Investigation of the effectiveness of sonic, ultrasonic and new laser-assisted irrigation activation methods on smear removal and tubular penetration.

The aim of this study was to examine the effectiveness of different irrigation activation methods on smear layer removal and tubular penetration. One hundred-five distal roots of mandibular molar teeth in total; 50 for smear removal efficiency (n = 10) analysis using scanning electron microscopy (SEM), and 55 roots were used to examine tubular penetration using confocal laser scanning microscope (CLSM). Five different irrigation activation methods were used in this study; conventional needle irrigation (CNI), sonic irrigation device of EDDY, passive ultrasonic irrigation (PUI), PIPS and SWEEPS techniques, which are two different laser irrigation activation methods. The obtained data were statistically analyzed and the significance level was determined as p < 0.05. At the apical level, the cleanest canal walls were observed when laser methods PIPS and SWEEPS were used, while in the middle third, there was no difference in smear removal efficiencies between all groups except for the CNI (p > 0.05). Penetration depths and percentages increased from apically to coronally in all groups. The PUI and EDDY generally showed similar penetration depths and percentages to the CNI, except at the coronal root level (p > 0.05). In all groups, when PIPS was used, it showed greater penetration depth and percentage (p < 0.05). PIPS and SWEEPS techniques showed lowest and similar smear scores compared to PUI and EDDY in the apical area where access and effectiveness of the irrigation solution are difficult.

The Effect of Different Final Irrigation Regimens on the Dentinal Tubule Penetration of Three Different Root Canal Sealers: A Confocal Laser Scanning Microscopy Study In Vitro.

This study evaluated the effects of different final irrigation regimens on the dentin tubule penetration of three different root canal sealers using confocal laser scanning microscopy (CLSM). A total of 160 single-rooted extracted mandibular premolar teeth were divided into five groups (n = 32 each) according to the solution used in the final rinse protocol, as follows: 17% ethylenediaminetetraacetic acid (EDTA) (group 1), 17% EDTA and 2% chlorhexidine gluconate (CHX) (group 2), 7% maleic acid (MA) (group 3), 7% MA and 2% CHX (group 4), and 5.25% NaOCl (group 5). Two roots from each group were examined under scanning electron microscopy (SEM) to visualize smear layer removal. Experimental groups were then split randomly into three subgroups (n = 10) and obturated using a cold lateral condensation technique with 0.1% rhodamine B-labelled sealers [either AH Plus (group A), EndoREZ (group E), or Tech BioSealer Endo (group T)] and gutta-percha. Specimens were sectioned and observed by CLSM to evaluate the percentage and maximum depth of sealer penetration at the apical, middle, and coronal levels. Statistical comparison was performed on grouped (apical, middle, and coronal segments) and ungrouped data using two-way ANOVA with Bonferroni post hoc test (p < 0.01). AH Plus showed the greatest tubule penetration while Tech BioSealer Endo showed the least. Resin-based sealers displayed deeper and more consistent penetration. CHX irrigation positively influenced sealer tubule penetration.

Odontogenic effects of two calcium silicate-based biomaterials in human dental pulp cells.

BACKGROUND: The goal of treating exposed pulp with an appropriate pulp capping material is to promote the dentinogenic potential of the pulpal cells. There have been recent attempts to develop more effective pulp-capping materials. OBJECTIVES: The aim of this study was to evaluate the effect of newly developed calcium silicate-based material on odontogenic differentiation of primary human dental pulp cells (HDPCs), in comparison with a contemporary calcium silicate-based material. MATERIAL AND METHODS: Human dental pulp cells isolated from dental pulps were cultured in standard culture conditions in Dulbecco's Modified Eagle's Medium (DMEM) and then the effects of Micro-Mega mineral trioxide aggregate (MM-MTA) (Micro-Mega, Besançon, France) and ProRoot MTA (MTA) (Dentsply Sirona, Tulsa, USA) (positive control) were evaluated on HDPCs at 1, 7 and 14 days. Untreated cells were used as a negative control. Odontoblastic differentiation was assessed by alkaline phosphatase (ALP) activity. Runtrelated transcription factor 2 (RUNX2), alkaline phosphatase liver/bone/kidney (ALPL), bone morphogenetic protein 2 (BMP2), dentin sialophosphoprotein (DSPP), and Distal-less homeobox 3 (DLX3), as odontoblastic/ osteoblastic expression markers, were evaluated by semi-quantitative real-time polymerase chain reaction (RT-PCR) analysis. Calcium levels of culture media were also determined. RESULTS: The MM-MTA group significantly increased the expression of BMP2 compared with that of the MTA group at 3 different time periods (p < 0.05). The up-regulation of ALPL between day 1 and 14 and the up-regulation of DSPP between day 7 and 14 were significant in both groups (p < 0.05). Micro-Mega MTA and MTA exhibited similar messenger RNA (mRNA) expression levels of ALPL, DSPP, RUNX2, DLX3, and ALP activities, as well as calcium levels. CONCLUSIONS: Based on the cell responses observed in this study, MM-MTA might be used efficiently in dental pulp therapy as a potential alternative to MTA.

A Comparison of Er:YAG Laser with Photon-Initiated Photoacoustic Streaming, Nd:YAG Laser, and Conventional Irrigation on the Eradication of Root Dentinal Tubule Infection by Enterococcus faecalis Biofilms: A Scanning Electron Microscopy Study.

This study evaluated the antimicrobial efficacy of Er:YAG laser activation with photon-initiated photoacoustic streaming (PIPS), Nd:YAG laser disinfection, and conventional irrigation on Enterococcus faecalis biofilms using scanning electron microscopy (SEM). Biofilms were grown on 110 root halves and divided into the following: Groups 1 and 2 (saline and 1% NaOCl with apical position of PIPS, resp.), Groups 3 and 4 (saline and 1% NaOCl with coronal position of PIPS, resp.), Groups 5 and 6 (Nd:YAG laser after saline and 1% NaOCl irrigation, resp.) and Groups 7, 8, and 9 (conventional irrigation with 1% NaOCl, 6% NaOCl, and saline, resp.). SEM images of the apical, middle, and coronal levels were examined using a scoring system. Score differences between Groups 1 and 2 were insignificant at all levels in the remaining biofilm. Group 4 had significantly greater bacterial elimination than Group 3 at all levels. Differences in Nd:YAG laser irradiation between Groups 5 and 6 were insignificant. Groups 7 and 8 were insignificantly different, except at the middle level. Saline group had a higher percentage of biofilms than the others. In this study, PIPS activation with NaOCl eliminates more E. faecalis biofilms in all root canals regardless of the position of the fiber tip.

Comparison of Three Final Irrigation Activation Techniques: Effects on Canal Cleanness, Smear Layer Removal, and Dentinal Tubule Penetration of Two Root Canal Sealers.

OBJECTIVE: The aim of this study was to compare three final irrigation activation techniques with respect to their effects on debridement efficacy, smear layer removal, and dentinal tubule penetration of two different root canal sealers. BACKGROUND DATA: Different applications to improve the delivery of irrigating solutions within the root canal system are currently being investigated, as not all of the mechanisms and effects of these techniques have been clearly identified. MATERIALS AND METHODS: One hundred forty-two single-rooted teeth were randomly divided into a control group and three experimental groups based on the irrigant activation technique used: EndoVac (EV) system, photon-induced photoacoustic streaming (PIPS), and conventional syringe irrigation (CSI). Thirteen specimens from each experimental group were evaluated for debris and smear layer removal using scanning electron microscopy. The remaining 30 specimens per group were divided into two subgroups according to the root canal sealer used: AH Plus and TotalFill BC. The maximum depth and total percentage of sealer penetration were measured using confocal laser scanning microscopy. RESULTS: PIPS resulted in significantly less debris in the middle third of the root canal compared with CSI (p < 0.01). There were no significant differences among CSI, EV, and PIPS concerning debris removal at coronal and apical levels or smear layer removal at all levels (p > 0.05). TotalFill BC use after final irrigation with EV and CSI at 2 mm or PIPS at 5 mm exhibited a significantly higher percentage of sealer penetration than that with AH Plus (p < 0.05). When AH Plus was used, PIPS allowed deeper sealer penetration than CSI at 2 mm (p < 0.05). CONCLUSIONS: The effects of EV, PIPS, and CSI on debridement efficacy, smear layer removal, and dentinal tubule penetration were almost comparable. TotalFill BC showed superior tubular penetration than AH Plus.

The evaluation of endodontic flare-ups and their relationship to various risk factors.

BACKGROUND: To evaluate the incidence of flare-ups and identify the risk factors including age, gender, tooth type, number of root canals, initial diagnosis, the type of irrigation regimen, treatment modality and the number of visits, in patients who received root canal treatment from January 2002 to January 2008. METHODS: Records of 1819 teeth belonging to 1410 patients treated by 1 endodontics specialist during 6-year period were kept. Patient, tooth, and treatment characteristics were evaluated and the relationships between these characteristics and flare-ups were studied. Statistical analysis was carried out by using Pearson Chi-square test, Fisher's Exact test, and Binary Logistic regression analyses. RESULTS: The incidence of flare-ups was 59 (3.2 %) out of 1819 teeth that received endodontic therapy. Pulpal necrosis without periapical pathosis was the most common indication for flare-up (6 %) (p < 0.01). Teeth undergoing multiple visits had a higher risk of developing flare-ups compared to those with single appointments (OR: 3.14, CI: 1.414-7.009, p < 0.01). There were also no statistically significant differences in the incidence of flare-ups regarding to age, gender, tooth type, number of root canals, treatment modality, and the irrigation solutions that used during the treatment. CONCLUSIONS: The incidence of flare-up is minimal when teeth are treated in one visit. Absence of a periapical lesion in necrotic teeth is a significant risk factor for flare-ups.

Extrusão cirúrgica de um dente com fratura coronorradicular: acompanhamento de 3.5 anos / Surgical extrusion of a crown-root fractured tooth: 3.5-year follow-up

Introdução: diferentes abordagens de tratamento sãoindicadas para dentes com fraturas coronorradiculares.A extrusão cirúrgica é um procedimento único, que envolveo reposicionamento imediato do dente à sua posiçãonormal. Objetivo: o objetivo deste relato de casofoi apresentar o tratamento multidisciplinar de um pré--molar superior com fratura coronorradicular. Métodos:neste caso, um pré-molar superior fraturado foi tratadopor meio da técnica de extrusão cirúrgica. Após aresolução da lesão periapical, o dente foi restauradocom coroa metalocerâmica. Resultados: após 3,5 anosde acompanhamento, o dente não apresentou sintomasou sinais clínicos e radiográficos de reabsorção radicularprogressiva, de perda óssea marginal ou de doença periapical.Conclusão: os resultados favoráveis do casodemonstram que a extrusão cirúrgica pode ser uma alternativade tratamento para os protocolos existentes.

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.

Rehydration of a reattached fractured tooth fragment after prolonged dehydration.

Crown fractures of the anterior teeth are one of the most common outcomes of trauma to the orofacial region. The reattachment of dental fragments is a conservative treatment and should be considered a primary treatment choice in the restoration of anterior tooth fractures. This article presents a clinical technique for the restoration of a fractured maxillary lateral incisor by reattaching the tooth fragment that was kept in dry conditions for five days with the aid of adhesive dentistry. The esthetic compromise of white color (due to excessive dehydration of the segment) was reconciled after one month of service in the mouth by regaining the natural color by rehydration. The one-year clinical evaluation revealed a successful outcome for this technique, and the patient was pleased with the esthetic results of the conservative treatment modality.

Evaluating the potential key factors in assessing the morphology of mesiobuccal canal in maxillary first and second molars.

The purpose of this study was to provide further information on the morphology of the root canals and pulp chambers of 100 maxillary first and 100 maxillary second molars, with particular reference to the anatomical relationship of the root canal patterns and the distance between mesiobuccal (MB) and mesiolingual (ML) orifices. Each transverse section was digitally imaged to measure the interorificial distance using a stereomicroscope. The angles of primary curvatures were determined in both buccolingual (clinic view, CV) and mesiodistal (proximal view, PV) directions and the canal configuration of the MB root was classified according to the Weine classification. The rhomboidal pulp chamber floor morphology predominated in each tooth type. The mean interorificial distance in both maxillary first and second molars was significantly shorter in type II compared with type III (P < 0.05). The interorificial distance was correlated with the primary curvature of MB canal in PV in maxillary first molars (P < 0.05), whereas the primary curvature of ML canal in CV was correlated with the primary curvature of ML canal in PV in maxillary second molars (P < 0.01). The evaluation of interorificial distance in both types of maxillary molars and the curvature of ML canal in CV in maxillary second molar can give valuable information to the clinician.

An in vitro evaluation of the apical sealing ability of new polymeric endodontic filling systems.

OBJECTIVE: The objective of this study was to compare the short-term sealing abilities of recently introduced polymeric endodontic filling systems. STUDY DESIGN: Root canals of 120 extracted and decoronated human single-rooted teeth were instrumented using crown-down technique with HERO Shaper rotary instruments. The roots were divided randomly into 8 groups (6 experimental and 2 control groups of 15 roots each) and filled with different combinations of core and sealer as follows: group 1, RealSeal/Resilon; group 2, RealSeal/Herofill; group 3, Hybrid Root Seal/Resilon; group 4, Hybrid Root Seal/Herofill; group 5, MM-Seal/Resilon; group 6, MM-Seal/Herofill; group 7, positive controls (Herofill only); group 8, negative controls. Apical leakage quantity was evaluated after 1 week by using a fluid filtration model. For each sample, measurements of fluid movement were recorded at 2-minute intervals for a total of 8 minutes, and then averaged. The data were calculated and analyzed using the Kolmogorov-Smirnov test, 1-way analysis of variance (ANOVA), and the Tukey test. Significance was set at P less than .05. RESULTS: Multiple paired comparisons (Tukey test) showed that, of all the groups, MM-Seal/Herofill combination exhibited the least microleakage, and RealSeal/Herofill combination ranked second in this regard. The mean leakage values for the RealSeal/Resilon and MM-Seal/Resilon combinations were both significantly higher than the means for the other 4 experimental groups (P < .01). Hybrid Root Seal combined with Resilon resulted in significantly less microleakage than Hybrid Root Seal combined with Herofill (P = .001). CONCLUSION: The results suggest that the sealing properties of epoxy-resin-based sealer (MM-Seal) combined with gutta-percha (Herofill) are superior to those of methacrylate-based sealers (Hybrid Root Seal and Realseal) combined with Resilon.

Push-out bond strength and SEM evaluation of new polymeric root canal fillings.

OBJECTIVE: The objective of this study was to compare the interfacial strengths and failure modes of new polymeric endodontic obturation systems consisting of different material combinations. STUDY DESIGN: Extracted human single-rooted teeth (n = 105) were instrumented using HERO Shaper rotary instruments and obturated with different combinations of core and sealer as follows: group 1, RealSeal/Resilon; group 2, RealSeal/Herofill; group 3, Hybrid Root Seal/Resilon; group 4, Hybrid Root Seal/Herofill; group 5, MM-Seal/Resilon; group 6, MM-Seal/Herofill; group 7 (control). Failure modes of root slices (1.00 +/- 0.05-mm thick) after push-out testing were examined with stereomicroscope and scanning electron microscopy. RESULTS: Hybrid Root Seal/Resilon combination had significantly greater bond strength than all the other groups (P < .001); RealSeal/Resilon combination proved to have the second highest bond strength (P < .001). Bond failure was mainly mixed failure in both adhesive and cohesive modes at the dentin/sealer interface. CONCLUSION: The push-out bond strengths of methacrylate-based sealers (Hybrid Root Seal and RealSeal) and thermoplastic synthetic-polymer-based core material (Resilon) combinations were higher than epoxy-resin-based sealer (MM-Seal) and gutta-percha (Herofill) combination.

Sealing capacity of a flowable composite, as a protective base, with different conditioning methods in nonvital bleaching.

OBJECTIVE: The purpose of this in vitro study was to determine the microleakage of a nano-flowable composite used as a protective base, applied with different conditioning methods in nonvital bleaching. MATERIALS AND METHODS: Forty root-filled teeth were divided into four treatment groups (n = 10 per group): group 1--Er:YAG laser etching + Adper Single Bond 2; group 2-37% phosphoric acid + Adper Single Bond 2; group 3--Adper Prompt L-Pop; and group 4--No treatment. A nano-flowable composite (Filtek Supreme Flow) base was used in each group. For a 24-h period, 40% hydrogen peroxide solution was applied to the pulp chambers, and they were subsequently subjected to a dye (silver nitrate) challenge for 4 h. After the dye was washed out with water, each tooth was cut in half and both halves were exposed to sunlight for 2 h to promote oxidation of the dye, turning it black. Finally the sections were examined under 4x magnification to determine the degree of leakage as assessed with a four-point scale. Statistical analysis was performed with the Mann-Whitney U test. RESULTS: There were no significant differences between groups 1, 2, and 3 (p > 0.05), but the teeth in group 4 had significantly higher microleakage scores than the teeth in the other groups (p < 0.05). CONCLUSION: Self-etching adhesive application, Er:YAG laser etching, and phosphoric acid etching combined with an adhesive system all showed similar microleakge scores when a nano-flowable composite was applied as a protective base in nonvital bleaching.

Assessment of possible risk indicators for apical periodontitis in root-filled teeth in an adult Turkish population.

OBJECTIVE: The objective of this study was to determine possible independent risk indicators of apical periodontitis (AP) in root-filled teeth in an adult Turkish population. STUDY DESIGN: This study included subjects older than 15 years who had 1 or more root-filled teeth examined at the Baskent University Faculty of Dentistry. A total of 812 root-filled teeth were evaluated in 425 individuals. AP was the dependent variable and age, gender, length and density of root fillings, presence of periodontal problems, posts, localization of tooth, and tooth type were identified as independent variables. Generalized Estimating Equation (GEE) models were used in statistical analysis. RESULTS: AP was detected on 148 teeth (18.2%) in 812 root-filled teeth. According to multiple GEE model, males were more likely to have AP than females. Of the dental variables, length of root fillings, periodontal problems and tooth type were significantly associated with AP. CONCLUSIONS: The present study indicates that to be male and dental variables including length of root fillings, periodontal problems, and molar teeth were significantly associated with AP.

Multidisciplinary approach to traumatized teeth: a case report.

Treatment of crown fractures often requires a multidisciplinary approach. In the anterior teeth, reestablishment of proper esthetics and function is quite important for the patient. However, crown-root fractures with fracture line below the gingival attachment or alveolar bone crest presents restorative difficulties. This case report presents a cervical tooth fracture that had been treated with minimal invasive approach with different disciplines. The tooth had endodontic treatment and a glass-fiber post, and a composite core was accomplished. Then, the tooth was extruded to the desired level with orthodontic forced eruption before definitive restoration.

Comparison of the area of resin-based sealer and voids in roots obturated with Resilon and gutta-percha.

The aim of this study was to compare the cross-sectional area of sealer plus voids of Epiphany sealer surrounding root fillings completed with Resilon cones and laterally compacted gutta-percha. The root canals of extracted human mandibular premolars were prepared to a final size of 40 (0.06 taper). The teeth were then randomly assigned into 2 groups (n = 12/group) for the filling procedures in conjunction with Epiphany sealer: group 1, Resilon cones, and group 2, gutta-percha. Horizontal sections were obtained every 1 mm up to 5 mm from the apical foramen. The sections were digitally photographed under magnification, and the cross-sectional area of the root canal and the area occupied by the sealer and voids were calculated, after which statistical comparisons were made. No differences were found between the sealer plus void or void area of Resilon or gutta-percha groups at any level of sectioning (P > .05). Comparisons within each obturation group showed that there was no significant difference between any level of sectioning with regard to the ratio of sealer plus void area or void area to that of the root canal (P > .05). Within the experimental conditions of the present study, both obturating techniques with the Epiphany sealer exhibited similar amounts of sealer and void area, regardless of the apical level of sectioning compared.

Re-attachment of a fractured tooth: a case report.

A 16-year-old patient who fractured her maxillary central incisors is presented. One of the original tooth fragments was available. The fracture was clean and there was no pulpal exposure. Juxtaposition of the fragment to the tooth showed that the margins of each fitted well against each other and no interfragmentary space was present. The fragment was re-attached with an adhesive bonding agent and the other tooth was restored with a resin composite. The esthetic result achieved in a single appointment was excellent. The tooth was vital and there was no change in the color of the tooth in 1-year recall.

Replantation after extended dry storage of avulsed permanent incisors: report of a case.

A 15-year-old boy lost his maxillary right and left central incisor teeth in a bicycle accident. He was referred to our clinic 1 week after the injury. The crown-root integrities of both the teeth were not damaged. Although the teeth were stored under dry conditions for 1 week, reimplantation of the teeth was planned to retain the teeth in the mouth for as long a period as possible because of the patient's age. Following the debridement and sterilization of root surfaces in 2.5% NaOCl, root canals were prepared and filled with calcium hydroxide. Then, about 2 mm of the apexes were resected to ensure that the roots easily seated in the alveolar socket and the prepared cavities in root ends were obturated with the amalgam. The teeth were placed into their respective sockets and splinted temporarily. The root canal therapy was completed 5 weeks later. Ankylosis was observed radiographically after 10 months. The patient is now 23 years old and he is still able to use both the central incisors functionally. However, there is a pink appearance on the cervical buccal surface of left central incisor because of progressive replacement resorption. In this case, the new treatment plan is to perform a permanent restoration with dental implants following the extraction of both teeth. Even though the long-term prognosis is uncertain, this treatment technique has provided an advantage for the patient in his adolescent period by maintaining the height of alveolar bone and making the provision of an aesthetically acceptable permanent restoration at a later age possible.

In vivo evaluation of the biocompatibility of a new resin-based obturation system.

OBJECTIVE: The aim of this study was to evaluate the in vivo biocompatibility of the new resin-based Epiphany-Resilon root canal filling system after implantation in rat connective tissue. STUDY DESIGN: Thirty-six female Wistar albino rats, 9 months old, weighing 200 to 220 g, were used to evaluate the biocompatibility. Four subcutaneous pockets were created in the back of the rats, and each material (Resilon, gutta-percha, a Teflon tube containing Epiphany, and an empty Teflon tube) was implanted into a specific dorsal site. The empty Teflon tubes were used as control. After 1, 4, and 8 weeks, the implants were removed with the surrounding tissues. The inflammatory tissue reactions were graded after a histopathologic examination. RESULTS: At each time period, there was practically no difference in the reaction of all the implant materials (P > .05). The intensity of the reaction had diminished by the 4-week observation period, and this reduction continued through the 8-week observation period. CONCLUSION: All the tested materials showed an acceptable biocompatibility.