Is SWEEPS better than PUI in reducing intracanal bacteria and inflammation in cases of apical periodontitis?

To evaluate the efficacy of SWEEPS mode of the Er: YAG laser(SL) and passive ultrasonic irrigation(PUI) in the eradication of microorganisms and in the inflammation detection by IL-1ß. Thirty patients with chronic apical periodontitis(AP) were allocated into two groups: Group SL-SWEEPS laser activated irrigation(n = 15) and Group PUI-passive ultrasonic irrigation(n = 15). Bacteriological samples were taken before(S1) and after chemomechanical preparation(S2), and then after final irrigation activation(S3). The levels of total bacteria and Streptococci were measured by means of PCR. Blood samples were collected before and 3rd day after treatment. Enzyme-linked immunosorbent assay was used to measure the levels of IL-1ß. The bacterial reduction showed no differences between groups after chemo-mechanical treatment and after irrigant activation(p = 0.590). Post-treatment IL-1ß levels were lower than pretreatment levels in both groups(p < 0.001). SL or PUI application in addition to chemomechanical preparation has similar effects on total bacterial level and inflammation detected by IL-1ß in patients with AP.

The importance of mechanosensitive cell mediated prostaglandin and nitric oxide synthesis in the pathogenesis of apical periodontitis: comparative with chronic periodontitis.

OBJECTIVES: Mechano-sensitive odontoblast cells, which sense mechanical loading and various stresses in the tooth structure, synthesize early signaling molecules such as prostaglandin E2 (PGE2) and nitric oxide (NO) as an adaptive response. It is thought that these synthesized molecules can be used for the diagnosis and treatment of periodontal and periapical diseases. The aim of this study was to investigate the relationship between the severity of apical periodontitis (AP) and chronic periodontitis (CP) and serum (s) TNF-α, IL-10, PGE2 and NO levels, as well as PGE2 and NO levels in gingival crevicular fluid (GCF) samples. MATERIALS & METHODS: A total of 185 subjects were divided into three categories: AP group (n = 85), CP group (n = 50) and healthy control group (n = 50). The AP group was divided into 3 subgroups according to abscess scoring (AS-PAI 1, 2 and 3) based on the periapical index. The CP group was divided into 4 subgroups according to the periodontitis staging system (PSS1, 2,3 and 4). After recording the demographic and clinical characteristics of all participants, serum (s) and gingival crevicular fluid (GCF) samples were taken. TNF-α, IL-10, PGE2 and NO levels were measured in these samples. RESULTS: Unlike serum measurements (sTNF-α, sIL-10, sNO and sPGE2), GCF-NO and GCF-PGE levels of the AP group were significantly higher than the control group in relation to abscess formation (54.4 ± 56.3 vs. 22.5 ± 12.6 µmol/mL, p < 0.001 and 100 ± 98 vs. 41 ± 28 ng/L, p < 0.001, respectively). Confirming this, the GCF-NO and GCF-PGE levels of the AS-PAI 1 group, in which abscesses have not yet formed, were found to be lower than those in AS-PAI 2 and 3, which are characterized by abscess formation [(16.7(3.7-117.8), 32.9(11.8-212.8) and 36.9(4.3-251.6) µmol/mL, p = 0,0131; 46.0(31.4-120.0), 69.6(40.3-424.2) and 74.4(32.1-471.0) ng/L, p = 0,0020, respectively]. Consistent with the increase in PSS, the levels of sTNF [29.8 (8.2-105.5) vs. 16.7(6.3-37.9) pg/mL, p < 0.001], sIL-10 [542(106-1326) vs. 190(69-411) pg/mL, p < 0.001], sNO [182.1(36.3-437) vs. 57.0(15.9-196) µmol/mL, p < 0.001], sPGE2 [344(82-1298) vs. 100(35-1178) ng/L, p < 0.001], GCF-NO [58.9 ± 33.6 vs. 22.5 ± 12.6 ng/L, p < 0.001] and GCF-PGE2 [ 99(37-365) vs. 30(13-119), p < 0.001] in the CP group were higher than the control group. Comparison ROC analysis revealed that the GCF-PGE2 test had the best diagnostic value for both AP and CP (sensitivity: 94.1 and 88.0; specificity: 64.0 and 78.0, respectively; p < 0.001). CONCLUSIONS: GCF-PE2 and GCF-NO have high diagnostic value in the determination of AP and CP, and can be selected as targets to guide treatment. In addition, the measurements of PGE2 and NO in GCF can be used as an important predictor of pulpal necrosis leading to abscess in patients with AP. CLINICAL RELEVANCE: In this article, it is reported that syntheses of early signaling molecules such as PGE2 and NO can be used for the diagnosis and treatment target of periapical and periodontal infections.

Relationship of MMP-9 with the clinical course of apical periodontitis and the main bacterial species in the oral microbiota.

Bacterial products, host immune cells and cytokines have been reported to play an important role in the pathogenesis of apical periodontitis (AP). This study aimed to determine the main bacterial species in the microbiota as gram positive and negative and to compare the relationship between matrix metalloproteinase (MMP)-9 and tumor necrosis factor (TNF)-α with controlled patient groups. 60 patients with AP and extraction indication were included in the study. 30 systemically healthy volunteers without AP were selected as the control group. After access cavity preparation, an initial microbiologic sample (S1) was taken from the root canal. After atraumatic extraction of the tooth, a second microbial sample (S2) was taken from the extraradicular region. After bacterial DNA extraction, 16S rRNA gene primer was designed for sequence analysis. Bacterial community profiling was made by Sanger sequencing of the PCR products. In addition, serum MMP-9 and TNF-α levels were measured from all patients. TNF-α levels of the AP group were higher than the control group, while MMP-9 levels were found to be lower (p = 0.0264 and p = 0.0146, respectively). There was no difference in the main bacterial species isolated from the samples taken from the intracanal and extraradicular region of the tooth with AP (p = 0.714). The main bacterial species in the intracanal region of the tooth with AP are similar to the main bacterial species in the extraradicular region. The pathophysiology of the tooth with AP is associated with low MMP-9 and high TNF-α, independent of the bacterial species in the intracanal and extraradicular regions.

Is adrenomedullin upregulation due to apical periodontitis independent of periodontal disease?

To investigate the relationship between apical periodontitis [AP] severity and inflammatory markers [interleukin (IL)-12, tumor necrosis factor-alpha (TNF-α), and Mid-Regional Pro Adrenomedullin (MR-proADM)] in patients with AP. A total of 162 subjects were divided into three categories: AP group (n = 80), periodontitis (P) group (n = 42), healthy control group (n = 40). The scoring of disease severity in 80 AP patients without any periodontal disease, using dental radiographs, was based on "The Abscess Score" (AS), as those having at least 1 tooth with AP and severity of PAI 3-4 were classified as AS 1 (mild); those with only1 tooth and severity of PAI 5 as AS 2 (moderate) and those having > 2 tooth with severity of PAI 5 as AS 3 (severe). Blood samples were collected from all of the patients. Enzyme-linked immunosorbent assay was used to evaluate the samples. The MR-pro ADM levels of both the AP and P groups were considerably higher than the control group (p < 0.01). The IL-12 levels of the AP group were higher than the P and control groups (p < 0.05). TNF-α levels of the P group were significantly higher than both the AP and control groups (p < 0.01). MR-pro ADM levels of both the AP and Periodontitis groups were higher than the control group. TNF-α was a biomarker of periodontitis, while IL-12 was a biomarker of apical periodontitis.

The importance of inflammatory biomarkers, IL-6 and PAPP-A, in the evaluation of asymptomatic apical periodontitis.

To examine the use of IL-6 and PAPP-A along with the new imaging for scoring methods to determine the severity of apical periodontitis (AP). The scoring of disease severity in 121 patients with AP, using dental radiographs, was based on "The Apical Periodontitis Grading Scale" (APGS), as those having 1 tooth with AP and severity of 3-4 were classified as grade 1 (mild); those having > 1 tooth and severity of 3-4 as grade 2 (moderate) and those with at least one tooth with a severity of 5 as grade 3 (severe). 45 systematically and orally healthy volunteers were selected as the control group (grade 0). Dental demographic data of all participants were recorded. Besides, venous blood samples were collected to study their complete blood count and levels of IL-6 and PAPP-A. Both NLR and PAPP-A levels of the grade 3 AP patients were found significantly higher than those of the control group and grade 1 and grade 2 AP patients (2.55 ± 1.40 vs 1.98 ± 1.05, 1.94 ± 0.58 and 1.86 ± 0.50; 0.606 ± 0.211 vs 0.422 ± 0.273, 0.447 ± 0.224 and 0.436 ± 0.242, p < 0.01, respectively). AP grades identified by the new scoring system were moderately correlated with IL-6 levels (Spearman r = 0.4168, p < 0.001). The risk of patients with IL-6 levels above 12.5 pg/ml to develop AP (relative risk) was found to be 2.19 times higher than that in those with lower IL-6 levels (98% Cl 1.233-3.905, p < 0.0024). APGS classification suggested to determine AP severity was found to be significantly correlated with levels of inflammatory markers IL-6 and PAPP-A.

Impact of various finishing and polishing techniques and composite materials on Candida albicans biofilm formation.

Candida albicans biofilms are commonly associated with severe oral infections. In dentistry, prosthetic and restorative materials are potential structures for the adhesion of C. albicans facilitating the formation of Candida biofilm and infection. Three composite resins (Charisma Classic, Sonic Fill, Estelite ∑ Quick) and two finishing-polishing systems (Biscover LV, Dental Finishing Disc) were evaluated for Candida biofilm formation. A Candida biofilm assay showed that both the resin and the finishing/polishing procedures affect Candida biofilm formation. Specifically, Candida biofilm formation was significantly lower in Sonic Fill resin than both Charisma Classic and Estelite ∑ Quick (P = .021). The type of finishing and polishing procedure also significantly affected the Candida biofilm formation to composite material (P < .001). Candida biofilm formation was more advanced after Biscover LV procedure than Dental Finishing Disc procedure.

Comparison of the Effects of Two Different Analgesics on Bone Regeneration During Mandibular Distraction Osteogenesis.

INTRODUCTION: Mandibular distraction osteogenesis (DO) is frequently used in the management of bone defects and craniofacial deformities, with analgesics commonly administered to relieve acute postoperative pain. This experimental animal study investigated the effects of 2 analgesics, acetaminophen and acemetacin, on bone regeneration after DO. MATERIALS AND METHODS: This study was conducted with 14 mature male New Zealand rabbits (2.8-3.2 kg) randomized into 2 groups of 7. Mandibular osteotomies were performed under optimal operating conditions, and a custom-made distractor was applied to the mandible of each subject, with distraction initiated after a 5-day latency period at a rate of 1.0 mm/d (2 × 0.5 mm/d) for 10 days. Analgesics were administered via oral gavage during the latency period and for the first 5 days of the distraction period for 10 days in total, with group I receiving acetaminophen (200 mg/kg/d) and group II receiving acemetacin (5 mg/kg/d). Subjects were sacrificed and their mandibles dissected at the end of 4 weeks postoperatively. Bone mineral density (BMD) and bone mineral content (BMC) were measured using dual-energy X-ray absorptiometry (DEXA), and histomorphometric analysis was performed to evaluate the quality of newly formed bone. Paired group comparisons of non-normally distributed numerical variables were made using the Mann-Whitney U test, with a P value of <0.05 considered statistically significant. RESULTS: No significant differences in BMC and BMD values of intact bone, newly formed bone, or bone around the pin site were observed between the 2 groups. Histometric analysis also indicated acetaminophen and acemetacin to have similar effects on bone regeneration during distraction. CONCLUSION: Acemetacin may be an alternative to acetaminophen for treating pain associated with DO, given the similarities in the effects of the 2 analgesics on bone regeneration. However, this finding should be supported by further experimental and human studies.

Comparison of Four Electronic Apex Locators in Detecting Working Length: An Ex Vivo Study.

AIM: To compare the accuracy of four different electronic apex locators (EALs) in detecting a position 0.5 mm short of the major foramen. MATERIALS AND METHODS: The actual working length of thirty-five extracted human teeth was determined visually as 0.5 mm short of the apical foramen. After actual working length measurements, electronic working length was measured with four different EALs (Apex Pointer+, Raypex 5, Apex ID, and Raypex 6). Measurements were repeated three times by different operators. The data were analyzed using the intraclass correlation coefficient (ICC), the repeated measure analysis of variance (rANOVA) and Bonferroni post hoc tests. The significance level was set at p < 0.05. RESULTS: The mean differences between electronic and actual working length were-0.305 mm, 0.098 mm, 0.037, and 0.144 mm for the Apex Pointer+, the Raypex 5, the Apex ID, and the Raypex 6, respectively. Multiple paired comparisons (Bonferroni test) also showed the Apex Pointer+ is significantly different from the Raypex 5, Apex ID and Raypex 6 (p = 0.000, p = 0.001, and p = 0.001 respectively). CONCLUSION: All EALs showed an acceptable determination of the working length between the ranges of ± 0.5mm except for the Apex Pointer+ device, which had the lowest accuracy. Further studies may be beneficial especially to better evaluate the accuracy of the Apex Pointer+. CLINICAL SIGNIFICANCE: This article shows that Apex ID, which has only recently been introduced into the market, showed an acceptable determination of the working length. Its accuracy was similar to that of Raypex 5 and 6.

Effect of intracanal medicaments used in endodontic regeneration on the push-out bond strength of a calcium-phosphate-silicate-based cement to dentin.

OBJECTIVE: To evaluate the effects of various endodontic regeneration agents on the push-out bond strength of Endosequence Root Repair Material (ERRM) to root-canal dentin. METHODS: Fifty single-rooted human teeth were selected and instrumented to obtain a standard internal diameter of 1.5 mm. Specimens were randomly divided into four experimental groups and treated with an intracanal medicament [calcium hydroxide (CH), double antibiotic paste (DAP), triple antibiotic paste (TAP), TAP with amoxicillin (mTAP)] and a non-treated control group. Medicaments were removed after three weeks, and ERRM was applied to all specimens. The coronal portion of each root was then sliced into 2-mm-thick parallel transverse sections (2 slices per tooth, n=20 slices per group), and a push-out test was used to measure the bond strength of ERRM to dentin. Data were analyzed using Bonferroni-corrected Mann-Whitney tests, with the level of significance set at p<0.05. RESULTS: The push-out bond strength of the CH group was significantly higher than that of the TAP, DAP and mTAP groups (p< 0.005). Furthermore, the bond strength of the control group was higher than the bond strength of both the DAP and mTAP groups. CONCLUSION: The use of CH in clinical practice may help improve the adhesion of ERRM to dentin.

The Efficacy of Laser Doppler Flowmetry, Electric Pulp Test and Cold Test in Diagnosing Revascularization of Extrusively Luxated Immature Maxillary Incisors.

OBJECTIVE: To evaluate the effect of extrusion on immature permanent tooth PBF values during a 6-month post-trauma period and to compare the accuracy of cold tests on pulp sensibility of traumatized teeth with that of electric pulp tests (EPT). METHODS: The study group comprised of 26 extruded immature maxillary incisors in 25 trauma patients. The respective contralateral homologous teeth (n=25) were included as a positive control group. Teeth in the study group were treated by repositioning and splinting. Pulp vitality readings for traumatized and control teeth were taken with LDF, EPT and cold test on the day of splint-removal (2-3 weeks after trauma-T1) as well as 6 weeks (T2), 3 months (T3) and 6 months (T4) post-trauma. Student t and Mann-Whitney U-tests were used to compare data among groups. Statistical significance was set at P< 0.05. RESULTS: LDF gave positive vitality readings (>4.5 PU) in all patients from T1 to T4 (with the exception of 1 patient at T1). CONCLUSIONS: LDF was able to accurately identify vitality in traumatized immature teeth even during the first few weeks following trauma, whereas conventional sensibility tests were unable to accurately recognize vitality shortly after trauma.

Changes in Maxillary Canine Pulpal Blood Flow During Dentoalveolar Distraction Osteogenesis.

OBJECTIVE: The aim of this study was to assess the effects of dentoalveolar distraction osteogenesis (DD) on the pulpal blood flow (PBF) of maxillary canines. MATERIALS AND METHODS: A laser Doppler flowmeter (LDF) was used to measure PBF in maxillary canines of 10 patients undergoing DD (study group) and 10 nonsurgical subjects who received no orthodontic treatment (control group). PBF was measured at baseline, at 4 and 7 days postoperatively, at the end of distraction and at the end of consolidation in the study group and at similar time-points in nonsurgical control subjects. Data were analyzed using paired and Student t tests, with the significance level set at 0.05. RESULTS: Study findings showed that baseline PBF values did not differ significantly between groups. PBF in the control group did not vary over time; however, in the study group, an initial decrease in PBF was observed at 4 days postoperatively and was followed by a gradual increase to preoperative levels at the end of distraction. CONCLUSIONS: During the DD latency period, there appears to be a short-lived ischemic phase when perfusion of pulp tissue declines; however, blood-flow returns to normal by the end of distraction.

Changes in human pulp blood flow during canine retraction.

AIM: To evaluate the effects of maxillary canine retraction on pulpal blood flow (PBF) in humans as recorded by laser Doppler flowmetry (LDF). METHODS: Maxillary canines of 24 participants were divided into two groups (n = 12 each). Teeth in the study group underwent maxillary canine retraction using mini-implants as anchorage for approximately 4 months, with 100 g of force applied via coil springs. Subjects in the control group received no orthodontic treatment. LDF measurements were recorded at baseline (T0); during retraction, at 24 hours (T1), 3 days (T2), 7 days (T3) and 1 month (T4); and at the end of retraction (T5) in the study group and at similar time-points in control subjects. Data were analyzed using the Friedman, Wilcoxon signed rank and Mann-Whitney U tests, with the significance level set at 0.05. RESULTS: No significant changes in PBF perfusion units (PU) were observed in the control group over the course of the study. However, PBF in the study group increased significantly from T0 (3.6 ± 0.2 PU) to T1 (3.7 ± 0.2 PU, p < 0.001) and decreased severely from T1 to T2 (3.3 ± 0.1, p < 0.001). PBF in the study group was still significantly lower at T3 (3.4 ± 0.1 PU, p < 0.001) in comparison to T0; however, at T4 and T5, PBF was found to have returned to pre-retraction levels. CONCLUSION: The fact that PBF values returned to initial levels within one month of the initiation of retraction despite short-term, hyperaemic, regressive changes demonstrates that the changes observed in PBF during canine retraction are reversible.

Effects of magnitude of intrusive force on pulpal blood flow in maxillary molars.

INTRODUCTION: In this study, we aimed to evaluate and compare blood-flow changes in the pulp tissues of maxillary molars over a 6-month period after orthodontic intrusion using different magnitudes of force. METHODS: Twenty patients were randomly divided into 2 groups (n = 10) according to the amount of intrusive force applied. An intrusive force of either 125 g (light) or 250 g (heavy) was applied to the overerupted maxillary first molars using mini-implants; no force was applied to the contralateral molars. Laser Doppler flowmetry was used to measure pulpal blood flow (PBF) at baseline and during intrusion at 24 hours, 3 days, 7 days, 3 weeks, 4 weeks, 3 months, and 6 months. The data were analyzed with the Mann-Whitney U and Wilcoxon signed rank tests, with P <0.05 considered statistically significant. RESULTS: PBF decreased significantly at 3 days and continued to remain suppressed until 3 weeks, after which a gradual trend of recovery was observed until 3 months, when the levels returned to near those measured before intrusion. When the data were analyzed with regard to the amount of applied force, significant differences were observed between the 2 groups only at 3 and 7 days. CONCLUSIONS: These findings demonstrate that despite slight regressive changes in pulpal tissue over the short term, PBF values tend to return to their initial levels within 3 months, indicating that changes observed in PBF are reversible, even during radical intrusions of molars with 125 and 250 g of forces.

Comparative evaluation of pulpal blood flow during incisor intrusion.

AIM: The aim of the present study was to evaluate and compare changes in pulpal blood flow (PBF) as a result of maxillary incisor intrusion achieved by one of two methods (utility arches or mini-implants). MATERIALS AND METHODS: Thirty subjects were divided into three groups, the first of which underwent maxillary incisor intrusion using utility arches (UA) and a second group, intrusion via mini-implants (MI). The third group acted as a control. An intrusive force of 100 g was applied to the upper incisors in the treatment groups, whereas no force was applied to the anterior teeth in the control group. A laser Doppler flowmeter (LDF) was used to measure PBF at baseline (T0) and during incisor intrusion at 24 hours (T1), three days (T2), seven days (T3) and three weeks (T4). Statistical changes in PBF were assessed by the Wilcoxon Signed Rank and Mann-Whitney U tests, with significance set at p < 0.05. RESULTS: The mean PBF in the UA and MI groups decreased significantly from T0 to T1 (p < 0.001), slightly increased at T2 and continued to increase gradually at T3. PBF attained levels similar to those measured prior to intrusion at T4. No significant changes in PBF were observed in the control group over the course of the study. The only statistically significant difference between the UA and MI groups were at T1 and T2, at which time the MI group had lower PBF values (p < 0.001). CONCLUSIONS: Despite slight regressive changes in pulpal tissue observed over the short-term, PBF values tended to return to initial levels within three weeks, indicating that changes observed in PBF with the UA and MI intrusion methods are reversible. Although the changes in PBF could not be directly related to the method of intrusion employed, in general, a more severe drop in PBF was observed in the MI group during the first three days of intrusion.

Changes in maxillary incisor dental pulp blood flow during intrusion by mini-implants.

AIM: The aim of this clinical study was to identify changes in pulpal blood flow (PBF) in human central incisors resulting from short- and long-term intrusive orthodontic forces from mini-implants. MATERIALS AND METHODS: A total of 40 sound upper central and lateral incisors in 20 patients scheduled for intrusion for orthodontic reasons were divided into two groups. From each group, 20 teeth were subjected to intrusive force from mini-implants (Group 1 = Light Force: 40 g; Group 2 = Heavy Force: 120 g), whereas the remaining 20 contralateral teeth were not subjected to forces from mini-implants and served as controls. Laser-Doppler flowmetry (LDF) measurements were recorded at baseline and at 3 days and 3 weeks following intrusion. RESULTS: PBF decreased significantly at 3 days (Light Force Group: 7.72 ± 0.50; Heavy Force Group: 7.72 ± 0.52) and then increased towards baseline at 3 weeks (Light Force Group: 10.37 ± 0.58; Heavy Force Group: 10.31 ± 0.45) following intrusion. CONCLUSIONS: In other words, despite slight regressive changes in pulpal tissue in the short-term, PBF improved after 3 weeks following intrusion by mini-implants, indicating that the changes observed in PBF is reversible, even following radical incisor intrusion.

Changes in maxillary molar pulp blood flow during orthodontic intrusion.

INTRODUCTION/OBJECTIVE: The aim of this prospective study was to evaluate the effects of maxillary first molar intrusion on pulpal blood flow (PBF) in humans as recorded by laser Doppler flowmetry (LDF). MATERIALS AND METHODS: Maxillary first molars of 16 participants were divided into two groups. In the study group, 20 teeth in 10 participants were subjected to an intrusive force of 100 g delivered from mini-implants for 6 months. A control group of 6 subjects (12 teeth) received no orthodontic treatment. LDF measurements were recorded at baseline and at 3 days, 3 weeks, 3 months and 6 months during intrusion. Data was analysed using the Wilcoxon Signed Rank and Mann-Whitney U tests, with a level of p < 0.05 considered statistically significant. RESULTS: No significant changes in PBF perfusion units (PU) were observed in the control group over the course of the study. However, PBF in the study group was significantly higher at TO (8.7 ± 0.9 PU) when compared with T1 (6.1 ± 0.6 PU, p < 0.001) and T2 (6.0 ± 0.6 PU, p < 0.001). PBF did not vary significantly between T1 and T2 (p = 0.073) or between T3 and T4 (p = 0.262). Moreover, PBF at the end of the study (T4) was similar to baseline PBF values for both groups (study group: p = 0.687; control group: p = 0.525). CONCLUSIONS: Despite significant short-term regressive changes in pulpal tissue during continuous molar intrusion with mini-implants and an applied force of 100 g, blood vessel function was maintained throughout intrusion, as indicated by LDF measurements of PBF, which tended to return to baseline values by the end of the observation period. These results highlight the changes that can occur in molar vascularity, especially during six months of intrusion.

Relationships among barodontalgia prevalence, altitude, stress, dental care frequency, and barodontalgia awareness: a survey of Turkish pilots.

Background: Gas expansion in body cavities due to pressure changes at high altitudes can cause barodontalgia. This condition may compromise flight safety. Aim: To investigate relationships among barodontalgia awareness, dental visit frequency, and barodontalgia prevalence in civilian and military pilots operating at high altitudes. Materials and Methods: Civilian pilots from Turkish Airlines and military pilots from the Turkish Air Force, flying between November 2022 and January 2023, participated in this study. A 20-question survey was administered to 750 pilots, covering topics such as barodontalgia awareness, dental visit frequency, breaks after dental treatments, in-flight pain, and pain type and severity. The voluntary surveys were distributed by email. Results: Of the 750 pilots, 526 completed the survey; 61% were aware of barodontalgia, and 81% of pilots who had experienced it reported pain at altitudes <2000 feet. The study revealed higher barodontalgia awareness among pilots who had experienced it, with the highest prevalence among jet pilots. Pilots with barodontalgia also showed a higher frequency of dental visits (p < 0.001). Additionally, this group reported more frequent interruption of flight due to dental treatment (IFDT), more problems experienced in flights after treatment (PFAT), and higher instances of bruxism or teeth clenching during flight, suggesting stress and anxiety (p < 0.05). Conclusions: Barodontalgia, a type of pain linked to stress, significantly impacts pilot performance, and can threaten flight safety, even at lower altitudes. Thus, there is a need to educate pilots about stress management, barodontalgia awareness, and the importance of regular dental check-ups.

Solubility and apical sealing characteristics of a new calcium silicate-based root canal sealer in comparison to calcium hydroxide-, methacrylate resin- and epoxy resin-based sealers.

AIM: To assess and compare the water sorption, solubility and apical sealing ability of iRoot SP and three other widely used root canal sealers. MATERIALS AND METHODS: Solubility was assessed by immersing standardized samples of calcium silicate- (iRoot SP), calcium hydroxide- (Sealapex), methacrylate resin- (EndoREZ) and epoxy resin- (AH Plus) based sealers in distilled water and measuring weight gain and weight loss at 6 h, 24 h and daily for 14 days. Roots of extracted mandibular premolars (n = 80) were prepared with 0.04-taper nickel-titanium rotary files to a final size 40. Roots were then randomly divided into four experimental groups (n = 18) and two control groups (n = 4), root canal sealers were applied and apical leakage was assessed using the fluid filtration method. Data was analyzed using Kruskal Wallis analysis of variance and Mann-Whitney U-tests, with the level of significance set at p ≤ 0.05. RESULTS: EndoREZ exhibited the highest water sorption, followed by iRoot SP, Sealapex and AH Plus. Sealapex exhibited significantly higher solubility than the other sealers, whereas no significant differences in solubility levels were observed between the other three sealers tested. AH Plus exhibited significantly lower microleakage than Sealapex and EndoREZ, whereas no difference in microleakage was found between AH Plus and iRoot SP. CONCLUSIONS: In view of the study findings, all tested sealers except Sealapex met the ANSI/ADA's requirements for solubility and no difference was found between AH Plus and iRoot SP in terms of apical sealing ability.

Is XP-endo Finisher a better treatment option for its efficacy against intracanal bacteria for post-treatment apical periodontitis cases than EndoActivator?

To investigate the efficacy of the supplementary use of a rotary agitation method [XP-endo Finisher (XPF)] and sonically-activated irrigation [EndoActivator (EA)], using droplet digital PCR (ddPCR) on reducing the bacterial load in previously root canal treated teeth with apical periodontitis. Twenty patients with post-treatment apical periodontitis were allocated into two groups according to the irrigation activation method used: XPF and EA group. Total bacterial loads, as well as the amount of Enterococcus faecalis (E. faecalis) were determined before (S1) and after (S2) chemomechanical preparation, and after final irrigation activation (S3) by means of ddPCR. The bacterial copy numbers were compared between groups using the Friedman test (Nonparametric Repeated Measures ANOVA). When the groups were examined in terms of gender, age, number of root canals, periapical index score, sterility control total bacteria (SCTB), S1- and S2-total bacteria copy number, it was found that there was no statistical difference between the XPF group and the EA group (p > 0.05). Subsequent activation (S3) resulted in a significant microbial reduction in both XPF and EA groups, both of which reduced significantly more bacteria than chemomechanical instrumentation (S2) (p < 0.0001). On the contrary, S3-total bacteria copy number of the EA group was lower than the XPF group (p < 0.0147). There was no statistical difference between the XPF group and the EA group in terms of E. faecalis copy number (p > 0.05). Although both the XPF and the EA optimised the antibacterial efficiency of chemomechanical preparation in previously root canal-treated teeth with apical periodontitis, a lower total bacterial copy number was achieved with the EA application than the XPF application.

Microbial analysis of endodontic infections in teeth with post-treatment apical periodontitis before and after medication.

This study aimed to determine the intraradicular microbiota of previously root canal-treated teeth with apical periodontitis and to investigate the antibacterial effectiveness of different intracanal medicaments. Sixteen patients with post-treatment apical periodontitis were allocated into two groups according to the intracanal medicament used: calcium hydroxide (CH) and 2% chlorhexidine gluconate gel (CHX) group. Total bacterial loads, as well as the amount of Enterococcus faecalis (E. faecalis) were determined before (S1) and after (S2) chemomechanical preparation and finally, after intracanal medication (S3) by means of ddPCR. The unpaired t test was used to compare parametric. S3-total bacteria copy number of the CH group was lower than the CHX group (p < 0.05). There was no statistical difference between the CHX- and the CH groups in terms of E.faecalis copy number (p > 0.05). But in terms of total bacteria, CH is better than CHX. Consequently, CH can be used to optimise the antibacterial efficiency of chemomechanical preparation in previously root canal-treated teeth with apical periodontitis.