Sealing ability of three different materials to repair furcation perforations using computerized fluid filtration method.

Background. The present study aimed to evaluate the sealing ability of three different calcium silicate-based materials in furcation perforations. Methods. Seventy-six human mandibular molar teeth were selected. Perforations were created in the center of the pulp chamber floor. The experimental teeth were randomly divided into three groups (n=22). Perforations were repaired with MTA Angelus, Endocem MTA, or EndoSequence BioCeramic Root Repair Material Fast Set Putty (BC-RRM Putty). Microleakage of the different repair materials to be tested was measured by computerized fluid filtration method at 24- and 72-hour intervals. Results. For each time interval, no statistically significant difference was observed between the groups. For Endocem MTA and BC-RRM Putty groups, the difference between the leakage values measured at both periods was not statistically significant (P > 0.05). However, there was a significant difference for the MTA Angelus group (P < 0.05). Conclusion. All the calcium silicate-based materials used in the present study showed similar performance in repairing furcation perforations at 24- and 72-hour intervals.

Influence of Post Space Preparation on the Apical Leakage of Calamus, Single-Cone and Cold Lateral Condensation Obturation Techniques: A Computerized Fluid Filtration Study.

PURPOSE: Apical microleakage between the root canal and periapical tissues is considered a common cause of endodontic failure. The aim of this study was to evaluate the apical microleakage of various obturation techniques after immediate post space preparations with different drills. MATERIALS AND METHODS: One hundred twenty human single-rooted teeth were selected for this study. The coronal portions were removed to achieve a uniform length of 15 mm. All root canals were instrumented with ProTaper Next rotary files using crown-down technique. The 120 roots were randomly assigned to 3 experimental groups according to obturation technique (n = 40). The root canals were obturated with lateral condensation in group 1, single-cone technique in group 2, and Calamus 3D obturation system in group 3. Each group was divided into two subgroups (n = 20) according to drill types (Gates Glidden and Peeso drills) leaving 5 mm of apical gutta-percha. The apical microleakage was measured using the computerized fluid filtration meter method. The results were evaluated using Kruskal-Wallis test with Bonferroni Corrected Mann-Whitney U multiple comparison post hoc tests. RESULTS: There was no statistically significant difference between obturation techniques after post space preparation with Peeso drills (p > 0.05). In Gates Glidden drill groups, single-cone technique demonstrated higher leakage (0.0051 ± 0.0037 µl x min-1 × cmH2 O-1 ) than Calamus techniques (0.0019 ± 0.0012 µl x min-1 × cmH2 O-1 ) (p < 0.017). CONCLUSIONS: Gates Glidden drills caused the highest apical leakage in teeth obturated with single-cone technique.

Evaluation of the effects of Er:YAG laser, Nd:YAG laser, and two different desensitizers on dentin permeability: in vitro study.

The purpose of this in vitro study was to evaluate and compare the efficacy of erbium-doped yttrium aluminum garnet (Er:YAG) laser, neodymium-doped yttrium aluminum garnet (Nd:YAG) laser, PrevDent nano-hydroxyapatite toothpaste plus Repairing Serum Kit (PNH), and NUPRO Sensodyne Prophylaxis Paste with NovaMin (NPP) on dentin permeability reduction. Forty dentin discs obtained from bovine incisors were divided into four study groups: Er:YAG laser-treated (2940 nm; 0.2 W, 80 mJ/pulse, 3 Hz); Nd:YAG laser-treated (1064 nm; 1 W, 10 Hz); PNH-treated; and NPP-treated groups. The quantitative changes in permeability of each dentin disc were measured using a computerized fluid filtration method (CFFM) before and after desensitizer treatments. The data were analyzed using the Wilcoxon, paired-samples t, Kruskal-Wallis, and Mann-Whitney U tests. The dentin surfaces and tubules were also morphologically detected by scanning electron microscopy (SEM). In all groups, dentin permeability was significantly reduced after the desensitizer and laser treatments (p < 0.05). Among the groups, we detected a significant difference in only when comparing the Er:YAG laser- and NPP-treated groups (p = 0.034). SEM analysis revealed physical changes in the dentin surface in all groups. This in vitro study shows that all tested desensitizers and laser treatments reduced dentin permeability. Also, surface changes, such as complete or partial occlusion or shrinkage of dentin tubules, were observed in all groups. Although the laser groups performed best, the PNH protocol can be considered as an alternative therapeutic product. In addition, clinical and laboratory studies should be performed for this product, and their efficacy should be assessed by combined therapy with lasers.

Evaluation of Five Different Desensitizers: A Comparative Dentin Permeability and SEM Investigation In Vitro.

BACKGROUND/OBJECTIVE: The purpose of this study was to evaluate the efficacy and durability of five different dentin desensitizers (Gluma Desensitizer Powergel, Bifluorid 12, Gluma Self Etch Bond, D/Sense Crystal, Nupro Sensodyne Prophylaxis Paste with Novamin) on tubule occlusion and dentin permeability reduction in vitro. METHOD: The quantitative changes in permeability of 100 dentin discs were measured after desensitizer treatments and following post-treatments of 6% citric acid challenge for 1 min or immersion in artificial saliva for 24 hours under hydrostatic pressure generated by a computerised fluid filtration meter. Qualitative SEM analyses were also carried out. RESULTS: Dentin permeability decreased after desensitizer application in all groups. Nevertheless, only the difference between 'Gluma Self Etch Bond' and 'Nupro Sensodyne Prophylaxis Paste with Novamin' groups was significantly different (p<0.05). Dentin permeability increased significantly after post-treatments (p<0.05). There was no statistically difference among the citric acid-subgroups (p>0.05). Of all the artificial saliva-subgroups, only the difference between 'D/Sense Crystal' and 'Bifluorid 12' was significantly different (p<0.05). In SEM analysis, morphological changes were detected on the dentin surface and within the tubules following desensitizer treatments and post-treatments. CONCLUSION: All the desensitizers significantly reduced dentin permeability by changing the morphology of the dentin surface and/or dentinal tubules. Following post-treatments, there was some reduction in the efficacy of the desensitizers which was represented by the reduction in permeability values. SEM analysis revealed some physical changes in the dentin structure which can partly give an explanation to the reduced efficacy of tested desensitizers.

Effect of spreader size on microleakage of roots filled with cold lateral compaction technique.

OBJECTIVES: To evaluate the effect of spreader size on apical leakage of maxillary incisor teeth. MATERIALS AND METHODS: A total of 75 permanent human teeth with no carious and no fracture or crack were used for this study. After removing the crown from the cementoenamel junction and the standardization of the root lengths, the specimens were randomly divided into five groups: Group 1 - Roots were not instrumented. Group 2 - Root canals were enlarged using the step-back technique to a #40 file and filled using cold lateral compaction (CLC) of gutta-percha (GP). Group 3 - During the filling procedure, the first spreader used was size 40. Group 4 - The first spreader used was size 35. Group 5 - The initial spreader used was size 25. The amount of leakage through the filled root canals was evaluated by computerized fluid filtration model. Statistical analyzes were done using Kruskal-Wallis test and Mann-Whitney test (P < 0.05). RESULTS: There were statistically significant differences among the groups (P < 0.05). While the uninstrumented group (Group 1) had no leakage, instrumented but not filled roots (Group 2) demonstrated the highest leakage values. There were no differences between Group 3 and 4. Group 5 showed significantly less leakage than Group 3 and 4. CONCLUSION: Spreader size used during CLC of GP appeared to be a significant factor on apical leakage of roots. Using smaller size spreader during CLC may provide relatively less leakage.

Determination of the Apical Sealing Abilities of Mineral Trioxide Aggregate, Portland Cement, and Bioaggregate After Irrigation with Different Solutions.

OBJECTIVES: The purpose of this study was to investigate the sealing ability of root-end filling materials such as mineral trioxide aggregate (MTA), Portland cement, and bioaggregate (BA) after irrigation with different solutions. MATERIALS AND METHODS: We examined 130 human maxillar central teeth. After cutting the teeth at the cementoenamel junction, the root canals were expanded using nickel-titanium rotary instruments. Root canals were filled with AH-plus and gutta-percha. Then, the roots were cut apically, and 3 mm deep retrograde cavities were prepared. The roots were divided 12 experimental groups, consisting 10 teeth each; the positive and negative control groups contained five teeth each. The retrograde cavities were rinsed using ethylenediaminetetraacetic acid (EDTA), chlorhexidine (CHX), BioPure(™) mixture of a tetracycline isomer, an acid, and a detergent (MTAD), or distilled water. Next, groups 1, 2, 3, and 4 were sealed with MTA; groups 5, 6, 7, and 8 were sealed with Portland cement; and groups 9, 10, 11, and 12 were sealed with BA. Then, apical microleakage was evaluated by using a computerized fluid filtration method. The results of the leakage test were statistically evaluated by the post-hoc Tukey's test. RESULTS: MTA, Portland cement, and BA root-end filling materials showed the least leakage in the CHX and distilled water groups. The highest leakage was observed in the EDTA and MTAD groups. CONCLUSIONS: The sealing ability of BA was as good as that of MTA. EDTA and MTAD increased the apical leakage and CHX and distilled water decreased the leakage of the root-end filling materials examined in this study.

Comparison of apical microleakage of dual-curing resin cements with fluid-filtration and dye extraction techniques.

BACKGROUND: Endodontically treated teeth with excessive loss of tooth structure are frequently restored using fiber posts. In this in vitro study, the apical leakage of self- and dual-activated curing modes for dual-curing resins cementing a translucent fiber post was evaluated using computerized fluid filtration meter and dye extraction method. MATERIAL AND METHODS: One hundred and four extracted human maxillary incisors with single root and canal were used. Experimental samples embedded in a closed system were divided into 4 groups (n=20) according to 2 dual-curing luting systems, with 2 different curing modes (either with self- or light-activation): (1) Panavia F 2.0 with self-cure, (2) Panavia F 2.0 with light-activation, (3) Clearfill SA with self-cure, and (4) Clearfill SA with light activation. Twenty-four teeth served as negative and positive controls. Translucent fiber posts were luted in the roots except in the control groups. RESULTS: Statistical analysis indicated no significant difference in leakage among groups (p>0.05) with 4.12 × 10(-4) (Panavia self-cure), 4.55 × 10(-4) (Clearfill SA self-cure), 5.17 × 10(-4) (Panavia dual-cure), and 5.59 × 10(-4) (Clearfill SA dual-cure) in fluid-filtration method. Absorbance values for dye-extraction method were 266 nanometer (nm) (Panavia self-cure), 268 nm (Clearfill SA self-cure), 270 nm (Panavia dual-cure), and 271 nm (Clearfill SA dual-cure), in which difference among the groups were not statistically significant (p>0.05). When comparing the leakage, assessment methods results showed no statistically significant difference between the tested evaluation techniques (p>0.05). CONCLUSIONS: Light- and self-activation curing modes of Panavia F 2.0 and Clearfill SA perform similar to each other in a closed system.

Microleakage of 4 post-luting cements evaluated by the computerized fluid filtration method.

PURPOSE: The aim of this study was to evaluate the microleakage of 4 fiber post-luting systems using the computerized fluid filtration method. METHODS: 60 extracted human mandibular permanent premolar teeth were used for the study. The teeth were instrumented with Hedstroem files up to size 60, post spaces were prepared and then Unicore fiber posts were cemented using 4 luting systems. Group1: Duolink, Group 2: Resinomer, Group 3: Fuji Plus, Group 4: Multilink Sprint, Group 5: Positive Control, and Group 6: Negative Control. The samples were stored in distilled water for 2 weeks and then microleakage was evaluated. Data were analyzed with 1 way-ANOVA and Dunett T3 tests (P<.05). Groups 2 and 3 significantly exhibited higher microleakage values than groups 1 and 4 (P<.05). RESULTS: Resin cements used with total etch-bonding systems demonstrated lower microleakage values than the other cements. CONCLUSIONS: Reduction of steps in dentin conditioning of resin luting cements may have a promoting effect on microleakage.

Comparative analysis of three different filling techniques and the effects of experimental internal resorptive cavities on apical microleakage.

OBJECTIVES: The aim of this study was to evaluate the sealing abilities of three different gutta-percha techniques in experimentally defective roots (EDR) and non-defective roots (NR). MATERIALS AND METHODS: Sixty canine teeth were divided into six groups of ten; Group 1, NR + cold lateral condensation (CLC); Group 2, EDR + LC; Group 3, NR + BeeFill; Group 4, EDR + BeeFill; Group 5, NR + Thermafil; and Group 6, EDR + Thermafil. Apical leakage was measured using a computerized fluid filtration meter with a laser system. RESULTS: Statistical analysis revealed that the CLC demonstrated more microleakage in the EDR than in the NR (P < 0.01). Thermafil demonstrated more microleakage in the NR than in the EDR (P < 0.01). No statistically significant differences were found between the BeeFill groups (P > 0.05). CONCLUSIONS: The results of this study indicate that internal resorptive cavities can affect the apical sealing properties of different root canal filling techniques, with Thermafil ensuring the lowest apical microleakage.

Effect of the angle of apical resection on apical leakage, measured with a computerized fluid filtration device.

OBJECTIVE: We determined the effect of the angle of apical resection on apical leakage using a computerized fluid filtration meter with a laser system and a digital air pressure regulator in 46 extracted single-rooted human teeth. Orthograde endodontic treatment was performed. The root canals were prepared up to a size 50 K-type file with 17% EDTA solution (Roth International, Chicago, IL) and 5% NaOCl solution as the irrigant. Gates Glidden burs (Maillefer Instruments, Ballaigues, Switzerland) were used to flare the coronal two thirds of the canal. All canals were dried with paper points and then obturated using cold lateral condensation (except for the positive controls) of gutta-percha points and AH plus (Dentsply DeTrey, Konstanz, Germany). All 40 roots were sectioned 3 mm from the apex. Forty teeth were assigned randomly into 1 of 4 experimental groups of 10 teeth each: in group 1, the teeth were resected apically (90° angle) and the cavities were obturated with mineral trioxide aggregate (MTA); in group 2, after apical resection (90° angle), a root-end cavity was prepared using ultrasonic diamond retrotips and the cavities were obturated with MTA; in group 3, the teeth were resected apically (∼45° angle) and the cavities were obturated with MTA; and in group 4, after apical resection (∼45° angle), a root-end cavity was prepared using ultrasonic diamond retrotips and the cavities were obturated with MTA. An additional 6 teeth were used as controls (3 each, negative and positive controls). Apical leakage was measured using a computerized fluid filtration meter with a laser system. RESULTS: The mean apical microleakage was 2.0 ± 0.4 × 10(-4), 1.6 ± 0.6 × 10(-4), 1.6 ± 0.9 × 10(-4), and 1.8 ± 0.7 × 10(-4) µL/cmH(2)O/min(-1) at 1.2 atm, in groups 1 to 4, respectively. Although the mean apical microleakage was greater in group 1, the differences among the 4 groups were not statistically significant (P > .05). CONCLUSIONS: The results of these in vitro studies showed that when an adequate retrograde cavity depth is prepared, variation in the root-end cutting angle does not necessarily cause any difference in microleakage.

Effect of Er,Cr:YSGG laser irradiation on the apical sealing ability of AH Plus/gutta-percha and Hybrid Root Seal/Resilon Combinations.

OBJECTIVE: The objective of this study was to evaluate the sealing ability of 2 different resin-based endodontic filling systems after smear layer removal with 2 different techniques. STUDY DESIGN: Extracted human single-rooted teeth (n = 74) were instrumented using HERO Shaper rotary instruments and irrigated with 1 mL of 2.5% NaOCl between each instrument. Additionally, the canals received either an extra 3-minute rinse with 2 mL of 17% EDTA or a 40-second Er,Cr:YSGG laser treatment. The root canals were filled with either Hybrid Root Seal/Resilon combination or AH Plus/gutta-percha combination using lateral condensation technique (n = 11). Apical leakage quantity was measured with the computerized fluid filtration meter at 1 and 4 weeks. One root from each group, which was not submitted to the fluid filtration test, was selected for scanning electron microscopy (SEM) analysis. Statistical analysis was performed using 3-way ANOVA and the post hoc Tukey HSD test (α = 0.05). RESULTS: A significant decrease was observed in the microleakage values of all the experimental groups tested with time (P < .0001). EDTA + AH Plus/gutta-percha combination exhibited the least microleakage, whereas laser irradiation + Hybrid Root Seal/Resilon combination showed the greatest microleakage at each of the 2 time periods. Each experimental combination exhibited architecture in SEM that seemed to correlate with its sealing performance. CONCLUSION: Er,Cr:YSGG laser treatment does not enhance the sealing ability of the sealers compared with EDTA application. The root canal adaptation and sealing ability of the Hybrid Root Seal/Resilon combination is not superior to that of the AH Plus/gutta-percha combination.

Apical microleakage of root-end cavities prepared by Er, Cr: YSGG laser.

The aim of this study is to assess the apical microleakage of the composite filled root-end cavities prepared by an Erbium, Chromium: Yttrium-Scandium-Gallium-Garnet laser. Fifty-five maxillary incisor teeth were enlarged and filled. Following the apical resection, root-end cavities were prepared using conventional methods: either using a bur (n = 30) or an ultrasonic retrotip (n = 15). Root-end cavities of the 15 teeth in the bur group were finished with the laser at 3.5 W. All root-end cavities were filled using two-step self-etching primer and composite resin. After 4 months of storage, apical microleakage was measured by a fluid filtration method. Microleakage of composite filled root-end cavities that were prepared by Er, Cr: YSGG was significantly larger than those made by conventional methods (p < 0.05). In conclusion, using the Er, Cr: YSGG laser has no advantages over conventional root-end cavity preparation methods when a composite filling material is used to seal root-end cavities.

The evaluation of the influence of using MTA in teeth with post indication on the apical sealing ability.

OBJECTIVES: The aim of this study was to evaluate the influence of using MTA in teeth with post-core indication and to compare it with the immediate or delayed post space preparation on the integrity of apical seal in teeth filled with gutta-percha and sealer. STUDY DESIGN: Fifty-one single-rooted freshly extracted human maxillary incisor teeth were selected. The crowns of the teeth were removed to a length of 14 mm and canals were prepared by using K-files with the step-back technique. The teeth were randomly divided into 3 groups of 15 specimens each. Group A was filled with gutta-percha and sealer using lateral compaction, and post space was prepared immediately using a heated instrument. Specimens in Group B were filled with the same materials as Group A and post space was prepared after 1 week with Gates-Glidden drills. Group C was filled with MTA as an apical 5-mm filling. In all groups, materials were left in the root canals at the apical 5-mm level. The remaining 6 teeth were used as controls. The microleakage values of each group were measured after 1 month, using a computerized fluid filtration method. RESULTS: The MTA (Group C) showed less microleakage than immediate and delayed post space preparation methods (Group A, B) in 1 month, and this difference was found to be statistically significant (P < .005). Additionally, no statistically significant difference was determined between Group A and Group B (P > .05). CONCLUSION: These results suggest that MTA can be used in the root canals as apical filling material in teeth with post-core indication.

Evaluation of the effect of four self-etching adhesives on dentin permeability.

OBJECTIVE: The aim of this study was to evaluate the effect of two two-step and two single-step self-etching adhesives on dentin permeability using a computerized fluid filtration (CFF) test method. METHODOLOGY: Forty recently extracted sound human molar teeth were sectioned at the mid level of the crown to obtain dentin discs of 1 +/- 0.2 mm. A total of 40 discs were obtained and randomly divided into four groups (n = 10). The permeability of the discs was measured using the CFF test method before and after application of the following self-etching adhesives: Hybrid Bond, G-Bond, AdheSE, and Protect Bond. Fluid movement measurements were made at 2-min intervals for 8 min, and a mean of the values obtained was calculated for each specimen. RESULTS: The in vitro fluid conductance of dentin discs treated with Hybrid Bond and AdheSE were lower than the dentin discs treated with G-Bond and Protect Bond (p < 0.05). CONCLUSION: 1-Treating dentin discs with self-etching adhesives caused significant reduction of dentin permeability. 2-All self-etching adhesives allowed diffusion of distilled water. However, AdheSE and Hybrid Bond showed the lowest permeability.

Effect of immediate and delayed post preparation on apical microleakage by using methacrylate-based EndoREZ sealer with or without accelerator.

The purpose of this study was to evaluate the effect of immediate and delayed post space preparation on the apical sealing ability of EndoREZ, a methacrylate-based dual-cured resin sealer, with or without accelerator. Fifty extracted human teeth were endodontically prepared and randomly divided into 6 groups. Teeth in experimental groups 1, 2, 3, and 4 (n = 10) were filled with resin-coated gutta-percha and either EndoREZ with accelerator (A+) or EndoREZ without accelerator (A-) by the lateral compaction technique. In group1 (A+) and group2 (A-), the post space was prepared immediately at the time of obturation. In groups 3 (A+) and 4 (A-), the post space was prepared after storage in 100% humidity at 37 degrees C for 1 week. Groups 5 and 6 (n = 5) represented positive and negative control groups, respectively. Leakage was determined by computerized fluid filtration device. Complete leakage was observed in group 5, and no leakage was evident in group 6 (P = 1.000). In experimental groups, mean apical microleakage values (microL/cmH(2)O/min(-1)) were as follows: group 1, 2.77 +/- 0.79(a); group 2, 2.88 +/- 1.38(a); group 3, 19.95 +/- 7.85(c); group 4, 6.20 +/- 2.09(b) (different letters indicate significantly different groups, P < .005). Immediate post space preparation achieved better sealing than delayed post preparation at the apical end, regardless of whether the EndoREZ accelerator was used. There was no significant difference between the (A+) and (A-) in immediate post space preparation. However, more leakage was found when using (A+) than (A-) in delayed post preparation. Under the conditions of this study, it was concluded that EndoREZ accelerator seems not to provide clinicians with any advantage for rapid transition from endodontic treatment to post-endodontic restorative procedures immediately after completion of root canal therapy.

Long-term evaluation of the influence of smear layer on the apical sealing ability of MTA.

The aim of this in vitro study was to investigate the effect of the smear layer on apical microleakage in teeth obturated with mineral trioxide aggregate (MTA). Fifty single-rooted central maxillary teeth were used in this study. All teeth were instrumented to size 60 by using the step-back technique. The selected teeth were randomly divided into 2 groups (n = 20). In the first group (smear [+]), the teeth were irrigated with only NaOCl (5.25%). In the second group (smear [-]), the teeth were irrigated with ethylenediaminetetraacetic acid (EDTA) (17%) and NaOCl (5.25%) to remove the smear layer. The teeth were then filled with MTA. The computerized fluid filtration method was used for evaluation of apical microleakage. The quantitative apical leakage of each tooth was measured after 2, 30, and 180 days. Statistical analysis was done with the Mann-Whitney U and Wilcoxon signed ranks tests. At the end of this study there was no difference in 2 days between the groups, but removal of the smear layer caused significantly more apical microleakage than when the smear layer was left intact for 30 and 180 days (P < .005). Within the constraints of this study it can be concluded that the apical microleakage of MTA is less when the smear layer is present than when it is absent.

Maxillary first molar with an unusual morphology: report of a rare case.

Variations in dental anatomy are found in all teeth. Knowledge of these variations, particularly concerning the location and treatment of all canals, is very important for the success of endodontic therapy, because the inability to find and properly treat the root canals may cause failures. Variations in canal morphology, such as extra canals, apical ramifications, apical deltas, or lateral canals, are commonly encountered, and their incidence and significance have been well documented. However, the clinician should also be aware of the possibility of the existence of fewer root and/or canal numbers. The goal of this clinical article is to describe root canal treatment in a maxillary first molar with the unusual morphology of a single root and a single canal.

Effect of unintentionally extruded calcium hydroxide paste including barium sulfate as a radiopaquing agent in treatment of teeth with periapical lesions: report of a case.

Calcium hydroxide [Ca(OH)2] has been widely used as short- or long-term intracanal antibacterial dressing material after endodontic treatment. In general when used in endodontics, Ca(OH)2 paste is composed of the powder, a vehicle, and a radiopacifier. To provide radiopacity, barium sulfate (BaSO4) powder is usually added to the paste. In this case report, BaSO4:Ca(OH)2 powders (ratio 1:8) and distilled water were mixed and applied as dressing material after root canals of mandibular left canine and premolar teeth with periapical lesions. However, the prepared paste was unintentionally extruded into the periapical lesion during application. The patient was seen 12 and 36 months later, at which point periapical healing was evaluated. At this time, it was observed that the periapical lesion had disappeared, but white radiopaque spots were seen at the place where calcium hydroxide remnants had originally been present. The presented case report reveals that when Ca(OH)2 paste that included BaSO4 was applied as an intracanal dressing and extruded through the periapical lesion associated with pulpless teeth, it had no detrimental effect. However, healing might take longer when Ca(OH)2 paste including BaSO4 is used, so deliberate overextension is not advocated.

Effect of a new restoration technique on fracture resistance of endodontically treated teeth.

The aim of the study was to investigate the effect of a new fiber-reinforced composite restoration technique on fracture resistance in endodontically treated premolars. Eighty sound extracted human mandibular premolars were assigned to four groups (n = 20). Group 1 did not receive any treatment. In groups 2, 3 and 4, the teeth received root canal treatment and a mesio-occluso-distal cavity preparation. Group 2 was kept unrestored. Group 3 was restored with a dentin bonding system and composite resin. In group 4, a piece of polyethylene ribbon fiber was inserted into the groove in a buccal to lingual direction during the restoration of teeth with dentin bonding system and composite resin. After finishing and polishing, the specimens were stored in 100% humidity at 37 degrees C for 24 h and placed at an angle of 45 degrees to the long axis of the tooth and subjected to compressive loading in a universal testing machine at a crosshead speed of 0.5 mm min(-1). The load necessary to fracture the samples was recorded in Newton (N) and submitted to Kruskal-Wallis anova and Mann-Whitney U-test. The fracture strength of the teeth reinforced with a combination of polyethylene fiber and composite resin were not significantly different than those that were restored with only composite resin (P > 0.05). However, most of the failure modes of the reinforced teeth were limited to the level of the enamel, while the other three groups showed fractures generally at the level of the dentin, cemento-enamel junction or more below (P < 0.05). Therefore, polyethylene ribbon fiber-reinforced composite resin restorations seemed a more reliable restorative technique than traditional composite restorations for extensive cavities.

Severe gingival recession caused by traumatic occlusion and mucogingival stress: a case report.

Gingival recession is displacement of the soft tissue margin apically leading to root surface exposure. Tooth malpositions, high muscle attachment, frenal pull have been associated with gingival tissue recession. Occlusal trauma is defined as injury resulting in tissue changes within the attachment apparatus as a result of occlusal forces. Trauma from occlusion may cause a shift in tooth position and the direction of the movement depends on the occlusal force. We present the clinical and radiological findings and the limitation of periodontal treatment of a severe gingival recession in a case with traumatic occlusion. A 16 years old male, systemically healthy and non-smoking patient presented to our clinic with severe gingival recession of mandibular canines and incisors. Clinical evaluation revealed extensive gingival recession on the vestibules of mandibular anterior segment. Patient has an Angle class III malocclusion and deep bite. To maintain the teeth until orthodontic therapy and maxillofacial surgery, mucogingival surgeries were performed to obtain attached gingiva to provide oral hygiene and reduce inflammation. After mucogingival surgeries, limited attached gingiva was gained in this case. Regular periodontal maintenance therapy was performed at 2 month intervals to preserve mandibular anterior teeth. Multidisciplinary approach should be performed in this kind of case for satisfactory results. Unless occlusal relationship was corrected, treatment of severe gingival recession will be problematic. For satisfactory periodontal treatment, early diagnosis of trauma from occlusion and its treatment is very important.