Viability and Proliferation Assessment of Gingival Fibroblasts Cultured on Silver Nanoparticle-Doped Ti-6Al-4V Surfaces.

PURPOSE: To investigate the biocompatibility of silver nanoparticle (AgNP)-doped Ti-6Al-4V surfaces by evaluating the viability and proliferation rate of human gingival fibroblasts (HGFs)-as the dominant cells of peri-implant soft tissues-seeded on the modified surfaces. MATERIALS AND METHODS: AgNPs (sizes 8 nm and 30 nm) were incorporated onto Ti-6Al-4V specimen surfaces via electrochemical deposition, using colloid silver dispersions with increasing AgNP concentrations of 100 ppm, 200 ppm, and 300 ppm. One control and six experimental groups were included in the study: (1) control (Ti-6Al-4V), (2) 8 nm/100 ppm, (3) 8 nm/200 ppm, (4) 8 nm/300 ppm, (5) 30 nm/100 ppm, (6) 30 nm/200 ppm, and (7) 30 nm/300 ppm. HGF cell primary cultures were isolated from periodontally healthy donor patients and cultured in direct contact with the group specimens for 24 and 72 hours. The cytotoxicity of AgNP-doped Ti-6Al-4V specimens toward HGF was assessed by the MTT (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide) and BrdU (5-bromo-2'-deoxyuridine) assay tests. Calcein AM and ethidium homodimer (EthD-1) fluorescent stains were used to determine the live and dead cells. The morphology and attachment properties of the HGFs were determined via scanning electron microscopy (SEM). RESULTS: Energy dispersive x-ray (EDX) analysis confirmed the presence of AgNPs on the specimens. The MTT test revealed that AgNPs of both sizes and all concentrations presented a decreased cellular metabolic activity compared to the control discs. All concentrations of both sizes of AgNPs affected the cell proliferation rate compared to the control group, as revealed by the BrdU assay. Overall, cytotoxicity of the modified Ti-6Al-4V surfaces depended on cell exposure time. Observation via confocal microscopy confirmed the results of the MTT and BrdU assay tests. Specifically, most cells remained alive throughout the 72-hour culture period. SEM images revealed that adjacent cells form bonds with each other, creating confluent layers of conjugated cells. CONCLUSIONS: The findings of the present study indicate that Ti-6Al-4V surfaces modified with 8 nm and 30 nm AgNPs at concentrations of 100 ppm, 200 ppm, and 300 ppm do not produce any serious cytotoxicity toward HGFs. The initial arrest of the HGF proliferation rate recovered at 72 hours. These results on the antibacterial activity against common periodontal pathogens, in combination with the results found in a previous study by the same research group, suggest that AgNP-doped Ti-6Al-4V surfaces are potential candidates for use in implant abutments for preventing peri-implant diseases.

In vivo assessment of the corrosion of nickel-titanium orthodontic archwires by using scanning electron microscopy and atomic force microscopy.

This study was undertaken to assess in vivo the corrosion in two commercial nickel-titanium (NiTi) orthodontic archwires removed from the oral cavity of patients using fluoride mouthwashes. Five volunteers took part in this study on the corrosion behavior of two brands of NiTi archwires (3M and AO (brand of archwire)) during use of two mouthwashes with neutral sodium fluoride 1.1%, one with acidulated fluoride 1.1%, and one with placebo and a control group. Each patient used one mouthwash in three different periods of time for 1 min a day for 30 days. The archwires were assessed with scanning electron microscopy and atomic force microscopy for qualitative and quantitative analysis. The values obtained with atomic force microscopy (AFM) were submitted to normality test, two-way analysis of variance, and Tukey's test at a significance level of 5%. The AFM images showed a gradual qualitative increase in the roughness of both types of wire between the treatments: control < placebo < neutral fluoride < acidulated fluoride. The arithmetic average of the roughness and root mean square of the roughness were similar. As for 3M archwires, only the acidulated fluoride group differed statistically from the others. As for AO archwires, the control and placebo groups did not differ from each other, but differed from the other fluoride treatments. The group using neutral fluoride also differed significantly from the acidulated fluoride group. 3M archwires were not affected by daily oral challenges. AO archwires were not affected by daily oral challenges either; their association with fluoride, either neutral or acidulated, increased their roughness.

Assessment of artefacts produced by metal posts on CBCT images.

AIM: To evaluate artefact intensity in cone beam computed tomography (CBCT) images of two alloys used in metal posts scanned using different exposure parameters. METHODOLOGY: The sample consisted of 20 single-rooted teeth divided into two groups for use with either a NiCr post or AgPd post. All teeth were scanned with and without their corresponding metal posts and with and without the presence of an extra restored tooth in the arch. The samples were scanned using CS 9000 3D scanner with two exposure protocols: 85 kV 6.3 mA and 85 kV 10 mA. Voxel size and FOV were fixed at 0.100 mm and 5 cm × 3.75 cm. The presence of artefacts was assessed qualitatively by two calibrated observers using the CBCT volume and paired 2D images, and quantitatively by one trained observer, using ImageJ software. Wilcoxon's signed rank, Mann-Whitney, kappa and chi-square tests were used for qualitative analyses. Two-way anova and Tukey's tests were used for quantitative analyses. All analyses were conducted considering the 95% confidence level (α < 0.05). RESULTS: For the CBCT volume qualitative analysis, significant differences were observed between the metal alloys in the presence of an extra restored tooth, with higher artefact intensity for AgPd when assessing hypodense halos and lines (P = 0.006). Images with two restored teeth had significantly more hypodense and hyperdense lines (P = 0.033). When evaluating exposure parameters and number of restored teeth, the paired image quality analysis revealed significant disagreement between observers for diagnostic image quality (P = 0.001). Quantitative artefact analysis revealed higher artefact intensity for the AgPd posts in the presence of two restored teeth. CONCLUSION: Although the exposure parameters tested did not interfere with artefact intensity, post alloys with a higher atomic number and the presence of another metal structure in the arch increased artefact intensity and impaired the diagnostic quality of CBCT images.

Assessment of corrosion resistance of cast cobalt- and nickel-chromium dental alloys in acidic environments.

BACKGROUND: The aim of this study was to compare the degradation resistance of nickel-chromium (Ni-Cr) and cobalt-chromium (Co-Cr) alloys used as a base material for partial dentures in contact with saliva. METHODS: Wiron® 99 and Wironit Extra-Hard® were selected as representative casting alloys for Ni-Cr and Co-Cr alloys, respectively. The alloys were tested in contact with deionized water, artificial saliva and acidified artificial saliva. Material characterization was performed by X-ray diffractometry (XRD) and microhardness and nanohardness testing. The corrosion properties of the materials were then analyzed using open circuit potential analysis and potentiodynamic analysis. Alloy leaching in solution was assessed by inductively coupled plasma mass spectrometry techniques. RESULTS: Co-Cr alloy was more stable than the Ni-Cr alloy in all solutions tested. Leaching of nickel and corrosion attack was higher in Ni-Cr alloy in artificial saliva compared with the acidified saliva. The corrosion resistance of the Co-Cr alloy was seen to be superior to that of the Ni-Cr alloy, with the former exhibiting a lower corrosion current in all test solutions. Microstructural topographical changes were observed for Ni-Cr alloy in contact with artificial saliva. The Ni-Cr alloy exhibited microstructural changes and lower corrosion resistance in artificial saliva. The acidic changes did not enhance the alloy degradation. CONCLUSIONS: Ni-Cr alloys are unstable in solution and leach nickel. Co-Cr alloys should be preferred for clinical use.

In vitro assessment of stainless steel orthodontic brackets coated with titanium oxide mixed Ag for anti-adherent and antibacterial properties against Streptococcus mutans and Porphyromonas gingivalis.

Orthodontic brackets made from stainless steel were introduced in dentistry, though they have less ability in reducing enamel demineralization and are not successful in preventing microbial as well as biofilm growth. In this study, we evaluated the significant role of different brackets in reducing enamel demineralization indirectly. Results from different tests indicate the significant reduction in adhesion, biofilm formation and slow growth of tested bacterial species on brackets coated with Ag + TiO2 and found to be statistically significant lower than control. There was no loss in cell viability in all brackets indicating that the cells are biocompatible with different bracket materials. Scanning electron microscopy showed less bacteria attached with the surface coated with Ag + TiO2 indicated that bacteria were losing adherent nature on coated surface. In conclusion, TiO2+Ag coating on stainless steel brackets possessed anti-adherent properties and also have demonstrable antibacterial properties therefore helps in preventing dental caries and plaque accumulation indirectly. The cell compatibility of TiO2+Ag coated brackets is superior to the uncoated samples therefore can be used in orthodontics as it not only provide suitable antimicrobial activity and resistance to biofilm formation but also sustained the cell viability of human gingival fibroblast (HGF) cell lines.

Ultrastrong steel via minimal lattice misfit and high-density nanoprecipitation.

Next-generation high-performance structural materials are required for lightweight design strategies and advanced energy applications. Maraging steels, combining a martensite matrix with nanoprecipitates, are a class of high-strength materials with the potential for matching these demands. Their outstanding strength originates from semi-coherent precipitates, which unavoidably exhibit a heterogeneous distribution that creates large coherency strains, which in turn may promote crack initiation under load. Here we report a counterintuitive strategy for the design of ultrastrong steel alloys by high-density nanoprecipitation with minimal lattice misfit. We found that these highly dispersed, fully coherent precipitates (that is, the crystal lattice of the precipitates is almost the same as that of the surrounding matrix), showing very low lattice misfit with the matrix and high anti-phase boundary energy, strengthen alloys without sacrificing ductility. Such low lattice misfit (0.03 ± 0.04 per cent) decreases the nucleation barrier for precipitation, thus enabling and stabilizing nanoprecipitates with an extremely high number density (more than 1024 per cubic metre) and small size (about 2.7 ± 0.2 nanometres). The minimized elastic misfit strain around the particles does not contribute much to the dislocation interaction, which is typically needed for strength increase. Instead, our strengthening mechanism exploits the chemical ordering effect that creates backstresses (the forces opposing deformation) when precipitates are cut by dislocations. We create a class of steels, strengthened by Ni(Al,Fe) precipitates, with a strength of up to 2.2 gigapascals and good ductility (about 8.2 per cent). The chemical composition of the precipitates enables a substantial reduction in cost compared to conventional maraging steels owing to the replacement of the essential but high-cost alloying elements cobalt and titanium with inexpensive and lightweight aluminium. Strengthening of this class of steel alloy is based on minimal lattice misfit to achieve maximal precipitate dispersion and high cutting stress (the stress required for dislocations to cut through coherent precipitates and thus produce plastic deformation), and we envisage that this lattice misfit design concept may be applied to many other metallic alloys.

Assessment of rotary and reciprocating movements in root canal filling material removal / Análise dos sistemas rotatórios e reciprocante com diferentes ligas na desobturação em retratamento endodônticos

The aim of this study was to evaluate the effects of preparation, filling removal material, reinstrumentation and reobturation of root canals with different Ni-Ti alloys in endodontic retreatment. Firstly, the selection and pairing of mesial root canals of mandibular molars (n = 45) were performed by computerized micro-tomography (micro-CT). After pairing, the specimens were divided into three groups (n = 15), instrumented with the Mtwo® (up to file 25.06), ProDesign Logic (25.06) and ProDesign R (25.06) systems. After this, the specimens were scanned again for root canal deviation analysis at 2, 4, 6, 8 and 10 mm from the apex and the volume increase of these root canals was evaluated through CTan Then, the root canals were filled with Endofill® with 0.1% rhodamine B and scanned in micro-CT once again. For the retreatment of the specimens, 3 groups were established according to the system used (Reciproc®, Hyflex® and ProDesign Duo Hybrid®). During the retreatment, the specimens were scanned in micro-CT in two more phases, after removal of filling material and after reinstrumentation of the root canals. All the images obtained previous and post-retreatment were compared to evaluate the capacity of removal filling material of each system through the volume of material remaining at 3mm in the apical third. Possible deviation of the root canal was assessed at 2, 4, 6, 8 and 10 mm from the apex. In addition, the times of preparation, removal filling material and reinstrumentation of these files were also evaluated. After the removal filling material and reinstrumentation of the root canals, they were refilled with AH Plus with 0.1% fluorescein. The specimens were sectioned crosswise into 2 mm slices to be analyzed by a confocal laser scanning microscope (CLSM) at 1, 3 and 5 mm from the apex, where the volume of material was evaluated through LAS X 3D and 2D software. The time of preparation, removal filling material and reinstrumentation of the root canals between the different systems was measured by a digital timer. The evaluation of canal volumetric increase and preparation time between Mtwo and ProDesign Logic systems were conducted using Student t-test analysis. Non-parametric Wilcoxon test was used to the intragroup comparison at the 2, 4, 6, 8 and 10 mm levels and non-parametric Mann-Whitney test was used to the comparison between groups in the root canal transportation in all sections of the root canal. The intra-group comparison regarding the presence or absence of root canal deviation after removal of root canal filling material and re-instrumentation was submitted to the parametric T-paired statistical test, since it had a normal distribution. The working time with the different alloys used to removal filling material an reinstrumentation was analyzed through parametric ANOVA e Tukey statistical test. The analysis of the remaining material present in the root canals was performed with nonparametric Kruskal-Wallis and Dunn tests. For the intra-group comparison between the different slices (1, 3 and 5 mm), the data were submitted to nonparametric Friedman and Dunn tests. The level of significance was established at 5% in all analysis. After the initial preparation of the root canals, the ProDesign Logic system proved to be faster than Mtwo system, with statistical difference between them (P <0.05). There was no statistical difference in root canal deviation after initial preparation and after retreatment (P> 0.05). In addition, the groups did not present a significant statistical difference to the volume increase of the root canals after the initial preparation or to the volume of filling material remaining after the retreatment (P> 0.05). The Reciproc system proved to be the fastest system for the removal filling material and reinstrumentation of the root canals (P <0.05). The present study demonstrated that the Prodesign Logic and Mtwo systems presented similar capacity of preparation of mesial root canals. The Reciproc, Hyflex and ProDesign Duo Hybrid systems are similar in the removal of filling material, preserving the original root canal shape in endodontic retreatment. However, Reciproc was the fastest compared to the other groups.(AU)

O presente trabalho teve como objetivo avaliar os efeitos decorrentes do preparo inicial, desobturação, reinstrumentação e reobturação de canais radiculares com diferentes ligas de Ni-Ti em casos de retratamento endodôntico. Primeiramente, foi realizado a seleção e o pareamento da anatomia de canais mesiais de primeiros molares inferiores (n=45) através de micro-tomografia computadorizada (micro-CT). Após o pareamento dos espécimes, os mesmos foram divididos em três grupos (n =15), instrumentados com os sistemas Mtwo® (até a lima 25.06), ProDesign Logic (25.06) e ProDesign R (25.06) sendo escaneados novamente para análise de desvio do canal radicular a 2, 4, 6, 8 e 10 mm, além do aumento de volume desses canais, avaliados através do CTan. Em seguida, os canais radiculares foram obturados com o cimento Endofill® acrescido de 0,1% de rodamina B e escaneados em micro-CT mais uma vez. Para o retratamento dos espécimes, foram estabelecidos 3 grupos, de acordo com o sistema utilizado (Reciproc®, Hyflex® e ProDesign Duo Híbrido®). Durante o retratamento, os espécimes foram escaneados em micro-CT em mais duas etapas, após a desobturação e a após a reinstrumentação dos canais. Todas as imagens obtidas referentes ao pré e pós retratamento foram confrontadas com o intuito de avaliar a capacidade de remoção de material obturador de cada sistema através do volume de material remanescente nos 3 mm apicais, além de avaliar possíveis desvios dos canais a 2, 4, 6, 8 e 10 mm do ápice. Foram avaliados também, o tempo efetivo de preparo, desobturação e de reinstrumentação desses instrumentos. Após a desobturação e reinstrumentação dos canais, os mesmos foram reobturados com cimento AH Plus acrescido de 0,1% de fluoresceína. Os espécimes foram seccionados transversalmente em fatias de 2 mm para serem analisados em microscópio confocal de varredura a laser (MCVL) a 1, 3 e 5 mm do ápice, onde foi avaliado, através do software LAS X 3D e 2D, o volume de material obturador antigo. O tempo de preparo, desobturação e reinstrumentação dos canais entre os diferentes sistemas foi marcado através de um cronômetro digital. A análise do aumento volumétrico e tempo de preparo entre os sistemas Mtwo e ProDesign Logic foi feita através do teste estatístico Student t. Para a análise do desvio do canal radicular após o preparo inicial, o teste não-paramétrico Wilcoxon foi utilizado para a comparação intra-grupos nos níveis a 2, 4, 6, 8 e 10 mm do ápice, enquanto o teste não-paramétrico Mann-Whitney foi utilizado para comparação entre os grupos nos mesmos níveis. Para a análise do desvio do canal radicular após a desobturação e reinstrumentação dos canais, os dados foram submetidos ao teste paramétrico T-pareado. O tempo de desobturação e reinstrumentação com os diferentes sistemas foi analisado através do teste ANOVA e Tukey. Os dados referentes ao remanescente de material obturador foram analisados através dos testes não-paramétrico Kruskal-Wallis e Dunn. Para a comparação intra-grupos entre os diferentes níveis (1, 3 e 5 mm) foram utilizados os testes não-paramétricos Friedman e Dunn. O nível de significância foi estabelecido a 5% em todas as análises. Após o preparo inicial dos canais, o sistema ProDesign Logic demonstrou ser mais rápido que o sistema Mtwo, havendo diferença estatística entre eles (P < 0.05). Não houve diferença estatística quanto ao desvio do canal radicular tanto após o preparo inicial quanto após o retratamento (P > 0.05). Além disso, os grupos também não apresentaram diferença estatística significante quanto ao aumento do volume dos canais após o preparo inicial, nem em relação ao volume de remanescente de material obturador após o retratamento (P > 0.05). O sistema Reciproc demonstrou ser o mais rápido dentre os sistemas quanto à desobturação e reinstrumentação dos canais (P < 0.05). O presente trabalho demonstrou que os sistemas Prodesign Logic and Mtwo apresentaram capacidade similar de preparo dos canais mesiais de molares inferiores. Os sistemas Reciproc, Hyflex e ProDesign Duo Híbrido são parecidos quanto à remoção de material obturador, preservando o formato original do canal em casos de retratamentos entodônticos. Entretanto, Reciproc foi o mais rápido comparado aos outros grupos.(AU)

Caries management by risk assessment (CAMBRA) and its effect on the surface roughness of various restorative materials.

STATEMENT OF PROBLEM: Whether topical anticaries medicaments used in the oral environment will affect the surface integrity of restorative materials is uncertain. PURPOSE: The purpose of this in vitro study was to investigate the effect of various anticaries agents on the surface roughness of 3 different restorative materials. MATERIAL AND METHODS: Sixty-four specimens of each restorative material (feldspathic porcelain, Ni-Cr metal ceramic alloy, and Ti-6Al-4V titanium alloy) were prepared and separated into 4 equal groups for soaking in anticaries agents (Prevident Dental Rinse, ACT mouth wash, chlorhexidine gluconate, and water). A profilometer was used to measure surface roughness before and after soaking the materials for 2 years of simulated usage. The mean change in surface roughness for each specimen was calculated. Statistical analysis was performed with a 2-way ANOVA, followed by the Tukey HSD test (α=.05). RESULTS: A significant interaction was found between the materials and anticaries agents (F=2.64, P=.02). The significant interaction was between Prevident and chlorhexidine gluconate. Porcelain specimens soaked in Prevident produced a negative change (-0.072 ±0.35 µm) in surface roughness (smoother surface), while chlorhexidine gluconate produced a positive change (0.094 ±0.42 µm) in surface roughness (rougher surface). CONCLUSION: Within the limitations of this in vitro study, it can be concluded that Prevident Dental Rinse and chlorhexidine gluconate may cause a change in the surface roughness of feldspathic porcelain.

Assessment of precipitation behavior in dental castings of a Co-Cr-Mo alloy.

This study investigated solute portioning and precipitation in dental castings of a Co-Cr-Mo alloy and discussed their effects on alloy performance, in particular, the mechanical properties. Samples of a commercial Co-29Cr-6Mo (mass%) alloy were prepared using a dental-casting machine. The precipitates formed owing to the partitioning behaviors of the alloying elements were investigated using scanning electron microscopy, electron backscatter diffraction analysis, electron probe microanalysis, and transmission electron microscopy. The prepared samples exhibited a very coarse face-centered-cubic γ-phase dendritic structure with an average grain size of a few millimeters. A large number of precipitates, which decomposed further into complex interdendritic constituents (σ- and M23C6 carbide phases) were observed in the interdendritic regions rich in Cr, Mo, Si, and C. A reaction between the σ-phase and carbon is probably responsible for the carbide M23C6; however, this reaction did not occur to completion in the current case in spite of slow cooling (i.e., long exposure to elevated temperatures) in dental casting. While these precipitates result in high strength (hardness) and/or brittleness, the properties can be improved further by optimizing the alloy composition and the manufacturing process. The results of this study shed light on the significance of precipitation control in dental castings of Co-Cr-Mo alloys and should aid in the design of novel biomedical Co-Cr-based dental alloys that exhibit better performances.

Numerical assessment of bone remodeling around conventionally and early loaded titanium and titanium-zirconium alloy dental implants.

The aim of this study was to investigate conventionally and early loaded titanium and titanium-zirconium alloy implants by three-dimensional finite element stress analysis. Three-dimensional model of a dental implant was created and a thread area was established as a region of interest in trabecular bone to study a localized part of the global model with a refined mesh. The peri-implant tissues around conventionally loaded (model 1) and early loaded (model 2) implants were implemented and were used to explore principal stresses, displacement values, and equivalent strains in the peri-implant region of titanium and titanium-zirconium implants under static load of 300 N with or without 30° inclination applied on top of the abutment surface. Under axial loading, principal stresses in both models were comparable for both implants and models. Under oblique loading, principal stresses around titanium-zirconium implants were slightly higher in both models. Comparable stress magnitudes were observed in both models. The displacement values and equivalent strain amplitudes around both implants and models were similar. Peri-implant bone around titanium and titanium-zirconium implants experiences similar stress magnitudes coupled with intraosseous implant displacement values under conventional loading and early loading simulations. Titanium-zirconium implants have biomechanical outcome comparable to conventional titanium implants under conventional loading and early loading.

Outcome assessment of lingual and labial appliances compared with cephalometric analysis, peer assessment rating, and objective grading system in Angle Class II extraction cases.

OBJECTIVE: To validate our hypothesis that there would be significant differences in treatment outcomes, including cephalometric values, degree of root resorption, occlusal indices, and functional aspect, between cases treated with labial and lingual appliances. MATERIALS AND METHODS: Twenty-four consecutively treated Class II cases with extractions and lingual appliance were compared with 25 matched cases treated with extraction and labial appliance. Orthodontic treatment outcomes were evaluated by cephalometric analysis, peer assessment rating, and an objective grading system (OGS). Additionally, functional analysis was also performed in both groups after orthodontic treatment. Statistical comparison was performed using the Wilcoxon signed rank test within the groups, and the Mann-Whitney U-test was used to compare between the labial and lingual groups. RESULTS: The only significant difference between the groups was that the interincisal angle was larger in the lingual group than in the labial group. OGS evaluation showed that control over root angulation was significantly worse in the lingual group than in the labial group. There was no significant difference between groups in the amount of root resorption or in functional evaluation. CONCLUSIONS: Generally, lingual appliances offer comparable treatment results to those obtained with labial appliances. However, care should be taken with lingual appliances because they are more prone to produce uprighted incisors and root angulation.

Assessment of the mechanical properties of ProTaper Next Nickel-titanium rotary files.

INTRODUCTION: The purpose of this study was to compare the torsional resistance, flexibility, and surface microhardness of ProTaper Next files (PTN) with Twisted Files (TF) and RaCe (RC). METHODS: A metal block with a cubical hole was used to evaluate the torsional resistance. Five millimeters of the tip of each file was securely held in place by filling the mold with a resin composite, and the files were driven clockwise at 300 rpm. The number of load applications before fracture was recorded for each file. A scanning electron microscope was used to characterize the topographic features of the fracture surfaces of the broken files. The files were tested for bending resistance by using cantilever-bending test. Vickers microhardness was measured on the cross section of instruments with 300-g load and 15-second dwell time. Torsional resistance data were analyzed by using the nonparametric Kruskal-Wallis and Mann-Whitney U tests. Bending resistance and microhardness data were analyzed by using analysis of variance and Tukey tests. RESULTS: PTN showed the highest torsional resistance and microhardness, followed by RC (P < .05). The fracture cross sections of all brands showed dimpling near the center of fracture surface. The ranking in the bending resistance values was as follows: RC > PTN > TF. CONCLUSIONS: PTN improved its resistance to torsional stresses and wear compared with TF and RC. TF showed improved flexibility compared with other tested brands.

Assessment of dentinal damage during canal preparation using reciprocating and rotary files.

INTRODUCTION: The role of motion kinematics in creating dentinal damage during instrumentation is not very clear. The purpose of this study was to compare the formation of dentinal cracks with instruments working in continuous rotation and reciprocating motion. METHODS: One hundred twenty extracted human mandibular premolars were selected for the study. Thirty teeth served as controls, and the remaining 90 teeth were divided into 3 groups depending on the root canal preparation technique. Group 1 samples were treated with WaveOne primary files (Dentsply Maillefer, Ballaigues, Switzerland), group 2 samples with single F2 ProTaper (Dentsply Maillefer) working in reciprocating motion, and group 3 samples were prepared with sequential ProTaper (Dentsply Maillefer) until F2 working in continuous rotation motion. Roots were then sectioned at 3, 6, and 9 mm from the apex, and the cut surface was observed under a stereomicroscope for the presence of dentinal microcracks. RESULTS: The control group and WaveOne, single F2 ProTaper in reciprocating motion, and continuous ProTaper groups caused cracks in 0%, 15%, 26%, and 53% of samples, respectively. A statistically significant difference was found between 2 reciprocating file groups (WaveOne and single F2 ProTaper in reciprocating motion) and the continuous rotation group (ProTaper) (P < .05). However, no significant difference was found among the 2 reciprocating file groups (P > .05). CONCLUSIONS: Dentinal cracks are produced irrespective of motion kinematics. Within the limits of this study and the current literature, such incidence is less with instruments working in reciprocating motion compared with those working in continuous rotation.

Assessment of the separation incidence of reciprocating WaveOne files: a prospective clinical study.

INTRODUCTION: Despite metallurgical advancements in the nickel-titanium file manufacturing process, file separation remains a concern. The purpose of this prospective clinical study was to assess the separation incidence of the reciprocating WaveOne file (Dentsply Tulsa Dental Specialties, Tulsa, OK) when used to prepare root canals of posterior teeth. METHODS: File separation incidence was assessed over an 18-month period in which 4 experienced and calibrated endodontists performed conventional endodontic treatment on posterior teeth using the WaveOne file system. The separation incidence was determined based on both the number of teeth and the number of canals instrumented during this time period. RESULTS: A total of 2,215 canals (711 teeth) were treated. Three instruments (two 21.06 and one 25.08) separated during use and were deemed to be irretrievable. The overall instrument separation incidence in relation to the number of canals shaped was found to be 0.13% (0.42% teeth). CONCLUSIONS: Based on the results of this study, the incidence of endodontic instrument separation when using the WaveOne reciprocating file was considerably low.

Comparative assessment of alignment efficiency and space closure of active and passive self-ligating vs conventional appliances in adolescents: a single-center randomized controlled trial.

INTRODUCTION: The aim of this study was to compare the time to initial alignment and extraction space closure using conventional brackets and active and passive self-ligating brackets. METHODS: One hundred adolescent patients 11 to 18 years of age undergoing maxillary and mandibular fixed appliance therapy after the extraction of 4 premolars were randomized with stratification of 2 age ranges (11-14 and 15-18 years) and 3 maxillomandibular plane angles (high, medium, and low) with an allocation ratio of 1:2:2. Restrictions were applied using a block size of 10. Allocation was to 1 of 3 treatment groups: conventional brackets, active self-ligating, or passive self-ligating brackets. All subjects were treated with the same archwire sequence and space-closing mechanics in a district general hospital setting. The trial was a 3-arm parallel design. Labial-segment alignment and space closure were measured on study models taken every 12 weeks throughout treatment. All measurements were made by 1 operator who was blinded to bracket type. The patients and other operators were not blinded to bracket type during treatment. RESULTS: Ninety-eight patients were followed to completion of treatment (conventional, n = 20; active self-ligating brackets, n = 37; passive self-ligating brackets, n = 41). The data were analyzed using linear mixed models and demonstrated a significant effect of bracket type on the time to initial alignment (P = 0.001), which was shorter with the conventional brackets than either of the self-ligating brackets. Sidak's adjustment showed no significant difference in effect size (the difference in average response in millimeters) between the active and passive self-ligating brackets (the results are presented as effect size, 95% confidence intervals, probabilities, and intraclass correlation coefficients) (-0.42 [-1.32, 0.48], 0.600, 0.15), but the conventional bracket was significantly different from both of these (-1.98 [-3.19, -0.76], 0.001, 0.15; and -1.56 [-2.79, -0.32], 0.001, 0.15). There was no statistically significant difference between any of the 3 bracket types with respect to space closure. Space-closure times were shorter in the mandible, except for the Damon 3MX bracket (Ormco, Orange, Calif), where active and total space-closure times were shorter in the maxilla. No adverse events were recorded in the trial. CONCLUSIONS: Time to initial alignment was significantly shorter for the conventional bracket than for either the active or passive self-ligating brackets. There was no statistically significant difference in passive, active, or total space-closure times among the 3 brackets under investigation.

Survival analysis of brackets and tubes: A twelve-month assessment.

OBJECTIVE: To compare the clinical performance of brackets bonded to anterior and posterior teeth, including second molars. MATERIALS AND METHODS: One operator, using the straight-wire technique, bonded metallic brackets to the teeth of 127 consecutive patients. All patients were observed for 12 months during their regular orthodontic appointments. Bracket failures were recorded and summarized for statistical analysis. The Cox proportional hazards regression analysis was performed to evaluate bracket failure rates. RESULTS: Statistically significant differences in survival rates were observed between molar tubes and anterior brackets (P < .05). Twelve-month failure rates of incisor, canine, premolar, and molar brackets were 3.6, 1.6, 4.8, and 11.6%, respectively. The first and second molar did not show significant difference in bond failure. Young patients (age <18 years) showed a higher failure rate than old patients (≥18 years). CONCLUSIONS: Brackets directly bonded to the buccal surfaces of molars failed significantly more often than those directly bonded to anterior teeth or premolars, but showed acceptable failure rate especially in adult patients. Bonding on second molars seems to be as reliable as bonding on the first molars.

Assessment of apically extruded debris produced by the self-adjusting file system.

INTRODUCTION: This study was designed to quantitatively evaluate the amount of apically extruded debris by the Self-Adjusting-File system (SAF; ReDent-Nova, Ra'anana, Israel). Hand and rotary instruments were used as references for comparison. METHODS: Sixty mesial roots of mandibular molars were randomly assigned to 3 groups (n = 20). The root canals were instrumented with hand files using a crown-down technique. The ProTaper (Dentsply Maillefer, Ballaigues, Switzerland) and SAF systems were used according to the manufacturers' instructions. Sodium hypochlorite was used as an irrigant, and the apically extruded debris was collected in preweighted glass vials and dried afterward. The mean weight of debris was assessed with a microbalance and statistically analyzed using 1-way analysis of variance and the post hoc Tukey multiple comparison test. RESULTS: Hand file instrumentation produced significantly more debris compared with the ProTaper and SAF systems (P < .05). The ProTaper system produced significantly more debris compared with the SAF system (P < .05). CONCLUSIONS: Under the conditions of this study, all systems caused apical debris extrusion. SAF instrumentation was associated with less debris extrusion compared with the use of hand and rotary files.

In vitro assessment of tooth color alteration by two different types of endodontic irrigants.

AIM: The purpose of this study was to assess in vitro the tooth color alterations associated with two commonly used endodontic irrigants, the chlorhexidine gluconate (CHX) and the sodium hypochlorite (NaOCl) up to 15 days post-treatment. Additionally, the possible influence of endodontic access preparation on tooth color was investigated. MATERIALS AND METHODS: Thirty intact human anterior teeth were used. Black adhesive tape with a 4 mm diameter window was used to standardize the enamel surface intended for color analysis. After the access cavity, preparation and the initial root canal negotiation with stainless steel hand files, the root canal shaping was completed with rotary nickel-titanium files. The teeth were divided into three groups (n = 10). Conventional syringe irrigation was performed with one irrigant for each group. The enamel surfaces were colorimetrically evaluated before access cavity, after cavity preparation and at 1, 3, 7 and 15 days post-treatment. The CIE color parameters (L*, a*, b*) were recorded and averaged for each material and the corresponding color differences (ΔE) were calculated and statistically analyzed. RESULTS: The most significant factor in tooth color alteration, during the endodontic treatment, was the access preparation. CHX and NaOCl caused tooth color changes comparable with the saline. CHX and NaOCl did not increase the tooth color changes relative to the values induced by the access preparation. CONCLUSION: The two endodontic irrigants were not able to induce tooth color alteration to a greater extent than the access preparation. CLINICAL SIGNIFICANCE: Chlorhexidine and NaOCl cannot be considered as discoloring endodontic materials. The most contributing factor in tooth color alteration during endodontic treatment in the anterior teeth is access preparation.

In vitro assessment of torque and force generated by novel ProTaper Next Instruments during simulated canal preparation.

INTRODUCTION: The purpose of this study was to assess torque and force for simulated canal preparation with a new root canal instrument, ProTaper Next. METHODS: Six sets of ProTaper Next Instruments (X1-X5) were used to prepare 36 artificial canals. Files were divided into 6 groups. Different settings of rotations per minute (250, 300, and 350 rpm) and numbers of in-and-out movements to reach working length (3 or 4 insertions [ins]) were applied in each group (250 rpm/3 ins, 250 rpm/4 ins, 300 rpm/3 ins, 300 rpm/4 ins, 350 rpm/3 ins, and 350 rpm/4 ins) by using an automated torque bench. Peak torques (Ncm) as well as positive and negative forces (N) were registered. Analysis of variance and Tukey post hoc tests were applied. Preliminary data for angle and stationary torque at failure were also obtained and compared with peak torque for each instrument. RESULTS: Significant differences in peak torque (P < .0001), positive force (P < .002), and negative force (P < .0001) were found for ProTaper Next instruments overall. X2 showed the highest torque with all settings. X5 showed the highest positive force in all groups. X1 and X2 showed the highest negative forces for all groups except for 350 rpm/4 ins. Significantly lower torque (P < .0001) and positive force (P < .007) were measured in the group 350 rpm/4 ins for all instruments except for X4. In contrast, X1 showed a significantly lower negative force for 350 rpm/4 ins. Torque at failure according to American Dental Association no. 28/ISO 36030-1 was lower for X1, X2, and X3 than torque during simulated canal preparation (P < .0001). CONCLUSIONS: Under the conditions of this study, using ProTaper Next at 350 rpm and with 4 in-and-out movements resulted in lowest levels of peak torque as well as positive and negative forces.

Selection patterns of dietary foods in edentulous participants rehabilitated with maxillary complete dentures opposed by mandibular implant-supported prostheses: a multicenter longitudinal assessment.

STATEMENT OF PROBLEM: Documentation of long-term changes in food intake is lacking for those treated with a maxillary complete denture opposed by a mandibular, screw-retained, implant-supported fixed prosthesis. PURPOSE: The purpose of this study was to evaluate the selection patterns of dietary foods over 5 years for edentulous participants treated in a multicenter prospective clinical trial that compared cast alloy versus laser-welded titanium frameworks of an implant-supported prostheses opposed by maxillary complete dentures to rehabilitate edentulous participants. MATERIAL AND METHODS: The study assessed data from a multicenter prospective clinical trial that followed edentulous participants from an initial baseline of wearing existing complete dentures to implant placement, restoration with a mandibular implant-supported prosthesis opposed by a maxillary complete denture, to follow-up assessment of these treatments over 5 years. The 32 participants in the cohort were treated at 5 of 9 participating centers. The data collected included 2 dietary forms, a standardized 4-day food diary form, and a dietary habits questionnaire. Each participant completed forms before entering into treatment (control) and at the 1- and 5-year follow-up assessment after being treated with a maxillary complete denture opposing a mandibular complete-arch fixed implant-supported prosthesis. Descriptive statistics were calculated for each measure at each assessment point. Regression analysis and the Sign test were used to calculate change in the participants' nutritional status (α=.05). RESULTS: Among the findings, it was noted that difficulty in masticating hard, raw, and fibrous foods decreased and intake of vegetable portions increased significantly from 2.5 to 3.3 servings. Participant comfort in eating in public places and their enjoyment of eating were significantly improved from 50% of participants being uncomfortable with their prior complete denture treatment to only 4% after 5 years. CONCLUSIONS: Within the limitations of this study, it was concluded that vegetable intake and ability to masticate raw, hard, and fibrous food for these participants improved when they received a mandibular implant-supported prosthesis opposed by a maxillary complete denture. According to the analysis and findings, the overall eating experience was more pleasurable, and eating in public was more comfortable after replacement of complete dentures with a mandibular implant-supported prosthesis.