kinematics. MATERIALS AND METHODS: A total of 150 extracted mandibular premolars with mature apices and straight root canals were divided into five groups and used in this study. In Group 1, 30 teeth were prepared using hand K-files and assigned to control group, Group 2 was instrumented using K3XF Rotary files (SybronEndo, Glendora, CA, USA) with continuous rotary motion. The teeth in Group 3 were instrumented by ProTaper Next (Dentsply Maillefer, Ballaigues, Switzerland) rotary files which make asymmetric rotary motion, In Group 4, teeth were instrumented by RECIPROC (VDW, Munich, Germany) with reciprocation motion and in Group 5, teeth were instrumented by Twisted File (TF) Adaptive (SybronEndo, Orange, CA, USA) files that use combination of continuous rotation and reciprocation motion (n = 30/per group). All the roots were horizontally sectioned 3, 6, and 9 mm from the apex with a low speed saw under water cooling. Then, the slices were examined through a stereomicroscope to determine the presence of dentinal microcracks. RESULTS: For the apical (3-mm) and coronal (9-mm) sections, the ProTaper Next and TF Adaptive produced significantly more cracks than the hand files, RECIPROC, and K3XF (P < 0.05). There was no significant difference between the experimental groups and control group at the 6-mm level (P > 0.05). CONCLUSIONS: Within the limitations of this in vitro study, all thermal-treated Ni-Ti instruments and hand files caused microcracks in root canal dentin.

Effect of double antibiotic and calcium hydroxide pastes on dislodgement resistance of an epoxy resin-based and two calcium silicate-based root canal sealers.

OBJECTIVES: The purpose of the present study was to determine the dislodgement resistance of AH Plus, MTA Fillapex, and Total Fill BC sealer to root canal dentin walls following placement of calcium hydroxide (CH) or double antibiotic paste (DAP) medicaments. MATERIALS AND METHODS: Root canals of 90 single-rooted human mandibular premolar teeth were instrumented with Reciproc rotary instruments to a size R50. The teeth were randomly divided into two experimental groups: those receiving an intracanal medicament with either CH or DAP and a control group (n = 30). After 3 weeks, the medicaments were removed by irrigation with 5 mL of 2.5 % NaOCl, 5 mL 17 % EDTA, and 5 mL distilled water under sonic agitation. Each group was then subdivided into three subgroups (n = 10), and the canals were filled with either AH Plus, MTA Fillapex, or Total Fill BC sealer. After 1 week, a push-out test was applied to the specimens and the results were analyzed using one-way analysis of variance (ANOVA) and post hoc Tamhane's tests. RESULTS: Regardless of the type of intracanal medicament used, Total Fill BC Sealer and MTA Fillapex showed the highest and lowest bond strength, respectively (P < 0.05). The use or absence of medicaments did not significantly affect the dislodgment resistance of root canal fillings (P > 0.05). Prior CH placement improved dislodgement resistance of all sealers without statistical difference (P > 0.05). Adhesive failure between core and sealer was the most frequent failure mode. CONCLUSIONS: Prior application of CH or DAP did not significantly affect the adhesion of the AH Plus, MTA Fillapex, and Total Fill BC Sealers. CLINICAL RELEVANCE: There is a little information about the influence of antibiotic medicaments on the bond strength of root canal sealer. These findings suggest that the use of DAP does not affect the adhesion strength of AH Plus, MTA Fillapex, and Total Fill BC Sealers.

Fracture resistance of teeth with oval canal morphology restored using oval and circular posts.

The study aimed to evaluate the effects of different post morphologies and placement lengths on the fracture resistance of teeth with oval canal morphology that had been restored with crowns. Extracted mandibular premolars with similar dimensions were decoronated. After the root canal treatment, the teeth were mounted on acrylic blocks. Samples were randomly divided into four groups (n = 10 each). In groups C-10 and C-5, 10-mm- and 5-mm-long circular post spaces were created. In groups O-10 and O-5, 10-mm- and 5-mm-long oval post spaces were ultrasonically created. After post cementation, all specimens were restored with composite cores and prepared at height of 6 mm. Thereafter, all teeth were restored with crowns. After thermocycling, all specimens underwent fracture resistance testing. Oval posts and placement at 10-mm depth showed higher fracture resistance than circular posts and placement at 5-mm depth (P < 0.001). Increased post length and use of oval posts enhanced the fracture strength of teeth with oval canal morphology. Based on the results of this study, although the fracture resistance of teeth restored with crowns was enhanced by deep fiber post placement, the use of oval fiber post is recommended in cases where deep placement is impossible. (J Oral Sci 58, 339-345, 2016).

Evaluation of the Reliability of Cone-beam Computed Tomography Scanning and Electronic Apex Locator Measurements in Working Length Determination of Teeth with Large Periapical Lesions.

INTRODUCTION: This study evaluates the endodontic working-length measurements in teeth with large periapical lesions and persistent intracanal exudate by using preexisting cone-beam computed tomography (CBCT). It compares the measurements with clinical root canal lengths determined by using 2 electronic apex locators. METHODS: All patients had undergone a CBCT scan independent of the present study and needed root canal treatment of at least 1 tooth visible in the field of view. Seventy-three teeth with single roots and canals were studied. An endodontist measured each root canal length with 2 different electronic apex locators. The measurements were repeated 3 times by using a digital caliper, and the mean was recorded. This mean was compared with the root canal length as measured on CBCT sections by an oral radiologist not involved in the endodontic treatment. The CBCT measurements were taken twice for analysis of intrarater reliability. The data were statistically analyzed. RESULTS: There were no significant measurement differences between the methods used (P > .05). CONCLUSIONS: In teeth with large periapical lesions and persistent intracanal exudate, measurement of the root canal length by using CBCT was as reliable as measurements that used apex locators.

Effect of Delayed Bonding and Antioxidant Application on the Bond Strength to Enamel after Internal Bleaching.

PURPOSE: This study evaluated the effect of delayed bonding and antioxidant application (AA, 10% sodium ascorbate) after internal bleaching (35% carbamide peroxide) on the shear bond strength of an adhesive cement to enamel. MATERIALS AND METHODS: Eighty-four human maxillary central incisors were endodontically treated. The control group remained unbleached with no AA. Experimental groups were all internally bleached. The buccal enamel was finished and polished with metallographic paper to a refinement of #600, in order to obtain a 5-mm(2) flat bonding area. An adhesive cement (Clearfil Esthetic) was placed into a plastic tube with internal diameter of 3 mm and a 3-mm height and cured on the enamel. Bonding occurred either immediately after bleaching (group Im), a 7-day delay (group 7), or a 14-day delay (group 14), and half the specimens were treated with antioxidant application (groups Im-AA, 7-AA, and 14-AA). Shear bond strength testing was performed on a universal testing machine, and data were analyzed with ANOVA and Fisher test (5%). RESULTS: Delaying of bonding is a useful factor for enhancing shear bond strength (p < 0.05), whereas AA only enhanced shear bond strength after 7 days delayed bleaching (p < 0.05). The highest bond strength was noted in groups 7-AA (20.51 ± 4.5 MPa), 14 (19.82 ± 4.6), 14-AA (20.27 ± 4.4), and control (20.51 ± 5.1), which were not significantly different from each other. CONCLUSIONS: After internal bleaching, adhesive cementation to enamel is recommended only when delayed 14 days, or delayed 7 days with sodium ascorbate application.

The effect of blood contamination on dislocation resistance of different endodontic reparative materials.

This study evaluated the retention characteristics of ProRoot mineral trioxide aggregate (MTA), RetroMTA, Supra MTA, and Biodentine biomaterials used to repair furcation perforations contaminated with blood. Furcal perforations measuring 1.3 mm in diameter and 2 mm in height were created in 96 mandibular first molar teeth, which were then randomly divided into the following two groups (n = 48): contaminated (+) or non-contaminated (-) with blood. The groups were subdivided into four groups (n = 12) according to the material used (ProRoot MTA, RetroMTA, Supra MTA, and Biodentine) to seal the perforations. The samples were allowed to set for 14 days and were then subjected to push-out testing. The results were analyzed using ANOVA, and the failure modes were examined using a surgical microscope. ProRoot MTA (+/-) and RetroMTA (+/-) exhibited superior bond strength values; in addition, there were no significant differences among these groups (P > 0.05). Biodentine (+) showed intermediate values that were sometimes statistically similar to the ProRoot MTA (+/-) and RetroMTA (+/-) groups (P > 0.05) and, at other times, the Biodentine (-) and Supra MTA (+/-) groups (P > 0.05). The lowest bond strength values were shown by the Biodentine (-) and Supra MTA groups (P > 0.05). "Adhesive failure mode" was the most frequently observed type for all tested materials. Blood contamination did not affect the dislocation resistance of materials.

The effects of different nickel-titanium instruments on dentinal microcrack formations during root canal preparation.

OBJECTIVE: The aim of the present study was to investigate the incidence of dentinal microcracks caused by different preparation techniques. MATERIALS AND METHODS: 120 extracted human mandibular incisor teeth were divided into five experimental groups and one control group (n = 20): Group 1: Hand preparation with balanced force technique up to #25 K-file. Group 2: Preparation with only ProTaper F2 instrument in a reciprocating movement. Group 3: Preparation with Reciproc R25 instrument in a reciprocating movement. Group 4: Preparation with ProTaper instruments up to F2 instrument. Group 5: Preparation with ProTaper Next instruments up to X2 instrument. No procedure was applied to control group. The roots were sectioned horizontally at 3, 6 and 9 mm from the apex and examined. Absence or presence of dentinal microcracks was noted. RESULTS: The Chi-square test was performed to compare the appearance of cracked roots between all groups. There were no significant differences among the groups (P > 0.05). CONCLUSIONS: In conclusion, except the hand file and control group, all experimental groups showed microcrack formations.

Evaluation of the resin cement thicknesses and push-out bond strengths of circular and oval fiber posts in oval-shapes canals.

PURPOSE: The aim of this study was to evaluate whether the push-out bond strength varies between oval and circular fiber posts, and to examine the effect on the resin cement thicknesses around the posts. MATERIALS AND METHODS: Eighteen mandibular premolar roots were separated into two groups for oval and circular fiber posts systems. Post spaces were prepared and fiber posts were luted to the post spaces. Roots were cut horizontally to produce 1-mm-thick specimens. Resin cement thicknesses were determined with a metallographic optical microscope and push-out tests were done. RESULTS: No significant differences were observed in terms of push-out bond strength between the oval and circular fiber posts (P>.05) The resin cement thicknesses of the oval posts were greater than those of the circular posts group in the coronal, middle and apical specimens (P<.05). CONCLUSION: In the light of these results, it can be stated that resin cement thickness does not affect the push-out bond strength.

Stress distribution of oval and circular fiber posts in amandibular premolar: a three-dimensional finite element analysis.

PURPOSE: The aim of the present study was to evaluate the effects of posts with different morphologies on stress distribution in an endodontically treated mandibular premolar by using finite element models (FEMs). MATERIALS AND METHODS: A mandibular premolar was modeled using the ANSYS software program. Two models were created to represent circular and oval fiber posts in this tooth model. An oblique force of 300 N was applied at an angle of 45° to the occlusal plane and oriented toward the buccal side. von Mises stress was measured in three regions each for oval and circular fiber posts. RESULTS: FEM analysis showed that the von Mises stress of the circular fiber post (426.81 MPa) was greater than that of the oval fiber post (346.34 MPa). The maximum distribution of von Mises stress was in the luting agent in both groups. Additionally, von Mises stresses accumulated in the coronal third of root dentin, close to the post space in both groups. CONCLUSION: Oval fiber posts are preferable to circular fiber posts in oval-shaped canals given the stress distribution at the post-dentin interface.

Effects of calcium hydroxide and propolis intracanal medicaments on bond strength of resin-based endodontic sealer as assessed by push-out test.

The aim of this study was to investigate the effects of calcium hydroxide (Ca(OH)2) and propolis intracanal medicaments on bond strength of AH Plus to root dentin. After chemomechanical instrumentation using Revo-S rotary system, three groups of root canal specimens were prepared: 10 root canals were left untreated as controls (G1), 10 received Ca(OH)2 intracanal medicament (G2), and another 10 received propolis intracanal medicament (G3). Canals were obturated with AH Plus and gutta-percha. After bond strength evaluation using micro push-out test, data were analyzed using ANOVA and Tamhane's test (p=0.05). At coronal and middle thirds, there were no significant differences in bond strength among the three groups (p>0.05). At apical third, G3 was significantly superior to G2 (p<0.05) and G1 (p<0.05), but there was no significant difference between G2 and G1 (p>0.05). Therefore, when AH Plus was used as the sealer in endodontic treatments, its combined use with propolis as an intracanal medicament seemed to result in favorable sealer-dentin interfacial bond strength.

Infrared thermographic comparison of temperature increases on the root surface during dowel space preparations using circular versus oval fiber dowel systems.

PURPOSE: The purpose was to evaluate temperature increases during dowel space preparations with oval and circular fiber dowel systems. MATERIALS AND METHODS: This study included 42 single-rooted human mandibular premolars. Roots were scanned with cone-beam computerized tomography (CBCT) to determine the ovoid root canal morphology. Root canals were treated with Ni-Ti rotary instruments and obturated. A second CBCT was taken to determine the thinnest dentin thickness of each root. Roots were randomly divided into two groups (n = 21) according to the fiber dowel system used: group 1, circular fiber dowel system (D.T. Light-Post); group 2, oval fiber dowel system (Ellipson Post). Dowel spaces were prepared using a circular fiber dowel drill and a diamond-coated ultrasonic tip with an oval section under water cooling until 9 mm dowel spaces were obtained. Temperature changes were recorded from the thinnest root surfaces using a FLIR E60 thermal imaging camera. RESULTS: Temperature increases were significantly greater with the circular fiber dowel system than with the oval fiber dowel system (p < 0.05). CONCLUSIONS: Although both dowel systems generated high temperature increases on root surfaces, the relatively lower temperature increase associated with the use of oval fiber dowels in ovoid canals makes it preferable to the use of circular fiber dowels.

The effect of peracetic acid on removing calcium hydroxide from the root canals.

INTRODUCTION: The goal of this study was to evaluate the efficiencies of different irrigation solutions in the removal of calcium hydroxide (CH). METHODS: Forty-eight maxillary central incisor teeth were used. Root canals were prepared with the ProTaper system (Dentsply Maillefer, Baillagues, Switzerland). Five milliliters 2% NaOCl, 5 mL 17% EDTA, and 10 mL saline were used for final irrigation. The canals were filled with CH paste. Specimens were randomly divided into 4 experimental groups (n = 10) according to irrigation protocols. Positive and negative control groups (n = 4) were used. Group 1 used 2.5 mL 17% EDTA, group 2 used 2.5 mL 2.5% NaOCl + 2.5 mL 17% EDTA, group 3 used 2.5 mL 1% peracetic acid (PAA), and group 4 used 2.5 mL 0.5% PAA. The specimens were evaluated with scanning electron microscope analysis and scored. Kruskal-Wallis and Student Newman-Keuls post hoc tests were used for statistical analysis. RESULTS: In the apical thirds, 1% PAA was superior to the other groups (P < .05); however, there were no significant differences among the other groups (P > .05). In the middle thirds, no significant differences were found among the groups (P > .05). In the coronal thirds, 1% PAA was superior to the other groups. There were significant differences among all the other groups (P < .05). CONCLUSIONS: According to the findings of the present study, 1% PAA could be recommended for the removal of CH from the root canals.