Comparative evaluation of anesthetic efficacy of inferior alveolar nerve block and inferior alveolar nerve block plus buccal or lingual infiltration using articaine in mandibular molars with irreversible pulpitis: a preliminary prospective randomized single-blind clinical trial.

OBJECTIVES: This study was designed as a prospective randomized single-blind clinical trial to compare the anesthetic efficacy of inferior alveolar nerve block (IANB), IANB plus buccal infiltration, and IANB plus lingual infiltration of 4% articaine with 1:100,000 epinephrine in mandibular molars with irreversible pulpitis. METHOD AND MATERIALS: Sixty healthy volunteers who had a first or second mandibular molar diagnosed with irreversible pulpitis participated in the present study. This study was composed of three arms for the first molar and three arms for the second molar. Subjects in test arm A received two IANB injections (3.6 mL). Subjects in test arm B received 1.8 mL IANB injection plus 1.8 mL buccal infiltration. Subjects in test arm C received 1.8 mL IANB injection plus 1.8 mL lingual infiltration. Articaine (4%) with 1:100,000 epinephrine was used for all injections. The subject's pain during access preparation and pulp extirpation was recorded on the Heft-Parker visual analog scale. Success was defined as "none" or "mild" pain during treatment. Kruskal-Wallis test was used to compare pain categories in three groups of interventions for each mandibular molar. RESULTS: IANB with a supplemented buccal infiltration provided more success than IANB alone or IANB plus lingual infiltration, in first molars (P = .019). There were no significant differences between the three injection techniques in second molars (P = .795). CONCLUSIONS: Adding a supplemental buccal infiltration to a standard IANB was more successful in providing pain-free treatment for patients experiencing irreversible pulpitis in mandibular first molars.

The Effect of Milling Metal Versus Milling Wax on Implant Framework Retention and Adaptation.

PURPOSE: The metal framework of implant-supported restorations can be made using different methods. For a successful outcome, the acceptability of each method depends on the retention and fit of the restoration. The aim of this study was to evaluate and compare the retention and adaptation of copings fabricated using two methods: casting wax patterns made by computer-aided design/computer-aided manufacturing (CAD/CAM) technology, and milling sintered chromium-cobalt (Cr-Co) blocks. MATERIALS AND METHODS: Twenty-four abutment analogs (height, 5.5 mm) were divided into two groups according to the framework fabrication method. In one group, wax patterns were prepared using a CAM milling machine, and they were cast with a Ni-Cr-Ti metal alloy. In the second group, the copings were milled from Cr-Co blocks using a CAD/CAM milling machine. All copings were equal in contour, thickness, and internal relief and were seated on the abutment analogs after the necessary adjustments. The vertical marginal discrepancy was investigated using a silicone replica method and stereomicroscope with 75× magnification. After copings were cemented onto the abutment analogs using zinc phosphate, a tensile resistance test was performed using a universal testing machine. Mann-Whitney U and Student's t-test were used for statistical analyses at a significance level of 0.05. RESULTS: An independent sample t-test revealed a significant difference between the two groups for retention (p = 0.010), and the milled wax group showed higher tensile resistance compared with the milled metal group. There was also a significant difference between the two groups in marginal discrepancy (p < 0.001), with a larger marginal gap in the milled metal group compared with the milled wax group. The milled metal copings required more adjustments to fit on the abutment analogs compared with the wax milled copings (p < 0.001). CONCLUSIONS: The CAD/CAM technique for wax milling resulted in more retentive copings with better marginal and internal adaptations compared with milling the metal blocks.

Ex vivo assessment of synergic effect of chlorhexidine for enhancing antimicrobial photodynamic therapy efficiency on expression patterns of biofilm-associated genes of Enterococcus faecalis.

BACKGROUND: It has clearly been demonstrated that Enterococcus faecalis, as a persistent microorganism, is the major agent in the etiopatogeny of endodontic infections. Recently, the limitations of conventional endodontic therapy have given rise to many attempts to introduce antimicrobial photodynamic therapy (aPDT) as an alternative treatment. The aim of this study was to analyze the ex vivo effect of aPDT in combination with 2.0% chlorhexidine (CHX) as a conventional therapy on colony count and expression patterns of genes associated with biofilm formation of E. faecalis. MATERIALS AND METHODS: A total of 125 extracted human single-rooted teeth were divide into six groups (A-F; n = 20) and were incubated with E. faecalis. Group A- photosensitizer (indocyanine green [ICG]); B- diode laser; C- aPDT; D- 2.0% CHX; E- aPDT with photosensitizer modified by 2.0% CHX; and F- control group (no procedure was performed). Five remaining teeth were used to confirm the presence of E. faecalis biofilm via scanning electron microscope. Counts of colony forming units (CFUs) in each group were evaluated separately and quantitative real-time PCR (qRT-PCR) was then applied to monitor genes expression of fsrC, efa, and gelE involved in E. faecalis biofilm. RESULTS: The results showed that none of the tested groups achieved eradication or inhibition of biofilm. On the other hand, aPDT + 2.0% CHX, 2.0% CHX, and ICG- mediated aPDT groups showed significantly less CFU/mL than ICG and diode laser groups. The group with the lowest CFU/mL count was the aPDT + 2.0% CHX, being statistically different from all other groups that could decrease the expression levels of efa, gelE, and fsrC genes 6.8-, 8.3-, and 12.1-fold, respectively. CONCLUSION: Based on the results, the synergism effect of ICG-aPDT with 2.0% CHX leads to modulation of the virulence of E. faecalis strains biofilm model by suppressing the expression of the genes associated with biofilm formation.

Evaluation and Comparison of Occurrence of Tooth Discoloration after the Application of Various Calcium Silicate-based Cements: An Ex Vivo Study.

INTRODUCTION: Biodentine (Septodont, Saint Maur des Fossés, France), OrthoMTA (BioMTA, Seoul, Korea), and EndoSequence Root Repair Material (ERRM; Brasseler, Savannah, GA) have been developed to overcome the shortcomings of mineral trioxide aggregate (MTA). The purpose of this study was to compare tooth discoloration after the application of ProRoot MTA (Dentsply Tulsa Dental Products, Tulsa, OK) and 3 recently introduced calcium silicate-based cements in the presence and absence of blood. METHODS: In total, 104 human anterior teeth were prepared; 96 were randomly divided into 2 groups (blood and saline contamination). Each group was subdivided into 4 experimental subgroups (n = 12) of ProRoot MTA, Biodentine, OrthoMTA, and ERRM that were used to fill the pulp chambers. The remaining 8 teeth served as the saline and blood groups. Color analysis of tooth crowns was performed using a spectroradiometer before the application of materials and at 24 hours, 1 month, and 6 months after application. Repeated measures analysis of variance was used to evaluate the effects of blood, material, and time on color change (ΔE*). RESULTS: Tooth color change in all experimental groups increased over time (P < .05). Blood contamination significantly increased ΔE* (P < .05), but no significant difference occurred between the 4 groups in this respect in the presence of blood. However, in the absence of blood, the ΔE* of Biodentine and ERRM was significantly less than that of OrthoMTA (P < .05). CONCLUSIONS: There was no significant difference between tooth discolorations with materials in the presence of blood. However, in the absence of blood, Biodentine and ERRM exhibited less tooth discoloration than OrthoMTA.

A Case Report of Dilacerated Crown of a Permanent Mandibular Central Incisor.

Trauma to primary teeth can lead to devastating sequels in development of permanent successors. The disturbance may range from enamel hypoplasia and/or hypo-calcification to arrest of dental bud development. Crown dilaceration of permanent teeth is one of the consequences of trauma to deciduous teeth mainly due to intrusion or avulsion. This report presents a mandibular central incisor with dilacerated crown and yellowish discoloration with symptomatic apical abscess. History revealed avulsion of primary mandibular central incisors. The purpose of this report is to present: 1. Reasons of dilacerated crown, yellowish discoloration and necrotic pulp in this case, 2. Treatment options in different types of crown dilacerations and also in this case. The tooth was successfully managed by nonsurgical root canal therapy and restoration with composite resin to restore esthetics. We emphasize that trauma to deciduous teeth should not be understated, and regular follow up is essential.

Comparative Scanning Electron Microscopic Study of the Marginal Adaptation of Four Root-End Filling Materials in Presence and Absence of Blood.

OBJECTIVES: The aim of this study was to evaluate marginal adaptation of mineral trioxide aggregate (MTA), calcium enriched mixture (CEM) cement, Biodentine and BioAggregate in presence of normal saline and human blood. MATERIALS AND METHODS: In this in-vitro experimental study, 80 extracted single-rooted human teeth were instrumented and filled with gutta-percha. After resecting the root-end, apical cavity preparation was done and the teeth were randomly divided into 4 groups (N=20)(a total of 8 subgroups). Root-end filling materials were placed in 3mm root-end cavities prepared ultrasonically. Half the specimens in each group were exposed to normal saline and the other half to fresh whole human blood. After 4 days, epoxy resin replicas of the apical portion of samples were fabricated and scanning electron microscopy (SEM) analysis was performed to find gaps in the adaptation of the root-end filling materials at their interface with dentin. The Kruskal-Wallis and Mann-Whitney tests were used for statistical analysis of data with P<0.05 as the limit of significance. RESULTS: There were no significant differences in marginal adaptation of the 8 tested groups (P>0.05). CONCLUSION: Based on the results, blood contamination does not affect the marginal adaptation of MTA, CEM cement, Biodentine or BioAggregate.

Does Abutment Collar Length Affect Abutment Screw Loosening After Cyclic Loading?

A significant vertical space that is corrected with vertical ridge augmentation may necessitate selection of longer abutments, which would lead to an increased vertical cantilever. This study investigated the influence of different abutment collar heights on single-unit dental implant screw-loosening after cyclic loading. Fifteen implant-abutment assemblies each consisted of an internal hexagonal implant were randomly assigned to 3 groups: Group1, consisting of 5 abutments with 1.5 mm gingival height (GH); Group2, 5 abutments with 3.5 mm GH; and Group3, 5 abutments with 5.5 mm GH. Each specimen was mounted in transparent auto-polymerizing acrylic resin block, and the abutment screw was tightened to 35 Ncm with an electric torque wrench. After 5 minutes, initial torque loss (ITL) was recorded for all specimens. Metal crowns were fabricated with 45° occlusal surface and were placed on the abutments. A cyclic load of 75 N and frequency of 1 Hz were applied perpendicular to the long axis of each specimen. After 500 000 cycles, secondary torque loss (STL) was recorded. One-way ANOVA analysis was used to evaluate the effects of abutment collar height before and after cyclic loading. One-way ANOVA showed that ITL among the groups was not significantly different (P = .52), while STL was significantly different among the groups (P = .008). Post-hoc Tukey HSD tests showed that STL values were significantly different between the abutments with 1.5 mm GH (Group1) and with 5.5 mm GH (Group3) (P = .007). A paired comparison t-test showed that cyclic loading significantly influenced the STL in comparison with the ITL in each group. Within the limitations of this study, it can be concluded that increase in height of the abutment collar could adversely affect the torque loss of the abutment screw.

Regenerative Endodontic Treatment: Report of Two Cases with Different Clinical Management and Outcomes.

Endodontic intervention in necrotic immature permanent teeth is usually a clinical challenge. With appropriate case selection, regenerative treatment can be effective, providing a desirable outcome. However, there is still no consensus on the optimal disinfection protocol or the method to achieve predictable clinical outcome. This article presents two cases of regenerative treatment in necrotic immature teeth, using mineral trioxide aggregate (MTA) and Biodentine(TM) as coronal barriers and different irrigants, which led to different clinical outcomes.

Effect of Different Obturation Materials on Residual Antimicrobial Activity of 2% Chlorhexidine in Dentin at Different Time Intervals: An Ex Vivo Study.

OBJECTIVES: The aim of this study was to evaluate the effect of gutta percha/AH26 and Resilon/RealSeal SE on residual antimicrobial activity of chlorhexidine (CHX) in human root dentin and suggest the best filling material when CHX is used as final irrigant. MATERIALS AND METHODS: One-hundred and forty-four single-rooted human teeth were selected for this study. Canals were instrumented to the apical size #35. Smear layer was removed using 5.25% NaOCl and 17% EDTA and then 108 teeth were irrigated with 2% CHX and randomly divided into three groups of gutta percha/AH26, Resilon/RealSeal SE and positive controls. Each group was divided into three subgroups for different time intervals (one, three and six weeks). Thirty-six teeth, as negative controls, were irrigated with saline and obturated with gutta percha/AH26 and Resilon/RealSeal SE. Dentin powder was prepared at the afore-mentioned intervals. After exposure to Enterococcus faecalis for 24 hours, colony forming units (CFUs) were counted and residual antimicrobial activity was calculated. The data were analyzed using the Kruskal Wallis test and one-way ANOVA. The significance level was set at P<0.05. RESULTS: The antimicrobial activity of CHX gradually decreased in a time-dependent manner but it maintained over 95% of its antimicrobial activity after six weeks. Moreover, Resilon/RealSeal SE significantly decreased the antimicrobial activity of CHX in comparison with gutta-percha/AH26 (P<0.05). CONCLUSION: After a final irrigation with CHX, gutta-percha/AH26 is a better choice for root canal obturation.

Comparison of Apical Sealing Ability of Two Phases of Gutta-Percha: A Bacterial Leakage Model.

OBJECTIVES: The aim of this study was to compare apical sealing ability of alpha and beta phases of gutta-percha by means of bacterial leakage model. MATERIALS AND METHODS: Fifty single-rooted human premolars were selected. The root canals were prepared with Mtwo rotary instruments up to apical #35.04. Forty teeth were randomly divided into two groups (n= 20). The root canals were obturated by alpha phase (G1) and beta phase (G2) of gutta-percha and AH26 sealer, respectively, with warm vertical compaction technique. Ten teeth served as positive (n=8) and negative (n=2) control groups. Then, the specimens were sterilized with ethylene oxide gas. Bacterial suspension of Enterococcus faecalis (E. faecalis) in 0.5 McFarland concentration was prepared. All teeth were mounted in plastic vial caps containing Muller Hinton broth and then exposed to bacterial suspension of E. faecalis every three days up to 31 days. The number of days required for the contamination of the entire root canals was recorded. The data were analyzed using Mann Whitney U test. RESULTS: There were no significant differences in bacterial leakage between the G1 and G2 groups (P>0.05). Negative controls revealed no microbial leakage; whereas positive controls showed gross microbial leakage. CONCLUSION: Despite better thermal conduction and adaptability of alpha phase of guttapercha, our study revealed no significant difference in bacterial leakage between alpha and beta phases of gutta-percha in warm vertical compaction.