Management of root resorption with mineral trioxide aggregate complicated by a luxation injury: report of a case with six-year follow-up.

Trauma to the oral region occurs frequently, comprising 5% of all injuries. The most common dental injuries are lateral luxations which can be seen with a prevalence of up to 27% among dental injuries. Ectopic eruption of maxillary canines can lead to root resorption on maxillary lateral incisors especially on apical and middle thirds of the roots. Half of these resorbed lateral incisors show severe resorption, in which the pulp is exposed. This case report describes non-surgical treatment with mineral trioxide aggregate (MTA) and a six-year follow-up of a maxillary lateral incisor, resorbed by ectopic eruption of the canine and affected by lateral luxation injury. The tooth was asymptomatic, and radiographic examination showed that the resorbed region had been successfully repaired with new hard tissue deposition within the six-year follow-up. MTA can be considered an effective repair material in nonsurgical treatment of this type of root resorption.

CAD/CAM Endocrown Fabrication from a Polymer-Infiltrated Ceramic Network Block for Primary Molar: A Case Report.

OBJECTIVE: The aim of this case report is to describe the treatment of a primary molar with a deep carious lesion by pulpotomy and placement of a ceramic endocrown. CLINICAL CASE: A 7-year-old male patient with profound caries in tooth number 85 was referred to our clinic and underwent a pulpotomy. As the final treatment in tooth restoration, placement of an endocrown was planned, because little more than half of the tooth structure remained. After an additional request from the patient's parents for an advanced and prompt restoration, a computer-aided design/computer-aided manufacturing (CAD/CAM) polymer-infiltrated ceramic network (PICN) block was chosen. A three-dimensional model of the arch was obtained after scanning the dental cast, and the endocrown was designed digitally according to the model. When the design was complete, the endocrown was fabricated with a milling machine. Finally, the endocrown was cemented with self-adhesive resin cement. RESULTS: Over the 9-month follow-up period, no pulpal or periradicular pathology was observed on radiographs. Regarding the crown, the marginal fit was excellent, the anatomical form was protected, and no discoloration occurred. CONCLUSION: During follow-up, the CAD/CAM PICN block endocrown proved to be a good material for the short- to long-term treatment of a primary tooth. However, more clinical cases and follow-up are required to investigate the long-term effects of antagonistic tooth wear.

Fracture resistance of simulated immature teeth after apexification with calcium silicate-based materials.

OBJECTIVE: To compare the fracture resistance of simulated immature teeth filled with an apical barrier of mineral trioxide aggregate (MTA), Biodentine, and calcium-enriched mixture (CEM). MATERIALS AND METHODS: Fifty-two single-rooted human maxillary central incisors were used. For standardization, the teeth were sectioned 6 mm above and 9 mm below the cementoenamel junction to simulate immature apex. Simulations of roots into immature apices were carried out using 1.5 mm diameter drills. The specimens were then randomly divided into three experimental groups (n = 13) and one control group (n = 13). In experimental groups, MTA, Biodentine, and CEM were placed to apical 4 mm of the simulated immature roots. The samples were stored at 37° C and 100% humidity for 1 week. A load was applied on the crown of all teeth at 135° to their long axis until fracture. The data were analyzed using one-way analysis of variance and Tukey post-hoc tests. RESULTS: No statistically significant differences were found among MTA, CEM, and Biodentine (P > 0.05), and these groups demonstrated higher fracture resistance than control group (P < 0.05). CONCLUSIONS: Using any of the MTA, Biodentine, and CEM as an apical plug and restoring with fiber post and composite resin increases the fracture resistance of immature teeth.

In Vitro Evaluation of Microleakage and Microhardness of Ethanolic Extracts of Propolis in Different Proportions Added to Glass Ionomer Cement.

OBJECTIVE: To evaluate the effect of ethanolic extracts of propolis (EEP) addition in different proportions to glass ionomer cement (GIC) on microleakage and microhardness of GIC. STUDY DESIGN: The cement was divided into four groups: one using the original composition and three with 10%, 25%, and 50% EEP added to the liquid and then manipulated. For microleakage assessment, sixty primary molars were randomly divided into four groups (n=15). Standard Class II cavities were prepared and then filled with EEP in different proportions added to GICs. Microleakage test was performed using a dye penetration method. The data were analyzed using one-way ANOVA and Mann-Whitney U tests (α = 0.05). Disc shaped specimens were prepared from the tested GIC to determine Vickers hardness (VHN). The data were analyzed using one-way ANOVA and post hoc Tukey test (α = 0.05). RESULTS: There were no statistically significant differences between the groups in terms of microleakage (p > 0.05). There were statistically significant differences between the VHN values of groups (p < 0.05). Increasing addition of EEP to GIC statistically significantly increased VHN value of GIC (p < 0.05). CONCLUSIONS: The addition of EEP to GIC increased the microhardness of the GIC and did not adversely affect the microleakage. Thus, it might be used during routine dental practice due to its antibacterial properties.

Comparison of cyclic fatigue resistance between different NiTi instruments with 4% taper.

The aim of this study was to make a comparison between the cyclic fatigue (CF) resistance of F360, twisted files (TF), FlexMaster (FM) and RaCE instruments with 4% taper. A total of 40 instruments were evaluated 8 mm from the tip. A stainless steel block with a simulated canal of 1.5 mm diameter, and a 60° angle of curvature was tested using CF testing. One-way ANOVA and posthoc Tukey's test (P < 0.05) were used. The F 360 files showed the highest CF resistance while the TF files had greater CF resistance than the FM and RaCE (P < 0.05). There was no significant difference between the FM and RaCE (P > 0.05). F360 instruments with a double S cross-section had the highest CF resistance among the group. The TF led the NiTi rotary files to be more resistant to fatigue than the FM and RaCE instruments.

Effects of different instrumentation techniques on calcium hydroxide removal from simulated immature teeth.

The aim of this study was to evaluate the effectiveness of endodontic instrument systems in the removal of calcium hydroxide [Ca(OH)(2)] from simulated immature teeth. The root canals of 106 human single-rooted teeth were shaped with ProTaper rotary files up to an F5 file size. Simulation of roots with immature apices was carried out using size 4 green 1.5-mm diameter Unicore drills. A non-setting Ca(OH)(2) was injected into each root canal and inserted into the working length using lentulo spiral, after which cotton pellets were placed over canal orifices. The apical and coronal side of the roots were then sealed with glass ionomer cement and light cured. Specimens were stored in distilled water for 3 months at 37 °C. After 3 months, the temporary coronal seal was removed and the samples were randomly divided into five experimental groups according to the method used for Ca(OH)(2) removal (ProTaper, Reciproc, OneShape, WaveOne, and Manual) (n = 20), one positive control group (n = 3) and one negative control group (n = 3). The amount of remaining Ca(OH)(2) in the canal walls was measured under a stereomicroscope at 30× magnification. The data were analyzed using Kruskal-Wallis test and Mann-Whitney U test at a significance level of 0.05. Positive and negative control groups were found to be statistically different from all other groups (p < 0.05). There were no significant differences among the ProTaper, Reciproc, OneShape, WaveOne, and Manual groups (p > 0.05). As a conclusion, none of the techniques completely removed Ca(OH)(2) from simulated immature teeth.

Shear Bond Strength of a Self-adhering Flowable Composite and a Flowable Base Composite to Mineral Trioxide Aggregate, Calcium-enriched Mixture Cement, and Biodentine.

INTRODUCTION: The purpose of this study was to investigate the shear bond strength (SBS) of a self-adhering flowable composite (Vertise Flow; Kerr, Orange, CA) and a flowable composite (X-tra base; Voco GmbH, Cuxhaven, Germany) to mineral trioxide aggregate (MTA), Biodentine (Septodent, Saint-Maur-des-Fosses Cedex, France), and calcium-enriched mixture (CEM; Yektazist Dandan, Tehran, Iran). METHODS: Sixty cylindric acrylic blocks with a hole (3 mm in diameter and 1.5 mm in height) were prepared. The acrylic blocks were filled with MTA, Biodentine, and CEM (n = 20) and accordingly allocated into 3 groups. The specimens were stored for 72 hours at 37°C and 100% humidity. Then, each group was divided into 2 subgroups according to the composite resin type used (n = 10). Vertise Flow and X-tra base were applied over MTA, Biodentine, and CEM and then polymerized. SBS was tested in a universal testing machine with a crosshead speed of 1 mm/min. Data were analyzed using 2-way analysis of variance and the Tukey test. RESULTS: The Vertise Flow-CEM and X-tra base-MTA groups showed significantly higher SBS values than the group made of Vertise flow-Biodentine (P < .05). There were no statistically significant differences among the other groups (P > .05). CONCLUSIONS: MTA and CEM exhibited higher SBS than Biodentine; therefore, they could be preferred under flowable composites.

Fracture strength of roots instrumented with three different single file systems in curved root canals.

OBJECTIVE: The aim of this study was to compare the fracture strength of roots instrumented with three different single file rotary systems in curved mesial root canals of maxillary molars. MATERIALS AND METHODS: Curvatures of 25°-35° on mesial roots of 60 maxillary molar teeth were sectioned below the cementoenamel junction to obtain roots 11 mm in length. The roots were balanced with respect to buccolingual and mesiodistal diameter and weight. They were distributed into three experimental groups and one control group (no instrumentation) (n = 15): Reciproc rotary file (R25, VDW, Munich, Germany), WaveOne Primary rotary file (Dentsply Tulsa Dental Specialties, Tulsa, UK) and OneShape (Micro-Mega, Besancon, France) rotary file. Vertical load was applied until fracture occurred. Data were statistically analyzed using one-way analysis of variance test (P < 0.05). RESULTS: The mean fracture load was 412 ± 72 Newton (N) for the control group, 395 ± 69 N for the Reciproc group, 373 ± 63 N for the WaveOne group and 332 ± 68 N for the OneShape group. The fracture load differences among three experimental groups were not statistically significant (P > 0.05.) Whereas, the fracture loads of control and OneShape groups were significantly different (P = 0.012). CONCLUSIONS: Fracture resistance of the roots instrumented with WaveOne and Reciproc file systems were similar to the control group whereas it was observed that OneShape rotary file systems enhance the fracture strength of standardized curved roots when compared with the control group.

Effectiveness of different irrigation protocols on calcium hydroxide removal from simulated immature teeth after apexification.

Aim: To evaluate the effectiveness of different irrigation solutions and ultrasonic activation of the irrigation solutions on the removal of calcium hydroxide (Ca(OH)2) from the simulated immature root canals after apexification. Materials and methods: One-hundred and one single-rooted teeth were used. The root canals were shaped with ProTaper rotary files up to F5. Simulation of roots with immature apices was carried out using size 4 Unicore drills. An injectable Ca(OH)2 was injected into each root canal, and packed to the working length. Then, cotton pellets were placed over canal orifices, and apical and coronal parts of the roots were sealed with resin-modified glass ionomer cement, and light cured. Specimens were stored in distilled water for 3 months at 37°C. After 3 months, the temporary coronal seal was removed and the samples were randomly divided into: (a) saline (n = 20), (b) ultrasonic activation of saline (n = 20), (c) sodium hypochlorite (NaOCl) (n = 20), (d) ultrasonic activation of NaOCl (n = 15), (e) chlorhexidine digluconate (CHX) (n = 20) and one positive control group (n = 3) and one negative control group (n = 3). The amount of remaining Ca(OH)2 on the canal walls was measured under stereomicroscope with 30× magnification. Comparisons between groups were made by the non-parametric Kruskal-Wallis test and Dunn post-test at a significance level of p < 0.05. Results: There were no significant differences among the saline, ultrasonic activation of saline, NaOCl, ultrasonic activation of NaOCl and CHX (p > 0.05) groups. Conclusions: Irrigation solutions and ultrasonic activation of the irrigation solutions could not completely remove Ca(OH)2 from the simulated immature root canals.

Antibacterial effects of fluoride varnish compared with chlorhexidine plus fluoride in disabled children.

PURPOSE: To evaluate the effects of fluoride varnish vs a combination of chlorhexidine-thymol varnish plus a gel containing chlorhexidine and fluoride on oral hygiene and caries prevention in disabled children. MATERIALS AND METHODS: Ninety patients aged 3-17 years who were treated under general anaesthesia were randomly assigned into three groups as follows: group 1: Fluor Protector (0.1% fluoride varnish); group 2: Cervitec Plus (1% chlorhexidine- 1% thymol varnish) + Cervitec Gel (0.2% chlorhexidine-0.2% sodium fluoride); group 3: control (toothbrushing only). Mutans streptococci (MS) and lactobacilli (LB) levels, visible plaque index (VPI) and gingival bleeding index (GBI) were evaluated at four stages: T0, before general anaesthesia; T1, one month after treatment; T2, six months after treatment; T3, twelve months after treatment. The data were evaluated using Kruskal-Wallis and Mann-Whitney U-tests (P < 0.05). RESULTS: Groups 1 and 2 showed significantly lower scores than group 3 for all parameters at T1 and T2. No statistically significant difference was detected among any of the the groups at T3 (P > 0.05). CONCLUSION: The use of materials that include both fluoride and chlorhexidine as routine treatment of children with disability may increase the success of restorations by improving oral hygiene, reduce the need for future restorative treatments and thus the need for general anaesthesia.

Residual HEMA and TEGDMA release and cytotoxicity evaluation of resin-modified glass ionomer cement and compomers cured with different light sources.

The purpose of this study was first to evaluate the elution of 2-hydroxyethyl methacrylate (HEMA) and triethylene glycol dimethacrylate (TEGDMA) monomers from resin-modified glass ionomer cement (RMGIC) and compomers cured with halogen and light-emitting diode (LED) light-curing units (LCUs). The effect of cured materials on the viability of L929 fibroblast cells was also evaluated. One RMGIC (Ketac N100) and two compomers (Dyract Extra and Twinkystar) were tested. Materials were prepared in teflon disks and light-cured with LED or halogen LCUs. The residual monomers of resin materials in solution were identified using high-performance liquid chromatography. The fibroblast cells' viability was analyzed using MTT assay. The type of LCU did not have a significant effect on the elution of HEMA and TEGDMA. A greater amount of HEMA than TEGMDA was eluted. The amount of TEGDMA eluted from Twinkystar was greater than Dyract Extra (P < 0.05) when cured with a halogen LCU. All material-LCU combinations decreased the fibroblast cells' viability more than the control group (P < 0.01), except for Dyract Extra cured with a halogen LCU (P > 0.05). Curing with the LED LCU decreased the cells' viability more than curing with the halogen LCU for compomers. For Ketac N100, the halogen LCU decreased the cells' viability more than the LED LCU.

The effect of different enamel surface treatments on the microleakage of fissure sealants.

The aim of this study was to evaluate the effects of different techniques of surface treatment on the microleakage of a fissure sealant in molar teeth. A total of 50 freshly extracted noncarious human third molars were randomly assigned to one of five groups. Occlusal fissures were treated with one of the following: acid etching with 35% orthophosphoric acid (group 1); fissurotomy with a Fissurotomy Micro NTF metal bur (group 2); laser etching with an Er,Cr:YSGG laser at 2 W and 20 Hz (group 3); laser etching with an Er,Cr:YSGG laser at 2 W and 40 Hz (group 4); and air abrasion for 20 s with 30-µm Al(2)O(3) particles via a CoJet Prep device (group 5). After surface pretreatment, a resin-based sealant was applied to the fissures. The sample teeth were subjected to thermocycling and stored in distilled water at 37°C for 1 month. Following immersion in 0.5% basic fuchsin solution for 24 h, three buccolingual slices of each sample tooth were scored under a stereomicroscope, and the morphological appearance of the area between the enamel surface and fissure sealant was examined under a scanning electron microscope. The Kruskal-Wallis test and one-way ANOVA revealed significant differences in marginal leakage, as follows: group 1 showed significantly lower scores than groups 2 and 5, the scores of groups 1, 3 and 4 were not significantly different, and group 2 showed significantly higher scores than groups 3 and 4. Laser irradiation, the metal bur, and the CoJet Prep device did not eliminate the need for acid etching of the enamel prior to placement of a fissure sealant. Laser etching at 2 W (20 Hz or 40 Hz) may be an alternative to conventional acid-etching.

Silorane-based composite: depth of cure, surface hardness, degree of conversion, and cervical microleakage in Class II cavities.

OBJECTIVE: The purpose of this study was to determine the depth of cure, degree of conversion (DC), hardness, and cervical sealing ability of silorane-based composite (Filtek Silorane [FS; 3M, Seefeld, Germany]) and to compare with methacrylate-based composites (MBCs = Filtek Supreme XT [FSXT] and Filtek P60 [FP60]). MATERIALS AND METHODS: The DC and hardness of every material were evaluated after 1, 7, and 30 days. The depth of cure was determined using the ISO 4049:2000 standard. Microleakage was evaluated by measuring dye penetration across the gingival wall in cross-sectioned specimens. RESULTS: FS showed lower depth of cure than FSXT and FP60. The DC of FS was significantly lower when compared to FP60 and FSXT. FS exhibited lower hardness than both FSXT and FP60 after 1 day of storage. The hardness of FS remained unchanged during the storage period. FS showed reduced microleakage scores compared to FSXT and showed similar microleakage scores compared to FP60. CONCLUSIONS: In conclusion, the DC and cure depth of FS are lower than those of MBCs. However, FS revealed stable hardness in water that is comparable to MBCs. The sealing ability of FS is similar or even better than that of MBCs.

Comparison of pre-emptive ibuprofen, paracetamol, and placebo administration in reducing post-operative pain in primary tooth extraction.

BACKGROUND: This study investigates preliminary investigations that a pre-emptive analgesia administration may reduce post-extraction pain. AIM: This prospective, placebo-controlled, randomized, double-blind trial was planned to compare the efficacy of the pre-emptive administration of ibuprofen, paracetamol, and placebo in reducing post-extraction pain in children. DESIGN: Forty-five children, ages 6-12, who needed primary mandibular molar tooth extraction were treated in paediatric dental clinics, with treatment preceded by local anaesthesia and analgesic drugs during the preoperative period. A five-face scale was used to evaluate pain reaction during the injection, extraction, and post-operative period. Self-report scores were recorded when the local anaesthesia had been administered in soft tissues and both before and after the extraction was completed. The Kruskal-Wallis and Mann-Whitney U tests (with Bonferroni correction paired t-test as the post hoc test) were used at a confidence level of 95%. RESULTS: The use of pre-emptive analgesics showed lower scores compared to the placebo, irrespective of the age, weight, gender of the child, and the number of teeth extracted during the study period. Additionally, ibuprofen exhibited lower pain scores (P < 0.05) compared to paracetamol at the 15-min (P < 0.001) and 4-h (P < 0.009) periods. CONCLUSIONS: Preoperative use of ibuprofen and paracetamol may provide a pre-emptive analgesic effect in paediatric patients who receive adequate analgesia during mandibular primary tooth extraction.

Treatment of horizontal root fractures using MTA as apical plug: report of 3 cases.

Root fractures are rare occurrences through all dental injuries. They comprise only 0.5% to 7.0% of traumas affecting the permanent teeth. Generally the cervical and middle thirds of the roots are affected. The healing of these lesions depends on the health of the pulp, dentine, cementum, and alveolar bone. These case reports describe the management and 2-year follow-up of 3 maxillary central incisors with horizontal root fractures treated with mineral trioxide aggregate (MTA) as apical plug.