Radiographic and electronic working length comparison. An in vivo study of three Electronic Apex Locator devices.

The aim of this study is to compare the working length measured with Root ZX (EAL1), Propex II (EAL2) and Endo Analyzer Model 8005 (EAL3) with radiographic measurements during endodontic treatment. Fifty single canal teeth scheduled for endodontic treatment were selected for the study. After endodontic access preparation, pulp chamber was irrigated with 5mL of 5% sodium hypochlorite (NaOCl). The canal was scouted with a size 10 K-file introduced slightly over the apex to verify the canal patency. The working length (WL) was measured using all three EAL devices and radiographically. All measured working lengths were recorded and compared using ANOVA for repeated measures considering the multiple comparison of paired data Least Significant Difference (LSD). The WL mean values for EAL1 were 19.1 ± 1.7 mm; for EAL2 were 19.4 ± 1.7; for EAL3 were 19.4 ± 1.6 and for RG were 19.2 ± 1.7. The Pearson correlation coefficients indicated that the following correlation between electronic devices and radiographic WL: EAL1- 0.986, EAL2- 0.953 and EAL3- 0.931. Considering the mean values compared to radiographic measures, Root ZX gave better results than the other tested EAL devices. Endo Analyzer Model 8005 showed the worst performance.

Microbial leakage evaluation of warm gutta - percha techniques.

The aim of this study is to compare bacterial leakage of MicroHeat and continuous wave with and without endodontic sealer. Thirty-eight single-rooted extracted mandibular premolars were selected and randomly divided into four experimental groups (n=8) and two control groups (n=3). Teeth were prepared with Mtwo NiTi files and obturated with MicroHeat or System B with or without endodontic sealer. Three teeth were used as positive controls (Ct+) and three intact teeth served as negative controls (Ct-). All samples were tested for bacterial infiltration every day for 60 days. On day 32 overall contamination value was 62.5% for Mseal, 75% for Mnoseal, 75% for SBseal and 37.8% for SBnoseal; after 60 days, the final contamination result was 100% for Mseal, Mnoseal and SBseal and 87.5% for SBnoseal. At the end of the observation period, groups showed no statistically significant differences.

Reduction of radiations exposure in endodontics: comparative analysis of direct (GX S-700, Gendex) and semidirect (VistaScan Mini View, Dürr) digital systems.

The importance of intraoral periapical radiography is crucial as it represents a fundamental mean of evaluation and diagnosis for supporting bone and teeth hard tissues diseases and pathologies. Even though conventional film technology is still widespread, presently there are many digital radiography alternatives. Direct digital systems are devices with an intraoral sensor wired or paired wireless with a computer. These devices do generate an image immediately during exposure and acquisition. The semi direct digital systems instead are based on phosphor image plates. Digital radiography offers many chances to improve our patient's healthcare standards reducing exposition to X-rays and the related stochastic radiation risk. Aim of this study is to compare the quality of images for endodontic purposes comparing three systems: conventional films, direct digital radiography and semidirect digital radiography.

Aesthetic correction of double tooth: simplified technique.

The aim of this study is to report aesthetic conservative treatment of double tooth anomaly. Case report: A 7.5-year-old patient presents an anomaly of the maxillary right upper central incisor with a bifid crown and an increased mesio-distal width and a central incisal notch, probably amenable to a gemination. Single tooth anesthesia and conservative enameloplasty procedure was performed, with universal adhesive and a single shade universal composite restorative material. Adhesive aesthetic restorations allow to resolve dental anomalies quickly, cheaply and asily for pediatric dentistry.

Epidemiological study on radiographic dental health in Albania.

The aim of this epidemiological study is to assess the dental health status of the Albanian population and the most frequently performed dental treatments, also highlighting the differences between sex, geographic area and educational level. The study was performed by analyzing digital orthopanoramic radiographs of 739 Albanian patients, male and female, divided into 5 age groups. In addition, the patients were divided according to regions of origin in North, Centre and South and classified according to the level of education. The parameters examined are as follows: Missed Teeth (MT), Filled teeth (FT), Endodontically treated teeth (TT), Prosthetic restorations (PR). There are no statistically significant results regarding the distribution by area. Subjects with at least one missing tooth (MT) decreases with increasing education level. The percentage of individuals with Missed Teeth in the population increases with increasing age groups. Educational background affects health. This study highlights the need to introduce a national oral health system in Albania that would extend interventions to a wider segment of the population.

Antibacterial activity of first and latest generation bioceramic sealers on the elimination of enterococcus faecalis: An in vitro study.

The main concern of endodontics are bacteria: the microorganisms and the toxins they release determine tissue destruction and inflammatory changes that trigger the pulpal and periapical pathology. Enterococcus faecalis is a particularly hostile bacterium; it is strongly associated with refractory periapical pathology. In this study 3 materials were tested: Aureoseal (OGNA, Italy) (Aur) (first generation bioceramic sealer); Endo Seuqence BC sealer (Brasseler USA, Savannah, GA, USA) (EsBC) (latest generation bioceramic sealer); Endoidrox (OGNA, Italy) (Endx) (calcium hydroxide material). The antimicrobial activity of these materials against Enterococcus faecalis was evaluated using agar diffusion test (ADT). The results confirm the antibacterial activity of bioceramic sealers, which however do not show significant differences in the obtained values; it can therefore be concluded that there has been no increase in the antibacterial efficacy of the latest generation bioceramic sealers compared to those of the first generation.

Effect of pressure and light curing of composite micro hardness.

The aim of this study is to evaluate the micro hardness Vickers of a composite micro hybrid polymerized under constant pressure. Twelve experimental samples were made equally divided into two groups: an experimental group and a control. Enamel plus HRi (Micerium) microbiotic composite resin, UD3 colour, was inserted into a syringe heater (ENA HEAT Composite Heating Conditioner) so that the material could be brought to a temperature of 39°C. A defined amount of composite resin is taken from the syringe with a Heidemann spatula and placed between two slides, previously cleaned with 90 ° alcohol. The samples are then inserted one at a time into a special device for constant pressure application. Vickers hardness measurements were made on the top of surfaces. The mean value of the samples belonging to the experimental group is 56.81 ± 0.71. The mean value of the control samples is 52.02 ± 2. The results obtained allow us to state that applying a constant pressure during the cementation phase of indirect adhesive restorations allows to obtain better mechanical characteristics of the composite used as a cementing agent.

Dentinal substrate variability and bonding effectiveness: SEM investigation.

Though the literature reports a well-documented scientific evidence of the performance of modern adhesive systems on normal dentin, few researches are available on the interaction between adhesives and compromised dentin. In this study, the authors analyzed the microscopic structural aspects of the adhesive interface on two common altered dentin substrates: dentin contaminated by metallic oxides and caries affected dentin. Thirty teeth were selected and divided in three groups of ten teeth according to the different dentin substrate they had: (A) normal dentin, (B) caries-affected dentin and (C) dentin contaminated by metallic oxides. The experimental cavity preparation was realised exposing in each sample, portion of pathologic dentin and portion of sound dentin as control. Each cavity was restored with micro-hybrid composite, with total etching and a two-step adhesive system. Each sample was sectioned in two halves analysed with two SEM micro-morphological methods: direct observation and decalcification. SEM investigations were able to show the difference in thickness and morphology of the adhesive interface with the two different dentin variables. Caries affected dentin determined the formation of less distinctive resin tags with few micro-tags. Discoloured dentin showed a poor infiltration with few resin tags probably due to alterations in the tubular structures. The micro-morphological variability of dentin substrate influences the clinical efficacy of bonding restorations determining significant differences in the qualitative and quantitative aspects of resin tags.

Comparative analysis of cleaning ability of two rotary instrument systems: Mtwo and ProTaper® universal. An in vitro scanning electron microscopic study.

This study is to compare the cleaning effectiveness of two Ni-Ti files systems. Thirty single-rooted human teeth were selected and two NiTi rotary systems were used. Group A: canal shaping with ProTaper® Universal (Dentsply Tulsa Dental Specialties, Tulsa, OK) (PTU); Group B: (n=15) canal shaping with Mtwo Ni-Ti instruments (Sweden and Martina, Padova, Italy) and apical finishing with Mtwo Apical Ni-Ti instruments (Sweden and Martina, Padova, Italy). The amount of debris and smear layer were quantified on a basis of a numerical evaluation scale. The data established for scoring the debris and the smear layer was recorded separately and statistically analysed using the Kruskal-Wallis test. No significant differences were found for debris. Mtwo instruments resulted in significantly less smear layer (P less than 0.05) compared with ProTaper® Universal. Under the conditions of this study, Mtwo resulted in significantly less smear layer compared with canal preparation with ProTaper® Universal.

Clinical antibacterial effectiveness Healozone Technology after incomplete caries removal.

AIM: Aim of this study was to evaluate the local effects of ozone gas on bacteria present within deep carious lesions after selective caries excavation. MATERIALS AND METHODS: The present study included 75 patients who had at least two Class I caries with deep lesion D2 and/or D3. The cavities were divided into 2 groups: the ozone group received treatment with Healozone X4, while the control group did not receive any treatment. Dentin samples were taken from both groups using two sterile multi-blade drills at 800 rpm without irrigation. The drills were then stored in separate tubes, each containing 5ml of RTF (Reduced Transport Fluid) and placed in culture for the next two hours. A total microbial count of the CFU of Streptococcus Mutans and Lactobacillus was performed. CONCLUSIONS: From the analysis of data on the dentin samples treated with ozone, there is a decrease in the bacterial load present in the infected carious dentin.

Indirect adhesive rehabilitation by cementation under pressure of a case of Dentinogenesis Imperfecta type II: follow-up after 13 years.

AIM: Dentinogenesis imperfecta (DI) is an autosomal dominant genetic disease that affects both deciduous and permanent teeth, with an incidence of 1 out of 6,000 to 1 out of 8,000. Teeth affected with DI type II present bulbous crowns, short and constricted roots, marked cervical constriction, translucent enamel and amber dentin. Also, they present a partial or total obliteration of pulp space, due to continuous dentin production. SEM analysis has shown an undulated dentin-enamel junction (DEJ) with irregularities and locally wide spaces between the two structures instead of a strict junction and a regular linear surface. Treatment options for patients affected by DI-II are intended to protect and restore function and aesthetics of both posterior and anterior teeth. In literature are presented many different therapies, but mainly centered on cemented prosthetic restorations instead of adhesive restorative procedures. We present in this paper a DI-II case successfully treated in 2005 with extensive adhesive rehabilitation. CONCLUSION: The 13 years follow-up proves the reliability of adhesion to dentine and enamel for indirect adhesive restorations even on this kind of anomalous substrates.

Pain and anxiety associated with Computer-Controlled Local Anaesthesia: systematic review and meta-analysis of cross-over studies.

AIM: This review focuses on Computer-Controlled Local Anaesthesia Delivery systems (CCLAD), in comparison with conventional carpule anaesthesia in means of pain and anxiety. METHODS: Medline, Embase, Web of Science and Cochrane Database for Systematic Reviews were searched up to August 2018. Only cross-over split-mouth design studies aimed to clinically compare CCLAD with a conventional carpule anaesthesia are included. Data about pain and anxiety associated with anaesthesia were sought. The authors performed meta-analysis where appropriate. RESULTS: A total of 20 studies are included in the systematic review (n = 973 subjects). Quantitative synthesis (conducted on VAS scores from 8 studies) shows that pain intensity is over 9 points lower in CCLAD than in conventional anaesthesia on a scale from 0 to 100 (95% confidence interval, ?12.90 to ?5,53; P<.001). The systematic review showed no differences between the two techniques according to the physiological parameters of pain (heart rate or blood pressure), and the data about anxiety are inconsistent. CONCLUSION: CCLAD results in significantly slightly less pain perception with respect to conventional injection and is a promising device to help patients. The literature needs to be expanded, mostly regarding anxiety.

Comparison of coronal leakage of different root canal filling techniques: an ex vivo study.

The aim of this study was to compare the quality of the coronal seal, using an in vitro bacterial invasion test, of three different root canal filling systems. Twenty-seven freshly extracted mandibular premolars were selected and divided into three experimental groups (G1, G2 and G3 n=7) and two control groups (Ct+ and Ct- n=3). All teeth in the experimental groups were prepared using NiTi Mtwo rotating instruments and then the endodontic treatments were completed using the three-tested warm guttapercha root filling techniques: Microseal (G1), Thermafil (G2) and System B (G3). All root filling techniques were performed using the same endodontic sealer (Pulp Canal Sealer). Three teeth were instrumented and not filled, serving as positive controls (Ct+) and the last three teeth, with intact crowns and no endodontic treatment, served as negative controls (Ct-). All samples were mounted in a two-chamber apparatus and exposed to Enterococcus faecalis performing a bacterial infiltration test. All samples were observed for a maximum period of 60 days checking for turbidity of the BHI broth on a daily basis recording when contamination occurred. A quantitative evaluation of the bacterial CFU/ml was performed using the URO-QUICK™ system. On day 32 an overall value was recorded of contamination of 42.85% for group G1, 71.42% for G2 and 42.85% for G3; after 60 days, the final contamination result was 85.71% for group G1, and 100% for both G2 and G3 groups. Considering the number of contaminated samples at the end of the observation period, the three techniques showed no statistically significant differences. The study highlighted the bacterial permeability of gutta-percha/seal barrier, underlining the importance of an effective coronal restoration to ensure a durable seal after root canal treatment.

In vitro evaluation of the post-space depth reading with an intraoral scanner (IOS) compared to a traditional silicon impression.

OBJECTIVES: The aim of the study was to assess the depth and quality of the post-space reading, using an IOS without scan-post, compared to a traditional silicon technique. METHODS: Six extracted bicuspids were decoronated and endodontically treated. After having prepared the space for the posts, a structure in pink acrylic resin was created with two resin elements. At the center of the structure one sample was put at a time. Digital and traditional impressions were taken for each sample.Digital impressions were developed through the Computer-aided design (CAD) software in order to integrate the scanner results into a three-dimensional grid to make the measurements. A K-file was used to measure the length of the post-space of each sample obtained through the traditional silicon impression and subsequently the measurement results were reported on a millimeter gauge. Furthermore, an assessment of the width of the entrances of the post-spaces was carried out. RESULTS: The mean reading depth discrepancy expressed in percentages (19.58%) indicates that the digital impression with current technologies fails to impress clearly the post-space. Standard deviation of the data expressed in percentage is 13.89, suggesting that the values were not similar to each other. In two cases the digital technique has achieved less than 10% difference compared to the traditional technique, but there have been also cases in which the variation in depth has reached almost 40%.The samples that showed the minor discrepancy between the two techniques expressed the widest post-space entrance. CONCLUSIONS: In this in vitro study, the application of the IOS for the post-space reading in order to deliver an anatomic post has been proven to be still not reliable, as there are still depth reading limitations for the narrow root channels. In fact, in this type of channels it is difficult to reach with the light beam of the IOS the deepest areas of the post-space, with a consequent incomplete post-space reading.

External Cervical Resorption: a case report.

AIM: External cervical resorption is a form of root resorption which begins in the cervical region of the tooth and spreads out in the thickness of the dentin in an irregular way; clinically, it may be not visible and, as it is generally asymptomatic before involvement of the pulp, it is often an occasional finding in radiographic examination. Several factors are related to its aetiology. This paper reports a case of external cervical resorption in a mandibular right first molar of a 17-year-old patient; the tooth was extracted and histological analysis was performed. MATERIALS AND METHODS: Radiographic examination showed a progressive external cervical resorption of the lower right first molar; extension of the lesion and pulp involvement indicated tooth extraction; the sample underwent histological analysis. RESULTS: The histological study confirmed the presence of vascular connective tissue in the resorptive lacunae, invading the dentin from the external surface of the root, and perforations from the defect into the pulp; it was also noticed the presence of bone-like tissue.

Evaluation of bond strength of different adhesive systems: Shear and Microtensile Bond Strength Test.

OBJECTIVES: Aim of this work is the in vitro bond strength evaluation of three bonding agents comparing the results of two kinds of test, Microtensile Bond Strength Test and a Shear Bond Strength Test. Bond strength tests have been used to test both direct and indirect restorative techniques to investigate if methods could give different results. METHODS: 72 human third molars have been collected and stored in physiological solution. Three kinds of test were conducted: 1- SB, 2- "Slice" preparation µTBS1, 3- "Stick" preparation µTBS2. We tested three different adhesive systems (Groups 1-2-3 n=24), two restorative techniques (subgroup A-B n=12). The tested adhesives were: Optibond FL (OFL) (Group 1), Optibond Solo Plus (OSP) (Group 2), Optibond Solo Plus Self-Etch (OSSE) (Group 3). For all tests was used a universal load machine Instron Machine. RESULTS: Best values were found for Optibond FL with mean values of 45-50 MPa. Optibond Solo Plus resulted in values very similar and in some cases almost identical to FL. Optibond Solo Self Etch showed poorer adhesion in both direct and indirect restorative techniques. The parametric and non parametric statistical variance analysis pointed out the absence of significant differences between OFL and OSP, and demonstrated a significant difference for OSSE adhesive. SIGNIFICANCE: The results confirm that a total etch two-step adhesive is the best compromise between easiness and effectiveness.

SEM-morphology in dentinogenesis imperfecta type II: microscopic anatomy and efficacy of a dentine bonding system.

AIM: Dentinogenesis Imperfecta is a hereditary defect consisting of opalescent teeth composed of irregularly formed and undermineralised dentin that obliterates the coronal and root pulpal chambers. The aim of this study was to examine the morphology of permanent human enamel, dentine and the dentine-enamel junction, in individuals affected by Dentinogenesis Imperfecta type II in undercalcified sections using scanning electron microscope (SEM) to compare the findings to the normal morphology, and to study the efficacy of modern bonding system to dentine and enamel DI type II affected. MATERIALS AND METHODS: Four third molars extracted from two 19 year-old subjects (one patient affected by Dentinogenesis Imperfecta type II) were included in resin, two divided in slices with a air-cooled diamond disc, and two used to study the characterisation of the resin-dentin interface. The sections of the teeth were examined by means of SEM. The slices were finished up with abrasive paper (400, 600, 1000, and 2000), the half surfaces obtained were etched with 37% phosphoric acid and then joined up to the stubs for SEM analysis. SEM Stereoscan 440 Leica with magnifications of 20X, 100X, 250X, 1000X, 2000X, 3000X was used. As control group were used four third molars with normal anatomy. RESULTS: This study shows that the permanent enamel from patients with DI exhibits few structural changes. No relationships were found between enamel morphology and the DI type II. Enamel appeared to be regularly mineralised. The major findings were anomalies in the dentine-enamel junction, locally a lower degree of mineralisation and an undulating morphology. The dentine showed absence of tubules. CONCLUSION: This study confirms that the problem with teeth affected by DI type II is the defect in dentine and weakness in the way the enamel is attached to the dentine. The adhesive system tested is not able to create a real hybrid layer in dentine DI type II affected and seems to be less effective than on normal substrates.