Evaluation of Antibacterial and Antifungal Effects of Calcium Hydroxide Mixed with Two Different Essential Oils.

BACKGROUND: Calcium hydroxide is a routinely used material for root canal disinfection during root canal treatment. Natural products have great potential in terms of their antibacterial effects. This study aimed to establish an effective alternative intracanal medicament using Origanum dubium (O. dubium) and Mentha spicata (M. spicata) essential oils. MATERIALS AND METHODS: O. dubium and M. spicata, collected from Lefke, Cyprus, were separately subjected to hydrodistillation. The obtained essential oil compositions were analysed simultaneously by gas chromatography (GC) and gas chromatography/mass spectrometry (GC-MS). The compositions were then divided into groups and mixed with calcium hydroxide at a 1:1 concentration; after that, the pastes were tested on Enterococcus faecalis (E. faecalis) and Candida albicans (C. albicans), which are the most common resistant pathogenic microorganisms in the root canal. The antibacterial activity of the pastes was measured using a disk diffusion assay. RESULTS: The GC and GC-MS analyses revealed that O. dubium and M. spicata had major compositions of carvacrol (75.8%) and carvone (71.3%), respectively. Antimicrobial activity was found to be significantly higher when study groups with O. dubium essential oil were applied to both E. faecalis and C. albicans. The results also show that M. spicata, together with calcium hydroxide, demonstrated a significant antifungal effect on C. albicans when incubated for 72 h. CONCLUSIONS: M. spicata was found to be an effective antimicrobial agent on C. albicans, whereas O. dubium was found to be very effective on both E. faecalis and C. albicans. These data demonstrate that these natural essential oils may be promising candidates for alternative intracanal medicament in future routine clinical applications.

Efficacy of preheated chelating agents on calcium ion removal from instrumented root canals.

BACKGROUND: The heating of chelating agents such as EDTA increases dentin wettability by decreasing surface tension. However, the calcium ion release effect of preheated chelating agents in instrumented root canals has not yet been mentioned. In this study, it was aimed to evaluate the number of calcium ions removed by the pre-heated chelating agents from the root canals. MATERIAL AND METHODS: After 51 bovine teeth were instrumented, three of them were separated as negative controls and the remaining teeth were divided into six groups according to the temperature of the solution (at 22 or 37ºC): EDTA-22, CITRIC-22, QMix-22, EDTA-37, CITRIC-37 and QMix-37. Following irrigation, calcium ion levels were determined by atomic absorption spectrophotometer in chelating agents collected from the root canals. RESULTS: QMix solution eliminated significantly more calcium ions than other chelating agents at different temperatures (p< 0.05). Regardless of the heating, QMix and 17% EDTA were significantly superior to 40% Citric acid (p< 0.05) while no significant difference was detected between QMix and 17% EDTA groups (p< 0.05). Heating all chelating agents did not significantly increase their ability to remove calcium ions from pre-instrumented root canals (P< 0.05). In the SEM examination, it was observed that the smear layer was removed from the middle third of the roots, except for the negative control group. CONCLUSIONS: Temperature changes have shown that these agents do not increase the ability of the smear layer to dissolve the inorganic structure. QMix at different temperatures may be recommended to use as the final chelating agent. Key words:EDTA, citric acid, QMix, calcium ions, temperature.

Does Maintaining Apical Patency during Instrumentation Increase Postoperative Pain or Flare-up Rate after Nonsurgical Root Canal Treatment? A Systematic Review of Randomized Controlled Trials.

INTRODUCTION: The concept of maintaining apical patency (AP) is a controversial issue in endodontics. The primary objectives of this systematic review of randomized controlled trials (RCTs) were to determine the influence of maintaining AP during instrumentation on postoperative pain severity and the prevalence of flare-ups. A second objective was to assess the effect of maintaining AP on the use of analgesics. METHODS: RCTs and controlled clinical trials were searched for in MEDLINE (Ovid), Embase (Ovid), and the Cochrane Library. Four reviewers independently screened all identified articles for eligibility. The included studies were assessed for bias using the Cochrane Risk of Bias Tool. The Grading of Recommendations Assessment, Development and Evaluation approach was used to rate the quality of the body of evidence. Because of the considerable heterogeneity of the studies, a meta-analysis was not possible. Therefore, the results were analyzed narratively. RESULTS: Five RCTs that included a total of 848 patients were found eligible and included in the review. An assessment of the risk of bias in the included studies provided results that classified the studies as showing a low risk (n = 1), high risk (n = 1), or unclear risk (n = 3) of bias. The available evidence indicated that maintaining AP (1) did not increase postoperative pain in teeth with nonvital pulp, (2) did not increase postoperative pain in teeth with vital pulp, and (3) did not cause (0%) flare-ups. The available evidence also indicated that maintaining AP did not increase analgesic use. The available evidence indicated that maintaining AP did not increase postoperative pain when a single-visit or 2-visit root canal treatment approach was used. CONCLUSIONS: In light of the current evidence, maintaining AP does not increase postoperative pain in teeth with vital/nonvital pulp when compared with nonapical patency (low to moderate quality evidence). Furthermore, maintaining AP did not cause flare-ups (low evidence) and did not increase analgesic use (moderate evidence).

Maintaining Apical Patency Does Not Increase Postoperative Pain in Molars with Necrotic Pulp and Apical Periodontitis: A Randomized Controlled Trial.

INTRODUCTION: This prospective, single-center, single-blind, randomized controlled trial aimed to evaluate whether maintaining apical patency (AP) during endodontic treatment increases postoperative pain in molar teeth with necrotic pulp and apical periodontitis. METHODS: Three hundred twenty qualified patients between 21 and 45 years of age were randomized into 1 of 2 groups (the AP group and the nonapical patency [NAP] group) using a series of random numbers in a 1:1 ratio. Qualified patients were selected from patients who had necrotic pulp and apical periodontitis in the maxillary or mandibular molar teeth. The primary outcome was to assess postoperative pain severity, and the secondary outcome was to evaluate analgesic consumption during the 7-day follow-up period using the visual analog scale (VAS). The VAS consisted of a 100-mm line. Pain severity was evaluated as no pain (0-4 mm), mild pain (5-44 mm), moderate pain (45-74 mm), and severe pain (75-100 mm). The Student t test was used to identify statistically significant differences between the study groups (P < .05). RESULTS: The mean VAS scores were significantly lower in the AP group in the first 5 postoperative days (P < .05); after which, it was nonsignificant. In the NAP group, the postoperative pain increased between 12 and 24 hours, whereas the postoperative pain decreased in the AP group during that period. At 12 and 24 hours, the mean VAS scores for the AP group were 42.90 and 37.78 mm, respectively. The mean VAS scores for the NAP group were 64.46 and 65.74 mm, respectively. None of the patients had severe postoperative pain during the follow-up period. No significant difference was found in analgesic consumption (P > .05) between the groups. CONCLUSIONS: The maintenance of AP in molar teeth with necrotic pulp and apical periodontitis was associated with less postoperative pain when compared with NAP.

The Effect of Foraminal Enlargement of Necrotic Teeth with a Continuous Rotary System on Postoperative Pain: A Randomized Controlled Trial.

INTRODUCTION: This single-blind, randomized controlled trial aimed to evaluate whether foraminal enlargement (FE) with a continuous rotary system during endodontic treatment causes more postoperative pain than nonforaminal enlargement (NFE). METHODS: Seventy qualified patients were randomized into 1 of 2 groups in a 1:1 ratio using a series of random numbers: the FE group and the NFE group. The patients were followed up for 7 days to evaluate between-group differences in the outcome measures. The study participants were selected from among patients who had necrosis and apical periodontitis in the maxillary or mandibular molar teeth. The primary outcome was to assess postoperative pain severity, and the secondary outcome was to evaluate analgesic consumption during the follow-up period. Pain severity was evaluated for the first 7 days using a visual analog scale (VAS). The VAS consisted of a 100-mm line. Pain severity was assessed as no pain (0-4 mm), mild pain (5-44 mm), moderate pain (45-74 mm), and severe pain (75-100 mm). The quality of life of patients during the follow-up period was assessed using a quality of life scale. The Student t test was used to identify statistically significant differences between the study groups (P < .05). RESULTS: A significant difference was noted in postoperative pain in the first 2 days; the FE group experienced more pain than the conventional NFE group (P < .05). In the FE group, 12 and 11 patients (34% and 31%) had severe postoperative pain (VAS score, >74 mm) on the first day and second day, respectively. VAS pain scores between the groups were not different (P > .05) on other days. No significant difference was found in analgesic consumption between the groups (P > .05). CONCLUSIONS: On the basis of the VAS results, this randomized controlled trial indicates that FE causes more pain on the first 2 days after an endodontic treatment.

[Evaluation of postoperative pain in root canal treatment]. / Kök kanal tedavisi sonunda duyulan agrinin degerlendirilmesi.

OBJECTIVES: The control of postoperative pain is very important for the success of root canal treatment. The aim of this study was to research the factors that affect pain periods and pain intensity during and after endodontic treatment. METHODS: The study included 128 patients. The teeth were grouped according to their type, location and vitality. Root canals were prepared by Hero-shaper and crown-down methods, and filled by lateral condensation. The postoperative 12th hour and postoperative 1st, 3rd, 7th and 15th day Visual Analog Scales (VAS) scores of the patients were recorded and analyzed by statistical methods. RESULTS: After treatment, the postoperative pain scores were statistically higher in devital than vital teeth. VAS pain score demonstrated statistical differences at the beginning of the treatment between anterior and molar teeth (p=0.012) and also at 3, 7 and 15 days after treatment between premolar and molar teeth (p=0.002, p=0.006, p=0.048, respectively). According to the localization of teeth, on the 3rd, 7th and 15th postoperative days, VAS scores were the highest in the mandibular teeth (p=0.014, p=0.036, p=0.023). CONCLUSION: In postoperative pain evaluation, type, localization and vitality of teeth were determined as important. In addition, analysis of the factors that affect treatment as a whole will positively impact the issues of patient satisfaction, workload and cost.

In vitro evaluation of matched-taper single-cone obturation with a fluid filtration method.

OBJECTIVE: Widespread use of rotary nickel-titanium systems has caused manufacturers to produce gutta-percha cones that match the taper of the canals prepared with these systems. Obturations with these cones may provide 3-dimensional obturation of the root canal in less time. The aim of this study was to use a fluid filtration method to compare the apical sealing ability of matched-taper single-cone, Thermafil and lateral condensation obturations. MATERIALS AND METHODS: Sixty-six extracted human lower premolar teeth were instrumented to size F3 with ProTaper instruments. The teeth were divided into 3 groups and obturated with matched-taper single-cone, Thermafil and lateral condensation techniques. AH Plus was used as a sealer. Six teeth were used as positive and negative controls. A fluid filtration system was used to evaluate the apical seal. Measurements were made at 2-minute intervals for 8 minutes and the average of these values was recorded. One-way analysis of variance test was used for statistical analysis. RESULTS: Mean leakage values for the lateral condensation, single-cone and Thermafil groups were 0.49 +/- 0.37 microL min(-1), 0.39 +/- 0.24 microL min(-1) and 0.44 +/- 0.25 microL min(-1), respectively. The difference between the groups was not statistically significant (p > 0.05). CONCLUSIONS: The apical sealing ability of matched-taper single-cone obturation was comparable with that of lateral condensation and Thermafil techniques.

The effect of mineral trioxide aggregate on the contractility of the rat thoracic aorta.

Mineral trioxide aggregate (MTA) is being advocated for vital pulp therapy. In the case of direct pulp capping, hemorrhage control is an important step on success, but little is known about the effect of MTA on pulpal bleeding. In addition, there has been a lack of information on the effect of MTA on smooth muscle contraction, such as can occur in the blood vessels of dental pulp. The present study assessed the vascular effects of MTA, using the rat aortic ring preparations as a tissue model. MTA (100-500 mg) induced dose-dependent contraction in rat thoracic aorta. The contractile effect of MTA was blocked by calcium channel blocker nifedipine (1 muM). These data suggest that the vasoconstrictor property of MTA is related to calcium influx and it may allow proper control of hemorrhage which is critical for the success of any pulp-capping treatment.

Bacterial reduction by extensive versus conservative root canal instrumentation in vitro.

OBJECTIVE: This study aimed to test the hypothesis that aggressive dentin removal through greater-tapered instrumentation reduces the intracanal bacteria more effectively than conservative dimension instrumentation. MATERIAL AND METHODS: Twenty extracted human lower premolar teeth were used. After extirpation of the pulps, the teeth were autoclaved and immersed in a broth inoculated with Enterococcus faecalis and incubated for 7 days to allow infection of the dentinal tubules. The teeth were divided into 2 experimental groups, each comprising 10 teeth. The teeth were instrumented either with ProTaper or with Hero Shaper nickel-titanium rotary instrumentation techniques. It was calculated that ProTaper theoretically has the potential to remove at least twice the dentin volume compared with Hero Shaper. The apical preparation was standardized to file size 30. Saline solution was used for irrigation. Bacteriological samples were taken before and after instrumentation and plated onto tryptic soy agar, and the reduction in numbers was calculated. RESULTS: Both instrumentation techniques significantly reduced the number of bacteria in the root canal (p<0.05). Reduction in absolute bacterial numbers was up to 98%. There was no statistically significant difference between the two techniques. CONCLUSIONS: Preparation with an instrumentation technique removing substantial amounts of dentin did not reduce the intracanal bacteria more effectively than a more conservative instrumentation technique.

In vitro antimicrobial activity of propolis samples from different geographical origins against certain oral pathogens.

Propolis is an agent having antimicrobial properties, however, its composition can vary depending on the area where it is collected. In the present study, the antimicrobial activity of five propolis samples, collected from four different regions in Turkey and from Brazil, against nine anaerobic strains was evaluated. Ethanol extracts of propolis (EEP) were prepared from propolis samples and we determined minimum inhibitory concentrations (MIC) and minimum bactericidal concentrations (MBC) of EEP on the growth of test microorganisms by using agar dilution method. All strains were susceptible and MIC values ranged from 4 to 512 microg/ml for propolis activity. Propolis from Kazan-Ankara showed most effective MIC values to the studied microorganisms. MBC values of Kazan-Ankara EEP samples were ranged from 8 to 512 microg/ml. Death was observed within 4 h of incubation for Peptostreptococcus anaerobius and micros and Lactobacillus acidophilus and Actinomyces naeslundii, while 8 h for Prevotella oralis and Prevotella melaninogenica and Porphyromonas gingivalis, 12 h for Fusobacterium nucleatum, 16 h for Veillonella parvula. It was shown that propolis samples were more effective against Gram positive anaerobic bacteria than Gram negative ones. The organic chemical compositions of EEPs were determined by high-resolution gas chromatography coupled to mass spectrometry (GC-MS). The main compounds of EEPs were flavonoids such as pinobanksin, quercetin, naringenin, galangine, chrysin and aromatic acids such as cafeic acid. Because of increased antimicrobial resistance, propolis may be kept in mind in the treatment of oral cavity diseases.