Retreatment of XP-endo Shaper and R-Endo files in curved root canals.

OBJECTIVES: To compare the retreatment efficiency of XP-endo Shaper and R-Endo files in curved root canals using ImageJ software. METHODS: Forty extracted mandibular first molars with curved mesial canals (25°-35°) were chosen. Access cavities, preparation and obturation of root canals were performed. Roots were randomly distributed into two groups corresponding to the retreatment files used. Group 1 retreated with XP-endo Shaper file, and group 2 retreated with R-Endo files. Each root was sectioned and photographed. ImageJ software was used to estimate the percentage of residual filling material that existed on the three root canal segments. Mann-Whitney U and the Kruskal-Wallis tests were used to compare the percentages of residual filling material between the teeth segments (P < .05). RESULTS: The R-Endo group showed a significantly higher median percentage of residual filling material than the XP-endo Shaper group. In both groups, the coronal segments had the highest median of the residual filling material, followed by the middle and apical segments. CONCLUSION: XP-endo Shaper is significantly more effective than R-Endo in removing root canal filling materials in the coronal, middle, and apical segments.

Effect of surface treatments on push-out bond strength of calcium silicate-based cements to fiber posts.

BACKGROUND: To evaluate the effect of surface treatments on the push-out bond strength of Biodentine (BD) and white mineral trioxide aggregate (WMTA) to fiber posts. METHODS: Two brands of fiber posts were used: Reblida post; RP and RelyX post; RX. Each type of post (n = 80/group) was divided into four groups (n = 20/group) and exposed to surface treatment as follows: Control (no treatment), sandblasting (SB), hydrofluoric acid (HF), and TiF4 4 wt/v%. Each group was further subdivided into two subgroups (n = 10/subgroup) based on the type of CSCs used as follows: Subgroup A: BD and Subgroup B: WMTA. Push-out bond strength of BD and WMTA to glass fiber posts was assessed. Data were statistically analyzed using three-way ANOVA and Tukey's test. A Weibull analysis was performed on the push-out bond strength data. RESULTS: BD showed higher bond strength than WMTA (P < 0.001). The push-out bond strength for posts treated with TiF4 4 wt/v% showed greater bond strength than the other surface treatments (P < 0.05). The BD/RP-TiF4 4 wt/v% showed the greater characteristic bond strength (σ0) (15.93) compared with the other groups. Surface treatments modified the surface topography of glass fiber posts. CONCLUSIONS: The BD/RP-TiF4 4 wt/v% showed greater bond strength compared with the other groups. The TiF4 4 wt/v% surface treatment enhanced the bond strength of BD and WMTA to glass fiber posts than the other treatments. Surface treatment of fiber post with TiF4 4 wt/v% could be used to improve the bond strength with calcium silicate-based cements.

Awareness, attitude and ethical concern of dental practitioners about stem cells: a cross-sectional study / Consciência, atitude e preocupação ética dos dentistas sobre as células-tronco: um estudo transversal

Objective: To evaluate the level of awareness and attitude among dental practitioners regarding the use of stem cells in dentistry and to determine their knowledge of ethical concerns related to the recent therapy. Material and Methods: A cross-sectional survey-based study was conducted at Taibah University Dental College and Hospital. Medina and at governmental and private dental clinics at the western region of Saudi Arabia. Responses of dental practitioners who completed the survey were recorded between March 2019 and July 2019 without containing any personal identifiers. Level of awareness and attitude and knowledge about ethical issues in relation to stem cell therapy was established. Results: A total of 214 male and female dental practitioners participated in this study and the majority were registered at the Saudi Commission for Health Specialists 128 (59.8%). Dental consultants reported the highest percentage of awareness about dental stem cells (96%, p= 0.005), whereas general dental practitioners (56.2%, p= 0.005) and specialists (52%, p= 0.005), respectively had a lower percentage. When ethical concerns were determined, dental consultants had the highest percentage of knowledge (56%, p= 0.005), whereas dental practitioners (71.2%, p= 0.005) with < 5 years of experience (69.1, p= 0.002) lacked information about related ethical issues. Conclusion: Ways to increase stem cell awareness among dental practitioners in this study recommended including stem cell topics in the dental curriculum and organizing frequent seminars and conferences on this subject. (AU)

Objetivo: Avaliar o nível de consciência e a atitude dos dentistas em relação ao uso de células-tronco na odontologia, e determinar o conhecimento desses profissionais sobre as questões éticas relacionadas à terapia recente. Material e Métodos: Um estudo transversal baseado em pesquisa foi conduzido na Faculdade e Hospital de Odontologia da Universidade Taibah de Medina e em clínicas odontológicas governamentais e privadas na região oeste da Arábia Saudita. As respostas dos dentistas que responderam à pesquisa foram registradas entre março de 2019 e julho de 2019, sem conter nenhum identificador pessoal. Foi estabelecido o nível de consciência, atitude e conhecimento sobre questões éticas em relação à terapia com células-tronco. Resultados: Um total de 214 dentistas do sexo masculino e feminino participaram deste estudo, sendo 128 (59,8%) desses cadastrada na Comissão Saudita de Especialistas em Saúde. Os consultores em odontologia relataram o maior percentual de conhecimento sobre as células-tronco dentárias (96%, p = 0,005), enquanto os dentistas gerais (56,2%, p = 0,005) e especialistas (52%, p = 0,005) tiveram um percentual menor. Quando as questões éticas foram determinadas, os consultores em odontologia tiveram o maior percentual de conhecimento (56%, p = 0,005), enquanto os dentistas (71,2%, p = 0,005) com menos de 5 anos de experiência (69,1%, p = 0,002) tinham menos informações sobre questões éticas relacionadas. Conclusão: Formas de aumentar a conscientização sobre as células-tronco entre os dentistas deste estudo incluem tópicos sobre células-tronco no currículo de odontologia, além de frequentemente organizar seminários e conferências sobre o assunto. (AU)

Sealing Ability of AH Plus and GuttaFlow Bioseal.

The objective of root canal obturation is to achieve a fluid-tight seal. Recently, GuttaFlow bioseal (GB), a root canal sealer composed of polydimethylsiloxane, gutta-percha particles, and bioactive glass ceramics, has been developed, to enhance the sealing ability of root canal filling material. The objective of this study was to assess the sealing ability of GB using a subnanoliter-scaled fluid-flow measuring device and to compare with that of AH Plus (AH). The fluid flow in root canal-filled teeth using either gutta-percha cone (GP) with AH (GAR; n = 10) or GP with GB (GBR; n = 10) and in GP inserted in AH blocks (GA; n = 10) or GP inserted in GB blocks (GB; n = 10) was measured. In addition, fluid flow in sealer blocks of AH (A; n = 10) and GB (B; n = 10), which served as negative controls, was measured. Root canal-filled teeth using GP without any sealer (GR) acted as positive controls (n = 10). The leakage was obtained by calculating the volume of moved water by time (s), after stabilization of the fluid flow was achieved. Statistical analysis was performed using the Kruskal-Wallis test and Mann-Whitney U-test with Bonferroni correction. A p value less than 0.00238 (0.05/21) was considered significantly different. The mean leakages (nL/s) in the groups are as follows: GAR, 0.0958 ± 0.0543; GBR, 0.0223 ± 0.0246; GA, 0.0644 ± 0.0803; GB, 0.0267 ± 0.0182; A, 0.0055 ± 0.0057; B, 0.0052 ± 0.005; and GR, 0.2892 ± 0.3018. The mean leakage in the GBR group was lower than that in the GAR group (p = 0.001), while the mean leakages in the GA and GB groups were not significantly different. GuttaFlow bioseal can be useful in single-cone obturation technique.

In vitro comparison of cyclic fatigue resistance of TruNatomy in single and double curvature canals compared with different nickel-titanium rotary instruments.

BACKGROUND: The purpose of this study was to compare the cyclic fatigue resistance of newly developed TruNatomy instruments (TRN) in single and double (S-shaped) curvature canals with HyFlex CM (HCM), Vortex Blue (VB) and RaCe (RC) instruments. METHODS: Size 20/.04 taper and size 25/0.04 of HCM, VB and RC were used. For TRN instruments, size 20/.04 taper (small) and size 26/.04 taper (prime) were used. The instruments were tested in artificial canals with double curvature (coronal curve; 60° curvature, 5 mm radius and apical curve; 70° curvature and 2 mm radius) and single curvature (60° curvature, 5 mm radius). The number of cycles to failure (NCF) was recorded. Data were statistically analyzed by Kruskal-Wallis and Dunn's multiple comparison tests. Weibull analysis was performed on NCF data. Statistical significant was set at p < 0.05. RESULTS: TRN and HCM revealed higher NCF compared with the other instruments for both tested sizes in single and double curvature canals (p < 0.05). TRN and HCM showed no statistically significant difference in the NCF (p > 0.05). The probability of survival was higher for HCM and TRN instruments than VB and RC instruments. CONCLUSIONS: HCM and TRN instruments were more resistant to cyclic fatigue than VB and RC instruments in single and double curvature canals. HCM and TRN instruments were anticipated to survive with higher number of cycles than the other tested instruments. RC instrument had the lowest fatigue resistance than the other instruments.

Internal Bleaching of Endodontically Treated Teeth: A Dental Practitioner's Perspective from Kingdom of Saudi Arabia.

AIM: To determine the knowledge and attitude of dental practitioners (DPs) for internal bleaching technique (IBT) in Kingdom of Saudi Arabia. MATERIALS AND METHODS: A cross-sectional study was developed based on a convenient sampling of dental practitioners and specialists working in Kingdom of Saudi Arabia. DPs responded to a structured, self-administered questionnaire for evaluation of their knowledge and attitude toward IBT. The questionnaire had two components: (i) the characteristics of the study participants; and (ii) the items related to the internal bleaching technique (IBT). Data analysis was conducted using SPSS (version 25.0), with descriptive statistics and a bivariate analysis. RESULTS: A total of 532 dental practitioners (61.3% males and 38.7% females) participated in this study. The response rate of participation was estimated at 92.5%. Almost 37% participants considered the sodium perborate as the most commonly used dental material for internal bleaching. Almost 70% participants reported that superficial enamel discoloration was a contraindication for internal bleaching in endodontically treated teeth. CONCLUSION: DPs have good knowledge and attitude on use of IBT for discolored teeth. In general, there is a need to improve knowledge and attitude of dental professionals about the IBT by attending continuing dental educational programs. CLINICAL SIGNIFICANCE: Saving of the remaining tooth structure is a main principle of the different types of dental treatments. So the IBT should be known for all dental practitioners to use it before going to more aggressive dental treatment options such as full crowns. How to cite this article: Doumani M, Alotaibi AN, Al Hussain F, et al. Internal Bleaching of Endodontically Treated Teeth: A Dental Practitioner's Perspective from Kingdom of Saudi Arabia. J Contemp Dent Pract 2019;20(10):1141-1145.

Effect of titanium tetrafluoride addition on the physicochemical and antibacterial properties of Biodentine as intraorfice barrier.

OBJECTIVE: To evaluate the influence of titanium tetrafluoride (TiF4) incorporation on the physicochemical and antibacterial properties of Biodentine (BD; Septodont, Saint Maur des Faussés, France) as an intraorfice barrier material. METHODS: Three different proportions of TiF4 powder were used with BD; 1wt%, 2wt%, and 3wt%; respectively. BD without TiF4 addition was used as the control group. The setting time (ST) was determined using Gillmore needle apparatus. Diametral tensile strength (DTS) and fracture resistance were measured in a universal testing machine. Solubility was assessed using mass variation after 7days water storage. The hardness test was conducted using Vickers microhardness tester. The antibacterial activity was assessed using direct contact test against Enterococcus faecalis. Radiopacity was assessed and expressed in thickness of aluminum. Surface topography and elemental composition of modified BD were also assessed. The pH of soaking water was measured up to 168h. Data of tested properties were analyzed using one-way analysis of variance, the paired t-test, two-way repeated measures analysis of variance, and Tukey post hoc tests (P<0.05). RESULTS: BD-incorporating 2wt% TiF4 revealed the highest surface microhardness, DTS, and fracture resistance compared with the unmodified group (P<0.001). Higher concentrations of TiF4 (3wt%) compromised the solubility and prolonged the ST of BD (P<0.05). Bacterial growth of BD-incorporating TiF4 was significantly reduced when compared with the control group (P<0.05). The tested materials induced alkalization of the soaking water that decreased with time. SIGNIFICANCE: Biodentine-incorporating TiF4 (1wt% and 2wt%) is a promising intraorfice barrier material with enhanced physicochemical and antibacterial properties.

Preference and usage of intracanal medications during endodontic treatment.

OBJECTIVES: To investigate the preferences of general dental practitioners (GDPs) and endodontists in using endodontic intra-canal medications (ICMs). METHODS: This observational and descriptive study was conducted in 2014 in the western province of Saudi Arabia. Following ethical clearance and 2 pilot studies, a web-based questionnaire was electronically sent to 375 randomly and systematically selected GDPs and all endodontists in the western province (n=49). An accompanying e-mail explained the study's aims and confirmed that the data yielded would remain confidential. The responses were collected, and the data was analyzed using the Chi-square test at p=0.05. RESULTS: Significantly, the highest proportion of respondents (53.7%) reported disinfection of the root canals as the main function of ICMs. Calcium hydroxide (CH) was the preferred material of the majority of those who used the same ICM in all cases (85.7%). While the vast majority of all endodontists (87.5%) used CH after pulp extirpation, 48.5% of GDPs used formocresol (p less than 0.001). Almost 30% of those who used ICMs after pulp extirpation did not do so after cleaning and shaping of vital cases. Most endodontists used CH (62.5%) and antibiotics (37.5%) in necrotic pulp cases without apical lesions, which were significantly greater than those of GDPs who did the same (43.8% and 17.2%). CONCLUSIONS: Participants were aware that the main function of ICMs is disinfection of the root canal system. However, it is clear that GDPs should reduce their reliance on phenol- and formaldehyde-based medications. There was a distinct trend toward the use of ICMs, especially CH, in necrotic pulp cases.

Effectiveness of XP-endo Finisher, EndoActivator, and File agitation on debris and smear layer removal in curved root canals: a comparative study.

The purpose of this study was to assess the efficacy of the XP-endo Finisher (FKG Dentaire SA, La Chaux-de-Fonds, Switzerland) file on debris and smear layer removal in curved root canals in comparison to different irrigation regimens. Seventy-five freshly extracted human mandibular molar teeth with mesial root curved more than 20° were used in this study. The mesial root canals were mechanically prepared using the BT-Race rotary system (FKG Dentaire) and divided into five groups (n = 15) according to the following irrigation techniques: positive control, non-agitated, File agitation, XP-endo Finisher, and EndoActivator (Dentsply Tulsa Dental Specialities, Tulsa, OK, USA). Root canals were split longitudinally and evaluated by scanning electron microscopy. Five-grade scoring system was used to assess the presence of debris and smear layer at the coronal, middle, and apical regions. The XP-endo Finisher and EndoActivator groups revealed significantly lower debris and smear layer scores than the other groups at the coronal, middle, and apical regions (P < 0.05). There was no significant difference between XP-endo Finisher and EndoActivator groups (P > 0.05). The apical region had higher debris and smear layer scores compared with the coronal regions in all groups (P < 0.05), except for the positive control group; there was no significant difference between the three regions of the root canal (P > 0.05). Irrigation of curved root canals using XP-endo Finisher and EndoActivator methods appears to be more effective on debris and smear layer removal than the other tested groups.

A finite element study on the mechanical behavior of reciprocating endodontic files

To evaluate the mechanical behavior of reciprocating endodontic files, comparing nickel-titanium NiTi and stainless steel 316L St.St. 316L as manufacturing material for such instruments. METHODS: A three-dimensional finite element model was designed for this study. The simplified instrument model geometry was created on commercial CAD/CAM software. Real strain stress curves of St.St. 316L and NiTi were used in the analysis. Non-linear static analysis was performed to simulate the instrument inside root canal at an angle of 45° in the apical portion, and subjected to torsion of 0.3 N.cm. RESULTS: Non-linear NiTi material showed super elasticity and high functionality in such applications. Very high levels of stress appeared in the file at 3 mm from the tip close to yield point. CONCLUSIONS: St. St. 316L is not suitable for manufacturing reciprocating instruments. Modeling of the instrument with equivalent circular cross-sectional area did not affect results quality. Reciprocating instruments have short lifespan, thus manufacturers recommend using one file per tooth. Reciprocating instruments are recommended for less experienced dentist...