Smear layer removal efficacy of irrigating solutions applied distinct needle designs: a scanning electron microscopy study.

This research aimed to assess the efficacy of different irrigants applied with different types of needle tips on smear layer removal (SLR) in primary incisors. This study was carried out with 35 freshly extracted upper primary incisors. The samples were randomly distributed to five study groups (n = 7) (1 to 4: experimental, 5: control). These included Group 1: 5% Ethylenediaminetetraacetic Acid (EDTA) + 1% Sodium Hypochlorite (NaOCl) applied with open-ended needle (OEN), Group 2: 6% Citric Acid (CA) + 1% NaOCl applied with OEN, Group 3: 5% EDTA + 1% NaOCl applied with double side-vented needle (DSVN), Group 4: 6% CA + 1% NaOCl applied with DSVN and Group 5: 1% NaOCl applied with OEN. Accordingly, the inner root surfaces were examined using scanning electron microscopy (SEM). The differences between the groups were analyzed using Kruskal-Wallis, Friedman and Siegel-Castellan tests (p < 0.05). In the coronal third, all the experimental groups (groups 1, 2, 3 and 4) were superior to the control group (p = 0.002, p = 0.002, p < 0.001 and p < 0.001, respectively). Groups 2, 3 and 4 showed superior SLR to the control group (p = 0.024, p = 0.001 and p = 0.004, respectively) in the middle third. DSVN groups of EDTA and CA showed superior SLR efficacy than the control (p < 0.001 and p = 0.002, respectively) in the apical third. The SLR efficacy was higher in the coronal third compared to the apical third in the experimental groups (groups 1, 2, 3 and 4) (p = 0.015, p = 0.048, p = 0.048 and p = 0.048, respectively). In addition, 3 samples of EDTA showed erosion (2 in the coronal with OEN, 1 in the middle with DSVN). It was possible to conclude that the SLR efficacy of DSVNs and OENs was similar. CA could be recommended since it did not cause erosive damage compared to EDTA in primary incisors.

Knowledge, Attitude and Clinical Practice of Dentists about Extraction of First Permanent Molars.

PURPOSE: The extraction of permanent first molar (PFM) teeth with poor prognosis allows the build of a new-and-ideal occlusion with the spontaneous movement of the healthy second and third molars by taking advantage of the patient's development. This study aimed to evaluate dentists' knowledge level about controlled tooth extractions and determine their information needs. STUDY DESIGN: The survey, consisting of 9 questions about balance and compensation extractions, was prepared on Google Forms and sent via email to dentists. RESULTS: The questionnaire was sent to 3137 dentists and 472 (15.04%) of them answered. While deciding on PFM extraction, the rate of those who checked the presence of permanent 3rd molar tooth was found to be 64.4%. Although 79% of pedodontists stated that they knew about balance extractions, only 60.9% of them apply it in the clinic. After maxillary PFM extraction, the rate of oral and maxillofacial surgeons who think that "mandibular PFM over-erupt" was 92.8%, and the rate of orthodontists was 68.7%. 87.1% of the participants stated that they needed more information about controlled extractions. CLINICAL SIGNIFICANCE: It is possible to raise awareness, encourage the common and follow-up of correct clinical practices, and avoid complications; by adding controlled extractions to the undergraduate education program.

Effects of Root Maturation and Thickness Variation in Coronal Mineral Trioxide Aggregate Plugs Under Traumatic Load on Stress Distribution in Regenerative Endodontic Procedures: A 3-dimensional Finite Element Analysis Study.

INTRODUCTION: Regenerative endodontic procedures (REPs) are the best biological-based treatment choice for managing necrotic immature permanent teeth. This study aimed to evaluate the stress distribution of immature maxillary permanent incisors and periodontal tissues under a traumatic load after root maturation achieved by REP with thickness variation in coronal mineral trioxide aggregate (MTA) plugs. METHODS: Five different mathematical 3-dimensional finite element analysis models of an immature permanent maxillary incisor were created. These involved immediate postoperative models after REP with varying coronal MTA plug thickness (model 1: 3-mm MTA and model 2: 5-mm MTA), postoperative models after REP with varying coronal MTA plug thickness with 15% volumetric root maturation (model 3: 3-mm MTA and model 4: 5-mm MTA), and a control model (model 5: a mature, healthy maxillary incisor). After the modeling procedures, a traumatic horizontal force load of 400 N was applied, and 3-dimensional finite element analysis was performed. The minimum principal, maximum principal, and von Mises stress criteria were calculated for evaluation. RESULTS: Regardless of the coronal MTA plug thickness, tensile stress in cervical root surfaces decreased with root maturation after REP. Using the 5-mm MTA plug reduced all types of stress in the middle third of the root. In bone tissue, the difference in MTA thickness did not affect stress values. However, stress decreased in most of the bony surfaces with root maturation after REP. CONCLUSIONS: Using the 5-mm coronal MTA plug may help in providing biomechanical advantages regarding stress transmission. Also, because root maturation after REP provided a more favorable stress distribution as mentioned, regenerative treatments can be recommended for immature permanent maxillary incisors for a good prognosis.

The effects of various irrigation protocols on root canal wall adaptation and apical microleakage in primary teeth.

Objective: The objective of this study is to evaluate the wall adaptation and apical microleakage values following the application of various irrigation protocols in primary teeth.Material and methods: For the two parts of the study, extracted upper incisor primary teeth were randomly included to the 1% sodium hypochlorite (NaOCl), 10% ethylenediaminetetraacetic acid (EDTA)+1% NaOCl, 6% citric acid (CA)+1% NaOCl and 0.9% physiological saline (PS) groups. Canal wall adaptation and apical microleakage were assessed by scanning electron microscopy (SEM) and stereomicroscope, respectively.Results: 6% CA + 1% NaOCl group was found to be the most successful irrigation protocol in providing strong canal wall adaptation and less apical microleakage, followed by 10% EDTA +1% NaOCl. 6% CA +1% NaOCl was significantly superior regarding apical microleakage (p < .05).Conclusions: Due to the ability to provide appropriate changes in the root canal walls to make a well-adapted and leak-proof canal filling, 6% CA + 1% NaOCl can be recommended as an irrigation protocol in primary teeth.

The effect of different irrigation protocols on smear layer removal in root canals of primary teeth: a SEM study.

OBJECTIVE: The purpose of this study was to compare the efficacy of different irrigation protocols on smear layer removal in root canals of primary teeth by scanning electron microscopy (SEM). MATERIAL AND METHODS: The study was conducted with 40 extracted maxillary primary incisor teeth divided into four groups (n = 10) as 1% sodium hypochlorite (NaOCl), 10% ethylenediaminetetraacetic acid (EDTA)+1% NaOCl, 6% citric acid (CA)+1% NaOCl, and 0.9% physiological saline (PS). After the irrigation procedures, root canal walls were examined by SEM and the efficacies of irrigation solutions in smear layer removal were scored and compared. Data were analyzed using Kruskal-Wallis, Friedman and Siegel Castellan tests. RESULTS: The smear layer removal was found to be statistically more effective in groups of 10% EDTA + 1% NaOCl and 6% CA + 1% NaOCl when compared with the other groups (p < .05). Smear removal efficacy was statistically significantly higher in coronal and medium thirds when compared with the apical regions in the experimental groups. CONCLUSIONS: It was concluded that 10% EDTA + 1% NaOCl and 6% CA + 1% NaOCl could be alternative irrigation protocols regarding smear layer removal. However, due to the absence of erosive dentinal changes, it might be suggested that using 6% CA + 1% NaOCl can be recommended compared to 10% EDTA + 1% NaOCl in primary root canals.

The evaluation of MTA and Biodentine as a pulpotomy materials for carious exposures in primary teeth.

OBJECTIVE: This study examined the effects of MTA and Biodentine on the clinical and radiographic success rates of pulpotomies performed on primary teeth with carious pulp exposures. MATERIALS AND METHODS: This study was conducted with 44 mandibular primary molars requiring vital pulpotomy. Carious dentin surrounding the exposure site was used as the inclusion criteria for all teeth, which were randomly divided into two groups according to pulpotomy material [MTA group (n = 24), Biodentine group (n = 20)]. Treatment was followed up clinically and radiologically for 24 months. Pulp canal obliteration was not regarded as a failure. RESULTS: Clinical and radiographic success rates at the end of 24 months were 100% for the MTA group and 89.4% for the Biodentine group. Success rates did not vary significantly between the groups (p = 0.646). Pulp canal obliteration was observed in two teeth (8.3%) in the MTA group at 6 months, but the teeth were found to be stabilized by 24 months. CONCLUSION: The long-term clinical and radiographic success rates obtained in this study indicate that both MTA and Biodentine are appropriate options for pulpotomy treatment of primary teeth with carious exposure in patients whose teeth should be retained for long periods of time. CLINICAL RELEVANCE: The etiology of exposure determines pulpal response, making it crucial to distinguish between mechanical and carious exposures. The carious exposure is presumed to be accompanied by severe inflammation, which makes the prognosis of treatment unpredictable. Biomaterials can be used especially in cases with carious pulp exposures.

Are Increased Masticatory Forces Risk for Primary 2nd Molars without Successors? A 3D FEA Study.

OBJECTIVE: Persistent primary teeth with healthy crown-root structures and acceptable functional and esthetic properties may be preserved over a long-term period if needed. However, they may experience root resorption, ankylosis or infraocclusion especially in the second or third decades of life. Despite a lack of sufficient detailed data, increases in occlusal forces by age are known to cause destructive stresses on root surfaces and periodontal tissue. The aim of this study was to evaluate the effect of increasing occlusal forces on mandibular persistent primary molars by using 3D finite element analysis. STUDY DESIGN: The impact of increased masticatory forces on compressive and tensile stresses in tooth and surrounding tissue was simulated in two different models (simulating child and adult mouths) by using 3D finite element analysis. RESULTS: In both models, the stress values increased by age and compressive stresses were seen on internal root surfaces, while the tensile stresses focused on the furcation area and external root surfaces. CONCLUSION: It was concluded that practices such as reducing occlusal surface width may be used to diminish the occlusal forces for long-term tooth survival in persistent primary molars.

Does Achievement of Hemostasis After Pulp Exposure Provide an Accurate Assessment of Pulp Inflammation?

PURPOSE: The purpose of this study was to determine in primary molars with carious exposures whether hemostasis at the exposure site and pulp orifice reflected inflammatory status of the pulp at the canal orifice based on cytokine levels. METHODS: Forty mandibular primary molars with deep caries were included in the study. Teeth were divided into two groups: group A had teeth where hemostasis at the exposure site was achieved within five minutes, and group B had teeth where hemostasis at the exposure site could not be achieved within five minutes. Blood samples were harvested from the exposure sites and canal orifices. Cytokine levels for IL-1ß, IL-2, IL-6, IL-8, IL-10, TNF-α, and PGE2 were measured using ELISA for all sample sites. RESULTS: The IL-6 levels at the exposure sites were found to be significantly higher in group A when compared to group B, but there was no statistically significant differences in any of the cytokine levels at the canal orifices between the two groups. CONCLUSIONS: Controlling bleeding at the exposure site or canal orifices does not provide accurate assessment of inflammation at the canal orifice and may be misleading for diagnosing vital pulp treatment in primary teeth with a carious pulp exposure.

Resin Nanoceramic CAD/CAM Restoration of the Primary Molar: 3-Year Follow-Up Study.

This case report presents the clinical use of a resin nanoceramic CAD/CAM restoration of a primary second molar without successor in the form of a permanent second premolar tooth in a patient. Three-year follow-up of the case revealed that resin nanoceramic CAD/CAM restoration of the primary molar without successor achieved both aesthetics and function. Despite the high cost of treatment, this type of restoration should be considered if the retained tooth is expected to maintain functionality over the long term.

Carious Exposure versus Mechanical Exposure for MTA Pulpotomy in Primary Teeth.

Introduction. The etiology of exposure determines pulpal response, making it crucial to distinguish between mechanical and carious exposure. This study clinically and radiographically evaluated the success of MTA pulpotomies conducted to treat carious and mechanical pulp exposure. Materials and Methods. This study was conducted with 50 mandibular primary molar teeth. Teeth were divided into 2 groups according to status of the exposure site, with teeth surrounded by carious dentin placed in a carious exposure group and those surrounded by sound dentin in a mechanical exposure group. MTA pulpotomies were performed for both groups. Treatment was followed up clinically and radiographically for 18 months. Results. Clinical and radiographic success rates at 18 months were 100% for both groups. Success rates did not vary significantly between the groups (p = 1.000). Pulp canal obliteration was only seen in the carious exposure group, observed in 2 teeth (8.3%). Conclusion. The long term success rates achieved in this study indicate that MTA can be used as a vital pulpotomy material for the long term success in primary teeth with either mechanical or carious exposure. The findings of the present study highlight the fact that treatment prognosis is dependent upon diagnosis and selection of the appropriate materials for treatment.

Comparison of Two Base Materials Regarding Their Effect on Root Canal Treatment Success in Primary Molars with Furcation Lesions.

Introduction. The aim of this study was to compare MTA with another base material, IRM, which is generally used on pulpal floor after root canal treatment, regarding their effect on the success of root canal treatment of primary teeth with furcation lesions. Materials and Methods. Fifty primary teeth with furcation lesions were divided into 2 groups. Following root canal treatment, the pulpal floor was coated with MTA in the experimental group and with IRM in the control group. Teeth were followed up considering clinical (pain, pathological mobility, tenderness to percussion and palpation, and any soft tissue pathology and sinus tract) and radiographical (pathological root resorption, reduced size or healing of existing lesion, and absence of new lesions at the interradicular or periapical area) criteria for 18 months. For the statistical analysis, Fisher's exact test and Pearson's chi-square tests were used and a p value of <0.05 was considered to be statistically significant. Results. Although there were no statistically significant differences between two groups in terms of treatment success, lesions healed significantly faster in the MTA group. Conclusion. In primary teeth with furcation lesions, usage of MTA on the pulpal floor following root canal treatment can be a better alternative since it induced faster healing.

Root canal filling in primary molars without successors: Mineral trioxide aggregate versus gutta-percha/AH-Plus.

The aim of this study was to compare the clinical and radiographical success of mineral trioxide aggregate (MTA) and gutta-percha/AH-Plus used as a root canal filling material in primary second molars without successors. A total of 16 patients (9 girls, 7 boys) aged 6-13 years (mean: 10.5) were selected and randomly distributed into the treatment groups. Children were recalled for clinical and radiographic examination at 6, 12, 18, 24 and 36 months. Differences in treatment outcomes were analysed using chi-squared and Fisher's exact tests. Clinically, there was no significant difference in the success rates between the groups at the end of a 3-year follow-up period (MTA: 100%; Gutta-percha/AH-Plus: 70%) (P > 0.05). However, radiographically, there was a significant difference between the groups (MTA: 80%; gutta-percha/AH-Plus: 30%) (P < 0.05). The present study showed that MTA can be recommended for use in root canal treatment of primary molars without successors based on better radiographic success.

Late developing supernumeraries in a case of nonsyndromic multiple supernumerary teeth.

Objective. This case report presents 3-year follow-up of a case of nonsyndromic multiple supernumerary teeth (NSMST) with 11 supernumerary teeth, 2 of which showed subsequent formation. Case Report. A 10-year-old girl was referred to the dental clinic with the chief complaint of delayed eruption. Radiographic examination showed 9 retained supernumerary teeth. The treatment plan consisted of extraction of the supernumerary teeth and associated primary teeth in order to allow the permanent teeth to erupt. After 2 years of follow-up, 2 additional supernumerary teeth were observed. Conclusion. Regular follow-up for late forming supernumeraries is crucial for NSMST cases.

Effects of sodium hypoclorite as disinfectant material previous to pulpotomies in primary teeth.

OBJECTIVES: Sodium hypochlorite (NaOCl) can be used to promote healing vital pulpotomies as an antibacterial agent. The aim of the present study was to histologically analyze the pulpal response of human primary teeth pulp following calcium hydroxide (CH) and mineral trioxide aggregate (MTA) pulpotomies with and without 5% NaOCl. MATERIALS AND METHODS: One hundred twenty-eight primary molars were randomly divided into two main groups according to pulpotomy material (CH/MTA) and into two subgroups according to selected cleansing agent (NaOCl/physiologic saline) used in the pulpotomy procedure. Thirty-four successfully treated teeth whose successor roots had completed formation of at least two thirds of their lengths were extracted for histological evaluation. Fisher's exact test, Pearson's Chi-square test, and Mann-Whitney U test with Bonferroni correction were used for statistical analysis. RESULTS: No significant differences in any of the tested parameters were observed between the NaOCl and physiologic saline subgroups of either the CH or MTA groups. Pulpal inflammation was significantly higher in the CH-treated teeth as compared with the MTA-treated teeth, whereas hard tissue bridge formation was significantly higher in the MTA-treated teeth as compared with the CH-treated teeth but regardless of cleansing agent (p < 0.025). CONCLUSIONS: The use of NaOCl does not affect the success of CH or MTA pulpotomies. Regardless of cleansing agent, MTA was found to be superior to CH. CLINICAL RELEVANCE: The proper medicament selection is more important than the choice of cleaning agent in vital pulpotomies.

Resistance to leakage of various thicknesses of apical plugs of Bioaggregate using liquid filtration model.

AIM: The aim of this study was to compare the resistance to leakage of different thicknesses of Bioaggregate (BA) and 4-mm-thick white mineral trioxide aggregate (WMTA) in an apexification model using liquid filtration. METHODS: 32 extracted mandibular premolar teeth were sectioned at the cemento-enamel junction and 3-4 mm from the tooth apex to obtain 12-mm-long root segments. The apical and coronal thirds were prepared with size two through six Gates Glidden burs. The teeth were divided into four groups according to material and thickness, as follows: Group 1: 2-mm BA; Group 2: 4-mm BA; Group 3: 12-mm (total length) BA; Group 4: 4-mm WMTA (control). The empty parts of the roots in Groups 1, 2, and 4 were filled with gutta-percha and root canal sealer, and leakage was measured using fluid filtration. The data were analyzed using the Kruskal-Wallis H-test. RESULTS: No statistical differences in microleakage were observed between Groups 1, 2, and 4 (P > 0.05). Group 3 (roots filled completely with BA) showed significantly less leakage than the other groups tested (P < 0.01). CONCLUSIONS: The findings of this study showed that 12 mm of BA exhibited the best resistance to leakage. At the same time, 2-4 mm of BA showed similar results when compared to 4-mm MTA. In light of these results, this study suggests that BA may be a good candidate for further clinical studies when used as an apical barrier for apexification.

The effect of sodium hypochlorite application on the success of calcium hydroxide and mineral trioxide aggregate pulpotomies in primary teeth.

PURPOSE: This study's purpose was to evaluate the success of calcium hydroxide (CH) and mineral trioxide aggregate (MTA) pulpotomies following the use of five percent sodium hypochlorite (NaOCl) as an antibacterial agent to clean the chamber prior to application of the pulpotomy agent. METHODS: A total of 128 teeth were randomly divided into two pulpotomy groups (CH or MTA). The teeth in each pulpotomy group, CH and MTA, were further randomly divided into subgroups to receive either the NaOCl (experimental) or saline (control) cleaning agent prior to applying the pulpotomy agent. The treatments were followed clinically and radiographically for 12 months. RESULTS: The radiographic success rates were 84 percent for CH NaOCl, 74 percent for CH saline control, 97 percent for MTA NaOCl, and 100 percent for MTA saline control. There were no significant differences between the radiographic success rates in the CH and MTA subgroups (CH NaOCl-CH control and MTA NaOCl-MTA control); no significant differences were observed when comparing the CH NaOCl-MTA NaOCl groups and the CH NaOCl-MTA control groups. CONCLUSION: Use of sodium hypochlorite as an antibacterial agent prior to application of the pulpotomy agent improved the success of calcium hydroxide pulpotomies to equal the success of mineral trioxide aggregate pulpotomies for observation up to 12 months.

Immunocompetent cell level as a diagnostic reference for pulpal pathosis of primary teeth.

OBJECTIVE: The present study was designed to measure changes in the level of immunocompetent cells as healthy pulp becomes inflamed in order to evaluate the use of CD4+/CD8+ and B/CD3+ lymphocyte ratios as a diagnostic reference for pulpal pathosis in primary teeth pulp. DESIGN: Based on clinical and radiographic examinations, 113 carious and non-carious primary teeth were grouped as healthy teeth, teeth with reversible pulpitis and teeth with irreversible pulpitis. Following dental extraction, pulp samples were collected from all teeth, and 81 of the samples were found to be suitable for flow-cytometric analysis of lymphocyte subset. Kolmogorov-Smirnov's test, One-way ANOVA and Tukey's Post Hoc tests were used for statistical analysis. RESULTS: Statistical analysis revealed no increases in the mean percentages of T, B and CD4+ lymphocytes in inflamed pulp when compared to healthy pulp. However, both CD8+ and NK cell numbers decreased in line with progressive inflammation. Whereas the CD4+/CD8+ ratios increased in accordance with the severity of pulpitis, B/T ratios remained unaffected. CONCLUSIONS: Immunocompetent cell levels did not change in line with progressive inflammation; therefore, the use of CD4+/CD8+ and B/CD3+ lymphocyte ratios cannot be used as a diagnostic reference for pulpal pathosis in primary teeth.

Using composite resin inclined plane for the repositioning of a laterally luxated primary incisor: a case report.

This case report describes the repositioning of a laterally luxated primary central incisor with occlusal interference, using a composite inclined plane. The patient was a 4-year-old girl who applied to our clinic three days after the injury. Because of the time delay between injury and presentation, it was not possible to reposition the tooth with pressure. Following a root-canal treatment, an inclined plane was prepared on the lower primary incisors, using composite resin. The tooth was repositioned in two weeks, and the inclined plane was then removed. After 1 year of follow-up, the treatment was found to be successful, both clinically and radiographically. The use of a composite inclined plane, accompanied by careful follow-up, is an effective alternative to extraction for laterally luxated primary incisors with occlusal interference.

The prevalence and treatment outcomes of primary tooth injuries.

OBJECTIVES: The aim of the present study was to evaluate the type and prevalence of primary tooth injuries, as well as their treatment and treatment outcomes, among children referred to the Department of Pedodontics at the Ankara University Faculty of Dentistry in Turkey. METHODS: The study population consisted of patients applying to the department with a primary tooth injury over a period of 21 months. Fifty-one patients presented with trauma to 99 primary teeth. Clinical and radiographic examinations were conducted on each patient. Age, sex, time, cause of injury, and number of teeth affected were recorded, and the type of trauma was identified according to Andreasen's classification. The teeth were treated by one of the authors. RESULTS: The majority of trauma occurred between the ages of 2 and 4. The most common type of injury was lateral luxation (33.3%). Most injuries (33.3%) presented during May. The most common form of treatment was follow-up only (39.4%), followed by extraction (29.3%) and root canal treatment (12.1%). The average follow-up period was 11 months. During the follow-up period, complications were observed in 4 teeth. CONCLUSIONS: The study results show that in the absence of acute symptoms, parents tend not to apply to a dental clinic for children's injuries. This finding highlights the importance of informing the public about primary tooth injuries and their consequences.

Bleaching a devital primary tooth using sodium perborate with walking bleach technique: a case report.

Nowadays, both children and parents place a greater value on appearance and aesthetics than has previously been the case. Primary teeth with intrinsic discoloration may be treated by a number of methods, including facings and abrasion. However, dental bleaching may offer a safer alternative that can be completed with less chair time and without harming dental structures. This case report describes the treatment of a darkened primary tooth of a 4-year-old boy with sodium perborate using the walking bleach technique and its 1-year clinical and radiographical follow-up. During this 1-year follow-up period, no signs of any pathology were observed either clinically (sensitivity to percussion or palpation, fistulae, color change) or radiographically (external or internal root resorption, apical radiolucency). In this study, using sodium perborate with the walking bleach technique is found to be successful in whitening primary teeth and can be recommended as a safe alternative for the bleaching of devital primary teeth with intrinsic discoloration.