Minimally invasive management of vital teeth requiring root canal therapy.

The present study aimed to investigate the possible use of a non-instrumentation technique including blue light irradiation for root canal cleaning. Extracted human single rooted teeth were selected. Nine different groups included distilled water, NaOCl, intra-canal heated NaOCl, and NaOCl + EDTA irrigation after either instrumentation or non-instrumentation, and a laser application group following non-instrumentation technique. The chemical assessment of the root canal dentine was evaluated using energy dispersive spectroscopy (EDS) and Fourier transform infrared (FT-IR) spectroscopy. Surface microstructural analyses were performed by using scanning electron microscopy (SEM). The antimicrobial efficacy of different preparation techniques was evaluated using microbial tests. Light application didn't change the calcium/phosphorus, carbonate/phosphate and amide I/phosphate ratios of the root canal dentin. The root canal dentin preserved its original chemistry and microstructure after light application. The instrumentation decreased the carbonate/phosphate and amide I/phosphate ratios of the root canal dentin regardless of the irrigation solution or technique (p < 0.05). The application of light could not provide antibacterial efficacy to match the NaOCl irrigation. The NaOCl irrigation both in the non-instrumentation and instrumentation groups significantly reduced the number of bacteria (p < 0.05). The use of minimally invasive root canal preparation techniques where the root canal is not instrumented and is disinfected by light followed by obturation with a hydraulic cement sealer reduced the microbial load and preserved the dentin thus may be an attractive treatment option for management of vital teeth needing root canal therapy.

Association between polymorphisms in catechol-O-methyl transferase, opioid receptor Mu 1 and serotonin receptor genes with postoperative pain following root canal treatment.

AIM: To evaluate the effect of single nucleotide polymorphisms in the COMT, OPRM1, 5HT1A, 5HT2A and 5HTR3B genes on the intensity of postoperative pain following root canal treatment. METHODOLOGY: Ninety-five patients with mandibular and maxillary molar teeth diagnosed with symptomatic apical periodontitis and a level of preoperative pain greater than 50 on a 100 mm visual analogue scale (VAS) were included. Salivary DNA was collected from the participants and stored in Eppendorf tubes at -80 °C. Preoperative percussion pain values were recorded before the root canal treatment procedures. After completion of root canal treatment, the participants were given instructions to record their postoperative pain intensity levels at 24, 48 and 72 h, 5 days and 1 week after treatment, using the VAS. A second visit for the patients after seven days was planned to record their intensity levels of percussion pain on VAS. The percussion test was performed by tapping on the occlusal surface of the tooth with a blunt instrument. A QIAamp DNA Mini Kit was used to isolate DNA from saliva, and SNP Genotyping Analysis software version 1 was used to analyse the genotypes by calculating FAM and HEX signals. The Kruskal-Wallis and Mann-Whitney U-tests were used to evaluate pain intensity values amongst the genotypes, alleles, haplotypes and allele combinations. Nominal data (gender, intake and tooth number) were analysed using a Chi-square test. Bonferroni correction was performed. Thus, the significance level was set at 1.6% (P = 0.016), 2.5% (P = 0.025) and 1.25% (P = 0.0125) for genotype, allele and haplotype comparisons, respectively. RESULTS: There was no significant difference amongst the genotypes and alleles in terms of pre- and postoperative pain intensity. There was no significant difference amongst the haplotypes formed for the COMT gene in terms of pain intensity. Additionally, there was no significant association between the allelic combination formed for 5HT1A + 5HT2A genes and the intensity of postoperative pain. CONCLUSION: The findings indicate that none of the evaluated SNPs for COMT, OPRM1, 5HT1A, 5HT2A and 5HTR3B genes were associated with the intensity of postoperative pain.

Antibacterial effectiveness of calcium hydroxide alone or in combination with Ibuprofen and Ciprofloxacin in teeth with asymptomatic apical periodontitis: a randomized controlled clinical study.

AIM: To evaluate the antimicrobial effectiveness of Ca(OH)2 paste combined with Ibuprofen or Ciprofloxacin in infected root canals of teeth with asymptomatic apical periodontitis. METHODOLOGY: Forty-five patients were randomly divided into three groups using a web programme according to the medication selected: Ca(OH)2 : 1 g Ca(OH)2 powder with 1 mL propylene glycol, Ca(OH)2  + Ibuprofen: 50 mg of Ibuprofen was added into 950 mg Ca(OH)2 powder and mixed with 1 mL propylene glycol, Ca(OH)2  + Ciprofloxacin: 50 mg of Ciprofloxacin was added into 950 mg Ca(OH)2 powder and mixed with 1 mL propylene glycol. Root canal bacteriological samples were collected before root canal treatment (S1) and after chemo-mechanical procedures (S2). After root canal preparation, the intracanal medicaments were placed into the root canals to a level approximately 1 mm short of the working length using K-files and access cavities were filled temporarily. The participants were scheduled for a second visit 7 days later when the medication was removed mechanically, and after irrigation of the root canals, the final samples (S3) were collected. Samples were subjected to quantitative real-time polymerase chain reaction to evaluate the numbers of total bacteria, Enterococcus faecalis and Streptococcus species. For intragroup analysis, a Friedman test was used to compare reduction of counts of total bacteria, Streptococci and E. faecalis amongst the three samples (S1, S2 and S3). The chi-square test was used to compare the number of root canals positive for bacteria in S1, S2 and S3 amongst the groups. RESULTS: Intragroup analysis revealed a significant reduction in the number of intracanal bacterial cells from S1 to S2 and from S2 to S3 in all medication groups (P < 0.01). Although there was no significant difference amongst the groups when comparing quantitative S1 or S2 data, there were significantly lower bacterial counts in the Ca(OH)2  + Ciprofloxacin group (0.49 × 102 ) than the pure Ca(OH)2 (1.25 × 102 ) and Ca(OH)2  + Ibuprofen groups (0.76 × 102 ) at S3. The percentage reduction from S1 to S3 and from S2 to S3 was significantly greater in the Ca(OH)2 + Ciprofloxacin than the pure Ca(OH)2 and Ca(OH)2 + Ibuprofen groups (P < 0.05). In the Ca(OH)2  + Ciprofloxacin group, there were significantly fewer positive cases (8/15) than the pure Ca(OH)2 (13/15) and Ca(OH)2  + Ibuprofen (13/15) groups (P < 0.05). CONCLUSION: The addition of Ciprofloxacin to Ca(OH)2 provided further antibacterial effectiveness when used as an intracanal medicament in vivo during root canal treatment.

Incidence of dentinal cracks after root canal preparation with ProTaper Gold, Profile Vortex, F360, Reciproc and ProTaper Universal instruments.

AIM: To assess the effect of root canal preparation using ProTaper Gold, Profile Vortex, F360, Reciproc and ProTaper Universal instruments on dentinal crack formation. METHODOLOGY: Ninety mandibular central incisor teeth with mature apices and straight canals (<5° ) were selected and stored in distilled water. Fifteen teeth were left unprepared (control group) and the remaining 75 teeth were assigned to the five root canal shaping groups (n = 15): ProTaper Gold, ProFile Vortex, F360, Reciproc and ProTaper Universal. All the roots were sectioned perpendicular to the long axis at 3, 6 and 9 mm from the apex with a low-speed saw under water cooling. The slices were then viewed through a stereomicroscope at 25×  magnification. The presence of dentinal cracks was determined by photographing all samples using a digital camera. RESULTS: All the experimental groups, except F360, produced significantly more cracks than the control group (P < 0.05). No significant difference was observed amongst the groups at the 6 and 9 mm levels (P > 0.05). The ProTaper Universal group produced significantly more cracks than the control, ProTaper Gold, ProFile Vortex, F360 and Reciproc groups at the apical section (3 mm) (P < 0.05). CONCLUSION: All the systems that were tested produced dentinal cracks. There was no significant difference between the control and F360 groups in terms of dentinal crack formation.

Comparison of apically extruded debris after root canal instrumentation using Reciproc(®) instruments with various kinematics.

AIM: To assess the amount of apically extruded debris using Reciproc(®) instruments with different kinematics (150° counter clockwise [CCW]-30° clockwise [CW], 270° CCW-30° CW, 360° CCW-30° CW and continuous rotation). METHODOLOGY: Forty-eight maxillary central incisors were selected and assigned to four root canal shaping groups as follows (n = 12): 150° CCW-30° CW, 270° CCW-30° CW, 360° CCW-30° CW and continuous rotation. Reciproc R25 and R50(®) instruments were used in all groups. Apically extruded debris was collected and dried in preweighed Eppendorf tubes. The weight of extruded debris was assessed with an electronic balance. The data were analysed with one way analysis of variance and LSD post hoc tests (P = 0.05). RESULTS: The 150° CCW-30° CW and 270° CCW-30° CW reciprocating motions extruded significantly less debris than continuous rotation (P < 0.05). However, no significant differences were found between the 360° CCW and 30° CW reciprocating motion and the continuous rotation (P > 0.05). CONCLUSIONS: All instrument movements were associated with apically extruded debris. However, the 150° CCW-30° CW and 270° CCW-30° CW reciprocating motions were associated with less extrusion than continuous rotation.

Effect of movement kinematics on the cyclic fatigue resistance of nickel-titanium instruments.

AIM: To compare the cyclic fatigue resistance of new generation OneShape and WaveOne instruments when used with different kinematics. METHODOLOGY: An artificial canal, made of stainless steel with an inner diameter of 1.5 mm, a 60° angle of curvature and a curvature radius of 3 mm, was used for cyclic fatigue test of new generation OneShape and WaveOne instruments. Groups were as follows (n = 20): 150°-30°, 210°-30°, 360°-30° and continuous rotation. The time to fracture was recorded in seconds, and the data were analysed statistically using a two-way anova and LSD tests (P = 0.05). RESULTS: Cyclic fatigue resistance was significantly affected by the movement kinematics (P < 0.001). The cyclic fatigue resistance of the new generation OneShape instruments increased significantly when operated in various reciprocation motions (150° CW-30° CCW, 210° CW-30° CCW and 360° CW-30° CCW) compared with the continuous rotation mode. New generation OneShape instruments had significantly more resistance to fracture under cyclic loading than WaveOne instruments (P < 0.001). CONCLUSIONS: When using new generation OneShape and WaveOne instruments, all the reciprocating motions (150° CW-30° CCW, 210° CW-30° CCW and 360° CW-30° CCW) resulted in extended fatigue life when compared with continuous rotation.

Quantitative evaluation of apically extruded debris with Twisted File Adaptive instruments in straight root canals: reciprocation with different angles, adaptive motion and continuous rotation.

AIM: To evaluate the influence of movement kinematics when using Twisted File Adaptive instruments (SybronEndo, Orange, CA, USA) (TF Adaptive) on the amount of apically extruded debris. METHODOLOGY: Forty-eight extracted mandibular incisor teeth were selected. The teeth were randomly divided into four groups (n ꞊ 12), and the root canals were instrumented using the following movement kinematics: TF Adaptive motion, 90° clockwise (CW) to 30° counterclockwise (CCW) reciprocating motion, 150°CW to 30°CCW reciprocating motion or continuous rotation. TF Adaptive instruments were used for all groups. Debris extruded apically during instrumentation was collected in pre-weighed Eppendorf tubes, and after drying, the mean weight of the debris was assessed with an electronic balance. The data were analysed statistically using a one-way analysis of variance. RESULTS: The 90° CW to 30° CCW reciprocating motion produced the highest mean extrusion value, and this was significantly greater when compared with continuous rotation (P < 0.05). 150° CW to 30° CCW reciprocating, adaptive and continuous rotation motions produced similar amounts of debris extrusion (P > 0.05). CONCLUSION: Movement kinematics affected the amount of apically extruded debris when using Twisted File Adaptive instruments.

Evaluation of orange-brown precipitate formed in root canals after irrigation with chlorhexidine and QMix and spectroscopic analysis of precipitates produced by a mixture of chlorhexidine/NaOCl and QMix/NaOCl.

AIMS: (i) To compare chlorhexidine and QMix(TM) in terms of orange-brown precipitate generation in root canals and (ii) to analyse the precipitate produced by mixing chlorhexidine and QMix(™) with NaOCl to determine whether para-chloroaniline was produced. METHODOLOGY: The root canals of 57 single-rooted anterior teeth were prepared using ProTaper Universal rotary instruments up to size F4. Two millilitres of 2.5% NaOCl was used between each instrument change. The specimens were then divided randomly into three groups (n = 19) and irrigated as follows: group 1, 5 mL of distilled water (control group) for 60 s; group 2, 5 mL of 2% chlorhexidine for 60 s; and group 3, 5 mL of QMix for 60 s. The roots were split longitudinally, and one of the halves was photographed using a stereomicroscope. The amount of orange-brown precipitate was evaluated using a four-grade scoring system. The data were analysed statistically using the Kruskal-Wallis and Mann-Whitney U-tests (P = 0.05). To evaluate whether the precipitates included para-chloroaniline, 5 mL of 2% chlorhexidine and 5 mL QMix were separately mixed with 5 mL of 2.5% NaOCl in two flasks. After centrifugation, precipitates were obtained and analysed using (1) H NMR spectra. The data were subjected to statistical analysis using the Kruskal-Wallis and Mann-Whitney tests at a 95% confidence level (P = 0.05). RESULTS: Chlorhexidine had significantly higher scores than QMix(™) in terms of orange-brown precipitate formed in the root canals (P < 0.001). According to the 1H NMR spectra, para-chloroaniline was present in the mixture of chlorhexidine and NaOCl. However, the mixture of QMix(™) and NaOCl did not result in para-chloroaniline formation. CONCLUSION: QMix(™) does not form para-chloroaniline when associated with NaOCl.

Comparison of the effect of nonactivated self-adjusting file system, Vibringe, EndoVac, ultrasonic and needle irrigation on apical extrusion of debris.

AIM: To compare the effects of Vibringe, EndoVac, nonactivated SAF and passive ultrasonic irrigation (PUI) with a conventional syringe on the amount of apically extruded debris. METHODOLOGY: Seventy-five extracted human maxillary incisors were selected and randomly assigned to 5 groups (n = 15). The root canals were irrigated with Vibringe (Vibringe B. V. Corp, Amsterdam, Netherlands), EndoVac (Discus Dental, Smart Endodontics, Culver City, CA, USA), nonactivated SAF (ReDent-Nova, Ra'anana, Israel), passive ultrasonic irrigation (PUI) and conventional syringe. Distilled water was used as an irrigant, and debris was collected in pre-weighed glass vials. The tubes were then stored in an incubator at 37 °C for 10 days to evaporate the irrigant before weighing the dry debris. The mean weight of debris was assessed, and one-way analysis of variance was used for comparison of values and post hoc Tukey's test was used between groups (P = 0.05). RESULTS: The SAF group extruded significantly less debris than PUI and Vibringe groups (P < 0.05). There were no significant difference between needle, Vibringe and EndoVac groups (P > 0.05). CONCLUSIONS: All irrigation systems were associated with apical extrusion of debris. Nonactivated SAF extruded significantly less than Vibringe, EndoVac, passive ultrasonic and syringe irrigation.

Evaluation of auditory functions in patients with asthma.

OBJECTIVE: The objective of this study is to evaluate the auditory functions in chronic asthma patients with the use of pure tone high frequency audiometry. PATIENTS AND METHODS: Twenty-two healthy controls and 42 adult patients were included as a prospective, randomized, and controlled study. Pulmonary function tests and blood gas studies were completed on all subjects. Asthma patients have divided into two groups [Group A: Arterial oxygen tension (PaO2) > 75 mmHg, Group B: PaO2 ≤ 75 mmHg, Group C: Control group). Acoustic assessments of patients were performed in 250-20,000 Hz by using pure-tone audiometry (PTA) and tympanometry. RESULTS: The mean value of air and bone conduction hearing threshold levels were in normal range for all groups. All patients had normal peripheral hearing all threshold levels across 250 Hz to 3000 Hz in the both ears. Significant differences were observed between the chronic asthma patients and control group for the extended high frequencies (10,000-20,000 Hz). Group B had statistically more significant increased hearing threshold levels than Group A in frequencies higher than 10,000 Hz. There were no statistical differences between the hearing threshold levels and FEV1, FVC, FEV1/FVC and tympanogram results in the groups. CONCLUSIONS: This is the first study of evaluating the auditory functions in asthma patients. Sensorineural hearing loss in high frequencies (10,000 Hz-20,000 Hz) is common in chronic asthma and is probably present more often than were formerly thought.

Promontory hemangioma mimics glomus tympanicum in the middle ear (promontory hemangioma).

Hemangiomas, common benign vascular tumors, have been well reported in the head and neck region. They have rarely been reported in the ear. Ear involvement hemangiomas are usually seen in the together with external auditory channel and middle ear. We presented a 62-year-old woman of capillary promontory hemangioma which was mimicking as glomus tympanicum with a review of the literature.

The role of high frequency tympanometry in newborn hearing screening programme.

BACKGROUNDS AND OBJECTIVE: The hearing assessment of the newborns ideally should detect both middle and inner ear functions. The aim of this study is to control the association between otoscopic evaluation, multifrequency tympanometry and TEOAE results. METHODS: Fifty new-borns otherwise healthy were tested after the otolaryngological evaluation by 226 and 1000 Hz tympanometries and transient evoked otoacoustic emissions (TEOAE's). The study was performed in three steps and 17 babies that could not pass from the first step they were tested in the second step with the same tests (226 Hz and 1000 Hz tympanometry and TEOAE) The babies that could not pass from the second step were evaluated by multifrequency tympanometries, TEOAE and acoustic brainstem responses (ABR) at the third step. RESULTS: The association between the results obtained from otoscopic evaluation, multifrequency tympanometry and TEOAE were assessed. We found that 1000 Hz tympanometry results were more sensitive and gives more correlated with TEOAE and otoscopic evaluation. CONCLUSIONS: Multifrequency tympanometry can detect the middle ear pathologies of the infants sensitively and should be a part of neonatal hearing screening test battery.

Intraosseous lipoma presenting as a sphenoid sinus mass.

Intraosseous lipoma is an uncommon mesenchymal tumor that is frequently found in appendecular skeleton. In extremely rare conditions, it can appear in sphenoid bone, and only 2 cases have been described in literature until now. We present a case of lipoma in the body of the sphenoid bone mimicking sphenoid sinus tumor. A 16-year-old man presented to Department of Otorhinolaryngology with a complaint of nonspecific headache. There were any clinical findings on physical examination. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed and the diagnosis was made on these imaging findings. Other diagnostic technique, invasive histopathological assessment was not necessary. To our knowledge, this is the first case of lipoma in the body of the sphenoid bone with indentation to sphenoid sinus. The patient has been followed-up radiologically without the need for surgery for two years.

Immunohistochemical analysis of PCNA, Ki67 and p53 in nasal polyposis and sinonasal inverted papillomas.

Immunoreactivity of proliferating cell nuclear antigen (PCNA), Ki67 and p53 in inflammatory nasal polyp and inverted papilloma tissues was investigated. Immunohistochemistry was performed using a standard avidin-biotin-peroxidase method, and the immunoreactivity of PCNA, Ki67 and p53 was quantified by counting immunostained nuclei in at least 1000 epithelial cells. The mean labelling index (percentage of immunostained cells) for PCNA was 40.68 in the inverted papilloma group and 14.73 in the nasal polyp group, and for Ki67 was 15.43 in the inverted papilloma group and 2.64 in the nasal polyp group. Both of these differences between the inverted papilloma and nasal polyp groups were significant. Immunoreactivity for p53 was detected in five (35.7%) inverted papilloma patients and two (9.5%) nasal polyp patients. The increase in epithelial cell proliferation seemed to be greater in inverted papillomas than in inflammatory nasal polyps. Increased epithelial cell proliferation may be involved in the development of inverted papillomas.

Effects of the chorda tympani damage on submandibular glands: scintigraphic changes.

The aim of this study is to compare the scintigraphic results of a denervated submandibular gland with the contralateral normal side in patients with unilateral chorda tympani damage. Sixteen patients (11 women and five men with a mean age of 27) with unilateral proven chorda tympani damage during their previous ear surgery were included in the study. The perfusion ratio (PR), concentration ratio (CR) and stimulated excretion ratio (SER) were calculated scintigraphically and the results from the salivary glands on opposite sides were compared. For submandibular glands, the perfusion ratio (PR), concentration ratio (CR) and stimulated excretion ratio (SER) were found to be 0.65 +/- 0.21, 0.70 +/- 0.21, 0.79 +/- 0.37, respectively. All ratios resulted from statistically decreased radioactivity accumulation on the affected side (p<0.05). Chorda tympani damage negatively affects the function of the ipsilateral submandibular glands despite the absence of atrophy. Dynamic salivary gland scintigraphy is a practical and valuable method of disclosing the decreased capacity of perfusion, concentration and secretion function in unilateral neurological deprivation.

[The existence of sinusitis in rabbits and the use of bromhexine as a mucolytic nose drop in the treatment of sinusitis]. / Tavsanlarda deneysel sinüzit olusturulmasi ve burun damlasi seklinde hazirlanan mukolitik bromhexine'in sinüzit tedavisindeki yeri.

To make an experimental sinusitis, 38 maxillary sinus ostia of 19 rabbits were closed by silicon plastic and 24 hours later 10(8)-10(10) germs/ml. of Streptococcus pneumoniae type C III were given to the antrums of sinuses. 5 days later all the rabbits showed sinusitis clinically, radiologically, bacteriologically and histopathologically. Viscous, purulent secretions collected in the antrums of sinuses. We thought that the medical treatment of sinuses which had drainage treatment necessitated to decrease the viscosity of secretions. Because of this bromhexine as a mucolytic nose drop was investigated for the first time for the treatment of sinusitis in two groups of rabbits. As a result of the study bromhexine as a nose drop in the eradication of sinus infections was seen a useful drug.