Evaluation of marginal leakage of bulk fill flowable composite resin filling with different curing time using micro-computed tomography technology

PURPOSE: To evaluate marginal leakage of bulk fill flowable composite resin filling with different curing time by using microcomputed tomography technology. MATERIALS AND METHODS: 30 previously extracted human molars were randomly divided into 6 groups based upon restorative system and different curing time. Class II cavities (vertical slot cavities) were prepared. An individual metallic matrix was used to build up the proximal wall. The SonicFill or SureFil SDR flow was inserted into the preparation by using 1 bulk increment, followed by light polymerization for different curing times. The different exposure times were 20, 40, and 60 seconds. All specimens were submitted to 5,000 thermal cycles for artificial aging. Micro-CT scanning was performed by using SkyScan 1272. One evaluator assessed microleakage of silver nitrated solution at the resin-dentin interface. The 3D image of each leakage around the restoration was reconstructed with CT-Analyser V.1.14.4. The leakage was analyzed with the Mann-Whitney test. RESULTS: Significant differences were observed between the light curing times, but no significant differences were found between the bulk fill composite resins. Increasing in the photoactivation time resulted in greater microleakage in all the experimental groups. Those subjected to 60 seconds of light curing showed higher microleakage means than those exposed for 20 seconds and 40 seconds. CONCLUSION: Increasing the photoactivation time is factor that may increase marginal microlekage of the bulk fill composite resins. Further, micro-CT can nondestructively detect leakage around the resin composite restoration in three dimensions.

Esthetic enhancement of a traumatized anterior tooth with a combination of forced eruption and tooth alignment: a case report

Exposing sound structure of a subgingivally fractured tooth using orthodontic extrusion is considered to be a conservative way to re-establish biologic width without sacrificing esthetics or jeopardizing periodontal support of neighboring teeth. When a misaligned tooth is traumatically involved, a more comprehensive approach combining tooth extrusion and re-alignment may be necessary for a successful restorative outcome. This case report describes a successful esthetic management of a patient with complicated crown-root fracture on the maxillary right central incisor and pre-existing malocclusion in the maxillary anterior region. Forced eruption along with re-alignment of teeth by orthodontic movement seems to allow re-positioning of the fracture line to a favorable position and correction of crowding, providing a better esthetic result.

Proximity of the mandibular molar root apex from the buccal bone surface: a cone-beam computed tomographic study

OBJECTIVES: The purpose of this study was to evaluate the proximity of the mandibular molar apex to the buccal bone surface in order to provide anatomic information for apical surgery. MATERIALS AND METHODS: Cone-beam computed tomography (CBCT) images of 127 mandibular first molars and 153 mandibular second molars were analyzed from 160 patients' records. The distance was measured from the buccal bone surface to the root apex and the apical 3.0 mm on the cross-sectional view of CBCT. RESULTS: The second molar apex and apical 3 mm were located significantly deeper relative to the buccal bone surface compared with the first molar (p < 0.01). For the mandibular second molars, the distance from the buccal bone surface to the root apex was significantly shorter in patients over 70 years of age (p < 0.05). Furthermore, this distance was significantly shorter when the first molar was missing compared to nonmissing cases (p < 0.05). For the mandibular first molars, the distance to the distal root apex of one distal-rooted tooth was significantly greater than the distance to the disto-buccal root apex (p < 0.01). In mandibular second molar, the distance to the apex of C-shaped roots was significantly greater than the distance to the mesial root apex of non-C-shaped roots (p < 0.01). CONCLUSIONS: For apical surgery in mandibular molars, the distance from the buccal bone surface to the apex and apical 3 mm is significantly affected by the location, patient age, an adjacent missing anterior tooth, and root configuration.

Endodontic treatment of maxillary lateral incisors with anatomical variations

Maxillary lateral incisors usually exhibit a single root with a single canal. However, maxillary lateral incisor teeth with unusual morphology of root canal system are frequently reported. These cases of variable root canal anatomy can be treated well by nonsurgical endodontic methods. A detailed description of root canal morphology is fundamental for successful endodontic treatment. Treatment using an operating microscope, radiographs from different angles, and cone-beam computerized tomography (CBCT) can produce more predictable endodontic outcomes.

Relationship of tooth mortality and implant treatment in Type 2 diabetes mellitus patients in Korean adults

PURPOSE: The purpose of this study was to to analyze the effect of Type 2 diabetes on tooth mortality, implant treatment and prosthetic status. MATERIALS AND METHODS: 275 Type 2 diabetics and 300 non-diabetics, aged 40-80 years were selected for analysis. The assessment of number of teeth, missing teeth, fixed prostheses (bridge pontics), implants using panoramic radiographs and dental records were carried out. RESULTS: Diabetes mellitus (DM) patients had a higher number of missing teeth (P<.05) and placed implants (P=.074), age (P<.05), male gender percentage (P=.042), smoker percentage (P<.05) than non-DM patients. In univariate analysis, the patients in older group showed significantly higher number of tooth loss rate at the first dental examination than the patients in younger group. Tooth loss rate of smokers did not show higher value than that of non-smokers. When multiple variables including DM, age, smoking, gender were considered together, diabetics and older group patients showed significantly higher tooth loss rate at the first dental examination than non-diabetics and younger group patients, respectively. Smokers and male group did not show a significant difference than non-smokers and female group, respectively. CONCLUSION: Tooth mortality and implant treatment rate were significantly higher in the DM group as indicated by univariate and multivariate logistic regression analysis. Old age groups showed significantly higher odds ratios and tooth loss rate. As diabetics showed the higher tooth loss rate than non-diabetics, diabetics also had more implant restorations than non-diabetics.

Prepare the pre-heated composite resin

No abstract available.

Mercury exposure from dental amalgam: a 6 month follow-up / 대한구강보건학회지

OBJECTIVES: Dental amalgam is a widely used filling material for oral cavity. The released mercury vapor from amalgam could have systemic adverse effects potentially. The purpose of this study is to evaluate the relationship between dental amalgam and urinary mercury levels in children during a 6-month timespan. METHODS: A total of 525 elementary school children participated in this study. Oral examination was carried out from one dentist. Urine samples collected at baseline and at 6 month were analyzed for mercury and creatinine excretion. Additionally, general characteristics of subjects were surveyed by a questionnaire. The statistical analysis was performed using the SPSS 18.0. RESULTS: Greater amalgam surfaces were associated to higher urinary mercury levels; this tendency was similar at the 6-month observation after the correct baseline data. In the multivariable model, urinary mercury excretion was only associated with amalgam surfaces positively. CONCLUSIONS: Even a small amount of mercury uptake from dental amalgam has been associated to increase the mercury concentration of urine.

Diastema closure using direct bonding restorations combined with orthodontic treatment: a case report

Closure of interdental spaces using proximal build-ups with resin composite is considered to be practical and conservative. However, a comprehensive approach combining two or more treatment modalities may be needed to improve esthetics. This case report describes the management of a patient with multiple diastemas, a peg-shaped lateral incisor and midline deviation in the maxillary anterior area. Direct resin bonding along with orthodontic movement of teeth allows space closure and midline correction, consequently, creating a better esthetic result.

Diagnostic challenges of nonodontogenic toothache

The objective of this article was to present two nonodontogenic conditions that may mimic odontogenic toothache: trigeminal neuralgia and burning mouth syndrome. Two cases are presented in which one is related to the upper left second premolar and the other is related to the upper left first molar. Both showed pain when chewing. These two cases highlight the complexities involved in diagnosing nonodontogenic toothache. This article demonstrates the importance of having a thorough knowledge of both odontogenic and nonodontogenic toothache, as well as the need for careful evaluation of the nature of the pain and history, clinical and radiographic examinations.

Comparison of screw-in effect for several nickel-titanium rotary instruments in simulated resin root canal / 대한치과보존학회지

Screw-in effect is one of the unintended phenomena that occurs during the root canal preparation with nickel-titanium rotary files. The aim of this study was to compare the screw-in effect among various nickel-titanium rotary file systems. Six different nickel-titanium rotary instruments (ISO 20/.06 taper) were used: K3(TM) (SybronEndo, Glendora, CA, USA), Mtwo (VDW GmbH, Munchen, Germany), NRT with safe-tip and with active tip (Mani Inc., Shioya-gun, Japan), ProFile(R) (Dentsply-Maillefer, Ballaigues, Switzerland) and ProTaper(R) (Dentsply-Maillefer, Ballaigues, Switzerland). For ProTaper(R), S2 was selected because it has size 20. Root canal instrumentations were done in sixty simulated single-curved resin root canals with a rotational speed of 300 rpm and single pecking motion. A special device was designed to measure the force of screw-in effect. A dynamometer of the device recorded the screw-in force during simulated canal preparation and the recorded data was stored in a computer with designed software (LCV-USE-VS, Lorenz Messtechnik GmbH, Alfdorf, Germany). The data were subjected to one-way ANOVA and Tukey's multiple range test for post-hoc test. P value of less than 0.05 was regarded significant. ProTaper(R) produced significantly more screw-in effects than any other instruments in the study (p 0.05), and between NRT with active tip and NRT with safe one neither (p > 0.05). From the result of the present study, it was concluded, therefore, that there seems significant differences of screw-in effect among the tested nickel-titanium rotary instruments. The radial lands and rake angle of nickel-titanium rotary instrument might be the cause of the difference.

Effect of pre-heating on some physical properties of composite resin / 대한치과보존학회지

The purpose of this study was to evaluate the effect of pre-heating on some physical properties of composite resin. Eighty extracted, noncarious human molars were used in the present study. Four different temperatures of composite resin were used: 4degrees C, 17degrees C, 48degrees C, and 56degrees C. The 4degrees C and 17degrees C values represented the refrigerator storage temperature and room temperature respectively. For 48degrees C and 56degrees C, composite resin was heated to the temperatures. As physical properties of composite resin, shear bond strength, microhardness, and degree of conversion were measured. The data for each group were subjected to one-way ANOVAs followed by the Tukey's HSD test at 95% confidence level. Both in enamel and dentin, among composite resin of 4degrees C, 17degrees C, 48degrees C, and 56degrees C, the pre-heated composite resin up to 56degrees C revealed the highest shear bond strength, and pre-heated composite resin to the higher temperature revealed higher shear bond strength. Microhardness value was also higher with composite resin of higher temperature. Degree of conversion was also higher with composite resin of the higher temperature. In this study, it seems that pre-heating composite resin up to the higher temperature may show higher shear bond strength, higher microhardness value, and higher degree of conversion. Therefore, when using composite resin in the clinic, preheating the composite resin could be recommended to have enhanced physical properties of it.

Long Term Clinical and Radiographical Evaluation of Tunneled Molars / 대한치주과학회지

PURPOSE: Tunneling is a periodontal surgical procedure that creates access for patient cleansing and maintenance within the furcal area of a molar tooth with severe furcation involvement. Up to date, there are few studies about a long term clinical and radiographic stability of tunneling. The purpose of this retrospective study is to evaluate the long term prognosis after tunnel preparation of molars with through and through furcation. MATERIAL AND METHODS: 25 teeth of 23 patients aged 36 to 70 (mean age 51.7) were treated surgically with tunnel preparation. These cases were followed for 2 to 13 years (mean 6.5years) after surgery. Patients were recalled for an evaluation which was based on a questionnaire, a clinical examination, and radiographic analysis. Clinical assessment included plaque index, caries registration, probing pocket depth, bleeding on probing, tooth mobility. Baseline and over 2-year follow-up radiographs were collected and evaluated for this study. RESULT: 3 teeth(12%) had been extracted and 1 tooth(4%) hemisected. Root caries was detected in 3 teeth(12%). Thus 72% of the teeth were still caries free and in function. Clinical parameters including PI, PD, BOP, mobility showed somewhat favourable results. Radiographic furcal bone loss showed no statistically significant difference compared to interproximal crestal bone loss (3.59+/-1.69% vs 3.42+/-2.95%) when root length was used as reference. There was no correlation between root trunk length and furcal bone loss. CONCLUSION: Over 2 years after tunneling procedure, teeth showed a clinically and radiographically stable condition, despite of slight root caries and alveolar bone loss within clinically acceptable range. The tunnel procedure may be considered as a viable periodontal treatment option for molar teeth with severe furcation involvement in individuals following a regular maintenance program.

Localization Patterns of Cytokeratin 1, 14 and PAX 9 in Mouse Embryonic Tongue Development / 체질인류학회지

Epithelial differentiation and morphogenesis in skin and oral mucosa were elucidated using various experimental tools. However, tongue epithelial differentiation has not been examined properly yet. In this study, we identified the relationship between morphological changes and localizations of differentiation markers, such as cytokeratins and PAX 9 in mice embryonic tongue development. Protective barrier formation and localization pattern of cytokeratins in tongue epithelium were examined with toluidine blue staining and immunohistochemistry respectively. Localization patterns of PAX 9 and Cytokeratin 14 were coincided during tongue epithelium development. In addition, compared with Ki67 localizations, marker for cell proliferation, localization patterns of PAX 9 and Cytokeratin 14 would suggest that these factors would involve in tongue barrier formation through cell proliferation. Based on these results, tongue epithelial differentiation would begin at E14 with the specific localizations of PAX 9 and Cytokeratin 14 prior to protective barrier formation then Cytokeratin 1, keratinization marker, would involve in protective barrier and filiform papillae formations.

Polymerization of dual cured composites by different thickness / 대한치과보존학회지

The purpose of this study was to evaluate the effect of thickness, filling methods and curing methods on the polymerization of dual cured core materials by means of microhardness test. Two dual cured core materials, MultiCore Flow (Ivoclar Vivadent AG, Schaan, Liechtenstein) and Bis-Core (Bisco Inc., Schaumburg, IL, USA) were used in this study. 2 mm (bulky filled), 4 mm (bulky filled), 6 mm (bulky and incrementally filled) and 8 mm (bulky and incrementally filled)-thickness specimens were prepared with light cure or self cure mode. After storage at 37degrees C for 24 hours, the Knoop hardness values (KHN) of top and bottom surfaces were measured and the microhardness ratio of top and bottom surfaces was calculated. The data were analyzed using one-way ANOVA and Scheffe multiple comparison test, with alpha = 0.05. The effect of thickness on the polymerization of dual cured composites showed material specific results. In 2, 4 and 6 mm groups, the KHN of two materials were not affected by thickness. However, in 8 mm group of MultiCore Flow, the KHN of the bottom surface was lower than those of other groups (p < 0.05). The effect of filling methods on the polymerization of dual cured composites was different by their thickness or materials. In 6 mm thickness, there was no significant difference between bulk and incremental filling groups. In 8 mm thickness, Bis-Core showed no significant difference between groups. However, in MultiCore Flow, the microhardness ratio of bulk filling group was lower than that of incremental filling group (p < 0.05). The effect of curing methods on the polymerization of dual cured composites showed material specific results. In Bis-Core, the KHN of dual cured group were higher than those of self cured group at both surfaces (p < 0.05). However, in MultiCore Flow, the results were not similar at both surfaces. At the top surface, dual cured group showed higher KHN than that of self cured group (p < 0.05). However, in the bottom surface, dual cured group showed lower value than that of self cured group (p < 0.05).

Change of working length in curved canals by various instrumentation techniques / 대한치과보존학회지

To evaluate the change of working length with various instrumentation techniques in curved canals, working length and canal curvature were determined before and after canal instrumentation in buccal or mesial canals of extracted human molars. Stainless steel K-files (MANI(R), Matsutani Seisakusho Co. Takanezawa, Japan), nickel-titanium K-files (Naviflex NT(TM), Brassler, Savannah, USA), ProFile(R), and ProTaper(TM) (Dentsply-Maillefer, Ballaigues, Switzerland) were used to prepare the canals with crown-down technique. In two hand instrumentation groups, coronal flaring was made with Gates Glidden burs. Apical canals were instrumented until apical diameter had attained a size of 30. Positional relation between the tooth apex and the #10 K-file tip was examined by using AutoCAD 2000 (Autodesk Corp., San Rafael. CA, USA) under a stereomicroscope before and after coronal flaring, and after apical instrumentation. Degree of canal curvature was also measured with Schneider's method in radiographs. Data of working length and canal curvature changes were statistically analyzed with one-way ANOVA and Tukey's studentized range test. Working length and canal curvature were decreased significantly in each step in all instrumentation groups. Coronal flaring using Gates Glidden burs in hand instrument groups and whole canal instrumentation using stainless steel hand K-files caused significantly more working length change than in ProFile instrumentation group (p < 0.05). The result of this study demonstrates that all of the above kinds of instrumentation in curved canals cause reduction of working length and canal curvature at each instrumentation steps, and hand instrumentation causes more working length change than ProFile.

The Ultrastructure of TRPV1-positive Nerve Terminals in the Human Tooth Pulp / 대한해부학회지

The vanilloid receptor TRPV1 has been suggested to play an important role in thermal nociception and inflammatory hyperalgesia. In our previous study, we examined the expression of TRPV1 and colocalization of TRPV1 with substance P (SP) and calcitonin gene related peptide (CGRP) through fluorescence immunocytochemistry. Here, we investigated ultrastructural characteristics of TRPV1 immunoreactive fibers in the human tooth pulp through preembedding immunocytochemistry. TRPV1 immunoreactivity was present in the unmyelinated nerve fibers in the tooth pulp. There were two types of TRPV1 IR nerve fibers identified in the human tooth pulp: one containing clear round vesicles and many dense-cored vesicles, the other containing clear round vesicles and few dense-cored vesicles. TRPV1 immunoreactive fibers were constant in diameter without swellings along the length. Boutons en passant and boutons terminaux usually observed in the CNS were not observed in the TRPV1 immunoreactive fibers. Many vesicles were accumulated in the TRPV1 immunoreactive fibers, however synaptic structure was not found. It is known that dense-cored vesicles contain neuropeptides such as SP and CGRP and clear round vesicles contain neurotransmitter such as glutamate. Taken together, our results suggest that TRPV1 immunoreactive fibers showing distinct ultrastructructural features may be involved in inflammatory hyperalgesia and thermal nociception in the tooth pulp.

Effect of vital tooth bleaching agent on dentin bonding / 대한치과보존학회지

To evaluate the effect of vital tooth bleaching agent and alcohol pretreatment on dentin bonding, flat dentin windows were produced on the buccal side of the crowns of fifty-five extracted, human premolars. A bleaching gel, Opalescence(R) with 10% of carbamide peroxide (Ultradent Product, USA) was daily applied on the teeth of three experimental groups for six hours for 10 consecutive days, while teeth of a control group were not bleached. After 6 hours of bleaching gel application, the specimens were washed and stored in saline until the next day application. After application of One-step(R) dentin bonding agent (Bisco, USA), Z-250(R) resin (3M-ESPE, USA) was bonded to dentin with a mount jig. Shear bond strength was measured with an Instron machine (Type 4202, Instron Corp., USA) after 24 hours. The results were analyzed using one-way ANOVA and Duncan's multiple range test at p 0.05) and between delayed bonding group and un-bleached control group (p > 0.05). In the condition of the present study, it seems that alcohol pretreatment after bleaching procedure can reduce the adverse effect of vital bleaching agent on dentin bonding.

The influence of AH-26 and zinc oxide-eugenol root canal sealer on the shear bond strength of composite resin to dentin / 대한치과보존학회지

The purpose of this study was to evaluate the influence of the AH-26 root canal sealer on the shear bond strength of composite resin to dentin. One hundred and forty four (144) extracted, sound human molars were used. After embedding in a cylindrical mold, the occlusal part of the anatomical crown was cut away and trimmed in order to create a flat dentin surface. The teeth were randomly divided into three groups; the AH-26 sealer was applied to the AH-26 group, and zinc-oxide eugenol (ZOE) paste was applied to the ZOE group. The dentin surface of the control group did not receive any sealer. A mount jig was placed against the surface of the teeth and the One-step dentin bonding agent was applied after acid etching. Charisma composite resin was packed into the mold and light cured. After polymerization, the alignment tube and mold were removed and the specimens were placed in distilled water at 37degrees C for twenty four hours. The shear bond strength was measured by an Instron testing machine. The data for each group were subjected to one-way ANOVA and Tukey's studentized rank test so as to make comparisons between the groups. The AH-26 group and the control group showed significantly higher shear bond strength than the ZOE group (p 0.05). Under the conditions of this study, the AH-26 root canal sealer did not seem to affect the shear bond strength of the composite resin to dentin while the ZOE sealer did. Therefore, there may be no decrease in bond strength when the composite resin core is built up immediately after a canal filling with AH-26 as a root canal sealer.

Influence of additional etching on shear bond strength of self-etching adhesive system to enamel / 대한치과보존학회지

Recently, self-etching adhesive system has been introduced to simplify the clinical bonding procedures. It is less acidic compared to the phosphoric acid, thus there is doubt whether this system has enough bond strength to enamel. The purpose of this study was to investigate the influence of additional etching on the adhesion of resin composite to enamel. Ninety extracted bovine permanent anterior teeth were used. The labial surfaces of the crown were ground with 600-grit abrasive paper under wet condition. The teeth were randomly divided into six groups of 15 teeth each. Clearfil SE Bond(R), Adper(TM) Prompt L-Pop and Tyrian SPE(TM) were used as self-etching primers. Each self-etching primers were applied in both enamel specimens with and without additional etching. For additional etching groups, enamel surface was pretreated with 32% phosphoric acid (UNI-ETCH, Bisco, Inc., Schaumburg, IL, USA). Hybrid resin composite Clearfil AP-X, (Kuraray Co., Ltd., Osaka, Japan) was packed into the mold and light-cured for 40 seconds. Twenty-four hours after storage, the specimens were tested in shear bond strength. The data for each group were subjected to independent t - test at p 0.01). In conclusion, self-etching adhesive system with weak acid seems to have higher bond strength to enamel with additional etching, while self-etching adhesive system with strong acid seems not.

Regulation of pulpal microcirculation by calcitonin gene-related peptide / 대한치과보존학회지

The purpose of this study was to investigate the function of calcitonin gene-related peptide (CGRP) in regulatory mechanism of pulpal microcirculation with the aim of elucidating neurogenic inflammation. Experiments were performed on twelve cats under general anesthesia. CGRP was administered through the femoral vein to see the systemic influence and through the external carotid artery to see the local effect. Sympathetic nerve to the dental pulp was stimulated electrically and pulpal blood flow (PBF) was measured with a laser Doppler flowmeter on the canine teeth to the drug administration. The paired variables of control and experimental data were compared by paired t-test and differences with p < 0.05 were considered statistically significant. Systemic administration of CGRP (0.3 microg/kg) exerted decreases in systemic blood pressure and caused changes in PBF with an initial increase followed by decrease and a more marked second increase and decrease. Close intra-arterial (i.a.) injection of CGRP (0.03 microg/kg) resulted in slight PBF increase. The effect of CGRP resulted in no significant increase in PBF in the presence of CGRP8-37. The electrical stimulation of the sympathetic nerve alone resulted in PBF decreases. The i.a. administration of CGRP following the electrical stimulation of the sympathetic nerve compensated the decreased PBF. Therefore, CGRP effectively blocked the sympathetic nerve stimulation-induced PBF decrease. Results of the present study have provided evidences that even though the local vasodilatory function of CGRP are weak, CGRP is effectively involved in blocking the vasoconstriction caused by sympathetic nerve stimulation in the feline dental pulp.