Evaluation of coronal microleakage of intra-orifice barrier materials in endodontically treated teeth: A systematic review.

Background: Endodontic success depends on complete sealing of the root canal orifice to prevent re-infection and re-Contamination of the treated teeth through microleakage. Intra-orifice barrier material provides a seal against micro-organisms, its by-products thus, preventing microleakage and subsequent endodontic failure. Several studies have been done to evaluate microleakage after placing various materials as IOB, but still there is no standardization for the same. Thus, this systematic review was conducted to evaluate the microleakage associated with mineral trioxide aggregate (MTA), composite, and glass ionomer cement (GIC) when used as IOB material. Materials and Methods: Protocol was formulated in accordance with PRISMA checklist 2020 and registered on PROSPERO (CRD42021226225). Electronic search from databases such as Medline/PubMed, Scopus, EBSCOhost, Embase, Google Scholar, and Cochrane were performed from the year 2000-2020. In vitro and ex vivo studies evaluating coronal microleakage after placing IOB material using methylene blue dye penetration test under a stereomicroscope were included. A total of 5 studies were included in the systematic review. After assessing the risk of bias using customized criteria referred from JBI critical appraisal tool, characteristics of the included studies, reason for exclusion of the studies, and data extraction sheet were prepared. Results: All studies included in this systematic review reported that placement of an IOB material significantly reduces microleakage as compared to control groups. MTA used as an IOB showed less microleakage than composite and GIC. Conclusion: MTA as IOB material demonstrated the least microleakage in vitro studies. However, in this systematic review, only in vitro studies were included. Thus, more studies in the form of randomized control trials are required to give a conclusive and definitive result.

Retrograde Peri-implantitis: Report of a Case Successfully Treated by Resection of the Implant Apex.

Retrograde peri-implantitis (RPI) is a periapical lesion that develops after implant insertion in which the coronal portion of the implant achieves a normal bone-to-implant interface. The most common etiology of RPI is the presence of an adjacent endodontic lesion. In most of the case reports available in the literature, the diagnosis of RPI occurred between 1 week and 4 years after implant placement. This case report illustrates the treatment of RPI that occurred more than 15 years after implant loading, caused by endodontic infection of the adjacent tooth.

Brain abscess and periodontal pathogens (Fusobacterium Nucleatum). Report of a case.

Patients who develop brain abscesses must be evaluated through a complete set of diagnostic tests including a microbiological and clinical periodontal assessment. A genetic comparison of the pathogens from intracranial/extracranial sites is necessary.

In Vitro Alteration by Dentine and Protein of the Antimicrobial Activity of Two Endodontic Irrigants: HybenX® and Sodium Hypochlorite.

Irrigant solutions commonly used for the treatment of endodontic infections can be inhibited by both organic and inorganic substances. The aim of this study was to evaluate the in vitro antimicrobial activity of the novel irrigant HybenX® and 2.5% and 5% sodium hypochlorite against Enterococcus faecalis, in presence of dentine powder (DP) or bovine serum albumin 20% (BSA) as inhibitory agents. An E. faecalis American Type Culture Collection (ATCC) 29212 suspension was added to the irrigants (Hybenx® or NaOCl) and one or two different inhibitors (BSA and DP) either after one-hour pre-incubation at 35 ± 1 °C or not. The antimicrobial activity of HybenX® against E. faecalis was already proved at 15 min and was neither affected by BSA nor by DP or combinations thereof. NaOCl 2.5% showed an effective antimicrobial activity starting from 15 min and this activity was partially inhibited by BSA and BSA plus DP combination within one hour when pre-incubation occurred. NaOCl 5% showed antimicrobial activity within 15 min, which was inhibited within one hour only in the presence of both BSA and DP regardless of the pre-incubation period. HybenX® could represent a good alternative to common irrigants for the treatment of E. faecalis endodontic infections, showing a rapid antimicrobial activity not inhibited by organic and inorganic inhibitors.

In Vitro Antimicrobial Activity of the Decontaminant HybenX® Compared to Chlorhexidine and Sodium Hypochlorite against Common Bacterial and Yeast Pathogens.

The recent increase in infections mediated by drug-resistant bacterial and fungal pathogens underlines the urgent need for novel antimicrobial compounds. In this study, the antimicrobial activity (inhibitory and cidal) of HybenX®, a novel dessicating agent, in comparison with commonly used sodium hypochlorite and chlorhexidine, against a collection of bacterial and yeast strains representative of the most common human pathogenic species was evaluated. The minimal inhibitory, bactericidal, and fungicidal concentrations (MIC, MBC, and MFC, respectively) of the three different antimicrobial agents were evaluated by broth microdilution assays, followed by subculturing of suitable dilutions. HybenX® was active against 26 reference strains representative of staphylococci, enterococci, Enterobacterales, Gram-negative nonfermenters, and yeasts, although at higher concentrations than sodium hypochlorite and chlorhexidine. HybenX® MICs were 0.39% for bacteria (with MBCs ranging between 0.39% and 0.78%), and 0.1-0.78% for yeasts (with MFCs ranging between 0.78% and 1.6%). HybenX® exhibited potent inhibitory and cidal activity at low concentrations against several bacterial and yeast pathogens. These findings suggest that HybenX® could be of interest for the treatment of parodontal and endodontic infections and also for bacterial and fungal infections of other mucous membranes and skin as an alternative to sodium hypochlorite and chlorhexidine.

Visits to figurative art museums may lower blood pressure and stress.

BACKGROUND: The research aimed to assess, through physiological measurements such as blood pressure and heart rate, whether exposure to art museums and to different art styles (figurative vs. modern art) was able to enhance visitors' well-being in terms of relaxing and stress reduction. METHOD: Participants (n = 77) were randomly assigned to one of three conditions, on the basis of the typology of the art style they were exposed to in the museum visit: (1) figurative art, (2) modern art and (3) museum office (as a control condition). Blood pressure and heart rate were measured before and after the visits. RESULTS: Diastolic values of the participants were quite stable, as expected in people who do not suffer hypertension; we therefore considered only variations in systolic blood pressure. The majority of the participants exposed to figurative art significantly decreased systolic blood pressure compared to those exposed to modern art and museum office. No differences were found in the heart rate before and after the visit for the three groups. CONCLUSION: Findings suggest that museum visits can have health benefits, and figurative art may decrease systolic blood pressure.

Influences of 432 Hz Music on the Perception of Anxiety during Endodontic Treatment: A Randomized Controlled Clinical Trial.

INTRODUCTION: Patients undergoing endodontic therapy often have severe perioperative and intraoperative anxiety, which may lead to increased perceptions of pain and vital sign instability throughout treatment. The purpose of this study was to test the influences of music, as a nonpharmacologic adjuvant, in terms of significant changes for systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) before, during, and after endodontic treatment in a population with different levels of anxiety assessed with the Corah Dental Anxiety Scale. METHODS: A total of 100 patients were recruited in the present study; before starting the endodontic treatment, the interviewer administered the Corah Dental Anxiety Scale to the participants to assess the baseline level of anxiety. Patients were randomly divided into 2 groups: the first one listened to the music and the second one did not. Before, during, and after the endodontic procedures, the vital signs (diastolic and systolic blood pressure and heart rate) were recorded. Results were collected and statistically analyzed. RESULTS: Direct contrasts between patients listening or not listening to music showed that all the measured vital signs decreased considering the overall period (during and after the canal therapy) in the group of patients listening to music (P < .05). CONCLUSIONS: This study shows the effects of music therapy on vital values and on subjective perception of anxiety during endodontic therapy. Music and medicine always work together; the soothing effects of sounds and musical frequencies make this union an extraordinary tool of synergistic care. Music therapy is a valid nonpharmacologic adjuvant to anxiety perception in endodontic therapies.

Shaping ability of waveone primary reciprocating files and ProTaper system used in continuous and reciprocating motion.

INTRODUCTION: The purpose of this study was to compare the shaping effects of Wave One (Dentsply Maillefer, Ballaigues, Switzerland) and full-sequence ProTaper nickel-titanium (NiTi) files (Dentsply Maillefer) used in reciprocating and conventional movements in a simulated canal. METHODS: Seventy-five S-shaped canals in resin blocks were randomly allocated to 3 groups (n = 25): WaveOne (group 1), full sequence of ProTaper Universal files in conventional movements (group 2), and full sequence of ProTaper Universal files in reciprocating movements (group 3). Preoperative and postoperative photographs of the simulated canals were taken under standardized conditions, after which they were accurately superimposed. Two methods were adopted to evaluate the shaping ability of the 3 approaches: measuring the differences in apical and coronal curvature modifications and measuring the amount of resin removed for both curvatures on the right and left sides of the simulated canals. Differences in canal curvature modifications and in the amount of resin removed were analyzed using 1-way analysis of variance (P < .0001) followed by a Tukey-Kramer multiple comparison post hoc test and mixed-effects linear model (P < .05), respectively. METHODS: Group 3 maintained better coronal and apical canal curvature and less straightening of the simulated canals with respect to groups 1 and 2. CONCLUSIONS: When preparing S-shaped canals, full-sequence ProTaper Universal NiTi files used in a reciprocating motion exhibited better shaping effects than full-sequence ProTaper Universal NiTi files used in a conventional motion and WaveOne.

Mineral trioxide aggregate as apical plug in teeth with necrotic pulp and immature apices: a 10-year case series.

INTRODUCTION: This 10-year study evaluated the clinical and radiologic outcomes of teeth with necrotic pulp, immature apices, and periapical lesions treated with the mineral trioxide aggregate (MTA) apical plug technique. METHODS: Seventeen single-rooted immature teeth with necrotic pulp and periapical lesion from 17 patients treated between January 2001 and December 2001 were included in this study. Apical obturation on all teeth included in the study was completed in 2 visits: first using calcium hydroxide as an interappointment intracanal medication and a second visit for the creation of the artificial apical barrier with MTA. The outcome, based on clinical and radiographic criteria, was assessed by 2 calibrated investigators using the periapical index (PAI). The Friedman test was used to verify the differences between baseline and the 1-, 5-, and 10-year PAI scores. RESULTS: Of the 17 patients treated, 1 patient dropped out at 5 years. At the 10-year follow-up, 15 teeth were healed (PAI ≤2), and 1 tooth had been extracted because of the presence of a longitudinal root fracture. The PAI score exhibited a significant decrease between baseline and 1 year and between 1 and 5 years. The difference between 5 and 10 years was not significant. CONCLUSIONS: The apical plug with MTA was a successful and effective technique for long-term management of this group of teeth with necrotic pulps with immature root development and periapical lesions.

Endodontic management in oculo-facio-cardio-dental syndrome: a case report.

INTRODUCTION: Oculo-facio-cardio-dental (OFCD) syndrome is an X-linked dominant trait. OFCD syndrome is characterized by congenital cataract with secondary glaucoma ocular defects; ventricular and atrial septal defects or mitral valve prolapses; facial traits such as a long narrow face, a high nasal bridge, a bifid nasal tip; and dental anomalies that include radiculomegaly, oligodontia, root dilacerations, malocclusion and delayed eruption. This clinical report describes the endodontic treatment for a 16-year-old girl who suffers from OFCD syndrome. METHODS: The treatment plan included orthograde re-treatment of #9, #10 with apical plug technique and orthograde retreatment and root canal obturation with modified Thermafil (Dentsply Maillefer, Ballaigues, Switzerland) technique of #21, #22 RESULTS: The modified Thermafil technique makes it possible to reach the working length even in teeth with radiculomegaly. CONCLUSIONS: Prompt treatment of dental caries make it possible to maintain tooth function and prevent difficult root canal procedures with poor prognoses for success.

Effects of pH on surface hardness and microstructure of mineral trioxide aggregate and Aureoseal: an in vitro study.

INTRODUCTION: The aim of the study was to evaluate the surface hardness and the morphologic microstructure of white mineral trioxide aggregate (WMTA) and Aureoseal in acid environment. METHODS: WMTA and Aureoseal were mixed and packed into 64 cylindrical stainless steel molds. Thirty-two of each group were exposed to pH values of 4.4 and 7.4, respectively, for 7 days. Four specimens, 2 exposed to acid pH and 2 exposed to pH of 7.4, were prepared for evaluation under scanning electron microscope by using scattered electron (SE) and backscattered electron (BSE) detectors. Vickers surface hardnesses were measured in the remaining 60 samples. RESULTS: The mean surface hardness values ± standard deviation were 37.54 ± 1.52 and 30.24 ± 1.47 for WMTA and 40.63 ± 1.35 and 28.67 ± 1.07 for Aureoseal after exposure to pH values of 7.4 and 4.4, respectively. WMTA showed higher hardness values in acid environment than Aureoseal, which showed the highest microhardness at pH values of 7.4. The SE detector revealed crystal formation on the WMTA surface at pH values of 7.4 and 4.4. In the WMTA specimens the BSE detector showed more unhydrated structures at pH values of 4.4 than at 7.4. The SE detector did not reveal crystal formation on the Aureoseal specimens at pH 7.4 and 4.4. BSE detection showed amorphous microstructures in the Aureoseal specimens treated in the pH 4.4 acid environment. CONCLUSIONS: There was significant interaction between the cements and the environments where the cements hardened.

Efficacy of ProTaper universal retreatment files in removing filling materials during root canal retreatment.

The aim of this study was to evaluate the efficacy of the ProTaper Universal System rotary retreatment system and of Profile 0.06 and hand instruments (K-file) in the removal of root filling materials. Forty-two extracted single-rooted anterior teeth were selected. The root canals were enlarged with nickel-titanium (NiTi) rotary files, filled with gutta-percha and sealer, and randomly divided into 3 experimental groups. The filling materials were removed with solvent in conjunction with one of the following devices and techniques: the ProTaper Universal System for retreatment, ProFile 0.06, and hand instruments (K-file). The roots were longitudinally sectioned, and the image of the root surface was photographed. The images were captured in JPEG format; the areas of the remaining filling materials and the time required for removing the gutta-percha and sealer were calculated by using the nonparametric one-way Kruskal-Wallis test and Tukey-Kramer tests, respectively. The group that showed better results for removing filling materials was the ProTaper Universal System for retreatment files, whereas the group of ProFile rotary instruments yielded better root canal cleanliness than the hand instruments, even though there was no statistically significant difference. The ProTaper Universal System for retreatment and ProFile rotary instruments worked significantly faster than the K-file. The ProTaper Universal System for retreatment files left cleaner root canal walls than the K-file hand instruments and the ProFile Rotary instruments, although none of the devices used guaranteed complete removal of the filling materials. The rotary NiTi system proved to be faster than hand instruments in removing root filling materials.

Mineral trioxide aggregate as repair material for furcal perforation: case series.

The purpose of treating furcal perforation is to seal the artificial communication between the endodontic space and the periradicular tissue to prevent alveolar bone resorption and damage to the periodontal ligament. These complications are not infrequent in cases of furcal and/or old perforations, which show a worse prognosis than fresh, small, coronal, and apical perforations. Mineral trioxide aggregate (MTA) is widely used to seal perforations because of its biocompatibility and sealability. Ten cases of furcal perforation were selected at the department of Endodontics, University of Florence. All the perforations were cleaned with NaOCl, EDTA, and ultrasonic tips and sealed with MTA without internal matrix. Finally, the teeth were endodontically treated and coronally restored. Clinical and radiographic follow-ups were done at 6 months, 1 year, 2 years, and 5 years. After 5 years, the absence of periradicular radiolucent lesions, pain. and swelling along with functional tooth stability indicated a successful outcome of sealing perforations in 9 out of 10 teeth. One patient dropped out of the study after the 1-year follow-up and could not be contacted for further recalls. The results confirm that MTA without matrix provides an effective seal of root perforations and clinical healing of the surrounding periodontal tissue.

Translucent fiber post cementation using a light-curing adhesive/composite system: SEM analysis and pull-out test.

OBJECTIVES: The performance of both light-curing and dual-cured adhesive/luting systems (as control), when used in combination with translucent fibre posts, was evaluated by means of pull-out test and scanning electron microscopy (SEM ) observation. METHODS: Forty root canal treated teeth were randomly divided into two groups of 20 specimens each. Group 1 light-curing system: Excite and Tetric Flow; Group 2 dual cured system: All Bond 2+RelyX ARC. Translucent, double taper fibre posts were used (2.1/1.4mm diameter). The teeth were stored in NaCl 0.9% solution at 37 degrees C. A week later, the pull-out test was carried out on all specimens. Ten tested specimens for each group and their corresponding posts were processed for SEM observation. Statistical analysis was performed applying one-way analysis of variance (ANOVA) followed by T-test as post-hoc comparison at a significance level set at p<0.05. RESULTS: There is no statistically significant difference (p>0.05) between the light-curing system group (275.2+/-58.9N) and the dual cured one (301.4+/-40.1N). SEM observations confirm a good bond between the dentine and the post whatever the curing method employed. CONCLUSIONS: Dual curing of the All Bond 2+RelyX ARC system seems to be the most appropriate method since it allows to cure even those areas which would not be otherwise reached by light. On the other hand, in apical areas, the incomplete curing of the Excite+Tetric Flow system could improve the post adaptation and allow the achievement of both an improved apical seal and a more even distribution of the stress along the canal walls.

The use of MTA in teeth with necrotic pulps and open apices.

Three clinical cases have been treated with the use of an apical plug of MTA for apexification. All three cases were central incisors that had suffered premature interruption of root development as a consequence of trauma. According to the treatment protocol, the root canals were rinsed with 5% NaOCl; then, calcium hydroxide paste was placed in the canals for 1 week. Consequently, the apical portion of the canal (4 mm) was filled with MTA. The remaining portion of the root canals was then closed with thermoplastic gutta-percha. At 6-month and 1-year follow-up period the clinical and radiographic appearance of the teeth showed resolution of the periapical lesions. MTA appears to be a valid option for apexification with its main advantage being the speed at which the treatment can be completed.