Apical Root Resorption of Endodontically Treated Teeth after Orthodontic Treatment: A Split-mouth Study.

Objective: The influence of pulp status on orthodontically induced root resorption has attracted attention. The purpose of this study was to compare orthodontically induced root resorption in endodontically treated teeth and their contralateral vital teeth in a split-mouth design. Methods: The sample included 173 patients who had at least one endodontically treated tooth, and their vital contralateral teeth served as the control group before the completion of orthodontic treatment. Apical root resorption measurements were performed by the comparison of digital panoramic X-ray images obtained at the beginning and at the end of the orthodontic treatment. Kruskal-Wallis, Mann-Whitney U, and Wilcoxon tests were used for statistical analysis. Results: There was no statistically significant difference in apical root resorption between the endodontically treated teeth and the contralateral teeth (p>0.05). Sex and tooth type had no effect on apical root resorption both in the endodontically treated teeth and the contralateral vital teeth (p>0.05). Orthodontic treatment with extraction caused more apical root resorption in the vital teeth than in the endodontically treated teeth (p<0.05). The quality of the endodontic treatment had no significant influence on apical root resorption (p>0.05). Conclusion: Endodontic treatment does not produce greater apical root resorption compared with the vital teeth.

Does the Endodontic Education Level Affect Decision-Making for Endodontically Treated Teeth With Apical Periodontitis? A Web-Based Survey.

OBJECTIVES: The management of endodontically treated teeth with apical periodontitis is debated among clinicians. The aim of this study was to evaluate treatment choices for endodontically treated teeth with different sizes of periapical lesions among endodontists, endodontics postgraduate students, general dental practitioners, and undergraduate students who had fulfilled their theoretical and clinical training in endodontics. MATERIALS AND METHODS: Periapical lesion images (no periapical lesion and 1-mm, 3-mm, and 5-mm periapical lesions) were formed on 4 different radiographs with a software program, and the survey included 16 radiographs that were emailed to 1881 participants. Treatment options included extraction, surgical or nonsurgical retreatment, and wait and see. The χ2 test was used to compare the responses of the participants. RESULTS: The survey was returned by 1039 participants (55.23%). There were statistically significant differences among the responses of all participants for all cases (P < .05), except a case with a broken file and no lesion (P = .918). All participants decided to extract at an increased size from a 1-mm periapical lesion to a 5-mm periapical lesion. At all lesion sizes, general dental practitioners planned retreatment less when compared with other groups. CONCLUSIONS: This survey study showed that there was a positive correlation between endodontic education level and retreatment decision-making. Dentists who confront seemingly hopeless endodontically treated teeth such as an instrument fracture, a missing canal, or a large periapical lesion should consult with an endodontist before making the decision to extract the tooth.

Investigation of the effect of different chelation solutions on penetration of resin-based and bioceramic sealers with a novel method.

This study aimed to investigate the effects of different chelation solutions on the penetration of resin-based and bioceramic root canal sealers into dentinal tubules using a device that assembles conventional microplate detection with automated digital microscopy. Eighty-four single-rooted teeth were prepared with 30.07 nickel-titanium instruments and divided into four groups of 21 according to the final irrigation solutions used: saline (control), ethylenediaminetetraacetic acid (EDTA), maleic acid (MA), and etidronic acid (HEBP). The samples were obturated with AH Plus, MTA Fillapex, or EndoSequence BC Sealer using the single-cone technique. The roots were then sectioned horizontally at 2, 6, and 10 mm and examined using a Cytation 5 reader and Gen5 software. Data were compared using two-way analysis of variance followed by univariate analyses and Tukey's multiple comparison test (p < .05). The mean penetration depth in the apical thirds was higher in the MA group than in the other groups (p = .013). The mean depth in the middle and coronal thirds was almost equal in the EDTA and HEBP groups. The mean depth was significantly higher in the coronal thirds of the root canals than in any other section in all final irrigation solution groups (p < .001). EndoSequence BC Sealer displayed higher penetration depth than AH Plus and MTA Fillapex, although the differences between the examined sealers were not statistically significant. The chelation solutions increased root canal sealer penetration into the dentinal tubule.

Micro-CT analysis of the marginal adaptation and porosity associated with ultrasonic activation of coronally placed tricalcium silicate-based cements.

This study aimed to evaluate the effect of ultrasonic activation on coronal marginal adaptation and microporosity of tricalcium silicate-based materials. Sixty freshly extracted human maxillary lateral incisor teeth were instrumented with ProTaper Next X2 files followed by Peeso-Reamer burs, sizes 1 to 5. The specimens were randomly divided into six groups (n = 10): Group 1, Biodentine + hand condensation; Group 2, Biodentine + ultrasonic activation; Group 3, NeoMTA Plus + hand condensation; Group 4, NeoMTA Plus + ultrasonic activation; Group 5, ProRoot WMTA + hand condensation; and Group 6, ProRoot WMTA + ultrasonic activation. All tested materials were mixed mechanically and placed 2 mm underneath the cement-enamel junction by hand condensation or indirect ultrasonic activation. Volumetric analysis of the voids between the dentine wall and coronal barrier material and the porosity within the material was evaluated with micro-CT. There was no significant difference in marginal adaptation among the six groups (P > 0.05). Ultrasonic activation favoured a reduced microporosity in Biodentine Group (P < 0.001).

Cardiologists' and cardiovascular surgeons' attitudes toward managing endodontic infections and oral health in patients with cardiovascular diseases.

Objective: A relationship between dentists and medical doctors should be encouraged to reduce cardiovascular risk in cardiac patients with dental infection. The aim of this study was to evaluate the attitudes of cardiologists and cardiovascular surgeons (cardiac specialists) toward managing endodontic infections and oral health in patients with cardiovascular diseases (CVDs).Methods: A survey of 16 questions assessing knowledge of endodontic infection, dental examination, timing of endodontic treatment, and antibiotic prophylaxis was sent to cardiac specialists in Turkey. The participants' responses were compared by means of the chi-square test (p ≤ 0.05).Results: Responses were received from 444 (44.71%) participants. Of all participants, 91.4% agreed that endodontic infections are important diseases that should be treated. Cardiac patients were referred to a dentist by 66.6% of the cardiologists and 80.3% of the cardiovascular surgeons (p = 0.002). Almost all participants (97.3%) believed that the heart health of cardiac patients with endodontic infections could be negatively affected by this infection.Conclusion: Although there is not yet any conclusive evidence on whether the presence of an endodontic infection may have an impact on CVDs, this study showed that most cardiac specialists attached importance to endodontic infections.

Do the intracanal medicaments affect the marginal adaptation of calcium silicate-based materials to dentin?

BACKGROUND/PURPOSE: In order to prevent reinfection of the pulp canal space and dressing for regenerative purpose, the coronal seal should have a perfect marginal adaptation. Mineral trioxide aggregate (MTA) and Biodentine are among the most popular sealing materials. These are commonly used in combination with antibiotic medicaments, to ensure disinfection. Aim of the present study was to evaluate the effect of 3 different medicaments on the marginal adaptation of MTA and Biodentine to the dentin. MATERIALS AND METHODS: Teeth were divided into 4 groups (n = 20) that were treated with the following medicaments; triple antibiotic paste (TAP), double antibiotic paste (DAP), a calcium hydroxide (CH) and a control group. The specimens were then assigned into two subgroups (n = 10), which received a coronal barrier of MTA or Biodentine. The specimens were scanned using an ex vivo micro-CT scanner. The data were statistically analysed using one-way ANOVA and the unpaired Student's t-test (P < 0.05). RESULTS: Percentage volume of external voids in the MTA group was as follows: DAP > TAP > Control > CH. In the Biodentine group, the percentage of voids was determined in the following order: TAP ≥ DAP > CH > Control. Significantly lower percentage of voids was observed in the CH-medicated specimens in the MTA group when compared to all test groups (P = 0.04). CONCLUSION: The application of CH as an intracanal medicament reduced the void occurrence between the ProRoot MTA and root dentin. However, TAP and or DAP decreased the marginal adaptation in both ProRoot MTA and Biodentine.

Comparison of Conventional Syringe, CanalBrush, EndoActivator, Photon-Induced Photoacoustic Streaming, and Manual Instrumentation in Removing Orange-Brown Precipitate: An In Vitro Study.

OBJECTIVE: The aim of this in vitro study was to compare the various techniques for removing precipitate formed after irrigation with sodium hypochlorite (NaOCl) and chlorhexidine (CHX). BACKGROUND DATA: It is still unclear whether different irrigant activation systems can effectively remove precipitate that is firmly attached to the root canal walls. METHODS: Eighty-two extracted single-rooted human teeth were instrumented by using the ProTaper rotary system. The roots were irrigated with 5% NaOCl and then 2% CHX to form orange-brown precipitate on the root canal walls. The teeth were sectioned longitudinally, and the amount of precipitate on the canal walls was measured under a stereomicroscope at 15 × magnification before the root halves were reassembled. Then, conventional syringe irrigation (CSI), CanalBrush (CB), EndoActivator (EA) system, photon-induced photoacoustic streaming (PIPS), and manual instrumentation (MI) techniques were used to remove the precipitate, during which 5 mL of distilled water was used for 1 min. The amount of precipitate remaining on the canal walls was measured, and the percentage of precipitate removed was calculated. Data were analyzed by using the Kruskal-Wallis and Mann-Whitney U tests (p = 0.05). RESULTS: All experimental groups contained residual precipitate. The precipitate was more effectively removed in the MI group than in the other groups (p < 0.05). The CB and EA groups showed better removal than the CSI and PIPS groups (p < 0.05), and there were no significant differences in removal between these latter two groups (p > 0.05). CONCLUSIONS: None of the techniques used was able to completely remove the orange-brown precipitate from the root canal surfaces.

Effect of sodium hypochlorite irrigation with or without surfactants on the bond strength of an epoxy-based sealer to dentin.

OBJECTIVES: This study evaluated the effect of sodium hypochlorite (NaOCl) irrigation with or without surfactants on the bond strength of an epoxy-based sealer to the root canal dentin. MATERIALS AND METHODS: Eighty decoronated single-rooted human mandibular premolars were instrumented using the rotary system. The roots were subsequently rinsed with 5 ml 17 % EDTA for 1 min and then randomly divided into 3 test groups (n = 20) and 1 control group (n = 20) according to the type of irrigation with experimental 5 % NaOCl (Wizard, RehberKimya, Istanbul, Turkey) solutions: Group 1: NaOCl-0.1 % benzalkonium chloride; Group 2: NaOCl-0.1 % Tween 80; Group 3: NaOCl-0.1 % Triton X-100; control group: NaOCl without any surfactants. Five samples from each group were prepared for scanning electron microscopy to examine the surface of root canal dentin. The 15 samples remaining in each group were obturated with gutta-percha and AH Plus (Dentsply DeTrey GmbH, Konstanz, Germany) using the cold lateral compaction technique. A push-out test was used to measure the bond strength between the sealer and root canal dentin. Data were analyzed using two-way analysis of variance and Tukey's post hoc tests (P = 0.05). RESULTS: The NaOCl-0.1 % Triton X-100 group demonstrated the highest mean bond-strength values in all root thirds among the groups (P < 0.05). However, the bond strength of the sealer in the NaOCl-0.1 % benzalkonium chloride and NaOCl-0.1 % Tween 80 groups did not differ from that in the control group (P > 0.05). Additionally, the bond-strength values decreased in the corono-apical direction for all groups (P < 0.05). CONCLUSIONS: NaOCl solution with Triton X-100 can provide higher bond strength of the epoxy resin-based sealer to root dentin compared to NaOCl solution wiithout any surfactant. CLINICAL RELEVANCE: The bond strength of sealer to dentin can be improved by the addition of the surfactants to NaOCl solution.

Apical extrusion of debris during root canal preparation using a novel nickel-titanium file system: WaveOne gold.

AIM: This study was intended to evaluate the amount of apically extruded debris following root canal preparation with three different instrumentation systems. MATERIALS AND METHODS: Sixty mandibular incisor teeth were selected and randomly divided into three groups (n = 20/group) according to the instrumentation system used: the ProTaper Next (PTN; Dentsply Maillefer, Ballaigues, Switzerland), the Twisted File Adaptive (TFA; SybronEndo, Orange, CA, USA), and the WaveOne Gold (WOG; Dentsply Maillefer, Ballaigues, Switzerland). All apically extruded debris was collected and dried in preweighed glass vials. The mean weight of the apically extruded debris was obtained using a microbalance. The time for root canal preparation was also recorded. The data were analyzed using a one-way analysis of variance. RESULTS: The mean weights of apically extruded debris were 0.00035 ± 0.00014 g (PTN); 0.00023 ± 0.0001 g (TFA); and 0.00019 ± 0.0001 g (WOG) (P < 0.01). The mean preparation time value was 301,13 ± 62.14 s (PTN); 234.27 ± 34.88 s (TFA); and 239.8 ± 58.6 s (WOG) (P < 0.05). CONCLUSIONS: The PTN system extruded more debris than the TFA and WOG systems. The TFA and WOG systems were faster than the PTN system.

Comparison of Smear Layer Removal Ability of QMix with Different Activation Techniques.

INTRODUCTION: To evaluate the effectiveness of QMix solution (Dentsply Tulsa Dental Specialties, Tulsa, OK) on the smear layer using the following irrigation activation techniques: the EndoActivator (EA) system (Dentsply Tulsa Dental Specialties), photon-initiated photoacoustic streaming (PIPS), and an Er:YAG laser with an endodontic fiber tip. METHODS: Sixty-four extracted single-rooted human teeth were decoronated and the canals instrumented with ProTaper (Denstply Maillefer, Ballagues, Switzerland) up to size F4. The canals were irrigated with 5.25% sodium hypochlorite and a saline solution for 1 minute each. The specimens were then divided randomly into 4 experimental and 4 control groups (n = 8) according to the final irrigation activation technique. These groups included group 1, 2.5 mL QMix; group 2, QMix + EA; group 3, QMix + PIPS; and group 4: QMix + Er:YAG. Laser activated distilled water was used as control groups 5, 6, 7, and 8. Teeth were split longitudinally, and specimens were observed under a scanning electron microscope. Images were taken at the coronal, middle, and apical thirds of the teeth at a magnification of 1000× and were scored in the presence of the smear layer. Data were analyzed with Kruskal-Wallis and Mann-Whitney U tests. RESULTS: The highest scores were found in the apical third of all groups (P < .05). The QMix + Er:YAG group removed the smear layer more effectively than the nonactivated QMix group in the apical third (P < .05). The QMix + EA group removed the smear layer significantly in all thirds of the teeth when compared with the nonactivated QMix group (P < .05). The QMix + PIPS group showed a significantly better effect than the QMix group in the coronal third (P < .05). CONCLUSIONS: The EA and Er:YAG laser enhanced the smear layer removal ability of QMix in the apical thirds of the canals. QMix removed more smear layer in the coronal thirds when activated with the PIPS technique.

Evaluation of debris extruded apically during the removal of root canal filling material using ProTaper, D-RaCe, and R-Endo rotary nickel-titanium retreatment instruments and hand files.

INTRODUCTION: The aim of this study was to evaluate the amount of debris extruded apically during the removal of root canal filling material using ProTaper (Dentsply Maillefer, Ballaigues, Switzerland), D-RaCe (FKG Dentaire, La Chaux-de-Fonds, Switzerland), and R-Endo (Micro-Mega, Besançon, France) nickel-titanium (NiTi) rotary retreatment instruments and hand files. METHODS: Sixty extracted single-rooted mandibular premolar teeth were prepared with K-files and filled with gutta-percha and AH Plus sealer (Dentsply DeTrey, Konstanz, Germany). The teeth were then randomly assigned to 4 groups (n = 15 for each group) for retreatment. The removal of canal filling material was performed as follows: hand files, ProTaper, D-RaCe, and R-Endo retreatment instruments. Debris extruded apically during the removal of canal filling material was collected into preweighed Eppendorf tubes. The tubes were then stored in an incubator at 70°C for 5 days. The weight of the dry extruded debris was established by subtracting the preretreatment and postretreatment weight of the Eppendorf tubes for each group. The data obtained were analyzed using 1-way analysis of variance and Tukey post hoc tests. RESULTS: All retreatment techniques caused the apical extrusion of debris. Hand files produced significantly more debris when compared with ProTaper, D-RaCe, and R-Endo rotary systems (P < .05). There was no statistical difference between the ProTaper, D-RaCe, and R-Endo retreatment systems (P > .05). CONCLUSIONS: The findings showed that during the removal of root canal filling material, rotary NiTi retreatment instruments used in this study caused less apical extrusion of debris compared with hand files.

The effect of different final irrigant activation techniques on the bond strength of an epoxy resin-based endodontic sealer: a preliminary study.

INTRODUCTION: The aim of this study was to evaluate whether or not different final irrigation activation techniques affect the bond strength of an epoxy resin-based endodontic sealer (AH Plus; Dentsply DeTrey, Konstanz, Germany) to the root canal walls of different root thirds. METHODS: Eighty single-rooted human mandibular premolars were prepared by using the ProTaper system (Dentsply Maillefer, Ballaigues, Switzerland) to size F4, and a final irrigation regimen using 3% sodium hypochlorite and 17% EDTA was performed. The specimens were randomly divided into 4 groups (n = 20) according to the final irrigation activation technique used as follows: no activation (control), manual dynamic activation (MDA), CanalBrush (Coltene Whaledent, Altststten, Switzerland) activation, and ultrasonic activation. Five specimens from each group were prepared for scanning electron microscopic observation to assess the smear layer removal after the final irrigation procedures. All remaining roots were then obturated with gutta-percha and AH Plus sealer. A push-out test was used to measure the bond strength between the root canal dentin and AH Plus sealer. The data obtained from the push-out test were analyzed using 2-way analysis of variance and Tukey post hoc tests. RESULTS: The bond strength values mostly decreased in the coronoapical direction (P < .001). In the coronal and middle thirds, ultrasonic activiation showed a higher bond strength than other groups (P < .05). In the apical third, MDA displayed the highest bond strength to root dentin (P < .05). The majority of specimens exhibited cohesive failures. CONCLUSIONS: The bond strength of AH Plus sealer to root canal dentin may improve with ultrasonic activation in the coronal and middle thirds and MDA in the apical third.

The effect of a new-generation flowable composite resin on microleakage in Class V composite restorations as an intermediate layer.

AIM: To evaluate the effect of application a new-generation bulk-fill flowable composite resin as an intermediate material between composite resin and dental substrates on micro-leakage in Class V composite restorations. MATERIALS AND METHODS: A total of 144 Class V cavities were prepared in 72 human molars. Specimens were then randomly distributed among three groups according to adhesive system applied (Group 1: Clearfil SE Bond; Group 2: Adper Easy One; Group 3: Adhesive 200T), and each group was divided into three subgroups according to liner material used (Group A: No liner-control group; Group B: Aelite Flo LV, low viscosity microhybrid composite; Group C: Smart dentin replacement). All cavities were restored using resin composite (Aelite LS, low shrinkage posterior composite). Specimens were stained with 0.5% basic fuchsin and evaluated dye penetration. RESULTS: There was no significant difference in dye penetration was found between the control and the experimental groups. CONCLUSIONS: Micro-leakage is not affected by the application of either conventional or new-generation flowable composite resin as an intermediate material between composite resin and dental substrates.

Use of cone-beam computed tomography to evaluate root and canal morphology of mandibular first and second molars in Turkish individuals

Objective: The aim of this study was to investigate the root and canal morphology of mandibular first and second molars in a Turkish population by using cone beam computed tomography (CBCT). Study design: CBCT images of mandibular first (n = 823) and second molar (n = 925) teeth from 605 Turkish patients were analyzed. The root canal configurations were classified according to the method of Vertucci. Results: The majority of mandibular molars (95.8% of first molars, 85.4% of second molars) had two separate roots; however, three roots were identified in 2.06% of first molars and 3.45% of second molars. C-shaped canals occurred 0.85% of first molars and 4.1% of second molars. Three canals were found in 79.9% of first molars and 72.8% of second molars. Most distal roots had a simple type I configuration, whereas mesial roots had more complex canal systems, with more than one canal. The most common root morphology of first and second molars is the two rooted morphology with three canals. Both the mesial and distal roots showed wide variations in canal anatomy with type IV and type I canal configuration predominating in the mesial and distal roots, respectively. Conclusion: Vertucci type I and IV canal configurations were the most prevalent in the distal and mesial roots, respectively, of both the mandibular first and second permanent molar teeth (AU)

Use of cone-beam computed tomography to evaluate root and canal morphology of mandibular first and second molars in Turkish individuals.

OBJECTIVE: The aim of this study was to investigate the root and canal morphology of mandibular first and second molars in a Turkish population by using cone beam computed tomography (CBCT). STUDY DESIGN: CBCT images of mandibular first (n = 823) and second molar (n = 925) teeth from 605 Turkish patients were analyzed. The root canal configurations were classified according to the method of Vertucci. RESULTS: The majority of mandibular molars (95.8% of first molars, 85.4% of second molars) had two separate roots; however, three roots were identified in 2.06% of first molars and 3.45% of second molars. C-shaped canals occurred 0.85% of first molars and 4.1% of second molars. Three canals were found in 79.9% of first molars and 72.8% of second molars. Most distal roots had a simple type I configuration, whereas mesial roots had more complex canal systems, with more than one canal. The most common root morphology of first and second molars is the two rooted morphology with three canals. Both the mesial and distal roots showed wide variations in canal anatomy with type IV and type I canal configuration predominating in the mesial and distal roots, respectively. CONCLUSION: Vertucci type I and IV canal configurations were the most prevalent in the distal and mesial roots, respectively, of both the mandibular first and second permanent molar teeth.

Frequency and distribution of early tooth loss and endodontic treatment needs of permanent first molars in a Turkish pediatric population.

OBJECTIVES: The objective of this study is to evaluate the frequency and distribution of early tooth loss and endodontic treatment needs of permanent first molars in a Turkish pediatric population. MATERIALS AND METHODS: A total of 7,895 panoramic radiographs taken for routine dental examination at the Department of Oral Maxillofacial Radiology between 2008 and 2012 years were investigated. Two independent specialists evaluated early tooth loss and endodontic treatment needs of permanent first molars using panoramic radiography and patient anamnesis forms. The teeth were classified according to the following data: (a) Missing teeth, (b) teeth requiring extraction, (c) endodontically treated teeth (ETT), (d) teeth requiring endodontic therapy. The data also classified according to four factors: Age group (6-12 and 13-16), gender (boy and girl), jaw (mandible and maxilla) and side (right and left). A Chi-square test was used for statistical analyses. RESULTS: A total of 19,488 and 12,092 teeth were evaluated in the child group and adolescent group respectively. All data were higher in adolescents than children (P < 0.001). For gender factor, only ETT was higher in girls than it was in boys (P < 0.001). For the jaw factor, all data were higher (P < 0.001) in mandible than in the maxilla. For the side factor, no statistical difference existed between right and left. CONCLUSIONS: Early tooth loss and endodontic treatment needs of permanent first molars showed variability according to age groups and jaws. When the results were compared according to the side and gender factors, no statistical difference was found (P > 0.05) except with the data of ETT in gender groups.