Investigating the mutagenic effects of three commonly used pulpotomy agents using the ames test.

PURPOSE: The mutagenic potency of materials used in dentistry is of great concern. The Ames test is a bacterial reverse mutation assay, which is used to determine the mutagenicity potential of chemicals. In this study, the Ames test was used to compare mutagenic effects of three pulpotomy agents, namely, CEM cement, formocresol and ferric sulfate. METHODS: TA100 strain of Salmonella typhimurium was used to evaluate mutagenicity of different concentrations of pulpotomy materials in the presence and absence of enzymatic system found in rat liver S9 fraction. Negative controls were 1% dimethyl sulfoxide and water. The positive controls were sodium azide and 2-aminoanthracene. The number of colonies per plate was counted. The material was regarded mutagenic if the number of histidine revertant colonies was twice or more than the spontaneous revertant colonies (Ames mutagenicity ratio). RESULTS: Ferric sulfate was found mutagenic in the concentrations prepared by addition of 50 µL of its 1 in 100 and 1 in 1000 times diluted solutions to the culture medium in the absence of S9 fraction (Ames test ratios of 2.8 and 2.2, respectively). Formocresol showed strong toxicity toward TA100 strain of S. typhimurium up to the concentration as low achieved using 1000 times diluted solution of the original preparation, particularly in the presence of S9 fraction. Ames assay failed to detect significant reverse mutations in all the concentrations of CEM cement. CONCLUSION: In contrast to formocresol and ferric sulfate, CEM cement is a less toxic and non-mutagenic agent.

Effect of Mineral Trioxide Aggregate, Calcium-Enriched Mixture Cement and Mineral Trioxide Aggregate with Disodium Hydrogen Phosphate on BMP-2 Production.

INTRODUCTION: One of the hypotheses regarding the calcification induction by mineral trioxide aggregate (MTA) is the involvement of transforming growth factor-Beta (TGF-ß) super family. Calcium-enriched mixture (CEM) cement is one of the endodontic biomaterials with clinical applications similar to MTA. The aim of the present in vitro study was to compare the induction of bone morphogenic protein-2 (BMP-2) by a combination of disodium hydrogen phosphate (DSHP) and tooth colored ProRoot MTA (WMTA), to that of CEM cement and WMTA. METHODS AND MATERIALS: Human gingival fibroblasts (HGFs) were obtained from the attached gingiva of human premolars. HGFs were cultured in Dulbecco's Modified Eagle's medium, supplemented with 10% fetal calf serum, penicillin, and streptomycin. Cells in groups 1, 2 and 3 were exposed to WMTA, CEM and WMTA+DSHP discs, respectively. The fourth group served as the control. After 72 h of exposure, HGF viability was determined by Mosmann's tetrazolium toxicity (MTT) assay. BMP-2 levels in cell-free culture media were determined by enzyme-linked immunosorbent assay (ELISA). Statistical analysis was performed using the one-way ANOVA, followed by the post hoc Games-Howell test for BMP-2 and post hoc Tukey's test for the results of MTT assay. RESULTS: Cellular viability was significantly higher in group 3 compared to the other groups (P<0.05); however, CEM and WMTA did not exhibit significant differences (P=0.08). The control group exhibited significantly higher cellular viability in comparison to the other groups of the study (P<0.05). The highest and lowest protein production rates were observed in the WMTA (3167±274.46 pg/mL) and WMTA+DSHP (1796±839.49 pg/mL) groups, respectively. There were no significant differences between the control, WMTA and CEM groups (P>0.05). CONCLUSION: WMTA and CEM did not exhibit any significant differences in terms of inducing BMP-2 production; however, incorporation of DSHP into WMTA resulted in a decrease in the induction of this protein.

Effect of premedication with ibuprofen and dexamethasone on success rate of inferior alveolar nerve block for teeth with asymptomatic irreversible pulpitis: a randomized clinical trial.

INTRODUCTION: The aim of this study was to compare 2 kinds of anti-inflammatory medicines (ie, dexamethasone and ibuprofen) with a placebo according to their effects on the success rates of an inferior alveolar nerve block (IANB) for the endodontic treatment of mandibular molars with irreversible pulpitis. METHODS: A total of 165 patients were divided into 3 groups of 55 patients each and were given a capsule of the same color and size (ie, a placebo of lactose powder, 400 mg ibuprofen, or 0.5 mg dexamethasone). One hour after the oral administration of the capsules, all the patients received a standard IANB. In patients with a successful IANB, the teeth were examined with a cold pulp test. Patients were asked to assess their pain using the visual analog scale. Then, endodontic access cavity preparation was initiated. In case of pain during the treatment, the patients were asked to rate the pain on the visual analog scale. Success was defined as no or mild pain during treatment. The chi-square test and analysis of variance were used to compare qualitative and quantitative data among the groups. RESULTS: No significant differences were found regarding the sex of the patients in the 3 groups (P > .05). The dexamethasone group showed significantly higher success rates compared with the placebo group (P = .001). There were no significant differences between the ibuprofen and placebo groups (P = .055) or the dexamethasone and ibuprofen groups (P = .34). CONCLUSIONS: Premedication with dexamethasone increased the success rate of an IANB in mandibular molars with asymptomatic irreversible pulpitis.

Dental and oral diseases in Medieval Persia, lessons from Hedayat Akhawayni.

Persian physicians had a great role in assimilation and expansion of medical sciences during the medieval period and Islamic golden age. In fact the dominant medical figures of that period were of Persian origin such as Avicenna and Razes, but their works have been written in Arabic that was the lingua franca of the period. Undoubtedly the most substantial medical book of that period that has been written in Persian belongs to Abubakr Rabi ibn Ahmad al-Akhawayni al-Bokhari and his book, Hidayat al-Mutallimin fi-al-Tibb (Learner's Guide to Medicine).There are two chapters related to oral and dental diseases in the Hidayat, a chapter on dental pain and a chapter on bouccal pain. Akhawayni's views on dental diseases and treatments are mainly based on anatomical principles and less influenced by humeral theory and no mention about the charms, magic and amulets. False idea of dental worm cannot be seen among his writings. Cutting of the dental nerve for relieving the pain, using the anesthetizing fume, using the natural antiseptic and keeping the tooth extraction as the last recourse deserves high praise.

Microleakage comparison of four dental materials as intra-orifice barriers in endodontically treated teeth.

INTRODUCTION: The aim of this in vitro study was to compare polymicrobial microleakage of calcium enriched mixture (CEM) cement, mineral trioxide aggregate (MTA), amalgam, and composite resin as intra-orifice sealing materials. MATERIALS AND METHODS: Seventy single-rooted mandibular premolars were instrumented and obturated by cold lateral compaction technique. The teeth were randomly divided into four experimental groups according to used material: CEM, MTA, amalgam and composite resin (n=15) and two control groups (n=5). In experimental groups, 2 mm of coronal gutta-percha was removed and replaced with the study material. All the teeth were mounted in a two-chamber apparatus and the coronal portion was exposed to human saliva. The day the turbidity occurred was recorded for each sample. Data were analyzed using one-way ANOVA. RESULTS: The negative control group showed no leakage while the average microleakage time in the positive control group was 3.5 days. The average bacterial leakage times for amalgam, composite resin, MTA, and CEM groups were 27.42±3.6, 29.35±3.15, 52.57±2.87, and 50.42±2.73 days, respectively. There was no significant difference between CEM and MTA groups (P=0.27) and also between amalgam and composite resin groups (P=0.36). However, in term of average leakage time, MTA and CEM groups exhibited significant differences with amalgam and composite resin groups (P<0.001). CONCLUSION: According to the results of the present in vitro study, in terms of coronal sealing in endodontically treated teeth, CEM and MTA are more effective than amalgam and composite resin.

Bactericidal effects of Nd:YAG laser irradiation and sodium hypochlorite solution on Enterococcus faecalis biofilm.

OBJECTIVE: The aim of this study was to evaluate the bactericidal effects of Nd:YAG laser on biofilm of Enterococcus faecalis. BACKGROUND DATA: It is difficult to eliminate bacterial biofilms with routine endodontic preparation techniques. It might be possible to eliminate biofilms remaining in the root canals of teeth with lasers. MATERIALS AND METHODS: The root canals of 60 extracted teeth were prepared and E. faecalis biofilms were formed within the root canals. Then the teeth were randomly divided into four groups of 15. Group 1 samples did not undergo any interventions, to serve as controls. Group 2 samples underwent a 3-W laser beam for 10 sec. The root canals in group 3 were irrigated with 1% sodium hypochlorite for 15 min and then irradiated with a 3-W laser beam for 10 sec. The root canals in group 4 were irrigated with 1% sodium hypochlorite for 15 min. Dentin chips were collected from the root canal walls and weighed. Then the chips were used to prepare a suspension. The classic colony-forming unit (CFU) counting technique was used to determine remaining bacterial counts. RESULTS: The bacterial counts in groups 2 and 4 had decreased to 54% and 2.39% of the control group, respectively. In group 3 no bacterial growth was observed. There were no significant differences between groups 1 and 2 (p>0.05). CONCLUSIONS: Based on the results of the present study, the effect of Nd:YAG laser beam on E. faecalis biofilm is less than that of sodium hypochlorite solution. A combination of laser and sodium hypochlorite results in complete elimination of E. faecalis biofilm.

Effects of various mixing techniques on push-out bond strengths of white mineral trioxide aggregate.

INTRODUCTION: The aim of this study was to evaluate the effect of 3 different mixing methods on push-out bond strength of white tooth-colored mineral trioxide aggregate (MTA). METHODS: Sixty 2-mm-thick root sections were prepared from 60 single-rooted human teeth and filled with MTA. The samples were randomly divided into 3 groups (n = 20) of MTA mixed by ultrasonic, trituration, or conventional methods and then allowed to set for 72 hours in a synthetic tissue fluid environment. Push-out bond strength values of the specimens were measured by a universal testing machine and examined under a stereomicroscope at × 4 to determine the nature of the bond failure. RESULTS: The means of push-out bond strength values of white MTA in the ultrasonic, conventional, and trituration groups were 105.67 ± 12.79, 118.95 ± 12.76, and 99.60 ± 14.27 MPa, respectively. The differences between the 3 groups were not statistically significant. CONCLUSIONS: On the basis of the results of this study, it can be concluded that different mixing methods have no significant effect on push-out bond strength of white MTA.

Effect of Er, Cr: YSGG laser irradiation on Enterococcus faecalis in infected root canals.

OBJECTIVE: The purpose of this study was to investigate the eradication of Enterococcus faecalis by high-power settings of Er, Cr:YSGG laser irradiation in root canals of extracted teeth. BACKGROUND DATA: The bacteria entering the root canal system invade dentinal tubules, resulting in persistent infections in root canals due to limited penetration of irrigation solutions into the dentinal tubules. The antibacterial effects of different lasers have been investigated in previous studies. MATERIALS AND METHODS: Sixty newly extracted maxillary central incisors were enlarged chemomechanically and sterilized after removal of the smear layer. Root canals were inoculated with E. faecalis, and bacteria were incubated in root canals for 48 h. Samples were randomly divided into four groups, each containing 15 teeth. One group was considered as control with no intervention. Two groups were irradiated with 2- and 3-W output powers of Er, Cr:YSGG laser for 16 s. In the last group, the canals were irrigated with 1% sodium hypochlorite for 20 min. RESULTS: In the laser groups at 2- and 3-W powers, the number of bacteria was reduced 2.4% and 1.53%, respectively, compared with the controls. No significant differences were found between the two laser groups (p > 0.05). The canals irrigated with 1% NaOCl solution demonstrated no bacterial growth. CONCLUSIONS: According to the results of the present study, 2- and 3-W powers of Er, Cr:YSGG laser have antibacterial effects on E. faecalis in root canals of infected teeth; however, the effect is less remarkable than that of NaOCl solution.

Effect of mineral trioxide aggregates and Portland cements on inflammatory cells.

INTRODUCTION: Recently, some studies have compared mineral trioxide aggregate (MTA) with Portland cements, concluding that the principal ingredients of Portland cements are similar to those of MTA. The purpose of the present study was to evaluate the effect of gray MTA, white MTA, and gray and white Portland cements on inflammatory cells in rats. METHODS: Fresh mixtures mixed with distilled water were placed in polyethylene tubes, which were implanted in the dorsal subcutaneous connective tissue of 60 Sprague-Dawley rats along with empty tubes as controls. Tissue specimens were collected after the rats were sacrificed after 7, 15, 30, 60, and 90 days. The specimens were fixed, stained, processed, and histologically evaluated under a light microscope. Inflammatory reactions were classified as grade 0: without inflammatory cells, grade I: sporadic infiltration of inflammatory cells, grade II: moderate infiltration (<25 cells), grade III: dense and severe infiltration (25-125 cells), and grade IV: very dense and severe infiltration (>125 cells). Data were analyzed with the nonparametric (two factor) analysis of variance and Kruskal-Wallis H-test. RESULTS: All the groups showed grade III inflammation after 7 and 15 days; there was a decrease in the inflammatory process after 30, 60, and 90 days. After 90 days, gray MTA, white MTA, and control groups had grade 0 inflammatory process, but gray Portland cement and white Portland cement groups showed grade 0 to grade I inflammatory processes. CONCLUSION: MTAs were more biocompatible; however, more studies are required.

Effect of calcium hydroxide dressing on microleakage of composite restorations in endodontically treated teeth subsequent to bleaching.

OBJECTIVE: This study evaluates the effect of calcium hydroxide dressing on microleakage of composite restorations following non-vital bleaching. METHODS: A total of 45 sound extracted human maxillary central incisors underwent endodontic treatment. The teeth were randomly divided into three groups (n=15). In group 1, access cavities were restored with composite. In group 2, the teeth underwent a bleaching procedure for one week before being restored with composite. In group 3, following a bleaching procedure, calcium hydroxide paste was placed in the pulp chamber for one week. The teeth were then restored with composite. The specimens were subjected to a dye leakage test. The data was analyzed using Kruskal-Wallis and Mann-Whitney U tests. RESULTS: There were significant differences between the groups (P<0.0005). No statistically significant differences were found between groups 2 and 3, while the differences between other groups were significant. CONCLUSIONS: The bleaching agent increased microleakage of composite restorations in non-vital bleaching, whereas microleakage was not found to be increased by calcium hydroxide.

Sealing ability of mineral trioxide aggregate and Portland cement for furcal perforation repair: a protein leakage study.

The purpose of this study was to compare the sealing ability of gray mineral trioxide aggregate (GMTA), white MTA (WMTA), and both white and gray Portland cement as furcation perforation repair materials. A total of 120 human mandibular first molars were used. After root canal obturation and preparation of furcal perforations the specimens were randomly divided into four groups of 25 teeth each. In groups A, B, C, and D furcation perforations were filled with WMTA, GMTA, white Portland cement, and type II Portland cement, respectively. Ten teeth were used as positive controls with no filling materials in the perforations and 10 teeth with complete coverage with two layers of nail varnish were used as negative controls. A protein leakage model utilizing 22% bovine serum albumin (BSA) was used for evaluation. Leakage was noted when color conversion of the protein reagent was observed. The controls behaved as expected. Leakage was found in the samples from group A (WMTA), group B (GMTA), and in the two other groups (white and gray Portland cement). There were no statistically significant differences between GMTA and WMTA or white and gray Portland cement, but significant differences were observed between the MTA groups and the Portland cement groups. It was concluded that Portland cements have better sealing ability than MTA, and can be recommended for repair of furcation perforation if the present results are supported by other in vivo and in vitro studies.

A comparative scanning electron microscopic study of the effect of three different rotary instruments on smear layer formation.

The aim of this study was to evaluate the effect of RaCe, FlexMaster and ProFile rotary instruments on smear layer formation by scanning electron microscopy. Eighty-four caries-free freshly extracted human single-rooted teeth were selected and divided into three groups, each containing 28 teeth. The teeth were instrumented with rotary instruments sequentially: Group A: ProFile Rotary Instruments; Group B: FlexMaster Rotary Instruments; and Group C: RaCe Rotary Instruments. Instrumentation was performed by the crown-down method and according to the manufacturer's instructions. The specimens were then examined with SEM according to Hülsmann's classification. One-way ANOVA and a post hoc Tukey test were used for statistical analysis. The results showed that there were no statistically significant differences among the three groups in the coronal third (P = 0.39), but at the apical and middle thirds there were statistically significant differences between the RaCe group and the other groups (P < 0.05). Smear layer in the RaCe group was less than that in the ProFile and FlexMaster groups, but the difference between the ProFile group and FlexMaster group was not statistically significant (P > 0.05). It was concluded that RaCe Rotary Instruments produce less smear layer than FlexMaster and ProFile Rotary Instruments.

Comparison of apical microleakage using Ni-Ti with stainless steel finger spreaders.

INTRODUCTION: The purpose of this in vitro study was to compare apical microleakage after obturation with Nickel-Titanium (NiTi) compared to Stainless Steel (SS) finger spreaders. MATERIALS AND METHODS: Eighty straight single-rooted human teeth were instrumented using step-back technique. The specimens were randomly divided into four groups. The two experimental groups (n=30) and the negative control group (n=10) were obturated by lateral condensation technique with Ariadent gutta-percha and AH26 sealer. The roots in the positive control group (n=10) were instrumented but not obturated. In one group, SS and in another group NiTi spreaders were used. Microleakage evaluation was conducted using dye penetration method t-test was used for statistical analysis. RESULTS: The results showed statistically significant differences between NiTi and SS groups (P=0.022), with the greatest dye penetration in SS group and the least in NiTi group. CONCLUSION: According to the results of the present study using NiTi spreader decrease apical microleakage in endodontically treated teeth. [Iranian Endodontic Journal 2009;4(4):149-51].

Pathosis associated with radiographically normal follicular tissues in third molar impactions: a clinicopathological study.

BACKGROUND: The follicular tissue around impacted third molars has a potential to develop pathosis. However, it is generally assumed that the absence of abnormal radiolucency indicates the presence of a normal follicle. AIMS: The aim of this study was to investigate abnormalities associated with radiographically normal follicular tissue of third molar impactions. MATERIALS AND METHODS: One hundred eighty-five impacted third molars from 170 patients with no signs of abnormal radiolucency (follicular space < 3 mm) were used for this study. Follicular tissues of the relevant teeth were collected. Specimens were fixed in 10% formalin and stained routinely with hematoxilin and eosin to be independently examined by two pathologists. A diagnosis was registered only when the results from both pathologists were in concordance. Clinical details for each patient were registered in WHO standard forms to undergo chi-square statistical analysis. RESULTS: Fifty-three per cent of the specimens had developed pathosis. The incidence of pathosis was higher in the age group of 20-30 years, in men compared to women and in the mandible compared to the maxilla. CONCLUSION: The findings of this study suggest that radiographic appearance may not be reliable in the diagnosis of pathosis in follicular tissue as a surprisingly high rate of pathosis was found in the absence of any radiographically detectable sign.

Root canal configuration and the prevalence of C-shaped canals in mandibular second molars in an Iranian population.

A total of 139 extracted mandibular second molars were injected with India ink and demineralized. They were made clear and transparent with methyl salicylate, and the anatomy of their canals was studied. It was found that 86.3% of mandibular second molars had two roots, 9.3% had one root, and 4.3% had three roots. Ninety percent of the mesial roots of the mandibular second molars with two roots had two canals (predominantly with a type II or III configuration), and 77.5% of the distal roots of these teeth had one canal (predominantly with a type I configuration). Among the mandibular second molars, 7.2% had C-shaped canals and these configurations were seen mostly in single-rooted mandibular second molars. The results of this study indicate that mandibular second molar teeth have many variations in the number of roots and the morphology of their canals. Therefore it should not be assumed that all mandibular second molar teeth have two roots and three canals.

Sealing ability of white and gray mineral trioxide aggregate mixed with distilled water and 0.12% chlorhexidine gluconate when used as root-end filling materials.

This in vitro study used dye penetration to compare the sealing ability of white and gray mineral trioxide aggregate mixed with distilled water and 0.12% chlorhexidine gluconate when used as root-end filling materials. Ninety-six single-rooted human teeth were cleaned, shaped, and obturated with gutta-percha and AH26 root canal sealer. The apical 3 mm of each root was resected, and 3-mm deep root-end cavity preparations were made. The teeth were randomly divided into 4 experimental groups, each containing 20 teeth, and 2 negative and positive control groups, each containing 8 teeth. Root-end cavities in the experimental groups were filled with the experimental materials. After decoronation of the teeth and application of nail polish, the teeth were exposed to India ink for 72 hours and longitudinally sectioned, and the extent of dye penetration was measured with a stereomicroscope. Statistical analysis showed that there were no significant differences among the 4 experimental groups.

An in vitro study of the effect of spreader penetration depth on apical microleakage.

The purpose of this study was to evaluate the effect of spreader penetration depth on apical microleakage using the lateral compaction method. A total of 96 extracted maxillary central incisors were instrumented using the step-back method, and randomly divided into the following four experimental groups: A) with tug-back and spreader penetration 1 mm short of the working length; B) without tug-back and spreader penetration 1 mm short of the working length; C) without tug-back and spreader penetration to the working length; D) with tug-back and spreader penetration to the working length. Microleakage evaluation was conducted using the dye penetration method, and ANOVA test was used for statistical analysis. The results showed that there was a significant difference in the amount of microleakage between the groups with spreader penetration to the working length and the groups with spreader penetration 1 mm short of the working length. There was no significant difference between the groups with and without tug-back.