Efficacy of Erbium, Chromium-doped Yttrium, Scandium, Gallium and Garnet Laser-activated Irrigation Compared with Passive Ultrasonic Irrigation, Conventional Irrigation, and Photodynamic Therapy against Enterococcus faecalis.

AIM: To compare the antimicrobial effects of two different irrigation solutions activated with erbium, chromium-doped yttrium, scandium, gallium and garnet (Er,Cr:YSGG) laser or an ultrasonic system and a photodynamic therapy (PDT) on Enterococcus faecalis (E. faecalis). MATERIALS AND METHODS: The root canals of 72 single-rooted human permanent incisors were prepared with ProTaper Universal rotary instruments and incubated with E. faecalis (ATCC 29212) for 4 weeks. Then the teeth were randomly divided into seven experimental groups with 10 specimens for canal disinfection procedures. Group I, standard needle irrigation (SNI) with 2.5% sodium hypochlorite (NaOCl); group II, SNI with 2% chlorhexidine gluconate (CHX); group III, laser-activated irrigation (LAI) by Er,Cr:YSGG of NaOCl; group IV, LAI of CHX; and group V, passive ultrasonic irrigation (PUI) of NaOCl; group VI, PUI of CHX; group VII, PDT. The remaining two teeth were used as the control group. After the disinfection procedures were completed, the root canals were filled with phosphate-buffered saline and bacterial samples were taken with sterile paper cones. The cultivation was performed on Mueller-Hinton agar (MHA) plates. The live bacteria were calculated by counting the colonies on these plaques. The statistical analysis was performed using Kruskal-Wallis H test and Miller's multiple comparison technique. RESULTS: Both LAI and PUI of NaOCl and PUI of CHX were more successful than the PDT on root canal disinfection (p < 0.05). CONCLUSION: Within the limitation of the present study, the activation of NaOCl solution by Er,Cr:YSGG laser or an ultrasonic system can be useful in the elimination of the E. faecalis from the canal. The PUI of CHX also has similar results. Photodynamic therapy showed a lower performance compared to these methods. CLINICAL SIGNIFICANCE: The activation of the sodium hypochlorite with Er,Cr:YSGG laser or PUI may be useful for removal of the E. faecalis biofilm layer in the root canal.

Push-out bond strength of three calcium silicate cements to root canal dentine after two different irrigation regimes.

OBJECTIVES: The aim of this study was to compare the push-out bond strength of three calcium silicate cements to dentine after two different irrigation regimes. MATERIALS AND METHODS: One hundred eighty 2-mm-thick root sections were prepared. The sections were divided into three main groups (n = 60). In group A, the sections were immersed in 1 % NaOCl for 3 min. In group B, the sections were immersed in 17 % EDTA for 3 min followed by 1 % NaOCl for the same period of time. In group C (control group), no irrigation was applied to the sections. The samples from each group were divided into four subgroups (n = 15). In subgroups A1, B1 and C1, DiaRoot BioAggregate; in subgroups A2, B2 and C2, MTA-Angelus and in subgroups A3, B3 and C3, MM-MTA were mixed with hand-mixing. In subgroups A4, B4 and C4, MM-MTA was mixed with auto-mixing. The mixed cements were then placed into cavities with a carrier. The samples were submitted to the push-out test and were loaded. All the data were analysed with one-way analysis of variance and the Tukey HSD multiple comparisons (p < 0.05). RESULTS: There were no statistically significant differences between the irrigation regimes regardless of the used materials. The resistance to displacement in subgroup B4 was significantly greater than that presented by subgroups A3, B3 and C3 (p < 0.05) while not different than all other groups. CONCLUSIONS: Irrigation regimes had not affected the push-out bond strength of the calcium silicate cements. Also, strength of auto-mixed MM-MTA was similar to the other cements. CLINICAL RELEVANCE: The novel calcium silicate cements would be a potentially useful material in endodontic procedures with favourable properties.

Bond strength of calcium silicate-based sealers to dentine dried with different techniques.

OBJECTIVE: To assess the influence of various canal-drying techniques on the push-out bond strength between radicular dentine and both MTA Fillapex and iRoot SP sealers. MATERIALS AND METHODS: Eighty extracted single-root teeth were instrumented with ProTaper Universal rotary instruments to a size F4. The teeth were randomly assigned to 1 of 4 groups as follows: group 1, excess fluid in the canals was removed using a Luer vacuum adapter; group 2, the canals were dried with a single paper point; group 3, the canals were dried with 3-5 paper points, and group 4, the canals were rinsed with 95% ethanol and then dried with 3-5 paper points. In each group, the specimens were subgrouped according to root canal sealer into either subgroup A (MTA Fillapex) or subgroup B (iRoot SP sealer). Horizontal sections (thickness 1 ± 0.1 mm) were obtained from each specimen and a push-out test was performed using a universal testing machine at a crosshead speed of 1 mm/min on root slices. Statistical analysis was done using the Kruskal-Wallis test and Dunn's test for pair-wise comparisons. p < 0.05 was considered statistically significant. RESULTS: Canals dried with only 1 paper point and obturated with the iRoot SP sealer (subgroup 2B) showed significantly higher bond strengths to the root canal wall compared to all other subgroups (p < 0.05), except for subgroup 1B (p > 0.05). CONCLUSIONS: The canal-drying technique influenced the adhesive bond strength between calcium silicate-based root canal sealers and the root canal wall.

Apically extruded debris of different file systems used with various kinematic movements during retreatment: An in vitro study.

This study aimed to examine the amount of apically extruded debris and time during retreatment with five current file systems, which exhibit various kinematic movements. One hundred upper central incisors were shaped with manual files and filled using the thermoplastic injection method. The root canal fillings in each group (n = 20) were removed using the Genius (GN), ProTaper Next (PTN), Reciproc (RCP) Blue, Tango-Endo (TE) and Twisted File Adaptive (TFA) file systems. The apically extruded debris was collected in preweighed Eppendorf tubes. Time to reach working length and total time were also recorded. The PTN, RCP Blue and TFA instruments caused significantly less apically extruded debris and shorter total retreatment time than the GN and TE file systems (p < 0.05). The time to reach the working length was the shortest in the PTN group compared to the other groups (p < 0.05). All file systems extruded debris while removing the root canal filling.

Intentional replantation of periodontally hopeless teeth using a combination of enamel matrix derivative and demineralized freeze-dried bone allograft.

This study evaluated the clinical and radiographic results of the intentional replantation of periodontally hopeless teeth with combined enamel matrix derivative and demineralized freeze-dried bone allograft therapy. Eleven patients (five female, six male; age range, 13 to 53 years) with 12 periodontally hopeless teeth resulting from extensive alveolar bone loss and vertical defects extending to the apexes were studied. At the 12-month clinical and radiologic follow-up, significant improvement was observed for all clinical and radiographic parameters except gingival recession (P < .05). These preliminary findings show that intentional replantation combined with regenerative techniques is a successful alternative to tooth extraction.

The effects of final irrigants on the push-out bond strength of two calcium silicate-based root canal sealers: an in vitro study.

PURPOSE: The purpose of the present study was to investigate the effect of the different irrigant combinations used in final irrigation on the push-out bond strength of root canal sealers that have different compositions. MATERIALS AND METHODS: In total 60 dentinal slices in 1 mm thickness were collected from 15 extracted mandibular premolar teeth; 4 slices from each tooth. 3 canal-like artificial cavities were opened on each dentinal slice. Samples were divided into 4 experimental groups, each of which consisted of 15 samples. In group 1, samples were immersed in 5.25% NaOCl and 17% EDTA solutions respectively; in group 2, immersed in 5.25% NaOCl and 2% CHX solutions respectively; in group 3, immersed in 5.25% NaOCl, 17% EDTA and 2% CHX solutions respectively; and in group 4 immersed in distilled water. After drying with absorbent papers, each cavity in dentinal slice sample was filled with different sealer (Endoseal MTA, Tech Biosealer Endo or AH Plus). Two days later, the push-out bond examination was performed. RESULTS: AH Plus showed higher push-out bond strength value in two combinations (group 2 and 3) in which final irrigants contained CHX (p<0.001). Dentinal push-out bond strengths of root canal sealers from Endoseal MTA and Tech BioSealer Endo were not affected by final irrigant (p=0.965). CONCLUSION: Using CHX after NaOCl in final irrigant increases push-out strength of epoxy resinbased sealer but, did not create any difference in dentinal push-out bond strength of calcium silicate-based sealers.

Antibacterial activity and physical properties of glass-ionomer cements containing antibiotics.

This study evaluated the antibacterial effects, physical properties and bonding strengths of conventional glass-ionomer cements (GICs) containing antibiotics and determined the optimal concentration of antibiotics addition for use with the ART approach. Fuji IX GIC was used as a control. Three antibiotic mixtures, ciprofloxacin, metronidazole and minocycline, were added to powdered GIC (Fuji IX) to obtain concentration ratios of 1.5, 3.0 and 4.5% w/w. The antibacterial activity of each GIC was evaluated against Streptococcus mutans or Lactobacillus casei using agar-diffusion methods. The release of antibiotics was analyzed by high-performance liquid chromatography (HPLC). The compressive strength and bonding strength to dentin were measured and compared with those of control samples. The results were analyzed using the Mann-Whitney test and Wilcoxon test. All tested groups showed a significantly greater inhibition with growth of the selected bacteria in comparison to the control groups (p < 0.01). However, the 3% and 4.5% concentration ratios of antibiotics had significantly lower compressive strength and lower bond strength to dentin than the control group (p = 0.003). The GIC-containing antibiotics were effective in inhibiting S Mutans and L Casei. The addition of a 1.5% antibiotic mixture was optimal to giving appropriate physical and bonding properties.

Evaluation of apical filling after root canal filling by 2 different techniques.

OBJECTIVE: To determine the percent gutta-percha-filled area in the apical third of root canals after filling with 2 different root filling techniques. MATERIALS AND METHODS: Thirty extracted human lower premolars were instrumented with ProTaper rotary files (Dentsply Maillefer) and then randomly divided into 2 groups of 15 teeth each. The first group was filled using the single-cone technique with a tapered gutta-percha cone. The second group was filled with the lateral condensation technique. Horizontal sections were cut 2 and 4 mm from the apical foramen of each tooth. Photomicrographs of the apical surface of each cross-section were obtained at magnification x40. Digital image analysis was used to measure the overall area of the canal and the aggregate area occupied by gutta-percha; from these values, the percent gutta-percha-filled area was calculated. The data were compared by t test. RESULTS: The single-cone technique produced significantly greater percent gutta-percha filled area at 2 mm from the apex (p = 0.046), but there was no significant difference between the techniques at 4 mm from the apex (p = 0.17). CONCLUSIONS: These results suggest that the single-cone technique with tapered gutta-percha cones may yield better filling (measured as the percent gutta-percha-filled area) than the lateral condensation technique, at a level 2 mm from the apex.

Comparative study of removal of current endodontic fillings.

The aim of the present study was to assess the removability of canal fillings performed by using current methods during re-treatment with rotary instruments. Seventy-two freshly extracted human anterior teeth with single straight root canals were instrumented with Mtwo rotary files. The teeth were randomly divided into 4 obturation groups of 18 specimens each as follows: group 1, Resilon and Epiphany; group 2, GuttaFlow obturation system; group 3, EndoTwinn obturation system; group 4, gutta-percha with AH Plus sealer. The filled canals were re-treated by using Mtwo-Retreatment instruments and Mtwo instruments. The time required to remove the obturation material was recorded. After splitting the roots, the amount of residual filling material on the canal walls was imaged and measured with image analyzer software. Statistical analysis was accomplished by Kruskal-Wallis and Mann Whitney U tests for the analysis of root canal cleanliness. There was no statistically significant difference among the 4 filling techniques regarding the amount of residual material in the apical, middle, and coronal thirds and inside the whole canal area (P > .05). Regarding the mean time of re-treatment, the fillings performed by using GuttaFlow and EndoTwinn methods were removed much more quickly compared with the other 2 methods (P < .001). It was observed that the fillings performed with the above canal filling methods were removed in a similar fashion with rotary instruments during re-treatment.

The restoration of a maxillary central incisor fracture with the original crown fragment using a glass fiber-reinforced post: a clinical report.

This report describes an esthetic, conservative, and economical alternative restoration technique for a fractured central incisor using the patient's own tooth crown piece and a bondable reinforcement glass fiber. Although the long-term durability of this adhesive post core restoration remains unknown, it remains successful after 1 year.

Bond strengths of two conventional glass-ionomer cements to irradiated and non-irradiated dentin.

This study evaluated the influence of irradiation on the dentin shear bond strength of two conventional glass ionomer cements (GICs). Thirty extracted molars were bisected in the mesio-distal direction. One-half of 20 teeth were irradiated with 60 Gy (5 days/week) for 6 weeks, and then GIC was placed on the irradiated dentin surface (Groups A1, B1). For the other halves of these tooth specimens, the GICs were first placed on their dentin surfaces and then the specimens irradiated (Groups A2, B2). The remaining 10 teeth were bisected and used as non-irradiated controls (Groups C1, C2). The GIC-dentin shear bond strengths were examined. Groups A2 and B2 had significantly lower bond strengths than groups A1, B1, C1, and C2 (p < 0.05). No significant differences were found among groups A1, B1, C1, and C2 (p > 0.05). In conclusion, irradiation may have an adverse effect on the bond strength of GICs depending on the application sequence.

Conservative treatment and follow-up of type III dens invaginatus using cone beam computed tomography.

Dens invaginatus is a well-recognized phenomenon, and its endodontic treatment poses a challenge, especially for peri-invagination lesions with vital pulp. Here we describe the outcome of conservative treatment and follow-up in a case of type III dens invaginatus. Cone-beam computed tomography was used for diagnosis and follow-up. Pulp vitality was preserved with endodontic treatment of only an invaginated canal. At the 24-month follow-up examination, the tooth was asymptomatic and repair of the lesion was evident radiographically. This case was managed successfully with endodontic treatment of the invagination. (J Oral Sci 56, 307-310, 2014).

Comparison of influence of different manufacturing methods on the cleaning efficiency of rotary nickel-titanium files.

The purpose of this study was to evaluate and compare cleaning effectiveness of TwistedFile, GT series X, Revo-S, RaCe, Mtwo, and ProTaper Universal rotary files in curved canals. Seventy mesiobuccal canals of extracted human first maxillary molars were divided into seven groups of 10 samples each. Canals were prepared with six nickel-titanium (NiTi) rotary systems and manual K-Flexofile. Irrigation was performed with 2 mL 2.5% NaOCl solution after each file, and 5 mL 2.5% NaOCl was used for the final flush. After the roots were split longitudinally, the presence of debris and smear layer was visualized using scanning electron microscopic photomicrographs taken at coronal, middle, and apical third. Mean scores for debris and the smear layer were calculated and statistically analyzed for significance between groups using the Kruskal-Wallis nonparametric analysis of variance (P < 0.05) and Mann-Whitney U test (P < 0.001). There was no significant difference among the groups in terms of debris and smear layer scores (P > 0.05). Without considering the preparation method used, while no statistically significant difference was found between the coronal third and the middle third (P > 0.05), higher amount of debris and smear layer were found in apical third (P = 0.001). The new generation of NiTi rotary files including the Twisted File and GT Series X presented similar cleaning effectiveness compared with traditionally ground NiTi rotary files.

Comparative study of 6 rotary nickel-titanium systems and hand instrumentation for root canal preparation in severely curved root canals of extracted teeth.

INTRODUCTION: Some improvements have been developed with new generations of nickel-titanium (NiTi) rotary instruments that led to their successful and extensive application in clinical practice. The purpose of this in vitro study was to compare the root canal preparations performed by using GT Series X and Twisted File systems produced by innovative manufacturing process with Revo-S, RaCe, Mtwo, and ProTaper Universal systems manufactured directly from conventional nitinol and with stainless steel K-Flexofile instruments. METHODS: The mesiobuccal root canals of 140 maxillary first permanent molars that had between 30°-40° curvature angle and 4- to 9-mm curvature radius of the root canal were used. After root canal preparations made by using GT Series X, Twisted File, Revo-S, RaCe, Mtwo, and ProTaper Universal NiTi rotary systems and stainless steel K-Flexofile instruments, transportation occurred in the root canal, and alteration of working length (WL) was assessed by using a modified double-digital radiographic technique. The data were compared by the post hoc Tukey honestly significant difference test. RESULTS: NiTi rotary systems caused less canal transportation and alteration of WL than K-Flexofile instruments (P < .05). There was no significant difference between NiTi rotary system groups at any levels (P > .05) except 2.5 mm from the WL. At this level ProTaper Universal system caused significant canal transportation (P < .05). CONCLUSIONS: GT Series X and Twisted File rotary systems produced with innovative process were concluded to shape the curved canals to result in minimal canal transportation, similar to Revo-S, RaCe, Mtwo, and ProTaper Universal rotary systems manufactured by traditional methods.

Fracture resistance of retreated roots using different retreatment systems.

OBJECTIVES: This study was designed to evaluate the fracture resistance of retreated roots using different rotary retreatment systems. METHODS: Forty eight freshly extracted human canine teeth with single straight root canals were instrumented sequentially increasing from size 30 to a size 55 using K-files whit a stepback technique. The teeth were randomly divided into three experimental and one control groups of 12 specimens each. The root canals were filled using cold lateral compaction of gutta-percha and AH Plus (Dentsply Detrey, Konstanz, Germany) sealer in experimental groups. Removal of gutta-percha was performed with the following devices and techniques: ProTaper Universal (Dentsply Maillefer, Ballaigues, Switzerland), R-Endo (Micro-Mega, Besançon, France), and Mtwo (Sweden & Martina, Padova, Italy) rotary retreatment systems. Control group specimens were only instrumented, not filled or retreated. The specimens were then mounted in copper rings, were filled with a self-curing polymethylmethacrylate resin, and the force required to cause vertical root fracture was measured using a universal testing device. The force of fracture of the roots was recorded and the results in the various groups were compared. Statistical analysis was accomplished by one-way ANOVA and a post hoc Tukey tests. RESULTS: There were statistically significant differences between the control and experimental groups (P<.05). However, there were no significant differences among the experimental groups. CONCLUSIONS: Based on the results, all rotary retreatment techniques used in this in vitro study produced similar root weakness.

Effect of unintentionally extruded mineral trioxide aggregate in treatment of tooth with periradicular lesion: a case report.

INTRODUCTION: This case report describes the effect of unintentionally extruded mineral trioxide aggregate (MTA) into periradicular lesions and tissues on the prognosis of periradicular healing in maxillary left central incisor with periradicular lesion. METHODS: A 17-year-old girl with a large periradicular lesion from the apices of her maxillary left central to lateral incisors was referred. Tooth #9 had an open apex, but tooth #10 was normal. Conservative root canal treatment was performed to tooth #10. The apical third of the canal of tooth #9 was filled with MTA as an apical plug because of open apex. During this procedure, a radiograph was taken, and it showed an excessive extrusion of MTA into the periradicular lesion. The remaining canal space was filled with gutta-percha and AH Plus sealer by using a lateral condensation technique. RESULTS: At follow-up examinations, the tooth was asymptomatic and radiographically showed repair of the lesion. Healing was achieved without any need for further endodontic surgical intervention. CONCLUSIONS: The results of this case showed that complete periapical healing is possible despite the extrusion of the MTA. This might be due to biologic properties of the MTA. Even so, extrusion of the filling material is not advocated.

Treatment of horizontal root fractures using a triple antibiotic paste and mineral trioxide aggregate: a case report.

This case report describes the treatment of a horizontal root fracture in a maxillary central incisor (tooth #8) using a triple antibiotic paste and mineral trioxide aggregate. A nonsurgical endodontic treatment was performed to a coronal root canal fragment of tooth #8. During the treatment procedure, 1% sodium hypochlorite solution was used for irrigation and a triple antibiotic paste was used as an intracanal medicament. The coronal part of the canal was obturated with mineral trioxide aggregate totally. At follow-up examination after 12 months, the tooth was asymptomatic and radiographically showed repair of the fracture region. Healing was achieved without any need for further interventions.

Comparison of the sealing ability of three filling techniques in canals shaped with two different rotary systems: a bacterial leakage study.

OBJECTIVE: This study compared the sealing ability of 3 current filling techniques in root canals shaped with 2 different rotary systems. STUDY DESIGN: Eighty human extracted mandibular premolars were divided randomly into 2 similar groups of 40 each and instrumented with either ProTaper (Dentsply Maillefer, Tulsa, OK; group A) or Mtwo (VDW; Antaeos, Munich, Germany; group B) rotary systems. Each group was divided into 3 subgroups (n = 10) and 2 control groups (n = 5). Canals were filled either with the tapered single-cone technique (SC; subgroups A1 and B1), with lateral condensation (LC; subgroups A2 and B2), or warm vertical compaction (WVC; subgroups A3 and B3). AH Plus was used as a root canal sealer in all groups. Samples were sterilized in an ethylene oxide sterilizer for 12 hours. The apical 3-4 mm of the roots were immersed in brain-heart infusion culture medium with phenol red indicator within culture chambers. The coronal access of each specimen was inoculated every 48 hours with a suspension of Enterococcus faecalis. Bacterial leakage was monitored every 24 hours for 8 weeks. The data obtained were analyzed using a chi-squared test, and P was set at .05. RESULTS: In group A, 70% of the specimens filled with SC (subgroup A1), 50% of the specimens filled with LC (subgroup A2), and 20% of the specimens filled with WVC (subgroup A3) leaked. There was no statistically significant difference between the subgroups (P > .05). In group B, bacterial leakage was observed in 50% of SC samples (subgroup B1), 40% of LC samples (subgroup B2), and 50% of WVC samples (subgroup B3). There was no statistically significant difference between subgroups B1, B2, and B3 (P > .05). There was also no statistically significant difference between group A and group B (P > .05). CONCLUSION: Filling with SC, LC, and WVC techniques in canals treated with ProTaper or Mtwo rotary instruments showed similar levels of sealing efficacy.

Effect of passive ultrasonic irrigation on apical extrusion of irrigating solution.

OBJECTIVES: To determine the influence of passive ultrasonic irrigation (PUI) on apical extrusion of irrigating solution. METHODS: Twenty freshly extracted maxillary and mandibular incisors with single straight root canals were instrumented with ProTaper rotary files. During final irrigation, the root canals were filled with 2.5% sodium hypochlorite (NaOCl) solution and PUI was performed with a piezoelectronic unit. A stainless steel instrument (size 15) was inserted into the root canal and the irrigant was ultrasonically activated for one minute. This sequence was repeated three times, resulting in a total PUI time of three minutes. The volume of extruded irrigant was measured by Pipetman pipettes. The data were statistically analyzed with the Mann-Whitney U test. RESULTS: The mean volume of apical extruded irrigant was 2.15 muL for the PUI group and 14 muL for the control group. The experimental group extruded significantly smaller amounts of irrigant than the control group (P<.05). CONCLUSIONS: The PUI procedure as a final irrigation was associated with less apical extrusion of the irrigating solution.