Comparison of microcomputed tomography, cone beam tomography, stereomicroscopy, and scanning electron microscopy techniques for detection of microcracks on root dentin and effect of different apical sizes on microcrack formation.

The aim of the study was to compare different imaging methods in the diagnosis of microcracks on root dentin and to evaluate the frequency of dentinal microcracks observed after root canal preparation using the ProTaper Universal (PTU) system of different sizes. A total of 30 mandibular molars' mesial roots were scanned with microcomputed tomography (micro-CT) and cone beam computed tomography (CBCT) imaging methods before instrumentation. Root canal instrumentation was performed up to PTU F2 and F4 files. After instrumentation stages, the roots were scanned again with micro-CT and then with CBCT in same parameters. All roots were sectioned horizontally at 2, 4, 6, 8, and 10 mm from the apices of the specimens. The sections were imaged under a stereomicroscope. Finally, imaging of the sections was done by scanning electron microscopy (SEM). Statistical data analysis of instrumentation steps was performed using Friedman and Wilcoxon tests, and the data of imaging methods were analyzed using Kruskal-Wallis and Mann-Whitney U tests (p = .05). Instrumentation with the PTU system up to F2 and F4 files significantly increased the number of microcracks compared with preoperative samples according to micro-CT imaging (p < .05). For detecting microcracks on the root dentin, there were no statistically significant differences between micro-CT (43.9%) and stereomicroscopy (45.8%) (p < .05). SEM showed significantly higher percentage of microcracks (88.3%) (p > .05). No microcrack was observed using the CBCT method. There were no statistically differences between micro-CT and stereomicroscopy. SEM showed more dentinal microcracks while no microcrack was observed with CBCT.

Evaluation of relationship between endodontic access cavity types and secondary mesiobuccal canal detection.

BACKGROUND: The aim of this study was to evaluate the relationship between Endodontic Access Cavity (EAC) types with MB2 canal detection ratio in the upper first molars. METHODS: A total of 60 roots of extracted human maxillary first molars were selected. All teeth were prepared with Point EAC (PEAC), Conservative EAC (CEAC) and Traditional EAC (TEAC) respectively. After each group were completed, extra canal was searched. Preoperative and postoperative tooth weigh was calculated using precise scale. McNemar's chi-square test and a paired test significant difference were used for statistical analyses. RESULTS: The EAC types statistically were changed of tooth tissue loss quantity (p = 0.000). MB2 detection rate of CEAC (%53,3) and TEAC (%60) are higher than statistically that of PEAC (%31.6) (p < 0.05). 8 teeth MB2 canal was detected only with the CBCT images. CONCLUSIONS: In upper molars, CEAC seems reasonable in terms of detected the MB2 canal and removed hard tissue.

Effect of Different Torque Settings on Crack Formation in Root Dentin.

INTRODUCTION: The aim of the present study was to observe the incidence of cracks in root canal dentin using the ProTaper Universal system (Dentsply Maillefer, Ballaigues, Switzerland) at low- and high-torque settings. METHODS: Sixty-nine mandibular premolar teeth that had been extracted for different reasons were selected. The teeth were divided into 3 groups: an unprepared control group, a low-torque settings group (SX = 3, S1 = 2, S2 = 1, F1 = 1.5, F2 = 2, F3 = 2, F4 = 2 N/cm), and a high-torque settings group (SX = 4, S1 = 4, S2 = 1.5, F1 = 2, F2 = 3, F3 = 3, F4 = 3 N/cm). After a root canal procedure, all the teeth were horizontally sectioned at 2, 4, 6, and 8 mm from the apex. Then, under a stereomicroscope, all the slices were examined to determine the presence of cracks. A chi-square test was used for data analysis. The significance level was set at P = .05. RESULTS: There were no cracks in the unprepared control group. Vertical root fractures were not observed in any of the groups. There were significantly fewer cracks (17.4% of the sections) in the low-torque group than in the high-torque group (29.4% of the sections) (P < .05). CONCLUSIONS: In this in vitro study, the instrumentation of root canals with the ProTaper Universal instrument caused more crack formation in root canal dentin at high-torque than at low-torque settings.

Evaluation of Apically Extruded Debris and Irrigant Produced by Different Nickel-Titanium Instrument Systems in Primary Teeth.

AIM: The purpose of this study was to determine the amount of extruded debris and irrigant associated with different single-file systems and one multiple-file system. MATERIALS AND METHODS: Forty-five newly extracted single rooted primary canine teeth were used in this study. The root canals were instrumented using the reciprocating single-file system, the single-file rotary system and the multiple-file rotary system. A 10(-6) precision micro-balance was used to calculate the amount of extruded debris and irrigant. The incubation period was set as 15 days at 37°C to obtain dry debris. The preparation time for instrumentation was also recorded. The data were statistically analyzed by Manova and Bonferroni adjustment. RESULTS: Considering the apically extruded debris, while there was statistically significant difference between Reciproc and OneShape groups (p < 0.05), no statistically significant difference was found among the other groups (p > 0.05). In terms of irrigation solution, although significant difference was obtained between the Reciproc and other two groups (p < 0.05), no statistically significant difference was obtained between the two rotary instruments (p > 0.05). Instrumentation was significantly faster using Reciproc than with all other instrument (p < 0.05). CONCLUSION: All systems caused apical debris and irrigant extrusion. Full-sequences rotary instrumentation systems may be preferable for preparation primary teeth. CLINICAL SIGNIFICANCE: This is the first study carrying out to compare both apical debris and irrigation solution extrusion with reciprocal and rotary single-file systems with other preparation systems in primary teeth.

Effect of the size of the apical enlargement with rotary instruments, single-cone filling, post space preparation with drills, fiber post removal, and root canal filling removal on apical crack initiation and propagation.

INTRODUCTION: The purpose of this study was to investigate the incidence of apical crack initiation and propagation in root dentin after several endodontic procedures. METHODS: Sixty intact mandibular premolars were sectioned perpendicular to the long axis at 1 mm from the apex, and the apical surface was polished. Thirty teeth were left unprepared and served as a control, and the remaining 30 teeth were instrumented with ProTaper Universal instruments (Dentsply Maillefer, Ballaigues, Switzerland) up to size F5. The root canals were filled with the single-cone technique. Gutta-percha was removed with drills of the Rebilda post system (VOCO, Cuxhaven, Germany). Glass fiber-reinforced composite fiber posts were cemented using a dual-cure resin cement. The fiber posts were removed with a drill of the post system. Retreatment was completed after the removal of the gutta-percha. Crack initiation and propagation in the apical surfaces of the samples were examined with a stereomicroscope after each procedure. The absence/presence of cracks was recorded. Logistic regression was performed to analyze statistically the incidence of crack initiation and propagation with each procedure. RESULTS: The initiation of the first crack and crack propagation was associated with F2 and F4 instruments, respectively. The logistic regression analysis revealed that instrumentation and F2 instrument significantly affected apical crack initiation (P < .001). Post space preparation had a significant effect on crack propagation (P = .0004). The other procedures had no significant effects on crack initiation and propagation (P > .05). CONCLUSIONS: Rotary nickel-titanium instrumentation had a significant effect on apical crack initiation, and post space preparation with drills had a significant impact on crack propagation.

Assessment of apically extruded debris and irrigant produced by different nickel-titanium instrument systems.

The aim of this study was to evaluate the preparation time and the amounts of apically extruded debris and irrigant using different nickel-titanium instrumentation systems. Forty-five extracted single-rooted mandibular premolar teeth were selected and divided into three groups. The root canals were instrumented according to the manufacturers' instructions, using a reciprocating single-file system, a single-file rotary system and a multiple-file rotary system. Bidistilled water was used as the irrigant solution. The apically extruded debris and irrigant were collected into preweighed Eppendorf tubes. The amounts of extruded debris and irrigant were assessed with a precision micro-balance. The Eppendorf tubes were incubated at 37°C for 15 days. After the incubation period, they were weighed again to assess the debris extrusion. The time required to prepare the canals was also recorded. The results were statistically analyzed using MANOVA and Bonferroni's adjustment. Considering the apically extruded debris and irrigant, there were no statistically significant differences among the groups (p > 0.05). The Reciproc group produced the highest debris (0.000632 ± 0.000162 gr) and irrigant (0.844587 ± 0.437814 ml) extrusion values. While the least extruded debris was observed with OneShape (0,000431 ± 0,000171 gr), the least extruded irrigant was observed with ProTaper system (0.564147 ± 0.370596 ml). Instrumentation was faster using the Reciproc than the other two instruments (70.27 ± 13.38 s) (p < 0.05). All of the instrumentation systems used in this study produced apical debris and irrigant extrusion. The reciprocating single-file system tended to produce more debris and irrigant extrusion, compared with the rotary systems. Considering the preparation time, the single-file systems appeared to be advantageous due to their working time.

Push-out bond strength of different mineral trioxide aggregates.

OBJECTIVE: This study was aimed to evaluate and to compare the push-out bond strength of different brands of mineral trioxide aggregate (MTA) with a calcium enriched mixture cement (CEM). MATERIALS AND METHODS: Fifteen extracted, single-rooted human teeth were used. The middle-third of the roots were sliced perpendicular to the long axis into 1.00 ± 0.05 mm thick serial slices (15 root × 4 slice = 60 specimen). The specimens were then divided into three groups (n = 20). The standardized root discs were filled with white CEM, ProRoot MTA, MTA-Angelus and wrapped in a serum-soaked gauze. After 3 days at relative humidity, the push-out bond strengths were measured with a universal testing machine. Data were analyzed using one-way analysis of variance and post hoc Tukey tests. RESULTS: The mean push-out bond strength value of the ProRoot MTA group (12.7 ± 2.5 MPa) was the highest and statistically significant difference was recorded between ProRoot MTA and other groups (P < 0.001). There was no significant difference between the mean bond strength of CEM cement (4.6 ± 1.1 MPa) and MTA-Angelus (4.5 ± 1.5 MPa) (P = 0.982). CONCLUSION: The push-out bond strength of MTA was changed with the brands and ProRoot MTA had the highest push-out bond strength.

Efficacy of needle irrigation, EndoActivator, and photon-initiated photoacoustic streaming technique on removal of double and triple antibiotic pastes.

INTRODUCTION: Photon-induced photoacoustic streaming (PIPS) is a novel technique used for the removal of material on root canal walls, such as bacteria and the smear layer. This study evaluated the efficacy of needle irrigation, the EndoActivator System (Dentsply Tulsa Dental Specialties, Tulsa, OK), and PIPS on the removal of antibiotic pastes from an artificial groove created in a root canal. METHODS: Root canal preparation was performed up to size #40 on 84 extracted single-rooted teeth using ProTaper rotary instruments (Dentsply Maillefer, Ballaigues, Switzerland). The specimens were then split longitudinally, and 2 standardized grooves were prepared in the coronal and apical part of each segment. Double (DAP) and triple antibiotic pastes (TAP) were placed in the grooves for 4 weeks, and the root halves were reassembled. Needle irrigation, the EndoActivator System, and PIPS were used for the removal of DAP and TAP. The root segments were disassembled, and the amount of remaining antibiotic pastes was evaluated under a stereomicroscope at 20× magnification using a 4-grade scoring system. The data were evaluated statistically using Mann-Whitney U tests with a 95% confidence level (P = .05). RESULTS: PIPS removed significantly more antibiotic pastes than the EndoActivator and needle irrigation (P < .001). The EndoActivator was superior to needle irrigation in removing antibiotic pastes (P < .001). There were no statistically significant differences between DAP and TAP and between coronal and apical thirds in their removing from artificially created grooves (P > .05). CONCLUSIONS: PIPS was more effective in removing both DAP and TAP from artificial grooves in root canals than the EndoActivator System and needle irrigation. The EndoActivator was also more effective than needle irrigation. It is difficult to completely remove antibiotic pastes from root canals.

Effects of ProTaper Universal, ProTaper Next, and HyFlex instruments on crack formation in dentin.

INTRODUCTION: The aim of the present study was to investigate the incidence of cracks in root dentin after root canal preparation with ProTaper Next (Dentsply Maillefer, Ballaigues, Switzerland), HyFlex (Coltene-Whaledent, Allstetten, Switzerland), and ProTaper Universal (Dentsply Maillefer) rotary instruments. METHODS: One-hundred mandibular premolars were selected. Twenty-five teeth were left unprepared and served as a negative control; another 25 teeth were instrumented with the ProTaper Universal system up to size F4 as a positive control, and the remaining 50 teeth were shaped with the following experimental groups with an apical size 40 file: ProTaper Next X4 and HyFlex 40/0.4. After root canal preparation, all of the roots were sectioned perpendicular to the long axis at 2, 4, 6, and 8 mm from the apex, and the sections were then observed under a stereomicroscope. The absence/presence of cracks was recorded, and the data were analyzed with a chi-square test. The significance level was set at P = .05. RESULTS: No cracks were observed in the negative control group. Vertical root fractures were not observed in any of the groups. The ProTaper Next and HyFlex instruments caused fewer cracks (28%) than the ProTaper Universal instrument (56%) (P < .05). However, there were no significant differences in crack formation between the ProTaper Next and HyFlex groups (P > .05). CONCLUSIONS: Within the limitations of this in vitro study, all of the instrumentation systems used in this study created cracks in the root dentin. The ProTaper Next and HyFlex instruments tended to cause fewer dentinal cracks compared with the ProTaper Universal instrument.

Effects of different irrigating solutions and disinfection methods on push-out bond strengths of fiber posts.

OBJECTIVE: The aim of this study was to evaluate the effects of various irrigating solutions and photoactivated disinfection (PAD) on the push-out bond strengths of fiber posts to root dentin. MATERIALS AND METHODS: Thirty-two human teeth were divided into eight groups, as follows: (1) irrigation with physiologic saline (control), (2) NaOCl irrigation, (3) chlorhexidine (CHX) irrigation, (4) ethanol (EtOH) irrigation, (5) NaOCl followed by 17% EDTA irrigation, (6) NaOCl-EDTA supplemented with CHX irrigation, (7) NaOCl-EDTA supplemented with EtOH irrigation and (8) NaOCl-EDTA irrigation supplemented with PAD. After the posts were cemented, the roots were transversally sectioned to obtain four slices (1 mm thick) (n = 16). Push-out tests were conducted by applying a load at 0.5 mm/min, types of fracture failures were recorded and data were analyzed with one-way ANOVA and Tukey post-hoc tests (p = 0.05). RESULTS: Push-out bond strength was significantly affected by the type of irrigating solution and the disinfection protocol (p < 0.05). The bond strength of the EtOH, NaOCl and NaOCl-EDTA-CHX irrigated groups was significantly higher than that of the other groups. The highest bond strength was observed in the EtOH irrigated group and the lowest was the NaOCl-EDTA irrigated group. CONCLUSIONS: Irrigation with NaOCl and EDTA combined caused lower bond strength than observed in the control group. However, supplementing this combination with CHX improved the post-dentin bond strengths; supplementing with PAD did not.

Assessment of apically extruded debris and irrigant produced by different nickel-titanium instrument systems

The aim of this study was to evaluate the preparation time and the amounts of apically extruded debris and irrigant using different nickel-titanium instrumentation systems. Forty-five extracted single-rooted mandibular premolar teeth were selected and divided into three groups. The root canals were instrumented according to the manufacturers’ instructions, using a reciprocating single-file system, a single-file rotary system and a multiple-file rotary system. Bidistilled water was used as the irrigant solution. The apically extruded debris and irrigant were collected into preweighed Eppendorf tubes. The amounts of extruded debris and irrigant were assessed with a precision micro-balance. The Eppendorf tubes were incubated at 37°C for 15 days. After the incubation period, they were weighed again to assess the debris extrusion. The time required to prepare the canals was also recorded. The results were statistically analyzed using MANOVA and Bonferroni’s adjustment. Considering the apically extruded debris and irrigant, there were no statistically significant differences among the groups (p > 0.05). The Reciproc group produced the highest debris (0.000632 ± 0.000162 gr) and irrigant (0.844587 ± 0.437814 ml) extrusion values. While the least extruded debris was observed with OneShape (0,000431 ± 0,000171 gr), the least extruded irrigant was observed with ProTaper system (0.564147 ± 0.370596 ml). Instrumentation was faster using the Reciproc than the other two instruments (70.27 ± 13.38 s) (p < 0.05). All of the instrumentation systems used in this study produced apical debris and irrigant extrusion. The reciprocating single-file system tended to produce more debris and irrigant extrusion, compared with the rotary systems. Considering the preparation time, the single-file systems appeared to be advantageous due to their working time.

Do fluoride and casein phosphopeptide-amorphous calcium phosphate affect shear bond strength of orthodontic brackets bonded to a demineralized enamel surface?

OBJECTIVE: To compare the effects of fluoride and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) containing topical agents on shear bond strength (SBS) and fracture mode of orthodontic brackets bonded to demineralized enamel. MATERIALS AND METHODS: Eighty freshly extracted human premolar teeth were randomly divided into four equal groups. The first group was the control, and no pretreatment was performed on this group. In the remaining three groups, demineralization process was performed and teeth were stored in artificial saliva. In group II, bonding was performed after demineralization. Pretreatment with fluoride and CPP-ACP gels was performed in groups III and IV, respectively. Brackets were bonded using a conventional system. The SBS of these brackets was measured and recorded in MPa. Adhesive remnant index (ARI) scores were determined after the brackets failed. Data were analyzed with analysis of variance (ANOVA), Tukey, and G-tests at the P < .05 level. RESULTS: ANOVA comparison of four groups revealed statistically significant differences. No significant differences were found between control and CPP-ACP-treated groups. However, lower SBS values were recorded for group II (6.6 ± 3.9 MPa) and group III (17.1 ± 2.9 MPa). ARI scores were significantly different among the four groups (P < .001). No enamel detachment was found in the control group, and enamel detachment measured 75% for group II. CONCLUSIONS: Fluoride and CPP-ACP gel applications showed higher debonding forces compared to bonding in untreated demineralized samples. CPP-ACP pretreatment resulted in comparable SBS values compared with the control group.

Are nano-composites and nano-ionomers suitable for orthodontic bracket bonding?

The aim of this study was to test nano-composite (Filtek Supreme Plus Universal) and a newly introduced nano-ionomer (Ketac N100 Light Curing Nano-Ionomer) restorative to determine their shear bond strength (SBS) and failure site locations in comparison with a conventional light-cure orthodontic bonding adhesive (Transbond XT). Sixty freshly extracted human maxillary premolar teeth were arbitrarily divided into three equal groups. The brackets were bonded to the teeth in each group with different composites, according to the manufacturers' instructions. The SBS values of the brackets were recorded in Megapascals (MPa) using a universal testing machine. Adhesive remnant index scores were determined after failure of the brackets. The data were analysed using analysis of variance, Tukey honestly significant difference, and chi-square tests. The results demonstrated that group 1 (Transbond XT, mean: 12.60 +/- 4.48 MPa) had a higher SBS than that of group 2 (nano-composite, mean: 8.33 +/- 5.16 MPa; P < 0.05) and group 3 (nano-ionomer, mean: 6.14 +/- 2.12 MPa; P < 0.001). No significant differences in debond locations were found among the three groups. Nano-composites and nano-ionomers may be suitable for bonding since they fulfil the previously suggested SBS ranges for clinical acceptability, but they are inferior to a conventional orthodontic composite.

Exposure of surgical staff in surgical probe applications in radioguided parathyroidectomy.

The aim of this study is to calculate the exposure of surgical staff during radioguided parathyroidectomy. Two parathyroidectomy operations on patients with parathyroid adenoma were selected. Fifty-centimeter spaced circles were drawn surrounding the operation bed on the floor of the operation room. During the operation, radiation dose was measured according to the drawn circles at distances of 50-200 cm from the side of patient's head, bilateral neck and abdomen while the patient lied on the operation bed. All the operations were recorded throughout with a video camera. Three physicians watched all records. The time spent at each distance for every staff during the operation was recorded. Whole body dose to senior surgeon was calculated as 8.78-11.00 microSv which means that a senior surgeon can perform 91-114 procedures per year to reach the annual International Commission on Radiological Protection (ICRP) radiation dose limit for a member of the public. We concluded that radiation risk to the surgical staff is low from radioguided parathyroidectomy.