Crown discoloration induced by endodontic sealers: spectrophotometric measurement of Commission International de I'Eclairage's L*, a*, b* chromatic parameters.

Despite the improvement of endodontic materials, crown discoloration induced by root canal sealers remains a concerning clinical issue. The aim of this study is the measurement of the alterations in CIE L*, a*, b* chromatic parameters of tooth crowns after placement of commonly used and new-generation endodontic sealers in pulp chambers. Eighty intact, fully developed third mandibular molars were randomly assigned in five groups. Crowns were cross-sectioned from the root complex 1 mm below the cement-enamel junction. The internal axial walls of the pulp chambers were debrided and coated with endodontic sealers (Roth-811, AH-26, Guttaflow, Epiphany SE). The apical access was sealed with glass-ionomer cement. The control group was only debrided. Crowns were stored in individually marked vials in standard conditions (100% humidity, 37°C). The spectral reflectance lines were recorded with a UV-Vis spectrophotometer in the visual spectrum. The CIE L*a*b* parameters were obtained by a linked computer software before sealer placement (baseline), after one week, one, three, and six months, respectively. Statistical analysis was performed with two-way mixed ANOVA models. The level of statistical significance was set at p<0.05. With the exception of the control group, experimental groups presented varying chromatic alterations. Among all experimental groups, Roth-811 sealer induced the most severe alterations in CIE L*, a*, b* chromatic parameters, during all observation periods. After root canal obturation, the clinician should be aware of the presence of remaining root canal filling materials. Thorough debridement of the pulp chamber is essential for the prevention of sealer-induced discoloration.

Spectrophotometric analysis of coronal discolouration induced by grey and white MTA.

AIM: To evaluate the specific alterations in tooth colour with white and grey MTA when used to fill pulp chambers. METHODOLOGY: Forty-five fully developed, intact, mandibular third molars were sectioned 1 mm below their cemento-enamel junction (CEJ). Their pulp chambers were chemo-mechanically debrided, and the specimens were randomly assigned into three groups: Group 1-white MTA (Angelus(™)), Group 2-grey MTA (Angelus(™)) and Group 3-negative control (unfilled). During the experimental period, specimens were immersed in vials containing distilled water up to the CEJ (37±1 °C). Spectral reflectance lines were recorded by utilizing a UV-vis spectrophotometer equipped with an integration sphere in the visual spectrum, at baseline, 1 week and 1, 2 and 3 months after placement of the materials. Data were transformed into values of the CIE L*a*b* colour system, and the corresponding ΔΕ values were calculated. The results were analysed using two-way mixed anova models, whilst pairwise comparisons were conducted with Bonferroni's method at P < 0.05 level of significance. RESULTS: Both types of MTA induced significant decreases in L*, a* and b* values. The colour change was greater with grey MTA. Grey MTA led to clinically perceptible crown discolouration after 1 month, whilst the total colour change caused by white MTA exceeded the perceptible threshold for the human eye after 3 months. CONCLUSIONS: The application of both grey and white MTA formulations induced a decrease in lightness and reduction in redness and yellowness in teeth. The present findings suggest that application of grey MTA in the aesthetic zone should be avoided, whilst white MTA should be used with caution when filling pulp chambers with the materials.

Ex-vivo area-metric analysis of root canal obturation using gutta-percha cones of different taper.

AIM: To evaluate the percentage of gutta-percha and sealer-filled canal area when four different types of master gutta-percha cones were used. METHODOLOGY: Sixty mandibular premolars with straight canals were instrumented using System ProTaper rotary instruments with a crown-down technique and assigned to four groups. Canals were obturated with AH-26 sealer either using lateral condensation and 0.02 taper gutta-percha cones (group A), 0.04 taper gutta-percha cones (group B), nonstandardized F- medium (group C) master gutta-percha cones, or a single System ProTaper gutta-percha cone (group D). The percentage of gutta-percha and sealer-filled area was calculated in horizontal sections of the apical portion of each canal, using image analysis software. The data was statistically analysed using Kruskal-Wallis test. RESULTS: The distribution of filling materials amongst groups was not significantly different at each level of sectioning (P > 0.05). CONCLUSION: The percentage of gutta-percha and sealer-filled canal area was similar when canals were filled with different master cones using lateral condensation or single cone techniques.

Cytotoxic effects of different concentrations of neutral and alkaline EDTA solutions used as root canal irrigants.

The cytotoxic effects of neutral and alkaline EDTA solutions were evaluated and compared with those of sodium hypochlorite solution using an established cell line: L929. Cytotoxicity was assessed by a quantitative technique at five observation periods (1, 3, 6, 12, and 24 h). All tested agents showed moderate to severe cytotoxicity in the present experimental model in a concentration-dependent manner.

Removal efficiency of calcium hydroxide dressing from the root canal.

The aim of this study was to investigate whether differences in the composition of calcium hydroxide (Ca(OH)2) preparations influence the removal efficiency of irrigation solutions used in combination with filing of the canal. Three Ca(OH)2 preparations were used: Calxyl, Pulpdent paste, and chemically pure Ca(OH)2 mixed with distilled water. Fifty-one single-rooted extracted human teeth were prepared with a step-back technique and divided into groups A, B, and C. In each group, 15 teeth were assigned to each Ca(OH)2 preparation while the remaining two served as positive and negative controls. Each group of treated teeth was divided into three subgroups of five teeth each: subgroup I--canals were irrigated with saline, filed with a #25 file, and finally flushed with saline; subgroup II--canals were irrigated with NaOCl, filed with a #25 file, and finally flushed with NaOCl; and subgroup III--canals were irrigated with NaOCl, filed with a #25 file, and finally flushed with tetrasodium EDTA. Canal sections were then photographed, and the percentage ratios of Ca(OH)2 coated area to the total canal surface area were calculated by image processing analysis. Results revealed: (a) none of the methods efficiently removed all dressing from the walls, and (b) concentration of the paste used had little effect on the efficacy of the methods applied for the removal of the dressing. Excipients (i.e. methylcellulose contained in Pulpdent) possibly effect retention of Ca(OH)2.

Long-term evaluation of the influence of smear layer removal on the sealing ability of different sealers.

The purpose of this study was to examine the effect of the smear layer on apical microleakage over 16 wk. One hundred and four extracted human teeth were assigned to four groups treated as follows: group A1--smear layer was left intact and canals were obturated with gutta-percha and Roth 811; group A2--smear layer was left intact and canals were obturated with gutta-percha and AH26; group B1--smear layer was removed and canals were obturated with gutta-percha and Roth 811; and group B2--smear layer was removed and canals were obturated with gutta-percha and AH26. Microleakage was measured by the electrochemical method. In parallel, 12 teeth were examined under a scanning electron microscope. The results indicated that the smear layer removal resulted in a statistically significant reduction of microleakage values in groups obturated with AH26. The presence or absence of smear layer had no significant effect on the sealing ability of Roth 811.

In vitro release of hydroxyl ions from calcium hydroxide gutta-percha points.

In endodontic practice, calcium hydroxide is widely used for a number of reasons associated with its high pH. The purpose of the present study was to determine in vitro the alkalizing potential of newly introduced calcium hydroxide gutta-percha points that are proposed for temporary filling of root canals. The materials tested were: calcium hydroxide gutta-percha points; chemical pure calcium hydroxide powder mixed with distilled water; and Reogan rapid, a nonsetting calcium hydroxide preparation. The materials were placed into dialysis tubing and transferred into plastic vials containing bidistilled water. Measurements were taken by a digital pH meter after 10, 20, and 30 s; 1, 15, and 30 min; and 1, 2, 3, 24, 48, 72, 96, and 120 h. The calcium hydroxide containing gutta-percha points showed a significantly lower alkalizing potential than Reogan rapid and calcium hydroxide mixed with distilled water (p < 0.05).

Cytotoxicity of three resin-based root canal sealers: an in vitro evaluation.

The cytotoxicity of three resin-based root canal sealers (AH26, AH-Plus, Topseal) was evaluated in vitro. The experiments included two cell lines, L929 mouse skin fibroblasts and RPC-C2A rat pulp cells. The cytotoxicity was assessed by sulforodamine B (SRB) colorimetric assay and hemocytometer viable cell counting after 24- and 48-h exposure. AH26 had a severe cytotoxic effect whilst Topseal and AH-Plus showed a markedly lower toxic influence on the cells during the experimental period.

In vivo comparison of the biocompatibility of two root canal sealers implanted into the subcutaneous connective tissue of rats.

The purpose of this study was to evaluate the in vivo biocompatibility of Apexit (a calcium hydroxide) and Pulp Canal Sealer (a classic zinc oxide-eugenol), root canal sealers, after implantation in rat connective tissue. Forty-four white female Wistar-Furth rats were used. Each sealer was placed in Teflon tubes and implanted into specific dorsal subdermal tissues sites. Implants were removed after 5, 15, 60, and 120 days; fixed; and histologically prepared for microscopical evaluation. Severe inflammatory reactions with differing extensions of necrosis were observed with Apexit on the 5th and 15th days. The intensity of the reaction had diminished by the 60th day, and this reduction continued progressively through the 120th day. It was characterized by the presence of connective tissue with a few macrophages. Moderate to severe inflammation with confined areas of necrosis was observed in the Pulp Canal Sealer specimens on the 5th day. The intensity of the reaction diminished by the 15th, 60th, and 120th days, but remained slightly greater than Apexit through longterm observation periods.

In vitro release of hydroxyl ions from six types of calcium hydroxide nonsetting pastes.

The role of intracanal medication in root canal treatment is very important. Calcium hydroxide (Ca(OH)2) is considered to fulfill many of the properties of an ideal root canal dressing mainly due to its alkalizing pH. It is bacteriocidal and neutralizing to the remaining tissue debris in the root canal(s) and through the continuous release of OH- ions it promotes an alkalizing osteogenic environment for the surrounding tissues. The purpose of this study was to examine the pH values of various Ca(OH)2 based on compounds used as intracanal medicaments over a period of 5 days. The following materials were tested: Calasept, Calcicur, Calxyl blue, Calxyl red, Reogan rapid, and Tempcanal. After a fast OH- release period (2 h) each compound reached an asymptotic pH state. The results showed that all materials exhibited alkalizing pH with Reogan rapid, Calxyl Red, and Calcicur being the most potent (p = 0.05). The final pH of each compound correlated positively with the Ca(OH)2 mass fraction contained in it.

Endodontic treatment in three cases of dens invaginatus.

Three cases of dens invaginated teeth with periapical lesions are presented in this article. In the first case the maxillary canine was treated with conventional endodontic treatment. The second and third cases, in mandibular and maxillary central incisors respectively, were treated surgically. Six months postoperatively all cases appeared radiographically to be improved.

Endodontic treatment of an unusual mandibular second molar.

A case involving unusual pulpal morphology due to fusion or gemination was treated by conservative endodontic treatment. Clinically, the involved mandibular second molar had an enlarged clinical crown and an extra cusp with a deep carious lesion. Careful negotiation, instrumentation and obturation of the root canal system led to successful treatment.

In vitro evaluation of the cytotoxicity of two glass-ionomer root canal sealers.

The cytotoxicity of two glass-ionomer root canal sealers (Ketac-Endo and Endion) was tested by using an established cell line, BHK21/C13. Under aseptic conditions, the sealers were prepared according to the manufacturers' directions, and 0.1 ml of each material was placed in petri dishes. After setting for 6 h, the sealers were covered with 20 x 10(4) cells per dish. The cultures were incubated at 37 degrees C for 24 h, 48 h, and 72 h. Cytotoxicity was assessed by a quantitative technique at three observation periods. Endion was highly cytotoxic, causing a significant decrease in cell density. Ketac-Endo proved to be a very biocompatible material.

Accidental swallowing of endodontic instruments.

Swallowing or aspiration of a foreign body is a complication that may arise from any procedure in the oral cavity performed without the use of a rubber dam. Two cases of swallowed endodontic instruments and possible complications are presented. Emphasis is given in the discussion on the early diagnosis and treatment and primarily on prevention with the use of rubber dam, an absolute essential during endodontic treatment.

Experimental study of the biocompatibility of a new glass-ionomer root canal sealer (Ketac-Endo).

Ketac-Endo, a new glass-ionomer cement for endodontic use as root canal sealer, and Tubli-Seal were tested for tissue biocompatibility in rat connective tissue. Forty-four white female Wistar-Furth rats were used. Each sealer was placed in Teflon tubes and implanted subcutaneously. The implants were removed after 5, 15, 60, and 120 days; fixed; and histologically prepared for microscopical evaluation. Mild inflammatory reaction was observed with Ketac-Endo on the 5th day. The connective tissue was infiltrated with plasma cells. Lymphocytes and macrophages were observed. The intensity of the reaction diminished by the 15th day, and this reduction continued progressively through the 60th and 120th days. Severe inflammation with differing extensions of necrosis was observed with Tubli-Seal on the 5th and 15th days, and the material remained irritating even after long-term implantation periods (60 and 120 days).

Role of cementoenamel junction on the radicular penetration of 30% hydrogen peroxide during intracoronal bleaching in vitro.

Intracoronal bleaching of nonvital, teeth with 30% hydrogen peroxide is occasionally associated with external cervical root resorption. The exact mechanism by which bleaching induced root resorption occurs is not yet fully understood. The relationship of cementum to the enamel at the cementoenamel junction may have clinical significance. Seventeen single rooted human mandibular premolars extracted atraumatically for orthodontic reasons were used. The radicular hydrogen peroxide penetration in each tooth was measured in vitro by an indirect colorimetric method. Thereafter, the teeth were examined with a scanning electron microscope to determine the type of the cementoenamel junction. It was found that the radicular penetration of 30% hydrogen peroxide was related to the type of cementoenamel junction.

In vitro evaluation of the cytotoxicity of calcium hydroxide-based root canal sealers.

The cytotoxicity of three calcium hydroxide-containing root canal sealers (Sealapex, CRCS and Apexit) was tested by using L929 and BHK 21/C13 cells. After setting for 24 h, the sealers were covered with cell suspension. Cytotoxicity was determined by a quantitative technique at 24 h, 48 h and 72 h. All the sealers were found to be cytotoxic. Sealapex showed the highest cytotoxicity, causing a significant decrease in cell density. CRCS was less toxic than Sealapex and more toxic than Apexit. Apexit proved to be the least toxic material.

In vitro evaluation of apical leakage of root canal fillings after in situ obturation with thermoplasticized and laterally condensed gutta percha.

The purpose of this investigation was to compare in vitro the sealing ability of root canal treatments performed in situ with injected thermoplasticized gutta-percha compared with the lateral condensation technique. Thirty single-rooted teeth with straight canals, due for extraction for orthodontic or periodontal reasons were prepared using a step-back technique. Teeth were then divided randomly into groups A and B and obturated, respectively, with the sectional injection thermoplasticized gutta-percha and the lateral condensation techniques. Teeth were extracted after 15 days, immersed in India ink for 3 days and the leakage was determined using area-metric analysis. The roots were ground transversally and the root portion was incrementaly removed with successive steps of 250 microns each, up to the coronal level of the dye penetration. Every section was photographed with a stereoscopic microscope under the same magnification (x20); 310 photographs were taken. Measurements of the area covered by ink as well as the whole cross-sectional area of the canal were made from each photograph with the aid of a digitizing computer. The measurements were subjected to non-parametric statistical analysis. No significant difference was found (P > 0.05). The technique of lateral condensation proved to be better in the first five sections (1.2 mm from the foramen) while thermoplasticized gutta-percha technique was superior in the rest of the root canal.

Inductive effect of native dentin on the dentinogenic potential of adult dog teeth.

Autogenous dentinal matrix was exposed to the pulp cells of adult dogs in order to determine whether the mature pulp cells possess the ability to differentiate into odontoblast-like cells as a direct response to known inductive influences. The pulps of molars, premolars, and canines of three dogs (2 to 4 yr old) were mechanically exposed through buccal class V cavities. Pieces of demineralized or native dentin and predentin were implanted in the pulp sites for periods of 2 to 6 wk. The reactions were analyzed by light microscopy. Induction of dentin formation was observed only after native dentin implantation; either as early response to exposure of predentinal surfaces or around mineralized dentin after 3 postoperative wk. Encapsulation by fibrous connective tissue or matrix degradation was seen around demineralized dentin implants. A characteristic enhancement of circumferential pulpal dentin deposition around the implantation site was demonstrated after native dentin exposure to light and scanning electron microscopic examination. These data indicate that specific inductive influences given by the native but not the acid-conditioned dentin, when it is exposed to the pulp environment of adult teeth, are able to direct differentiation of odontoblast-like cells and to enhance the biosynthetic activity of primary odontoblasts.

[Control of sealing ability of the root canal sealers. An experimental study--in vitro]. / Elegchos tes apophraktikes ikanotetas emphraktikon phyramaton rizikon solenon. Melete--in vitro.

Prime requirement for successful root canal therapy is the hermetic obturation of the root canal. Root canal sealers contribute a lot in achieving the three dimensional hermetic obturation of the root canal. In this in vitro experimental study the sealing ability of six root canal sealers (Grossman, Roth 801, Hermetic, Diaket, AH26, Endomethasone) was evaluated. A hundred and twenty single rooted human teeth, divided into six groups, were prepared and obturated with lateral condensation gutta-percha technique and the sealers under evaluation correspontantly. The extent of mikroleakage of Indian ink in cleared samples was calculated under stereoscopic microscope. Results obtained showed minimum leakage with Roth 801.