CBCT study of mandibular first molars with a distolingual root in Koreans

OBJECTIVES: This study aimed to investigate the prevalence of a separate distolingual root and to measure the thickness of the buccal cortical bone in mandibular first molars in Koreans using cone-beam computed tomography (CBCT) images. MATERIALS AND METHODS: High-quality CBCT data from 432 patients were analyzed in this study. The prevalence of a separate distolingual root of the mandibular first molar was investigated. The distance from the distobuccal and distolingual root apices to the outer surface of the buccal cortical bone was measured. We also evaluated the thickness of the buccal cortical bone. RESULTS: The prevalence of a separate distolingual root (2 separate distal roots with 1 canal in each root; 2R2C) was 23.26%. In mandibular first molars with 2R2C, the distance from the distobuccal root apex to the outer surface of the buccal cortical bone was 5.51 mm. Furthermore, the distance from the distolingual root apex to the outer surface of the buccal cortical bone was 12.09 mm. In mandibular first molars with 2R2C morphology, the thickness of the buccal cortical bone at the distobuccal root apex of the mandibular first molar was 3.30 mm. The buccal cortical bone at the distobuccal root apex was significantly thicker in the right side (3.38 mm) than the left side (3.09 mm) (p < 0.05). CONCLUSIONS: A separate distolingual root is not rare in mandibular first molars in the Korean population. Anatomic and morphologic knowledge of the mandibular first molar can be useful in treatment planning, including surgical endodontic treatment.

Analysis of C-shaped root canal configuration in maxillary molars in a Korean population using cone-beam computed tomography

OBJECTIVES: The purpose of this study was to investigate the incidence of root fusion and C-shaped root canals in maxillary molars, and to classify the types of C-shaped canal by analyzing cone-beam computed tomography (CBCT) in a Korean population. MATERIALS AND METHODS: Digitized CBCT images from 911 subjects were obtained in Chosun University Dental Hospital between February 2010 and July 2012 for orthodontic treatment. Among them, a total of selected 3,553 data of maxillary molars were analyzed retrospectively. Tomography sections in the axial, coronal, and sagittal planes were displayed by PiViewstar and Rapidia MPR software (Infinitt Co.). The incidence and types of root fusion and C-shaped root canals were evaluated and the incidence between the first and the second molar was compared using Chi-square test. RESULTS: Root fusion was present in 3.2% of the first molars and 19.5% of the second molars, and fusion of mesiobuccal and palatal root was dominant. C-shaped root canals were present in 0.8% of the first molars and 2.7% of the second molars. The frequency of root fusion and C-shaped canal was significantly higher in the second molar than the first molar (p < 0.001). CONCLUSIONS: In a Korean population, maxillary molars showed total 11.3% of root fusion and 1.8% of C-shaped root canals. Furthermore, root fusion and C-shaped root canals were seen more frequently in the maxillary second molars.

Analysis of C-shaped root canal configuration in maxillary molars in a Korean population using cone-beam computed tomography

OBJECTIVES: The purpose of this study was to investigate the incidence of root fusion and C-shaped root canals in maxillary molars, and to classify the types of C-shaped canal by analyzing cone-beam computed tomography (CBCT) in a Korean population. MATERIALS AND METHODS: Digitized CBCT images from 911 subjects were obtained in Chosun University Dental Hospital between February 2010 and July 2012 for orthodontic treatment. Among them, a total of selected 3,553 data of maxillary molars were analyzed retrospectively. Tomography sections in the axial, coronal, and sagittal planes were displayed by PiViewstar and Rapidia MPR software (Infinitt Co.). The incidence and types of root fusion and C-shaped root canals were evaluated and the incidence between the first and the second molar was compared using Chi-square test. RESULTS: Root fusion was present in 3.2% of the first molars and 19.5% of the second molars, and fusion of mesiobuccal and palatal root was dominant. C-shaped root canals were present in 0.8% of the first molars and 2.7% of the second molars. The frequency of root fusion and C-shaped canal was significantly higher in the second molar than the first molar (p < 0.001). CONCLUSIONS: In a Korean population, maxillary molars showed total 11.3% of root fusion and 1.8% of C-shaped root canals. Furthermore, root fusion and C-shaped root canals were seen more frequently in the maxillary second molars.

Apical foramen morphology according to the length of merged canal at the apex

OBJECTIVES: The aim of this study was to investigate the relationship between the apical foramen morphology and the length of merged canal at the apex in type II root canal system. MATERIALS AND METHODS: This study included intact extracted maxillary and mandibular human premolars (n = 20) with fully formed roots without any visible signs of external resorption. The root segments were obtained by removing the crown 1 mm beneath the cementum-enamel junction (CEJ) using a rotary diamond disk. The distance between the file tip and merged point of joining two canals was defined as Lj. The roots were carefully sectioned at 1 mm from the apex by a slow-speed water-cooled diamond saw. All cross sections were examined under the microscope at x50 magnification and photographed to estimate the shape of the apical foramen. The longest and the shortest diameter of apical foramen was measured using ImageJ program (1.44p, National Institutes of Health). Correlation coefficient was calculated to identify the link between Lj and the apical foramen shape by Pearson's correlation. RESULTS: The average value of Lj was 3.74 mm. The average of proportion (P), estimated by dividing the longest diameter into the shortest diameter of the apical foramen, was 3.64. This study showed a significant negative correlation between P and Lj (p < 0.05). CONCLUSIONS: As Lj gets longer, the apical foramen becomes more ovally shaped. Likewise, as it gets shorter, the apical foramen becomes more flat shaped.

Antimicrobial Activity of Berberine against Oral Bacteria Related to Endodontic Infections

It has been established that berberine has strong antimicrobial effects. Little is known however regarding the antimicrobial activity of berberine against endodontic pathogenic bacteria or its cytotoxicity in human oral tissue cells. The antibacterial properties of berberine were tested against 5 strains of Enterococcus faecalis and type strains of Aggregatibacter actinomycetemcomitans, Prevotella nigrescens, Prevotella intermedia, and Tannerella forsythia, which are involved in endodontic infections. Antimicrobial activity was evaluated through minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) measurements. The viability of normal human gingival fibroblast (NHGF) cells after exposure to berberine was measured using a methyl thiazolyl tetrazolium (MTT) assay. The data showed that berberine has antimicrobial effects against A. actinomycetemcomitans with an MIC and MBC of 12.5 microg/ml and 25 microg/ml, respectively. In the cytotoxicity studies, cell viability was maintained at 66.1% following exposure to 31.3 microg/ml berberine. Overall, these findings suggest that berberine has antimicrobial activity against the tested bacteria. Nevertheless, lower concentrations in combination with other reagents will need to be tested before these in vitro results can be translated to clinical use.

An evaluation of the accuracy of Root ZX according to the conditions of major apical foramen

OBJECTIVES: The purpose of this study was to assess the accuracy of Root ZX (J. Morita Corp.) according to the location of major foramen and open apex. MATERIALS AND METHODS: 81 mandibular premolars with mature apices were selected. After access preparation, 27 teeth were instrumented to simulate open apices. 54 teeth were classified according to location of major foramen under surgical microscope (x16). The file was fixed at the location of apical constriction by Root ZX using glass ionomer cement. The apical 4 mm of the apex was exposed and photo was taken and the distance from file tip to the major foramen was measured by calibrating metal ruler on graph paper. The results were statistically analyzed using ANOVA and Scheffe test at p < 0.05 level. RESULTS: Mean distance from file tip to major foramen was 0.308 mm in Tip foramen group (I), 0.519 mm in Lateral foramen group (II) and 0.932 mm in open apex group (III). Root ZX located apical constriction accurately within +/- 0.5 mm in group I of 85.71%, in group II of 59.09%, and in group III of 33.33%. There was a statistically significant difference between group I and III (p < 0.05). CONCLUSION: Root ZX located apical constriction accurately regardless of location of major foramen. However, Root ZX couldn't find it in open apex. Clinicians have to use a combination of methods to determine an appropriate working length at open apex. It may be more successful than relying on just electronic apex locator.

An evaluation of canal curvature at the apical one third in type II mesial canals of mandibular molars

OBJECTIVES: The purpose of this study was to evaluate the buccolingual curvature at the apical one third in type II mesial canals of mandibular molars using the radius and angle of curvature. MATERIALS AND METHODS: Total 100 mandibular molars were selected. Following an endodontic access in the teeth, their distal roots were removed. #15 H- or K-files (Dentsply Maillefer) were inserted into the mesiobuccal and mesiolingual canals of the teeth. Radiographs of the teeth were taken for the proximal view. Among them, type II canals were selected and divided into two subgroups, IIa and IIb. In type IIa, two separate canals merged into one canal before reaching the apex and in type IIb, two separate canals merged into one canal within the apical foramen. The radius and angle of curvature of specimens were examined. RESULTS: In type II, mean radius of curvature in mesiolingual and mesiobuccal canals were 2.82 mm and 3.58 mm, respectively. The radius of the curvature of mesiolingual canals were significantly smaller than that of mesiobuccal canals in type II, and especially in type IIa. However, there were no statistically significant differences in radius of curvature between mesiobuccal and mesiolingual canals in type IIb and there were no significant differences in angle of curvature between type IIa and IIb. CONCLUSION: In this study, type II mesial canals of mandibular molars showed severe curvature in the proximal view. Especially, mesiolingual canals of type IIa had more abrupt curvature than mesiobuccal canals at the apical one third.

Detection of Prevotella intermedia and Prevotella nigrescens using Pn17 and Pn34 DNA Probes

The DNA probes Pn17 and Pn34 were evaluated for their ability to specifically detect clinical strains of P. intermedia and P. nigrescens from a Korean population by dot blot hybridization. These probes were sequenced by extension termination and their specificity was determined by Southern blot analysis. The results revealed that the Pn17 sequence (2,517 bp) partially encodes an RNA polymerase beta subunit (rpoB) and that Pn34 (1,918 bp) partially encodes both rpoB (1-169 nts) and the RNA polymerase beta subunit (rpoB'; 695-1918 nts). These probes hybridized with both HindIII- and PstI-digested genomic DNAs from the strains of P. intermedia and P. nigrescens used in this study. Interestingly, each of the hybrid bands generated from the HindIII-digested genomic DNAs of the two bacterial species could be used to distinguish between them via restriction fragment length polymorphism. These results thus indicate that Pn17 and Pn34 can simultaneously detect P. intermedia and P. nigrescens.

The Effect of canal obturation according to the depth of the System B Plugger tip in the Type IV canal / 대한치과보존학회지

The purpose of this study was to evaluate the effect of the apical sealing according to the depth of the System B Plugger tip when root canal was filled with gutta-percha and sealer by Continuous Wave of Condensation technique in the Type IV canal. 50 simulated resin blocks with J-shaped curvature canals were instrumented by ProTaper (Dentsply Maillefer, Ballagiues, Switzerland) Ni-Ti files using the crown-down technique. Type IV canals were made using a broken ProTaper F3 Ni-Ti file for making a ledge at 3mm short from the working length. And ProTaper F1 Ni-Ti file was used for perforating resin block. The prepared Type IV canals were randomly divided into three experimental groups of 15 each according to the depth of System B Plugger tip. All of experimental groups were obturated with Continuous Wave of Condensation technique. The length of gutta-percha and sealer in lingual of the Type IV canals was measured with a measuring digital calliper under magnifying glass (x 2.3). The results are as follows : 1. In control group, there was no gutta-percha and sealer in lingual canal. 2. 3 mm group showed relatively more gutta-percha than 5mm or 7 mm group (p<0.05). 3. 7 mm group did not showed gutta-percha and relatively more void were observed than 3mm or 5 mm group. (p<0.05) In conclusion, within the limits of the results of this experiment, the 3 mm depth of System B Plugger tip was acceptable for obturating the Type IV canal.

A comparison of master apical file size according to instrumentation in type II root canal / 대한치과보존학회지

Type II root canal was defined that two canals leave the chamber and merge to form a single canal at short of the apex. The aim of this study was to analyse the master apical file (MAF) size according to various instrumentation techniques in the type II root canal when each canal was enlarged to working length. Eighty mesial roots of molar with ISO #15 initial apical file (IAF) size in type II root canals were randomly divided into four experimental groups with 20 teeth each. According to enlarging instruments, four groups are: K-FLEXOFILE(R) (KF), engine-driven Ni-Ti PROTAPER(R) (PT), HERO Shaper(R) (HS), K3 (TM) (K3). All canals were enlarged to each working length with ISO #30 size: #30 in KF, F3 in PT, .04/30 in HS, and .06/30 in K3. The master apical file (MAF) size was confirmed by tactile sensation and universal testing machine (EZ test, Shimadzu Co., Kyoto, Japan). The mean MAF size was statistically compared using one-way ANOVA and Tukey HSD test at the 0.05 probability level. These results show that the MAF size was appeared one or two sizes larger than the final enlarging instrument when all canal in type II configuration were enlarged to each working length. Therefore, the clinician have to confirm the apical stop once more after instrumentation of type II root canal.

Detection of methicillin or vancomycin-resistant Staphylococcus aureus from dental hospital / 대한치과보존학회지

The purpose of this study was to obtain the basic information for the improvement of dental environment by investigating the presence of methicillin- or vancomycin-resistant Staphylococcus aureus (MRSA or VRSA) isolated from dental health care workers (DHCWs) and environment of the Chosun University Dental Hospital (CUDH) and a private dental clinic (control group). Staphylococcus aureus (S. aureus) was isolated from anterior nares of 42 DHCWs and 38 sites, unit chairs, x-ray devices, computers, etc., at 10 departments of the CUDH and 20 DHCWs and 11 sites at the private dental clinic. S. aureus was isolated on mannitol salt agar plate and confirmed by PCR with S. aureus species-specific primer. Antimicrobial susceptibility test of clinical isolates of S. aureus against several antibiotics including methicillin (oxacillin) was performed by investigating minimum inhibitory concentration (MIC) using broth microdilution assay. In addition, PCR was performed to detect the methicillin- or vancomycin-resistant gene. The data showed that one strain of S. aureus was isolated from DHCWs of the CUDH and three strains of S. aureus was isolated from 3 samples of the private dental clinic, respectively. All of the isolates from the CUDH and the private dental clinic had resistance to penicillin G, amoxicillin and vancomycin and susceptibility to oxacillin and ciprofloxacin. The S. aureus strains were already obtained the resistance to penicillin G and amoxicillin. These results suggest that two dental clinics were under relatively safe environment.

A study on the C-shaped root canal system of mandibular second molar / 대한치과보존학회지

C-shaped canals are known to present a complex canal anatomy with numerous fins connecting individual canals, thus requiring supplementary effort to accomplish a successful root canal treatment. This study examined the frequency of the C-shaped mandibular second molars and interrelation between the clinical records and radiographs to recognize them treated in the Department of Conservative Dentistry of the Chosun University Dental Hospital during a six-year period (1998 - 2004). This study reviewed the clinical records of 227 patients who underwent root canal treatment of the mandibular second molars. After opening the chamber, those cases with C-shaped orifices in the pulpal floor were selected, and the C-shaped root canal types were classified according to Melton's criteria. Three experienced dentists evaluated the radiographs of the C-shaped mandibular second molar on a viewer using a magnifying glass in order to determine if the root apex was fused or separated, the distal root canal was either centered or mesial shifted in the distal root, and if there was bilateral symmetry in a panorama. In conclusion, there is a high frequency of C-shaped mandibular second molars in Koreans. Simultaneous interpretation of the root shape and distal root canal using the preoperative, working length and post-treatment radiographs is important for diagnosing a C-shaped mandibular second molar.

Histological Study of Reparative Dentin Formation after Direct Pulp Capping and Pulpotomy using MTA / 대한해부학회지

The ultimate goal of a regenerative pulp treatment strategy is to reconstitute normal tissue continuum at the pulp-dentin border, regulating tissue-specific processes of reparative dentinogenesis. However, little is known about the molecular mechanism of reparative dentinogenesis. The purpose of this study was to investigate the pulpal response after direct pulp capping and pulpotomy with mineral trioxide aggregate (MTA) by histological and immunohistochemical studies. There was continuous reparative dentin bridge formation at 2 weeks after treatment with MTA in both the pulp capping and the pulpotomy groups. The cells in the pulp capping group showed typical odontoblast characteristics, while the cells of reparative dentin in pulpotomy group were round in shape, lost their polarity, organized as a sheet of cells, and trapped in osteodentin-like mineralized tissue. In pulp capping group, upper layer of the reparative dentin showed cell lacunae indicating osteoblastic characteristics, whereas lower layer of the reparative dentin contained predentin and dentinal tubule-like structures as normal dentin. However, there was osteodentin formation in pulpotomy group. DSP protein was expressed at 4 weeks in odontoblasts of pulp capping group, while BSP was expressed at 4 weeks after pulpotomy. These results suggest that two different types of reparative dentin formation, dentin-like and bone-like dentin, may depend on the type and extent of the injury and the effect of the associated defense reaction on the structural and functional integrity at the dentin-pulp border.

Coincidence between radiographs and clearing samples on the root canal systems of single rooted premolars / 대한치과보존학회지

The aim of this study was to compare the root canal systems of maxillary and mandibular premolars that had a single root using radiographs and clearing samples. 142 single rooted premolars were selected and mesio-distal and bucco-lingual views were radiographed using intra-oral dental standard films. Four equally trained examiners classify the root canal types from the developed radiographs. After opening the tooth for access, it was stored in 5% NaOCl to dissolve the pulp tissue. Indian ink was then injected into the pulp cavity to stain the pulp tissue. It was cleared in methyl salicylate after being decalcified with 5% nitric acid for 48 hours, and the root canal type was evaluated at a magnification of x 20 using a stereomicroscope. The results are as follows; There were statistically significant differences between the radiographs and clearing samples of the root canal types among examiners (p < 0.05). There might be differences in the root canal types among examiners when the same radiograph is used. Therefore, considering the difficulty in estimating the root canal types, clinicians need to be careful when interpreting radiographs before root canal therapy.

An accuracy of the several electronic apex locators on the mesial root canal of the mandibular molar / 대한치과보존학회지

The aim of this study was to compare the length between the mesio-buccal and mesio-lingual canal of the mandibular molars before and after early coronal flaring at the different measuring time using several electronic apex locators. Fifty mandibular molars with complete apical formation and patent foramens were selected. After establishing the initial working length of the buccal and lingual canal of the mesial root using a surgical microscope (Carl Zeiss Co. Germany) at 25X with #15 K-file tip just visible at the foramen, radiographs were taken for the working length. After measuring the length of mesio-buccal and mesio-lingual canal (control group), the electronic lengths were measured at different times using several electronic apex locators (experimental groups; I-Root ZX, II-Bingo, III-Propex, IV-Diagnostic). After early coronal flaring using the K3 file, the additional electronic lengths were measured using the same manner. The results were as follows: One canal has a correct working length for the mesial root of the mandibular molar, it can be used effectively for measuring the electronic working length of another canal when the files are superimposed or encountered at the apex. In addition, the accuracy of the electronic apex locators was increased as the measurement was accomplished after the early coronal flaring of the root canal and the measuring time was repeated.

Isolation and identification of bacteria from the root canal of the teeth diagnosed as the acute pulpitis and acute periapical abscess / 대한치과보존학회지

The aim of this study was to identify the bacteria isolated from acute endodontic lesions by cell culture and 16S rDNA sequencing. The necrotic pulpal tissue was collected from 17 infected root canals, which were diagnosed as being either an acute pulpitis or acute periapical abscess. Samples were collected aseptically from the infected pulpal tissue of the infected root canals using a barbed broach and a paper point. The cut barbed broaches and paper points were transferred to an eppendorf tube containing 500 ul of 1 X PBS. The sample solution was briefly mixed and plated onto a BHI-agar plate containing 5% sheep blood. The agar plates were incubated in a 37degrees C anaerobic chamber for 7 days. The bacteria growing on the agar plate were identified by 16S rRNA coding gene (rDNA) cloning and sequencing at the species level. Among the 71 colonies grown on the agar plates, 56 strains survived and were identified. In dental caries involving the root canals, Streptococcus spp. were mainly isolated. Actinomyces, Clostridia, Bacteroides and Fusobacteria were isolated in the periapical lesion without dental caries. Interestingly, two new Actinomyces spp. (ChDC B639 and ChDC B631) were isolated in this study. These results showed that there was diversity among the species in endodontic lesions. This suggests that an endodontic infection is a mixed infection with a polymicrobial etiology. These results may offer the bacterial strains for pathogenesis studies related to an endodontic infection.

A comparison of the length between mesio-buccal and mesio-lingual canals of the mandibular molar / 대한치과보존학회지

The aim of this study was to compare the initial apical file (IAF) length between the mesio-buccanl and mesio-lingual canals of the mandibular molar before and after early coronal flaring. Fifty mandibular molars with complete apical formation and patent foramens were selected. After establishing the initial working length of the buccal and lingual canal of the mesial root using the Root-ZX, radiographs were taken for the working length with a 0.5 mm short of #15 K-file tip just visible at the foramen under a surgical microscope (OPMI 1-FC, Carl Zeiss Co. Germany) at 25X. After early coronal flaring using the K3 file, additional radiographs were taken using the same procedure. The root canal morphology and the difference in working length between the buccal and lingual canals were evaluated. These results show that the difference in the length between the mesio-buccal and mesio-lingual canals of the mandibular molar was < or = 0.5 mm. If one canal has a correct working length for the mesial root of the mandibular molar, it can be used effectively for measuring the working length of another canal when the files are superimposed or loosening. In addition, the measured the working length after early coronal flaring is much more reasonable because the difference in the length between the mesio-buccal and mesio-lingual canals can be reduced.

Antibiotic susceptibility in mutans streptococci and Streptococcus anginosus isolated from dental plaque / 대한치과보존학회지

The aim of this study was to investigate the susceptibility of mutans streptococci (S. mutans and S. sobrinus) and Streptococcus anginosus, for seven antibiotics, penicillin G, amoxicillin, ciprofloxacin, cefuroxime, erythromycin, bacitracin, and vancomycin. The minimum inhibitory concentration (MIC) of seven antibiotics against 3 species (type strains) of mutans streptococci and S. anginosus, 10 strains (wild type) of S. mutans, 7 strains (wild type) of S. sobrinus, and 11 strains (wild type) of S. anginosus, were measured by broth dilution method. All of the type strains of mutans streptococci and S. anginosus had the same susceptibility for penicillin G, amoxicillin, cefuroxime and bacitracin. Type strain of S. anginosus was sensitive in ciprofloxacin, but those of mutans streptococci were not. All of the clinical isolates of mutans streptococci and S. anginosus had the same susceptibility for the seven antibiotics. Our data reveal that mutans streptococci and S. anginosus have similar antibiotic-resistant character. In addition, these results may offer the basic data to verify the antibiotic-resistant mechanism of mutans streptococci and S. anginosus.

The effect of gutta-percha removal using nickel-titanium rotary instruments / 대한치과보존학회지

The purpose of this study was to quantify the amount of remaining gutta-percha/sealer on the walls of root canals when three types of nickel-titanium rotary instruments(Profile, ProTaper and K3) and a hand instrument(Hedstrom file) used to remove these materials. The results of this study were as follows: 1. In the total time for gutta-percha removal, Profile group was the fastest and followed by K3, Protaper, Hedstrom file group. 2. In case of the evaluation of the volume of remained gutta-percha from radiograph, K3 group got the highest score and followed by Protaper, Hedstrom file, Profile group in the apical 1/3. 3. In case of the evaluation of the volume of gutta-percha remained from stereomicroscope, K3 group got the highest score and followed by Protaper, Hedstrom file, Profile group in the apical 1/3. These results showed that instrumentation using nickel-titanium rotary instrument groups was faster than that using hand instrument group. The effect of gutta-percha removal using Profile group was better than that using Protaper and K3 group in the nickel-titanium rotary instrument groups.

The effect of early coronal flaring about apical extrusion of debris / 대한치과보존학회지

The purpose of this study was to investigate the quantity of debris which was extruded apically after canal instrumentation using different types of enlarging instrument in endodontic resin models. Five groups of 9 endodontic resin models were instrumented using each different technique : hand instrumentation without early coronal flaring, hand instrumentation after early coronal flaring, and three nickel-titanium engine-driven instrumentations (Hero 642, Protaper, K3). Debris extruded from apical foramen during instrumentation was collected on preweighed CBC bottle, desiccated and weighted using electronic balance. The results were analyzed using Kruskal-wallis test and Mann-Whitney U rank sum test at a significance level of 0.05. The results were as follows: 1. All of instrumentation techniques produced apically extruded debris. 2. Group without early coronal flaring extruded significant more debris than groups with early coronal flaring. 3. There was no significant difference among early coronal flaring groups. The early coronal flaring is very important to reduce the amount of debris extruded apically.