Evaluation of Root and Root Canal Morphology of Mandibular First and Second Molars in a Greek Population: A CBCT Study.

OBJECTIVE: Τo study the number of roots, canal configurations, and frequency of morphological variations in mandibular first and second molars in a Greek population. METHODS: This study examined 478 mandibular first molars and 524 mandibular second molars using a high-resolution cone-beam computed tomography (CBCT). The number of roots was recorded and the root canal configuration was categorized based on the classification by Vertucci. The presence and configuration of C-shaped root canals were recorded and they were classified according to the Fan classification. The symmetry between the right and the left side was also evaluated. RESULTS: Among the mandibular first molars, 0.2% teeth were single-rooted, 96.4% were two-rooted, and 3.3% were three-rooted. In the mandibular second molars, 12.2%, 82.8%, and 4.9% were single-rooted, two-rooted, and three-rooted, respectively. In two-rooted mandibular first and second molars, the most frequent root canal pattern observed was Vertucci's type II in the mesial root (69.8% and 64.1%, respectively) and Vertucci's type I in the distal root (81.7% and 97.7%, respectively). Three-rooted molars showed one oval-shaped mesial root and two distal roots (56.2% in first molars, 65.4% in second molars), where each distal root contained a single root canal (type I), and the mesial root presented either type II (53.3%), IV (26.6%), I (13.3%), or V (6.6%) canal configurations. C-shaped canals were only detected in mandibular second molars (5.3% of teeth, 10.8% of individuals), and bilateral occurrence was observed in 24.5% patients. The most frequent root canal pattern was Fan's C1 type at the orifice, followed by C3a and C3b in the coronal and middle third, which joined into a single canal (C4) apically. CONCLUSION: The characteristics of the root and root canal anatomy of the mandibular first and second molars of Greek individuals were similar to those observed in Caucasians. However, the higher incidence of third roots in mandibular molars in Greek individuals compared to Caucasians requires absolute clinical awareness.

Mandibular canines with additional roots: An ex vivo study of the external and internal morphology.

The aim of this study was to investigate the root and root canal morphologies of mandibular canines with additional roots using cone-beam computed tomography. Seventy-seven extracted two-rooted and one-three-rooted permanent human mandibular canines were selected. Aspects of the external morphology evaluated were crown length, root length, total length, root bifurcation distance from the cementoenamel junction, root size, and direction of the root curvature in the apical third. Features of internal morphology assessed were root canal number per root, root canal bifurcation distance from the cementoenamel junction, and the angle between the buccal or lingual canal and the main canal. The root size and length presented considerable diversity. Most of the roots bifurcated at the middle third and exhibited a buccal curvature. The main root canal bifurcated coronally in two root canals, a buccal and a lingual. The majority of the buccal and lingual root canal angles were blunt. The presence of a third root in a specimen was a novel finding of this study.

3-Rooted Maxillary First Premolars: An Ex Vivo Study of External and Internal Morphologies.

INTRODUCTION: This study aimed to analyze the external and internal morphologies of 3-rooted maxillary first premolars using cone-beam computed tomographic (CBCT) imaging. METHODS: Fifty-six three-rooted maxillary first premolars were imaged by CBCT imaging and classified into 4 groups on the basis of external root morphology. Internal morphologic features, including the shapes of the buccal and palatal orifices and distances of bifurcation of the buccal-palatal and mesiobuccal-distobuccal root canals from the cementoenamel junction (CEJ), were measured. RESULTS: The teeth were classified into 4 groups on the basis of external morphology: group A, separation of the buccal and palatal roots with bifurcation of the former into the mesiobuccal and distobuccal roots (n = 22); group B, fusion of 2 buccal roots with the palatal root being separate (n = 19); group C, complete or partial fusion of the distobuccal and palatal roots (n = 9); and group D, fusion of all 3 roots (n = 6). The buccal orifice was mainly triangular/heart shaped. The distance of bifurcation of the buccal-palatal root canals from the CEJ in group A differed significantly from those in groups B and C (P < .05). There were significant differences in the distance of bifurcation of the mesiobuccal-distobuccal root canals from the CEJ among groups A, B, and C (P < .05). Four teeth exhibited C-shaped root canal systems of different configurations. CONCLUSIONS: The external and internal morphologies of 3-rooted maxillary first premolars vary considerably.

Spectrophotometric analysis of crown discoloration induced by MTA- and ZnOE-based sealers.

UNLABELLED: Crown discoloration can be induced by root canal sealer remnants following root canal treatment. OBJECTIVE: The aim of this study was to evaluate chromatic alterations in human tooth crowns induced by a Mineral Trioxide Aggregate-based sealer (MTA Fillapex®) and a commonly used ZnOE-based sealer (Roth-811). The tested null hypothesis was that the application of the materials did not induce clinically perceptible crown discoloration (Ho: CIE color difference ΔE<3.7). MATERIAL AND METHODS: Forty five fully developed, intact, mandibular third molars were sectioned 1 mm below the cemento-enamel junction. The pulp chambers were chemomechanically debrided via the cervical access. The specimens were randomly assigned into three groups Group 1: MTA Fillapex, Group 2: Roth 811, Group 3: Negative control (unfilled) and immersed in individually marked vials containing distilled water up to the cervix (37±1°C). The spectral reflectance lines were recorded by utilizing a UV-VIS spectrophotometer equipped with integration sphere in the visual spectrum at baseline, 1 week, 1 and 3 months after material placement. Data were transformed into values of the CIE L*a*b* color system and the corresponding ΔE values were calculated. Statistical analysis was performed using two-way mixed ANOVA models, at p=0.05 level of significance. RESULTS: A statistically significant increase in a* and b* chromatic parameters of the MTA Fillapex Group was measured. However, ΔE values did not exceed the human eye perceptibility threshold (set at ΔE<3.7) during the experimental period (ΔEt3=2.88). In Roth-811 Group, a statistically significant decrease in L* and a statistically significant increase in a* and b* chromatic parameters was measured, during all observation periods. Resultant ΔE values exceeded the human eye perceptibility threshold after 1 week (ΔEt1=5.65). CONCLUSIONS: Application of MTA Fillapex in tooth crowns resulted in minimal color alterations, while Roth 811 induced severe discoloration, in vitro. It could be suggested that, in terms of aesthetics, the use of MTA Fillapex appears to be favorable.

Spectrophotometric analysis of crown discoloration induced by MTA- and ZnOE-based sealers

Crown discoloration can be induced by root canal sealer remnants following root canal treatment. Objective: The aim of this study was to evaluate chromatic alterations in human tooth crowns induced by a Mineral Trioxide Aggregate-based sealer (MTA Fillapex®) and a commonly used ZnOE-based sealer (Roth-811). The tested null hypothesis was that the application of the materials did not induce clinically perceptible crown discoloration (Ho: CIE color difference ΔE<3.7). Material and Methods: Forty five fully developed, intact, mandibular third molars were sectioned 1 mm below the cemento-enamel junction. The pulp chambers were chemomechanically debrided via the cervical access. The specimens were randomly assigned into three groups Group 1: MTA Fillapex, Group 2: Roth 811, Group 3: Negative control (unfilled) and immersed in individually marked vials containing distilled water up to the cervix (37±1°C). The spectral reflectance lines were recorded by utilizing a UV-VIS spectrophotometer equipped with integration sphere in the visual spectrum at baseline, 1 week, 1 and 3 months after material placement. Data were transformed into values of the CIE L*a*b* color system and the corresponding ΔE values were calculated. Statistical analysis was performed using two-way mixed ANOVA models, at p=0.05 level of significance. Results: A statistically significant increase in a* and b* chromatic parameters of the MTA Fillapex Group was measured. However, ΔE values did not exceed the human eye perceptibility threshold (set at ΔE<3.7) during the experimental period (ΔEt3=2.88). In Roth-811 Group, a statistically significant decrease in L* and a statistically significant increase in a* and b* chromatic parameters was measured, during all observation periods. Resultant ΔE values exceeded the human eye perceptibility threshold after 1 week (ΔEt1=5.65). Conclusions: Application of MTA Fillapex in tooth crowns resulted in minimal color alterations, while Roth 811 induced severe discoloration, in vitro. It could be suggested that, in terms of aesthetics, the use of MTA Fillapex appears to be favorable.

Validation and spectrophotometric analysis of crown discoloration induced by root canal sealers.

OBJECTIVES: A major cause of crown discoloration is root canal sealer remnants in the pulp chamber, after root canal obturation. The aim of this study was the evaluation of the chromogenic effect of common and new-generation root canal sealers. The tested null hypothesis was that none of the sealers induced clinically perceptible crown discoloration, ex vivo (H(0): CIE color difference ∆Ε < 3.7). METHODS: The crowns of 80 intact, fully developed third mandibular molars were cross-sectioned 1 mm below the cementoenamel junction and stored in standard conditions (100 % humidity, 37 °C). The pulp chambers were chemomechanically debrided with hand files and sodium hypochlorite (NaOCl) and the specimens were randomly assigned into four experimental (1-4) and one control (5) groups. In the experimental groups, the internal axial walls of the pulp chambers were coated with sealers (Group 1; Roth 811, Group 2; AH26, Group 3; GuttaFlow, Group 4; Epiphany SE). The pulp chambers of the control group (Group 5) remained unfilled. The spectral reflectance lines of the crowns were recorded by a UV-Vis spectrophotometer. CIE total color differences [Formula: see text] were calculated after 1 week, 1 month, 3 months, and 6 months, respectively. A pilot study was also conducted for the validation of the experimental model. Two-way mixed ANOVA models were used for statistical data analysis. RESULTS: The experimental model presented values of ∆Ε < 1 unit and high positive correlation values, after repeated measurements (p < 0.05). Roth 811 sealer (Group 1) induced clinically perceptible crown discoloration (∆Ε > 3.7, p < 0.05) and presented statistically significant differences from Groups 2-5 in all examination intervals (p < 0.05). In Groups 2-5, clinically perceptible crown discoloration was not observed (∆Ε < 3.7, p < 0.05). CONCLUSIONS: Roth 811 sealer exhibited severe discoloration effects. Within the limitations of this study, it can be concluded that any sealer remnants should be removed from the pulp chamber after root canal obturation and before placement of a final restoration. CLINICAL RELEVANCE: The chromogenic potential may play an important role in selecting proper root canal sealers.

Endodontic management and cone-beam computed tomography evaluation of seven maxillary and mandibular molars with single roots and single canals in a patient.

INTRODUCTION: The knowledge of root canal morphology and the existing anatomical variations is essential for successful endodontic therapy. METHODS: This report presents an extraordinary case of unusual tooth morphology involving the bilateral existence of 7 maxillary and mandibular first and second molars with a single root and a single canal in a patient. RESULTS: Endodontic retreatment of the affected teeth #15, #19, and #18 was performed. Cone-beam computed tomography (CBCT) images confirmed our diagnostic and therapeutic measures after endodontic management of the teeth. CONCLUSIONS: This morphologic variation has not been reported in the literature. The availability of 3-dimensional images further provided the opportunity for the precise description of the anatomy of 7 maxillary and mandibular molars with single roots and single canals.

Fluid-transport evaluation of lateral condensation, ProTaper gutta-percha and warm vertical condensation obturation techniques.

The purpose of this study was to compare the microleakage of four obturation techniques (lateral condensation, lateral condensation of ProTaper Gutta-percha, single ProTaper Gutta-percha and warm vertical condensation) over a 3-month period. A fluid-transport model was used to measure microleakage. Sixty human-extracted teeth, divided into four groups, were prepared with ProTaper rotary instruments before the root canals were filled by one of the four examined techniques. All groups were obturated using Sultan as a root canal sealer. Microleakage was measured 7 days, 1 month and 3 months after the procedures. There were no statistically significant differences between the four groups at any of examination points (P > 0.05). The leakage was increased in all obturation techniques over the 3-month period.

In vitro evaluation of the cytotoxicity of ProRoot MTA and MTA Angelus.

The purpose of the present in vitro study was to compare the cytotoxic effect of two commercially available brands of mineral trioxide cement (ProRoot MTA and MTA Angelus), modified zinc oxide-eugenol cement (SuperEBA) and resin-modified glass ionomer cement (Vitrebond) using rat pulp cells (RPC-C2A) and human lung fibroblasts (MRC-5). The cells were cultured in typical culture conditions and exposed to the tested materials by adaptation of insert wells. The cytotoxic effect was recorded at two observation periods (24 and 72 h) by using a colorimetric assay of tetrazolium reduction (XTT method) in reference to controls. Overall, the degree of cytotoxic effect in ascending order was ProRoot MTA - MTA Angelus < SuperEBA < Vitrebond. Both MTA materials tested exerted mild suppression of cellular mitochondrial activity and may be characterized as biologically inert materials.

Effect of heat application on adhesion of epoxy resin sealer.

Sealers are subjected to high temperatures during the warm condensation of gutta-percha; however, there are few reports on the impact of this temperature rise on the physical properties of a sealer. The purpose of this study was to compare the bond strength of AH26 to human dentin substrates, with or without heat application, by measuring the shear bond strength with a single plane shear test assembly. The results showed that there was no statistically significant difference between the shear bond strength of AH26 with or without heat application, indicating that the use of this sealer with all warm compaction techniques might be considered safe from this perspective.

Shear bond strength of AH-26 and Epiphany to composite resin and Resilon.

The aim of this study was to evaluate the relative bond strengths of AH-26 and Epiphany sealers to both Resilon and composite resin. Four groups of substrate/bonded sealer combinations were tested: group A, composite resin substrate + Epiphany sealer; group B, composite resin substrate + AH-26 sealer; group C, Resilon substrate + Epiphany sealer; and group D, Resilon substrate + AH-26 sealer. Bond strength was evaluated in shear mode by using a universal testing machine at a crosshead speed of 0.5 mm/min. Statistical analysis (Kruskall-Wallis and Dunn tests) showed that the bond strength of AH-26 to both substrates was significantly greater than the bond strength of Epiphany. Therefore, the monoblock in the root canal might be more effectively achieved by combining Resilon core material with the epoxy resin-based sealer (AH-26) rather than Epiphany sealer.

Comparative study of the cytotoxic effect of Resilon against two cell lines.

Resilon is a new material that is a candidate to replace gutta-percha as a root filling material. This study evaluated the antiproliferative effect of Resilon and two commercially available gutta-percha points (Roeko, Dentsply). Two established cell lines (L929 and RPC-C2A) were used for the experiment. Cell survival fraction was estimated by the sulforhodamine-B assay, in reference to controls after 48-h exposure. Non-parametric tests (Kruskal-Wallis followed by Dunn's multiple comparisons) were used to evaluate the statistical significance of the results (alpha=0.05). Cytotoxicity in a descending order was: Resilon > Roeko gutta-percha > Dentsply gutta-percha. At 24-h exposure, no statistically significant differences (p>0.05) were observed between tested materials in both cell lines. At 48-h exposure, statistically significant differences (p<0.05) were found between Resilon and the other materials in the L929 cell line. In the RPC-C2A cell line Resilon was significantly more cytotoxic than Dentsply gutta-percha (p<0.05), but no statistically significant differences (p>0.05) were found between Resilon and Roeko gutta-percha. The cytotoxicity of Resilon increased significantly from 24 h to 48 h in both cell lines. Resilon points were more cytotoxic than gutta-percha points. The cytotoxicity was time dependent and increased after 48 h.

Comparative study of the cytotoxic effect of resilon against two cell lines

Resilon is a new material that is a candidate to replace gutta-percha as a root filling material. This study evaluated the antiproliferative effect of Resilon and two commercially available gutta-percha points (Roeko, Dentsply). Two established cell lines (L929 and RPC-C2A) were used for the experiment. Cell survival fraction was estimated by the sulforhodamine-B assay, in reference to controls after 48-h exposure. Non-parametric tests (Kruskal-Wallis followed by Dunn's multiple comparisons) were used to evaluate the statistical significance of the results (α=0.05). Cytotoxicity in a descending order was: Resilon > Roeko gutta-percha > Dentsply gutta-percha. At 24-h exposure, no statistically significant differences (p>0.05) were observed between tested materials in both cell lines. At 48-h exposure, statistically significant differences (p<0.05) were found between Resilon and the other materials in the L929 cell line. In the RPC-C2A cell line Resilon was significantly more cytotoxic than Dentsply gutta-percha (p<0.05), but no statistically significant differences (p>0.05) were found between Resilon and Roeko gutta-percha. The cytotoxicity of Resilon increased significantly from 24 h to 48 h in both cell lines. Resilon points were more cytotoxic than gutta-percha points. The cytotoxicity was time dependent and increased after 48 h.

Resilon é um material novo com potencial para substituir a guta-percha como material obturador radicular. Este estudo avaliou o efeito anti-proliferativo do Resilon e de duas marcas comerciais de pontas de guta-percha (Roeko e Dentsply). Para os fins deste estudo foram utilizadas duas linhagens celulares conhecidas (L929 e RPC-C2A). A fração de sobrevivência celular foi estimada pelo método colorimétrico de sulforodamina B comparado aos controles após exposição por 48 h. A significância estatística dos resultados (α=0,05) foi avaliada pelos testes não-paramétricos de Kruskal-Wallis e Dunn para comparações múltiplas. A citotoxicidade dos materiais em ordem decrescente foi: Resilon > guta-percha Roeko > guta-percha Dentsply. Após 24 h de exposição, não foram encontradas diferenças estatisticamente significantes (p>0,05) entre os materiais testados em ambas as linhagens celulares. Após 48 h, o Resilon apresentou um efeito citotóxico significantemente maior (p<0,05) em comparação aos outros dois materiais na linhagem celular L929. Na linhagem RPC-C2A, a citotoxicidade do Resilon foi significantemente maior (p<0,05) que a da guta-percha Dentsply, mas não houve diferenças significantes (p<0,05) entre Resilon e guta-percha Roeko. A citotoxicidade do Resilon aumentou significativamente de 24 para 48 h para ambas as linhagens celulares. As pontas de Resilon foram mais citotóxicas do que as pontas de guta-percha. A citotoxicidade foi tempo-dependente e aumentou após 48 h de exposição.

Antiproliferative effect of mineral trioxide aggregate, zinc oxide-eugenol cement, and glass-ionomer cement against three fibroblastic cell lines.

An important requirement for dental materials placed in direct contact with living tissues is biocompatibility. The purpose of this study was to evaluate the antiproliferative activity of three dental materials (mineral trioxide aggregate, zinc oxide-eugenol cement, and glass-ionomer cement) against a panel of established fibroblastic cell lines (L929, BHK21/C13, and RPC-C2A). The materials were prepared according to the manufacturer's instructions and were tested in insert wells for 12, 24, and 48 h. Cell number fraction was estimated by the sulforhodamine-B assay, in reference to controls. The degree of antiproliferative effect in ascending order was mineral trioxide aggregate, glass-ionomer cement, and zinc oxide-eugenol cement in all cell lines tested.