Two-year Outcomes of Coronal Pulpotomy in Young Permanent Molars with Clinical Signs Indicative of Irreversible Pulpitis.

PURPOSE: The purpose of this study was to assess the outcome of coronal pulpotomy using mineral trioxide aggregate (MTA) in mature and immature teeth with symptoms indicative of irreversible pulpitis. METHODS: Fifty permanent molars with symptomatic irreversible pulpitis were divided into two groups according to complete or incomplete radicular growth (25 teeth in each group). Coronal pulpotomy was performed with MTA. Clinical follow-up evaluations were scheduled at the third, sixth, ninth, 12th, 18th, and 24th months. Follow-up radiographs were taken at the sixth, 12th, 18th, and 24th months. Pain levels were scored preoperatively and two days post-treatment. RESULTS: At two years of recall, 10 patients were lost to follow-up and the success of molars with complete or incomplete radicular growth were 100 percent and 95 percent, respectively. All teeth with periapical rarefaction were present preoperatively and showed complete radiographic healing. Radiographic evidence of dentin bridge formation was discernable in 31 of 38 cases. CONCLUSIONS: Full coronal pulpotomy using mineral trioxide aggregate was successful in controlling pain and any infections after two years in 39 of 40 teeth regardless of whether they had immature or mature roots.

A pilot study of the effects of a vacuum sealing barrier method for photostimulable phosphor plates regarding plate damage and prevention of microbiologic cross-contamination.

OBJECTIVE: The aim of this study was to evaluate the effectiveness of a new sealing method for preventing cross-contamination of photostimulable phosphor (PSP) plates. STUDY DESIGN: Twelve new PSP plates were divided into 3 groups (PSP-a, PSP-b, and PSP- c) and placed in 3 different barriers (2 different brands of envelopes and a vacuum sealing method). All plates were exposed to X-rays with an aluminum step wedge, and the images were evaluated for the presence of any artifacts. After radiography, the PSP plates were removed from the barriers. The barriers and the PSP plates were disinfected and culture performed to assess any microorganism burden. Subsequently, the PSP plates were coated again with all barriers. The barriers were then contaminated and microbiologic specimens were collected. Subsequently, the barriers were wiped with alcohol. The PSP plates were removed, and microbiologic specimens were obtained. RESULTS: No artifacts were recorded on the radiographic images on the sensors in any group. Microorganisms were detected on the PSP plates placed in envelopes. No colonization of microorganisms was detected on the vacuum sealed PSP plates. CONCLUSIONS: The new vacuum-sealing method may be useful in preventing cross-contamination of PSP plates during radiographic procedures.

The Clinical and Radiographic Success of Primary Molar Pulpotomy Using Biodentine™ and Mineral Trioxide Aggregate: A 24-Month Randomized Clinical Trial.

PURPOSE: The purpose of this study was to compare the clinical and radiographic success of Biodentine™ and mineral trioxide aggregate (MTA) pulpotomy in primary molars. METHODS: Thirty-two four- to nine-year-olds were included in this study. The primary molars were randomly assigned to the Biodentine™ and MTA groups. After coronal pulp removal and hemostasis, the remaining pulp tissue was covered with Biodentine™ or MTA. All teeth were restored with stainless steel crowns. Clinical and radiographic successes and failures were recorded at six-, 12-, 18- and 24-month follow-ups. Data were statistically analyzed using Mann-Whitney U and Wilcoxon tests. RESULTS: The 24-month follow-up evaluations revealed that the clinical success rates were 96.8 percent (30 out of 31) for both Biodentine™ and MTA. The radiographic success rates at 24 months were 93.6 percent (29 out of 31) for Biodentine™ and 87.1 percent (27 out of 31) for MTA. No significant differences were found among the groups at all follow-up appointments (P>0.05) Conclusion: Biodentine™ and mineral trioxide aggregate did not differ significantly in combined clinical and radiographic success after 24 months.

Efficacy of Biodentine as an Apical Plug in Nonvital Permanent Teeth with Open Apices: An In Vitro Study.

The aim of this study was to evaluate the apical microleakage of Biodentine and MTA orthograde apical plugs and to compare the effect of thickness of these biomaterials on their sealing ability. A total of eighty maxillary anterior teeth were used. The apices were removed by cutting with a diamond disc (Jota, Germany) 2 mm from the apical root end in an attempt to standardize the working length of all specimens to 15 ± 1 mm. Both materials were placed in 1-4 mm thickness as apical plugs root canal. Root canal leakage was evaluated by the fluid filtration technique. One-way ANOVA was used in order to determine normality of dispersal distribution of parameters; thereafter, results were analyzed by Kolmogorov-Smirnov test. Overall, between microleakage values of MTA and Biodentine regardless of apical plug thickness, no difference was observed. In terms of plug thickness, a statistically significant difference was observed between the subgroups of MTA and Biodentine (p < 0.05). The apical sealing ability of Biodentine was comparable to MTA at any apical plug thickness.

Shear bond strengths of different adhesive systems to biodentine.

The aim of this study was to measure the shear bond strength of different adhesive systems to Biodentine with different time intervals. Eighty specimens of Biodentine were prepared and divided into 8 groups. After 12 minutes, 40 samples were randomly selected and divided into 4 groups of 10 each: group 1: (etch-and-rinse adhesive system) Prime & Bond NT; group 2: (2-step self-etch adhesive system) Clearfil SE Bond; group 3: (1-step self-etch adhesive systems) Clearfil S(3) Bond; group 4: control (no adhesive). After the application of adhesive systems, composite resin was applied over Biodentine. This procedure was repeated 24 hours after mixing additional 40 samples, respectively. Shear bond strengths were measured using a universal testing machine, and the data were subjected to 1-way analysis of variance and Scheffé post hoc test. No significant differences were found between all of the adhesive groups at the same time intervals (12 minutes and 24 hours) (P > .05). Among the two time intervals, the lowest value was obtained for group 1 (etch-and-rinse adhesive) at a 12-minute period, and the highest was obtained for group 2 (two-step self-etch adhesive) at a 24-hour period. The placement of composite resin used with self-etch adhesive systems over Biodentine showed better shear bond strength.

Comparison of the anesthetic efficacy of articaine and mepivacaine in pediatric patients: a randomized, double-blind study.

PURPOSE: The purpose of this study was to evaluate and compare the reaction to pain during local injection and duration of numbness of soft tissue with 4% articaine or 3% mepivacaine in children. METHODS: A randomized, double-blind, split-mouth study was used with a sample of 50 7- to 13-year-old children (25 boys and 25 girls; mean age=11.3 years old) that had similar operative procedure needs in symmetric primary teeth. The modified behavioral pain scale was used for objective evaluation of the children. The sensation after injection and treatment was evaluated using the Wong-Baker FACES pain rating scale. Parents were instructed to ask the child and to record the time when feeling of numbness disappeared. RESULTS: The duration of soft tissue was longer for articaine (140.69 ± 49.76 minutes) than for mepivacaine (117.52 ± 42.99 minutes). No difference regarding efficacy of the anesthesia was observed. No statistically significant difference was found in blood pressure, heart rate, or oxygen saturation in all evaluation periods for both solutions. The feeling after treatment was similar for the 2 solutions. CONCLUSION: Four percent articaine with 1:200,000 and 3% mepivacaine presented the same efficacy, and children displayed the same behavior during injection.

Accuracy of an electronic apex locator: a clinical evaluation in primary molars with and without resorption.

OBJECTIVE: The aim of this study was to evaluate the accuracy of electronic apex locator (Root ZX) in primary teeth with and without apical root resorption in vivo. STUDY DESIGN: The electronic working length was determined in 28 primary teeth (A total of 46 primary molar root canals with 24 roots without resorption and 22 roots with resorption) from twenty-eight healthy children using Root ZX. The teeth were then extracted. The actual length of each root was measured placing a K-File until the tip was visible at the apical foramen or the apical resorption level and approved with digital microscopic evaluation under 20x magnification and then withdrawn 1 mm. The distances from the file tip to the base of the rubber stop were measured and compared with the measurement obtained from apex locator. The data were evaluated with t test using standard statistical software (SPSS 13.0). The critical value of statistical significance was 5%. RESULTS: For root canals without resorption, the accuracy of Root ZX was 79.16% and 95.82% within +/- 0.5 and +/- 1 mm, respectively. For root canals with resorption, the accuracy of Root ZX was 63.63% and 86.35% within +/- 0.5 and +/- 1 mm, respectively. No statistically significant differences were detect between the electronically determined lengths and the actual lengths regardless of whether or not resorption. CONCLUSION: Using a Root ZX Electronic Apex Locator in primary teeth with or without resorption is recommended for the determination of working length.

Microleakage of different temporary filling materials in primary teeth.

OBJECTIVE: The aim of this study was to compare the sealing properties of IRM, Coltosol, Cavit G, Adhesor and Clip, which used as temporary filling material in coronal access openings in extracted human primary teeth. STUDY DESIGN: Standardized access cavities of 2 x 2 mm were prepared in the eighty-four, caries-free human primary anterior teeth. The teeth were divided randomly into five groups of 16 teeth each. Temporary restorative materials Group A: IRM (Dentsply), Group B: Coltosol (Coltone), Group C: Cavit G (3M), Group D: Adhesor (Spofa Dental) and Group E: Clip (Voco) were applied according to the manufacturer's directions. The specimens were immersed silver nitrate and placed in film developer under fluorescent for 24 hours. The sectioned specimens were evaluated under a digital microscope at x 20 magnifications and blindly scored for microleakage. RESULTS: Clip presented the least microleakage value whereas; Adhesor and IRM presented the higher microleakage values. There were statistically significant differences between Clip and the others groups, while there were no statistically significant differences in microleakage between IRM, Adhesor, Coltosol and Cavit G. However the leakage scores of Clip and Cavit G were congruent (p = 0.454). CONCLUSION: Amongst the five materials, Clip exhibited a better sealing ability.

Clinical, radiographic, and histopathologic evaluation of Nd:YAG laser pulpotomy on human primary teeth.

The purpose of this study was to compare clinical, radiographic, and histopathologic effects of Nd:YAG laser pulpotomy to formocresol pulpotomy on human primary teeth. Patients with at least two vital primary molar teeth that required pulpotomy, because of pulpal exposure to caries, were selected for this study. After hemorrhage control, complete hemostasis into the canal orifice was achieved by exposure to Nd:YAG laser (1064 nm) and an He-Ne laser (the aiming beam of the Nd:YAG laser) in noncontact mode at 2 W, 20 Hz, 100 mJ, or was achieved by applying 1:5 dilution of formocresol. Forty-two teeth in two groups were to be followed up clinically and radiographic at 1, 3, 6, 9, and 12 months. Eighteen teeth planned for serial extractions were selected for histopathologic study. The teeth were extracted at 7 and 60 days. The teeth in the laser group had a clinical success rate of 85.71% and a radiographic success rate 71.42% at 12 months. The teeth in the formocresol group had a clinical and radiographic success rate of 90.47% at 12 months. There were no statistically significant differences between laser and formocresol group with regard to both clinical and radiographic success rates. There was a statistically significant difference between 7- and 60-day laser groups with regard to inflammatory cell response criteria. Dentin bridge was absent in all samples. No stained bacteria were observed in any of these samples. In conclusion, Nd:YAG laser may be considered as an alternative to formocresol for pulpotomies in primary teeth.