Intentional replantation and management of avulsion related ankylosis and external cervical resorption. A 10-year follow up case report.

Replantation is the treatment of choice for avulsed permanent teeth; ankylosis and cervical root resorption are among survival complications. A 9.5-year-old boy presented with an avulsed maxillary permanent central incisor with an open root apex following a school accident. The tooth was kept in milk, after a dry time of 15-20 min. Its replantation was performed 60 min after the accident. At 8 months, apexification with apical plug was attempted upon radiographic evidence of apical periodontitis. Ankylosis sound with infraocclusion and radiographic evidence of external cervical root resorption (ECR) were evident at 3 years and 3 months. At the patient's return one year later with esthetic concerns (2 mm infraocclusion) there was a 5 mm diameter ECR cavity. After intentional atraumatic extraction the resorptive cavity was debrided and restored with Biodentine; subsequently the tooth was reimplanted and splinted at an extruded position. At the 10-year follow up since the first avulsion the tooth remains esthetically pleasing, asymptomatic, non-ankylotic and functional. The present case supports intentional replantation as an option in managing infraoccluded teeth with advanced ECR.

Flow characteristics and alkalinity of novel bioceramic root canal sealers.

OBJECTIVE: This study aimed to examine the physical properties (pH and flow) of 2 novel bioceramic sealers. MATERIALS AND METHODS: The tested sealers were a calcium hydroxide sealer (Sealapex) and 2 bioceramic sealers (BioRoot RCS and TotalFill BC Sealer). Flow measurements were conducted according to ISO 6876/2012, with a press method of 0.05 mL of sealer. The pH of fresh samples was tested immediately after manipulation, while set samples were stored for 3 times the recommended setting time. The predetermined time intervals ranged from 3 minutes to 24 hours for fresh samples and from 10 minutes to 7 days and 4 weeks for the set samples. Analysis of variance was performed, with p = 0.05 considered indicating significance. RESULTS: The mean flow values were 26.99 mm for BioRoot, 28.19 for Sealapex, and 30.8 mm for TotalFill BC Sealer, satisfying the ISO standard. In the set samples, BioRoot RCS had higher pH values at 24 hours to 1 week after immersion in distilled water. At 2 weeks, both bioceramic sealers had similar pH values, greater than that of Sealapex. In the fresh samples, the bioceramic sealers had significantly higher initial pH values than Sealapex (p < 0.05). At 24 hours post-immersion, all sealers showed an alkaline pH, with the highest pH observed for TotalFill. CONCLUSIONS: The TotalFill BC Sealer demonstrated the highest flow. The bioceramic sealers initially presented higher alkaline activity than the polymeric calcium hydroxide sealer. However, at 3 and 4 weeks post-immersion, all sealers had similar pH values.

Top 50 cited articles on dental stem cell research.

OBJECTIVES: Citation analysis provides a unique insight into how scientific interests and research trends have changed over time. The aim of this study was to report on the 50 top-cited papers in dental stem cell research using the Science Citation Index Expanded provided by the Web of Science database to determine the academic importance of each contribution. MATERIALS AND METHODS: After the screening, article title and type, total citations and citations per year, publication journal, publication year, first and senior authors, country of origin, institution, and university of reprint author were documented for the 50 top-cited articles in dental stem cell research. Keyword analysis was performed to determine which keywords were most/least popular. RESULTS: Top 50-cited articles were cited between 179 to 2,275 times. The majority of papers were published in 2008 and originated from the United States with the highest contribution from the National Institute of Dental & Craniofacial Research. Journal of Dental Research published the highest number of top-cited articles, followed by Stem Cells and Journal of Endodontics. The greatest number of articles was published by two individual authors, Shi and Gronthos. Among 197 unique keywords, dental pulp stem cells and mesenchymal stem cells were the most frequently used. Thirty-eight of the 50 most cited articles were original articles, and 37 of them were in the field of basic science. CONCLUSIONS: Basic science studies in dental stem cell research published in high impact factor journals had the highest citation rates.

Top 100 cited systematic reviews and meta-analyses in dentistry.

Objective: The purpose of the present study was to identify the 100 top cited systematic reviews and meta-analyses on dental journals so as to gain insight into the influential publications in dentistry.Material and methods: The Web of Science was used to comprehensively identify the 100 most cited papers without year and language restriction. Specific parameters regarding the title, journal, publication year, authors, country of origin, institution and university, collaborations, keyword analysis and field of study of each manuscript were retrieved.Results: The citations ranged from 642 to 140. The most productive years were 2008 and 2009. The majority of top cited papers were published in Clinical Oral Implants Research and Journal of Clinical Periodontology. The leading countries were United States, followed by Switzerland. The University of Zurich was the most productive institution with 8 articles. Major topics of interest in the top 100 most-cited papers were dental implants and periodontology. The most frequently occurring keywords were systematic review, dental implants and meta-analyses.Conclusions: Systematic reviews published in high impact factor Dental journals focused on implantology and periodontology had the highest citation rates. Obviously, the top cited list is dynamic, as scientific interests and research tendencies evolve over the years.

Cytotoxicity of a New Calcium Silicate Endodontic Sealer.

INTRODUCTION: Resin sealers with biocompatible and bioactive additives have been used in clinical practice. Recently, a calcium silicate root canal sealer was introduced under the name BioRoot RCS (Septodont, Saint Maur-des-Fossés, France). The aim of this study was to evaluate the effects of BioRoot RCS on cell survival and proliferation of cultured cells in parallel with an epoxy resin sealer with calcium phosphate and calcium oxide and a salicylate resin sealer with mineral trioxide aggregate filler. The tested hypothesis was that BioRoot RCS is significantly less cytotoxic than the other tested sealers. METHODS: The experiments were performed on NIH/3T3 cells (American Type Culture Collection, Manassas, VA) grown as monolayer cultures at 37°C in atmosphere containing 5% CO2 in air and 100% relative humidity. The sealers' extracts (24 hours and 1 week) were applied to cells at 1:1 and 1:2 dilutions. The effect was assessed by a modified sulforhodamine B staining assay in reference to controls after 24 and 72 hours of exposure. All experiments were performed at least twice in 6 replicates. Analysis of variance and post hoc comparison tests were used to evaluate the statistical significance of the results at a level of significance of P = .05. RESULTS: BioRoot RCS was significantly less cytotoxic than the other 2 sealers. MTA-Fillapex (Angelus, Londrina, Brazil) and SimpliSeal (Discuss Dental, LLC, Calver City, CA) exhibited a similar antiproliferative profile with no statistically significant differences in all settings. CONCLUSIONS: BioRoot RCS showed quite a positive biological behavior. Further investigation is needed in order to clarify the mechanism and the components that contribute to the beneficial results observed.

Evaluation of Antimicrobial Photodynamic Therapy Using Indocyanine Green and Near-Infrared Diode Laser Against Enterococcus faecalis in Infected Human Root Canals.

OBJECTIVE: Photodynamic therapy (PDT) is considered a promising adjunct to the currently available endodontic disinfection techniques leading to more effective reduction of intracanal bacteria. The present ex vivo study aimed to assess the antimicrobial effect of PDT using indocyanine green (ICG) as photosensitizer and a near-infrared (NIR) diode laser in root canals of human teeth infected with Enterococcus faecalis. MATERIALS AND METHODS: Ninety single-rooted teeth after chemomechanical preparation and sterilization were contaminated with an E. faecalis strain. The specimens were divided, randomly, into eight experimental groups: (1) PDT with ICG and laser (0.5 W output power-medium-energy fluence), (2) PDT with ICG and laser (1 W output power-high-energy fluence), (3) only laser emission, (4) only ICG, (5) 2.5% sodium hypochlorite (NaOCl) as irrigant, (6) 2.5% NaOCl and PDT with ICG and laser, (7) no treatment (positive control), and (8) no bacterial biofilm growth (negative control). The root canal contents were sampled by flushing and the collected washings were plated on an appropriate culture medium, which was incubated for 48 h at 35°C ± 2.0. The colony-forming units (CFUs) were determined to assess the bactericidal effect of the tested experimental combinations. RESULTS: The microbiological tests revealed that PDT groups, regardless of the overall power, showed significant lower mean log10 CFU levels, than groups 3 and 4 (p < 0.001) and similar reduction of viable counts with group 5. The combination treatment (group 6) achieved adequate reduction of log10 CFU levels in the viable counts. However, no significant difference (p > 0.05) was observed between groups 1, 2, 5, and 6 and significant difference was noticed between groups 3, 4, and 5 (p < 0.001). CONCLUSIONS: ICG-mediated PDT activated by an NIR diode laser provided increased disinfection of the root canal system, but the overall benefit in total bacterial elimination should be further investigated.

Antimicrobial photodynamic therapy using Indocyanine green and near-infrared diode laser in reducing Entrerococcus faecalis.

BACKGROUND: The use of Antimicrobial Photodynamic Therapy (aPDT) has been suggested as an adjuvant method to eliminate facultative bacteria during root canal disinfection. The purpose of this preliminary in vitro study was to determine whether the light-activated antimicrobial agent, Indocyanine green (ICG), could be used as photosensitizer and kill Enterococcus faecalis strain under planktonic conditions when irradiated with near-infared (NIR) diode laser emitting in 810nm wavelength. METHODS: Planktonic suspension containing Enterococcus faecalis strain was divided into nine experimental groups: (1) aPDT with ICG and laser (medium energy fluence), (2) aPDT with ICG and laser (high energy fluence), (3) only ICG without laser activation, (4) only laser emission without ICG (5) 2.5% Sodium hypochlorite (NaOCl) as irrigant, (6) 2.5% NaOCl and aPDT with ICG and laser, (7) 2.0% Chlorhexidine gluconate (CHX) as irrigant (8) No treatment (positive control), (9) No bacterial biofilm growth (negative control). The samples were incubated for 7days and colony-forming units (CFUs) were determined to evaluate bacterial viability. RESULTS: The microbiological test revealed that aPDT groups, regardless the overall power, showed significant lower mean log10 CFU levels, than groups 3, 4 and 7 (p<0.01). The irrigation with 2.5% NaOCl and the combination of PDT and NaOCl achieved total elimination of bacteria. CONCLUSION: These preliminary in vitro findings imply that the combination of ICG and NIR diode laser may be a novel supplement in aPDT and provide better disinfection during endodontic treatment.

Management of bilateral invasive cervical resorption lesions in maxillary incisors using a novel calcium silicate-based cement: A case report.

Invasive cervical resorption is a pathologic process leading to progressive and usually destructive loss of tooth structure. The pathogenic mechanism is not completely understood and the diagnosis may be challenging. The aim of this article is to present an unusual case of bilateral presence of invasive cervical resorption lesions in maxillary central incisors and to discuss the treatment procedures using a novel repair material. The management of the present case was carried out in three phases. The first stage of the treatment aimed at curetting the active tissue from the resorption cavity and restoring the defect with the novel calcium silicate-based cement (Biodentine, Septodont). In the maxillary left central incisor it was not possible to remove the resorptive tissue without exposing the pulp, and therefore root canal treatment was performed. At the second phase, a full-thickness flap was raised in order to expose and repair the defect that was extending subgingivally. At the third phase teeth were restored with composite resin. The patient was kept under review and after a follow-up period of 2 years neither signs of periradicular lesion nor recurrence of resorption were observed. The teeth were asymptomatic, and restorations appeared to be in excellent condition. In conclusion, Biodentine seems to be a promising material for the treatment of invasive cervical resorption lesions.

Effect of Er,Cr:YSGG laser irradiation on apical sealing ability of calcium silicatecontaining endodontic materials in root-end cavities.

The aim of this research was to evaluate the apical sealing abilities of 60 root-end cavities filled with mineral trioxide aggregate (MTA) and iRoot BP cements after treated with either 17% EDTA solution or Er,Cr:YSGG laser irradiation. After the filling procedure, apical leakage quantity was measured at 4 weeks using a fluid filtration method. One root from each group was processed for scanning electron microscopy and energy dispersive X-ray spectroscopy analyses. Both EDTA/MTA and laser irradiation/MTA combinations showed significantly lower microleakage than EDTA/iRoot BP and laser irradiation/iRoot BP combinations (p<0.05). Between groups of the same filling material, there were no significant differences among specimens treated with EDTA or laser (p>0.05). Both MTA and iRoot-BP demonstrated tag-like structures within the dentinal tubules when used in conjunction with EDTA.

An ex vivo comparison of the push-out bond strength of a new endodontic filling system (Smartseal) and various gutta-percha filling techniques.

The purpose of this study was to evaluate, ex vivo, the push-out bond strength of a new filling material (Smartseal) compared with gutta-percha/AH-26. A total of 40 extracted single-rooted human teeth were used. After instrumentation using the ProTaper rotary system, the root canals were filled as follows: Group 1, Smartseal sealer and a 0.06 taper Smartpoint calibrated to apical tip size 30; Group 2, Smartseal sealer and an F3 SmartpointPT; Group 3, AH-26 sealer and a single F3 ProTaper gutta-percha cone and Group 4, AH-26 sealer and gutta-percha using the cold lateral condensation technique. Two successive disk shaped slices were cut from each root sample and the bond strength was measured using the push-out test. Two-way analysis of variance was used for data analysis with the level of significance set at 0.05. Statistical analysis revealed no significant differences (p > 0.05) between the mean bond strengths of the various groups; thus indicating there was no difference in adhesion to dentine between the Smartseal system and gutta-percha/AH-26 applied using either the single cone or lateral condensation technique.

Top-cited articles in endodontic journals.

INTRODUCTION: The purpose of this study was to identify the 100 top-cited articles published in journals dedicated to endodontology and analyze their characteristics to describe the quality and evolution of research in the field of endodontology. METHODS: The Institute for Scientific Information Web of Knowledge Database and the Journal Citation Report Science Editions were used to retrieve the 100 most cited articles published in journals dedicated to endodontics. The top-cited articles were selected and analyzed with regard to journals, authors, institution, country of origin, publication title and year, number of citations, article type, study design, level of evidence, and field of study. RESULTS: The top 100 articles were cited between 87 and 554 times. These articles appeared in 4 different journals, with more than half in the Journal of Endodontics, followed by the journals Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology, the International Endodontic Journal, and Endodontics & Dental Traumatology. Forty-eight articles were published between 1990 and 1999. All articles were published in English and primarily originated from the United States (n = 52). The majority of articles were basic science articles (n = 55), followed by clinical research studies (n = 28) and nonsystematic reviews (n = 17). Uncontrolled case series with level IV of evidence and narrative reviews with level V of evidence were the most frequent types of study design. The main topics covered by the top-cited articles were microleakage and endodontic microbiology. CONCLUSIONS: This analysis of citation rates reveals useful and interesting information about scientific progress in the field of endodontics. Basic research and observational studies published in high-impact endodontic journals had the highest citation rates.

Fluid-transport evaluation of lateral condensation, ProTaper gutta-percha and warm vertical condensation obturation techniques.

The purpose of this study was to compare the microleakage of four obturation techniques (lateral condensation, lateral condensation of ProTaper Gutta-percha, single ProTaper Gutta-percha and warm vertical condensation) over a 3-month period. A fluid-transport model was used to measure microleakage. Sixty human-extracted teeth, divided into four groups, were prepared with ProTaper rotary instruments before the root canals were filled by one of the four examined techniques. All groups were obturated using Sultan as a root canal sealer. Microleakage was measured 7 days, 1 month and 3 months after the procedures. There were no statistically significant differences between the four groups at any of examination points (P > 0.05). The leakage was increased in all obturation techniques over the 3-month period.

In vitro evaluation of the cytotoxicity of ProRoot MTA and MTA Angelus.

The purpose of the present in vitro study was to compare the cytotoxic effect of two commercially available brands of mineral trioxide cement (ProRoot MTA and MTA Angelus), modified zinc oxide-eugenol cement (SuperEBA) and resin-modified glass ionomer cement (Vitrebond) using rat pulp cells (RPC-C2A) and human lung fibroblasts (MRC-5). The cells were cultured in typical culture conditions and exposed to the tested materials by adaptation of insert wells. The cytotoxic effect was recorded at two observation periods (24 and 72 h) by using a colorimetric assay of tetrazolium reduction (XTT method) in reference to controls. Overall, the degree of cytotoxic effect in ascending order was ProRoot MTA - MTA Angelus < SuperEBA < Vitrebond. Both MTA materials tested exerted mild suppression of cellular mitochondrial activity and may be characterized as biologically inert materials.

Psychometric properties of Greek versions of the Modified Corah Dental Anxiety Scale (MDAS) and the Dental Fear Survey (DFS).

BACKGROUND: A growing body of literature describes the performance of dental fear questionnaires in various countries. We describe the psychometric properties of Greek versions of the Modified Dental Anxiety Scale (MDAS) and the Dental Fear Survey (DFS) in adult Greek patients. METHODS: Greek versions of the MDAS and DFS were administered to two samples of adult dental patients. In the first sample, 195 patients attending one of three private practice dental offices in a large city in Greece completed the questionnaires in the waiting room before dental treatment. After treatment, their dentists (who did not know how the patients had answered the questionnaire) rated their anxiety during dental treatment. In the second sample, 41 patients attending a Greek university dental school clinic completed the questionnaire twice at two separate visits, in order to provide test-retest data. Cronbach's alpha was used to compute the internal consistencies, while Spearman's rho was used to compute the test-retest reliabilities. Construct validity was assessed by correlating the responses to the MDAS and DFS by Spearman's rho. Spearman's rho was also used to examine the criterion validities, by comparing the questionnaire responses with the dentists' ratings of anxiety. RESULTS: The internal consistencies for the MDAS were 0.90 and 0.92 in the two samples; for the DFS, the internal consistencies were 0.96 in both samples. The test-retest reliabilities were 0.94 for the MDAS and 0.95 for the DFS. The correlation between the two questionnaires was 0.89. The patients' responses to both questionnaires were significantly related to the dentists' ratings of their anxiety during dental treatment (both p values <0.001). CONCLUSION: The results indicate that the Greek versions of the MDAS and DFS have good internal consistencies and test-retest reliabilities, as well as good construct and criterion validities. The psychometric properties of the Greek versions of these questionnaires appear to be similar to those previously reported in other countries.

Shear bond strength of AH-26 and Epiphany to composite resin and Resilon.

The aim of this study was to evaluate the relative bond strengths of AH-26 and Epiphany sealers to both Resilon and composite resin. Four groups of substrate/bonded sealer combinations were tested: group A, composite resin substrate + Epiphany sealer; group B, composite resin substrate + AH-26 sealer; group C, Resilon substrate + Epiphany sealer; and group D, Resilon substrate + AH-26 sealer. Bond strength was evaluated in shear mode by using a universal testing machine at a crosshead speed of 0.5 mm/min. Statistical analysis (Kruskall-Wallis and Dunn tests) showed that the bond strength of AH-26 to both substrates was significantly greater than the bond strength of Epiphany. Therefore, the monoblock in the root canal might be more effectively achieved by combining Resilon core material with the epoxy resin-based sealer (AH-26) rather than Epiphany sealer.

Antiproliferative effect of mineral trioxide aggregate, zinc oxide-eugenol cement, and glass-ionomer cement against three fibroblastic cell lines.

An important requirement for dental materials placed in direct contact with living tissues is biocompatibility. The purpose of this study was to evaluate the antiproliferative activity of three dental materials (mineral trioxide aggregate, zinc oxide-eugenol cement, and glass-ionomer cement) against a panel of established fibroblastic cell lines (L929, BHK21/C13, and RPC-C2A). The materials were prepared according to the manufacturer's instructions and were tested in insert wells for 12, 24, and 48 h. Cell number fraction was estimated by the sulforhodamine-B assay, in reference to controls. The degree of antiproliferative effect in ascending order was mineral trioxide aggregate, glass-ionomer cement, and zinc oxide-eugenol cement in all cell lines tested.

Comparative study of apical sealing ability of a new resin-based root canal sealer.

The purpose of this study was to compare the microleakage of two root canal sealers, Fibrefill (resin-based sealer) and calciobiotic root canal sealer (CRCS; calcium hydroxide-based sealer), with and without the presence of smear layer. The model used for the measurement of microleakage was a fluid transport model. Sixty human extracted teeth were used in this study. The teeth were divided into four groups and treated as follows. In group A, the smear layer was left intact, and canals were obturated with gutta-percha and Fibrefill. In group B, the smear layer was removed, and canals were obturated with gutta-percha and Fibrefill. In group C, the smear layer was left intact, and the canals were obturated with gutta-percha and CRCS. In group D, the smear layer was removed, and canals were obturated with gutta-percha and CRCS. Microleakage was measured at 7 days, 1 month, and 2 months. The results showed that the Fibrefill groups with and without smear layer leaked significantly less than the CRCS groups at all experimental times. No significant difference was found between the groups of same materials, but the microleakage values were less when the smear layer was removed.

Comparative study of sealing ability of two root-end-filling materials with and without the use of dentin-bonding agents.

The purpose of this study was to examine microleakage of two root-end-filling materials with and without the use of bonding agents. For microleakage measurement a fluid transport model was used. Sixty single-rooted teeth were used in this study. They were prepared with step-back technique and then an apicoectomy was performed. Then the teeth were divided into four groups. Group A were filled with Fuji II LC glass-ionomer cement, group B were filled with Fuji II LC and a new bonding agent, Fuji Bond, group C were filled with Admira composite resin, and group D were filled with Admira and Admira Bond, a new bonding agent. At 24 h, 1 month, and 2 months after filling the leakage along these filling materials was determined under a low pressure of 0.1 atm. At all experimental times, glass-ionomer groups showed significantly less microleakage than resins groups. Between Admira and Admira Bond groups, significantly less leakage was observed in the root sections with Admira Bond at 24 h.

Shear bond strength of AH-26 root canal sealer to dentine using three dentine bonding agents.

OBJECTIVE: The purpose of the study was to compare the bond strength of AH-26 root canal sealer to human root canal dentine exposed to different intracanal medications both with and without the use of three bonding agents. The materials used were AH-26 sealer, two one-bottle bonding agents (Single Bond, Bond-1) and one self-etching bonding agent (Clearfill SE Bond). METHODS: The dentine substrate was obtained from single rooted human teeth. The dentine specimens were treated either with EDTA 15% or phosphoric acid 37% to achieve the removal of smear layer. The AH-26 sealer was placed on the dentine surfaces both with and without the use of the bonding agents. Bond strength was tested using a single plane shear test assembly. RESULTS: The SBS values were (MPa): Group A (EDTA-AH-26) 3.678+/-0.853, Group B (Phosphoric acid-AH-26) 3.470+/-0.834, Group C (EDTA-Single Bond-AH-26) 4.8+/-0.865, Group D (Phosphoric acid-Single Bond-AH-26) 5.043+/-1.022, Group E (EDTA-Bond 1-AH-26) 4.939+/-0.877, Group F (Phosphoric acid-Bond 1-AH-26) 5.101+/-1.117, Group G (Clearfill SE Bond-AH-26) 6.975+/-1.694. The use of dentine bonding agents improved significantly (p<0.05) the adhesion of AH-26 sealer with the root canal dentine. However, the best results were obtained with the self-etching system. Similar results were observed from the pretreatment of dentine either with phosphoric acid 35% or EDTA 15%. CONCLUSIONS: The use of dentine bonding agents gave higher shear bond strengths of AH-26 sealer to human root canal dentine.