Comparison of the Enterococcus faecalis Colony Reduction Effect of Two Wavelengths of Diode Lasers With Three Methods of Root Canal Irrigation: An In Vitro Study.

Introduction: The basis of successful root canal therapy is the reduction of microorganisms. The aim of this in vitro study was to compare the antibacterial effect of three different irrigation methods with two laser wavelengths on Enterococcus faecalis biofilm. Methods: Ninety-five single-canal teeth were prepared, sterilized, and divided randomly into a negative control, a positive control, and five test groups. They were inoculated with the standard strain of E. faecalis. The test groups were conventional irrigation (group 1), Passive ultrasonic irrigation (group 2), Gentle file finisher brush (group 3), 810 nm diode laser (group 4), and 980 nm diode laser (group 5). Microbial sampling, cultivation, and colony counting were done. Data were analyzed with the Kruskal-Wallis test and a negative binomial regression model. Results: There was a significant difference in the colony count between the groups (P<0.001). the 810 nm diode had the highest and the conventional irrigation group had the lowest reduction in the microbial load. Passive ultrasonic, 980 nm diode laser, and Gentle file finisher brush groups were also ranked respectively from the highest to the lowest in terms of decreasing effect on the number of colonies. Conclusion: The 810 nm diode laser and conventional irrigation were respectively the most and the least effective methods for reducing the number of E. faecalis colonies.

Prevalence of C-shaped canals and three-rooted mandibular molars in the Iranian population by using cone-beam computed tomography.

OBJECTIVES: This study aimed to evaluate the prevalence of C-shaped canals and three-rooted mandibular molars in the Iranian population using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: This study evaluated mandibular teeth on 292 CBCT scans of patients referred to the Department of Radiology, Faculty of Dentistry, Islamic Azad University, Isfahan, Iran. All CBCT scans were obtained with the same three-dimensional CBCT scanner, and sections were reconstructed in all three planes (sagittal, axial, and coronal) with 1 mm slice thickness. A total of 291,402, and 200 first, second, and third molars, respectively, were evaluated. Data were analyzed using SPSS software (version 26.0). RESULTS: Of 291 mandibular first molars, 0.7% were single-rooted, 96.6% were two-rooted, and 2.7% were three-rooted. The prevalence of C-shaped canals was 1.7% in mandibular first molars. Of 402 mandibular second molars, 8.5% were single-rooted, 90.5% were two-rooted, and 1% were three-rooted. The prevalence of C-shaped canals was 2% in mandibular second molars. Of 200 mandibular third molars, 21.5% were single-rooted, 77.5% were two-rooted, and 1% were three-rooted. The prevalence of C-shaped canals was 2% in mandibular third molars. CONCLUSION: In the present study, the majority of mandibular molars were two-rooted, and three-rooted mandibular molars were less common. The third and second mandibular molars both had an increased prevalence of C-shaped canals. Mandibular first molars had the highest prevalence of three-rooted molars.

Long-term pH Alterations in the Periradicular Area Following the Application of Calcium Hydroxide and MTA.

STATEMENT OF THE PROBLEM: A rise in pH and the presence of calcium ions play an important role in prevention or management of external root resorption. PURPOSE: This study assessed the long-term pH alterations in the periradicular area following the application of calcium hydroxide (CH) and mineral trioxide aggregate (MTA) intracanal medicaments. MATERIALS AND METHOD: This in vitro, experimental study evaluated 45 single-canal extracted human teeth. After decoronation and root canal instrumentation, defects (3×3×1mm) were created in the middle third of the roots. Following smear layer removal, the root surface (except for the defect) was sealed with nail varnish. Five teeth served as negative controls and were filled with distilled water. The remaining 40 teeth were randomly divided into two groups (n=20) for application of MTA and CH as intr-acanal medicaments. Periapical radiographs were obtained to ensure optimal quality of obturation. After coronal sealing with glass ionomer, the teeth were incubated at 37°C, and their pH was measured at 1 and 2 weeks, and 1 and 3 months, using a pH-meter. Data were analyzed using one-way ANOVA, Tukey's test and Bonferroni adjustment. RESULTS: The mean pH was significantly higher in CH group at 1 and 2 weeks (p< 0.01) but no difference was noted at 1 and 3 months (p= 0.52). The mean pH in both groups was significantly higher at 2 weeks compared with other time points (p< 0.05). CONCLUSION: CH may be preferred for use in the first weeks following the initiation of root resorption to provide a high pH. MTA can be later applied to maintain the high pH for a longer period of time without the need for medicament exchange.

Micro-CT Evaluation of Four Root Canal Obturation Techniques.

PURPOSE: The aim of this in vitro study was to evaluate the quality of four root canal obturation techniques using microcomputed tomography (micro-CT). MATERIALS AND METHODS: A total of 36 mandibular first premolars with mostly round canals were decoronated, then instrumented up to a size F3 rotary file, and dressed with an epoxy resin-based sealer. Subsequently, they were divided into 4 different groups (n = 9) based on the method of obturation: lateral condensation using 0.02 tapered master cone (LC2), lateral condensation using 0.04 tapered master cone (LC4), matched single-cone technique (MS), and matched single cone-mediated ultrasonic activation (MSUA). All the teeth were scanned using micro-CT (resolution of 19 µm), and the percentage volume of voids was calculated. One-way analysis of variance and Tukey test were used to analyze the data (α = 0.05). RESULTS: The total percentage volume of voids was significantly lower in the MSUA group compared to all other groups (P < 0.05). The total percentage volume of voids was significantly lower in the MS group compared to the LC4 (P < 0.001) and LC2 (P < 0.001) groups. However, there was no significant difference between the LC2 and LC4 groups (P < 0.65). CONCLUSIONS: MSUA, significantly, showed the least root canal filling voids amongst all the obturation techniques studied. MSUA can be considered an effective method for the filling of the round root canals. In general, lateral condensation using either 0.02 or 0.04 tapered master cones had significantly the highest volume percentage of voids amongst the experimental groups.

Comparison of MTA, CEM Cement, and Biodentine as Coronal Plug during Internal Bleaching: An In Vitro Study.

BACKGROUND: Internal bleaching is a choice of treatment in discolored endodontically treated teeth. Cervical root resorption is one of the important complications of this treatment. A suggested procedure to prevent this type of resorption is using a coronal barrier under the bleaching materials. The aim of the study was to compare the microleakage of mineral trioxide aggregate (MTA), calcium-enriched mixture (CEM) cement, and Biodentine. MATERIALS AND METHODS: In this in vitro study, a total of 60 single canal incisors were included. They were randomly divided into three experimental groups (n = 16), one positive control group (n = 6), and one negative control group (n = 6). Coronal portion of the canals in the experimental groups was sealed with 3 mm of MTA, CEM cement, or Biodentine as a coronal barrier. After 3 days, specimens were bleached. A fresh Enterococcus faecalis suspension was added to the samples. The culture tubes were observed for 45 days, and the daily turbidity was recorded. Statistical analysis was accomplished by the Kaplan-Meier test and SPSS 22. RESULTS: All positive samples showed turbidity, whereas none of the negative samples allowed bacterial leakage. Results showed no significant difference between MTA, CEM cement, and Biodentine groups. (P value = 0.304, 0.695, and 0.217). The bacterial microleakage for the two groups also did not show significant differences. CONCLUSIONS: CEM cement and Biodentine showed promising results as coronal plug, and clinical studies are needed to test these materials with MTA for avoiding microleakage in internal bleaching treatment.

Combination effects of diode laser and resin-modified tricalcium silicate on direct pulp capping treatment of caries exposures in permanent teeth: a randomized clinical trial.

OBJECTIVE: The purpose of this randomized clinical trial was to evaluate efficiency of diode 808-nm (Picasso-AMD, USA) laser using power 1.5 W, continuous wave (CW), fiber diameter of 400 µm, non-initiated and in contact mode, tip angle set at 90°, beam divergence 16°, 2 s per an area with 1-mm diameter, power density 190.98 W/cm2, energy density 381.97 J/cm2, vertical and horizontal scanning movement on the exposure site, and laser irradiation combined with a resin-based tricalcium silicate material (TheraCal LC, Bisco, USA) in direct pulp capping in caries exposures of permanent teeth over a period of 6 months. MATERIAL AND METHODS: In this randomized clinical trial, a total of 20 anterior and posterior vital teeth without symptoms and radiographic changes of 14 patients between the age group of 15-35 years, of which randomly 10 teeth were considered, each for TheraCal LC, the exposed area was sealed with TheraCal paste and TheraCal combined with diode laser; the treated area was sealed with TheraCal paste after diode 808-nm laser irradiation. At the 1-, 3-, and 6-month recall examinations, the loss of vitality, spontaneous pain, reactions to thermal stimuli and percussion, and radiographic changes were considered failure. The samples were randomly divided using runs test. Measurements on the digitized radiograph were performed at the recalls. The data were analyzed by repeated measurements ANOVA using SPSS 25. RESULTS: Analysis had indicated that at the end of follow-ups, a statistically significant increase in dentin thickness with both groups (p value < 0.001) was found. Clinically, diode laser group has shown better results (p value < 0.001); however, radiographically, no significant difference was observed between groups (p value = 0.56). In both groups, the highest thickness of dentin formed was at the first month; 0.40 mm ± 0.19 mm (p value < 0.001). CONCLUSION: Diode laser 808 nm under proper parameters combined with TheraCal LC can be recommended for direct pulp therapy in caries exposure of permanent teeth. CLINICAL TRIAL REGISTRATION: This research was approved by Esfahan Medical University, Dental School, Azad Branch (KHUISF)) Esfahan, Iran [IR.IAU.KHUISF.REC.1397.261].

Effect of calcium hydroxide on inflammatory root resorption and ankylosis in replanted teeth compared with other intracanal materials: a review.

Calcium hydroxide (CH) is the gold-standard intracanal dressing for teeth subjected to traumatic avulsion. A common complication after the replantation of avulsed teeth is root resorption (RR). The current review was conducted to compare the effect of CH with that of other intracanal medications and filling materials on inflammatory RR and replacement RR (ankylosis) in replanted teeth. The PubMed and Scopus databases were searched through June 2018 using specific keywords related to the title of the present article. The materials that were compared to CH were in 2 categories: 1) mineral trioxide aggregate (MTA) and endodontic sealers as permanent filling materials for single-visit treatment, and 2) Ledermix, bisphosphonates, acetazolamide, indomethacin, gallium nitrate, and enamel matrix-derived protein (Emdogain) as intracanal medicaments for multiple-visit management of avulsed teeth prior to the final obturation. MTA can be used as a single-visit root filling material; however, there are limited data on its efficacy due to a lack of clinical trials. Ledermix and acetazolamide were comparable to CH in reducing RR. Emdogain seems to be an interesting material, but the data supporting its use as an intracanal medication remain very limited. The conclusions drawn in this study were limited by the insufficiency of clinical trials.

Comparison of Endodontic Medicaments on Bond Strength of Fiber Post to Root Dentin Using Resin Cement.

STATEMENT OF THE PROBLEM: Endodontic irrigants and medicaments may affect the bond strength of intracanal posts to root dentin. PURPOSE: The aim of this study was to compare the effect of calcium hydroxide (Ca(OH)2) and 2% chlorhexidine gel (CHX) on bond strength of fiber post cemented with resin cement to root dentin. MATERIALS AND METHOD: This in vitro experimental study was conducted on 36 mandibular premolars. Canals were prepared using the step back technique. After root canal irrigation, the teeth were divided into three groups of 12. Ca(OH)2 paste and CHX gel were used as intracanal medicaments in the first and second groups respectively. No intracanal medicament was used in the third group (control group). Access cavities were then sealed and the teeth were incubated for one week. The root canals were then filled using gutta percha and AH26 sealer and the teeth were incubated for 72 hours. Tooth crowns were then cut at the level of the cementoenamel junction and intracanal posts were placed. The teeth were mounted in auto-polymerizing acrylic resin, and incubated for one week .They were then sectioned into 1.5mm thick slices from their coronal surface using a fully automated cutting machine, and subjected to push-out test until failure. The load at debonding was recorded and data were analyzed using one-way ANOVA, post-hoc test and t-test. The coronal margin of the root was at the level of the surface of acrylic resin in the mold. RESULTS: The mean bond strength was 4.45 MPa in the Ca(OH)2, 2.45 MPa in the CHX and 2.48 MPa in the control group. The difference in this regard was statistically significant among groups (p= 0.04). The Ca(OH)2 group had significant differences with the CHX and control groups (p= 0.03 and p= 0.02, respectively). The difference between the CHX and control groups was not significant (p= 0.974). CONCLUSION: Based on the results, Ca(OH)2 increased the bond strength of fiber post to root dentin but 2% CHX had no effect on bond strength.

Cytotoxicity evaluation of Iranian propolis and calcium hydroxide on dental pulp fibroblasts.

Background and aims. Since intracanal medicaments can affect the cell viability in periapical tissues, the aim of this study was to evaluate the effect of calcium hydroxide and propolis on pulp fibroblasts. Materials and methods. Two healthy third molars were used as a source to obtain fibroblasts. The fibroblasts were cultured and subjected to 1 mg/mL of propolis and calcium hydroxide. This experiment was performed in six replicates and cell viability was evaluated with MTT assay. Statistical analysis was performed by t-test. Results. Comparison of cell viability with the use of 1 mg/mL of calcium hydroxide and propolis showed that cells subjected to propolis were more viable when compared to calcium hydroxide (P < 0.05). Conclusion. In this study, calcium hydroxide reduced fibroblast viability, significantly more than Iranian propolis. Other properties should be evaluated before Iranian propolis could be indicated for use as intracanal medicament.

Effect of post length and type of luting agent on the dislodging time of metallic prefabricated posts by using ultrasonic vibration.

INTRODUCTION: The purpose of this study was to determine and compare the times needed to dislodge prefabricated titanium posts of different luting lengths with various cements. METHODS: Eighty-one intact extracted, single-canal human teeth were selected and endodontically treated. Specimens were randomly divided into 9 groups, which were arranged according to the post space length (5, 7, and 9 mm) and cement type (zinc phosphate, glass ionomer, and resin cement). Titanium posts were cemented into the post spaces, and after 1 week of storage they were subjected to ultrasonic vibration. The dislodging times were recorded and analyzed by using the Kruskal-Wallis and Mann-Whitney tests (P < .05). RESULTS: A significant difference was observed between the dislodging times on the basis of post length and luting agent (P < .001). There were also significant differences between different cements luted with the same length posts (P < .001). Significant differences were observed between the 5-mm posts and both the 7- and 9-mm posts for each cement, but the differences between the 7-mm and 9-mm posts were not significant (P < .05). CONCLUSIONS: Changes in the cement type and post length alter the time required to dislodge a post with an ultrasonic device.

Propolis: a new alternative for root canal disinfection.

INTRODUCTION: This study evaluated and compared colony forming units (CFUs) and minimum inhibitory concentrations (MICs) of calcium hydroxide and propolis as intracanal medicaments. MATERIALS AND METHODS: Eighty human single-root and caries-free teeth were selected and divided into five groups. Crowns were removed. Root canals were then prepared in a step-back manner. The samples were then inoculated by Enterococcus (E.) faecalis and incubated for 21 days. Intracanal medications were applied including, calcium hydroxide (n=20), propolis (n=20), and ethanol (n=20). Two groups of 10 teeth were also used as the positive and negative controls. Microbiological sampling was performed utilizing a piezo-reamer drill after one week of incubation. The samples were plated and CFUs were counted after 48 hours. MICs of calcium hydroxide and propolis were measured by serial dilution and agar dilution methods, respectively. The statistical tests of ANOVA and Duncan post-hoc were used to compare different medications. RESULTS: MICs and CFUs of propolis were dramatically less than calcium hydroxide. The difference between the groups was statistically significant (P<0.001). CONCLUSION: Our results reveal that propolis is an effective antimicrobial intracanal agent.

Fracture strength of mesiobuccal roots following canal preparation with hand and rotary instrumentation: an in vitro study.

INTRODUCTION: The aim of this in vitro study was to compare the effect of hand and rotary instruments on fracture strength of tooth roots. MATERIALS AND METHODS: Thirty two teeth were randomly divided into two experimental groups of 15 each and one negative control group with two samples. In group 1, step-back technique with conventional stainless steel K-files was used, and in group 2, instrumentation was performed using rotary Ni-Ti Hero642. Samples in control group did not receive cleaning or shaping after access cavity preparation. After obturating each canal, tip of the spreader was locked within canal. The required force for root fracture was measured using Instron testing machine. Recorded data was statistically analyzed using t-test. RESULTS: The mean and standard deviation force required for vertical root fracture were 50.33±19.1 and 63.1±25.46 N for hand and rotary groups respectively. However, no significant difference was found between experimental groups. CONCLUSION: The results indicate that the manual technique did not lower fracture strength of obturated roots in comparison with the rotary preparation technique.

Comparing Coronal Discoloration Between AH26 and ZOE Sealers.

INTRODUCTION: Intrinsic tooth discolorations after endodontic treatment are principally attributed to the composition of necrotic pulp tissue, hemorrhage within the pulp cavity, endodontic medicaments and/or filling materials. Residual sealer left in pulp chamber after obturation can cause discoloration. The objective of this in vitro study was to evaluate coronal discoloration created by AH26 and ZOE sealers after four months. MATERIALS AND METHODS: Fifty intact human extracted maxillary central incisors were employed. Access cavities were prepared in all samples and root canals were instrumented; coronal orifices were then sealed using self-cure glass ionomer. The teeth were divided into two experimental groups (n=20) according to utilized sealer in pulp chambers including AH26 and Dorifill (ZOE). The remaining 10 teeth served as negative and positive controls (n=5). The access cavities were sealed with self-cure glass ionomer. Teeth were kept in incubator for four month. Preliminary digital images of the teeth were taken and then compared with those related to 4-month follow-up. The images were assessed using Photoshop software. Data was analyzed using paired t-test and independent samples t-test. RESULTS: The teeth which were filled with AH26 sealer showed significantly greater discoloration than those filled with ZOE sealer (Dorifill) (P<0.05). CONCLUSION: AH26 sealer causes greater discoloration of the crown compared to ZOE sealer. Despite the other disadvantage of AH26 sealer, it seems that Dorifill is more esthetically considerate.

The effect of three irrigants on the coronal leakage of the root canals system irrigants.

INTRODUCTION: The production of smear layer during canal instrumentation is thought to increase coronal microleakage even after canal obturation. Previous studies have shown that the type of irrigant does not necessarily affect the seal of the obturation. Our study aimed to evaluate the effect of three irrigation solutions (MTAD, citric acid and EDTA/NaOCl) on the coronal microleakage of root canals. MATERIALS AND METHODS: Fifty five intact single rooted teeth were instrumented and randomly divided into three experimental groups (15 teeth each) and two control groups (5 teeth each). Final irrigation was carried out with MTAD in group I, citric acid in group II, and EDTA/NaOCl in group III. EDTA/NaOCl was used for the negative control group and saline irrigation was carried out in the positive control group. After lateral compaction with gutta-percha, the access cavities of the experimental specimens were restored with temporary restorative material. Temporary cement was not used in the positive control group. In the negative control group, access cavities and foramen apices were sealed with glass ionomer. Microleakage of samples was measured using the dye penetration technique. Data were analyzed with ANOVA and Tukey test to determine statistical differences between groups. RESULTS: MTAD, citric acid and EDTA/NaOCl all had less microleakage compared to normal saline. However, no difference was detected between the experimental groups. CONCLUSION: In this study, all three groups demonstrated effective seal with gutta-percha obturation. This is likely to be due to various factors including their ability to remove smear layer.