Influence of sodium hypochlorite/etidronic acid combination and SmearOFF on push-out bond strength of fiber posts to root dentin.

The aim was to evaluate the effects of different irrigation protocols on the bonding ability of fiber posts on root canal dentin through push-out test and the dentin tubule penetration of luting cement by confocal laser scanning microscope (CLSM). Forty-eight single-rooted premolars were divided into six groups (n=8) based on post space irrigation protocols: Saline 0.85%; Etidronate 18% (HEBP); EDTA 17%; NaOCl 5.25%+EDTA 17%; NaOCl 2.5%/HEBP 9% combination; SmearOFF. Two specimens per group were assessed with CLSM. The push-out test and the failure analysis were performed. Whilst EDTA had the highest bond strength at the coronal and middle thirds, it was not statistically significant compared to saline, HEBP, and NaOCl/HEBP at the middle third (p>0.05). Cement/dentin adhesive failures were predominant (41.9%) and the intratubular fluorescence intensity was significant among the groups (p<0.05). EDTA resulted in highest bond strength values and dentinal penetration.

Qualitative analysis of smear layer treated with different etidronate concentrations: A scanning electron microscopy study.

The aim of this study was to examine the smear layer removal capacity of various etidronate treatments. Seventy-eight roots were instrumented up to apical size X4 and randomly divided into five treatment groups and a positive control group (n = 13). Groups were as follows: irrigation with 5 ml of sterile saline (control) for 3 min, 5 ml of 17% ethylenediaminetetraacetic acid (EDTA) for 3 min, 5 ml of 9% A1-hydroxyethylidene-1,1-bisphosphonate (HEBP) for 3 min, 5 ml of 18% HEBP for 3 min, irrigation with 5 ml of 1% sodium hypochlorite (NaOCl) + 9% HEBP for 3 min, and 5 ml of 2% NaOCl + 18% HEBP for 3 min. The roots were examined using a scanning electron microscope. The smear layer scores in the 2% NaOCl + 18% HEBP group were lower than those in the other treatment groups and the control group (p < .05). There were no significant differences among the treatment groups in the smear layer scores of the coronal and middle thirds. However, the smear layer scores in the 2% NaOCl + 18% HEBP treatment group were lower those in the 9% HEBP and 18% HEBP treatment groups in the apical third (p < .05). In the clinical setting, the recommended concentration of HEBP is 18%, and it should be used with an oxidizing agent to ensure optimum smear layer removal.

Shaping ability of the profile 25/0.06 and protaper F2 in rotary motion, and reciproc in simulated canals.

BACKGROUND: Since the introduction of nickel-titanium (Ni-Ti) instruments to dentistry, a wide variety of Ni-Ti instruments have become commercially available. These Ni-Ti instruments are expensive, which limits their usage in developing countries and forces practitioners to use instruments repeatedly. Another problem is the possible prion cross-contamination associated with the multiple usage of endodontic instruments. In addition, the use of these instruments requires new skills and experience. In this article, the shaping capacities of two conventional rotary file systems, ProFile 25/0.06 and ProTaper F2, were reviewed and compared with the Reciproc single-file system. METHODS: A total of 45 simulated canals with 40° curvature, in clear resin blocks, were prepared using conventional rotary systems consisting of ProFile orifice shaping (OS) #3 and final flaring #25/.06, Reciproc R25, and ProTaper shaping file SX and finishing file F2. Pre-and post-instrumentation images were analyzed at ten different levels, using AutoCAD 2007 software. The measurement positions were defined in 1-mm intervals: positions 0-3 established the apical part, positions 4-6 constituted the middle part, and positions 7-10 established the coronal part of the canal. The amount of removed resin, the transportation, instrumentation time, change in working length (WL), instrumentation fractures, and the presence of ledge were evaluated. Data were analyzed using ANOVA, Kruskal-Wallis and independent t-test (p < 0.001). RESULTS: ProFile removed the least resin (p < 0.001) and caused less transportation than Reciproc and ProTaper, in total (p < 0.001). ProTaper caused more transportation ProFile and Reciproc in the apical part (p < 0.000). Reciproc caused more transportation than ProTaper and ProFile (p < 0.001), and the transportation tendency toward the inner aspect of the curvature in the middle part. Reciproc caused the less transportation than ProFile and ProTaper in the coronal part. The transportations tended to occur toward the outside of the curvature, except the middle part with Reciproc and at points 5 and 6 with ProTaper. There were no significant differences among the groups in terms of maintaining the original WL. Reciproc was significantly faster than the others group (p < 0.001). Only one instrument fracture (25/0.06 ProFile) was noted. All groups showed one ledge each. DISCUSSION: The results of the present study showed that both ProFile 25/06 and ProTaper F2, combined with a file used for coronal enlargement (OS3 and SX), have the potential to create satisfactory canal shape in the curved root canals. Further studies using real human teeth are needed to confirm our results.

Correction: Enhancing antibacterial effect of sodium hypochlorite by low electric current-assisted sonic agitation.

[This corrects the article DOI: 10.1371/journal.pone.0183895.].

Enhancing antibacterial effect of sodium hypochlorite by low electric current-assisted sonic agitation.

BACKGROUND: This research focused on the effects of low electric current (µE)-assisted sonic agitation of sodium hypochlorite on Enterococcus faecalis infected human root dentin. METHODS: Extracted human canine roots were instrumented, sterilized, and experimentally contaminated with E. faecalis. After incubation for 21 days, the presence of the biofilm was confirmed by scanning electron microscopy (n = 3). Roots were randomly divided into seven groups according to decontamination procedures: G1: no treatment; G2: sterile saline; G3: 5.25% sodium hypochlorite; G4: passive ultrasonic irrigation; G5: EndoActivator (Dentsply Tulsa Dental Specialties, Tulsa, OK) agitation (EA); G6: µE agitation; and G7: µE-assisted sonic agitation. Fixed µE amperage and intensities were applied in G6 and G7. Following microbial sampling, bacterial colonies were counted using the direct plating method. RESULTS: Biofilm was not eradicated in any sample. The µE-assisted sonic agitation of sodium hypochlorite revealed the lowest cfu values (p<0.05), whereas there were no significant differences among the passive ultrasonic irrigation, EndoActivator and µE agitation alone (p>0.05). CONCLUSIONS: Based on available evidence, the following conclusions were drawn: The µE-assisted sonic agitation increased the antibiofilm efficiency of sodium hypochlorite than passive ultrasonic irrigation and EndoActivator. The µE-assisted sonic agitation on 5.25% sodium hypochlorite is not capable to eradicate biofilms at 10mA energy level in 60s.

The effect of micro-electric current and other activation techniques on dissolution abilities of sodium hypochlorite in bovine tissues.

BACKGROUND: The aim of the study was to evaluate the effects of micro-electric current on sodium hypochlorite's (NaOCl's) tissue-dissolution abilities, compared with other activation methods, including sonic, ultrasonic, pipetting, and temperature. METHODS: Bovine muscle tissues (n = 154) with standard sizes and weights were prepared and divided into two temperature groups: room temperature and 45 °C. Each temperature group was divided into seven sub-groups by activation methods: D = distilled water (-control); NaOCl = 5.25 % passive NaOCl (+ control); P = 5.25 % NaOCl with pipetting; SA = 5.25 % NaOCl with sonic activation; UA = 5.25 % NaOCl with ultrasonic activation; E-NaOCl = 5.25 % NaOCl with micro-electric current; and E-NaOCl + P = 5.25 % NaOCl with micro-electric current and pipetting. Specimens were weighed before and after treatment. Average, standard deviation, minimum, maximum, and median were calculated for each group. Resulting data were analyzed statistically using multi-way ANOVA and Tukey HSD tests. The level of the alpha-type error was set at < 0.05. RESULTS: At room temperature, the E-NaOCl + P group dissolved the highest amount of tissue (p < 0.05), and the UA, SA, and P groups dissolved significantly higher amounts of tissue than did the positive control or E-NaOCl groups (p < 0.05). At 45 °C, there was no significant difference between the SA and E-NaOCl groups (p > 0.05), and the E-NaOCl + P group dissolved a higher amount of tissue than any other group (p < 0.05). CONCLUSIONS: Using NaOCl with micro-electric current can improve the tissue-dissolving ability of the solution. In addition, this method can be combined with additional techniques, such as heating and/or pipetting, to achieve a synergistic effect of NaOCl on tissue dissolution.

Rapid tissue dissolution efficiency of electrically-activated sodium hypochlorite on bovine muscle.

OBJECTIVE: Sodium hypochlorite (NaOCl) is a common antimicrobial and tissue-dissolving irrigant. The aim of this in vitro study is to evaluate and compare dissolution capacities of sodium hypochlorite solutions after electrically activation (E-NaOCl) on bovine muscle specimens at various time periods and concentrations. MATERIALS AND METHODS: Three sodium hypochlorite solutions of 1.25%, 2.5%, and 5% were tested at 3-min. and 5-min. with and without activation by electrically. Distilled water and NaOCl solutions without electrically activation were used as controls. Pieces of bovine muscle tissue (34 ± 2 mg) were placed in 10 mL of each solution at room temperature. In the group of E-NaOCl, electrically activation was performed through the potentiostat. The tissue specimens were weighed before and after treatment, and the percentage of weight loss was calculated. RESULTS: Weight loss of the tissue increased with the concentration of E-NaOCl and NaOCl. Higher concentration and electrically activation considerably enhanced the efficacy of sodium hypochlorite. The effect of electrically activation on tissue dissolution was much greater than that of same concentrations in the groups of NaOCl (P < 0.001). Tissue weight loss was significantly higher in 2.5% and 5% E-NaOCl at 3 min. than in 2.5% and 5% NaOCl at 5 min. (P < 0.05). There were not any significant differences between the 2.5% E-NaOCl and 5% NaOCl at 5 min. (P > 0.05). CONCLUSION: Electrically activation can improve the tissue-dissolving effectiveness of sodium hypochlorite.

Determination of the effect of Nd:YAG laser irradiation through dentinal tubules on several oral pathogens.

The effects of Nd:YAG laser irradiations at different power settings on several oral pathogens were evaluated. A total of 252 dentin samples were divided into seven groups consisting of 36 dentin specimens each. In each group, 9 of the 36 specimens were used as controls, thereby including a control in every group. The remaining 27 specimens were divided into three subgroups consisting of nine specimens according to different Nd:YAG laser settings (1.5, 1.8, and 2 W). Each group was inoculated on the nonpulpal side with one of the following microorganisms: Candida glabrata, Candida tropicalis, Candida krusei, Candida sake, Candida lusitaniae, Candida kefyr, and Rhodotorula mucilaginosa. The following irradiation procedure was used: the specimens were irradiated on the bacteria-free side (the side consisting of the pulpal wall) using contact mode under the constant scanning movement of the optical fiber at an angle of 10°. One lasing cycle consisted of four irradiation cycles of 10 s each, with 15-s intervals in between each irradiation cycle. The remainder of the controls and the lased specimens of each group were prepared for the microbiological investigation. After incubation for 24 h at 37 °C, the colonies were counted, and the total number of surviving microorganisms was statistically assessed. Microorganisms irradiated with Nd:YAG laser at power settings 2 W, 15 pps did not survive. Although there was a significant reduction of microorganisms at 1.5 and 1.8 W, when comparing Nd:YAG laser irradiation with the control group, sterilization did not occur.

Effects of dissolving solutions on the accuracy of an electronic apex locator-integrated endodontic handpiece.

The effects of three dissolving agents on the accuracy of an electronic apex locator- (EAL-) integrated endodontic handpiece during retreatment procedures were evaluated. The true lengths (TLs) of 56 extracted incisor teeth were determined visually. Twenty teeth were filled with gutta-percha and a resin-based sealer (group A), 20 with gutta-percha and a zinc oxide/eugenol-based sealer (group B), and 16 roots were used as the control group (group C). All roots were prepared to TL. Guttasolv, Resosolv, and Endosolv E were used as the dissolving solutions. Two evaluations of the handpiece were performed: the apical accuracy during the auto reverse function (ARL) and the apex locator function (EL) alone. The ARL function of the handpiece gave acceptable results. There were significant differences between the EL mode measurements and the TL (P < 0.05). In these comparisons, Tri Auto ZX EL mode measurements were significantly shorter than those of the TL.

Root canal shaping using rotary nickel-titanium files in preclinical dental education in Turkey.

The purposes of this study were to evaluate the ability of a group of third-year dental students without any endodontic clinical experience to use the ProTaper Instruments (Dentsply Maillefer) to decrease the amount of straightening of curved canals on human molar teeth and to determine the incidence of instrument fractures and instrumentation time. Thirty-one undergraduate dental students in Turkey received a training session. The students prepared a total of 144 root canals in human mandibular or maxillary molar teeth with ProTaper. Fifty-six teeth were excluded due to unreadable image, misinformation, or straight or severe curve. Using pre- and post-preparation digital radiographs, the straightening of curved root canals was investigated. Loss of working length and incidence of fracture were also noted. A total of eighty-eight curved root canals were selected. Mesiobuccal or mesiolingual roots with curvatures of between 20° and 43° as assessed by Schneider's method and working length of between 15 mm and 22.5 mm were included in the study. The means of the curved root canals before and after the instrumentation were 29.5° ± 6° and 27° ± 6.3°, respectively. The means of the working length before and after the instrumentation were 19 mm ± 2.1 mm and 18.3 mm ± 1.9 mm, respectively. A statistically significant difference between straightening of curved root canals and loss of working length was found between before and after instrumentation (p<0.000). The mean straightening of curved root canals and loss of working length after preparation with the size F1 ProTaper file were 2.5 mm ± 3.6 mm and 0.7 mm ± 0.6 mm, respectively. Only two F1 ProTaper instruments fractured at the apical level. The study concluded that rotary instruments performed adequately with inexperienced operators who received a brief structured training session.

Repair of Furcal Iatrogenic Perforation with Mineral Trioxide Aggregate: Two Years Follow-up of Two Cases.

Furcal perforation is usually an undesired complication that can occur during preparation of endodontic access cavities or exploring canal orifice of multirooted teeth. Inadequacy of the repair materials has been a contributing factor to the poor outcome of repair procedures. On the basis of the recent physical and biologic property studies of the relatively new introduced mineral trioxide aggregate, this material may be suitable for closing the communication between the pulp chamber and the underlying periodontal tissues. There are few reports on repair of furcal perforation with MTA in molar teeth. The purpose of this case report was to describe the treatment of two furcal perforation using MTA in molar teeth. The perforations were cleaned with NaOCl and saline solution and sealed with MTA without internal matrix. Finally, the teeth were endodontically treated and coronally restored with composite resin and ceramic veneer crown and bridge. After 2 years, the absence of periradicular radiolucent lesions, pain, and swelling along with functional tooth stability indicated a successful outcome of sealing perforations in two cases.

Comparative investigation of 2 rotary nickel-titanium instruments: protaper universal versus protaper.

OBJECTIVE: The objective of this study was to evaluate whether the changes in the design of the ProTaper canal instruments contribute to the shaping ability of the instrument in terms of the morphology of curved canals measured by the cross-sectional area using the Bramante method. STUDY DESIGN: Ten extracted human mandibular molars with root canal curvatures between 25 degrees and 41 degrees were used. Ten mesiobuccal canals were instrumented with ProTaper and 10 mesiolingual canals were instrumented with ProTaper Universal rotary instruments. Pre- and postoperative sections were obtained from the coronal, middle, and apical portions and analyzed. Statistical analysis was performed using the Student t test (P < .05). RESULTS: No statistically significant difference was observed in terms of amount of dentin removed, transportation, variation of canal shape factor or change in working length, and working time (P > .05). Only one instrument fracture (F2 in the ProTaper group) and 2 instrument deformations (S1 and F3 in ProTaper and ProTaper Universal, respectively) were noted. CONCLUSION: Within the limitations of this study, the modifications on ProTaper instruments were found to not create any discrepancy on the shaping abilities of instruments and the evaluated other factors. In addition, both rotary nickel-titanium instruments prepared a well-shaped root canal with minimal canal transportation.

Effects of Nd: YAG laser irradiation on the adaptation of composite resins to root dentin.

One of the most important goals of the restoration of endodontically treated teeth with a composite resin post system is to achieve good adaptation of the composite material to dentin walls to prevent microleakage apically and coronally. In post core systems, to avoid microleakage between the dentin wall and resin material, laser irradiation may seem to be an alternative therapy for increasing adaptation quality. The aim of this study was to investigate the adaptation of a packable composite resin to lased root canal dentin when it was used as post material. Forty-five freshly extracted human teeth were selected and post spaces were prepared. The teeth were divided into three groups. In group 1 the dentin of the post spaces were etched with 35% phosphoric acid, in group 2 the dentin surfaces were irradiated with an Nd: YAG laser, and in group 3 the dentin surfaces were initially treated with the laser and then etched. The teeth of all groups were obturated with a bonding agent and composite. The groups were divided into two subgroups: a group for the scanning electron microscope (SEM) study and a group for the microleakage study. The lased group showed poor adaptation and more microleakage was detected (p<0.05; variance analysis). The laser beam and acid-etching showed no advantage compared to the acid-etching alone (p>0.05). The Nd: YAG laser irradiation adversely affects adhesion to dentin for using composite resin as a post material and does not constitute an alternative to acid-etching.

The effect of disruption of apical constriction on periapical extrusion.

The aim of this study was to compare the amount of apical extrusion during manual instrumentation and engine-driven rotary instrumentation in teeth with disrupted apical constriction. Fifty-two teeth were divided into two groups comprising 26 teeth each. Teeth in each group were further divided into two sub-groups, the apices of which were enlarged approximately to a diameter of 0.2 mm and 0.4 mm. One group was instrumented using standardized technique with K-files and the other with ProFile .04 Taper Series 29, while irrigating with sodium hypochlorite. Glass vial model was modified for collection of extruded debris and irrigant as well as to integrate an electronic apex locator to the experimental assemble. The statistical analysis using Student's t test revealed no significant difference between instrumentation with K-files and ProFile .04 taper files (p > 0.05). There was a tendency with both techniques to extrude apically more material as the diameter of the apical patency increased.

Lateral perforation in parallel post space preparations.

This study evaluates the amount of remaining tooth structure and possibility of producing lateral perforation following the use of different diameters of parallel-sided Parapost drills in groups of different canal curvatures (0 degrees-15 degrees, 16 degrees-25 degrees, 26 degrees <) in distal canals of first and second mandibular molar teeth. After enlargement of root canals using the crown-down pressureless technique, Parapost drills #1, #2, and #3 were used in the different canal groups for the preparation of a post space. Standardized digital radiographs were taken before the post space preparation and after each Parapost drill application. Four horizontal lines (a, b, c, and d) were drawn at equal distances on these images, starting from the pulp chamber floor moving apically at 2 mm increments. There were no significant differences between the different curvature groups at the a, b, c, and d levels for the critical level of the remaining tooth structure (multiple comparison test; p>0.05). However, in considering root perforation, both at the inner and outer side of the roots, there were statistically significant differences at "c" and "d" levels in group 3 (#3 drill) without taking into account the root curvature (ANOVA; p< 0.5). None of the specimens showed strip perforation.

The accuracy of three different electronic root canal measuring devices: an in vitro evaluation.

The main objective of this in vitro study was to evaluate the effects of the operator's experience level and pre-flaring on the accuracy of the results of three different brands of a new generation of root canal measuring devices, as well as the comparison among them. Extracted human teeth were prepared and then actual length and electronic length measurements were made by three different operators according to a double-blind technique. Three different operators performed electronic measurements on each specimen separately with three different electronic root canal measuring devices using in vitro models. Measurements were repeated by all operators after the pre-flaring. Taking the clinical tolerance of +/- 0.5 mm into account, there was no statistically significant difference between the accuracy of the instruments (P > 0.01). However, the results obtained from the Bingo electronic apex locator in pre-flared canals by the beginner operator were statistically significant (P < 0.01). All of the instruments had a clinically acceptable result at the tolerance of +/- 0.5 mm. If the instruments are used in accordance with the manufacturer's instructions, experience with electronic root canal measurement is not essential. However, the operator has to be more careful when working on pre-flared canals.

Evaluation of apical leakage of root canals obturated with Nd: YAG laser-softened gutta-percha, System-B, and lateral condensation techniques.

In endodontics, a laser can be used as a heat source and gutta-percha can be softened by a laser and used in the root canals. The System-B endodontic heat source unit was designed for the obturation of the root canal system with a single continuous wave of thermoplasticized gutta-percha. The aim of this study was to compare the apical leakage of lateral condensation; Nd: YAG laser-softened gutta-percha and System-B techniques. Fifty-five extracted, single root human maxillary anterior and premolar teeth were used in this study. After working length determination, the "step-back technique" was used to prepare the root canals. The teeth were randomly divided into three experimental groups of 15 each and two control groups of 5 specimens each. The first group was obturated by lateral condensation, the second group by gutta-percha softened with an Nd: YAG laser, and the third group was obturated using the System-B technique. Apical leakage of the roots was evaluated by dye penetration using a stereomicroscope after sectioning the roots. The results of the first and third groups were similar, and the results of the second group showed differences when compared with the other groups. However, variance analysis revealed there was no statistically significant difference among the results.