Evaluation of the effectiveness of a mobile application in the management of dental anxiety: A randomised controlled trial.

BACKGROUND: The software, which was developed according to the principle of perceived control, can be installed on tablets and smartphones and used by patients to help them control their anxiety. OBJECTIVE: The aim of this study was to evaluate the effectiveness of a specially designed mobile application developed to provide patients with a sense of anxiety control during the various stages of endodontic treatment. The patients' anxiety was assessed by measuring their salivary cortisol levels. METHODS: A total of 46 patients requiring endodontic treatment were recruited. The patients were randomly assigned to two groups. The experimental group used the special communication application, while the control group did not. Salivary samples were collected from all patients preoperatively, postanaesthesia, and postoperatively. The samples were analysed with an enzyme-linked immunosorbent assay to measure the cortisol levels. RESULTS: A significant difference in cortisol levels was observed between the experimental and the control group (Mann-Whitney U-test, p < .05). This difference was significant in the experimental group in each step (p < .01). No difference was found in the control group steps (p > .05). CONCLUSIONS: Perceived control of anxiety using the specially designed software was effective in reducing salivary cortisol levels.

Evaluation of postoperative pain/discomfort after intracanal use of Nd:YAG and diode lasers in patients with symptomatic irreversible pulpitis and asymptomatic necrotic pulps: a randomized control trial.

OBJECTIVES: This study aimed to investigate the ability of the diode and Nd:YAG lasers to decrease postoperative pain/discomfort after intracanal application in vital and devital endodontic cases. MATERIAL AND METHODS: One hundred two patients with symptomatic irreversible pulpitis and asymptomatic necrotic pulps were selected and randomly divided into three groups. After chemomechanical preparation, Nd:YAG and diode laser was applied to first and second groups for final treatment of the root canals. In the control group, no further disinfection protocol was performed upon traditional procedures. Then all the teeth were obturated in the same appointment. Pre- and postoperative pain were recorded using the VAS at 0, 12th, 24th, 48th, and 72nd hours following the treatment Kruskal-Wallis and Dunn test. RESULTS: VAS scores were significantly the most at 12-h period compared with other time periods after treatment for all groups. There was no significant difference among Nd:YAG laser, diode laser, and control groups in non-vital cases (p > 0.05). In vital cases, Nd:YAG laser group represented significantly fewer scores compared with diode laser and control groups at 48-h period (p < 0.05). CONCLUSIONS: The processes involving the use of Nd:YAG and diode lasers after chemomechanical preparation was found to be equivalent in terms of postoperative pain intensity after completion of treatment in one session both in vital or non-vital cases except in vital cases in Nd:YAG group at 48 h. CLINICAL RELEVANCE: Adjunct clinical use of Nd:YAG or diode lasers to traditional chemomechanical preparation did not cause any improvement or deterioration on postoperative discomfort and pain in patients with symptomatic irreversible pulpitis and asymptomatic necrotic pulps.

Fracture Resistance of Premolars Restored Either with Short Fiber or Polyethylene Woven Fiber-Reinforced Composite.

OBJECTIVE: To compare the fracture resistance of endodontically treated maxillary premolars with one remaining cavity wall restored either with short fiber-reinforced composite or polyethylene woven fiber-reinforced composite. MATERIALS AND METHODS: Forty-eight maxillary premolars were endodontically treated and randomly assigned to four groups (n = 12). Palatal cusp was removed, buccal wall was remained. In groups 1 to 3, standardized cavities were prepared in the palatal canal entrances. In group 1, short fiber-reinforced composite was used for restoration both of deep cavity and coronal part. In group 2, short fiber-reinforced composite was placed inside the deep cavity and core part of the restoration. Coronal restoration was restored by using conventional filler composite. In group 3, both deep cavities and coronal parts were built up by using conventional filler composite. In group 4, post space was prepared in the palatal canal. Polyethylene woven fiber-reinforced composite post then was placed into post space and the coronal part was restored by using conventional filler composite. Specimens were placed into a universal testing machine. The fracture loads were recorded and analyzed statistically using one-way ANOVA (α = 0.05). Fracture patterns were analyzed by using Chi-square test (α = 0.05). RESULTS: No statistically significant difference was found in fracture strength (p > 0.05). Group 1 exhibited the highest and group 4 exhibited the lowest incidence of restorable fracture (p < 0.05). CONCLUSIONS: The restoration of severely weakened premolar teeth with the use of short fiber-reinforced composite might have advantages over conventional filler composite or polyethylene woven fiber-reinforced composite techniques. CLINICAL SIGNIFICANCE: The results of this in vitro study will be helpful to understand reinforced composite materials for restoring endodontically treated maxillary premolars. (J Esthet Restor Dent 28:412-418, 2016).

Microhardness evaluation of root dentin after using resin sealer solvents.

Background. This study aimed to assess the effects of methyl ethyl ketone (MEK) and ethyl acetate (EA) on dentin microhardness, used as resin sealer solvents. Methods. Eighty halves of single-rooted teeth were randomly divided into four groups to apply MEK, EA, chloroform, or saline solution. Vickers hardness values were measured for three root levels before and after the direct application of solvents for 5 and 15 minutes or a 1-minute application with ultrasonic agitation. The results were analyzed using repeated-measures ANOVA, and adjustments were made for comparisons with Bonferroni tests. Results. The dentin microhardness decreased in all the solvent groups (P < 0.05). The changes in microhardness increased with prolonged exposure times, except for the saline solution group. Chloroform exhibited the most significant decrease in value. Furthermore, ultrasonic agitation elicited a more substantial decline in values. Conclusion. MEK and EA might be preferred over chloroform as a solvent for resin sealers because they offer an attenuated decrease in dentin microhardness and do not have gutta-percha-dissolving properties.

Fracture resistance of premolars with one remaining cavity wall restored using different techniques.

The aim of the study was to compare the fracture resistance of maxillary premolars with one remaining cavity wall restored using different post systems. Forty-eight maxillary premolars were endodontically treated and randomly assigned to four groups for postcore restoration. The first three test groups were restored with polyethylene woven fiber posts, custom-made glass fiber-reinforced composite posts, and titanium posts respectively. In the control Group 4, standardized cavities (3.5 x 1.5 mm) were prepared in the palatal canal entrance and filled with a resin composite. All the specimens were then restored with a resin composite crown seated on the post. Load was applied with a stainless steel ball (1 mm/min), and the failure modes of all specimens were evaluated. There were no significant differences in fracture resistance and failure mode among the different restorative materials (p>0.05). Within the limitations of this in vitro study, it was concluded that the presence and type of post did not influence the fracture load and failure mode of maxillary premolar teeth with one remaining cavity wall.

Virgin Olive Oil, Soybean Oil, and Hank's Balanced Salt Solution Used as Storage Media on Periodontal Ligament Cell Viability.

Purpose: The purpose of this study was to compare the effects of virgin olive oil (VOO), soybean oil (SO), and Hank's Balanced Salt Solution (HBSS) on the vitality of periodontal ligament (PDL) cells of simulated avulsed teeth. Methods: Forty freshly extracted teeth were randomly divided into three experimental groups (n equals 10), one positive control group (n equals five), and one negative control group (n equals five). The experimental teeth were air-dried for 30 minutes and then soaked in one of the three storage solutions: HBSS, VOO, or SO. To quantify the number of viable cells, a collagenase-dispase assay was used. The viable PDL cells were determined via 0.4% Trypan blue staining. Data were statistically analyzed using the Kruskal-Wallis H test and Mann-Whitney U test with a significance level of 0.05. Results: The number of viable cells was significantly higher after storage in SO than in HBSS (P=0.004). There was no significant difference between SO and VOO in terms of PDL cell viability. Conclusion: Vegetable oils can be promising storage solutions for maintaining the periodontal ligament cell viability of avulsed teeth.

Second mesiobuccal canal detection in maxillary first molars using microscopy and ultrasonics.

The aim of this study was to investigate whether the use of operating microscope in combination with ultrasonics increased the rate of second mesiobuccal (MB2) canal detection in permanent maxillary first molar teeth. A hundred extracted human maxillary first molars were assessed. After location of the main canals, the MB2 canal was sought in all teeth first without microscopy, then with the aid of the operating microscope and finally with the combined use of the operating microscope and ultrasonics. With these techniques, the MB2 canal was detected in 62%, 67% and 74% of the teeth, respectively. The combination of the operating microscope and ultrasonics detected significantly more MB2 canals than when no microscopy was utilized (P < 0.05). Sectioning of the roots disclosed the presence of the MB2 canal in 82% of the teeth. Twenty-nine per cent of the teeth had a separate MB2 canal orifice and separate apical foramina. The results of this study suggested that the combined use of the operating microscope and ultrasonics increased the detection of MB2 canals in maxillary first permanent molars.

The antimicrobial and antifungal efficacy of tetracycline-integrated gutta-percha.

The purpose of this study was in vitro evaluation of the antimicrobial and antifungal efficacy of commercially available gutta-percha containing tetracycline on some potential endodontic pathogens. The test microorganisms were Enterococcus faecalis, Pseudomonas aeruginosa, Staphylococcus aureus, Porphyromonas endodontalis, and Candida albicans . Tetracycline-integrated gutta-percha (TGP) cones, tetracycline disc, and conventional gutta-percha cones of the same size were placed on the inoculated plates. The plates were incubated at 37 degrees C aerobically or anaerobically. Growth inhibition zones on each plate were inspected at 24, 48, and 72 h. Tetracycline disc and TGP cones inhibited all the tested bacterial strains, however the greatest antimicrobial effect was seen on S. aureus. Tetracycline disc and TGP seemed less effective on E. faecalis and P. aeruginosa. However, all tested treatments were unable to affect C. albicans . Based on the results of this study, it seems that TGP offers an antimicrobial advantage over conventional gutta-percha.

Apical accuracy of two apex-locating handpieces in root canal retreatments of root-end resected teeth.

We aimed to evaluate the accuracy of 2 apex locator integrated endodontic motors during retreatment of root-end resected teeth by using 40 extracted incisor teeth. The apical 3 mm of the roots were resected, and the root lengths were recorded as resected length of the roots. Forty roots were randomly divided into 2 groups of 20 to evaluate the 2 handpieces, Tri Auto ZX and TCM Endo V. The working lengths measured during the auto reverse function and during the electronic apex locator function with Tri Auto ZX and TCM Endo V were recorded and compared with resected length of the roots. The repeated measures analysis of variance was used for statistical analyses. Electronic apex locator functions of both devices might be used for apical accuracy, but the auto reverse functions might not be useful to 0.0-mm accuracy in retreatment procedures of root-end resected teeth.

Enlarging characteristics of four nickel-titanium rotary instrument systems under standardized conditions of operator-related variables.

We aimed to describe a computer-controlled testing device and evaluate the amount of material removed by using 4 Ni-Ti systems in simulated root canals. Eighty resin blocks were used. Hero 642, Hero Shaper, ProFile, and ProTaper rotary instruments were used to prepare the canals. Operator-related variables were standardized with the aforementioned device. Preoperative/postoperative photographic images of canals were measured at 11 levels from the apical tip. Statistical analyses were done with one-way analysis of variance, Tukey honestly significant difference, and Bonferroni tests. Significantly more material was removed by the ProTaper at 9 levels, ProFile at 6, and Hero 642 at 2 levels (P < .05); no significant difference was determined at 5 levels. Our results showed that ProTaper and ProFile removed significantly more material than Hero 642 and Hero Shaper at different levels of the curved root canals under controlled conditions of operator-related variables.

Evaluation of the surface characteristics of used and new ProTaper Instruments: an atomic force microscopy study.

The purpose of this study was to evaluate the topography of new and used ProTaper rotary nickel-titanium (NiTi) instruments by using atomic force microscope. Four new and four used size S1, S2, F1, and F2 instruments were selected for this study. New and used instruments were analyzed on 11 points along a 3-mm section at the tip of the instrument. Quantitative measurements according to the topographic deviations (root mean square) were recorded. Data were analyzed by paired samples t test. Mean root mean square values for used ProTaper instruments were higher than the new ones, and the difference between them was statistically significant. The results of this study showed that used ProTaper instruments demonstrated more surface deformation and wear.

The antimicrobial and antifungal activity of a root canal core material.

BACKGROUND: The authors conducted an in vitro study to determine the antimicrobial and antifungal activity of a recently introduced thermoplastic, synthetic, polymer-based polyester root canal core material (Resilon, Resilon Research, Madison, Conn.) against five different microorganisms by means of the agar diffusion test over different periods. METHODS: The microorganisms tested were Enterococcus faecalis, Pseudomonas aeruginosa, Staphylococcus aureus, Porphyromonas endodontalis and Candida albicans. A microbiologist transferred Resilon cones and gutta-percha cones to the inoculated agar and incubated them at 37 C, either aerobically or anaerobically, as required for optimal growth. RESULTS: The Resilon cones exhibited no antimicrobial effect against any of the bacteria tested, except for S. aureus. It showed antimicrobial efficacy against S. aureus during the first 24-hour period (P < .05). However, after 48 and 72 hours, Resilon cones no longer inhibited the growth of S. aureus. In addition, the material demonstrated no antifungal activity during any of the three testing periods. CONCLUSION: The results of this study indicate that the antibacterial and antifungal efficacy of the Resilon cone is not superior to that of conventional gutta-percha. CLINICAL IMPLICATIONS: Clinicians should not use the new root canal core material for its antimicrobial or antifungal efficacy.

Evaluation of antimicrobial and antifungal effects of iodoform-integrating gutta-percha.

OBJECTIVE: The antibacterial and antifungal effects of medicated gutta-percha (MGP) over different time periods have not been evaluated. The aim of this study was to evaluate and compare the antimicrobial and antifungal effectiveness of MGP and regular gutta-percha cones over different time periods using the disk diffusion method. METHODS: Enterococcus faecalis, Pseudomonas aeruginosa, Staphylococcus aureus and Escherichia coli were spread onto Mueller-Hinton agar, and Candida albicans was spread onto Sabouraud agar supplemented with glucose. Same-size MGP cones, conventional gutta-percha cones and disks impregnated with povidone-iodine were placed on the inoculated plates. The dishes were incubated at 37 degrees C aerobically. Growth inhibition zones were inspected and measured at 24, 48 and 72 hours. For each strain, experiments were performed in triplicate. The Kruskal-Wallis test was used to compare k independent samples. RESULTS: The disks impregnated with povidone-iodine inhibited all bacterial strains for up to 72 hours. No inhibition zones were seen around regular gutta-percha cones. MGP inhibited the growth of all bacteria over 24 hours, but in some cases these effects did not continue over longer periods. Specifically, the antimicrobial properties of MGP cones against E. coli and P. aeruginosa disappeared by 48 and 72 hours. Regardless of time and bacterial strain, MGP was statistically more effective than regular gutta-percha (p < 0.05). Povidone-iodine and MGP were effective against C. albicans for up to 72 hours, but regular gutta-percha exhibited no antifungal activity. CONCLUSION: The antimicrobial and antifungal characteristics of MGP may offer additional advantages over conventional gutta-percha.

Evaluation of the smear layer removal effectiveness of EDTA using two techniques: an SEM study.

Obtaining the cleanest canal possible before obturation is one of the goals of endodontic treatment. The purpose of this study was to compare the smear layer removal capability of ethylenediamine tetra-acetic acid (EDTA) application with passive ultrasonic and cotton wrapped on reamer activation. Twelve extracted human teeth with single root canals were used for the study. They were conventionally hand instrumented using reamers and K files. The apical aspect of the canals was enlarged to a #40 file. The teeth were divided into 4 four groups, instrumented and irrigated as follows: Group-A EDTA agitated at the end of preparation with cotton wrapped on a reamer for 1 min; Group-B EDTA applied with ultrasonic agitation for 1 min; Group-C irrigated with EDTA+sodium hypochlorite (NaOCl) (negative control group); and Group-D irrigated with distilled water (positive control group). After scanning electron microscopic study at three different levels, smear layer and dentinal tubules were scored. Means were tested for significance using the Z test. When the techniques were compared, the cotton wrapped on reamer agitation method was as successful as the ultrasonic activation of the files. Although all groups had significantly higher smear layer scores at apical compared to coronal sections, no significant differences were recorded.

Critical Assessment of Search Strategies in Systematic Reviews in Endodontics.

INTRODUCTION: The aim of this study was to perform an overview of literature search strategies in systematic reviews (SRs) published in 2 endodontic journals, Journal of Endodontics and International Endodontic Journal. METHODS: A search was done by using the MEDLINE (PubMed interface) database to retrieve the articles published between January 1, 2000 and December 31, 2015. The last search was on January 10, 2016. All the SRs published in the 2 journals were retrieved and screened. Eligible SRs were assessed by using 11 questions about search strategies in the SRs that were adapted from 2 guidelines (ie, AMSTAR checklist and the Cochrane Handbook). RESULTS: A total of 83 SRs were retrieved by electronic search. Of these, 55 were from the Journal of Endodontics, and 28 were from the International Endodontic Journal. After screening, 2 SRs were excluded, and 81 SRs were included in the study. Some issues, such as search of grey literature and contact with study authors, were not fully reported (30% and 25%, respectively). On the other hand, some issues, such as the use of index terms and key words and search in at least 2 databases, were reported in most of the SRs (97% and 95%, respectively). The overall quality of the search strategy in both journals was 61%. No significant difference was found between the 2 journals in terms of evaluation criteria (P > .05). CONCLUSIONS: There exist areas for improving the quality of reporting of search strategies in SRs; for example, grey literature should be searched for unpublished studies, no language limitation should be applied to databases, and authors should make an attempt to contact the authors of included studies to obtain further relevant information.

Antibacterial Efficacy of Super-Oxidized Water on Enterococcus faecalis Biofilms in Root Canal.

BACKGROUND: The success of endodontic treatment depends on a few crucial factors. One of these factors is the complete chemomechanic preparation of root canal against various bacteria. In particular, the effect of resistant bacteria may cause intense pain with flare-up and formation of periapical lesions. Therefore, the strong effect of irrigants plays an important role in terms of the complete elimination of these bacteria to achieve long-term successful treatment. OBJECTIVES: The aim of this study was to investigate the antibacterial effects of super-oxidized water (SPO) in root canals infected with Enterococcus faecalis biofilms. METHODS: One hundred twenty single-root, premolar teeth were selected. Initially, the teeth were prepared and then disinfected. E. faecalis were inoculated and kept at 37°C for 24 hours in the root canals. The re-inoculation procedure was repeated on the first, fourth, seventh, and tenth days. The infected root canals were divided into one negative (saline) and one positive (sodium hypochlorite) control group and four experimental groups (super-oxidized water: 1, 2, 3, or 5 minutes) (n = 20). Paper points were placed in the root canals to control and evaluate the biofilm formation. Biofilms were counted on blood agar plates, and data was evaluated and statistically analyzed using one-way ANOVA and Tukey's test. RESULTS: Although sodium hypochlorite (NaOCl) showed no statistically significant difference when compared with three and five minutes of SPO irrigation (P > 0.05), NaOCl showed statistically significant differences among all other groups (P < 0.05). CONCLUSIONS: Super-oxidized water indicated a remarkable and similar bactericidal effect to that of traditional NaOCl against E. faecalis biofilms. In terms of successful endodontic treatment approaches, super-oxidized water may be used as an effective irrigation solution in clinics.

Evaluation of crown discoloration induced by endodontic sealers and colour change ratio determination after bleaching.

The aim of this study was to evaluate tooth discoloration after the use of root canal sealers and the effect of internal bleaching on sealer discoloration. The crowns of 56 incisors were cut and randomly filled with four sealers (n = 14): Pulpispad, AH26, MTA Fillapex, EndoREZ. The colour measurement was taken with a spectrophotometer prior and after placement of sealers. Colour changes (ΔE) were recorded after 4 weeks then sealers were removed and an internal bleaching treatment was performed. After bleaching treatment colour changes (ΔE) were measured. Data were analysed using ANOVA and Tukey's test (α = 0.05). All tested sealers induced varying chromatic alterations. Pulpispad showed statistically more discoloration than other sealers (P < 0.05). After bleaching, EndoREZ showed statistically more bleaching ratio than MTA Fillapex and AH26 (P < 0.05). Internal bleaching was efficient in discoloured teeth induced by root canal sealers.

Microhardness of composites in simulated root canals cured with light transmitting posts and glass-fiber reinforced composite posts.

The aim of this study was to evaluate the depth of cure of composite resin cured within simulated root canals by means of light-transmitting plastic posts, glass-fiber-reinforced composite posts, and conventional light curing method. Thirty black plastic cylinders measuring 15 mm in length and 4 mm in internal diameter were divided into three groups. The composite resin was packed into simulated canals. The light-transmitting plastic posts and glass-fiber-reinforced composite posts were inserted into simulated canals and light cured for 90 seconds. The control group was light cured directly. To ensure continual change of material properties by increasing the length of material, a surface microhardness test was done 2 mm, 4 mm, 6 mm, 8 mm, 10 mm, 12 mm, and 14 mm from the light exposure surface. The results showed a significant increase in microhardness of composite resin (depth of cure) for both light-transmitting plastic posts and glass-fiber-reinforced composite posts compared with the control group. The microhardness of composite resin was also significantly higher with light-transmitting plastic posts than glass-fiber-reinforced composite posts after 8 mm.

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.

Interappointment emergencies in teeth with necrotic pulps.

The incidence of interappointment emergencies in symptomatic and asymptomatic teeth with necrotic pulps was evaluated, and severity of flare-ups was determined by a quantitative method using a flare-up index. There were no significant differences in the incidence of flare-ups attributable to gender, age, diameter of lesion, taking analgesics, placebos, or no medication, or preoperative symptomatic or asymptomatic tooth diagnoses (p > 0.05). There were significantly more painful flare-ups in mandibular teeth than in maxillary (p < 0.05).