Characterisation of deformed or separated nickel-titanium retreatment instruments after clinical use - A multicentre experience: Defect profiles of clinically-used retreatment instruments.

OBJECTIVES: The present study examined the defect characteristics of clinically-used, discarded nickel titanium rotary retreatment instruments and analysed the impact of clinical use on their metallurgical properties. METHODS: 92 XP-endo Shaper (XPS; FKG Dentaire) and 20 XP-endo Finisher (XPFR; FKG Dentaire) instruments with structural deformation or separation were collected after retreatment from four endodontic clinics over a 20-month period. The types of defects and their relative locations were recorded. The lateral and fractured surfaces of the separated instruments were examined with scanning electron microscopy. Differential scanning calorimetry was used to investigate the thermal behaviour of new, deformed and fractured instruments. RESULTS: 77 (84%) XPS and 4 (20%) XPFR had an area with structural change while 15 (16%) XPS and 16 (80%) XPFR were fractured. All unfractured, deformed XPFR showed unwinding close to the coronal end of the flute. Fractures in XPS and XPFR were often close to the coronal end of the flutes or the expanding segments of the insruments. Most of the XPS fractures were torsional failure (67%) while XPFR failed predominantly by cyclic fatigue (81%). The austenite-finishing temperature of XPFR (40 °C) was higher than that of XPS (35 °C). Both XPS and XPFR exhibited 2-stage phase transformations. CONCLUSIONS: Torsional failure was more prevalent in XPS instruments and fatigue failure was more prevalent in XPFR instruments. amongst the investigated instruments, XPFR were more likely to separate without warning whereas XPS frequently exhibited plastic deformation. The latter may be used as a pre-separation forewarning sign during clinical retreatment. CLINICAL SIGNIFICANCE: The failure mode of XP-endo Shaper and XP-endo Finisher used clinically for retreatment appeared to be different. Plastic deformation, the forewarning sign of instrument seaparation, occurs when XP-endo instruments are used for retreatment.

Antibiotic and Opioid Analgesic Prescribing Patterns of Dentists in Vancouver and Endodontic Specialists in British Columbia.

AIM: To assess the prescribing decisions of general dentists in Vancouver and endodontists in British Columbia regarding analgesics and antibiotics for patients with endodontic disease. An additional aim was to determine whether gender, clinical experience or practice location have an impact on such decisions. METHODS: A 4-page survey was developed and distributed to approximately half the general dentists in Vancouver (n = 259) and all of the endodontists in British Columbia (n = 50). Basic demographic questions were followed by 7 clinical scenarios and a list of endodontic diagnoses. Participants were asked questions regarding their decisions to prescribe analgesics and antibiotics. RESULTS: The overall response rate was 49%: 72% of endodontists responded, compared with 45% of general dentists. A substantial proportion of clinicians prescribed opioid analgesics and antibiotics in the various clinical scenarios. The rate of prescription of opioid analgesics ranged from 4%-47% for the various scenarios; the rate of prescription of antibiotics was 5%-88%. General dentists reported prescribing opioid analgesics and antibiotics more often than endodontists. Gender, clinical experience and practice location did not seem to have an impact on the decision to prescribe opioid analgesics or antibiotics. CONCLUSIONS: Based on the results of our survey, a significant proportion of dental professionals in British Columbia prescribe opioid analgesics and antibiotics during endodontic procedures when they are likely not required. General dentists tend to prescribe these medications more often than endodontists. We found no apparent differences in terms of gender, clinical experience or practice location. Dentists must be conscientious when prescribing these medications as over-prescription has negative consequences.

WaveOne Rotary Instruments after Clinical Use.

INTRODUCTION: The purpose of this study was to evaluate the incidence and mode of WaveOne (Dentsply Tulsa Dental Specialties, Tulsa, OK) instrument defects after single use at different endodontic clinics. METHODS: A total of 438 WaveOne instruments were collected after clinical use from the 4 specialist clinics over a 12-month period and from 1 graduate program over a 20-month period. The incidence and type of instrument defects were analyzed. The lateral surfaces of part of the defective instruments and fracture surfaces of fractured files were examined using scanning electron microscopy. Unused and clinically used files were examined by a nanoindentation test. RESULTS: Of the 438 WaveOne instruments collected, 42 (9.6%) had defects: 40 (9.1%) were distorted and 2 (0.5%) files had fractured, 1 Small and 1 Primary file. Clear differences in the frequency of defects were found among the 3 file sizes; the occurrence of distortion and fracture were highest with the Small file (21.2% and 0.7%, respectively) followed by the Primary file (4.4% and 0.4%, respectively) (P < .05). No defects were detected on the Large file. The cause of the 2 fractures was shear stress. Instruments from various clinics showed no significantly different occurrence of instrument deformation. Unwinding occurred at 1.2-3.1 mm from the tip. No significant difference in nanohardness was detected among unused and used instruments. CONCLUSIONS: The risk of WaveOne fracture is very low when files are singly used by endodontists and residents. Unwinding of the files occurred most frequently in the Small file. The frequency of defects of WaveOne instruments were not influenced by the operator.

ProFile Vortex and Vortex Blue Nickel-Titanium Rotary Instruments after Clinical Use.

INTRODUCTION: The aim of this study was to analyze the incidence and mode of ProFile Vortex and Vortex Blue instrument defects after clinical use in a graduate endodontic program and to examine the impact of clinical use on the instruments' metallurgical properties. METHODS: A total of 330 ProFile Vortex and 1136 Vortex Blue instruments from the graduate program were collected after each had been used in 3 teeth. The incidence and type of instrument defects were analyzed. The lateral surfaces and fracture surfaces of the fractured files were examined by using scanning electron microscopy. Unused and used instruments were examined by full and partial differential scanning calorimetry. RESULTS: No fractures were observed in the 330 ProFile Vortex instruments, whereas 20 (6.1%) revealed bent or blunt defects. Only 2 of the 1136 Vortex Blue files fractured during clinical use. The cause of fracture was shear stress. The fractures occurred at the tip end of the spirals. Only 1.8% (21 of 1136) of the Vortex Blue files had blunt tips. Austenite-finish temperatures were very similar for unused and used ProFile Vortex files and were all greater than 50°C. The austenite-finish temperatures of used and unused Vortex Blue files (38.5°C) were lower than those in ProFile Vortex instruments (P < .001). However, the transformation behavior of Vortex Blue files had an obvious 2-stage transformation, martensite-to-R phase and R-to-austenite phase. The trends of differential scanning calorimetry plots of unused Vortex Blue instruments and clinically used instruments were very similar. CONCLUSIONS: The risk of ProFile Vortex and Vortex Blue instrument fracture is very low when instruments are discarded after clinical use in the graduate endodontic program. The Vortex Blue files have metallurgical behavior different from ProFile Vortex instruments.

Identification of possible factors impacting dental students' ability to locate MB2 canals in maxillary molars.

This study examined the effect of the access size and straight-line path of access on third-year dental students' ability to locate a second mesiobuccal (MB2) canal in maxillary first and second molars. One hundred and six third-year dental students at one Faculty of Dentistry performed simulated root canal treatment with the aid of 2x magnification loupes on extracted teeth. A postgraduate endodontic student subsequently made a reasonable search for an untreated MB2 canal with the aid of a dental operating microscope. The mesiobuccal roots were then sectioned horizontally for determination of the canal configuration. The dental students were able to treat an MB2 canal in 15.8 percent of the teeth, but this was not associated with satisfactory access criteria. The postgraduate endodontic student identified an MB2 canal in 54.7 percent of the remaining tooth samples excluding those where the MB2 canal was found by the dental students; this represented 94.3 percent of those teeth confirmed by horizontal sectioning of the root to have an MB2 canal. The postgraduate student troughed, on average, 2.6 mm before negotiating the MB2 canal. As satisfactory access criteria and straight-line path of access did not correlate with the dental students' ability to find a second mesiobuccal canal, this result has important implications for educational goals with respect to endodontic treatment of maxillary molar teeth.

ProFile Vortex instruments after clinical use: a metallurgical properties study.

INTRODUCTION: The aim of the study was to analyze the incidence and mode of ProFile Vortex instrument (Dentsply Tulsa Dental Specialties, Tulsa, OK) defects during a predefined schedule of clinical use by the undergraduate students in a dental school setting and to examine the metallurgical characteristics of unused and clinically used Vortex instruments. METHODS: A total of 2,203 ProFile Vortex instruments discarded after single use from the undergraduate students program over 24 months were collected and examined for defects using a stereomicrosocpe at 10× magnification. The incidence and type of instrument defects or separation were analyzed. The lateral surfaces of part of the defected instruments and fracture surfaces of fractured files were examined using scanning electron microscopy. Unused and clinically used files were examined by differential scanning calorimetry and X-ray diffraction. Vickers hardness of the files was measured with a 200-g load. RESULTS: Only 1 of the 2,203 files fractured during clinical use. The cause of fracture was shear stress, and the file also showed unwinding of the helix structure. None of the remaining 2,202 files exhibited unwinding after clinical use. Blunt apicals were detected in 86 used files (3.9%). Austenite-finish temperatures were very similar for as-received, used files with defects and used files without defects, all exceeding 50°C. No difference in microhardness was detected among these 3 instrument groups. X-ray diffraction results showed that NiTi files had austenite structure at room temperature. CONCLUSIONS: The risk of ProFile Vortex fracture is very low when files are used 1 time by undergraduate students. Unwinding of the files was not detected except for the fractured file. Clinical single use had no detectable effect on austenite-martensite phase transformation of the files. Unused and clinical single-use files contain a similar phase structure at body temperature.

Effect of time of extraction on the biocompatibility of endodontic sealers with primary human fibroblasts

The aim of this work was to evaluate the effects of different times of extraction on the cytotoxicity of six representatives of different root canal sealer groups-Real Seal SE, AH Plus, GuttaFlow, Sealapex, Roth 801, and ThermaSeal Plus-with human gingival fibroblasts. The materials were prepared according to manufacturers' specifications, and were incubated in culture medium (DMEM) at 37ºC for 1, 7, 14, 21, and 28 days, with daily washing, to simulate periodontal ligament clearance. Human fibroblasts were exposed to the final extracts at 24 hours, and cell viability was determined by MTT assay, with exposure to unconditioned DMEM as a negative control. Statistical analysis comparing cytotoxicities at each exposure time was performed by ANOVA with Scheffé adjustment for multiple comparisons at a 95% confidence level. Results indicated that GuttaFlow was significantly less cytotoxic than all other sealers (p < 0.05) at 1 day of extraction. After 7 days of extraction, cell viability for GuttaFlow was significantly increased as compared with that of all groups except sealer AH Plus. At day 14, cytotoxicity of Sealapex was significantly higher than that of all other sealers (p < 0.05). At days 21 and 28, there were no significant differences in cytotoxicity among sealer groups. All materials presented some level of cytotoxicity to fibroblasts, while GuttaFlow was the least cytotoxic sealer tested. However, the cytotoxicity of all materials seemed to decrease similarly in a time-dependent manner.

Effect of time of extraction on the biocompatibility of endodontic sealers with primary human fibroblasts.

The aim of this work was to evaluate the effects of different times of extraction on the cytotoxicity of six representatives of different root canal sealer groups-Real Seal SE, AH Plus, GuttaFlow, Sealapex, Roth 801, and ThermaSeal Plus-with human gingival fibroblasts. The materials were prepared according to manufacturers' specifications, and were incubated in culture medium (DMEM) at 37ºC for 1, 7, 14, 21, and 28 days, with daily washing, to simulate periodontal ligament clearance. Human fibroblasts were exposed to the final extracts at 24 hours, and cell viability was determined by MTT assay, with exposure to unconditioned DMEM as a negative control. Statistical analysis comparing cytotoxicities at each exposure time was performed by ANOVA with Scheffé adjustment for multiple comparisons at a 95% confidence level. Results indicated that GuttaFlow was significantly less cytotoxic than all other sealers (p < 0.05) at 1 day of extraction. After 7 days of extraction, cell viability for GuttaFlow was significantly increased as compared with that of all groups except sealer AH Plus. At day 14, cytotoxicity of Sealapex was significantly higher than that of all other sealers (p < 0.05). At days 21 and 28, there were no significant differences in cytotoxicity among sealer groups. All materials presented some level of cytotoxicity to fibroblasts, while GuttaFlow was the least cytotoxic sealer tested. However, the cytotoxicity of all materials seemed to decrease similarly in a time-dependent manner.

Treatment options for teeth with open apices and apical periodontitis.

Three clinical cases involving teeth with open apices and apical periodontitis were treated using different protocols. The first case was managed with intracanal calcium hydroxide paste for 12 months before obturation with gutta-percha and sealer. In the second case, an apical plug of mineral trioxide aggregate (MTA) was used before obturation with gutta-percha and sealer and treatment was completed during 2 appointments. In the third case, the tooth, which had a divergent root canal system, was completely obturated with MTA and treatment was also completed over 2 appointments. In all 3 cases, signs of bone healing were observed after treatment.

Defects in nickel-titanium instruments after clinical use. Part 5: single use from endodontic specialty practices.

INTRODUCTION: Single use of endodontic nickel-titanium (NiTi) instruments has been recommended to reduce instrument fatigue and the possibility of cross-contamination. The purpose of this study was to evaluate the defects of three NiTi rotary systems (ProFile series 29 [Dentsply Tulsa Dental Products, Tulsa, OK], ProFile [Dentsply Tulsa Dental Products], and ProTaper [Dentsply Maillefer, Ballaigues, Switzerland]) that were discarded after single use by two endodontic clinics. METHODS: A total of 1,071 ProFile .04, 432 ProFile series 29 .04, and 1,895 ProTaper rotary instruments were collected over 12 months and analyzed. These discarded files were ultrasonically cleaned and autoclaved. The lateral view of the deformed instruments and fracture surface of the separated instruments were examined by scanning electron microscopy. Qualitative X-ray energy-dispersive spectrophotometric (EDS) spot analyses were performed on particles adherent to the surface and those apparently wedged in surface microcracks. RESULTS: There were no fractures or deformations in the ProFile Series 29. The overall prevalence of deformation was 2.9% in ProTaper and 0.75% in ProFile. The incidence of instrument separation was 0.26% in ProTaper, whereas no fractures occurred in ProFile instruments. The majority of instrument defects occurred in size 25 (6/8) for ProFile and in Sx for ProTaper (22/60). The separated ProTaper instruments failed mostly because of shear stress. Some surface deposits and microcracks were found in single-use NiTi instruments. EDS indicated that surface deposits may be dentin. CONCLUSION: The risk of NiTi rotary instrument fracture in the canal is low when a new instrument is used by experienced endodontists. The most common cause of failure, albeit rare, was shear failure.

Does a final rinse to remove smear layer interfere on dentin permeability of root canals?

OBJECTIVE: The objective of this study was to assess the influence of different final irrigating solutions on dentin permeability and smear layer removal using the same specimens and relate the results obtained. STUDY DESIGN: Forty anterior human teeth were instrumented and divided into 4 groups (n = 10) at the final rinse step, according to the irrigant used: G I (control) - 1% NaOCl; G II - 17% EDTA; G III - 17% EDTAT; and G IV - Biopure MTAD. The canals were filled with 0.5% methylene blue and maintained in bottles for 48 hours. The roots were transversally split in coronal, middle, and apical fragments. The specimens were photographed and analyzed regarding dye penetration. The fragments were then axially split and prepared for SEM. The photomicrographs were analyzed and qualified by scores. RESULTS: Only the EDTA-T group exhibited statistical difference in which the apical third had less dentin permeability (P < .05). When a decalcifying agent was used, smear layer was removed, which did not happen in the NaOCl group. Regarding smear layer removal, differences were found only in the EDTA group in which the apical third presented more smear layer (P < .05). No correlation was found for both studies (r = 0.4207). CONCLUSIONS: There was not an even relationship between the results from both studies, which inferes that higher or lower dentinal permeability does not necessarily correspond to a higher or lower amount of smear layer. The analysis of dentin permeability and smear layer removal was shown to be a feasible procedure using the same specimens.

Defects in nickel-titanium instruments after clinical use. Part 3: a 4-year retrospective study from an undergraduate clinic.

The purpose of this study was to analyze the incidence and mode of ProFile (Dentsply Tulsa Dental, Johnson City, TN) instrument separation during a predefined schedule of clinical use by the undergraduate students in a dental school over 4 years. A total of 3,706 ProFile instruments discarded from the same undergraduate students program between 2003 and 2007 were analyzed. The lateral and fracture surfaces of 12 separated instruments were examined by scanning electron microscopy, and the location of the fractures was recorded. The overall proportion of instrument defects was 1.3%; deformation without fracture occurred in 1% and separation in 0.3%. The majority of instrument defects occurred in size 20 (34/48). The ProFile instruments (10/12) failed mostly because of shear stress, whereas only two failed because of fatigue fracture. The results of this study indicated that NiTi rotary instrument system was successfully introduced into an undergraduate endodontic program. Small size files should be considered as single-use, disposable instruments because of the higher possibility of torsional deformation.

Comparative SEM evaluation of three solvents used in endodontic retreatment: an ex vivo study.

This study compared, by scanning electron microscopy (SEM), the efficacy of three solvents on the removal of filling materials from dentinal tubules during endodontic retreatment. Forty human maxillary canines with straight canals were prepared according to a crown-down technique and enlarged to a#30 apical file size, before obturation with gutta-percha and a zinc-oxide-eugenol based sealer. The samples were stored for 3 months before being randomly assigned to four groups: chloroform (n=10), orange oil (n=10), eucalyptol (n=10) and control (n=10). Solvents were applied to a reservoir created on the coronal root third using Gates Glidden drills. The total time for retreatment using the solvents was 5 minutes per tooth. Following retreatment the roots were split longitudinally for SEM evaluation. SEM images were digitized, analyzed using Image ProPlus 4.5 software, and the number of dentinal tubules free of filling material from the middle and apical thirds was recorded. No significant difference was found among the solvent groups regarding the number of dentinal tubules free of root filling remnants in the middle and apical root thirds (p>0.05). However, the control group had fewer dentinal tubules free of filling material (p<0.05). Under the tested conditions, it may be concluded that there was no significant difference among the solvents used to obtain dentinal tubules free of filling material remnants.

Coronal and apical leakage analysis of two different root canal obturation systems.

This study compared the coronal and apical leakage of AH Plus with gutta-percha to that of Epiphany with Resilon. Twenty-four single rooted teeth were instrumented and divided into 2 groups according to the solutions for smear layer removal and the obturation materials employed: Group A - 17% EDTA-T and AH Plus with gutta-percha; Group B - primer and Epiphany with Resilon. The Group B specimens were light-cured in the coronal area for 20 s. The external root surfaces were covered with a double layer of ethyl cyanoacrylate, except for the apical foramen and the cavity access. The teeth were immersed in 0.5% methylene blue for 48 h. The specimens were rinsed, dried and axially split for dye penetration measurement with the ImageLab 2.3 software. The t-test showed no significant differences for coronal leakage between the groups, but there were significant differences for apical leakage between the groups (P < 0.05). AH Plus with gutta-percha and Epiphany with Resilon provided the same coronal seal, whereas Epiphany with Resilon provided the best apical seal.

Influence of different volumes of EDTA for final rinse on smear layer removal.

OBJECTIVE: The aim of this study was to analyze the influence of different volumes of 17% EDTA for final rinse on smear layer removal on the different areas of the root canal. STUDY DESIGN: Forty single-rooted teeth were instrumented using rotary instruments. The teeth were divided into 3 test groups according to the EDTA volume for final rinse (5 mL, 10 mL, 15 mL) and 1 control group (10 mL of 1% sodium hypochlorite). The roots were axially split into halves, and the smear layer removal from the canals was determined under scanning electron microscope. The data were analyzed using Kruskal Wallis and Dunn tests. RESULTS: The 3 experimental groups showed no statistical difference (P > .05); however, when the test groups were compared to the control group statistically significant differences were found (P < .01). The root canal wall surfaces of teeth in the control group showed the presence of heavy smear layer through the entire length of the root canals. The other groups showed mainly smear layer-free surfaces or a small amount of debris. When coronal, middle and apical thirds were compared, there was no statistically significant difference (P > .05). CONCLUSIONS: Based on the results, it appears that a final rinse with 5 mL of EDTA per canal provides good smear layer removal, with root canal walls free of debris and mostly open dentinal tubules in all areas.

Comparative sem evaluation by of three solvents used in endodontic retreatment: an ex vivo study

This study compared, by scanning electron microscopy (SEM), the efficacy of three solvents on the removal of filling materials from dentinal tubules during endodontic retreatment. Forty human maxillary canines with straight canals were prepared according to a crown-down technique and enlarged to a#30 apical file size, before obturation with gutta-percha and a zinc-oxide-eugenol based sealer. The samples were stored for 3 months before being randomly assigned to four groups: chloroform (n=10), orange oil (n=10), eucalyptol (n=10) and control (n=10). Solvents were applied to a reservoir created on the coronal root third using Gates Glidden drills. The total time for retreatment using the solvents was 5 minutes per tooth. Following retreatment the roots were split longitudinally for SEM evaluation. SEM images were digitized, analyzed using Image ProPlus 4.5 software, and the number of dentinal tubules free of filling material from the middle and apical thirds was recorded. No significant difference was found among the solvent groups regarding the number of dentinal tubules free of root filling remnants in the middle and apical root thirds (p>0.05). However, the control group had fewer dentinal tubules free of filling material (p<0.05). Under the tested conditions, it may be concluded that there was no significant difference among the solvents used to obtain dentinal tubules free of filling material remnants.

Coronal and apical leakage analysis of two different root canal obturation systems

This study compared the coronal and apical leakage of AH Plus with gutta-percha to that of Epiphany with Resilon. Twenty-four single rooted teeth were instrumented and divided into 2 groups according to the solutions for smear layer removal and the obturation materials employed: Group A - 17 percent EDTA-T and AH Plus with gutta-percha; Group B - primer and Epiphany with Resilon. The Group B specimens were light-cured in the coronal area for 20 s. The external root surfaces were covered with a double layer of ethyl cyanoacrylate, except for the apical foramen and the cavity access. The teeth were immersed in 0.5 percent methylene blue for 48 h. The specimens were rinsed, dried and axially split for dye penetration measurement with the ImageLab 2.3 software. The t-test showed no significant differences for coronal leakage between the groups, but there were significant differences for apical leakage between the groups (P < 0.05). AH Plus with gutta-percha and Epiphany with Resilon provided the same coronal seal, whereas Epiphany with Resilon provided the best apical seal.

Diffusion of calcitonin through the wall of the root canal.

The aim of this study was to evaluate the in vitro diffusion of synthetic salmon calcitonin (CT), used as an intracanal medication, to the external root surface, with or without the presence of intact root cementum. Fifty-four human central incisors were used in the experiment, and were divided into two groups of 21 (test groups) and two groups of 6 teeth (control groups). After root canal preparation, 10 mul of calcitonin was inserted within the root canal chamber. The root was sealed and made externally impermeable. Specimens were then placed in tubes with saline solution buffered with phosphates and stored at 37 degrees C. The diffusion of calcitonin was measured after 1, 4 and 7 days. To count calcitonin present at the external media (PBS), ELISA test (an antigen-antibody reaction) was used. Results showed that there was calcitonin diffusion through dentin in all of the test samples. The absence of cementum increased the diffusion of calcitonin (p=0.05). The highest counts of CT were obtained on day 7 for groups with or without cementum - showing a direct relation between time and diffusion of the medication.

Diffusion of calcitonin through the wall of the root canal

O presente estudo determinou in vitro a difusão da calcitonina sintética de salmão, como medicação intracanal, até a superfície externa radicular, com e sem a presença de cemento radicular. Foram utilizados cinqüenta e quatro incisivos centrais humanos, divididos em dois grupos com 21 dentes cada e dois grupos com 6 dentes cada (controle negativo). Após o preparo endodôntico, os dentes receberam 10 ml de calcitonina como medicação intracanal. Feitos o selamento e a impermeabilização externa da raiz, os espécimes foram acondicionados em tubos com solução salina tamponada com fosfatos e incubados em estufa a 37°C. Foram colhidas amostras da solução salina nos períodos de 1, 4 e 7 dias. Para a análise das soluções teste, utilizou-se teste ELISA. Os resultados mostram que existe a difusão da medicação testada até a superfície externa radicular em todas as amostras dos grupos teste. O fator ausência de cemento radicular permite a passagem de maiores quantidades de calcitonina, dados estatisticamente significantes ao nível de 5%. Os maiores valores de difusão foram encontrados no sétimo dia, tanto para o grupo com cemento como para o grupo sem cemento, mostrando uma relação direta entre tempo e difusão da medicação intracanal testada.

Proinflammatory cytokine profiles in pulp fibroblasts stimulated with lipopolysaccharide and methyl mercaptan.

Pulpal disease is intimately associated with the immune system's response to bacteria products. Clinical pathology is mediated in part by the production of pyrogenic cytokines, especially interleukin (IL)-1, tumor necrosis factor (TNF)-alpha, and IL-6. Methyl mercaptan (CH3SH), a volatile sulfur compound produced by anaerobic Gram-negative bacteria, has been shown to contribute to the production of IL-1 by human mononuclear cells. In this report, we investigated the production of IL-1, TNF-alpha, and IL-6 by human pulp fibroblasts when stimulated for various periods of time with lipopolysaccharide (LPS) with or without the presence of CH3SH. We found that LPS and CH3SH had no effect on the production of IL-1 or TNF-alpha. However, LPS stimulated IL-6 production, and this production was augmented when CH3SH was present. We conclude that the volatile sulfur compound CH3SH plays a role in activation and modulation of the immune response through its role in production of IL-6.