Evaluation of the safety and efficiency of novel metallic ultrasonic scaler tip on titanium surfaces.

AIM: To evaluate the safety and efficiency of novel ultrasonic scaler tips, conventional stainless-steel tips, and plastic tips on titanium surfaces. MATERIAL AND METHODS: Mechanical instrumentation was carried out using conventional ultrasonic scalers (EMS, Nyon, Switzerland) with novel metallic implant tip (BS), a plastic-headed tip (ES), a plastic tip (PS) and a conventional stainless-steel tip (CS) on 10 polished commercially pure titanium disks (Grade II) per group. Arithmetic mean roughness (R(a) ) and maximum height roughness (R(y) ) of titanium samples were measured and dissipated power of the scaler tip in the tip-surface junction was estimated to investigate the scaling efficiency. The instrumented surface morphology of samples was viewed with a scanning electron microscope (SEM) and surface profile of the each sample was investigated using contact mode with a commercial atomic force microscope (AFM). RESULTS: There were no significant differences in surface roughness (R(a) and R(y) ) among BS, ES, and PS group. However, CS group showed significant higher surface roughness (R(a) and R(y) ). The efficiency of CS tip is twice as much higher than that of BS tip, the efficiency of BS tip is 20 times higher than that of PS tip, and the efficiency of BS tip is 90 times higher than that of ES tip. CONCLUSION: Novel metallic copper alloy ultrasonic scaler tips may minimally influence the titanium surface, similar to plastic tip. Therefore, they can be a suitable instrument for implant maintenance therapy.

Microleakage of accelerated mineral trioxide aggregate and Portland cement in an in vitro apexification model.

The purpose of this study was to evaluate the microleakage of accelerated mineral trioxide aggregate (MTA) and Portland cement by flow porometry analysis in an in vitro apexification model. Sixty-four single-rooted, extracted teeth were divided into 4 groups (group 1, MTA; group 2, MTA with accelerator; group 3, Portland cement; and group 4, Portland cement with accelerator). In an in vitro apexification model, MTA or Portland cement mixed with or without 10% CaCl2 was condensed to 2-mm thickness. The negative control group (n = 4) had the apical foramen sealed with epoxy resin. The maximum and mean flow pore diameters of the samples were tested by capillary flow porometry at 90 minutes and 48 hours after obturation. The addition of accelerator significantly reduced the maximum pore diameters of MTA and Portland cement at the initial setting phase. After 48 hours of obturation, the maximum and mean flow pore diameters of the accelerated samples were significantly reduced compared with the normal samples. There was no statistically significant difference in the maximum pore diameter of MTA and Portland cement between the measurements at 90 minutes and 48 hours. The results imply that the addition of accelerator into MTA or Portland cement can be useful in a one-visit apexification by reducing microleakage even in an early setting time.

Effects of short-term chemical disinfection of gutta-percha cones: identification of affected microbes and alterations in surface texture and physical properties.

The aims of this study were to identify microorganisms on the surface of gutta-percha (GP) cones using a polymerase chain reaction (PCR) and to evaluate the sterilization effect of 5.25% sodium hypochlorite (NaOCl), 2% chlorhexidine (CHX), and ChloraPrep on these bacteria. Alterations of the surface texture and physical properties of GP cone after chemical sterilization were compared. A total of 150 GP cones were randomly selected in endodontic clinics, and a PCR assay was performed to identify the contaminating microorganisms. After inoculation with the same microorganisms followed by drying for 1 day, the GP cones were immersed in the three chemical disinfectants. The sterilization effects were assessed by measuring the turbidity and through subculturing. The changes in surface texture were observed by scanning electron microscopy, and Instron 5500 (Instron Corp, Canton, MA) was used to measure the tensile strength and elongation rate of the GP cones after chemical sterilization. Statistical analysis was performed. Results indicate that 19.4% of GP cones from the clinic were contaminated, and all the species belonged to the genus Staphylococcus. Three chemical disinfectants were all effective in the rapid disinfection of GP cones against Staphylococcus spp, and 1-minute immersion of the GP cones was adequate for disinfection. Microphotographs of the NaOCl-soaked cone showed a cluster of cuboidal crystals. The tensile strength between the NaOCl- and CHX-soaked groups was significantly different (p<0.05), but there was no significant difference between the NaOCl- and ChloraPrep-soaked groups (p>0.05). All disinfectants significantly increased the elongation rate of the GP cones compared with fresh GP cones (p<0.05), especially in the ChloraPrep (Medi-flex, Leawood, KS). These results show that the three chemical disinfectants are effective agents for the rapid sterilization of GP cones. However, further research will be needed to determine the clinical relevance of the changes in physical properties.

In vitro evaluation of the sealing ability of newly developed calcium phosphate-based root canal sealer.

This study compared the sealing ability of newly developed calcium phosphate-based root canal sealers (CAPSEAL I, CAPSEAL II) with other calcium phosphate-based sealer (Sankin Apatite Root Canal Sealer: SARCS I, SARCS III), a resin-based sealer (AH Plus), a ZOE-based sealer (Pulp Canal Sealer EWT), and a calcium hydroxide-based sealer (Sealapex) by using an anaerobic bacterial leakage model with Prevotella nigrescens during a 90-day observation period (n=15/group). SARCS I and III had significantly greater leakage with P. nigrescens than all other groups (P<.05). There was no other statistical difference between the sealers. Field emission-scanning electron microscope observations showed that both CAPSEAL I and II sealers were well-adapted to the canal wall and infiltrated into the dentinal tubules.

Multiplex polymerase chain reaction detection of black-pigmented bacteria in infections of endodontic origin.

The purpose of this study was to detect the presence of Porphyromonas endodontalis, P. gingivalis, Prevotella intermedia, P. nigrescens, and P. tannerae from clinical samples using multiplex polymerase chain reactions (PCR). Two different multiplex PCR protocols were used (one for the two Porphyromonas species and the other for the three Prevotella species), each one using a primer pair specific for each target species. The results were compared to those of the conventional culture procedures. Microbial samples were taken aseptically from 40 infected root canals and abscesses from patients. Samples were cultured in an anaerobic condition for conventional identification using a Rapid ID 32 A kit. Multiplex PCR was processed using the DNA extracted from each sample. At least one of the five species of black-pigmented bacteria (BPB) were detected in 65% (26 of 40) of the samples using multiplex PCR, and in 15% (6 of 40) using the conventional culture procedures. Multiplex PCR was more rapid, sensitive, specific, and effective in detecting BPB than the conventional culture procedures.

Saving an Integrating Implant Involved with Endodontic Implant Pathology Using Surgical Treatment.

Endodontic implant pathology (EIP) refers to cases in which endodontic infections cause infections in adjacent implants, and vice versa. This case report demonstrates the successful resolution of two types of EIPs, implant endodontitis and endodontic implantitis, by endodontic intervention with surgical treatment. In case 1, the patient complained of tooth discomfort after implant placement in the adjacent tooth. The tooth was sensitive to percussion and showed slight mobility with a negative reaction to an electric pulp test. The symptoms persisted despite conventional root canal treatment, and surgical treatment of the symptomatic tooth and implant lesion was performed. In case 2, the patient suffered from repeated infection around a newly installed implant. The adjacent devitalized tooth exhibited a periapical lesion that was contiguous with the implant. Conventional root canal treatment and retreatment did not successfully resolve the symptoms. Surgical root canal therapy was then performed with regenerative biomaterials as needed. Neither case showed radiographic or clinical evidence of failure after 4 and 5 years of follow-up, respectively, after the surgery and the adjacent implants were successfully osseointegrated. Endodontic intervention combined with surgical treatment resolved both types of EIPs and led to tooth preservation and successful osseointegration of adjacent implants.

The expression of alpha4 integrins by human polymorphonuclear neutrophils in response to sonicated extracts of Enterococcus faecalis.

This study was undertaken to investigate immunopathologic mechanism of Enterococcus faecalis in relation to persistent apical periodontitis. We monitored the expression levels of alpha4 integrin in human polymorphonuclear neutophils (PMNs) after stimulated with sonicated extracts of E. faecalis (SEF) and compared with lipopolycaccarides (LPS) of Escherichia coli for various incubation time. Venous blood was collected from healthy volunteers and then PMNs were isolated and cultured with various concentrations of SEF for different periods of time. The levels of alpha4 integrin were measured by flow cytometry analysis. E. coli LPS group was used as a positive control and untreated PMNs as a negative control. Results showed that the expressions levels of alpha4 integrin were increased in human PMNs stimulated with E. coli LPS in comparison with unstimulated control cells (p < 0.05). In case of SEF stimulated group, the expression levels were decreased in time-dependent manner in comparison to E. coli LPS group (p < 0.05). Notably, after 12 h for incubation with SEF, the expression of alpha4 integrin was decreased in dose-dependent manner (p < 0.05). These findings suggest that E. faecalis seem to suppress PMNs recruiting activity by down-regulating alpha4 integrin expression, providing the possible mechanism that E. faecalis may play a crucial role in persistent apical periodontitis.

Mechanical properties and microstructure analysis of mineral trioxide aggregate mixed with hydrophilic synthetic polymer.

INTRODUCTION: In dentistry, mineral trioxide aggregate (MTA) has been widely used for root perforation, retrograde filling, pulp capping and regenerative endodontics. Despite its superior sealing ability and biocompatibility, MTA has critical drawbacks regarding handling property such as sandy property, lacking cohesive properties and wash-out tendency. So, it is necessary to improve the fluidity of MTA in order to improve its handling properties. In this study, we applied modified liquid to improve handling properties of MTA. METHODS: Polyvinyl alcohol (PVA; 3 and 5 wt %) aqueous solutions were prepared and the samples were divided into three groups: DW group (MTA mixed with distilled water), P3 group (MTA mixed with 3% PVA), and P5 group (MTA mixed with 5% PVA). Handling property, initial setting time, and compressive strength were evaluated. The microstructures were observed by Field emission scanning electron microscope (FE-SEM) and X-ray diffractometer (XRD) phase analyses were performed. RESULTS: PVA modified group showed similar behavior of IRM compared to DW group. The initial setting time of P3 or P5 group was significantly longer than that of DW group (p < 0.05). The compressive strength of DW group was higher than that of P3 or P5 groups (p < 0.05). Experimental groups (P3 and P5) showed no microstructural differences compared with DW group when the fractured surfaces were observed by FE-SEM with XRD patterns after 3 and 14 days. CONCLUSIONS: Polyvinyl alcohol, a modified liquid for MTA, improved the handling properties of the material without violating its microstructure.

Comparison of the rheological properties of four root canal sealers.

The flowability of a root canal sealer is clinically important because it improves the penetration of the sealer into the complex root canal system. The purpose of this study was to compare the flowabilities of four root canal sealers, measured using the simple press method (ISO 6876), and their viscosities, measured using a strain-controlled rheometer. A newly developed, calcium phosphate-based root canal sealer (Capseal) and three commercial root canal sealers (AH Plus, Sealapex and Pulp Canal Sealer EWT) were used in this study. The flowabilities of the four root canal sealers were measured using the simple press method (n=5) and their viscosities were measured using a strain-controlled rheometer (n=5). The correlation between these two values was statistically analysed using Spearman's correlation test. The flow diameters and the viscosities of the root canal sealers were strongly negatively correlated (ρ=-0.8618). The viscosity of Pulp Canal Sealer EWT was the lowest and increased in the following order: AH Plus

Scanning electron microscopy study of the adhesion of Prevotella nigrescens to the dentin of prepared root canals.

The purpose of this study was to evaluate the effect of the presence or absence of amorphous, irregular smear layers on the adhesion of Prevotella nigrescens, to the dentin of the root canal by using scanning electron microscopy (SEM). Human incisors extracted within 7 days, with no cavities, no fractures, and no evidence of calcification of the canal, were selected. After cutting the crown portion at the CEJ, root canal preparation was undertaken by using a modified crown-down technique with Profile and Gates Glidden drills. Ten milliliters of physiologic saline solution (groups 1 and 4), 10 ml of 3.5% NaOCl (groups 2 and 5), or 10 ml of NaOCl and 10 ml of 0.5 M EDTA (groups 3 and 6) were used as irrigation solution while preparing the canal. After vertical sectioning and ethylene oxide gas sterilization, samples (groups 1, 2, and 3) were immersed in brain-heart infusion broth with yeast extract, hemin, and menadione, inoculated with P. nigrescens (ATCC 33563), and incubated for 3 h at 37 degrees C. All samples were prepared for and observed with SEM. The data were analyzed by using t test and one-way ANOVA. Smear layer was observed to cover the entire root canal surface after root canal preparation. Smear layer was removed and the entrances of dentinal tubules opened widely after applying 3.5% NaOCl and 0.5 M EDTA. A significantly greater number of bacteria were found to adhere to those teeth in which a smear layer was present (p < 0.05). Given that the smear layer produced during root canal preparation promoted adhesion and colonization of P. nigrescens to the dentin matrix, it might also increase the likelihood of canal reinfection.

Sonicated extract of Enterococcus faecalis induces irreversible cell cycle arrest in phytohemagglutinin-activated human lymphocytes.

The purpose of this study was to examine whether the sonicated extract of Enterococcus faecalis (SEF) alters the cell cycle transition of lymphocytes and thus regulates the fate of the arrested cells. Human lymphocytes were activated by phytohemagglutinin in the presence or absence of SEF, and cell cycle was assessed by flow cytometry. Seventy-two hours after activation with phytohemagglutinin, cells were activated from G0/G1 to S (6.1%) and G2/M (3.8%) phases of the cell cycle. In contrast, pretreatment with SEF resulted in 90.5% of cells remaining in G0/G1, and cell cycle progression to the S and G2/M phases was consequently inhibited. Caspase assay demonstrated that SEF-treated cells exhibited significantly increased apoptosis (56.7%) compared with phytohemagglutinin alone (28.1%). We propose that if this irreversible cell cycle arrest induced by E. faecalis occurs in vivo, it may result in local immunosuppression and contribute to the pathogenesis of endodontic failure. Our findings that E. faecalis can inhibit lymphocyte responses may be of particular relevance to the pathogenesis of endodontic failure. Although the immunologic mechanism involved in the pathogenesis of persistent periapical lesion is not clearly defined, it is reasonable to predict that the altered immune reaction may be linked to the immunosuppressive potential of E. faecalis or other oral bacteria.

In vivo study on the biocompatibility of newly developed calcium phosphate-based root canal sealers.

This study compared the biocompatibility of two new calcium phosphate-based root canal sealers (CAPSEAL I, CAPSEAL II) with another type of commercially available calcium phosphate sealer (Apatite Root Sealer type I, Apatite Root Sealer type II) and a zinc oxide eugenol-based sealer (Pulp Canal Sealer EWT) after implanting them in the subcutaneous tissue of rats. After 1, 2, 4, and 12 weeks, the tubes were removed with the surrounding tissues. The tissue reactions were graded as being mild or 1, moderate or 2, and severe or 3 after a histopathological examination. The results were analyzed statistically with the Kruskal-Wallis test. The biocompatibility of the materials was interpreted according to the Federation Dentaire Internationale criteria (1980). The inflammatory reactions decreased with time. The new sealers showed a lower tissue response than any of the other sealers in all the experimental periods. All the tested sealers showed an acceptable biocompatibility.

Shaping ability of the conventional nickel-titanium and reciprocating nickel-titanium file systems: a comparative study using micro-computed tomography.

INTRODUCTION: This study used micro-computed tomographic imaging to compare the shaping ability of Mtwo (VDW, Munich, Germany), a conventional nickel-titanium file system, and Reciproc (VDW), a reciprocating file system morphologically similar to Mtwo. METHODS: Root canal shaping was performed on the mesiobuccal and distobuccal canals of extracted maxillary molars. In the RR group (n = 15), Reciproc was used in a reciprocating motion (150° counterclockwise/30° clockwise, 300 rpm); in the MR group, Mtwo was used in a reciprocating motion (150° clockwise/30° counterclockwise, 300 rpm); and in the MC group, Mtwo was used in a continuous rotating motion (300 rpm). Micro-computed tomographic images taken before and after canal shaping were used to analyze canal volume change and the degree of transportation at the cervical, middle, and apical levels. The time required for canal shaping was recorded. Afterward, each file was analyzed using scanning electron microscopy. RESULTS: No statistically significant differences were found among the 3 groups in the time for canal shaping or canal volume change (P > .05). Transportation values of the RR and MR groups were not significantly different at any level. However, the transportation value of the MC group was significantly higher than both the RR and MR groups at the cervical and apical levels (P < .05). In the scanning electron microscopic analysis, file deformation was observed for 1 file in group RR (1/15), 3 files in group MR (3/15), and 5 files in group MC (5/15). CONCLUSIONS: In terms of shaping ability, Mtwo used in a reciprocating motion was not significantly different from the Reciproc system.

Analysis of six heavy metals in Ortho mineral trioxide aggregate and ProRoot mineral trioxide aggregate by inductively coupled plasma-optical emission spectrometry.

Ortho mineral trioxide aggregate (MTA) is a mineral aggregate newly developed for perforation repair, root end filling and pulp capping. The aim of this study was to investigate the levels of cadmium (Cd), copper (Cu), iron (Fe), manganese (Mn), nickel (Ni) and zinc (Zn) in Ortho MTA and ProRoot MTA. A total of 0.2 g of each MTA was digested using a mixture of hydrochloric and nitric acids and filtered. Six heavy metals in the resulting filtrates were analyzed by inductively coupled plasma-optical emission spectrometry (n = 5). The results were statistically analyzed using the Mann-Whitney U-test. The concentrations of Cd, Cu, Fe, Mn, Ni and Zn in Ortho MTA were 0.10, 7.73, 49.51, 2.58, 0.82 and 10.09 p.p.m., respectively. The concentrations of Cd, Cu, Fe, Mn, Ni and Zn in ProRoot MTA were 0.16, 9.38, 1438.11, 74.51, 18.98 and 4.05 p.p.m., respectively. In conclusion, Ortho MTA had lower levels of Cd, Cu, Fe, Mn and Ni than ProRoot MTA.

Effect of laser-activated irrigation of 1320-nanometer Nd:YAG laser on sealer penetration in curved root canals.

INTRODUCTION: The purpose of this study was to investigate the efficacy of laser-activated irrigation (LAI) of 1320-nm neodymium-doped:yttrium-aluminum-garnet (Nd:YAG) laser on sealer penetration into dentinal tubules in the presence of 5.25% sodium hypochlorite (NaOCl) or 17% ethylenediaminetetraacetic acid (EDTA). METHODS: The curved root canals (>20°) from 63 extracted human molars (negative control, n = 3) were prepared to size #30.06 with NaOCl irrigation. Teeth were divided into 4 groups (n = 15) as follows: group N, NaOCl irrigation without LAI; group E, EDTA irrigation without LAI; group NL, LAI with NaOCl; group EL, LAI with EDTA. In all groups, the laser fiber was inserted and withdrawn 4 times for 5 seconds each. Teeth were obturated with gutta-percha and fluorescent-labeled sealer. Transverse sections at 2 and 5 mm from root apex were examined with confocal laser scanning microscopy, and the percentage of sealer penetration into dentinal tubules was measured. RESULTS: Groups E, NL, and EL showed higher percentage of sealer penetration than group N (P < .05). With NaOCl as irrigant, LAI (group NL) resulted in significantly higher amount of sealer penetration than nonactivated group (group N) in both levels (P < .05). However, with EDTA, no significant differences in sealer penetration were observed between the laser-activated group (group EL) and its nonactivated counterpart (group E) in both levels (P > .05). CONCLUSIONS: The 1320-nm Nd:YAG laser activation with either NaOCl or EDTA was much better than NaOCl irrigation alone and as effective as EDTA final flush for sealer penetration into dentinal tubules. Additional use of laser with EDTA did not improve the quality of obturation in the curved canals.

Effects of calcium phosphate endodontic sealers on the behavior of human periodontal ligament fibroblasts and MG63 osteoblast-like cells.

In regard to biological properties of endodontic sealers, there are many characteristics that should be considered. The aim of this study was to examine the biological effects of new calcium phosphate-based root canal sealers, CAPSEAL I and CAPSEAL II (CPS), on human periodontal fibroblast cells by examining the expression levels of inflammatory mediators and to compare the effects of CPS on the viability and osteogenic potential of human osteoblast MG63 cells compared to those of other commercially available calcium phosphate sealers [Apatite Root Sealer type I (ARS I) and Apatite Root Sealer III (ARS III); Sankin Kogyo, Tokyo, Japan] and a zinc oxide eugenol-based sealer (Pulp Canal Sealer EWT [PCS EWT]; Kerr, Detroit, MI). The levels of IL-6 in the new CPS group (CAPSEAL I, II) were higher than those in the control and all experimental groups at all time points after 2 h. TGF-ß1 and FGF-1 levels decreased at 72 h compared to the levels in the control, in cells treated with every sealers except ARS I. The new CPS sealers showed low cytotoxicity. Reverse transcription polymerase chain reaction showed that CAPSEAL I, II, and Apatite Root Sealer type III induced expression of early stage markers of differentiation (alkaline phosphatase and osteopontin) at 7 days. Also, new CPS showed higher mineralized nodule formation at 28 days. These results suggest that CAPSEAL I and II facilitate the periapical dentoalveolar and alveolar healing by controlling cellular mediators from PDL cells and osteoblast differentiation of precursor cells.

Chemical interaction of alexidine and sodium hypochlorite.

INTRODUCTION: Recent studies have reported the color change and formation of precipitates containing para-chloroaniline (PCA) after a reaction of sodium hypochlorite (NaOCl) and chlorhexidine (CHX). Alexidine (ALX), a biguanide disinfectant similar to CHX, has greater affinity for bacterial virulence factors than CHX. This study determined by electrospray ionization mass spectrometry (ESI-MS) and scanning electron microscopy (SEM) whether the chemical interaction between ALX and NaOCl results in PCA or precipitates. METHODS: ESI-MS was performed on 4 different concentrations of ALX (1%, 0.5%, 0.25%, and 0.125%) with 4% NaOCl to detect the presence of PCA. As control groups, 1% ALX, 0.5% PCA, and a mixture of 2% CHX and 4% NaOCl were analyzed. The formation of precipitates on the dentinal surfaces of premolar root canals treated with the solutions of ALX and NaOCl (AN) or CHX and NaOCl (CN) was observed by SEM and the color change in the reaction solutions was also analyzed. RESULTS: ESI-MS showed that the peak (mass/charge ratio = 128.026) in the PCA spectrum was not detected in any of the 4 AN solutions, whereas the peak was found in the CN solution. SEM revealed precipitates covering dentinal surfaces in the CN solution. The AN solutions produced no precipitate. The AN solutions changed in color from light yellow to transparent with decreasing ALX concentration, whereas peach-brown discoloration was observed in the CN solution. CONCLUSIONS: The interaction of ALX and NaOCl did not produce PCA or precipitates, and the color of the reacted solution changed transparent with decreasing ALX concentration.

Evaluation of pH and calcium ion release in capseal I and II and in two other root canal sealers.

OBJECTIVE: The aim of this study was to compare the pHs and calcium ion releases of newly developed, calcium phosphate-based root canal sealers (Capseal I and II) with those of Sealapex (SA) and Sankin Apatite Root Sealer III (SARS III). STUDY DESIGN: Each material (n = 10) was mixed, inserted into polyvinyl chloride (PVC) tubes, and immersed in a vial containing deionized water. The control group consisted of empty PVC tubes (n = 10). The pHs and calcium ion releases were measured by pH meter and ICP-AES (inductively coupled plasma atomic emission spectrometer) at 24 hours and 96 hours, and at 7, 15, and 28 days. The results were analyzed with the Kruskal-Wallis test. RESULTS: Capseal I and II produced pHs and calcium ion releases higher than or equal to those of SA and SARS III (P < .05). CONCLUSIONS: Capseal I and II resulted in higher alkalinity and higher calcium ion releases than SA and SARS III.

Shaping ability of reciprocating motion in curved root canals: a comparative study with micro-computed tomography.

INTRODUCTION: Recently, root canal shaping with reciprocating motion has been postulated to reduce the possibility of unexpected file fractures. However, there has been little information on the shaping capability of this reciprocating motion preparation technique. Therefore, the purpose of this study was to evaluate the shaping ability of reciprocating motion when compared with continuous rotation motion in curved root canals. METHODS: The mesiobuccal and distobuccal canals of 20 extracted maxillary molars with curvatures of 20-45 degrees were instrumented with a series of ProTaper rotary files. The canals in the continuous rotation motion (CM) group (n = 20) were prepared by using continuous rotation with pecking motion, whereas the canals in the reciprocating motion (RM) group (n = 20) were prepared with reciprocating motion (clockwise 140 degrees and counterclockwise 45 degrees). Basic geometric parameters such as curvature, root canal volume, surface area, and structure model index (SMI) before and after canal shaping were evaluated by using micro-computed tomography. The degrees and directions of transportation were also measured, and statistical analysis was carried out with one-way analysis of variance and Tukey post hoc tests. RESULTS: There were no significant differences between the 2 groups in canal curvature, volume, surface area, and SMI categories measured before preparation (P > .05). Changes in curvature, root canal volume, surface area, and SMI were not affected by the instrumentation technique used (P > .05). There were no significant differences in the degrees and directions of transportation between CM and RM groups (P > .05). CONCLUSIONS: The application of reciprocating motion during instrumentation did not result in increased apical transportation when compared with continuous rotation motion, even in the apical part of curved canals. Reciprocating motion might be an attractive alternative method to prevent procedural errors during root canal shaping.

Matrix metalloproteinase-8 and substance P levels in gingival crevicular fluid during endodontic treatment of painful, nonvital teeth.

OBJECTIVE: The aim of this study was to investigate levels of matrix metalloproteinase-8 (MMP-8) and substance P (SP) in gingival crevicular fluid (GCF) during root canal treatment (RCT) of nonvital teeth. STUDY DESIGN: Patients scheduled for nonsurgical RCT were prospectively selected; all patients provided informed consent. GCF samples were collected from teeth scheduled for RCT and their contralateral teeth across 3 different time periods. MMP-8 and SP levels were measured using enzyme-linked immunosorbent assay (ELISA). Data were analyzed using a mixed model analysis and the Pearson correlation analysis. RESULTS: Patients' subjective pain levels were significantly related to both MMP-8 and SP levels. MMP-8 and SP levels in GCF were decreased during RCT, and they showed a positive correlation with each other (P < .05). CONCLUSIONS: This study demonstrated that periradicular inflammation of endodontic origin can elevate SP and MMP-8 levels in GCF.