Clinical and Radiographic Failure of Non-surgical Endodontic Treatment and Retreatment Using Single-cone Technique with Calcium Silicate-Based Sealers: A Systematic Review and Meta-Analysis.

INTRODUCTION: This systematic review and meta-analysis aimed to evaluate the clinical and radiographic failure of non-surgical endodontic treatment and retreatment for mature permanent teeth with or without apical periodontitis using the single-cone (SC) obturation technique with calcium silicate-based bio-ceramic (CSBC) sealers and to compare these failure rates to other sealer materials and obturation techniques. METHODS: A comprehensive search was conducted using MEDLINE (PubMed), Embase, Cochrane Library, Scopus, Web of Science, and gray literature up to March 2023. Two reviewers assessed the eligibility of the included studies. Eligible studies were critically appraised for risk of bias and quality of evidence. Subsequently, a meta-analysis of pooled data was conducted utilizing the RevMan software (P< 0.05) to evaluate the failure rate of non-surgical root canal therapy using CSBC sealers and SC obturation procedures. Separately, another analysis was conducted to compare those results with the outcome of non-surgical root canal therapy using alternative obturation materials and methods. RESULTS: 5 studies were included. The pooled failure rate for non-surgical endodontic treatment and retreatment combined using CSBC sealers and SC obturation technique was 6.8% [95% confidence interval (CI)= (3%-12%), I2 = 46%]. A second analysis was conducted on the three included clinical trials to compare the outcomes of the intervention (CSBC sealers and SC obturation technique) and control groups (other sealers and other obturation techniques). This analysis found no significant difference between the two groups regarding clinical and radiographic failure of endodontic treatment and retreatment [Risk ratio=0.71, 95% CI = (0.33,1.51), I2 = 0]. This difference was also not statistically significant when the failure rate of primary root canal treatment and retreatment were separately analyzed [Combined Risk ratio of primary root canal treatment=0.94, 95% CI = (0.46,1.93), I2= 0%; Combined Risk ratio of retreatment=0.21, 95% CI = (0.001, 75.46), I2= 0%]. CONCLUSIONS: The overall results of this systematic review and meta-analysis demonstrate that the SC obturation technique with CSBC sealer provides similar results compared to other obturation materials and techniques in facilitating the healing of apical periodontitis.

Comparative Outcomes of Pulpotomy in Mature Molars with Irreversible Pulpitis: A Non-Randomized Trial Evaluating Calcified and Non-Calcified Pulp Chambers.

Introduction: This non-randomized clinical trial investigated the outcomes of full pulpotomy in adult molars with irreversible pulpitis, comparing those with calcified and non-calcified pulp chambers over 6 and 12 months. Materials and Methods: A total of 101 adult permanent molars with irreversible pulpitis, in individuals over 12 years old, were categorized based on pulp chamber calcification observed in radiographic images by two endodontists. Subsequently, full pulpotomy procedures were performed, achieving hemostasis, and applying a 2 mm layer of calcium-enriched mixture (CEM) cement as a pulp covering agent. After 48 hours, the setting of the CEM cement was verified, followed by the application of a layer of resin-modified glass-ionomer. The tooth was then restored using amalgam. Clinical and radiographic evaluations were conducted at 6-month and 1-year follow-ups by blinded endodontists. Success rates were compared using Fisher's exact test and logistic regression tests with a significance level of 0.05. Results: Among the 97 patients with 6-month and 1-year follow-ups, all achieved clinical success. Radiographic success rates were 99% at 6 months and 96.9% at 1 year, regardless of pulp calcification. In the 6-month follow-up, success rates were 98.07% for non-calcified pulp chambers and 100% for calcified pulp chambers. At the 1-year follow-up, success rates were 96.1% and 97.8%, respectively. Statistical analysis showed no significant difference in radiographic success rate between the two groups at both follow-ups (P>0.05). Conclusions: Full pulpotomy using CEM cement is a successful treatment for adult permanent teeth with calcified and non-calcified pulp chambers presenting signs and symptoms of irreversible pulpitis up to a 1-year follow-up. This study provides compelling evidence that vital pulp therapy can be effectively employed in the pulpotomy of calcified teeth, at least in the short term.

Treatment outcomes of regenerative endodontic therapy in immature permanent teeth with pulpal necrosis: A systematic review and network meta-analysis.

AIM: The aim of this study was to assess which treatment modality regarding scaffold selection for immature permanent teeth with pulpal necrosis will be the most successful for regenerative endodontic treatment (RET). METHODOLOGY: PubMed, Cochrane, Web of Science and Embase, and additional records until August 2022 were searched providing a total of 3021 articles, and nine of these articles were included for quantitative synthesis. The reviewers selected eligible randomized controlled trials and extracted pertinent data. Network meta-analysis was conducted to estimate treatment effects for primary outcomes (clinical and radiographic healing) and secondary outcomes (apical closure, root length and root wall thickness increase) following RET [mean difference (MD); 95% credible interval (CrI) and surface under the cumulative ranking curve (SUCRA)]. The quality of the included studies was appraised by the revised Cochrane risk of bias tool, and the quality of evidence was assessed using the GRADE approach. RESULTS: Six interventions from nine included studies were identified: blood clot scaffold (BC), blood clot scaffold with basic fibroblast growth factor, blood clot scaffold with collagen, platelet pellet, platelet-rich plasma (PRP) and platelet-rich fibrin (PRF). The PRP scaffold showed the greatest increase in root lengthening at 6-12 months (MD = 4.2; 95% CrI, 1.2 to 6.8; SUCRA = 89.0%, very low confidence). PRP or PRF achieved the highest level of success for primary and secondary outcomes at 1-6 and 6-12 months. Blood clot scaffold (with collagen or combined with basic fibroblast growth factor (bFGF)) achieved the highest level of success for secondary outcomes beyond 12 months follow-up. A very low to low quality of evidence suggests that both PRP and PRF exhibit the greatest success evaluating primary and secondary outcomes within 12 months postoperatively compared to the traditional blood clot scaffold protocol. CONCLUSION: Limited evidence suggests both PRP and PRF exhibit success in the short-term, not long-term. The value of this information stems in its recommendation for future randomized trials prioritizing both of these materials in their protocol.

The Effect of Master Apical Preparation Size on Healing Outcomes in Endodontic Treatment: A Systematic Review and Meta-Analysis.

INTRODUCTION: The aim of this systematic review was to assess the existing literature and examine whether or not the size of apical enlargement during mechanical preparation affects the outcome of treatment in patients undergoing nonsurgical root canal therapy (NSRCT). METHODS: MEDLINE (PubMed), Embase, Cochrane Library, and gray literature were searched (January 2000-May 2023). Study selection and data extraction were performed in duplicate. Eligible studies were critically appraised for risk of bias and quality of evidence and were meta-analyzed to estimate the treatment effects. RESULTS: Two studies were included in the meta-analysis. The overall pooled success rate was 75.8%. The success rates of treatment with an apical size ≥ 30 and < 30 were 80.9% and 52.9%, respectively. Cases with an apical size ≥ 30 demonstrated significantly more favorable results (RR = 0.63, 95% Confidence Interval 0.46-0.79, P < .05). The overall quality of evidence was low. CONCLUSIONS: With a low certainty of evidence, master apical preparation size ≥ 30 may result in an increased healing outcome in terms of clinical and radiographic evaluations.

Cell-Based Regenerative Endodontics for the Treatment of Irreversible Pulpitis: AnIn VivoInvestigation.

INTRODUCTION: This study aims to investigate the ability of umbilical cord mesenchymal stem cells (UC-MSC) to enhance the regeneration of pulp-dentin complex in immature permanent teeth with irreversible pulpitis. METHODS: A total of 32 mandibular premolar teeth with immature apices in 5 dogs were used in this in-vivo randomized controlled trial (RCT). Eight healthy teeth without pre-existing pathosis served as the positive control samples and received no treatment, while in another 8 teeth, the pulp was completely extirpated (negative control). Class V cavities were prepared to induce inflammation in the remaining 16 teeth (groups 3 and 4) and the pulp was extirpated 2-4 mm short of the radiographic apex. Of the 16, the 8 teeth in group 4 received 1 mL of cord blood stem cells with a hydrogel scaffold. Blood clots were covered with mineral trioxide aggregates at the cementoenamel junction in the experimental groups, and teeth were filled with RMGI and composite. Three months later, block sections were removed for histologic evaluations for the evaluation of postoperative apical closure, degree of inflammation, and presence of normal pulp tissue. The data were statistically analyzed with the chi-square test (P < .05). RESULTS: All teeth with complete pulp extirpation demonstrated pulpal necrosis with no postoperative closure of their apices, while apical closure was seen in all the teeth in the remaining groups. There was a statistically significant (P < .001) difference in the presence of inflammation and normal pulp tissue between the experimental groups. The teeth in group 3 showed normal pulp tissue extending to the level of MTA, but there was inflammation within the canal space. In contrast, the teeth in the UC-MSC group demonstrated organized, normal pulp tissue with no inflammation. CONCLUSION: Based on these results, the regeneration of the pulp-dentin complex is possible with no inflammation when UC-MSCs are used and 2-4 mm of the apical pulp remains intact in immature teeth with irreversible pulpitis.

Expression of Selected Inflammatory Mediators with Different Clinical Characteristics of Pulpal Inflammation.

INTRODUCTION: Accurately diagnosing the state of dental pulp is crucial when addressing tooth pain to determine the best treatment approach. This study aimed to investigate the concentration of inflammatory mediators in the dental pulp of mature teeth that have been exposed via caries but show no signs of apical periodontitis. METHODS: Samples of pulpal blood from adults with mature teeth responsive to pulp testing and have carious pulp exposures were obtained. These samples were analyzed for 12 inflammatory cytokines and other inflammatory proteins using the Luminex assay platform. Clinical factors were correlated with cytokine levels, and statistical analysis was performed to evaluate the impact of these factors on cytokine expression. RESULTS: Of the 36 patients that were included, 44.44% took pain medications, 33.33% had prolonged pulpal bleeding, 41.67% felt spontaneous pain, and 72.22% were diagnosed with symptomatic irreversible pulpitis. Significant correlations existed between presenting pain scores and levels of interleukin (IL)-1α, IL-6, and IL-8 (P < .05). Factors like analgesic medication intake, pain to percussion, pain to thermal testing, spontaneous pain, and nocturnal pain were significantly associated with higher levels of specific inflammatory proteins. No significant associations were observed with pain to palpation, bleeding time, or pulpal diagnosis. CONCLUSIONS: Inflammatory proteins, including cytokine levels may play a critical role in characterizing pulpal inflammation. Future studies should investigate the role of these potential biomarkers in determining the diagnosis of pulpitis and the prognosis of vital pulp therapy.

The effect of hard tissue defects on the clinical outcome of endodontic microsurgery: a systematic review and meta-analysis.

OBJECTIVES: The purpose of this systematic review was to appraise the existing literature on the effect of hard tissue defects on the clinical outcome of endodontic microsurgery (EMS). METHODS: MEDLINE (PubMed), Embase, Web of Science, Cochrane Library and grey literature were searched from January 2000 to May 2023. Study selection and data extraction were performed in duplicate. Eligible studies were critically appraised for the risk of bias using the Cochrane Risk of bias tool. The quality of evidence was assessed using GRADE. Review Manager (RevMan Computer program Version 5.4, The Cochrane Collaboration, 2020) was utilized and the Mantel Haenszel fixed or random effects model was applied, depending on the heterogeneity of the studies. Meta-analysis was performed to estimate the Risk ratio (RR) and 95% Confidence Interval (CIs) to correlate the effects of these factors on treatment outcomes. RESULTS: Nineteen studies were included. The EMS overall pooled success rate was 84.5%. Five characteristics of hard tissue were identified. The size of the lesion (Small ≤ 5 mm: 78.4% vs. Large > 5 mm: 63.3%, RR = 1.12, 95% CI 1.00-1.26, P ≤ .05), significantly affected the outcomes of EMS. Endodontic lesions exhibited slightly better outcomes than endodontic-periodontal lesions (81.4% vs. 68.2%, RR = 1.14 95% CI 0.98-1.33, P > .05). Cases with the height of the buccal bone > 3 mm also exhibited slightly better outcomes (91.5% vs. 71.4%, RR = 1.20, 95% CI 0.88-1.62, P > .05). Additionally, through and through lesions exhibited better outcomes when grafting was completed during the EMS procedure both in 2D (RR = 1.12 95% CI 0.97-1.29, P > .05) and 3D evaluation ((RR = 1.28 95% CI 0.69-2.37 P > .05). The overall quality of evidence was graded as low to high. CONCLUSION: With a low to high quality of evidence, the size of the lesion is a key prognostic variable that significantly affects the outcome of EMS, as lesions ≤ 5 mm exhibit better outcomes as compared to larger lesions. CLINICAL SIGNIFICANCE: The presence of hard tissue defects can affect the outcome of endodontic microsurgery (EMS). The presented data can aid the clinicians' decision-making process by examining certain pre-operative prognostic variables, when considering EMS as a treatment option. Clinical cases with more favorable hard tissue characteristics lead to a better prognosis in EMS.

The efficacy of mouthwashes in reducing SARS-CoV-2 viral loads in human saliva: A systematic review.

This systematic review aimed to evaluate existing randomized controlled trials (RCT) and cohort studies on the efficacy of mouthwashes in reducing SARS-CoV-2 viral loads in human saliva. Searches with pertinent search terms were conducted in PubMed, MEDLINE, Scopus, and Web of Science databases for relevant records published up to Oct 15, 2022. Google Scholar and ProQuest were searched for grey literature. Manual searches were conducted as well for any pertinent articles. The protocol was prospectively registered at PROSPERO (CRD42022324894). Eligible studies were critically appraised for risk of bias and quality of evidence to assess the efficacy of mouthwash in reducing the SARS-CoV-2 viral load in human saliva. Eleven studies were included. The effect on viral load using various types of mouthwash was observed, including chlorhexidine (CHX), povidone-iodine (PI), cetylpyridinium chloride (CPC), hydrogen peroxide (HP), ß-cyclodextrin-citrox mouthwash (CDCM), and Hypochlorous acid (HCIO). Eight articles discussed CHX use. Five were found to be significant and three did not show any significant decrease in viral loads. Eight studies reviewed the use of PI, with five articles identifying a significant decrease in viral load, and three not showing a significant decrease in viral load. HP was reviewed in four studies, two studies identified significant viral load reductions, and two did not. CPC was reviewed in four studies, two of which identified significant viral load reductions, and two did not. CDCM was reviewed in one article which found a significant decrease in viral load reduction. Also, HCIO which was evaluated in one study indicated no significant difference in CT value. The current systematic review indicates that based on these eleven studies, mouthwashes are effective at reducing the SARS-CoV-2 viral load in human saliva. However, further studies should be performed on larger populations with different mouthwashes. The overall quality of evidence was high.

Histopathological Investigation of Dental Pulp Reactions Related to Periodontitis.

OBJECTIVE: Since the 1960s, there has been contradictory evidence regarding the association between periodontal pathology and the status of the pulp. The purpose of this study was to evaluate the histopathological changes of pulp tissue with severe periodontal disease, including vertical bone loss involving the major apical foramen, and compared them with the histological pulpal status of teeth with healthy periodontium. METHODS: This case-controlled study included 35 intact teeth with severe periodontitis of hopeless prognosis (test group) and 35 teeth without periodontitis extracted for orthodontic reasons (control group). For each tooth, periodontal and endodontic parameters such as probing depth and pulpal vitality were recorded, and the pulp tissue was evaluated histologically. The data were analysed with a significance level of 0.05. RESULTS: Vital pulp was observed in all specimens of both groups (P=1). Pulpal inflammation in the apical portion was observed in 81.71% of the severe periodontitis group, whereas all teeth in the control group demonstrated no signs of pulpal inflammation. Dystrophic calcification and pulp stones were observed in 7.5% of the periodontitis group and 5.7% of the healthy group (P>0.05). Pulp fibrosis was observed in 22.8% of the periodontitis group and 2.8% of the control group (P=0.012). Pulpal necrosis was not noted in either group. In the periodontitis group, internal resorption was present in 22.8% of cases (P=0.005) and external resorption was present in 80% of cases (P<0.001). In the control group, no internal or external resorption was observed in any of the specimens. No differences were noted in the study patients with regard to sex or age. CONCLUSION: Periodontal disease does not significantly affect pulp vitality and pulpal calcifications. However internal and/or external resorption was significantly different between the two groups as well as apical inflammation and pulp fibrosis.

Prognosis of Vital Pulp Therapy on Permanent Dentition: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

INTRODUCTION: The aim of this systematic review was to evaluate the existing randomized controlled trials (RCTs) on the safety and efficacy of vital pulp therapy (VPT) and to analyze the outcomes of VPT performed with a variety of pulp-capping materials and techniques. METHODS: MEDLINE (PubMed), Embase, Cochrane Library, and gray literature were searched (January 2000-March 2021). Study selection and data extraction were performed in duplicate. Eligible RCTs were critically appraised for risk of bias and quality of evidence and were meta-analyzed to estimate the treatment effects. RESULTS: Fourteen studies were included. The pooled success rate of VPT using contemporary capping materials such as mineral trioxide aggregate (MTA) or calcium silicate-based materials (CSMs) was 93.2% (95% confidence interval [CI], 91.6%-94.9%). Multiple subgroup analyses by different etiologies, procedure types, developmental stages of teeth, and preoperative diagnoses were performed. Analyses presented low certainty of evidence. No significant difference was noted between MTA and CSM at 12 months or a longer follow-up (risk ratio = 0.99; 95% CI, 0.95-1.03) with low certainty of evidence. Laser-assisted VPT failed to show significantly better outcomes than conventional VPT (risk ratio = 1.19; 95% CI, 0.99-1.49) with very low certainty of evidence. CONCLUSIONS: When MTA or CSM was used as a capping material, VPT was 93% successful. The techniques, etiologies, developmental stages of teeth, and preoperative diagnosis had no significant influence on treatment outcomes. No major adverse effects (except discoloration associated with the use of MTA) were identified. The overall quality of evidence was low.

Valacyclovir in Pain Management of Acute Apical Abscesses: A Randomized Placebo-Controlled Double-Blind Pilot Study.

INTRODUCTION: The acute (symptomatic) apical abscess is characterized by pulp necrosis, rapid onset, spontaneous pain, percussion pain, pus formation, and tissue swelling. The etiopathology of acute apical abscesses includes active (lytic) herpesviruses and gram-negative anaerobic bacteria. The present study examined the potential of valacyclovir, an anti-herpesvirus agent, and systemic amoxicillin to manage the pain of acute apical abscesses. METHODS: Twenty emergency patients with moderate to severe apical abscess pain received randomly either amoxicillin (1 g immediate dose followed by 500 mg, 4 times a day, totally 7 days) + valacyclovir (2 g immediate dose followed by 500 mg, twice a day, totally 3 days) ("valacyclovir" group, 10 patients) OR amoxicillin (1 g immediate dose followed by 500 mg, 4 times a day, totally 7 days) + placebo ("placebo" group, 10 patients). Daily telephone calls during the 6-day follow-up period assessed pain level on a numeric rating scale and analgesic intake. The Mann-Whitney and the Friedman statistical tests analyzed the outcome data. RESULTS: At the baseline examination, all 10 valacyclovir and 9 placebo patients exhibited moderate to severe pain and 18 patients needed pain medication. On the first day after baseline, the valacyclovir group showed 2 patients with moderate/severe pain and 1 patient on pain medication, but the placebo group revealed as many as 8 patients with moderate/severe pain and 9 patients on pain medication. The difference in pain level and analgesic usage between the valacyclovir and the placebo group remained statistically significant during the entire post-baseline study period (P < .05). CONCLUSION: The present study points to valacyclovir as a promising adjunctive agent in pain control with acute apical abscesses.

Clinical and Histological Evaluation of Tissue Healing in Beveled or Perpendicular Vertical Releasing Incision.

OBJECTIVES: The aim of this investigation was to evaluate the clinical and histological differences in wound healing between beveled and perpendicular vertical releasing incisions in dogs. MATERIAL AND METHODS: Four male mongrel dogs were used in this investigation. In each quadrant, a vertical releasing incision was made on either the mesial or the distal aspect of the cuspid teeth of each animal all on the same day. The sites were randomly selected to either receive a beveled incision or a perpendicular incision. A sulcular muco-periosteal flap was raised, reapproximated, and then sutured using 3-0 Vicryl. The animals were evaluated daily for the first week, and then at different time intervals during this investigation. One animal was killed at each time interval of 9, 14, 21, and 28 days after surgery. One animal was killed at each time interval, and a bone block consisting of the cuspid teeth and their surrounding bone and soft tissues was harvested, formalin fixed, and paraffin embedded. Samples were sectioned serially and stained with hematoxylin-eosin. Specimens were evaluated using a microscope with magnification ranging from ×10 to ×400 by a histopathologist. Four indices were used for histologic evaluation. RESULTS: At day 9 after surgery, a visible groove was seen in the marginal tissues of both perpendicular and beveled incisions. At day 9, both of the histologic sections showed less organized connective tissue and capillary networks with no significant difference in inflammation. In the 14-day samples, a depression was still present at the perpendicular incision sites, but not in the beveled incision group, where the groove was not visualized at all. In the 21- and 28-day samples, irregular capillary arrangements were seen in the connective tissue of the perpendicular incision groups with completely healed epithelium. There were no statistically significant differences noted histologically between the beveled and perpendicular incision groups noted at 9, 14, 21, or 28 days (P > .05). CONCLUSION: Based on these findings, it appears that clinical and histologic healing of beveled or perpendicular releasing incisions are similar 28 days after surgery.

Regeneration of Pulp-Dentin Complex in a Tooth with Symptomatic Irreversible Pulpitis and Open Apex Using Regenerative Endodontic Procedures.

Regenerative endodontic procedures are undertaken on permanent teeth with necrotic pulps and open apices in an attempt to resolve symptoms, to allow the continued development of the root(s), and to reestablish vitality. The available histologic analysis of these teeth has, in the majority of studies, shown that true regeneration of the pulp-dentin complex is not achieved. A recent investigation using an animal model outlined a procedure wherein pulpal amputation a few millimeters short of the apex followed by evoked bleeding allowed the complete regeneration of the normal pulp-dentin complex in immature vital teeth of ferrets. By implementation of this procedure, we report successful pulp regeneration outcome evidenced by continued root development and a positive response to pulp vitality tests in a maxillary central incisor with an open apex diagnosed with symptomatic irreversible pulpitis.

Identification of microorganisms in irreversible pulpitis and primary endodontic infections with respect to clinical and radiographic findings.

OBJECTIVES: The aim of this study was to evaluate the composition of microbiota of irreversible pulpitis and primary endodontic infections with respect to clinical and radiographic findings by performing cultures and 16s rDNA sequencing in Iranian patients. MATERIAL AND METHODS: In this prospective cross-sectional study, samples were collected from 41 root canals for 4 main groups of patients. Bacterial identification was performed by the polymerase chain reaction (PCR) and 16s rDNA sequencing of aerobic and anaerobic cultivable colonies taken from patients' culture plates. Additionally, the presence of 13 bacterial species and 3 nonbacterial species was also explored using PCR and species-specific primers. RESULTS: Sixteen microbial species, 1 fungus (Candida albicans), and 1 virus (Herpes simplex virus) were discovered and isolated. Species with the highest prevalence were Dialister invisus (68.3%), Porphyromonas gingivalis (58.8%), Streptococcus salivarius (58.5%), and Treponema denticola (56.1%). Lysinibacillus fusiformis (19.1%) was detected in the root canals for the first time. Candida albicans was seen in 11 cases (26.8%). Herpes simplex virus (HSV) was seen in 4 patients (9.8%). CONCLUSIONS: Our results suggest that Gram-negative anaerobic oral bacteria are the majority of the microbes in primary endodontic infections. Various combinations of bacterial species were related to different clinical and radiographic conditions. Lysinibacillus fusiformis was detected for the first time in primary endodontic infections. CLINICAL RELEVANCE: The results of this investigation might help clinicians choose to identify suspected endodontic pathogens in the etiology of each form of pulpal and periradicular diseases to determine the best therapeutic measures.

Effect of Er:YAG laser etching on topography, microstructure, compressive strength, and bond strength of a universal adhesive to calcium silicate cements.

OBJECTIVE: To evaluate the effect of Er:YAG etching on topography, microstructure, compressive strength, and shear bond strength (SBS) of All-Bond Universal adhesive to mineral trioxide aggregate-Angelus (AMTA) and Biodentine (BD). METHODS AND MATERIALS: Sixty cylindrical specimens of each cement (AMTA and BD) in five groups were prepared and stored for 72 h. The control groups were non-etched, and four other groups were acid-etched and laser-etched with a pulse energy of 60, 80, or 100 mJ, followed by compressive strength testing. Surface micromorphology and topography were evaluated. Similar groups were bonded using All-Bond Universal with self-etch and etch-and-rinse (acid-etch) approaches, and laser-etch 60, 80, and 100 mJ, and SBS was tested. Data were analyzed using two-way and one-way ANOVA and the Bonferroni post hoc tests (α = 0.05). RESULTS: BD had a significantly higher compressive strength and SBS (except for laser-etch 100) compared to AMTA, regardless of the etching method (p < 0.001). Acid etching and laser etching 100 of both cements and laser etching 80 of BD alone produced a significantly lower compressive strength than that for the other groups. Contrary to BD, for AMTA, all the treatments significantly increased SBS compared to that of the self-etch group. CONCLUSIONS: Etching of AMTA was needed for stronger bonding; laser etching with 60 or 80 mJ without compromising compressive strength was recommended. Etching not only did not improve bonding ability of BD, but it also negatively affected the strength of BD. CLINICAL RELEVANCE: To achieve successful combined calcium silicate cement-resin material restoration, an adequate bond between the materials is mandatory. This might be provided with the ultramild adhesive through laser etching without compromising compressive strength, depending on cement composition and laser energy level used.

Correction to: Effect of Er:YAG laser etching on topography, microstructure, compressive strength, and bond strength of a universal adhesive to calcium silicate cements.

Figure 2 was incorrect in the original published version of this article. Correct figure in presented here. The original article has been corrected.

Antimicrobial efficacy of clindamycin and triple antibiotic paste as root canal medicaments on tubular infection: An in vitro study.

This study compared the antibacterial effect of 2% clindamycin and 2% and 100% concentration of triple antibiotic paste (TAP) on an Enterococcus faecalis biofilm. Dentinal tubules of 100 root specimens were infected and randomly assigned to five groups. A total of 1000 mg mL-1 of TAP, 20 mg mL-1 of TAP and clindamycin, calcium hydroxide or methylcellulose (control) were placed in the root canal for 1 week. After treatment, dentine shavings were collected from 200 and 400 µm dentine depth and the number of colony-forming units (CFU) per mg was determined. Reduction in viable bacteria in first three groups was significantly better than calcium hydroxide and control groups. However, the antimicrobial effectiveness among these three groups was not significantly different from each other. There was no significant difference between data at 200 and 400 µm in all groups except the Ca(OH)2 group. The antibiofilm effect of clindamycin was comparable with TAP, so it may be used instead of TAP.

Impact of Access Cavity Design and Root Canal Taper on Fracture Resistance of Endodontically Treated Teeth: An Ex Vivo Investigation.

INTRODUCTION: The susceptibility of endodontically treated teeth (ETT) to fracture is mainly associated with the loss of tooth structure. This study evaluated the effect of the access cavity design and taper preparation of root canals on ETT fracture resistance of maxillary molars. METHODS: For tapering assessment, 30 sound distobuccal roots of maxillary molars were randomly assigned to 1 of 3 groups (n = 10): a .04 taper, a .06 taper, or a .08 taper. Endodontic canal preparations were performed using the Twisted Files rotary system (Kerr Co, Glendora, CA). In addition, 48 intact maxillary first and second molars were randomly assigned to 1 of 3 groups (n = 16) for cavity preparation approaches: intact teeth, traditional access cavity (TAC), or conservative access cavity (CAC). Fracture resistance was tested using a universal testing machine. For statistical analysis, the level of significance was P ≤ .05. RESULTS: The .04 taper instrumentation had the highest fracture resistance (259.61 ± 52.06), and the .08 taper had the lowest (168.43 ± 59.63). The .04 and .06 groups did not differ significantly (P > .05); however, these groups differed significantly from the .08 group (P ≤ .05). Regarding the cavity preparation approaches, the 3 groups of intact teeth, CAC, and TAC showed fracture resistance mean values of 2118.85 ± 336.97, 1705.69 ± 591.51, and 1471.11 ± 435.34, respectively, with no significant difference between the CAC and TAC groups (P > .05). CONCLUSIONS: Increasing the taper of the root canal preparation can reduce fracture resistance. Moreover, access cavity preparation can reduce resistance; however, CAC in comparison with TAC had no significant impact.

Comparison of Postoperative Pain after Root Canal Preparation with Two Reciprocating and Rotary Single-File Systems: A Randomized Clinical Trial.

INTRODUCTION: Root canal preparation techniques may cause postoperative pain. The aim of the present study was to compare the intensity of postoperative pain after endodontic treatment using hand files, single file rotary (OneShape), and single file reciprocating (Reciproc) systems. METHODS AND MATERIALS: In this single-blind, parallel-grouped randomized clinical trial a total of 150 healthy patients aged between 20 to 50 years old were diagnosed with symptomatic irreversible pulpitis of one maxillary or mandibular molars. The teeth were randomly assigned to three groups according to the root canal instrumentation technique: hand files (control), OneShape and Reciproc. Treatment was performed in a single visit by an endodontist. The severity of the postoperative pain was assessed by the visual analogue scale (VAS) after 6, 12, 24, 48 and 72 h. Data were analyzed using the Kruskal-Wallis and Mann-Whitney U tests. RESULTS: The patients in control group reported significantly higher mean postoperative pain intensity at 12, 24, 48, and 72 h compared to the patients in the two other groups (P<0.05). There was no significant difference in mean intensity of postoperative pain between Reciproc and OneShape at 5 time points (P>0.05). CONCLUSION: The instrumentation kinematics (single-file reciprocating or single-file rotary) had no impact on intensity of postoperative pain.

Subcutaneous tissue responses to three endodontic irrigants: a comparative study.

INTRODUCTION: This study aimed to compare the subcutaneous tissue responses to MTAD (mixture of a tetracycline isomer, an acid, and a detergent), 17% EDTA, and 2.6% NaOCl. MATERIALS AND METHODS: Thirty-six Wistar albino rats were used for this study. Test solutions were injected subcutaneously into predetermined areas on the animal dorsum. The rats were then randomly divided into three groups of twelve each and sacrificed at 2 hours, 2 days, and 2 weeks. The severity of inflammation induced by each irrigant at different time intervals was assessed histologically. The data were analyzed using Kruskal-Wallis and Friedman tests. RESULTS: The difference in severity of inflammatory reactions induced by tested irrigants at the different time intervals was statically significant (P<0.05). There was no significant difference between the severity of inflammation induced by MTAD and 2.6% NaOCl at the various time intervals (P>0.05). Subcutaneous tissue responses to MTAD were not different from those observed in 17% EDTA specimens at 2-hour and 2-day intervals (P>0.05). CONCLUSION: Under the conditions of this study, MTAD has the same toxicity as 2.6% NaOCl.