Impact of cooling on shaping ability of thermally treated files in canal models with double curvature.

Background: This study compared the ability of thermally treated files in shaping simulated canals with double curvature. Fifty-six canals were enlarged to a final size of 25 with ProTaper Next (PTN) or ZenFlex (ZF). Materials: Half of the samples were shaped with cooled files (n = 14 each). The amount of removed resin was measured and canal deviation was determined at eight levels. Shaping time and maximum shaping torque values were also recorded. Data were statistically analyzed using analysis of variance and LSD, Kruskal-Wallis, and chi-square tests at a 0.05 significance level. Results: Compared to PTN and cooled PTN, ZF and cooled ZF required lesser time to shape the canals. The maximum torques were found comparable between the groups. All the groups generated negligible deviations at every canal level evaluated and maintained the canal geometry. Although not significant, the cooled PTN and ZF files exhibited lesser canal deviations than their counterparts. Conclusion: All groups demonstrated similar shaping ability whilst maintaining the original curvature of the canal in simulated canals with double curvature. However, ZF groups were able to shape the canals faster than PTN groups. There was a trend that cooled files made lesser canal deviations compared to their counterparts.

Soft and Hard Tissue Remodeling after Endodontic Microsurgery: A Cohort Study.

INTRODUCTION: The aim of this study was to investigate the impact of the incision type, with or without a coronally repositioning flap (CRF), on soft tissue healing and crestal bone remodeling after endodontic microsurgery (EMS). METHODS: Clinical pictures and cone-beam computed tomography images from 47 patients (120 teeth) taken before surgery and at the follow-up appointment were included in this study. Clinical pictures were qualitatively evaluated by 2 endodontists for the gingival marginal level (GML) (recession, same position, or coronal root coverage), papillary height (same position/receded), and for presence/absence of scars for each tooth. Cone-beam computed tomography images were used to calculate the changes in the distance between the cementoenamel junction and the crestal bone level (CBL) between the preoperative and follow-up scans. Statistical analyses were performed to determine a correlation between patient-related factors (age, sex, tooth type, position, and presence/absence of a crown), incision techniques, and changes within the CBL. RESULTS: Gingival recession was more prevalent in mandibular teeth, molar teeth, and teeth that received intrasulcular or papilla-based incisions (P < .05). Scar formation was affected by the flap design (P < .05). CRF was the only technique resulting in coronal root coverage (P < .05). There were no changes observed in the papillary height between the various flap designs. There was also no statistically significant difference in the crestal bone height between the preoperative and follow-up scan measurements (P > .05). CONCLUSIONS: Soft tissue changes are evident after EMS and can be affected by the flap design selected, as well as the site being treated. Application of CRF can improve the position of GML after EMS. There are insignificant changes within the CBL at the facial aspect of the root after EMS.

Dentin Conditioning Protocol for Regenerative Endodontic Procedures.

INTRODUCTION: This study focused on the optimization of sodium hypochlorite-EDTA irrigation in terms of the viability and morphology of dental pulp stem cells (DPSCs) and the effects of an optimized EDTA protocol alone or prepared with nanobubble (NB) water on cell behavior. METHODS: In the first part, human dentin discs were conditioned with the following protocols: (1) Sodium hypochlorite followed by phosphate-buffered saline (PBS), (2) Irrigation protocol from group 1 followed by EDTA, (3) Irrigation protocol from group 2 followed by PBS, (4) Sodium hypochlorite followed by EDTA, (5) Irrigation protocol from group 4 followed by PBS. DPSC viability and morphology were determined. In the second part, dentin discs were conditioned with the (1) optimized protocol in the first part, (2) EDTA prepared using NB water, (3) ultrasonic-activated EDTA, or (4) ultrasonic-activated EDTA prepared using NB water. Transforming growth factor beta release and DPSC viability, morphology, and migration were determined using the enzyme-linked immunosorbent assay, the water-soluble tetrazolium salt-1 cell viability assay and live-dead assay, and the transwell migration assay, respectively. Data were analyzed using Kruskal-Wallis or one-way analysis of variance and post hoc tests. RESULTS: The highest cell viability was observed in group 3 followed by group 5 (P < .05) in which PBS was used as a final rinse. Irrigation protocol from group 3 was used for the subsequent experiments. Ultrasonic-activated EDTA improved transforming growth factor beta release, viability, and migration of the cells compared with EDTA (P < .05). The preparation of EDTA with NBs did not change the biological properties of the EDTA-conditioned dentin (P > .05). CONCLUSIONS: Removing the residual EDTA using PBS improved the cell viability on the dentin surface. Ultrasonic activation enhanced the growth factor release and biological properties, whereas the preparation of EDTA with NBs showed a similar effect to regular EDTA without compromising the cellular effect.