The association of body composition and fat distribution with dysmobility syndrome in community-dwelling older adults: Bushehr Elderly Health (BEH) program.

BACKGROUND AND OBJECTIVE: Dysmobility Syndrome (DS) is characterized as an accumulation of clinical risk factors for functional disability, such as osteoporosis, sarcopenia, and obesity. Neurological disorders that affect the motor and sensory systems can also contribute to the condition, resulting in gait and muscle strength disturbances, as well as a history of falls and fractures. The study aimed to determine the association between fat distribution in different body areas and the odds of older adults developing DS, as there is still uncertainty about the accumulation of fat in which area is most closely linked to the condition. METHODS: This cross-sectional study was conducted according to the data from the second phase of the Bushehr Elderly Health Cohort (BEH). Dysmobility Syndrome was defined based on the co-occurrence of at least three outcomes of its criteria. Body composition was measured using dual-energy X-ray absorptiometry (DXA) and anthropometric studies. For evaluating the relationship, multivariate logistic regression and adjusted univariate linear regression were used. RESULTS: Of 2,359 who were recruited in the study, 1,277 participants (54.13%) had DS. According to the final logistic regression model in the limb region, FM and FM to FFM ratios were significantly associated with DS [OR (95%CI) = 1.04 (1.02 to 1.05), and 3.42 (1.95 to 5.99), respectively]. Also, In the trunk region, the FM and FM to FFM ratio were significantly related to the odds of DS, although this relationship was weaker than in the limbs region [OR (95%CI) = 1.02 (1.00 to 1.03), and 2.45 (1.36 to 4.39), respectively]. CONCLUSION: Our findings indicate that a higher regional and whole-body amount of fat mass rather than fat-free mass is closely linked to an increased risk of DS, particularly in the elderly population. Notably, higher fat mass in the limbs (especially in the legs) is associated with greater odds of DS, while a higher android-to-gynoid fat mass ratio is associated with lower DS risk. Screening fat mass distribution in older individuals can be a valuable strategy for promptly diagnosing DS, implementing interventions to prevent disabilities, and improving their quality of life.

Effect of Silver Nanoparticles of Herbal Origin on the Compressive and Push-out Bond Strengths of Mineral Trioxide Aggregate.

Introduction: The purpose of this in vitro study was to investigate the effect of incorporating silver nanoparticles (AgNPs) of herbal origin into mineral trioxide aggregate (MTA) on the push-out bond strength (PBS) and compressive strength (CS) in simulated furcal area perforations. Materials and Methods: In this in vitro study, simulated furcal area perforations (1.3 mm in diameter and 2 mm in depth) were created in 40 extracted human lower molar teeth, which were divided into two groups (n=20): MTA alone and MTA combined with AgNPs (2% wt). Using a universal testing machine, PBS was evaluated by performing push-out tests, while CS was assessed using cylindrical specimens. The normal distribution of data was checked using the Kolmogorov-Smirnov test, and statistical analysis was performed using two-way ANOVA. Results: The CS results showed no significant difference between the MTA group at 4 and 21 days (P=0.297), but a significant difference was observed in the nanosilver/MTA group (P=0.013). However, there was no significant difference in the push-out bond strength among the study groups (P>0.05). Conclusion: The incorporation of herbal origin silver nanoparticles did not significantly affect the PBS or CS of MTA.

Antimicrobial Effect of Nano-Calcium Hydroxide on the Four- and Six-Week-Old Intra-Canal Enterococcus Faecalis Biofilm.

Statement of the Problem: Enterococcus faecalis (E. faecalis) is one of the most important microorganisms in the evaluation of the antibacterial effects of intra-canal medications due to its ability to penetrate dentinal tubules and form biofilms. Calcium hydroxide, as the most common intra-canal medication, has little effect on this bacterial species. In contrast, it is hypothesized that nano scale hydroxide particles are more effective due to their smaller size and higher surface-to-volume ratio. Purpose: This study aimed to investigate the antimicrobial effect of nano-calcium hydroxide on the four- and six-week-old intra-canal E. faecalis biofilms. Materials and Method: In this in vitro study, seventy maxillary single-canal premolar teeth were used. After cleaning and preparing the root canals, the samples were placed in vials containing E. faecalis solution in which the culture medium was changed daily. Each group was divided into three subgroups (n=20) in terms of the antimicrobial material used as the intra-canal medication including subgroup 1: nano-calcium hydroxide, subgroup 2: calcium hydroxide, and subgroup 3: phosphate-buffered saline solution (control group). The antimicrobial property was measured by counting colony-forming units (CFU). The data were analyzed with Mann-Whitney U and Kruskal-Wallis tests. Statistical significance was set at p< 0.05. Results: The mean CFU in the six-week-old biofilm group was significantly higher than that in the four-week-old biofilm (p= 0.003). A comparison between the subgroups showed a significant decrease in CFU in the six-week-old biofilm in the nano-calcium hydroxide subgroup compared to that in the calcium hydroxide subgroup (p= 0.002). However, the decrease was not significant in the four-week-old biofilm group (p= 0.06). Conclusion: Under the limitations of the present study, the antimicrobial properties of nano-calcium hydroxide were higher than conventional calcium hydroxide on mature biofilm, whereas the antimicrobial properties were not clinically and significantly different on immature biofilm.

Comparison of the success of inferior alveolar nerve anesthesia in the mandibular first molars with symptomatic irreversible pulpitis using two anesthetic solutions of prilocaine and mepivacaine: A randomized controlled clinical trial.

Background: This study aimed to compare the success rate of inferior alveolar nerve (IAN) anesthesia in the mandibular first molars with symptomatic irreversible pulpitis using two anesthetic solutions of prilocaine and mepivacaine. Materials and Methods: The current randomized controlled clinical trial was conducted on 100 patients in two groups (n = 50). Standard injection of IAN block (IANB) was performed using two cartridges of 3% mepivacaine plain in the first group and using two cartridges of 3% prilocaine with 0.03 IU felypressin in the second group. Fifteen minutes after injection, the patients were asked about lip anesthesia. In case of a positive answer, the tooth was isolated with a rubber dam. Success was defined as no or mild pain on the basis of the visual analog scale recording upon access cavity preparation, entry into the pulp chamber, and initial instrumentation. Data were analyzed with SPSS 17 using the Chi-square test, and P < 0.05 was set as statistically significant. Results: The patients' pain severities during the three stages were significantly different (P = 0.001, 0.0001, and 0.001, respectively). The success rate of IANB during access cavity preparation was 88% with prilocaine and 68% with mepivacaine. This rate during entry into the pulp chamber was 78% and 24%, respectively, which was 3.25 times higher with prilocaine than mepivacaine. The success rates during instrumentation were 32% and 10%, respectively, which was 3.2 times higher with prilocaine than mepivacaine. Conclusion: The success rate of IANB in the teeth with symptomatic irreversible pulpitis was higher using 3% prilocaine with felypressin than using 3% mepivacaine.

Effect of three intracanal medicaments used in pulp regeneration on the push-out bond strength of mineral trioxide aggregate and calcium-enriched mixture: An in vitro study.

Background. The bond strength of the materials used as a cervical barrier in the pulp regeneration is essential for the success of treatment. This study aimed to evaluate the effects of triple antibiotic paste (TAP), double antibiotic paste (DAP), and simvastatin as intracanal medicaments on the dislodgement resistance of mineral trioxide aggregate (MTA) and calcium-enriched mixture (CEM). Methods. A total of 160 extracted human single-rooted teeth were selected, and root canal preparation was carried out. The teeth in each group were randomly divided into four subgroups: TAP, DAP, simvastatin, and the control group (without intracanal medicament). Four weeks after placing the medicaments, it was removed by sodium hypochlorite, and MTA and CEM were placed in the coronal third of the root canals. After a week, 2-mm-thick dentin disks were prepared from the coronal third of the roots, and the push-out test was performed using a universal testing machine. The data were analyzed using two-way ANOVA and independent t-test at a significance level of 0.05. Results. Regardless of the intracanal medicament, there was no significant difference between the overall bond strength of MTA (59.3±10 MPa) and CEM (55.8±11 MPa) (P=0.6). Furthermore, there were no significant differences in bond strength between the two intracanal medicament groups and the control group (P>0.05). Conclusion. Under the limitations of the current study, DAP, simvastatin, and TAP, as intracanal medicaments, did not adversely affect the push-out bond strength of CEM and MTA.

Effect of different intracanal medicaments on the fracture resistance of the human root.

Background: The effect of different intracanal medicaments on root fracture resistance has not been thoroughly investigated in the short and long term. To assess the effect of calcium hydroxide (CH), CH combined with Chlorhexidine (CHX), double antibiotic paste (DAP), and simvastatin as intracanal medicaments on the fracture resistance of the human root. One hundred and twenty single-rooted mandibular premolars which were extracted for periodontal reasons were collected for this in vitro study. Materials and Methods: This was an in vitro study. All teeth were decoronated. Root canals were prepared by the Pro taper system, and %2.5 NaOCl was used for irrigation. The smear layer was removed using %5.25 NaOCl and 17% ethylenediaminetetraacetic acid each for 3 min. The samples were randomly divided into five groups based on the medicament: (1) CH (2) CH + CHX (3) Simvastatin (4) DAP (5) Control group. All specimens in each group were incubated for 1 week (Subgroup A) and 1 month (Subgroup B). Then, medicaments were removed and filled with gutta-percha and AH26 sealer. All samples were tested for fracture resistance. The data were statistically evaluated with the SPSS software 17. ANOVA and Mann-Whitney U and Wilcoxon tests were used for the analysis of the data. P = 0.05 was considered statistically significant. Results: Although CH and CH + CHX increased the fracture resistance in a 1-week period, there was no significant difference between the groups after 1 month. Conclusion: Under the limitations of this study, CH and CH + CHX, DAP and simvastatin do not have a negative effect on root fracture resistance when used as intracanal medicaments for <1 month.

Push-out bond strength of the calcium silicate-based endodontic cements in the presence of blood: A systematic review and meta-analysis of in vitro studies.

OBJECTIVES: The push-out bond strength (POBS) of calcium silicate-based cements (CSCs) to the dentinal wall is considered one of the essential physical properties for clinical success. The presence of blood in the treatment area affects the POBS of these types of cement. This study aimed to evaluate the impact of blood contamination on the bond strength of CSCs and dentinal walls. MATERIAL AND METHODS: This systematic review was performed by searching electronic databases (MEDLINE-PubMed, Scopus, and EMBASE) to include relevant in vitro studies published between 1992 and April 2020. Two reviewers independently evaluated the selected studies and extracted data on the type of studied CSCs, evaluated area of the teeth, sample size, the dimension of a prepared area, slice thickness, storage duration, the setting of the universal testing machine (UTM), effects of blood contamination on POBS of CSCs and their failure modes. The bond strength of evaluated CSCs in studies was used for network meta-analysis. RESULTS: Initial searches identified 292 articles, while only 13 articles met the inclusion criteria. Full texts of these articles were evaluated, and data extraction was performed. The effect of blood contamination on bond strength to the dentinal wall was assessed in various CSCs such as PMTA, Biodentine, and AMTA. The network meta-analysis results showed that the bond strength of Biodentine was significantly higher than other types of cement in blood presence (p < .05). CONCLUSIONS: Based on the current systematic review, despite controversies among the result of the different articles and the lack of data for some CSCs like bioaggregate, it could be concluded that the bond strength of Biodentine to the dentinal wall is better than other evaluated CSCs in the presence of blood.

Antimicrobial effects of different concentrations of simvastatin versus triple antibiotic paste on Enterococcus faecalis biofilms at different stages of development.

Background. This study assessed the antimicrobial effects of different concentrations of simvastatin versus triple antibiotic paste (TAP) on Enterococcus faecalis biofilms at different stages of development. Methods. In this in vitro study, 70 human single-rooted mature premolars were decoronated, instrumented, and autoclave-sterilized. Next, an E. faecalis suspension was prepared and inoculated into the canals to obtain 4- and 6-week biofilms. After ensuring biofilm formation, the samples in each group were randomly assigned to 5 subgroups (n=12): 1 mg/mL TAP, 10 mg/ mL TAP, 1 mg/mL simvastatin, 10 mg/mL simvastatin, and positive control (phosphate-buffered saline solution). The medicaments were applied in the canals, and the teeth were incubated for one week. Dentin samples were collected by a rotary file, cultured, and the number of E. faecalis colonies was counted. The Kruskal-Wallis, Mann-Whitney U, and Wilcoxon tests were used for data analysis (α=0.05). Results. There were significant differences in colony counts between the two concentrations of TAP and the control group against both 4- and 6-week biofilms (P<0.05). The antibacterial effect of 10 mg/mL TAP and simvastatin was stronger than that of 1 mg/mL concentration against the 4- and 6-week E. faecalis biofilms (P<0.05). Furthermore, 10 mg/mL TAP and simvastatin were more effective against the 4-week biofilms than the 6-week biofilms (P<0.05). Conclusion. According to the present results and since biofilms may remain viable in the root canal system for weeks to months, applying 10 mg/mL TAP and simvastatin might be more effective.

The Effect of Photodynamic Therapy on the Smear Layer Removal: a Scanning Electron Microscopic Study.

STATEMENT OF THE PROBLEM: The efficacy of photodynamic therapy (PDT) in smear layer removal compared to the currently accepted protocol is not well established. PURPOSE: This study aims to evaluate the effect of PDT on smear layer removal from human root canal compared to combined use of irrigation solutions including sodium hypochlorite (NaOCl) and ethylene diamine tetra acetic acid (EDTA) by scanning electron microscopy (SEM). MATERIALS AND METHOD: In this in vitro study, straight roots from 48 extracted human maxillary incisors and canines were selected and decoronated. Instrumentation was completed with RaCe rotary system and normal saline irrigation between files. Then roots were randomly divided into 3 groups (n=16). Group 1 was the control group to confirm smear layer formation. In the group 2, the canals were irrigated with 2ml of 2.5% NaOCl solution for 10 minutes and 2ml of 17% EDTA solution for 1 minute. In the group 3, PDT with methylene blue and diode laser (625nm, 150mW, for 5minutes) was the final procedure for smear layer removal. All the specimens were sectioned into two halves, gold coated, and analyzed under SEM. The smear layer in the coronal, middle, and apical thirds, were evaluated and scored by two examiners independently. Statistical analysis was done using Chi-square test. RESULTS: It was observed that the NaOCl+EDTA removed the smear layer significantly better than PDT in the coronal and apical thirds (p< 0.05) whereas PDT was unable to remove the smear layer in none of the root areas. At the apical thirds, there was no significant difference between NaOCl+EDTA and PDT (p< 0.05). Both procedures were unable to remove smear layer from radicular dentine of this area. CONCLUSION: According to the results of this in vitro study, the use of PDT alone is not recommended to remove smear layer. The combined application of NaOCl and EDTA is ineffective in removing smear layer of apical third, despite its efficacy on the coronal and middle regions.

Effect of Incorporation of Zeolite Containing Silver-Zinc Nanoparticles into Mineral Trioxide Aggregate on Odontogenic Activity of Human Dental Pulp Stem Cells.

STATEMENT OF THE PROBLEM: The stimulation of odontogenic activity is considered an essential property for biomaterials used in vital pulp therapy. PURPOSE: The present study aimed to evaluate the effect of the incorporation of zeolite containing silver-zinc nanoparticles (Ze-Ag-Zn) into Angelous mineral trioxide aggregate (AMTA) on the odontogenic activity of human dental pulp stem cells (HDPSCs). MATERIALS AND METHOD: In this in vitro study, HDPSCs were treated with 2% wt of synthesized Ze-Ag-Zn particles+AMTA, AMTA and Ze-Ag-Zn disks. The negative control cells did not receive any treatment. Then, cell viability was measured using the MTT assay after 7 and 14 days of the treatment course. The alkaline phosphatase (ALP) activity and calcium ion level were also measured in the supernatant culture media using auto-analyzer kits. The obtained data were analyzed using one-way ANOVA and Student t-test where appropriate. The level of the statistical significance was set at p< 0.05. RESULTS: The results indicated that HDPSCs treated with AMTA and AMTA+Ze-Ag-Zn particles did not show any significant cell death compared with the control cells after 14 days of the treatment course while the ALP activity and calcium ion levels were significantly (p< 0.05) elevated. Also, the addition of AMTA particles to the cell culture media resulted in increased ALP activity and calcium ion level compared with HDPSCs treated with AMTA+ Ze-Ag-Zn particles on day 7 of the treatment course (p< 0.05). CONCLUSION: It seems that the incorporation of Ze-Ag-Zn particles into AMTA did not have any significant positive effect on the biomineralization properties of AMTA.

Effects of various liquid-to-powder ratios on the compressive strength of calcium enriched mixture: Original research.

Background. Calcium-enriched mixture (CEM) cement has been introduced and marketed as a biomaterial for use in furcal perforation repair and apexogenesis procedures, in which the compressive strength that indicates the material's resistance against crushing is of utmost importance. This study evaluated the effect of various liquid-to-powder ratios on CEM cement's compressive strength. Methods. One gram of the cement was mixed with 0.5, 0.34, and 0.25 mL of demineralized water and transferred to stainless steel molds (6 and 4 mm in height and diameter, respectively). Five cells in the mold were considered for each group. The compressive strength test was conducted using the universal testing machine after incubating for seven days under 95% humidity at 37°C. One-way ANOVA was applied for data analysis at P ≤ 0.05 significance level. Results. The mean compressive strength in the liquid-to-powder ratios of 0.5, 0.34, and 0.25 were 3.4456, 3.2960, and 3.3485, respectively, with no significant differences between them. Conclusion. Under this study's limitations, changing the liquid-to-powder ratio did not affect CEM cement's compressive strength.

Corrigendum to "Antibacterial Properties of Aloe vera on Intracanal Medicaments against Enterococcus faecalis Biofilm at Different Stages of Development".

[This corrects the article DOI: 10.1155/2020/8855277.].

Antibacterial Properties of Aloe vera on Intracanal Medicaments against Enterococcus faecalis Biofilm at Different Stages of Development.

BACKGROUND: Use of herbal compounds as an intracanal medicament in the field of endodontics has become noteworthy, one of which is the Aloe vera compound whose antibacterial effect has already been proven in the planktonic form of Enterococcus faecalis. The purpose of this study is to evaluate the antibacterial effect of Aloe vera on E. faecalis biofilms at the 4th and 6th week of development. MATERIALS AND METHODS: 130 single root canal teeth without anomalies and caries were used. They were divided into two groups of 65 teeth for four and six weeks of biofilm production. Five samples of each group were examined for confirmation of biofilm formation under an electron microscope. Study groups were investigated with an antimicrobial agent as an intracanal medicament including 20 samples treated with Aloe vera, calcium hydroxide, and phosphate-buffered saline, and biofilm and survival of pathogens were investigated. Dentin chip suspensions were used for colony-forming unit (CFU) counting to estimate remaining E. faecalis counts. RESULTS: The CFU mean in the 4th week subgroup in Aloe vera, phosphate-buffered saline, and calcium hydroxide was 0, 69166.66 ± 31688.58, and 25000 ± 30822.07, and in the 6th week, it was 136.36 ± 323.33, 95000 ± 12247.44, and 27501.66 ± 36570.34, respectively, which showed a significant difference between the used materials (p < 0.05). CONCLUSION: Aloe vera, in contrast to calcium hydroxide, eliminated 4th and 6th week biofilms and showed remarkable antibacterial properties against E. faecalis biofilm. These results support potency of Aloe vera to use as a natural antimicrobial material in the intracanal medicament.

Effect of the of Zeolite Containing Silver-Zinc Nanoparticles on the Push out Bond Strength of Mineral Trioxide Aggregate in Simulated Furcation Perforation.

STATEMENT OF THE PROBLEM: Recently, zeolite has been regarded to improve the properties of dental materials such as mineral trioxide aggregate (MTA). PURPOSE: The aim of the present study was to evaluate the effect of incorporating zeolite/silver/zinc (Ze/Ag/Zn) composite at 2 wt% to MTA powder on the push-out bond strength in simulated furcation perforations. MATERIALS AND METHOD: Furcal perforations, measuring 1.3 mm in diameter and 2 mm in height, were simulated in 40 human mandibular first molars. The samples were allocated to two groups (n=20) based on the material used for the repair of perforations. In the group 1, MTA and in the group 2, MTA plus Ze/Ag/Zn (2%) was used. The samples were incubated at 37°C for 1 week. Then the universal testing machine was employed to measure bond strength. The resistance of materials to dislodgment was recorded in MPa. Data were analyzed using t-test. Statistical significance was set at p< 0.05. RESULTS: The push-out bond strength in the group 1 (6.40±1.98 MPa) was significantly higher than that in the group 2 (2.1±0.6 MPa) with p= 0.001. CONCLUSION: Under the limitations of the present study, it can be concluded that incorporation of Ze/Ag/Zn at 2 wt% to MTA powder had a negative effect on the push-out bond strength.

In vitro induction of odontogenic activity of human dental pulp stem cells by white Portland cement enriched with zirconium oxide and zinc oxide components.

Background . The aim of this in vitro study was to investigate the effect of zinc oxide (ZnO) and zirconium oxide (ZrO2) microparticles (MPs) and nanoparticles (NPs) in combination with white Portland cement (WPC) on odontogenic capacity of human dental pulp stem cells over a period of 21 days. Methods . Synthesized ZnO and ZrO2 particles were characterized using scanning electron microscopy and transmission electron microscopy. The viability of human dental pulp stem cells was measured by a 3-(4,5-dimethylthiazolyl-2-yl)-2,5- diphenyltetrazolium bromide assay at 7-, 14- and 21-day intervals after seeding on WPC disks enriched with ZnO and ZrO2 MPs and NPs. Odontogenic potential of ZnO and ZrO2 particles in combination with WPC was investigated by alkaline phosphatase (ALP) activity and ionized calcium level of supernatant culture media at different time intervals. Data were analyzed using one-way ANOVA and post hoc Tukey tests. Results . All the materials exhibited cell viability over a 21-day period, except for WPC with ZnO NPs on day 7, although it was not statistically significant (P>0.05). The ALP activity and ionized calcium level increased in all the groups compared to the control group (P<0.05). ZnO NPs had superior effect on odontogenic activity and calcium ion release compared to ZnO MPs (P=0.046). There was no significant difference between ZrO2 MPs and NPs in odontogenic activity (P>0.05). Conclusion . WPC enriched with ZnO and ZrO2 increased ALP activity and calcium ion release of human dental pulp stem cells over a period of 21 days in vitro.

Anesthetic efficacy of articaine/epinephrine plus mannitol in comparison with articaine/epinephrine anesthesia for inferior alveolar nerve block in patients with symptomatic irreversible pulpitis: A randomized controlled clinical trial.

Background. It is difficult to achieve successful pulpal anesthesia in mandibular posterior teeth with symptomatic irreversible pulpitis. The present study aimed to compare the effect of articaine/epinephrine anesthesia with articaine/epinephrine at a combination of 0.5 mol/mL of mannitol for the inferior alveolar nerve block (IANB) in patients presenting with symptomatic irreversible pulpitis in the mandibular first molar tooth. Methods. One hundred patients with symptomatic irreversible pulpitis in the mandibular first molar tooth were selected and randomly divided into two groups based on the injection method. The first group underwent an IANB technique with 1.8 mL of articaine, whereas the second group received 2.9 mL of a formulation, consisting of 1.8 mL of articaine plus 1.1 mL of 0.5 mol/L of mannitol. Fifteen minutes after injections and anesthesia of the lip, the access cavity was prepared. According to the visual analog scale (VAS) criteria, no pain or mild pain for caries removal, pulp exposure and canal instrumentation were regarded as success. Chi-squared test was used for the analysis of data. The level of significance was set at 0.05. Results. The success rate in the group with articaine/epinephrine anesthesia plus mannitol was higher than that in the group with articaine/epinephrine anesthesia, with no significant difference between the two groups (P>0.05). Conclusion. It was concluded, under the limitations of this study, that adding mannitol to articaine/epinephrine anesthesia did not increase the success of IANB in mandibular posterior teeth with symptomatic irreversible pulpitis.

Success Rate of 3 Injection Methods with Articaine for Mandibular First Molars with Symptomatic Irreversible Pulpitis: A CONSORT Randomized Double-blind Clinical Trial.

INTRODUCTION: Previous studies have reported that it is difficult to obtain proper anesthesia in mandibular molars with symptomatic irreversible pulpitis, and supplemental injections are usually unavoidable. The aim of the present study was to determine the anesthetic efficacy of articaine in mandibular first molars with symptomatic irreversible pulpitis with 3 injection methods: an inferior alveolar nerve block (IANB), an IANB with an intraligamentary injection, and an IANB with buccal infiltration before initiating the endodontic treatment. METHODS: Ninety-six patients (54 women and 42 men) with a diagnosis of symptomatic irreversible pulpitis in mandibular first molars were selected and randomly assigned into 3 groups (n = 32) according to the injection method as follows: group 1, a conventional IANB injection; group 2, an IANB injection, and after profound lip numbness after the IANB (after 15 minutes), buccal infiltration was administered; and group 3, an IANB injection, and after profound lip numbness after the IANB (after 15 minutes), an intraligamentary injection was performed, and after 20 minutes from the IANB, the endodontic treatment was initiated. The anesthetic solution was articaine 4% with 1:100,000 epinephrine. Success was defined as no or mild pain on the basis of the visual analog scale recording upon access cavity preparation or initial instrumentation. Data were statistically analyzed using the chi-square and Mann-Whitney U tests, and P < .05 was set as significant. RESULTS: The success rate for IANBs with an intraligamentary injection was 75%, and for IANBs with a buccal injection, it was 65.6%. For IANBs alone, the success rate was 28.1%. CONCLUSIONS: Considering the limitations of the present study, in can be concluded that the success rate of IANBs increased with intraligamentary injections and buccal infiltrations with articaine that were performed before initiating treatment. Also, none of the injection methods showed complete success in anesthesia in all patients.

Effect of the Bone Graft on the Surface Microhardness of Endodontic Biomaterials.

INTRODUCTION: During periapical surgery, using of bone products in large endodontic lesions, is a treatment option that could affect the properties of the retro-filling endodontic material. The aim of present study was to evaluate the effect of Osteon II bone powder on the surface microhardness of calcium-enriched mixture (CEM) and mineral trioxide aggregate (MTA). METHODS AND MATERIALS: Each material was mixed and carried into 40 sterile custom-made plastic cylinders. Half of the samples in each group were exposed to Osteon II. All cylinders were submerged in simulated tissue fluid and incubated at 37°C and 100% relative humidity for 7 days. Surface microhardness values of each study group was attained using Vickers microhardness test. The data were analyzed statistically using two-way ANOVA and independent t-test at a significance level of 0.05. RESULTS: The highest and lowest microhardness values were recorded in the MTA/without Osteon and MTA/with Osteon groups, respectively. Irrespective of the presence or absence of bone powder, the overall microhardness of CEM cement and MTA was not significantly different. In the MTA group, the presence of the powder resulted in a significant decrease (P<0.05) of the microhardness; however, its effect on CEM cement was not significant (P>0.05). CONCLUSION: Under the limitations of the present in vitro study, the presence of Osteon bone powder had no negative effect on the microhardness of CEM cement, contrary to its effect on MTA.

The Effect of a Mineralized Bone Graft on the Surface Microhardness of Mineral Trioxide Aggregate and Biodentine.

INTRODUCTION: This study was designed to determine the effect of Osteon II mineralized bone powder on the surface microhardness of two retrofilling materials: Mineral trioxide aggregate (MTA) and Biodentine (BD). METHODS AND MATERIALS: Each retrograde material was mixed and carried into 30 sterile custom-made plastic cylinders. Half of the samples in each group were exposed to Osteon II. All cylinders were submerged in simulated tissue fluid and incubated at 37°C and 100% relative humidity for 7 days. Surface microhardness values of each study group was attained using Vicker's microhardness test. The data were analyzed statistically using two-way ANOVA and independent t test at a significance level of 0.05. RESULTS: In all the setting conditions, BD had significantly greater surface microhardness than MTA (P<0.001). Surface microhardness of both materials was significantly reduced in the presence of osteon II (P=0.006 for BD and P<0.001 for MTA). CONCLUSION: Mineralized bone graft materials negatively affect surface microhardness of both MTA and BD. In presence of osteon II, BD had the highest surface microhardness.