The prevalence, characteristics, and risk factors of external cervical resorption: a retrospective practice-based study.

OBJECTIVES: External cervical root resorption (ECR) is a poorly understood and aggressive form of resorption. The purpose of this study was to examine the prevalence, characteristics, and risk factors associated with the occurrence of ECR in patients seeking endodontic care from private practice settings. MATERIALS AND METHODS: Records of 343 patients with 390 teeth diagnosed with ECR were identified from 3 private endodontic practices from 2008 to 2022. The patients' demographic information, systemic conditions, and dental history were recorded. The characteristics of the cases including Heithersay classification, pulpal and periapical status, and their management were documented. The association between case severity and potential predisposing factors was examined using chi-square analysis. RESULTS: The overall prevalence of ECR among patients seeking endodontic care was low (< 1%). However, there was a greater than twofold increase in the pooled prevalence from 2016 to 2021 (0.99%) compared to the data from 2010 to 2015 (0.46%). The most commonly affected teeth were anterior teeth (48.7%). Class II (30.0%) and class III (45.4%) defects were the most often identified. Patients with a history of trauma or orthodontic treatment were significantly more likely to be diagnosed with severe cervical resorption (class III or IV) (p < 0.05). CONCLUSIONS: There has been an increase in the prevalence of ECR in patients seeking endodontic care. A history of orthodontic treatment and traumatic dental mechanical injuries may predict the severity of resorption. CLINICAL RELEVANCE: The upward trend in the occurrence of ECR warrants close monitoring of the patients at high risk of developing the condition to facilitate early detection and management.

Prevalence of Nonendodontic Diagnoses in Periapical Biopsies: A 6-year Institutional Experience.

INTRODUCTION: The purpose of this study was to identify nonendodontic periapical lesions (NPLs) mimicking endodontic pathosis, which are most frequently encountered by clinicians. METHODS: A retrospective study was conducted on biopsies obtained from 2015-2020 at Texas A&M College of Dentistry's oral pathology laboratory. The online database was screened for cases submitted as suspected endodontic pathology using specific key words. Histologic diagnoses were collected to determine the prevalence of NPLs that were originally thought to be of endodontic origin. The frequency and percentage of endodontic pathology and NPLs were documented. RESULTS: Among 6704 biopsies clinically diagnosed as endodontic lesions, 190 (2.8%) were histopathologically diagnosed as NPLs. The most frequent NPLs were odontogenic keratocytes' (n = 70, 36.8%), cemento-osseous dysplasia (n = 27, 14.2%), and dentigerous cysts (n = 22, 11.6%). Of all NPLs, 3.7% were malignant neoplasms, with the most common diagnosis being squamous cell carcinoma. Of 6514 endodontic histologic diagnoses, the prevalence of periapical granulomas and cysts was 60.2% (n = 3924) and 39.1% (n = 2549), respectively. CONCLUSIONS: Although most endodontic submissions are likely to be histologically diagnosed as periapical granulomas or cysts, the clinician should be aware that a small portion of these lesions may be nonendodontic in origin and possibly neoplastic in nature. Histopathologic evaluation of biopsied specimens is critical to achieve a proper diagnosis to ensure the appropriate management of patients.

Severe Pain after Endodontic Surgery: An Analysis of Incidence and Risk Factors.

INTRODUCTION: The aim of this study was to determine the prevalence and characteristics of postoperative pain after endodontic microsurgery and to identify potential predictors for severe pain. METHODS: One hundred seventy-three patients who underwent endodontic microsurgery at a private practice were included in the study. The patients were asked to fill out a questionnaire to assess their postoperative pain levels for 5 days after surgery. The questionnaires were analyzed to record the changes in pain levels over time. The presence and size of preoperative lesions and bone thickness were determined on preoperative cone-beam computed tomographic scans. Statistical analyses were performed to identify predictors for developing severe pain after surgery. A binary logistic regression model was established to predict the occurrence of severe pain. RESULTS: Severe pain was most prevalent on day 1 (17.3%) and gradually decreased until a small increase on day 5. The average pain level also peaked on day 1 postoperatively and gradually decreased afterward. No significant difference was observed between patients who reported severe pain and those who did not report severe pain regarding tooth position (anterior vs posterior), lesion size, and presence of fenestration. However, sex, age, and bone thickness were all significant predictors of severe postoperative pain, with odds ratios of 2.8, 0.96, and 1.41, respectively. CONCLUSIONS: Severe pain was reported only in a small number of patients after endodontic microsurgery. Younger patients, females, and patients with thicker bone covering the apex are significantly more likely to develop severe pain.

The Effect of Crown Lengthening on the Outcome of Endodontically Treated Posterior Teeth: 10-year Survival Analysis.

INTRODUCTION: The purpose of this study was to investigate the effect of a crown lengthening (CL) procedure and the crown-root ratio after CL on the long-term survival of endodontically treated teeth (ETT). METHODS: Permanent posterior teeth with opposing dentition that had received adequate nonsurgical root canal treatment (NSRCT) and a full-coverage crown between January 1, 2006, and January 1, 2016 were included in this retrospective study. The data collected included dates of the NSRCT, time of extraction if extracted, age, sex, location, the crown-root ratio after CL, and the presence of a lesion. All included ETT were divided into 2 groups: RESULTS: 5-year survival rates of ETT in the control and CL groups were 88.6% and 82.2%, respectively (P > .05). The 10-year survival rates of ETT in the control and CL groups were 74.5% and 51%, respectively (P < .05). ETT that received the CL procedure after NSRCT were almost 2.3 times more likely to get extracted compared with ETT that did not need the CL procedure at the 10-year follow-up (hazard ratio = 2.29, P < .05). Also, ETT with an inadequate crown-root ratio (1:1) after CL showed the lowest survival rate (40%) compared with ETT with an adequate crown-root ratio (<1:1). CONCLUSIONS: A crown-root ratio of 1:1 after osseous CL may affect the long-term survival of ETT. Despite the promising survival rate of ETT with an adequate crown-root ratio after CL, the long-term survival of NSRCT with an inadequate crown-root ratio (1:1) should be considered in the treatment planning phase. Also, it is worth mentioning that the results of the present study should be evaluated in future prospective studies.

The Association between the Anatomic Landmarks of the Pulp Chamber Floor and the Prevalence of Middle Mesial Canals in Mandibular First Molars: An In Vivo Analysis.

INTRODUCTION: The present study aimed to determine the incidence and anatomic variation of the middle mesial (MM) canal in mandibular permanent first molars using cone-beam computed tomographic imaging and to evaluate the association between the presence of MM canals and anatomic landmarks of the pulp chamber floor in the mesial root. METHODS: In this in vivo cross-sectional study, 210 CBCT scans of mandibular fist molars from 210 patients were included. CBCT scans were evaluated in 3 sections, and the following data were collected for further analysis: identification of the MM canal, the distance between the mesiobuccal (MB) and mesiolingual (ML) orifices, the presence of any isthmus between the MB and ML orifices, and the MB and ML root canal system (RCS) configurations. Binary logistic regression was performed to assess the effect of pulp floor anatomic characteristics as an independent variable on the outcome variable (the presence of an MM canal). RESULTS: The overall prevalence of the identification of an MM canal regardless of age was 14.7%. Mandibular first molars with an isthmus between the MB and ML RCS configurations were almost 5 times more likely to show an MM canal (P < .05, odds ratio [OR] = 4.9). The MB-ML intraorifice distance was inversely associated with the presence of an MM canal (P < .05, OR = 0.73). Patients less than 42 years old were 4 times more likely to have an MM canal in their CBCT scans compared with patients older than 42 years old (P < .05, OR = 3.9). CONCLUSIONS: The suggested anatomic landmarks of the pulp chamber floor could act as a reliable predictive factor for the presence of an MM canal. This knowledge of anatomic clues may serve to better direct endodontists in locating an MM canal, which could prevent excessive removal of tooth structures.

Apical Periodontitis, a Predictor Variable for Preeclampsia: A Case-control Study.

INTRODUCTION: Preeclampsia (PE) is characterized by hypertension and proteinuria after the 20th week of gestation. There is an association between systemic inflammation and adverse pregnancy outcomes such as PE. Therefore, for the first time, the present study aimed to investigate the possible association between maternal apical periodontitis (AP) and PE. METHODS: In this case-control study, 50 mothers who were diagnosed with PE during pregnancy were included in the experimental group. The control group consisted of 50 matched mothers with a normal course of pregnancy. The endodontic and periodontal status of all participants was reviewed using the digital panoramic radiographs that were available before pregnancy. The number of remaining teeth and the presence of AP in all teeth and endodontically treated teeth were recorded using the periapical index. Binary logistic regression was used to determine the possible association between AP and PE (α = 0.05). RESULTS: AP in at least 1 tooth was found in 27 of the mothers who developed PE (54%) and in 16 of the control patients (32%) (odds ratio [OR] = 2.4, P < .05). Adjusted for the maternal periodontitis, number of teeth, and endodontic treatment, maternal AP was significantly associated with the occurrence of PE (P < .05; OR = 2.23; 95% confidence interval, 95% = 1.92-6.88). CONCLUSIONS: AP was significantly more prevalent in the experimental group. For the first time, this study has provided evidence that maternal AP may be a strong independent predictor of PE. Considering the high occurrence of PE, particularly in developing countries, it could be suggested that the risk of PE may be reduced through comprehensive dental examinations for detecting and treating any source of inflammation, including AP, before pregnancy.

The Influence of Periodontal Status on Endodontically Treated Teeth: 9-year Survival Analysis.

INTRODUCTION: The aim of this study was to investigate the effect of periodontal status at the time of nonsurgical root canal treatment (NSRCT) on the survival rate of endodontically treated teeth (ETT). METHODS: In this retrospective investigation, molars that received NSRCT in an advanced specialty education program in endodontics from 2009 through 2017 were initially recruited. After the application of inclusion and exclusion criteria, 315 teeth were included in the study. Inclusion criteria were ETT with an acceptable quality of NSRCT; ETT that received an adequate crown within 3 months after NSRCT; and ETT with complete periodontal charting before NSRCT including pocket depths, clinical attachment loss, and bone loss. The periodontal status of all included teeth was assessed based on American Academy of Periodontology guidelines. All included ETT were divided into 3 groups as follows: healthy group, mild periodontitis, and moderate periodontitis. The survival rate of ETT was analyzed using univariate Kaplan-Meier and log-rank tests for differences between groups (P < .05). A Cox regression model was used to assess the effect of independent variables on the survival rate. RESULTS: Teeth that were diagnosed with mild periodontitis were almost 2 times more likely to be extracted compared with ETT diagnosed with normal periodontium at the time of NSRCT (odds ratio [OR] = 1.9, P < .05). This increased risk of tooth loss was 3.1 (OR = 3.1, P < .05) for ETT diagnosed with moderate periodontitis. Smokers were twice as likely to have tooth loss compared with nonsmokers (OR = 2.2, P < .05). CONCLUSIONS: Patients' periodontal health, being 1 of the prognostic determinants of the outcome of NSRCT, requires attention before and subsequent to NSRCT. This may improve the survival of ETT and help patients maintain their natural dentition.

Association of End-stage Renal Disease with Radiographically and Clinically Diagnosed Apical Periodontitis: A Hospital-based Study.

INTRODUCTION: The present study aimed to evaluate the prevalence of apical periodontitis (AP) and endodontic treatment in patients with end-stage renal disease (ESRD) as compared with patients with no history of ESRD. METHODS: In this cross-sectional study, 40 patients diagnosed with nondiabetic ESRD were included. The control group consisted of 40 age-matched and sex-matched healthy individuals. Digital panoramic radiographs were exposed on patients in both the experimental and control groups. The number of remaining teeth and the prevalence of nonsurgical and/or surgical root canal treatment were evaluated. Also, the presence of AP in all teeth and endodontically treated teeth (ETT) was recorded using the periapical index. Logistic regression was used to determine the possible association between ESRD and AP. RESULTS: AP in at least 1 tooth was found in 29 of the patients with ESRD (73%) and in 16 of the control patients (40%) (odds ratio [OR] = 3.9, P < .05). In 21 (52%) patients with ESRD in the experimental group, at least 1 ETT was diagnosed with AP. In the control group, 11 (28%) individuals had AP affecting at least 1 of the ETT (OR = 2.9, P < .05). Adjusted for the number of teeth and endodontic treatment, ESRD was significantly associated with the presence of AP (P < .05; OR = 2.6; 95% confidence interval, 1.43-4.8). Also, the number of teeth with AP was significantly associated with the urea serum level in the experimental group (P < .05, ß coefficient = 4.35). CONCLUSION: AP was significantly more prevalent in the experimental group. This may suggest that ESRD could possibly alter the pathogenesis of AP. However, these findings do not confirm the presence of any cause-and-effect relationship between these conditions. Also, considering the modifying effect of AP on urea serum level, the treatment of AP could be incorporated in the treatment planning of patients with ESRD.

The Effect of the Dental Operating Microscope on the Outcome of Nonsurgical Root Canal Treatment: A Retrospective Case-control Study.

INTRODUCTION: The aim of the current investigation was to assess the effect of the use of a dental operating microscope on the outcome of nonsurgical root canal treatment (NS RCT) while treating the mesiobuccal (MB) root of the maxillary first molar. METHODS: This retrospective investigation included endodontically treated maxillary first molars (ETMs) with apparent adequate previous NS RCT and restorations referred for endodontic retreatment at the endodontic graduate clinic. Inclusion criteria were ETMs that were diagnosed with irreversible pulpitis and normal periapical tissues before the initial NS RCT and ETMs that presented with a minimum of 1 identifiable periapical lesion (PAR) at 1 of the roots at the time of retreatment. One hundred ninety-five ETMs were included and divided into 2 groups: (1) the initial NS RCT had been performed using a microscope (n = 83) and (2) NS RCT had been performed without the use of a microscope (n = 112). Data extracted were whether the second MB (MB2) canal was located initially and the presence of an MB PAR at the time of retreatment. Data were statistically analyzed using binary logistic regression (α = 0.05). RESULTS: The MB root was 3 times more likely to present with a PAR at the time of retreatment if the initial NS RCT was performed without the use of a microscope (P < .05, odds ratio = 3.1). There was a significant association between a missed MB2 canal and an MB PAR in the group in which the initial NS RCT was performed without the use of a microscope (P < .05, odds ratio = 5.1). However, in cases in which the initial NS RCT was performed using a microscope, a missed MB2 canal was not associated with the presence of an MB PAR. CONCLUSIONS: With proper education, dentists can gain further insight into recognizing limitations in treating cases that require advanced training and advanced optics such as a microscope. Based on this strategy, it would appear that the outcome of NS RCT can be improved.

Association between Systemic Diseases and Apical Periodontitis.

INTRODUCTION: To date, the relationships between systemic diseases and periapical microbial infection remain unknown. Thus the purpose of this systematic review was to evaluate the relationship between host modifying factors and their association with endodontic pathosis. METHODS: Two reviewers independently conducted a comprehensive literature search. The MEDLINE, Embase, Cochrane, and PubMed databases were searched. In addition, the bibliographies of all relevant articles and textbooks were manually searched. There was no disagreement between the 2 reviewers. RESULTS: Sixteen articles were identified and included. The overall quality of the studies and the risk of bias were rated to be moderate. Only 3 studies demonstrated a low level of bias. CONCLUSIONS: The results of this review suggest that there may be a moderate risk and correlation between some systemic diseases and endodontic pathosis. More prospective and longitudinal research in this area is warranted to determine greater specificity in these possible interactions to potentially decrease or minimize the effects of systemic disease on the formation of apical periodontitis.

Eight-Year Retrospective Study of the Critical Time Lapse between Root Canal Completion and Crown Placement: Its Influence on the Survival of Endodontically Treated Teeth.

INTRODUCTION: The purpose of this study was to investigate the effects of factors associated with various coronal restorative modalities after root canal treatment (RCT) on the survival of endodontically treated teeth (ETT) and to assess the effect of time lapse between RCT and crown placement after RCT to form a tooth loss hazard model. METHODS: Computerized analysis was performed for all patients who received posterior RCT from 2008 to 2016 in the graduate endodontic department. Data collected included dates of RCT, type of post-endodontic restoration, and time of extraction if extracted. Teeth that received crown after RCT were also divided into 2 groups: receiving crown before 4 months and after 4 months after RCT. Data were analyzed by using Kaplan-Meier log-rank test and Cox regression model (α = 0.05) by using SPPS Statistic 21. RESULTS: Type of restoration after RCT significantly affected the survival of ETT (P = .001). ETT that received composite/amalgam buildup restorations were 2.29 times more likely to be extracted compared with ETT that received crown (hazard ratio, 2.29; confidence interval, 1.29-4.06; P = .005). Time of crown placement after RCT was also significantly correlated with survival rate of ETT (P = .001). Teeth that received crown 4 months after RCT were almost 3 times more likely to get extracted compared with teeth that received crown within 4 months of RCT (hazard ratio, 3.38; confidence interval, 1.56-6.33; P = .002). CONCLUSIONS: Patients may benefit by maintaining their natural dentition by timely placement of crown after RCT, which otherwise may have been extracted and replaced by implant because of any delay in crown placement.

Salivary levels of interleukin-6 and tumor necrosis factor-α in patients undergoing hemodialysis.

BACKGROUND: Inflammatory cytokines such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) are elevated in end-stage renal disease (ESRD). IL-6 and TNF-α are toxins which deteriorate renal function, and their pathogenic role has been confirmed in cardiovascular and oral diseases. This study was designed to investigate the salivary levels of IL-6 and TNF-α in patients with ESRD undergoing hemodialysis (HD). MATERIALS AND METHODS: Twenty patients with ESRD who were treated with 4 h HD sessions, with low flux membrane were included in this cross-sectional study. Average Kt/V index in patients was 1.19 ± 0.1. Twenty age-sex-matched healthy controls with no infectious diseases during 1 month before saliva sampling were selected. Unstimulated whole saliva was collected and TNF-α and IL-6, concentrations were measured using human IL-6 and TNF-α ELISA kits. Independent t-test was used to analyze the data using SPSS (α = 0.05). RESULTS: There was a significant difference between dialysis and control groups regarding the salivary levels of TNF-α (P = 0.034) and IL-6 (P = 0.001). CONCLUSION: Considering the results of this study and reported role of inflammatory cytokines in the pathogenesis of cardiovascular and oral diseases, measurement of salivary IL-6 and TNF-α in HD patients may help in risk stratification of HD patients and in planning pertinent preventive strategies.

Effects of endodontic tri-antibiotic paste on bond strengths of dentin adhesives to coronal dentin.

OBJECTIVES: The aim of this study was to evaluate the effects of tri-antibiotic paste (TAP) on microtensile bond strengths (MTBS) of dental adhesives to dentin. MATERIALS AND METHODS: Sixty extracted molars had their occlusal surfaces flattened to expose dentin. They were divided into two groups, i.e., control group with no dentin treatment and experimental group with dentin treatment with TAP. After 10 days, specimens were bonded using self-etch (Filtek P90 adhesive) or etch-and-rinse (Adper Single Bond Plus) adhesives and restored with composite resin. Teeth were sectioned into beams, and the specimens were subjected to MTBS test. Data were analyzed using two-way ANOVA and post hoc Tukey tests. RESULTS: There was a statistically significant interaction between dentin treatment and adhesive on MTBS to coronal dentin (p = 0.003). Despite a trend towards worse MTBS being noticed in the experimental groups, TAP application showed no significant effect on MTBS (p = 0.064). CONCLUSIONS: The etch-and-rinse adhesive Adper Single Bond Plus presented higher mean bond strengths than the self-etch adhesive Filtek P90, irrespective of the group. The superior bond performance for Adper Single Bond when compared to Filtek P90 adhesive was confirmed by a fewer number of adhesive failures. The influence of TAP in bond strength is insignificant.

Histological assessment of pulpal responses to resin modified glass ionomer cements in human teeth.

BACKGROUND: The biocompatibility of resin-modified glass ionomers (RMGIs) as a lining material is still under question. The present study evaluated the response of the pulp-dentin complex following application of resin-modified glass-ionomer cement, calcium hydroxide and conventional glass-ionomer in deep cavities prepared in human teeth. MATERIALS AND METHODS: In this controlled clinical trial, 30 deep class V buccal cavities (3 mm × 2 mm × 2 mm) were prepared in human premolars treatment planned to be extracted for orthodontic reasons and divided into 3 groups. Groups were lined by a RMGI (Vivaglass), conventional glass Ionomer (Ionocid) and calcium hydroxide respectively. The cavities were subsequently filled with amalgam. Each group was then divided into two sub-groups according to time intervals 5 and 30 days. The patients were referred to Kerman Dental School and in accordance with orthodontic treatment plan; premolars were extracted and then prepared for histological assessment. The sections were stained with hematoxylin and eosin and periodic acid Schiff techniques. All of the samples were examined using a number of criteria including odontoblastic changes, inflammatory cells response, reactionary dentin formation and presence of microorganisms. The data were analyzed by Kruskal-Wallis and Mann-Whitney tests. P < 0.05 was considered as significant. RESULTS: There was no significant difference among odontoblastic changes, reactionary dentin, presence of bacteria and inflammatory cells response of the groups (P > 0.05). CONCLUSION: Ionocid and Vivaglass resin-modified glass ionomers can be used as lining materials in human teeth.

Histologic evaluation of apical pulp of immature apex following extraction, surface treatment, and replantation in different storage media in dogs.

AIM: This study was designed to evaluate the apical pulp of open apex teeth following extraction, surface treatment, and preservation in different storage media in dogs. MATERIALS AND METHODS: Four healthy male dogs were included in this prospective animal study. In the first phase of extraction, 30 teeth were extracted atraumatically from dogs (incisors and premolars) and then randomly divided into three groups based on different types of storage media: (i) milk, (ii) HBSS, and (iii) dry storage. In milk and HBSS groups, teeth were contaminated by dog's saliva and then kept in milk and HBSS solution, respectively, for 2 h. In the third group, teeth were stored in a dry storage for 2 h. Before replantation, all teeth were soaked in 10% doxycycline. After 2 months, in the second phase of extraction, all experimental teeth were extracted (40 teeth including control group). Three longitudinal sections (3-4 mm thickness) were stained with H&E and investigated under optical microscope. Histologic evaluations were performed, and data were analyzed using Kruskal-Wallis and Fisher's exact test (α = 0.05). RESULTS: There was a significant difference between the milk and control groups regarding the presence of the odontoblastic layer and resorption (P = 0.04). Also, there was a significant difference between dry storage and control group in the presence of the odontoblastic layer (P = 0.02). There was no statistically significant difference in other histologic factors between different groups (P > 0.05). It was revealed that there is no significant difference between different groups regarding the intensity (P = 0.06) and the type of the inflammation (P = 0.24). Also, the hyperemia showed no significant difference between different groups (P = 0.51). CONCLUSION: It was concluded that HBSS and milk are appropriate storage media. Also, it was shown that 2 h dry storage probably does not threaten the vitality of the pulp cells.

Effect of antioxidants on push-out bond strength of hydrogen peroxide treated glass fiber posts bonded with two types of resin cement.

OBJECTIVES: Hydrogen peroxide (H2O2) surface treatment of fiber posts has been reported to increase bond strength of fiber posts to resin cements. However, residual oxygen radicals might jeopardize the bonding procedure. This study examined the effect of three antioxidant agents on the bond strength of fiber posts to conventional and self-adhesive resin cements. MATERIALS AND METHODS: Post spaces were prepared in forty human maxillary second premolars. Posts were divided into five groups of 8 each: G1 (control), no pre-treatment; G2, 10% H2O2 pre-treatment; G3, G4 and G5. After H2O2 application, Hesperidin (HES), Sodium Ascorbate (SA) or Rosmarinic acid (RA) was applied on each group respectively. In each group four posts were cemented with Duo-Link conventional resin cement and the others with self-adhesive BisCem cement. Push-out test was performed and data were analyzed using 2-way ANOVA and tukey's post-hoc test (α = 0.05). RESULTS: There was a statistically significant interaction between the cement type and post surface treatment on push-out bond strength of fiber posts (p < 0.001, F = 16). Also it was shown that different posts' surface treatments significantly affect the push-out bond strength of fiber posts (p = 0.001). H2O2 treated posts (G2) and control posts (G1) cemented with Duo-link showed the highest (15.96 ± 5.07MPa) and lowest bond strengths (6.79 ± 3.94) respectively. CONCLUSIONS: It was concluded that H2O2 surface treatment might enhance the bond strength of fiber posts cemented with conventional resin cements. The effect of antioxidants as post's surface treatment agents depends on the characteristics of resin cements used for bonding procedure.

Effect of dentin conditioning on bond strength of fiber posts and dentin morphology: a review.

PURPOSE: Post and core systems are commonly used to restore endodontically treated teeth. A durable bond between fiber posts and dentin contributes to the success of the restorative treatment. Different irrigants are used during post space preparation and various studies have investigated the effects of these chemical agents on bond strength and dentin morphology. METHODS: The MEDLINE-PubMed, Cochrane, and SCOPUS databases were searched for appropriate papers addressing the effects of irrigants on bonding of fiber posts to dentin and on dentin morphology. Databases were searched from 2002 through 2012. The search was performed using a variety of keywords including fiber posts, bond strength, post space preparation, post space irrigation, and smear layer removal. RESULTS: Using multiple key words and different strategies, 68 publications were initially screened. The abstracts of these 68 publications were scanned for relevance, and 50 full-text articles were selected and read in detail. Thirty publications which discussed the effect of various intracanal irrigants on bond strengths of fiber posts and dentin morphology were incorporated in this review. Following review of all relevant papers, it can be concluded that bond strengths of fiber posts to radicular dentin can be affected by the irrigants used and that various irrigants affect different types of resin cements differently.

Immunologic and psychologic parameters associated with geographic tongue.

OBJECTIVE: Several conditions have been associated with geographic tongue (GT). However, there is no consensus on the etiology of GT. The purpose of this study was to investigate whether immunologic and psychologic parameters are associated with diagnosis of GT. STUDY DESIGN: A case-control study was performed on 170 participants (85 with GT, 85 controls). Unstimulated whole saliva was collected, and tumor necrosis factor alpha (TNF-α) and interleukin 6 (IL-6) concentrations were measured. Anxiety level was measured using psychologic and physiologic testing instruments. An independent t test and a Pearson correlation analysis were performed with SPSS (α = .05). RESULTS: There was a significant difference between the 2 groups regarding the salivary concentrations of TNF-α (P = .008) and IL-6 (P = .001). The concentration of salivary cortisol and state and trait anxiety levels in the GT group were significantly higher than those in the control group (P = .001). CONCLUSIONS: Immunologic and psychologic parameters appear associated with GT and may constitute risk factors of this condition.

In vitro evaluation of two methods of ultrasonic irrigation on marginal adaptation of MTA plugs in open apex teeth: a SEM analysis.

CONTEXT: Different factors can affect the marginal adaptation of MTA. AIMS: The present study was designed to investigate the effect of two ultrasonic irrigation methods on the marginal adaptation of MTA plug in open apex teeth by scanning electron microscope. SETTINGS AND DESIGN: Thirty single mature teeth were included in this in vitro experimental prospective study. MATERIALS AND METHODS: A total of 5 mm thickness of MTA plug was inserted at the end of the canals and after 24 h an ultrasonic file was used to irrigate the canals and remove the MTA remnants. Teeth were randomly divided into three groups: In the first and second groups, the canals were irrigated for 1 min by 2.5% sodium hypochlorite as #25 ultrasonic file was in direct contact and 1 mm away from MTA plug, respectively. The third group was not irrigated and left as control. A total of 1 mm transverse sections were prepared through the coronal and the apical parts of MTA plug and specimens were prepared for SEM analysis. The extent of gap was measured linearly under SEM device. STATISTICAL ANALYSIS USED: Statistical analysis of the results was performed using the kruskal-Wallis test by SPSS software ver.18(a = 0.05). RESULTS: There was no significant difference between groups regarding the marginal gap size in apical (P: 0.17) and coronal sections (P: 0.33). However, the mean marginal gap size was higher in apical section compared to coronal section. CONCLUSIONS: It can be concluded that ultrasonic irrigation dose not adversely affect the marginal adaptation of MTA plugs.