The outcome of combined use of iRoot BP Plus and iRoot SP for root-end filling in endodontic microsurgery: a randomized controlled trial.

OBJECTIVES: Root-end filling is important for the clinical outcome of endodontic microsurgery. Our previous study showed that combined application of iRoot BP Plus Root Repair Material (BP-RRM) and iRoot SP Injectable Root Canal Sealer (SP-RCS) in root-end filling exhibited better apical sealing as compared to the application of BP-RRM alone. The aim of this randomized controlled clinical trial was to evaluate the effect of the combined use of BP-RRM and SP-RCS on the prognosis of teeth with refractory periapical diseases after endodontic microsurgery. MATERIALS AND METHODS: 240 teeth with refractory periapical diseases scheduled for endodontic microsurgery were randomly divided into BP-RRM/SP-RCS group (n = 120) and BP-RRM group (n = 120). The patients were followed up at 3 months, 6 months, and 12 months after endodontic microsurgery. Pre- and post-operative clinical and radiographic examinations were performed to evaluate the treatment outcome. The 1-year success rate of endodontic microsurgery in BP-RRM/SP-RCS and BP-RRM groups was compared by Chi-square test. Factors that might impact the prognosis were further analyzed using Chi-square test or Fisher's exact test. RESULTS: A total of 221 teeth completed the 12-month follow-up. The 1-year success rates of the BP-RRM/SP-RCS and BP-RRM groups were 94.5% (104/110) and 92.8% (103/111), respectively. The combined use of BP-RRM and SP-RCS achieved a clinical outcome comparable to BP-RRM alone (P = 0.784). Tooth type (P = 0.002), through-and-through/apico-marginal lesion (P = 0.049), periodontal status (P < 0.0001), and Kim's lesion classification (P < 0.0001) were critical factors associated with the 1-year success of endodontic microsurgery. CONCLUSIONS: The combined use of BP-RRM and SP-RCS is a practicable method for root-end filling in endodontic microsurgery with a satisfactory 1-year clinical outcome. CLINICAL RELEVANCE: The combined application of BP-RRM and SP-RCS in EMS is an effective root-end filling method with a satisfactory 1-year clinical outcome. TRIAL REGISTRATION: This study was registered in the Chinese Clinical Trial Registry (ChiCTR2100052174).

3D-fEA of stress levels and distributions for different bases under a Class I composite restoration.

PURPOSE: To investigate the level and distribution of stresses in composite-restored mandibular first molars with various combinations of base materials. METHODS: The finite element package Abaqus was used for the stress analysis. Several different base materials were evaluated [light-cured glass ionomer (LC-GI), chemically-cured calcium hydroxide (CC-CH), and light-cured calcium hydroxide (LC-CH)] in combination with light-cured composite (LC-CP). Four models of restored molars with Class I deep cavity preparations were simulated, including (1) LC-GI/LC-CP, (2) CC-CH/LC-CP, (3) CC-CH/LC-GI/LC-CP, and (4) LC-CH/LC-GI/LC-CP. A 250N static single-point load was applied vertically on the central fossa of the tooth to simulate physical loading conditions. RESULTS: In each case, the peak stresses were found to be concentrated mainly at the interfaces between the various materials and the dental tissues. In the residual tooth structures, the maximum Von Mises stresses were 20.01 MPa in model LC-GI/LC-CP, 23.85 MPa in model CC-CH/LC-CP, 23 MPa in model CC-CH/LC-GILC-CP and 21.83 MPa in model LC-CH/LC-GIILC-CP. In the LC-CP restorations, the maximum Von Mises stresses were 43.68 MPa in model LC-GILC-CP, 42.24 MPa in model CC-CH/LC-CP, 42.29 MPa in model CC-CH/LC-G/LC-CP and 42.55 MPa in model LC-CH/LC-GI/LC-CP. In the bases, the maximum Von Mises stresses were 5.71 MPa in model LC-GI/LC-CP, 0.85 MPa in model CC-CH/LC-CP, 4.69 MPa in model CC-CH/LC-GI/LC-CP, and 4.93 MPa in model LC-CH/LC-GILC-CP.

A retrospective study of endodontic microsurgery about 302 patients.

OBJECTIVES: To investigate the outcome of endodontic microsurgery and analyze the potential prognostic factors, and to evaluate the value of surgical classification by Kim and Kratchman. METHODS: Collecting clinical examination and radiographical examination of endodontic microsurgery cases (which were followed up at least 1 year), which were classified according to Kim and Kratchman, and we analyzed the outcome of endodontic microsurgery and its potential prognostic factors. RESULTS: 302 patients (400 teeth) who received endodontic microsurgery were included. The one year success rate of endodontic microsurgery was 94.25%. Different classification had significant influences on the outcome of endodontic microsurgery (P<0.05), and the success rate of class B and C were better than those of class D, E, and F. The position of teeth had significant influences on the outcome of endodontic microsurgery (P<0.05). The success rate of maxillary teeth was higher than that of mandibular teeth. The success rate of anterior teeth was higher than that of posterior teeth (P<0.05). The quality of root end filling and first or second surgery had no effect on the outcome (P>0.05). CONCLUSIONS: Endodontic microsurgery is an effective treatment method for saving affected teeth, and it can get a good result. Tooth position and classification are the potential prognostic factors. The surgical classification of Kim and Kratchman can help to predict the outcome of endodontic microsurgery.

Formation of Fe3O4@SiO2@C/Ni hybrids with enhanced catalytic activity and histidine-rich protein separation.

In this paper, we have developed an extended Stöber method to construct a Ni(2+)-polydopamine (PDA) complex thin coating on Fe3O4@SiO2 spheres, which can be carbonized to produce hybrid composites with metallic nickel nanoparticles embedded in a PDA-derived thin graphitic carbon layer (named Fe3O4@SiO2@C/Ni). Interestingly, by introducing a thin SiO2 spacer layer between PDA-Ni(2+) and Fe3O4, the reverse electron transfer from PDA to Fe3O4 is probably able to be suppressed in the calcination process, which leads to the in situ reduction of only Ni(2+) by PDA instead of Fe3O4 and Ni(2+). Consequently, the size and density of nickel nanoparticles on the surface of SiO2@Fe3O4 can be finely adjusted. Moreover, it is found that the ability of tuning nickel nanoparticles is mainly dependent on the thickness of the spacer layer. When the thickness of the SiO2 spacer is beyond the electron penetration depth, the size and density of nickel nanoparticles can be exactly tuned. The as-prepared Fe3O4@SiO2@C/Ni was employed as the catalyst to investigate the catalytic performance in the reduction of 4-nitrophenol (4-NP); furthermore, nickel nanoparticles decorated on Fe3O4@SiO2@C spheres display a strong affinity to His-tagged proteins (BHb and BSA) via a specific metal affinity force between polyhistidine groups and nickel nanoparticles.

[The influence of gene vaccines pcDNA3-pac and pcDNA3-gtfB of Streptococcus mutans on plaque index and S. mutans score in rats].

OBJECTIVE: This study was aimed at using the gene vaccines pcDNA3-pac and pcDNA3-gtfB which were constructed on PAc and GTF-B gene vaccinating gnotobiotic rats by submandibular gland-target injection to observe the level of salivary S. mutans and dental plaque inhabitation. METHODS: Thirty-six 28-day-old Wistar rats were divided into 6 groups, including those vaccinated with pcDNA3-pac, pcDNA3-gtfB, pcDNA3-pac combined with pcDNA3-gtfB, inactive whole cell of S. mutans JBP, and those injected with pcDNA3 and 0.1 mol/L PBS buffer respectively. Each rat was administrated with 100 micrograms vaccines or controlled materials by submandibular gland-target injection, vaccinated three times at 1-2 weeks interval. Then the gnotobiotic rat model was constructed, following that all rats were fed with cariogenic diet 2000# for 3 months. Rat saliva was collected to assay the level of S. mutans in saliva and evaluate the dental plaque index. RESULTS: The level of S. mutans in saliva and the dental plaque index of the group vaccinated with pcDNA3-pac combined with pcDNA3-gtfB and the group with inactive S. mutans cell were lower than those of other groups. And they were the highest in the groups injected with pcDNA3 or PBS buffer (P < 0.01 or P < 0.05). No statistically significant differences were observed between the group vaccinated with pcDNA3-pac and the group vaccinated with pcDNA3-gtfB, between the group vaccinated with pcDNA3-pac combined with pcDNA3-gtfB and the group for positive control, and between the pcDNA3 group and PBS buffer group (P > 0.05). CONCLUSION: The two gene anticaries vaccines induce the specific antibodies and thus produce effects on the level of S. mutans in saliva and dental plaque index. Therefore gene vaccines pcDNA3-pac and pcDNA3-gtfB are effective, and joint gene vaccines inoculation is optimal.

[Evaluation of the in vitro cariogenic potential of Streptococcus mutans (serotype C) strains isolated from caries-free and -active people: the ability of acidogenicity].

OBJECTIVE: To investigate the ability of acidogenicity of S. mutans (serotype C) strains isolated from the people with different caries experience. METHODS: Same density solutions of all isolated S. mutans were made and cultured in different pH TPPE liquid for the same period of time. Terminal pH of the solutions was measured. The values of delta pH were compared. RESULTS: Significant difference of acidogenicity was observed between the strains of different genotypes isolated from the same person. The ratio of high acidogenicity isolates harbored in caries-active people was greater than that of caries-free people; a significant difference was noted (P<0.05). CONCLUSION: The high cariogenicity of isolated S. mutans strains of caries-active people shows a close relationship with the high acidogenicity of the isolated S. mutans (serotype C) strains.

[Micro-CT evaluation of root canal deviation after preparation].

OBJECTIVE: To establish a new evaluation system of curved root canal deviation by the technique of micro-CT. METHODS: Curved simulated root canals were prepared with ProTaper NiTi-hand files by crown-down technique. After root canals were scanned by micro-CT and analyzed by image processing software, the planar area and centers' transportation of each cross-section were compared to evaluate the prepare effect of ProTaper, and a three-dimensional model about it were established. RESULTS: The same cross-section's area of the root canals which was prepared with ProTaper NiTi-hand files were essentially consistent. With the data analysis of micro-CT, a system of combining planar and three-dimensional index to evaluate the root canal deviation were established. The shapes of root canal before and after prepared with ProTaper showed less deviation, which proved the shaping ability of ProTaper could meet the requirements for clinical use. CONCLUSION: A three-dimensional root canal central axis model is established using micro-CT. It provides a new method to analyze the shaping ability of the instrumentation after root canal preparation. It will give us a more direct view to analyze the situation of the root canal deviation combining the two-dimensional image and the three-dimensional model.

[Three-dimensional finite analysis of the stress in first mandibular molar with composite class I restoration when various mixing ratios of bases were used].

OBJECTIVE: To analyze the possible damage to the remaining tooth and composite restorations when various mixing ratios of bases were used. METHODS: Testing elastic modulus and poission's ratio of glass-ionomer Vitrebond and self-cured calcium hydroxide Dycal with mixing ratios of 1:1, 3:4, 4:3. Micro-CT was used to scan the first mandibular molar, and the three-dimensional finite element model of the first permanent mandibular molar with class I cavity was established. Analyzing the stress of tooth structure, composite and base cement under physical load when different mixing ratios of base cement were used. RESULTS: The elastic modulus of base cement in various mixing ratios was different, which had the statistic significance. The magnitude and location of stress in restored tooth made no differences when the mixing ratios of Vitrebond and Dycal were changed. The peak stress and spreading area in the model with Dycal was more than that with Vitrebond. CONCLUSION: Changing the best mixing ratio of base cement can partially influence the mechanistic character, but make no differences on the magnitude and location of stress in restored tooth. During the treatment of deep caries, the base cement of the elastic modulus which is proximal to the dentin and restoration should be chosen to avoid the fracture of tooth or restoration.

[Influence of hand-mixed methods on compressive strength of zinc phosphate dental cement].

OBJECTIVE: To study the influence of hand-mixed methods on the compressive strength of the zinc phosphate dental cement. METHODS: Three skilled nurses used three kinds of common clinical hand-mixed methods (included the unidirectional rotation method, the alternate pro and con bidirectional rotation method and the pulling and pushing with folding method) to mix the zinc phosphate dental cement on the same condition (i.e. same indoor temperature and humidity, the same mixing ratio, mixing time, mixing frequency and the same mixing instruments and so on). The mixed zinc phosphate cement was packed into the plastic cylinders with 10 mm-high and 5 mm-bore. After the mixed zinc phosphate cement coagulated, compressive strength was tested separately. RESULTS: The compressive strength of the zinc phosphate dental cement mixed with the alternate pro and con bidirectional rotation method was the best, and the value was (106.11+/- 4.82) MPa. The compressive strength of the zinc phosphate dental cement mixed with the pulling and pushing with folding method was lower, and the value was (77.57 +/- 6.26) MPa. The compressive strength of the zinc phosphate dental cement mixed with the unidirectional rotation method was the lowest, and the value was (54.41 +/- 5.08) MPa. The compressive strength of the zinc phosphate dental cement mixed with the unidirectional rotation method and the pulling and pushing with folding method could not achieve the clinical required compressive strength (about 100 MPa), while the compressive strength mixed with the alternate pro and con bidirectional rotation method was above 100 MPa. CONCLUSION: The alternate pro and con bidirectional rotation method to mix the zinc phosphate dental cement is recommended in clinic.

[Study on the effect of concentrations of glucose on initial adherence of Streptococcus mutans].

OBJECTIVE: To study the effect of concentrations of glucose on the initial adherence of Streptococcus mutans (S. mutans) to saliva-coated hydroxyapatite (SHA), and to compare the initial adherence of S. mutans from caries-active group with that of S. mutans from caries-free group. METHODS: Each 10 clinical isolates of S. mutans from caries-active and caries-free subjects were used in this study. And S. mutans UA159 was also included in this experiment. SHA was used to simulate tooth surface in oral cavity. S. mutans clinical isolates and strain UA159 were cultured in TPY liquid medium containing 3H-TdR in the same radioactive concentration and glucose in 0.2%, 1.0%, 5.0% concentration. Then grown cells were harvested to produce a suspension. SHA and radiolabelled bacterial suspension (A550(nm) = 0.52) were mixed for 90 minutes, samples were assayed by using liquid scintillation counter, and binding abilities of strains were evaluated by the count per minute (CPM). RESULTS: The initial adherence ability of S. mutans from caries-active group was higher than that of S. mutans from caries-free group (P < 0.05). And the initial adherence ability of S. mutans cultured in different concentration of glucose was also significantly different (P < 0.05), 5.0% glucose group had the highest adherence ability, and 0.2% glucose group had the lowest adherenceability. CONCLUSION: (1)Difference of the initial adherence of S. mutans might relate to difference of carious experiences; (2) Glucose may play an important role in S. mutans initial adherence, to some extent, S. mutans cultured in the higher concentration of glucose has the higher initial adherence property.

[Clinical analysis of 1 423 cases of root canal therapy].

OBJECTIVE: To evaluate the clinical quality of root canal therapy (RCT) in West China Dental Hospital of Sichuan University. METHODS: 1 423 RCT teeth were finished from Mar. 2001 to Feb. 2002 in West China Dental Hospital. Root canal filling quality and treatment period of these teeth were evaluated. 695 teeth of the total were revisited 2 years later and 2-year success rate were evaluated. RESULTS: The ratios of adequate filling, underfilling, and overfilling were 79.97%, 14.62% and 5.41%, receptively. Full canal RCT ratio of molar was 89.44%. Average RCT treatment period was 2.8 weeks. 2-year success rate of RCT was 94.39%. CONCLUSION: Clinical RCT level of West China Dental Hospital was satisfactory from 2001 to 2002.

[Histological evaluation of direct pulp capping with a self-etching adhesive and calcium hydroxide].

OBJECTIVE: To evaluate the beagles' pulp response following direct pulp capping with Clearfil SE BOND (SB). METHODS: 130 sound teeth were used. 120 had their pulps mechanically exposed and were divided in two groups. In group A, teeth were capped with SB. In group B, teeth were capped with calcium hydroxide (CH). The left 10 teeth were used as control. After 7, 30 and 90 days, the teeth were extracted and processed for light microscopical examination. RESULTS: In 7 day observation period, inflammatory reaction in SB group was slighter than that of CH group, but the difference was statistical insignificant. In the 30 day and 90 day observation period, inflammatory reaction was slight in both groups, but specimens with dentin bridge formation was significantly less in SB group than in CH group (P < 0.05). CONCLUSION: SB showed acceptable biocompatibility with pulp, but its ability to induce hard tissue barrier on pulp exposure is weaker than CH.

[Expression of plasmid pcDNA3-gtfB in mammalian cell].

OBJECTIVE: This study aimed at investigating the transcription and expression of recombined plasmid pcDNA3-gtfB which encoding multiple glucosyltransferase-B antigenic gene, and the feasibility of the pcDNA3-gtfB used as gene vaccine. METHODS: The pcDNA3-gtfB was transfected into mammalian cell COS-1 with liposome. The total RNA of COS-1 cell transfected by pcDNA3-gtfB was extracted and purified. Using the total RNA as template, the transcription of pcDNA3-gtfB was assayed by reverse transcription polymerase chain reaction (RT-PCR). The expression product of pcDNA3-gtfB was identified with 5% SDS-PAGE, and then assayed using Western-blotting. The expression product of pcDNA3-gtfB was also assayed by using LSAB method, and cell transfected by pcDNA3 as the negative control. RESULTS: Identified by agarose gel electrophoresis, the target gene fragment had the same molecular size (3.6 kb) as it was predicted, and it indicated that pcDNA-3gtfB was correctly transcribed into mammalian cells. Proved by SDS-PAGE, the molecular weight of the expression product (116-212 kD) was also the same as it was supposed to be. It was also indicated by Western-blotting and LSAB assay that the expression product induced immunizing response. CONCLUSION: As gene vaccine, it is importance that the recombined plasmid could be correctly transcribed and expressed in mammalian cells. It was suggested by RT-PCR, LSAB and Western-blotting that recombined plasmid pcDNA3-gtfB could be correctly transcribed and expressed in mammalian cells, and the expression product could induce immunizing response, which support its use as gene vaccine candidates in the development of anticaries vaccines.

[A study on screening effective immunization route of anticaries DNA vaccine pcDNA3-gtfB].

OBJECTIVE: Glucosyltransferase-B (GTF-B) of Streptococcus mutans has been implicated as a principal virulent factor in the development of dental caries. The objective was to use recombined plasmid pcDNA-gtfB expressing multiple antigen of glucosyltransferase-B as gene vaccine to immunize rats through different route, and to investigate the immunization effects of immunization routes. METHODS: A total of 18 Wistar rats were divided into 3 groups, including the quadriceps injection group, the intransal irrigation group and the submandibular gland-targeted injection group. The serum IgG and salivary IgA were assayed by using ELISA after pcDNA3-gtfB immunization. The serum IgG and salivary IgA in different groups were compared using statistical one-way ANOVA. RESULTS: Compared these 3 groups, the serum IgG in the quadriceps injection group was much higher than those of other two groups (P < 0.01), while the salivary IgA of the submandibular gland-targeted injection was much higher than those of other two groups (P < 0.01). CONCLUSION: It is indicated pcDNA3-gtfB is good candidate for anticarious gene vaccine, and submandibular gland-targeted injection is an effective immunization route for stimulating salivary IgA.

[Study on potential anti-caries DNA vaccine pcDNA3-gtfB integration into host cell genome].

OBJECTIVE: Gene vaccine security is of concern because of the possibility of insertion mutagenesis resulting in inactivation of tumor suppressor or activation of oncogene. The purpose of this study was to examine the potential of anti-caries DNA vaccine pcDNA3-gtfB integrating into the host cell genome. METHODS: Anti-caries DNA vaccine pcDNA3-gtfB was constructed by the previous study. The gtfB gene(904-4,578 bp, genebank M17361) was cloned from Streptococcus mutans GS-5. 36 Wistar rats were divided into 2 groups: submandibular gland-targeted injection(SGT) group and control group. Rats in SGT group were injected with 100 micrograms of plasmid pcDNA3-gtfB, rats in control group with PBS solution. Genomes from submandibular gland, kidney, heart, liver, lung, and brain tissues were isolated later in 12 weeks. Genomes from different tissues were purified by low-melting agarose electrophoresis. Using the purified genomes as template, plasmid integration were examined by PCR(upper primer: 5'-ATATGGTACCATGACCGAAGCGACATCTAAGCAAGA-3', lower primer: 5'-ACTACTCGAGTTAGAACCATTGACCCTG AGCATTGC-3'). The sensitivity level of PCR was determined by adding gradient plasmid copies into genomes in control group. RESULTS: The examination of 6 tissues failed in revealing any evidence of integration at the sensitivity level that could detect 1 copy integration in 10,000 nuclei. CONCLUSION: The potential frequency of plasmid pcDNA3-gtfB integration into host cell genome would not exceed that of the spontaneous mutation. It was indicated that pcDNA3-gtfB was genetically safe as a promising anti-carious DNA vaccine.

[Initial clinic research on curved canal preparation by reverse flaring technique].

OBJECTIVE: Curved canal preparation is much difficult in root canal therapy(RCT). Step back technique and routine technique are still regular methods in curved canal preparation. The purpose of this study was to introduce a new method reverse flaring technique, and to investigate its preparation efficiency in intermediate-curvature canals. METHODS: 48 cases of lower first molars RCT were collected, which were first treated because of pulpitis or apical periodontitis in West China College of Stomatology, Sichuan University from Nov. 2001 to Aug. 2003, mesial canal curvature was intermediate (30 degrees-60 degrees), determined by Schineider method. Cases were divided into two groups, in reverse flaring technique group, canal preparation in 27 cases were finished by reverse flaring technique, 21 cases by step back technique as control. In working length determination and fitting master cone stages, cases in two groups which fit full working length were recorded, determined by radiograph, and analyzed by chi 2 test. RESULTS: In working length determination stage, cases which fit full working length in reverse flaring technique group were significantly more than that of step back technique group (P < 0.05), in fitting master cone stage, cases which fit full working length in reverse flaring technique group were also significantly more than that of step back technique group(P < 0.05). CONCLUSION: In working length determination stage, cases which fit full working length in reverse flaring technique group were significantly more than that of step back technique group (P < 0.05), in fitting master cone stage, cases which fit full working length in reverse flaring technique group were also significantly more than that of step back technique group(P < 0.05).