Color Match of Composite Resin and Remaining Tooth Structure over a Period of 28 Days Using Spectrophotometer-A Randomized Clinical Trial.

OBJECTIVES: The tooth and the composite restoration can undergo a change in color after the restorative procedure over time. The purpose of this randomized clinical trial was to evaluate the color difference (ΔE) of two types of composite resins and remaining tooth structure over a period of 28 days. METHODS AND MATERIALS: A total of 40 teeth in 30 patients with Class IV caries or EllisClass II fracture in maxillary incisors were randomized into two groups based on the type of composite resin used for restoration: IPS Empress (n=20 teeth) and Filtek Z250 (n=20 teeth). Shade selection was done using a spectrophotometer. Restorations were performed using an anatomical layering technique, and finishing and polishing was done after 48 hours. Baseline spectrophotometer color values for the remaining tooth structure were measured before isolation and for composite restorations, 10 minutes after light cure. Further color evaluations using a spectrophotometer for the remaining tooth structure and composite restorations were done at 48 hours (both before and immediately after finishing and polishing), 7days, 14 days, and 28 days, and color difference (ΔE) from baseline values for remaining tooth structure and restorations and ΔE between remaining tooth structure and restorations were calculated. Descriptive statistics including mean, standard deviation, and frequencies were computed. Mann-Whitney U test was done to compare spectrophotometer values. RESULTS: There was a significant reduction in mean color difference (ΔE) from baseline values for both tooth (p<0.05) and composite restoration (p<0.05) at all evaluation periods in both groups. Filtek Z250 showed significantly lower mean ΔE between the tooth and the composite resin restoration than IPS Empress at 48 hours (before and after finishing and polishing), 7 days and 14 days (p<0.05). At the 28 day recall, mean ΔE value of IPS Empress restorations to tooth structure was 3.5, while the mean ΔE value of Filtek Z250 restorations to tooth structure was 3.6, which was not statistically different (p>0.05). CONCLUSION: The remaining tooth structure as well as the composite restorations showed color changes at all evaluation periods, compared to baseline values in both the composite resin groups. Filtek Z250 exhibited less ΔE with remaining tooth structure at 48 hours, 7 days, and 14 days, when compared to IPS Empress. The composite restorations of both the groups reached clinically acceptable color match (mean ΔE<3.7) with the remaining tooth structure 28 days after the procedure.

Impact of root canal treatment on high-sensitivity C-reactive protein levels in systemically healthy adults with apical periodontitis - a preliminary prospective, longitudinal interventional study.

AIM: To assess the influence of root canal treatment on serum high-sensitivity C-reactive protein (hsCRP) levels in systemically healthy human adults. METHODOLOGY: Fifteen individuals aged 20-40 years diagnosed with apical periodontitis [Periapical Index (PAI) score ≥3] who were otherwise healthy took part in this prospective interventional study. Patients with moderate to severe periodontitis, systemic diseases and traditional cardiac risk factors (hypertension, diabetes, dyslipidemia and smoking) were excluded. Root canal treatment was completed in two visits with an inter-appointment calcium hydroxide intracanal medicament. After 6 months, healing of apical periodontitis was evaluated clinically and radiographically, and serum hsCRP levels were recorded. A paired sample T-test was used to compare the mean hsCRP values between the pre- and post-treatment groups. The Mann-Whitney U test was used to compare hsCRP values between patients with PAI scores of 3 and 4, and the Wilcoxon signed-rank test was used to compare pre- and postoperative PAI scores. RESULTS: The mean preoperative baseline serum hsCRP level was 2.88 ± 1.06 mg L-1 which can be associated with a moderate risk for cardiovascular disease (CVD). Based on the preoperative hsCRP levels, eight of the 15 patients were categorized as high risk (hsCRP > 3 mg L-1 ) and the other seven as medium risk (hsCRP 1-3 mg L-1 ) for CVD. The mean preoperative hsCRP value of patients with a PAI score of 3 was 2.88 ± 1.19 mg L-1 , and the mean preoperative hsCRP of patients with a PAI score of 4 was 2.87 ± 0.15 mg L-1 , which was not significantly different (P = 0.942). Six months after root canal treatment, the mean PAI score had significantly reduced from 3.2 ± 0.42 to 1.4 ± 0.69 (P = 0.003). The PAI score had reduced to ≤2 in 87% of the patients, and the mean serum hsCRP levels had significantly reduced to 1.34 ± 0.52 mg L-1 (P < 0.001). Ten of the 15 patients had a reduction in their CVD risk status. CONCLUSIONS: This study suggests that root canal treatment can reduce serum hsCRP levels in systemically healthy individuals with apical periodontitis.

Impact of apical extent of root canal filling on vertical root fracture: a case-control study.

AIM: To investigate the impact of apical extent of root filling on vertical root fracture (VRF) in a case-control study. METHODOLOGY: Eighty-six patients (119 roots) diagnosed with VRF in crowned root filled anterior and posterior teeth were selected. The cases were matched individually with control teeth in a ratio of 1:1 for age (±5 years), gender, tooth type, canal instrumentation method, master apical file (MAF) size and taper, technique of canal filling and time period after root filling. All root canals had been prepared using nickel-titanium (NiTi) rotary instruments and filled using the lateral compaction technique. The apical extent of root filling (overfilled to or beyond the radiographic apex or not overfilled and short of the radiographic apex) was recorded as the dependent variable by two individual examiners. Inter-examiner agreement was obtained using Kappa statistics. Recorded numbers of overfilled and not overfilled canals in cases and controls were analysed using chi-square tests and conditional logistic regression, and odds ratio was calculated. In addition, the frequency distribution of vertical and cross-sectional extensions and the course of VRFs were evaluated. RESULTS: The mean age of patients with VRFs was 50 ± 10 years with 27 (31%) males and 59 (69%) females. The Kappa score for inter-observer agreement was 0.832 (P < 0.001). There was a significant difference between cases and controls with respect to apical extent of root filling (P < 0.0001). When compared to roots not overfilled, overfilled roots had 11.5 times higher odds for occurrence of VRF (OR = 11.5; CI: 4.99 - 26.48). Most VRFs had a complete corono-apical longitudinal extension and were present bucco-lingually/palatally. CONCLUSION: After matching for age, gender, tooth type, MAF size and taper, canal filling technique and time period after root filling, root canals filled to or beyond the radiographic apex following lateral compaction had a greater association with VRF than canals filled short of the radiographic apex.