Evaluation of the marginal and internal discrepancies of CAD-CAM endocrowns with different cavity depths: An in vitro study.

STATEMENT OF PROBLEM: The marginal and internal discrepancies of computer-aided design and computer-aided manufacturing (CAD-CAM) endocrowns are unknown. PURPOSE: The purpose of this in vitro study was to evaluate the marginal and internal discrepancies of endocrowns with different cavity depths by measuring them with microcomputed tomography (µCT). MATERIAL AND METHODS: Endocrowns (n=48) of 2 different cavity depths (2 mm and 4 mm) were fabricated in 2 different chairside CAD-CAM systems (CEREC AC and E4D). A µCT scan was made before and after cementation. For analysis of the marginal and internal discrepancies, reference points were selected in 2-dimensional views of 3 buccolingual cross-sections and 3 mesiodistal cross-sections. To calculate the total discrepancy volume, the µCT sections were reconstructed 3-dimensional views, and changes in volume and surface area were examined. Statistical analysis was performed using 2-way ANOVA with Bonferroni correction (α=.05). RESULTS: An endocrown with a 4-mm cavity showed a larger marginal and internal volume than one with a 2-mm cavity. Cementation did not show significant differences in total discrepancy thickness. Discrepancies on the pulpal floor were largest in other sites. Both chairside CAD-CAM systems showed similar discrepancy in the endocrowns. CONCLUSIONS: Based on the present study, marginal and internal discrepancies increased depending on cavity depth. Cementation did not increase the dimension of the discrepancy between the restoration and the cavity wall. The discrepancy on the pulpal floor appeared to affect these results.

Dentin wear after simulated toothbrushing with water, a liquid dentifrice or a standard toothpaste.

PURPOSE: To investigate the influence of dentifrices with and without abrasives on the wear and surface topography of human dentin following simulated toothbrushing in vitro. METHODS: 24 dentin specimens were prepared and randomly allocated to a liquid dentifrice (Garglin Gum-Guard), conventional dentifrice (333 Clinic Total Care), and control (distilled water) groups. Specimens were subjected to simulated toothbrushing of 50,000 repeated strokes under a 150 g-load. The dentin surface was profiled in each specimen using a profilometer before and after toothbrushing. The mean surface roughness (Ra) of the specimens was calculated and compared by one-way ANOVA and Tukey's post-hoc test (α = 0.05). The dentin surfaces were further examined by scanning electron microscopy (SEM). RESULTS: The Ra values were similar between the liquid dentifrice and control groups (P > 0.05), and was significantly higher in the conventional dentifrice group (P < 0.001). On SEM examination, patent dentin tubules were observed in the conventional dentifrice and liquid dentifrice groups, but were not observed in the control group.

Influence of preparation design on fit and ceramic thickness of CEREC 3 partial ceramic crowns after cementation.

OBJECTIVE: This study investigated the influence of preparation design on the marginal and internal gap and ceramic thickness of partial ceramic crowns (PCCs) fabricated with the CEREC 3 system. MATERIALS AND METHODS: Sixteen extracted human mandibular molars were prepared according to two different preparation designs (n = 8): a retentive preparation design with traditional cusp capping (Group I) and a non-retentive preparation design with horizontal reduction of cusps (Group II). PCCs were fabricated from IPS Empress CAD with the CEREC 3 system. The parameters for luting space and minimum occlusal ceramic thickness were set to 30 µm and 1.5 mm, respectively. The fabricated PCCs were cemented to their corresponding teeth with self-adhesive resin cement and were then scanned by micro-computed tomography. The marginal and internal gaps were measured at pre-determined measuring points in five bucco-lingual and three mesio-distal cross-sectional images. The ceramic thicknesses of the PCCs were measured at the measuring points for cusp capping areas. RESULTS: Group II (167.4 ± 76.4 µm) had a smaller overall mean gap, which included the marginal and internal gap measurements, than that of Group I (184.8 ± 89.0 µm). The internal gaps were larger than the marginal gaps, regardless of preparation design. Group I presented a thinner ceramic thickness in the cusp capping areas than the minimum occlusal ceramic thickness parameter of 1.5 mm. CONCLUSION. Preparation design had an influence on fit, particularly the internal gap of the PCCs. Ceramic thickness could be thinner than the minimum ceramic thickness parameter.

Color and Translucency Stability of Three-Dimensional Printable Dental Materials for Crown and Bridge Restorations.

The purpose of this study was to examine and compare color and translucency stability of three-dimensional (3D) printable dental materials for crown and bridge restorations. Five different materials were investigated, and twelve disc-shaped specimens of two different thicknesses (1 and 2 mm) were prepared using a digital light processing 3D printer. Color measurements were made according to the CIELAB color scale (L*, a*, and b*) using a spectrophotometer 1 h, 1 day, 1 week, one month, and six months after post-curing of the materials, and the translucency parameter (TP) was calculated. The L*, a*, b*, and TP values were compared among the different materials and storage periods using repeated measures analysis of variance. Color and translucency changes of the specimens after the different storage periods were compared with 1 h measurements to determine whether they exceeded clinically perceivable thresholds. The L*, a*, b*, and TP values showed significant differences according to the storage periods, as well as among the materials. Until one month, some materials demonstrated distinct color differences, while others showed small color differences below a clinically perceivable threshold. The translucency differences were not clinically perceivable for any specimen. After six months, all specimens demonstrated large color changes, whereas the changes in translucency were relatively small. In conclusion, the color of 3D printable dental materials changed with time, and the differences varied with the materials used. On the contrary, the changes in translucency were small. Overall, the materials became darker, more yellowish, and more opaque after six months of water storage.

Effect of tooth-brushing with a microcurrent on dentinal tubule occlusion.

The purpose of this study was to investigate whether tooth-brushing with a microcurrent was effective in inducing dentinal tubule occlusion. The specific aims of the study were (1) to evaluate the effectiveness of tooth-brushing with a microcurrent on dentinal tubule occlusion by using scanning electron microscopy (SEM); and (2) to compare the dentinal fluid flow rate after tooth-brushing with a microcurrent by using a sub-nanoliter-scaled fluid flow measuring device (NFMD). All experimental groups showed partially occluded dentinal tubules and crystal-like structures at a specific microcurrent intensity indicated that tooth-brushing with a microcurrent could efficiently occlude dentinal tubules. The decrease in dentinal fluid flow rate in the tooth-brushing with microcurrents group indicated that dentinal tubules were occluded and the flow of dentinal fluid had decreased.

Comparison of Self-Etching Ceramic Primer and Conventional Silanization to Bond Strength in Cementation of Fiber Reinforced Composite Post.

Various mechanical and chemical surface treatments have been proposed to improve the retention of fiber-reinforced composite post (FRCP), but the results are still controversial. The bond strength and durability of a self-etching ceramic primer, which was recently released as an alternative to etching and silane, are not yet known. This study aimed to compare and evaluate the push-out bond strength of different surface treatments of FRCPs after an artificial aging procedure. Four groups (n = 10) were established to evaluated FRCP surface treatments (dentin adhesive bonding; silane and adhesive bonding; hydrofluoric acid, silane and adhesive bonding; and a self-etching ceramic primer). They were bonded with dual-curing rein cement (Multilink N) and stored in distilled water at 37 °C for 30 days, then thermal cycled for 7500 cycles. After being sectioned into 1 mm thickness, each coronal and apical part was evaluated for its the push-out bond strength by a universal testing machine. Each debonded specimen was observed by an optical microscope and divided according to the failure modes. The results showed that silane treatment significantly improved push-out bond strength, but the self-etching ceramic primer did not do so. Additional hydrofluoric acid treatment or the adhesive bonding agent alone did not significantly improve the retention of FRCPs. Cohesive failure of the luting material was found most frequently in all groups.

Morphological Characteristics and Classification of Mandibular First Molars Having 2 Distal Roots or Canals: 3-Dimensional Biometric Analysis Using Cone-beam Computed Tomography in a Korean Population.

INTRODUCTION: The aim of this study was to determine the morphologic characteristics of mandibular first molars having 2 canals in distal roots. Interorifice distance, buccal bone thickness, and root curvature were evaluated using cone-beam computed tomography images in a Korean population. METHODS: In total, 1958 mandibular first molars were evaluated in axial, coronal, sagittal, and paraxial planes. Distal roots having 2 canals were classified according to their root and canal shapes (2 roots, 2 canals [2R2C]; 1 root, 2 canals with 2 apical foramina [1R2C(2-2)]; and 1 root, 2 canals with 1 apical foramen [1R2C(2-1)]). The distances between orifices and the distance from the apex to the buccal bone plate were measured for each root canal shape (2R2C, 1R2C[2-2], and 1R2C[2-1]). The curvature of distolingual (DL) roots was classified according to severity using 3-dimensional reconstructed images, and the direction of curvature was determined. The relationships of these characteristics to sex and side were evaluated. RESULTS: The prevalences of 2R2C, 1R2C(2-2), and 1R2C(2-1) were 25.89%, 10.32%, and 14.15%, respectively. The distances between distobuccal (DB) and DL orifices were 3.77 ± 0.74 mm for 2R2C, 3.02 ± 0.65 mm for 1R2C(2-2), and 2.44 ± 0.64 mm for 1R2C(2-1). The distances from the buccal plate to the DB canal were 3.84 ± 1.35 mm for 2R2C, 5.33 ± 1.41 mm for 1R2C(2-2), and 5.96 ± 1.63 mm for 1R2C(2-1). The distance from the buccal plate to the DL canal was 9.85 ± 1.46 mm for 2R2C, and 8.28 ± 1.50 mm for 1R2C(2-2). All distances differed significantly according to root canal configurations, and all were greater in men than women (P < .05), except for the DB-DL orifice distance in 1R2C(2-2) and the DB to buccal cortical plate distance in all root configurations (P > .05). No significant difference between the left and right sides was found (P > .05). The prevalence of most severely curved DL roots (type III) was 62.92%, and the direction was commonly toward the buccal side (69.03%). CONCLUSIONS: The prevalence of mandibular first molars having 2 canals in distal roots was more than 50% in a Korean population. Interorifice distances between DB and DL canals and distances from the apex to the buccal cortical plate differed according to root and canal numbers and shapes.

Effect of air-particle pressures on the surface topography and bond strengths of resin cement to the hybrid ceramics.

This study aimed to determine the appropriate pressure for airborne-abrasion by comparing the shear bond strength values for different hybrid ceramic surfaces. Two materials were used to produce hybrid ceramic specimens: Lava Ultimate and MAZIC Duro. The group of specimens whose surfaces were not subjected to airborne-abrasion was set as the control group. In the experimental group, airborne-abrasion was performed at pressures of 0.1, 0.2, and 0.3 MPa. After the adhesive and resin cement was applied, an SBS test was performed. For the MAZIC Duro block, the SBS increased monotonically with the airborne-abrasion pressure increased, peaking at 0.3 MPa. For the Lava Ultimate block, the SBS increased as the airborne-abrasion pressure increased to 0.2 MPa, and then decreased in the 0.3-MPa group, thereby peaking at 0.2 MPa. This study has confirmed that the bonding strength varies with the material used even when applying the same surface treatment.

A randomized controlled trial of various MTA materials for partial pulpotomy in permanent teeth.

OBJECTIVES: The aim of this study was to evaluate and compare the clinical applicability of various MTA materials as partial pulpotomy materials in permanent teeth. METHODS: Partial pulpotomy was performed on 104 permanent teeth from 82 people (mean 29.3±14.8years old), who met the inclusion criteria in randomized clinical trial. The teeth were divided into three groups: ProRoot MTA (n=33), OrthoMTA (n=36), RetroMTA (n=35). Clinical examination and radiographic comparison were carried out at 1, 3, 6 and 12 months after the treatment. Survival analysis was performed using the Kaplan-Meier survival curves and log rank tests. RESULTS: Partial pulpotomy sustained a high success rate up to 1year with no significant differences in the outcomes treated with three MTA materials: ProRoot MTA, 96.0%; OrthoMTA, 92.8%; RetroMTA, 96.0%. The Kaplan-Meier survival function curves showed no significant differences among three groups concerning clinical and radiographic cumulative survival rates. In addition, no potential prognostic factors related to the success rate of partial pulpotomy among age, sex, tooth type, root apex status, the site and type of pulp exposure, and the type of restoration were observed in log rank analysis. CONCLUSIONS: Partial pulpotomy with ProRoot MTA, OrthoMTA and RetroMTA had favorable results and clinical and radiographic results were not significantly different in three groups after 1year.

Effect of Topical Anesthesia on Pain from Needle Insertion and Injection and Its Relationship with Anxiety in Patients Awaiting Apical Surgery: A Randomized Double-blind Clinical Trial.

INTRODUCTION: We aimed to simultaneously investigate the effects of topical anesthesia on needle insertion and injection pain in the labial mucosa of the maxillary central incisors of patients awaiting apical surgery and to assess the relationship between patients' anxiety and pain scores. METHODS: Forty-four patients scheduled for apical surgery of the maxillary anterior incisor or canine were included, and all completed the Modified Dental Anxiety Scale (MDAS) questionnaire. One piece of Xylocaine (AstraZeneca, Sodertalje, Sweden) gauze was applied to the right or left side of the labial vestibule below the central incisor according to a randomization process, and 1 piece of water gauze was applied to the contralateral side of the labial vestibule. Each piece of gauze remained in place for 2 minutes. The subjects were asked to rate their pain according to the numeric rating scale immediately after needle insertion and anesthetic solution injection. RESULTS: Topical anesthetic application significantly reduced both insertion- and injection-related pain. Injection pain was significantly higher than insertion pain throughout the experiment. The difference in pain scores between the placebo and topical anesthetic groups was significantly greater for insertion pain than injection pain. The group with higher MDAS scores showed significantly higher pain scores, except for insertion pain reported by the topical anesthetic group, which did not show a significant difference between MDAS score groups. CONCLUSIONS: The topical anesthetic was highly effective for both insertion and injection pain during infiltration anesthesia in the maxillary central incisors. Highly anxious patients reported higher pain scores; however, topical anesthetics reduced the effect of anxiety on increasing pain.

Anatomical study of C-shaped canals in mandibular second molars by analysis of computed tomography.

The aim of this study was to investigate the prevalence and configuration of the C-shaped canal using serial axial computed tomography images of the mandibular second molars that had not been restored severely or treated endodontically, and to compare the thickness of the remaining tooth structure from the center of the canal to the outer surface of the deepest groove area in C-shaped mandibular second molar to that of "danger zone of perforation" in normal mandibular second molar. This distance was measured at the cervical, middle, and apical third level each. From 220 teeth, C-shaped canals were found in 98 teeth (44.5%). Almost all the grooves were directed lingual (99%). The continuous C-shaped canal was the most frequently found (49%) and the separated canal was the least (17.4%). The thinnest remaining tooth structure in the groove area of the C-shaped mandibular second molar was not different from that of the danger zone of normal mandibular second molar at the three levels (p > 0.05).

Influence of Dentoalveolar Ankylosis on the Biomechanical Response of a Single-rooted Tooth and Surrounding Alveolar Bone: A 3-dimensional Finite Element Analysis.

INTRODUCTION: Dentoalveolar ankylosis necessarily accompanies the loss of periodontal ligament (PDL), which might alter the biomechanical response of the tooth. The purpose of this study was to investigate the influence of dentoalveolar ankylosis on a single-rooted tooth and the surrounding alveolar bone structures in the biomechanical standpoint. METHODS: A basic model of an intact maxillary central incisor and the surrounding bone structures was chosen for the numeric analysis. From this basic model, 6 different models were further developed by combining 3 types of endodontic status (an intact model, a nonsurgically treated model, and a surgically treated model) and 2 types of periodontal attachment condition (models with or without PDL). For each condition, maximum von Mises stress (σ max) in dentin and bone and maximum tooth displacement (ΔR max) were calculated. RESULTS: In models with dentoalveolar ankylosis, stress was concentrated on the cervical dentin around the cementoenamel junction and the alveolar bone crest, whereas the stress was more evenly distributed along the entire length of the root in models with normal PDL. The models with dentoalveolar ankylosis showed higher stress values in dentin (44.72%-80.56% of σ max increase) and bone (24.23%-80.68% of σ max increase) and lower tooth displacement (59.22%-63.97% of ΔR max decrease) compared with the models with normal PDL. CONCLUSIONS: Dentoalveolar ankylosis exerts significant changes on the biomechanical response of a single-rooted tooth and the surrounding bone structures. The dentoalveolar complex with ankylosis showed characteristic stress concentrations, increased stress values, and decreased tooth displacement compared with that with normal PDL.

Accidental injury of the inferior alveolar nerve due to the extrusion of calcium hydroxide in endodontic treatment: a case report.

During clinical endodontic treatment, we often find radiopaque filling material beyond the root apex. Accidental extrusion of calcium hydroxide could cause the injury of inferior alveolar nerve, such as paresthesia or continuous inflammatory response. This case report presents the extrusion of calcium hydroxide and treatment procedures including surgical intervention. A 48 yr old female patient experienced Calcipex II extrusion in to the inferior alveolar canal on left mandibular area during endodontic treatment. After completion of endodontic treatment on left mandibular first molar, surgical intervention was planned under general anesthesia. After cortical bone osteotomy and debridement, neuroma resection and neurorrhaphy was performed, and prognosis was observed. But no improvement in sensory nerve was seen following surgical intervention after 20 mon. A clinician should be aware of extrusion of intracanal medicaments and the possibility of damage on inferior alveolar canal. Injectable type of calcium hydroxide should be applied with care for preventing nerve injury. The alternative delivery method such as lentulo spiral was suggested on the posterior mandibular molar.

Effect of Curing Mode on Shear Bond Strength of Self-Adhesive Cement to Composite Blocks.

To overcome the disadvantages of computer-aided design/computer-aided manufacturing (CAD/CAM) processed indirect restorations using glass-ceramics and other ceramics, resin nano ceramic, which has high strength and wear resistance with improved polish retention and optical properties, was introduced. The purpose of this study was to evaluate the shear bond strength and fracture pattern of indirect CAD/CAM composite blocks cemented with two self-etch adhesive cements with different curing modes. Sand-blasted CAD/CAM composite blocks were cemented using conventional resin cement, Rely X Ultimate Clicker (RXC, 3M ESPE, St. Paul, MN, USA) with Single Bond Universal (SB, 3M ESPE, St. Paul, MN, USA) for the control group or two self-adhesive resin cements: Rely X U200 (RXU, 3M ESPE, St. Paul, MN, USA) and G-CEM Cerasmart (GC, GC corporation, Tokyo, Japan). RXU and GC groups included different curing modes (light-curing (L) and auto-curing (A)). Shear bond strength (SBS) analyses were performed on all the specimens. The RXC group revealed the highest SBS and the GC A group revealed the lowest SBS. According to Tukey's post hoc test, the RXC group showed a significant difference compared to the GC A group (p < 0.05). For the curing mode, RXU A and RXU L did not show any significant difference between groups and GC A and GC L did not show any significant difference either. Most of the groups except RXC and RXU L revealed adhesive failure patterns predominantly. The RXC group showed a predominant cohesive failure pattern in their CAD/CAM composite, LavaTM Ultimate (LU, 3M ESPE, St. Paul, MN, USA). Within the limitations of this study, no significant difference was found regarding curing modes but more mixed fracture patterns were showed when using the light-curing mode than when using the self-curing mode.

Survival Rate of Teeth with a C-shaped Canal after Intentional Replantation: A Study of 41 Cases for up to 11 Years.

INTRODUCTION: Teeth with a C-shaped canal have been regarded as a challenge for nonsurgical root canal treatment (RCT) and apical microsurgery because of their anatomic variations and low accessibility. For such teeth, intentional replantation might be a treatment option. The purpose of this study was to investigate the prognostic factors for the clinical outcome of intentionally replanted teeth with a C-shaped canal. METHODS: We retrospectively investigated patients who had undergone intentional tooth replantation at the Department of Conservative Dentistry, Yonsei University Dental Hospital, Seoul, Korea, from June 2002 to November 2015. Consequently, 41 intentionally replanted teeth with C-shaped canals were identified. The cumulative survival rate and related prognostic factors were assessed based on clinical and radiographic examination using survival analysis. RESULTS: The cumulative survival rate of intentionally replanted teeth with a C-shaped canal was 83.4% at 4 years and 73.0% at 11 years postoperatively. Based on Cox proportional hazard regression analysis, extraoral time (≤15 minutes vs >15 minutes) and retrofilling material (ProRoot MTA [Dentsply, Tulsa, OK] vs others) were significantly associated with tooth survival (P < .05). CONCLUSIONS: Extraoral time exceeding 15 minutes and the use of ProRoot MTA as a retrofilling material were significantly associated with a lower survival of intentionally replanted teeth with C-shaped canals. With improved clinical procedures based on an understanding of the prognostic factors, intentional replantation would be a favorable treatment option for treating teeth with a C-shaped canal.

Prognostic Factors for Clinical Outcomes in Autotransplantation of Teeth with Complete Root Formation: Survival Analysis for up to 12 Years.

INTRODUCTION: Tooth autotransplantation is a treatment option that has the potential to restore masticatory function and esthetics to edentulous spaces resulting from extracted teeth. The purpose of this study was to investigate the prognostic factors and clinical outcomes for autotransplanted teeth with complete root formation. METHODS: Patients who had received tooth autotransplantation in the Department of Conservative Dentistry, Yonsei University Dental Hospital, Seoul, Korea, from July 2001 to August 2010 were electronically searched, and a total of 105 cases of autotransplanted teeth met the inclusion criteria. Tooth survival, inflammatory root resorption (IRR), ankylosis, and related prognostic factors were assessed by using the survival analysis that was based on clinical and radiographic examination. RESULTS: The cumulative tooth survival rate was 68.2% at 12 years after the tooth autotransplantation. According to the Cox proportional hazard regression analysis, patient age, donor position, and extraoral time were significantly associated with tooth survival (P < .05). Donor extraction type was significantly associated with IRR (P < .05), and transplantation timing and initial stability were significantly associated with ankylosis (P < .05) CONCLUSIONS: Patients less than 45 years of age, maxillary donor teeth, and an extraoral time of less than 15 minutes were associated with significantly higher tooth survival. Surgical extraction of the donor tooth was associated with a significantly higher incidence of IRR. Immediate transplantation after the extraction of the recipient site's tooth and low initial stability were associated with a significantly lower incidence of ankylosis.

Effect of Surface Treatment on Shear Bond Strength between Resin Cement and Ce-TZP/Al2O3.

Purpose. Although several studies evaluating the mechanical properties of Ce-TZP/Al2O3 have been published, to date, no study has been published investigating the bonding protocol between Ce-TZP/Al2O3 and resin cement. The aim of this study was to evaluate the shear bond strength to air-abraded Ce-TZP/Al2O3 when primers and two different cement types were used. Materials and Methods. Two types of zirconia (Y-TZP and Ce-TZP/Al2O3) specimens were further divided into four subgroups according to primer application and the cement used. Shear bond strength was measured after water storage for 3 days or 5,000 times thermocycling for artificial aging. Results. The Y-TZP block showed significantly higher shear bond strength than the Ce-TZP/Al2O3 block generally. Primer application promoted high bond strength and less effect on bond strength reduction after thermocycling, regardless of the type of cement, zirconia block, or aging time. Conclusions. Depending on the type of the primer or resin cement used after air-abrasion, different wettability of the zirconia surface can be observed. Application of primer affected the values of shear bond strength after the thermocycling procedure. In the case of using the same bonding protocol, Y-TZP could obtain significantly higher bond strength compared with Ce-TZP/Al2O3.

A study on the compatibility between one-bottle dentin adhesives and composite resins using micro-shear bond strength.

OBJECTIVES: This study was performed to determine whether the combined use of one-bottle self-etch adhesives and composite resins from same manufacturers have better bond strengths than combinations of adhesive and resins from different manufacturers. MATERIALS AND METHODS: 25 experimental micro-shear bond test groups were made from combinations of five dentin adhesives and five composite resins with extracted human molars stored in saline for 24 hr. Testing was performed using the wire-loop method and a universal testing machine. Bond strength data was statistically analyzed using two way analysis of variance (ANOVA) and Tukey's post hoc test. RESULTS: Two way ANOVA revealed significant differences for the factors of dentin adhesives and composite resins, and significant interaction effect (p < 0.001). All combinations with Xeno V (Dentsply De Trey) and Clearfil S(3) Bond (Kuraray Dental) adhesives showed no significant differences in micro-shear bond strength, but other adhesives showed significant differences depending on the composite resin (p < 0.05). Contrary to the other adhesives, Xeno V and BondForce (Tokuyama Dental) had higher bond strengths with the same manufacturer's composite resin than other manufacturer's composite resin. CONCLUSIONS: Not all combinations of adhesive and composite resin by same manufacturers failed to show significantly higher bond strengths than mixed manufacturer combinations.

Influence of apical root resection on the biomechanical response of a single-rooted tooth-part 2: apical root resection combined with periodontal bone loss.

INTRODUCTION: In a clinical situation, an apically resected tooth is often accompanied by a varying degree of periodontal bone loss. The purpose of this study was to assess the influence of apical root resection combined with periodontal bone loss on the biomechanical response of a single-rooted tooth. METHODS: A basic intact model and a basic apically resected model of the upper central incisor were selected for the numerical analysis. From each basic model, 6 models were developed assuming different amounts of periodontal bone loss (0, 0.5, 1, 1.5, 2, and 3 mm). Maximum von Mises stress (σ max), maximum tooth displacement (ΔR max), and effective crown-to-root ratio (α) were calculated for each condition. RESULTS: There were only marginal differences (a 2.1% difference in σ max and a 16.9% difference in ΔR max) between the biomechanical responses of the intact model and the apically resected model when the tooth was supported by a normal periodontium. However, when destruction of the periodontium was assumed, the intact model and the apically resected model responded differently. The difference increased as the periodontal bone loss progressed, resulting in a 68.7% difference in σ max and a 56.3% difference in ΔR max when the periodontal bone loss increased to 3 mm (α = 0.48). CONCLUSIONS: Although the biomechanical response of an apically resected tooth was relatively stable when the tooth was supported by a normal periodontium, the apically resected tooth showed a more deteriorated response compared with the intact tooth as the periodontal bone loss progressed.

A Randomized Controlled Study of the Use of ProRoot Mineral Trioxide Aggregate and Endocem as Direct Pulp Capping Materials: 3-month versus 1-year Outcomes.

INTRODUCTION: The purpose of this study was to assess the long-term clinical outcomes of direct pulp capping (DPC) with ProRoot MTA (Dentsply, Tulsa, OK) and Endocem (Maruchi, Wonju, Korea) as pulp capping materials. To this end, the 1-year cumulative successes of both materials were evaluated and compared with those of the 3-month outcomes in a prospective, randomized controlled trial. METHODS: Patients were recruited from the Department of Conservative Dentistry of the Yonsei University Dental Hospital, Seoul, South Korea, from January to May 2013. Of the 48 teeth that met the inclusion criteria, 46 teeth were randomly allocated to either ProRoot MTA or Endocem groups (n = 23). Direct pulp capping was performed, and clinical and radiographic examinations were conducted over 1 year after the treatment. Survival analyses were conducted to compare the cumulative successes between ProRoot MTA and Endocem and to evaluate other clinical variables. RESULTS: Forty-one teeth were recalled 1 year after the treatments (recall rate = 89.13%). There were no significant differences between the cumulative successes of ProRoot MTA and Endocem in either log-rank or Cox proportional hazard regression analyses (P > .05). Among the other clinical variables, cavity type (class I, II, III vs class V) was determined to be significant in both the log-rank test (P = .001) and Cox regression analysis (P = .006). CONCLUSIONS: Both ProRoot MTA and Endocem exhibited similar cumulative successes as direct pulp capping materials up to 1 year. The teeth restored with class V cavities exhibited significantly lower cumulative success rates after direct pulp capping compared with the teeth restored with other types of cavities.