An Evaluation of the Fracture Resistance of Teeth with Simulated External Cervical Resorption Cavities Categorized Using Three-Dimensional Classification.

(1) Background: External cervical resorption causes dental hard tissue destruction that may reduce the fracture resistance of affected teeth. By using a compressive strength test, this study aimed to evaluate the fracture resistance of teeth with simulated external cervical resorption cavities that have different three-dimensional classifications. (2) Methods: In total, 170 teeth with simulated external cervical resorptions were divided into 16 experimental groups (n = 10) and 1 control group (n = 10) based on the three-dimensional classification: 1Ap, 1Bp, 1Cp, 1Dp, 2Ap, 2Bp, 2Cp, 2Dp, 3Ap, 3Bp, 3Cp, 3Dp, 4Ap, 4Bp, 4Cp, 4Dp and a control group. Defects were restored with mineral trioxide aggregate. The fracture resistances of the samples were statistically analyzed using two-way repeated ANOVA and the Bonferroni correction for multiple comparisons at a significance level of p < 0.05. (3) Results: The lowest resistance to fracture was observed in samples with vertical height level "4" and circumferential spread of "D" (p < 0.001). In the groups with circumferential spreads "B", "C" and "D", there were significant differences between the samples with vertical height levels "1", "2", "3" and "4" regarding fracture resistance (p < 0.001). (4) Conclusions: The circumferential spread and vertical height of the external cervical resorption influenced the fracture resistance of the affected teeth.

Dislodgement resistance and structural changes of tricalcium silicate-based cements after exposure to different chelating agents.

This study aimed to evaluate the dislodgement resistance and structural changes of different mineral trioxide aggregate cements (MTA) like Pro-Root MTA, Ortho MTA, and Retro MTA after exposure to sodium hypochlorite (NaOCl), NaOCl-Ethylenediaminetetraacetic acid (EDTA), 1-hydroxyethylidene-1, 1-bisphosphonate (Dual Rinse HEDP), and NaOCl-Maleic acid (MA). The root canal spaces of 150 dentine slices were obturated using tricalcium silicate cements and divided into 3 groups (n = 50): Group1: ProRoot MTA, Group2: Retro MTA, and Group3: Ortho MTA. The samples in each group were further subdivided into four experimental (n = 10) and one control groups (n = 10): 2.5% NaOCl-17% EDTA, Dual Rinse HEDP, 2.5% NaOCl-7% Maleic acid, 2.5% NaOCl, distilled water (control). The dislodgement resistance and structural changes of cements were measured. Use of DR HEDP resulted in higher dislodgement resistance compared to17% EDTA and 7% MA in the samples obturated with Ortho MTA and Pro-Root MTA (p<0.001). In Retro MTA group, samples treated with DR HEDP and 17% EDTA had higher dislodgment resistance compared to 7% MA (p<0.001). On microstructural and elemental analysis of all the three MTA cements, samples treated with 17% EDTA and 7% MA were more amorphous and granular when compared to DR HEDP, which was pettle shaped. Calcium level was decreased more in samples treated with 17% EDTA and 7% MA when compared to DR HEDP.

Effect of various calcium hydroxide removal protocols on the dislodgement resistance of biodentine in an experimental apexification model.

BACKGROUND/PURPOSE: Residual calcium hydroxide (CH) in the root canal dentine walls may influence the adhesion of tricalcium silicate-based materials. The aim of this study is to evaluate the effect of various CH removal protocols on the dislodgement resistance of biodentine from simulated immature root canals in an experimental apexification model. MATERIALS AND METHODS: CH was applied to 120 simulated immature root canals. The samples were divided into 12 experimental groups (n = 10) according to the applied irrigation protocols used for the removal of CH: Group 1: Sodium hypochlorite (NaOCl), Conventional needle irrigation (CNI); Group 2: NaOCl, EndoActivator; Group 3: NaOCl, XP-endo Finisher; Group 4: NaOCl- Ethylenediaminetetraacetic acid (EDTA), CNI; Group 5: NaOCl-EDTA, EndoActivator; Group 6: NaOCl-EDTA, XP-Endo Finisher; Group 7: NaOCl+etidronic acid (HEBP), CNI; Group 8: NaOCl+HEBP, EndoActivator; Group 9: NaOCl+HEBP, XP-endo Finisher; Group 10: NaOCl- Peracetic acid (PAA), CNI; Group 11: NaOCl-PAA, EndoActivator; Group 12: NaOCl-PAA, XP-endo Finisher; Control Group: CH was not applied. Biodentine was placed at the apical thirds of 130 immature root canals. Vertical loading was applied to biodentine fillings inside the dentin discs. Maximum force to dislodge the material was statistically analyzed with ANOVA. RESULTS: The control, NaOCl+HEBP (CNI, EndoActivator, XP-endo Finisher) and NaOCl-PAA (EndoActivator, XP-endo Finisher) groups exhibited the lowest dislodgement resistance values (p < 0.001). When used CNI, irrigation with NaOCl+HEBP resulted in lower resistance to dislodgement of biodentine compared to NaOCl, and NaOCl-EDTA (p < 0.001). CONCLUSION: Adhesion of apical barrier materials to root canal dentine can be influenced by the irrigation protocols used for CH removal.

Effect of Orthodontic Brackets on the Accuracy of Apex Locators: A Pilot Study.

The purpose of this study was to evaluate the effect of metal orthodontic brackets on the accuracy of electronic apex locator (EAL). The actual canal lengths (ACL) of 40 mandibular incisor teeth were determined. Then, the teeth were randomly divided into two groups (n = 20). Orthodontic metal brackets were applied in the first group, and no brackets, in the second group. The working length of each tooth was measured with an EAL under 3 test conditions according to the distance between the lip clip and sample tooth. Data were analyzed using one-way repeated measures analysis of variance and Tukey's post hoc tests (p = 0.05). In the bracketed samples, when the lip clip was located at 1 cm and 2 cm from the samples. The mean differences between the EAL measurements and ACLs were statistically higher than those when the samples were located 3 cm from the lip clip (p < 0.05). There were also statistically significant differences between EAL measurements and ACLs in the bracketed samples located 1 and 2 cm from the lip clip (p < 0.05). In the nonbracketed group, the differences between EAL measurements and ACLs were not statistically significant in the samples located 1, 2, and 3 cm from the lip clip (p > 0.05). Use of orthodontic metal brackets can negatively influence the accuracy of the electronic apex locator when the distance between the lip clip and bracket was short. A minimum of 3 cm distance should be kept between the lip clip and tooth in order to make consistent electronic measurements.

Effect of final irrigation protocols on the fracture resistance of roots with varying dentine thickness.

This study evaluated the effects of 9% etidronic acid (HEBP) and 17% ethylenediaminetetraacetic acid (EDTA) used either with conventional syringe irrigation (CSI) or passive ultrasonic irrigation (PUI) on the fracture resistance of roots with different dentine thickness. The root canals of 120 extracted teeth were widened, leaving dentinal walls with different thicknesses of either 0.75 mm, 1.50 mm, or 2.25 mm with 40 teeth in each group. Within each of these groups, four subgroups (n = 10) were formed according to the final irrigation regimens applied: 2.5% NaOCl-17% EDTA with CSI; 2.5% NaOCl-17% EDTA with PUI; 2.5% NaOCl + 9% HEBP with CSI; 2.5% NaOCl + 9% HEBP with PUI. The irrigated root canals were obturated with AH Plus sealer and gutta-percha cones. A compressive vertical loading was applied to the samples and the force at fracture was recorded. Data were statistically analysed using a multiple linear regression analysis. The most influencing factor for the fracture strength of roots was the remaining dentine thickness, followed by the irrigation method, and then the irrigation solution. The samples irrigated using PUI were statistically significantly more resistant to fracture than those using CSI (mean difference = 116.3 N; 95% CI = [53.9, 178.6] N). The application of HEBP was associated with higher resistance to fracture than the application of EDTA (mean difference = 71.0 N; 95% CI = [8.6, 133.3] N).

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

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

The efficacy of different irrigation protocols in removing tricalcium silicate-based sealers from simulated root canal irregularities.

OBJECTIVE: The aim of this study was to evaluate the efficacy of different irrigation protocols in removing two tricalcium silicate-based sealers from simulated root canal irregularities and root canal walls. MATERIAL AND METHODS: Root canals of 140 single-rooted teeth were instrumented. In one-half of each root, an apical groove was created. The samples were divided into two main groups (n = 70) based on the sealer used. In group 1, the grooves were filled with MTA Fillapex; in group 2, BioRoot RCS. The reassembled root halves were divided into six experimental and one control groups: 2.5% NaOCl-17% EDTA (Passive ultrasonic irrigation [PUI]), 5% NaOCl/9% DualRinse HEDP (PUI), 2.5% NaOCl-7% Maleic acid (PUI), 2.5% NaOCl-17% EDTA (Er:YAG laser activated irrigation [LAI]), 2.5% NaOCl/9% DualRinse HEDP (LAI), 2.5% NaOCl-7% Maleic acid (LAI), Distilled water (Control). Specimens were scored using SEM. The data were analysed using Kruskal-Wallis and Mann Whitney U tests. RESULTS: Maleic acid and DualRinse HEDP removed higher amounts of MTA Fillapex from the grooves compared to EDTA, when used with both activation methods (p < .001). CONCLUSIONS: Ultrasonically activated maleic acid or DualRinse HEDP can be an effective irrigation regimen in removing tricalcium silicate-based sealers.

Effect of novel chelating agents on the push-out bond strength of calcium silicate cements to the simulated root-end cavities.

To compare the effects of different chelating agents on the push-out bond strength of calcium silicate-based cements to the simulated root-end cavities. Root-end cavities were prepared on the roots of fifty extracted maxillary anterior teeth. The specimens were then randomly divided into 5 groups (n = 10) based on the final irrigation regimen: Group 1: 17% EDTA, Group 2: 7% maleic acid, Group 3: QMix, Group 4: 2.25% peracetic acid (PAA), Group 5: 0.9% saline. Then, the samples from each group were subdivided into two groups (n = 5) based on the apical filling material. In group 1, root-end cavities of all samples were filled with Biodentine and in group 2, with MTA. Each sample was horizontally sectioned to produce two discs of ∼1 mm thick per specimen. The maximum load required for the dislodgement of 100 retrofillings was recorded. The specimens were examined under scanning electron microscope after debonding to assess the type of bond failure. Data were statistically analyzed using Kruskal Wallis and Mann Whitney U tests. Irrigation with saline resulted in higher bond strength compared to the other irrigants in the retrograde cavities obturated with MTA or Biodentine (p < .05). In MTA group, there was no significant difference between the test irrigants (p > .05). EDTA and PAA groups showed higher dislodgement resistance values than the other test irrigants, when Biodentine was used as a filling. The type of irrigation solution influences the bond strength of the root-end fillings.

Evaluation of smear layer removal and marginal adaptation of root canal sealer after final irrigation using ethylenediaminetetraacetic, peracetic, and etidronic acids with different concentrations.

The purpose of this study was to investigate the effects of different irrigation solutions on the smear layer removal and marginal adaptation of a resin-based sealer to root canal dentine. A total of 152 instrumented roots were irrigated with the following irrigants: 9,18% etidronic acid (HEBP), 0.5, 1,2% peracetic acid (PAA), 17% ethylenediaminetetraacetic acid (EDTA), saline. The amount of smear layer was evaluated using scanning electron microscope (SEM) in seventy root samples. Eighty-two roots were filled with AH Plus and gutta-percha. Slices obtained from apical third of each specimen were viewed with SEM to assess marginal adaptation. Use of 9% and 18% HEBP resulted in more efficient smear layer removal in the apical third than the other chelators (p < 0.05). Higher smear layer scores in the coronal and middle thirds were obtained from 0.5%, 1% PAA groups. Regarding marginal adaptation, 18% HEBP group showed the lowest gap size values (p < 0.05), and better marginal adaptation. Etidronic acid is a promising candidate for final irrigation of root canals.

Fracture resistance of roots with simulated internal resorption defects and obturated using different hybrid techniques.

BACKGROUND/PURPOSE: Teeth with internal resorption are susceptible to fracture because of the remaining thin dentinal walls. The aim of this study was to investigate the fracture resistance of roots with simulated internal resorption cavities and obturated with different hybrid techniques. MATERIALS AND METHODS: Seventy single root canals were instrumented. On the coronal half of the roots, standardized internal cavities with a length of 8 mm were created. The apical 6 mm of the 60 root canals were filled with AH Plus sealer and gutta-percha cones. Then, 80 roots were divided into four experimental groups and two control groups according to the internal cavity obturation: Group 1, AHPlus sealer + high-temperature thermoplasticized injectable gutta-percha; Group 2, DiaRoot Bioaggregate; Group 3, Biodentine; Group 4, MTA Fillapex; Group 5, instrumented, but not obturated roots; Group 6, intact roots. A compressive vertical loading at a speed of 1 mm/min was applied to the roots. The forces when the fracture occurred were statistically analyzed with one-way analysis of variance and post hoc Tukey test. RESULTS: Biodentine group showed statistically higher resistance to fracture than the other experimental groups (P < 0.05). CONCLUSION: Filling the internal resorption cavities with thin dentinal walls using Biodentine may provide strength to the tooth structure more than the other calcium silicate-based materials.

Apical microleakage of different root canal sealers after use of maleic acid and EDTA as final irrigants.

This study aimed to compare the effects of ethylenediaminetetraacetic acid (EDTA) and maleic acid (MA) on the sealing ability of various root canal sealers. Eighty root canals were instrumented and irrigated with either EDTA or MA. They were divided into eight experimental groups and obturated as follows: Group 1: MA + Hybrid Root SEAL/gutta-percha. Group 2: EDTA + Hybrid Root SEAL/gutta-percha. Group 3: MA + iRoot SP/gutta-percha. Group 4: EDTA + iRoot SP/gutta-percha. Group 5: MA + EndoREZ/EndoREZ points. Group 6: EDTA + EndoREZ/EndoREZ points. Group 7: MA + AH Plus/gutta-percha. Group 8: EDTA + AH Plus/gutta-percha. Another ten roots were used as negative and positive controls. The microleakage of each sample was measured at 2-min intervals for 8 min using the fluid filtration method. Data were statistically analyzed with one-way ANOVA, post-hoc Tukey, and paired-samples t tests. The minimum microleakage values were obtained from the teeth obturated with AH Plus and EndoREZ selaers (p < 0.001). The samples with Hybrid Root SEAL showed the maximum leakage (p < 0.001). There were significant differences between the groups irrigated with MA or EDTA in terms of microleakage (p < 0.05). Use of MA resulted in higher microleakage values compared with those using EDTA. The type of final irrigation solution seems to influence the postobturation apical seal. Use of AH Plus and EndoREZ sealers showed better sealing ability compared with IRoot SP and Hybrid Root SEAL.

Effect of light-activated bleaching on pulp chamber temperature rise: an in vitro study.

This study aimed to compare the pulp chamber temperature changes that occur with the use of different light sources during vital bleaching with and without application of bleaching agents. One hundred and forty-four mandibular incisor teeth were divided into four groups (n = 36) according to the use of halogen light, light-emitting diode, 3 W and 1.5 W diode laser. The teeth in the main groups were divided into three subgroups (n = 12). First subgroup had no bleaching gel application. By White and Whiteness HP were applied with a thickness of 2 mm to the other subgroups respectively. The labial surfaces of the teeth were irradiated with a total time of 20 s. Temperature changes in the pulp chamber were measured and analysed by using anova and Tukey test. The 3 W diode laser induced the highest pulp chamber temperature rise (P = 0.000). Bleaching gel application reduced the temperature changes in the diode laser groups (P < 0.05). Diode laser activation during vital bleaching induces pulp chamber temperature rise, which may cause thermal tissue damage.

Effect of different root canal sealers on fracture strength of simulated immature roots.

OBJECTIVE: The objective of this study was to compare the effects of different root canal sealers on fracture resistance of simulated immature teeth. STUDY DESIGN: One hundred eight roots were divided into 9 groups. The roots were instrumented except the negative controls. Four millimeters of mineral trioxide aggregate (MTA) barriers were placed apically. The roots were backfilled as follows: group 1, AH Plus+gutta-percha; group 2, EndoREZ+gutta-percha; group 3, EndoREZ+Resilon; group 4, Hybrid Root SEAL+gutta-percha; group 5, Hybrid Root SEAL+Resilon; group 6, iRootSP+gutta-percha; group 7, iRootSP+Resilon; group 8, No obturation other than MTA barrier; group 9, No instrumentation, no obturation. A compressive loading was applied at a speed of 1 mm/min. Data were compared with ANOVA and Duncan tests. RESULTS: Group 5 showed the highest resistance to fracture. The fracture values of group 3 were lower than those of the other experimental groups. CONCLUSIONS: Hybrid Root SEAL and iRootSP reinforce the simulated immature roots against fracture when used with either gutta-percha or Resilon.

Sharp curvature of premolar resulting in external apical root resorption of the neighbouring molar.

This case report describes an external apical root resorption resulted from the unusual root morphology of the neighbouring tooth. A 28-year-old female was referred to the department of endodontics with a complaint of intense pain in her maxillary second premolar tooth. The clinical and radiographical evaluation revealed an external apical resorption in the mesial root of the maxillary first molar, which shows close proximity to the severely curved root of the premolar. A successful root canal treatment of the premolar was performed using anticurvature filing method. However, molar tooth received no curative treatment. One-year followup of the apical external resorption did not show any progression. External apical root resorption affecting single permanent tooth may be induced from the pressure exerted during the eruption of the adjacent tooth with unusual root morphology. The preferred approach for the management of such apical resorption cases includes long-term observation and no curative treatment.

Temperature rise and shear bond strength of bondable buccal tubes bonded by various light sources.

The objective of the present investigation was to determine the intrapulpal temperature changes and to compare the shear bond strength (SBS) of bondable buccal tubes bonded by high-intensity light sources. Ninety caries-free human first molar teeth extracted for periodontal reasons were used. For the temperature measurement test, 30 teeth were randomly divided into three groups (n = 10) whereas 60 teeth were used in three groups (n = 20) for SBS testing. Three light sources, high-intensity halogen, blue light-emitting diode (LED), and xenon plasma arc (PAC), were used for polymerization of Transbond XT. Temperature variations (Delta T) were recorded by a K-type thermocouple wire connected to a data logger. For SBS testing, a universal testing machine was used at a crosshead speed of 1 mm/minute until buccal tube bonding failure occurred. Data were analyzed using the Kruskal-Wallis test. The high-intensity halogen light resulted in significantly (P < 0.01) higher intrapulpal temperature changes than the LED or PAC. The results of the shear bond test revealed significant (P < 0.05) differences only between the halogen and LED groups. The findings of the present investigation showed that high-intensity curing devices can safely be used in bonding buccal tubes to molar teeth without causing a deleterious effect on the dental pulp.

Effects of Er:YAG laser and Nd:YAG laser treatment on the root canal dentin of human teeth: a SEM study.

The objective of the study was to observe the morphological changes on root canal dentin after Er:YAG laser and Nd:YAG laser treatment. Twenty-one teeth biomechanically prepared were divided into three groups with seven teeth of each. Group A was unlased as a control. In group B, Er:YAG laser and in group C, Nd:YAG laser was applied to the root canal dentin. The roots were split longitudinally and examined using a scanning electron microscopy for the evaluation of debris, smear layer, and recrystallization. There was no statistically significant difference between the groups. This study indicates that laser beam is not effective in removing debris and smear layer.

Fracture resistance of roots obturated with three different materials.

OBJECTIVE: The aim of this study was to compare the fracture resistance of roots obturated with different materials. STUDY DESIGN: Sixty root canals were instrumented and divided into 4 equal groups (n = 15 each). The root canals in group 1 were filled with AH26 sealer and gutta-percha, in group 2 with Resilon and Epiphany, and in group 3 with Ketac-Endo Aplicap and gutta-percha. Fifteen root canals had no obturation. The force required to fracture was recorded. The data was analyzed with analysis of variance and Duncan test. RESULTS: The mean force of fracture for group 1 was significantly higher than for the other 3 groups (P < .05). There was significant difference between group 2 and group 3 (P < .05). Group 2 and group 3 were not significantly different from the control group (P > .05). CONCLUSION: The use of AH26 + gutta-percha increased the fracture resistance of instrumented root canals compared with Resilon + Epiphany and Ketac-Endo Aplicap + gutta-percha.

Endodontic treatment of a maxillary second molar with 2 palatal roots: a case report.

The incidence of second palatal root in the maxillary second molar is very rare. This case report describes the treatment of a 4-rooted maxillary second molar with 2 distinct palatal roots. Clinical examination and radiographs showed the presence of a second palatal root. After biomechanical preparation, the root canals were filled with gutta-percha cones and AH26 sealer. One year later, the restored tooth and periodontal tissues were healthy both clinically and radiographically.

Effects of Nd: YAG laser irradiation on the adaptation of composite resins to root dentin.

One of the most important goals of the restoration of endodontically treated teeth with a composite resin post system is to achieve good adaptation of the composite material to dentin walls to prevent microleakage apically and coronally. In post core systems, to avoid microleakage between the dentin wall and resin material, laser irradiation may seem to be an alternative therapy for increasing adaptation quality. The aim of this study was to investigate the adaptation of a packable composite resin to lased root canal dentin when it was used as post material. Forty-five freshly extracted human teeth were selected and post spaces were prepared. The teeth were divided into three groups. In group 1 the dentin of the post spaces were etched with 35% phosphoric acid, in group 2 the dentin surfaces were irradiated with an Nd: YAG laser, and in group 3 the dentin surfaces were initially treated with the laser and then etched. The teeth of all groups were obturated with a bonding agent and composite. The groups were divided into two subgroups: a group for the scanning electron microscope (SEM) study and a group for the microleakage study. The lased group showed poor adaptation and more microleakage was detected (p<0.05; variance analysis). The laser beam and acid-etching showed no advantage compared to the acid-etching alone (p>0.05). The Nd: YAG laser irradiation adversely affects adhesion to dentin for using composite resin as a post material and does not constitute an alternative to acid-etching.