Microstructure and color stability of calcium silicate-based dental materials exposed to blood or platelet-rich fibrin.

OBJECTIVES: To investigate the effects of blood and platelet-rich fibrin (PRF), commonly used scaffolds in regenerative endodontic treatment (RET), on the hydration, microstructure, and color stability of three hydraulic calcium silicate cements (HCSCs), OrthoMTA, RetroMTA, and TotalFill-BC-RRM. MATERIALS AND METHODS: The HCSCs were prepared and placed into polyethylene molds and transferred to Eppendorf tubes containing PRF, blood, or PBS and then incubated for 1 week or 1 month. The microstructure and hydration of the cements were studied by scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDS), and X-ray diffraction (XRD). The chromatic alteration of materials was also measured using a spectrophotometer. The data for color stability were analyzed using 2-way analysis of variance and Tukey post hoc tests. RESULTS: There was no significant difference between the color stability of cements exposed to PBS (p > 0.05). The chromatic alteration of cements exposed to blood was significantly greater than those exposed to PRF and PBS (p < 0.001). In the presence of blood and PRF, the color change of OrthoMTA was significantly greater than that of RetroMTA and TotalFill (p < 0.05), with no significant difference between RetroMTA and TotalFill (p > 0.05). XRD analysis of all cements revealed a calcium hydroxide peak after 1-week and 1-month exposure to the media; however, OrthoMTA and TotalFill exposed to blood and PRF for 1 month showed weaker calcium hydroxide peaks. SEM images revealed cements exposed to PBS had a different surface microstructure compared to those exposed to blood and PRF. Furthermore, the surface microstructure of HCSCs was influenced by the type of cement radiopacifier (bismuth oxide or zirconium oxide). EDS analysis of the elemental composition in all groups displayed peaks of Ca, O, C, Si, P, and Al. CONCLUSIONS: Color stability, hydration behavior, and microstructure of HCSCs were affected by exposure to PRF and blood and the type of cement radiopacifier. CLINICAL RELEVANCE: As some important physicochemical properties of HCSCs could be influenced by the environmental conditions and the type of radiopacifier, alternatives to blood clot and HCSCs containing substitutes for bismuth oxide might be more suitable in RETs.

Evaluation of the Effectiveness of Laser-Assisted Bleaching of the Teeth Discolored due to Regenerative Endodontic Treatment.

Regenerative endodontic treatments (RETs) as a valuable treatment option to save the immature necrotic teeth, have been reported to be associated with discoloration which is an inevitable unfavorable outcome. The present study aimed to compare three laser-assisted protocols with conventional walking bleaching in terms of bleaching efficacy. Seventy-two human incisor teeth underwent regenerative treatment. A triple antibiotic paste containing minocycline, ciprofloxacin, and metronidazole was used as an intracanal medicament. A human blood clot was applied as a scaffold and capped by a hydraulic calcium silicate-based cement. Ten weeks after the RET procedure, a four-session bleaching course started. Teeth were assigned to four groups: (1) 35% hydrogen peroxide gel, (2) 35% hydrogen peroxide gel + Nd: YAG laser, (3) 35% hydrogen peroxide gel + 980 nm diode laser, and (4) 35% hydrogen peroxide gel + 810 nm diode laser. The color changes (ΔE) were measured before and after bleaching sessions. The data were analyzed using Kruskal-Wallis nonparametric test. The statistical significance level was set at 0.05. Significant discoloration, exceeding the perceptibility threshold (ΔE > 3.7) was observed in all of the samples ten weeks after RET. There was no significant difference between groups in terms of RET-induced discoloration values (p > 0.05). Bleaching either by using 35% hydrogen peroxide or 35% hydrogen peroxide activated by different lasers used in this study resulted in significant tooth whitening (p < 0.05). There was no statistically significant difference among the groups in terms of bleaching efficacy (p > 0.05). Internal bleaching by using 35% hydrogen peroxide is as effective as laser-assisted protocols for correction of crown discoloration in teeth that have undergone RET.

Effect of irrigation solutions on the coronal discoloration induced by mineral trioxide aggregate cements containing different radiopacifiers.

BACKGROUND: The aim of this study was to assess the discoloration of coronal tooth structure irrigated with different irrigation solutions and filled with calcium silicate-based materials containing bismuth oxide or calciumzirconia complex as radiopacifier. MATERIALS AND METHODS: In this ex vivo study, 72 bovine enamel-dentin blocks were prepared and divided into three groups. The dentinal cavities in each group were irrigated with 5.25% sodium hypochlorite (NaOCl), 2% chlorhexidine (CHX), or normal saline for 30 min. After that, irrigation solutions were removed using a cotton pellet. Each group was then randomly divided into two subgroups according to the cavity-filling materials (ProRoot mineral trioxide aggregate [MTA] and RetroMTA). The color assessments were performed before filling the cavities and 1 month and 6 months after filling the cavities. Data were analyzed with two-way ANOVA. The level of statistical significance was set at P < 0.05. RESULTS: The effect of irrigation solution on the color change of calcium silicate-based materials was not statistically significant at none of the time intervals (P = 0.334 and P= 0.252, respectively, for ProRoot MTA and RetroMTA). ProRoot MTA caused a significantly higher color change compared with RetroMTA exposed to different irrigation solutions at each time interval (P < 0.001). Color change of both materials exposed to each irrigation solution significantly increased over time (P < 0.05). CONCLUSION: Under the condition of this ex vivo study, irrigation of dentin with NaOCl and CHX and then removing the excess solution might be ineffective in increasing the tooth color change potential of either bismuth oxide or zirconium-containing calcium silicate-based materials. Furthermore, calcium silicate-based material, which contained bismuth oxide, caused higher tooth discoloration.

Coronal tooth discoloration induced by regenerative endodontic treatment using different scaffolds and intracanal coronal barriers: a 6-month ex vivo study.

OBJECTIVE: The aim of this study was to evaluate discoloration of teeth undergoing regenerative endodontic procedures (REPs) using blood clot or platelet-rich fibrin (PRF) as the scaffolds and different calcium silicate-based materials as the intracanal coronal barriers in an ex vivo model. MATERIALS AND METHODS: Forty-eight bovine incisors were prepared and disinfected using 1 mg/mL double antibiotic paste (DAP). The specimens were then randomly divided into 2 groups (n = 24) according to the scaffolds (blood or PRF). After placement of scaffolds each group was divided into 2 subgroups (n = 12) according to the intracanal coronal barriers (ProRoot MTA or Biodentine). The pulp chamber walls were sealed with dentin bonding agent before placement of DAP and before placement of scaffolds. The color changes (∆E) were measured at different steps. The data were analyzed using 2-way analysis of variance. RESULTS: Coronal discoloration induced by DAP was not clinically perceptible (ΔE ≤ 3.3). Regarding the type of the scaffold, coronal discoloration was significantly higher in blood groups compared with PRF groups at the end of REP and after 1 month (p < 0.05). However, no significant difference was found between PRF and blood clot after 6 months (p > 0.05). Considering the type of intracanal coronal barrier, no significant difference existed between ProRoot MTA and Biodentine (p > 0.05). CONCLUSIONS: With sealing the dentinal tubules of pulp chamber with a dentin bonding agent and application of DAP as an intracanal medicament, coronal color change of the teeth following the use of PRF and blood sealed with either ProRoot MTA or Biodentine was not different at 6-month follow-up.

Prevention of coronal discoloration induced by regenerative endodontic treatment in an ex vivo model.

OBJECTIVES: The aim of this study was to assess the effect of sealing the pulp chamber walls with a dentin-bonding agent (DBA) on prevention of discoloration induced by regenerative endodontic procedures (REPs) in an ex vivo model. MATERIALS AND METHODS: Ninety-six bovine incisors were prepared and randomly divided into two groups. In one group, the pulp chamber walls were sealed with DBA before placement of triple antibiotic paste (TAP) containing minocycline inside the root canals, but in the other group, DBA was not applied. After 4 weeks, the root canals were filled with human blood and each group was then randomly divided into four subgroups (n = 12) according to the endodontic cements placed over the blood clot (ProRoot MTA, OrthoMTA, RetroMTA, or Biodentine). The color changes (∆E) were measured at different steps. The data were analyzed using t test and two-way ANOVA. RESULTS: The specimens in which dentinal walls of pulp chamber were sealed with DBA showed significantly less coronal discoloration at each step of regenerative treatment (p < 0.001). However, application of DBA did not completely prevent the clinically perceptible coronal color change. Sealing the blood clot with different endodontic cements did not result in significant difference in coronal discoloration (p > 0.05). CONCLUSIONS: Sealing the pulp chamber walls before insertion of TAP decreased coronal discoloration following REP using different endodontic cements but did not prevent it. CLINICAL RELEVANCE: Discoloration of teeth undergoing REPs is an unfavorable outcome. Considering the significant contribution of TAP containing minocycline to the coronal tooth discoloration even after sealing the pulp chamber walls, the revision of current guidelines in relation to the use of TAP with minocycline might need to be revised.

The Effects of Inflammatory Tooth Pain on Anxiety in Adult Male Rats.

INTRODUCTION: This study aimed to examine the effects of induced inflammatory tooth pain on anxiety level in adult male rats. METHODS: The mandibular incisors of 56 adult male rats were cut off and prefabricated crowns were fixed on the teeth. Formalin and capsaicin were injected intradentally to induce inflammatory tooth pain. Diazepam treated group received diazepam 30 minutes before intradental injection. The anxiety-related behavior was evaluated with elevated plus maze test. RESULTS: Intradental application of chemical noxious stimuli, capsaicin and formalin, significantly affected nociceptive behaviors (P<0.001). Capsaicin (P<0.001) and formalin (P<0.01) significantly increased the anxiety levels in rats by decrease in the duration of time spent in open arm and increase in the duration of time spent in closed arm. Rats that received capsaicin made fewer open arm entries compared to the control animals (P<0.05). Capsaicin (P<0.001) and formalin (P<0.01) treated rats showed more stretch attend postures compared to the control and sham operated animals. In diazepampretreated rats, capsaicin induced algesic effect was prevented (P<0.001). CONCLUSION: Inflammatory pulpal pain has anxiogenic effect on rats, whereas diazepam premedication showed both anxiolytic and pain reducing effects.

Surface microhardness of different thicknesses of a premixed bioceramic material with or without the application of a moist cotton pellet.

BACKGROUND: This study was conducted to assess the effect of thickness and hydration condition on the surface microhardness of Endosequence Root Repair Material putty (ERRM; Brasseler USA, Savannah, GA), a premixed bioceramic material. MATERIALS AND METHODS: Polymethyl methacrylate cylindrical molds with an internal diameter of 4 mm and three heights of 2, 4, and 6 mm were fabricated. In Group 1 (dry condition), the molds with heights of 2, 4, and 6 mm (10 molds of each) were filled with ERRM. In Groups 2 and 3 (wet condition), a distilled water- or phosphate-buffered saline (PBS)-moistened cotton pellet was placed directly on the upper surface of ERRM, respectively. The lower surface of ERRM was in contact with floral foams soaked with human blood. After 4 days, Vickers microhardness of the upper surface of ERRM was tested. The data were analyzed using two-way analysis of variance. Significance level was set at P < 0.05. RESULTS: No significant difference was found between the microhardness of three thicknesses of ERRM (2, 4, and 6 mm) with or without placing a distilled water- or PBS-moistened cotton pellet over the material (P > 0.05). CONCLUSION: Based on the results of this study, it could be concluded that placing a moistened cotton pellet on ERRM putty up to 6 mm thick might be unnecessary to improve its surface microhardness and hydration characteristics.

Evaluation and Comparison of Occurrence of Tooth Discoloration after the Application of Various Calcium Silicate-based Cements: An Ex Vivo Study.

INTRODUCTION: Biodentine (Septodont, Saint Maur des Fossés, France), OrthoMTA (BioMTA, Seoul, Korea), and EndoSequence Root Repair Material (ERRM; Brasseler, Savannah, GA) have been developed to overcome the shortcomings of mineral trioxide aggregate (MTA). The purpose of this study was to compare tooth discoloration after the application of ProRoot MTA (Dentsply Tulsa Dental Products, Tulsa, OK) and 3 recently introduced calcium silicate-based cements in the presence and absence of blood. METHODS: In total, 104 human anterior teeth were prepared; 96 were randomly divided into 2 groups (blood and saline contamination). Each group was subdivided into 4 experimental subgroups (n = 12) of ProRoot MTA, Biodentine, OrthoMTA, and ERRM that were used to fill the pulp chambers. The remaining 8 teeth served as the saline and blood groups. Color analysis of tooth crowns was performed using a spectroradiometer before the application of materials and at 24 hours, 1 month, and 6 months after application. Repeated measures analysis of variance was used to evaluate the effects of blood, material, and time on color change (ΔE*). RESULTS: Tooth color change in all experimental groups increased over time (P < .05). Blood contamination significantly increased ΔE* (P < .05), but no significant difference occurred between the 4 groups in this respect in the presence of blood. However, in the absence of blood, the ΔE* of Biodentine and ERRM was significantly less than that of OrthoMTA (P < .05). CONCLUSIONS: There was no significant difference between tooth discolorations with materials in the presence of blood. However, in the absence of blood, Biodentine and ERRM exhibited less tooth discoloration than OrthoMTA.

Effect of Bacterial Lipopolysaccharide Contamination on Gutta Percha- versus Resilon-Induced Human Monocyte Cell Line Toxicity.

OBJECTIVES: Cytotoxic effects of obturation materials were tested in presence and absence of endotoxin on human monocytes in vitro. MATERIALS AND METHODS: Human monocytes from THP-1 cell line were cultured. Three millimeters from the tip of each Resilon and gutta percha points were cut and directly placed at the bottom of the culture wells. Cultured cells were exposed to gutta percha (groups G1 and G2) and Resilon (R1 and R2). Ten µg/ml bacterial lipopolysaccharide (LPS) was added to the culture wells in groups G1 and R1. Positive control included the bacterial LPS without the root canal filling material and the negative control contained the cells in culture medium only. Viability of cells was tested in all groups after 24, 48, and 72 hours using the methylthiazolyldiphenyl-tetrazolium bromide (MTT) assay for at least 3 times to obtain reproducible results. Optical density values were read and the data were analyzed using three-way ANOVA and post hoc statistical test. RESULTS: The results showed that cells in G2 had the lowest rate of viability at 24 hours, but the lowest rate of viable cells was recorded in G1 at 48 and 72 hours. The effect of LPS treatment was not statistically significant. Resilon groups showed cell viability values higher than those of gutta percha groups, although statistically non-significant (P=0.105). Cell viability values were lower in gutta percha than Resilon groups when LPS-treated and LPS-untreated groups were compared independently at each time point. CONCLUSION: It could be concluded that none of the tested root canal filling materials had toxic effects on cultured human monocyte cells whether in presence or absence of LPS contamination.

Isolation and evaluation of dental pulp stem cells from teeth with advanced periodontal disease.

INTRODUCTION: Successful isolation of mesenchymal stem cells from waste tissues might be extremely promising for developing stem cell-based therapies. This study aimed to explore whether cells retrieved from teeth extracted due to advanced periodontal disease present mesenchymal stem cell-like properties. METHODS: Pulp cells were isolated from 15 intact molars and 15 teeth with advanced periodontal disease. Cell proliferation and markers of mesenchymal stem cells were evaluated. RESULTS: Based on the RT-PCR and agarose gel electrophoresis, nucleostemin, Oct-4 and jmj2c, but not Nanog, were expressed in undifferentiated mesenchymal stem cells of both groups. Interestingly, diseased pulp exhibited higher gene expressions although it was not statistically significant. The average percentage of BrdU positive cells in the diseased group (84.4%, n = 5) was significantly higher than that of the control group (65.4%, n = 5) (t-test, P = 0.001). CONCLUSION: Our results indicate the successful isolation of mesenchymal stem cells from the pulp tissue of hopeless periodontally involved teeth.

Regenerative Endodontic Treatment: Report of Two Cases with Different Clinical Management and Outcomes.

Endodontic intervention in necrotic immature permanent teeth is usually a clinical challenge. With appropriate case selection, regenerative treatment can be effective, providing a desirable outcome. However, there is still no consensus on the optimal disinfection protocol or the method to achieve predictable clinical outcome. This article presents two cases of regenerative treatment in necrotic immature teeth, using mineral trioxide aggregate (MTA) and Biodentine(TM) as coronal barriers and different irrigants, which led to different clinical outcomes.

Surface microhardness of three thicknesses of mineral trioxide aggregate in different setting conditions.

OBJECTIVES: This study aimed to compare the surface microhardness of mineral trioxide aggregate (MTA) samples having different thicknesses and exposed to human blood from one side and with or without a moist cotton pellet on the other side. MATERIALS AND METHODS: Ninety cylindrical molds with three heights of 2, 4, and 6 mm were fabricated. In group 1 (dry condition), molds with heights of 2, 4, and 6 mm (10 molds of each) were filled with ProRoot MTA (Dentsply Tulsa Dental), and the upper surface of the material was not exposed to any additional moisture. In groups 2 and 3, a distilled water- or phosphate-buffered saline (PBS)-moistened cotton pellet was placed on the upper side of MTA, respectively. The lower side of the molds in all the groups was in contact with human blood-wetted foams. After 4 day, the Vickers microhardness of the upper surface of MTA was measured. RESULTS: In the dry condition, the 4 and 6 mm-thick MTA samples showed significantly lower microhardness than the 2 mm-thick samples (p = 0.003 and p = 0.001, respectively). However, when a distilled water- or PBS-moistened cotton pellet was placed over the MTA, no significant difference was found between the surface microhardness of samples having the abovementioned three thicknesses of the material (p = 0.210 and p = 0.112, respectively). CONCLUSIONS: It could be concluded that a moist cotton pellet must be placed over the 4 to 6 mm-thick MTA for better hydration of the material. However, this might not be necessary when 2 mm-thick MTA is used.

Effect of acidic environment on dislocation resistance of endosequence root repair material and mineral trioxide aggregate.

OBJECTIVE: The aim of this study was to compare the effect of an acidic environment on dislocation resistance (push-out bond strength) of EndoSequence Root Repair Material (ERRM putty and ERRM paste), a new bioceramic-based material, to that of mineral tri-oxide aggregate (MTA). MATERIALS AND METHODS: One-hundred twenty root dentin slices with standardized canal spaces were divided into 6 groups (n = 20 each) and filled with tooth-colored ProRoot MTA (groups 1 and 2), ERRM putty (groups 3 and 4), or ERRM paste (groups 5 and 6). The specimens of groups 1, 3, and 5 were exposed to phosphate buffered saline (PBS) solution (pH=7.4) and those of groups 2, 4, and 6 were exposed to butyric acid (pH= 4.4). The specimens were then incubated for 4 days at 37°C. The push-out bond strength was then measured using a universal testing machine. Failure modes after the push-out test were examined under a light microscope at ×40 magnification. The data for dislocation resistance were analyzed using the t-test and one-way analysis of variance. RESULTS: In PBS environment (pH=7.4), there were no significant differences among materials (P=0.30); but the mean push-out bond strength of ERRM putty was significantly higher than that of other materials in an acidic environment (P<0.001). Push-out bond strength of MTA and ERRM paste decreased after exposure to an acidic environment; whereas ERRM putty was not affected by acidic pH. The bond failure mode was predominantly cohesive for all groups except for MTA in an acidic environment; which showed mixed bond failure in most of the specimens. CONCLUSION: The force needed for dislocation of MTA and ERRM paste was significantly lower in samples stored in acidic pH; however, push-out bond strength of ERRM putty was not influenced by acidity.

A modified efficient method for dental pulp stem cell isolation.

BACKGROUND: Dental pulp stem cells can be used in regenerative endodontic therapy. The aim of this study was to introduce an efficient method for dental pulp stem cells isolation. MATERIALS AND METHODS: In this in-vitro study, 60 extracted human third molars were split and pulp tissue was extracted. Dental pulp stem cells were isolated by the following three different methods: (1) digestion of pulp by collagenase/dispase enzyme and culture of the released cells; (2) outgrowth of the cells by culture of undigested pulp pieces; (3) digestion of pulp tissue pieces and fixing them. The cells were cultured in minimum essential medium alpha modification (αMEM) medium supplemented with 20% fetal bovine serum(FBS) in humid 37°C incubator with 5% CO 2. The markers of stem cells were studied by reverse transcriptase polymerase chain reaction (PCR). The student t-test was used for comparing the means of independent groups. P <0.05 was considered as significant. RESULTS: The results indicated that by the first method a few cell colonies with homogenous morphology were detectable after 4 days, while in the outgrowth method more time was needed (10-12 days) to allow sufficient numbers of heterogeneous phenotype stem cells to migrate out of tissue. Interestingly, with the improved third method, we obtained stem cells successfully with about 60% efficiency after 2 days. The results of RT-PCR suggested the expression of Nanog, Oct-4, and Nucleostemin markers in the isolated cells from dental pulps. CONCLUSION: This study proposes a new method with high efficacy to obtain dental pulp stem cells in a short time.

Marginal adaptation of new bioceramic materials and mineral trioxide aggregate: a scanning electron microscopy study.

INTRODUCTION: This study aimed to compare the marginal adaptation of new bioceramic materials, EndoSequence Root Repair Material (ERRM putty and ERRM paste), to that of mineral trioxide aggregate (MTA) as root-end filling materials. MATERIALS AND METHODS: Thirty-six extracted human single-rooted teeth were prepared and obturated with gutta-percha and AH-26 sealer. The roots were resected 3 mm from the apex. Root-end cavities were then prepared with an ultrasonic retrotip. The specimens were divided into three groups (n=12) and filled with MTA, ERRM putty or ERRM paste. Epoxy resin replicas from the resected root-end surfaces and longitudinally sectioned roots were fabricated. The gaps at the material/dentin interface were measured using scanning electron microscope (SEM). Transversal, longitudinal, and overall gap sizes were measured for each specimen. The data were analyzed using the Kruskal-Wallis test. RESULTS: In transversal sections, no significant difference was found between MTA, ERRM putty and ERRM paste (P=0.31). However, in longitudinal sections, larger gaps were evident between ERRM paste and dentinal walls compared to MTA and ERRM putty (P=0.002 and P=0.033, respectively). Considering the overall gap size values, the difference between three tested materials was not statistically significant (P=0.17). CONCLUSION: Within the limits of this study, the marginal adaptation of ERRM paste and putty was comparable to that of MTA. However, ERRM putty might be more suitable for filling the root-end cavities because of its superior adaptation compared to ERRM paste in longitudinal sections.

Gene expression and cytokine release during odontogenic differentiation of human dental pulp stem cells induced by 2 endodontic biomaterials.

INTRODUCTION: Mineral trioxide aggregate (MTA) and calcium-enriched mixture (CEM) have shown osteogenic/cementogenic/dentinogenic activities; however, their mechanism of action is not fully understood. We aimed to evaluate the effect of these biomaterials on odontogenic differentiation of human dental pulp stem cells (DPSCs). METHODS: Flow cytometry with stem cell markers for the confirmation of stemness and homogeneity was first performed. Then isolated DPSCs were seeded on prepared discs of MTA, CEM, differentiation medium (DM), and growth medium (GM) and incubated up to 14 days. Concentrations of transforming growth factor-ß1, bone morphogenetic protein (BMP)2, BMP4, and fibroblast growth factor 4 were measured at each interval using an enzyme-linked immunosorbent assay reader. Gene expression of dentin sialophosphoprotein, dentin matrix protein 1, and the cytokines were evaluated by reverse-transcription polymerase chain reaction. To evaluate the cell morphology, scanning electron micrographs were taken; mineralization potential was evaluated using alizarin red S staining. RESULTS: Scanning electron micrographs showed that DPSCs spread/adhered/proliferated similarly on MTA and CEM. On day 14, alizarin red S staining confirmed that mineralization occurred in all groups except GM. Expressions of dentin matrix protein 1 and dentin sialophosphoprotein genes were similar in the CEM, MTA, and DM groups; they were significantly higher compared with the GM group (P < .05). A greater amount of transforming growth factor-ß1 gene was expressed in MTA compared with the other groups (P < .05). However, the expression of fibroblast growth factor 4 and BMP2 genes was significantly greater in the CEM group (P < .05). In all the tested groups, the expression of BMP4 was less than GM (P < .01); however, CEM and DM were similar but more than MTA (P < .05). Concentrations of protein product detected using an enzyme-linked immunosorbent assay reader confirmed these gene expressions. CONCLUSIONS: MTA and CEM can induce osteo-/odontogenic-like phenotype differentiation of human DPSCs; however, they stimulate different gene expressions and growth factor release.

Long-term effect of an educational intervention regarding dental trauma first aid: a phase II study.

AIM: Interventions that improve knowledge about emergency management of traumatic dental injuries may be a good way to achieve a more favorable prognosis in such situations. We set out to evaluate the short- and long-term effects of combined educational interventions on health teachers, including lecture presentation, question-and-answer sessions, and informational posters to promote awareness regarding emergency measures for traumatized teeth. Assessment was performed using a three-part questionnaire, including demographic data, knowledge, and self-assessment. Using a census sampling method, 52 health teachers of 68 potential candidates participated in the study. The questionnaires of 38 teachers who participated at all three intervals, including before (T0), immediately after (T1), and 36 months after (T2) the intervention, were analyzed. Statistical analysis involved Cochrane and McNemar's tests. Totally, results revealed an increase in knowledge from T0 to T1 and T2 intervals (P < 0.017). This study shows the positive effect of educational campaigns and, therefore, serves to encourage professionals to embark on innovative educational programs in this field.

An In Vitro Comparison of Marginal Adaptation of MTA and MTA-Like Materials in the Presence of PBS at One-Week and Two-Month Intervals.

OBJECTIVE: This study compared the marginal adaptation of mineral trioxide aggregate (MTA) and MTA-like materials as root-end fillings after incubation in phosphate buffer saline (PBS), a synthetic tissue fluid, for either 1 week or 2 months. MATERIALS AND METHODS: In this experimental study, seventy-two extracted human single-rooted teeth were prepared and obturated with gutta-percha and AH26 sealer. The apical 3 mm of the roots were resected. Root-end cavities were prepared with an ultrasonic retrotip. The specimens were randomly divided into three groups (n=24) and filled with either ProRoot MTA, OrthoMTA, or RetroMTA. Half of the specimens in each group were stored in PBS for 1 week the other half for 2 months. Epoxy resin replicas from the resected root-end surfaces and longitudinally sectioned roots were fabricated. The gaps at the material/dentin interface were measured using a scanning electron microscope (SEM). Transversal, longitudinal, and overall gap sizes were measured. The data were analyzed using Kruskal-Wallis and Mann-Whitney tests. The significance level was set at p < 0.05. RESULTS: There were no significant differences between the marginal adaptation of ProRoot MTA, RetroMTA, and OrthoMTA in both transverse and longitudinal sections after incubation for either 1 week or 2 months (p > 0.05). In addition, the test groups were not significantly different regarding the overall mean gap values (p > 0.05). CONCLUSION: Under the conditions of this study, there was no difference between the marginal adaptation of ProRoot MTA, OrthoMTA, and RetroMTA as root-end filling materials after exposure to PBS for either 1 week or 2 months.

Push-out bond strength of gutta-percha with a new bioceramic sealer in the presence or absence of smear layer.

The purpose of this study was to compare the bond strength of a new bioceramic sealer (EndoSequence BC Sealer) and AH Plus in the presence or absence of smear layer. Extracted single-rooted human teeth were prepared and randomly divided into four groups. In groups 1 and 3, the root canals were finally irrigated with 5.25% NaOCl and smear layer was not removed, but in groups 2 and 4, the root canals were finally irrigated with 17% EDTA followed by 5.25% NaOCl in order to remove the smear layer. In groups 1 and 2, the root canals were obturated with gutta-percha/AH Plus, but in groups 3 and 4, obturation was performed with gutta-percha/EndoSequence BC Sealer. Push-out bond strength and failure modes were evaluated. The bond strength of gutta-percha/AH Plus and gutta-percha/EndoSequence BC Sealer was not significantly different (P = 0.89). The presence or absence of smear layer did not significantly affect the bond strength of filling materials (P = 0.69). The mode of bond failure was mainly cohesive for all groups. In conclusion, the bond strength of the new bioceramic sealer was equal to that of AH Plus with or without the smear layer.

The effect of different irrigation protocols for smear layer removal on bond strength of a new bioceramic sealer.

INTRODUCTION: The purpose of this study was to assess the effect of different irrigation protocols for smear layer removal on the bond strength of EndoSequence BC Sealer, a new bioceramic sealer, to root canal dentin. MATERIALS AND METHODS: The middle third of forty-four extracted human teeth were sectioned horizontally to obtain 128 dentin disks. After standardization of canal spaces, dentin disks were immersed in 5.25% NaOCl for 20 min. The specimens were then randomly assigned to four groups (n=32) according to dentin treatment procedure: group 1, 17% EDTA (1 min); group 2, 17% EDTA (1 min) + 5.25% NaOCl (5 min); group 3, 17% EDTA (1 min) + 2% chlorhexidine (CHX) (5 min); and group 4, 17% EDTA (1 min) + saline (5 min). After dentin treatment, two specimens of each group were prepared for investigation with scanning electron microscopy (SEM). Surface of root canal wall was assessed in each specimen. Then the canal spaces were filled with EndoSequence BC Sealer in the remaining specimens. Push-out bond-strength and failure modes were assessed. The data on push-out test were analyzed using one-way ANOVA test. The significance level was set at P=0.05. RESULTS: There was no significant difference between the bond strengths of test groups (P=0.203). The bond failure was mainly cohesive for all groups. CONCLUSION: Under the conditions of this ex vivo study, it could be concluded that the application of 17% EDTA alone or followed by 5.25% NaOCl, 2% CHX, or saline resulted in similar bond strength of EndoSequence BC Sealer to dentinal walls.