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Introduction: One of the most common problems in endodontic treatments is post-treatment pain, and sealers might be one of the factors influencing the degree of pain following root canal therapy. The purpose of this study is to compare pain following endodontic treatment using an AH-26 resin sealer against the Resil experimental sealer in mandibular molars with irreversible pulpitis. Materials and Methods: One hundred patients with irreversible pulpitis in the mandibular first or second molar were randomly divided into two groups (n=50) based on the type of sealer applied. Two postgraduate students with at least five years of experience treated all patients. All patients had a single root canal treatment. Postoperative pain scores and analgesic consumption were assessed after 6, 12, 24, and 48 hours and 3, 4, 5, 6, and 7 days after the treatment. The data were statistically analyzed by Fisher's exact or Chi-Square test (to compare the distribution of qualitative variables in two groups), repeated measures ANOVA (to compare changes in pain intensity over time in two groups), Boneferronie (for pairwise comparisons), Friedman, Wilcoxon and Mann-Whitney tests (for assessment of the changes in pain scores over time). The generalized estimating equations (GEE) were used for assessing time and group effects. Results: There was no significant difference in postoperative pain between groups at any of the time points studied (P>0.05), and also for patient analgesic consumption between groups (P>0.05). Both groups recorded the maximum pain levels in the first 6 hours. For each subsequent day postoperatively, the odds ratio (OR) of not using analgesics was 2.078. Conclusion: Resil and AH-26 perform similarly in terms of the occurrence and intensity of postoperative pain in mandibular molar teeth with irreversible pulpitis.
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BACKGROUND: This study aimed to assess the accuracy of two different endodontic guides for fiber post removal. METHODS: In this in vitro study, 54 maxillary canine fiber posts were mounted on 36 maxillary stone casts; 18 teeth were mounted unilaterally, and 36 teeth were mounted bilaterally. Static endodontic guides were fabricated according to baseline cone-beam computed tomography (CBCT) and intraoral optical scans using Blue Sky software. In the single-sleeve endodontic guides group (SSG), two anterior and two posterior teeth were included in a 5-unit guide. In the double-sleeve endodontic guides group (DSG) group, the guide was passed through the midline to include both canine teeth and extended by 2 teeth posterior to the canine teeth bilaterally (a 10-unit guide). After drilling, postoperative CBCT scans were taken and superimposed on the virtually designed path, and the maximum coronal deviation (MCD) at the marginal entry point of the tooth, maximum apical deviation (MAD) at 10 mm apical to the tooth margin, and maximum angular deflection (MAnD) of the drill were calculated. RESULTS: The mean MCD, MAD, and MAnD were 0.34 mm, 0.6 mm, and 2.32 degrees, respectively, in the SSG and 0.31 mm, 0.7 mm, and 2.37 degrees, respectively, in the DSG. The two groups were not significantly different from each other in terms of MCD (P = 0.573), MAD (P = 0.290), or MAnD (P = 0.896). CONCLUSIONS: The accuracies of the two techniques, the extended double sleeve guide and the single sleeve guide, were comparable and thus DSG may be used for removal of fiber posts in adjacent or distant teeth.
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Tomografía Computarizada de Haz Cónico , Técnica de Perno Muñón , Humanos , Técnica de Perno Muñón/instrumentación , Diente Canino/diagnóstico por imagen , Técnicas In VitroRESUMEN
Objectives: The positive effects of strontium on dental and skeletal remineralization have been confirmed in the literature. This study aimed to assess the properties of a calcium silicate cement (CSC) containing a sintered strontium silicate phase. Materials and Methods: The calcium silicate and strontium silicate phases were synthesized by the sol-gel technique. Strontium silicate powder in 0 (CSC), 10 (CSC/10Sr), 20 (CSC/20Sr), and 30 (CSC/30Sr) weight percentages was mixed with calcium silicate powder. Calcium chloride was used in the liquid phase. X-ray diffraction (XRD) of specimens was conducted before and after hydration. The setting time and compressive strength were assessed at 1 and 7 days after setting. The set discs of the aforementioned groups were immersed in the simulated body fluid (SBF) for 1 and 7 days. The ion release profile was evaluated by inductively coupled plasma-optical emission spectrometry (ICP-OES). Biomineralization on the specimen surface was evaluated by scanning electron microscopy/energy dispersive X-ray spectroscopy (SEM/EDS). Data were analyzed by the Kolmogorov-Smirnov test, one-way and mixed ANOVA, Levene's test, and LSD post hoc test (P < 0.05). Results: Except for an increasement in the peak intensity of hydrated specimens, XRD revealed no other difference in the crystalline phases of hydrated and nonhydrated specimens. The compressive strength was not significantly different at 1 and 7 days in any group (P > 0.05). The setting time significantly decreased by an increase in percentage of strontium (P < 0.05). Release of Ca and Si ions significantly decreased by an increase in percentage of strontium (P < 0.05). SEM/EDS showed the formation of calcium phosphate deposits at 1 and 7 days. Conclusion: Incorporation of 10-30 wt% sintered strontium silicate phase as premixed in CSC can significantly decrease the setting time without compromising the compressive strength or biomineralization process of the cement.
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BACKGROUND: This study intended to evaluate the association between several endodontic prognostic factors with the presence of periapical lesions (PLs), their volume, and bone characteristics including cortical bone destruction (CBD) and buccal plate bone height (BPBH) in root-filled molar teeth using cone-beam computed tomography. METHODS: A collection of 143 scans of endodontically treated maxillary/mandibular first or second molars recorded over 8 years, were obtained from a specialized radiology center. Data on prognostic factors including tooth number, gender, jaw type, the status and number of missed canals, obturation length, restoration type, presence of a separated instrument, presence of a post or screw in the canals, and presence of perforation were collected. The assessed outcomes included PL presence, PL volume, CBD, and BPBH. The association between prognostic factors and outcomes was evaluated using multiple logistic regression models with adjusted covariates and multifactorial ANOVA at a significance level of 0.05. RESULTS: A total of 282 molars from 82 women and 50 men with a mean age of 40.6 ± 12.27 were included. Among those, 139 teeth presented PL with a mean volume of 18.68 mm3. CBD was prevalent in 137 teeth and the mean BPBH appeared to be 9.45 mm. The presence of a missed canal (OR = 10.022, P < .05), underfilled canal (OR = 3.725, P < .05), overfilled canal (OR = 15.859, P = .018), and perforation (OR = 15.261, P = .013) was significantly associated with PLs. None of the prognostic factors could considerably contribute to the CBD (P > .05). The presence of a missed canal was positively associated with the PL volume (P < .05). Similarly, missed canals (P < .05), perforation (P < .05), and separated instruments (P = .004) were associated with a significantly reduced BPBH. CONCLUSIONS: Overfillings, perforations, missed canals, and underfillings were identified as remarkable predictors of PL, arranged in descending order of their respective impact. The only factor capable of significantly increasing the PL volume was the missed canal. In brief, obturation length errors, perforations, missed canals, and separated instruments were robustly correlated with endodontic failure, which highlights the importance of mitigating the potential for errors by following the fundamentals of endodontics.
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Tornillos Óseos , Diente Molar , Masculino , Femenino , Humanos , Adulto , Persona de Mediana Edad , Estudios Transversales , Pronóstico , Diente Molar/diagnóstico por imagen , Tomografía Computarizada de Haz CónicoRESUMEN
OBJECTIVES: To evaluate a modified two-step buccal infiltration (MBI) of 1.7 mL 4% articaine as primary or supplemental anesthesia in mandibular first and second molars diagnosed with symptomatic irreversible pulpitis (SIP). MATERIALS AND METHODS: One hundred and eight patients with SIP were randomly assigned to one of three groups (n = 36). They were given an inferior alveolar nerve block (IANB) of 2% lidocaine with 1:80.000 epinephrine or a primary MBI of 4% articaine with 1:100.000 epinephrine in the IANB and MBI groups, respectively. Patients in the IANB + MBI group received an IANB followed by an MBI. Pain levels during the injection, access cavity preparation, and initial filing were recorded on the Heft-Parker visual analog scale (HP-VAS). No or mild pain (HP-VAS ≤ 54) upon access cavity preparation and initial filing was considered a success. Chi-square and Kruskal-Wallis tests were used to analyze the data. RESULTS: MBI (77.8%) and IANB + MBI (94.4%) had both significantly higher success rates than IANB (50.0%) (P < .001). However, when the Bonferroni adjustment was applied, there was no statistically significant difference between the MBI and IANB + MBI techniques (P = .041 > .017). MBI was associated with significantly less injection pain than IANB (P < .001). CONCLUSIONS: Both primary and supplemental MBI with 4% articaine were superior to IANB with 2% lidocaine in mandibular first and second molars diagnosed with SIP. Further research may be needed to confirm the findings of this study. CLINICAL RELEVANCE: The findings of this study suggest that supplemental or primary MBI can be a clinically viable alternative to IANB, which has a relatively low success rate when managing mandibular molars diagnosed with SIP.
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Anestesia Dental , Anestésicos , Pulpitis , Humanos , Carticaína , Pulpitis/cirugía , Lidocaína , Dolor , Diente Molar/cirugía , EpinefrinaRESUMEN
Pulp canal obliteration (PCO) in calcified teeth presents a challenge for endodontic treatment, especially when accompanied by discoloration. Guided endodontic access (GEA) has emerged as an advanced method for root canal therapy (RCT) in such cases. This case report describes the successful treatment of a calcified maxillary central incisor with discoloration using GEA. A 32-year-old female with a history of dental trauma presented with discoloration in the left maxillary central incisor that did not respond to external bleaching. Clinical examination revealed a pulpless infected canal with asymptomatic apical periodontitis. Cone-beam computed tomography (CBCT) and intraoral scanning were utilized to create a three dimensional (3D) template, enabling minimally invasive access preparation through the palatal aspect. The RCT was performed in a single visit, followed by tooth whitening using hydrogen peroxide. At 18 months follow-up, the tooth was asymptomatic, and the apical lesion was healed. GEA offers a predictable and conservative approach, preserving tooth structure and providing enhanced long-term prognosis for teeth with calcified canals and discoloration.
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Introduction: This study aimed to compare the accuracy and agreement between cone-beam computed tomography (CBCT) and micro-computed tomography (micro-CT) in the assessment of canal transportation and centering ratio following root canal instrumentation with rotary files. Material and Methods: Twenty mesiobuccal canals of mandibular molars were prepared using the 2Shape sequential rotary system. CBCT and micro-CT scans were performed before and after instrumentation, and the magnitude of transportation and centering ratio were measured. The acceptable transportation was set at ≤0.15 mm. The accuracy and agreement between CBCT and micro-CT were calculated, and the intra-class correlation coefficient (ICC) and kappa coefficient were determined to assess the agreement between the two modalities. Statistical analyses were performed using repeated measures ANOVA. Results: Transportation was detected by both modalities at all distances from the apex after instrumentation. The agreement between CBCT and micro-CT in assessing canal transportation was observed in 80%, 85%, 75%, and 75% of specimens at 1-, 3-, 5-, and 7-mm from the apex, respectively. The ICC for transportation and centering ratio was much lower than 0.75, indicating poor agreement between the modalities. The kappa coefficient did not show acceptable agreement between the methods. Conclusions: CBCT and micro-CT demonstrated poor agreement in assessing canal transportation and centering ratio. Micro-CT remains the preferred modality for in vitro investigations, while CBCT should be limited to clinical settings.
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The superior lateral incisors are primarily affected by the developmental deformity known as dens invaginatus (DI). Oehler's type III DI has the highest complexity rendering a root canal treatment (RCT) an arduous challenge for this type, so early diagnosis and treatment before pulp involvement are important. This report presents two maxillary lateral incisors with type IIIb DI, the left one being associated with a periapical lesion and the right one with normal pulp. A nine-year-old boy was referred to our clinic complaining of mobility of the maxillary left lateral incisor (LLI) associated with gumboil throughout the previous two months. Periapical radiolucency was visible on radiographs, as well as an invagination that crosses the apical foramen from the pulp chamber in both maxillary lateral incisors. The pulp of the main canal of LLI was vital and pseudo canals were necrotized and associated with chronic apical abscess. Based on the condition of the main pulp of maxillary lateral incisors, two separate treatments were carried out. RCT was done only for the pseudo canals in the LLI, while the main root canal was preserved. The right maxillary lateral incisor (RLI) had vital pulp with normal periapical tissue So the invagination was sealed as the tooth was erupting. During the one-year follow-up period, the development of the root in LLI with a thick root wall and closed apex was observed in the periapical radiograph but pseudo canals became infected and the tooth became symptomatic, therefore retreatment for pseudo canals was carried out. The RLI root was developed and the tooth was clinically asymptomatic, so it didn't need further treatment. Maintaining pulp vitality is crucial for type III Dens invaginated young permanent teeth since it could support root formation and improve long-term prognosis, and in cases with pulp involvement, non-surgical RCT is clinically predictable.
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Materials and Methods: In this randomized clinical trial, 64 patients who had mandibular first and second molars with irreversible pulpitis were randomly divided into two groups (n = 32) by stratified permuted block randomization. The experimental group used 60 mg KTP every 6 hours, and the control group received 400 mg ibuprofen tablets every 6 hours for 1 day. The severity of pain experienced by patients was quantified before and at 2, 4, 8, 12, 24, and 48 hours after endodontic treatment, using the numerical rating scale (NRS). Data were analyzed by using the t-test, Mann-Whitney test, and generalized estimating equation (GEE) (alpha = 0.05). Results: The pain score was not significantly different between the two groups at the baseline or any other postoperative time point (P > 0.05). The reduction in the pain score was significant in both groups from 2 to 10 hours and 10 to 48 hours, postoperatively (P < 0.001). The interaction effect of time and group was not significant on the postoperative pain score in the abovementioned time intervals, and the pattern of pain reduction was the same over time in both groups (P > 0.05). Conclusion: Both KTP and ibuprofen effectively decreased postendodontic pain. Considering the comparable pattern of pain reduction, KTP can be used as an alternative to ibuprofen tablets for effective pain control after endodontic treatment of mandibular first and second molars with irreversible pulpitis.
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Cetoprofeno , Pulpitis , Humanos , Ibuprofeno/uso terapéutico , Pulpitis/tratamiento farmacológico , Cetoprofeno/uso terapéutico , Parche Transdérmico , Método Doble Ciego , Analgésicos/uso terapéutico , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/etiologíaRESUMEN
Introduction: Nano-technology applied for the local delivery of different agents and/or drugs has made its path to endodontics. In the current study, the antibacterial efficacy of biopolymer-coated ceramic microparticles loaded with a modified combination of triple antibiotics, i.e. Penicillin G, Metronidazole and Ciprofloxacin (PMC), was evaluated against two strains of Enterococcus faecalis (E.faecalis); a standard clinical strain obtained from previously root-filled teeth with persistent periapical lesions, and compared to the most common antimicrobials used in endodontics. Methods and Materials: After synthesis of the polymer-coated microparticles loaded with antibiotics, the 21-day release of antibiotics were evaluated and a stock solution was produced using the maximum released amount of drugs and distilled water. The antibacterial activity of PMC, triple antibiotic paste (TAP), calcium hydroxide (CH), chlorhexidine (CHX) and sodium hypochlorite (NaOCl) against two bacterial strains was determined using "Minimum Inhibitory Concentration" and "Agar Diffusion Test". Additionally, "Microtiter Plate Assay" was performed to assess anti-biofilm properties. Results: Minimum inhibitory concentration values reported for TAP and PMC were 1/256. PMC showed the maximum diameter of growth inhibition in both strains (33 mm and 35 mm), while CH had the minimum diameters (13 mm and13 mm). Based on microtiter plate assay, TAP showed higher biofilm formation than PMC. Biofilm formation was higher in the standard strain for PMC; however, NaOCl, CHX and CH completely inhibited biofilm formation. Conclusions: Based on the findings of the present study, it could be concluded that PMC and TAP were the most effective medicaments against E.faecalis in its planktonic form; however, none could inhibit its biofilm formation. Further studies using larger sample size and "Confocal Scanning Laser Microscopy" are recommended.
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Introduction: This study compared the cleaning effectiveness of NeoNiTi, 2Shape and Revo_S rotary instruments. Materials and Methods: Fifty mandibular molar mesial roots were selected with an angle of curvature less than 20 degrees divided into three groups (n=15). Five samples were selected as negative control group. In all three systems, the final file was 25, 6%. The score of debris and smear layer in three thirds (coronal, middle and apical) of the root canal walls were evaluated using scanning electron microscopic (SEM) magnification. The data were analyzed using the Kruskal Wallis and Mann Whitney U tests for intergroup comparison (P≤0.05) and Freidman and Wilcoxon signed-rank test was employed for intragroup comparison (P≤0.05). Results: Residual debris of the 2Shape system in the apical region was significantly higher than the other two systems (P=0.039). Revo_S and 2Shape groups had significantly higher quantities of debris in the apical than the coronal region (P=0.029 and P=0.02, respectively). In the 2Shape group, the amount of mid-region debris was significantly higher (P=0.005) than the coronal. In inter-group comparison there was no significant difference in residual smear layer between the systems. In intra-group comparison in all three systems, the amount of smear layer in the coronal third was significantly higher than in the other two areas. (P=0.017, P<0.001 and P=0.032, respectively). Conclusion: 2Shape left the highest amount of debris in the apical region. The amount of debris in Revo_S and 2Shape groups in the apical region was significantly higher than in the coronal. The amount of smear layer in all three groups in the coronal area was higher than the middle and apical areas.
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OBJECTIVE: The management of postoperative endodontic pain (PEP) is essential to contemporary endodontic practice. Diclofenac and ibuprofen (IBU) are two of the most widely-used non-steroidal anti-inflammatory analgesics. However, their comparative data are neither sufficient nor conclusive. This prospective randomised clinical trial aimed to compare the analgesic efficacy of diclofenac potassium (DFK) with IBU on PEP in maxillary and mandibular first molars diagnosed with irreversible pulpitis after single-visit non-surgical root canal treatment. METHODS: Sixty-four patients were randomised into two groups of DFK (n=32) and IBU (n=32), using the stratified permuted randomisation method, and 61 participants completed the trial. After root canal treatment, patients randomly received IBU 400 mg every 6 hours (n=31) or DFK 50 mg every 8 hours (n=30) for 24 hours. Patients recorded their pain level on 0-100 mm visual analogue scales (VAS) at 2, 4, 6, 12, and 24 hours after the treatment. Recorded VAS scores and the number of pain-free patients (VAS<5) were compared between the two groups. A generalised linear estimation equation model, Chi-Square test, and Mann-Whitney U test were used to analyse the data. RESULTS: The mean overall PEP score was statistically significantly lower in the DFK group than the IBU group with a p value of 0.030. Pain scores at 2 (p=0.034), 4 (p=0.021), and 24 hours (p=0.042) after the treatment were also significantly lower for DFK than IBU. The number of pain-free patients was also significantly higher in the DFK group at 2-hour (p=0.015) and 4-hour (p=0.048) time points and overall (p=0.013) compared to the IBU group. There was no adverse effect observed in either group. CONCLUSION: Based on the results, taking multi-dose DFK 50 mg by the clock had better analgesic outcomes than multi-dose IBU 400 mg for PEP management. (EEJ-2022-01-07).
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Ibuprofeno , Pulpitis , Humanos , Ibuprofeno/uso terapéutico , Diclofenaco/uso terapéutico , Pulpitis/terapia , Estudios Prospectivos , Analgésicos/uso terapéutico , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/etiología , Diente Molar/cirugíaRESUMEN
Background: Conflicting findings on the potency of antibiotic pastes versus calcium hydroxide (CH) have been evident in the literature. Aims: To compare the antibacterial efficacy of single antibiotic paste (SAP), double antibiotic paste (DAP), triple antibiotic paste (TAP), and modified TAP (mTAP) with CH on bacterial biofilms. Methods: PubMed, Scopus, and Embase were comprehensively searched until August 23, 2021. The study protocol was registered in the PROSPERO. Ex vivo studies performed on Enterococcus faecalis or polymicrobial biofilms incubated on human/bovine dentin were selected. The quality of the studies was assessed using a customized quality assessment tool. Standardized mean difference (SMD) with a 95% confidence interval (CI) was calculated for the meta-analysis. Meta-regression models were used to identify the sources of heterogeneity and to compare the efficacy of pastes. Results: The qualitative and quantitative synthesis included 40 and 23 papers, respectively, out of 1421 search results. TAP (SMD = -3.82; CI, -5.44 to -2.21; P < 0.001) and SAPs (SMD = -2.38; CI, -2.81 to - 1.94; P < 0.001) had significantly higher antibacterial efficacy compared to the CH on E. faecalis biofilm. However, no significant difference was found between the efficacy of DAP (SMD = -2.74; CI, -5.56-0.07; P = 0.06) or mTAP (SMD = -0.28; CI, -0.82-0.26; P = 0.31) and CH. Meta-regression model on E. faecalis showed that SAPs have similar efficacy compared to TAP and significantly better efficacy than DAP. On dual-species (SMD = 0.15; CI, -1.00-1.29; P = 0.80) or multi-species (SMD = 0.23; CI, -0.08-0.55; P = 0.15) biofilms, DAP and CH had similar efficacy. Conclusions: Ex vivo evidence showed that antibiotic pastes were either superior or equal to CH. The studied SAPs had considerably higher or similar antibacterial effectiveness compared to DAP, CH, and TAP. Hence, combined antibiotic therapy was not necessarily required for root canal disinfection ex vivo.
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Background: To compare the anesthetic efficacy of supplemental buccal infiltration (BI) (1.7 ml) versus intraligamentary (IL) injection containing 0.4 ml of 4% articaine with 1:100.000 epinephrine after an inferior alveolar nerve block (IANB) with 1.7 ml 2% lidocaine in the first and second mandibular molars diagnosed with irreversible pulpitis (IP). Methods: One hundred subjects diagnosed with IP of either the mandibular first (n = 50) or second molars (n = 50) and failed profound anesthesia following an IANB were selected. They randomly received either the IL or BI techniques of anesthesia. Pain scores on a 170 mm Heft-Parker visual analog scale were recorded initially, before, and during supplemental injections. Furthermore, pulse rate was measured before and after each supplemental injection. During the access cavity preparation and initial filing, no or mild pain was assumed to indicate anesthetic success. The chi-square test, Mann-Whitney U test, and independent samples t-test were used for the analyses. Results: The overall success rates were 80% in the IL group and 74% in the BI group, with no significant difference (P = 0.63). In the first molars, there was no significant difference between the two techniques (P = 0.088). In the second molars, IL injection resulted in a significantly higher success rate (P = 0.017) than BI. IL injection was statistically more successful (P = 0.034) in the second molars (92%) than in the first molars (68%). However, BI was significantly more successful (P = 0.047) in the first molars (88%) than in the second molars (64%). The mean pulse rate increase was significantly higher in the IL group than in the BI group (P < 0.001). Conclusions: Both the IL and BI techniques were advantageous when used as supplemental injections. However, more favorable outcomes were observed when the second molars received IL injection and the first molars received BI.
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INTRODUCTION: Pulp sensitivity tests are commonly used for assessment of pulp vitality. However, indirect assessment of pulp vitality by evaluation of nerve response and subjective nature are the main limitations of these tests. Pulse oximetry is used for assessment of blood oxygen saturation in medicine, and its efficacy for assessment of pulp vitality needs to be evaluated.
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Medicina , Oximetría , Dentición Permanente , OxígenoRESUMEN
OBJECTIVE: Streptococcus mutans is one of the principal causative agents of dental caries (tooth decay) found in the oral cavity. Therefore, this study investigates whether selenium nanoparticles (SeNPs) enhance the efficacy of photodynamic therapy (PDT) against both planktonic communities and the one-day-old biofilm of S. mutans. In this study, the planktonic and 24-h biofilm of S. mutans have been prepared in 96-cell microplates. These forms were treated by methylene blue (MB) and SeNPs and then were exposed to light-emitting diode (LED) lighting. Finally, the results have been reported as CFU/ml. RESULTS: The outcomes demonstrated that MB-induced PDT and SeNPs significantly reduced the number of planktonic bacteria (P-value < 0.001). The comparison between the treated and untreated groups showed that combining therapy with SeNPs and PDT remarkably decreased colony-forming units of one-day-old S. mutans biofilm (P-value < 0.05). The findings revealed that PDT modified by SeNPs had a high potential to destroy S. mutans biofilm. This combination therapy showed promising results to overcome oral infection in dental science.
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Caries Dental , Nanopartículas , Selenio , Biopelículas , Caries Dental/tratamiento farmacológico , Humanos , Fármacos Fotosensibilizantes/farmacología , Plancton , Selenio/farmacología , Streptococcus mutans/fisiologíaRESUMEN
Introduction: This study investigated the amount of debris and smear layer remaining followed chemomechanical preparation using three systems: ProTaper Universal, reciprocating SafeSider, and hand K-Flexofiles with scanning electron microscope (SEM). Materials and Methods: Sixty-five mandibular molars with mesiobuccal canal curvature (25 to 40°) were extracted and divided into one control group (n=5), and three experimental groups (n=20) according to the preparation method; K-Flexofile, ProTaper Universal and SafeSider instruments. All canals were irrigated with 3 ml of 5.25% sodium hypochlorite solution and 3 mL of 17% EDTA. Subsequently, the canals were irrigated with 5 ml of normal saline. Then the teeth were examined under the scanning electron microscope (SEM). Kruskal-Wallis, Dunn-Q Bonferroni, and Friedman tests were used for statistical analysis of results. Results: To assess the accumulation of debris, statistically significant differences were observed only in the coronal area among ProTaper Universal, SafeSider, K-Flexofile, and the control group. (P=0.029). To evaluate the residual smear layer amount, statistically significant differences were observed only in the coronal and middle areas, following the preparation of the canals using ProTaper Universal, SafeSider, and hand K-Flexofiles and control groups (P=0.019). Conclusions: Based on the present in vitro study, we can declare that the canals were utterly cleaned of debris and smear layer in none of the groups. Manual Flexofile and ProTaper Universal groups result in cleaner canal walls than reciprocal SafeSider, in the coronal and middle thirds.
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AIMS: A glide path is created prior to root canal instrumentation by nickel-titanium (NiTi) rotary files to increase the efficiency and safety of cleaning and shaping. This study aimed to assess root canal transportation in use of different glide path files in curved canals. MATERIALS AND METHODS: 30 sound mesiobuccal root canals of mandibular molars with 20° to 40° curvature were selected and randomly assigned to 3 groups of EdgeGlidePath (EGP, EdgeEndo), One-G (Micro-Mega), and Neolix (Neoniti). The specimens were scanned before and after glide path creation by microcomputed tomography (micro-CT). The pre- and postoperative micro-CT scans were superimposed, and the degree of canal transportation and centering ratio were measured at 1, 3, 5, and 7 mm distances from the apical foramen. Statistical Analysis. The data were analyzed by two-way and one-way ANOVA. RESULTS: The effects of distance from the apical foramen and instrument type and the interaction effect of the two were not significant on the centering ability of the files or canal transportation. CONCLUSION: EdgeGlidePath, One-G, and Neolix files fabricated from the conventional NiTi alloy or heat-treated M-Wire alloy showed similar performance regarding centering ability and canal transportation in glide path preparation in curved canals.
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BACKGROUND: Selenium Nanoparticles (SeNPs) were reported as an agent that may enhance the effectiveness of Photodynamic Antimicrobial Chemotherapy (PACT). This in vitro study evaluates the effect of SeNPs on the efficacy of Methylene Blue (MB)-induced PACT against the biofilm formated in 96-well plates and the dentine tubule biofilm of Enterococcus faecalis. METHODS: Chitosan coated SeNPs were synthesized using chemical reduction method and were characterized by Transmission Electron Microscope (TEM) and Dynamic Light Scattering (DLS). Twenty-four-hour biofilms of E. faecalis were developed on 96-well plates and treated with SeNPs, MB, and Light-Emitting Diode (LED). Also, three-week biofilms of E. faecalis were formed on 67 specimens of dentinal tubules, and the antibacterial effects of MB+SeNPs on these biofilms were studied. RESULTS: The average hydrodynamic diameter of SeNPs was 80/3 nm according to DLS measurement. The combined use of MB and SeNPs significantly reduced Colony-Forming Units (CFUs) of one-day-old E. faecalis biofilms in comparison with the control group (P value < 0.05). Besides, combination therapy had the most antibacterial effect on root canal E. faecalis biofilms at both 200 and 400 µm depths of dentine tubules (P value < 0.001). Of note, about 50% of human fibroblast cells survived at a concentration of 128 µg/ml of SeNPs, compared to the control group. CONCLUSION: The results demonstrated that the photodynamic therapy modified by SeNPs could be an effective disinfection alternative to the destruction of E. faecalis biofilms and root canal treatment.
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Antiinfecciosos , Nanopartículas , Fotoquimioterapia , Selenio , Biopelículas , Cavidad Pulpar , Enterococcus faecalis , Humanos , Fotoquimioterapia/métodos , Fármacos Fotosensibilizantes/farmacología , Selenio/farmacologíaRESUMEN
The objective of the current study was to compare the anaesthetic efficacy of supplemental intraligamentary (IL) injection of 4% articaine with that of 2% lidocaine in the mandibular first and second molars with irreversible pulpitis after an ineffective inferior alveolar nerve block injection (IANB) using the same anaesthetic in a randomised triple-blind clinical trial. Seventy-six adult patients, who were diagnosed with irreversible pulpitis in the mandibular first or second molars, were divided into 2 groups and received IANB randomly. In patients with lip numbness, anaesthesia was evaluated with the cold and electrical pulp (EPT) tests, and if the reported number on EPT was below 100, supplemental IL injection was administered using the same anaesthetic. The teeth were retested after 5 minutes. The Heft-Parker visual analogue scale was used to evaluate pain after IANB and IL injections. Statistical analysis was performed using repeated measures ANOVA, chi-square, and independent-sample and paired-sample t-tests. The results showed that there was no significant difference in the success rates of supplemental IL and IANB injections between articaine and lidocaine. Furthermore, there was no significant difference in the success rates of supplemental IL injection with lidocaine between the mandibular first and second molars. However, there was a significant difference in the success rates of supplemental IL injection with articaine between the mandibular first and second molars. Moreover, supplemental IL injections indicated no significant difference in the anaesthetic efficacy between articaine and lidocaine; nevertheless, they were more effective in the mandibular second molars, especially with articaine.