Sinus membrane thickness of healthy endodontically treated maxillary molars.

OBJECTIVE: The study aimed to investigate the sinus membrane thickness (SMT) adjacent to healthy endodontically-treated maxillary molars with or without protruded apical foramen into the sinus cavity using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: Images of 207 non-smoker patients aged 18-40 were retrospectively analyzed, 140 were endodontically treated, and 136 were without endodontic treatment. Patients with any sinus pathology, teeth that have symptoms, or poor root filling were excluded. Study groups consisted of Group EM-I (endodontically treated and protruded apical foramen), Group EM-C (endodontically treated and contacted apical foramen), and similarly without endodontic treatment; Group M-I and Group M-C. SMT upon the mesial, distal, and palatal roots was measured. One-way ANOVA and Student's t-tests were performed. RESULTS: Group EM-I had the thickest sinus membrane compared to other groups (p = 0.013). SMT values were 2.37-2.60 mm in Group EM-I, and 1.34-1.58 mm in other groups. Thickening (> 2 mm) percentages were 33.45% in Group EM-I and between 4.25 and 8.25% in other groups. No statistical difference was detected between first and second molars and genders (p > 0.05). CONCLUSION: When the apical foramen protruded into the sinus cavity, the conventional root canal treatment caused a minimal (between 2.37 mm and 2.60 mm) sinus membrane thickening with a rate of 33.45% based upon CBCT examinations.

Glycolic acid on push-out bond strength of fiber post and smear removal: an in vitro study.

This study aims to investigate glycolic acid (GA) as a final irrigant on push-out bond strength of fiber post and smear removal. Ninety mandibular premolars were stabilized with a silicone key and photographed, and canal cross-section was calculated by image processing software. Round canal morphology was selected. The specimens were divided into five groups (n = 18); 10%GA, 17%EDTA, NaOCl + 10%GA, NaOCl + 17%EDTA, and the control. Fifteen specimens were used for the push-out. Three specimens were evaluated using a scanning electron microscope after post space preparation. Two-way ANOVA and Chi-square were used for statistics. GA presented higher strength than EDTA (p < 0.05). The NaOCl + GA showed higher strength than the NaOCl + EDTA (p < 0.05). The highest values were observed in cervical and lowest in apical thirds (p < 0.05). The most failure type was between dentin and resin (p < 0.05). GA removed the smear in the post space including the apical third. The NaOCl + GA has superiority to NaOCl + EDTA on push-out strength. Glycolic acid improved the bond strength of fiber post when used as a final post space irrigant. The combination of NaOCl and glycolic acid did not negatively affect the bond strength and was more effective compared to the combination with EDTA. Glycolic acid improved the bond strength of fiber post when used as a final post space irrigant. The combination of NaOCl and glycolic acid did not negatively affect the bond strength and was more effective compared to the combination with EDTA.

Biocompatibility of fiber-reinforced composite (FRC) and woven-coated FRC: an in vivo study.

OBJECTIVES: To investigate biocompatibility and bone contact area of FRC and woven-coated FRC (FRC-C) in rats. MATERIALS AND METHODS: Sixty rats were allocated to three groups: FRC (n=20), FRC-C (n=20), and control group (n=20). Subgroups were determined as 4th (n=10) and 12th weeks (n=10). The specimens were placed in the femur of rats. In the control group, the bone defects were left empty and sutured. Four and 12 weeks after implantation, the rats were sacrificed. Histopathological examinations were performed in a semi-quantitative manner. Twenty rats (n=20) were used for scanning electron microscopy (SEM) examination. Bone contact surfaces were calculated in SEM analysis. A chi-square test was performed to analyze the data. RESULTS: No statistical difference was detected between the 4th and 12th weeks in the quality of bone union. Quality of bone union was lower in FRC compared to the control group in the 4th week (p=0.012) and the 12th week (p=0.017). The periosteal reaction at the 12th week was lower in FRC than in the control group (p=0.021). Bone contact of FRC and FRC-C was 85.5% and 86.3%, respectively. CONCLUSIONS: FRC and FRC-C were biocompatible and showed no inflammation. The woven coating did not increase the quality of bone union and bone contact area, while not reducing biocompatibility. CLINICAL RELEVANCE: The biocompatibility and good bone response of the woven glass fiber net were demonstrated to have the potential as a scaffold for the augmentation of alveolar bone deficiencies and the reconstruction of maxillofacial defects.

In vivo vs. in vitro color stability of hybrid ceramic and resin nanoceramic blocks used for endocrowns: A new method.

PURPOSE: To evaluate and compare in vitro and in vivo color parameters of hybrid ceramic, resin nanoceramic, and artificial acrylic resin teeth. METHODS: For the in vitro stages, 120 specimens (2 mm) were prepared from Vita Enamic (VE), Lava Ultimate (LU), CeraSmart (CS), and acrylic teeth (IV), and immersed in coffee, red wine, and distilled water for 24, 72, and 144 hours. For the in vivo stage, 16 individuals received a complete denture that had upper premolars made of VE, LU, CS blocks, and IV. The color was measured at 1, 3, and 6 months. Color difference (ΔE00), translucency (TP), and contrast ratio (CR) were obtained using a spectrophotometer. Shapiro Wilk, one-way ANOVA, and repeated measures ANOVA were used for statistical analysis. RESULTS: ΔE00 of VE and LU were higher than CS and IV (P< 0.05). ΔTP of VE and LU were lower than CS and IV (P< 0.05). ΔTP of CS was higher in red wine compared to coffee. ΔCR of CS and IV were increased with prolonged immersion (P< 0.001). ΔE00 and ΔCR were similarly affected in coffee and red wine. All discolorations were higher than clinical acceptability (ΔE00> 1.77). For in vivo stages, ΔE00 of VE and LU increased over time (P< 0.01). No difference was detected between in vivo and in vitro ΔE00 of CS (P> 0.05). ΔE00 of VE, LU, and IV was higher in in vitro stages. LU and VE showed lower color stability; their use in esthetic regions is questionable. The prolonged immersion increased discoloration. Coffee and red wine had a similar effect on discoloration and opalescence. Discoloration in laboratory conditions did not correspond to the clinical discoloration according to the new method presented in this study. CLINICAL SIGNIFICANCE: The use of CAD-CAM blocks for endocrowns is rising; however, Lava Ultimate and Vita Enamic showed lower color stability, thus, their use in esthetic regions is questionable. This is the first study that investigates the discoloration of CAD-CAM blocks in clinical use. Discoloration in laboratory conditions did not correspond to the clinical discoloration.

Stress distribution of a novel bundle fiber post with curved roots and oval canals.

OBJECTIVE: The aim of this study was to compare the stress distribution of teeth with curved and straight roots with oval and round canals restored with the bundle and conventional post systems. MATERIAL AND METHODS: Six three-dimensional premolars were modeled with round and oval canals, and curved roots using the software. The bundle post and the round posts were modeled. All post models were placed on the canals. The models were subjected to 200 N oblique loading. The results were evaluated by von Mises stresses. RESULTS: This study demonstrated that the bundle post showed higher stress values compared to the conventional post. The stresses in the oval canal were higher than those in the round canal. The highest stress values were found in the curved roots. The stress distribution on the curved roots was observed in the middle and apical third of the canal. CONCLUSION: The bundle post presented higher stress compared to conventional posts. Besides, a more uniform stress distribution was observed in the bundle groups. CLINICAL SIGNIFICANCE: When a post was required in extremely irregular, wide canals and curved roots, the bundle post was the material of choice. Canal and root morphology influenced stress distribution.

Shaping ability of three instrumentation system in moderately curved canals: A micro-CT study.

This study aims to compare the shaping ability of three systems using micro-computed tomography (micro-CT). Moderately-curved mesial canals of 36 mandibular molars were assigned to three groups (n = 24); Protaper Next (PTN, 0.25, 0.06), WaveOne Gold (WOG, 0.25, 0.07), TruNatomy (TRN, 0.25, 0.04), and instrumentation was performed. Pre- and post-micro-CT scans were obtained. Canal volume and surface, structure model index (SMI), centroid shift, canal transportation, and untouched canal were analyzed. One-way ANOVA and Student's t-test were used for statistics. There was no difference in SMI, centroid shift, and centering ability between the study groups (p > .05). Removed dentin and canal surface changes were lower in TRN, while untouched dentin walls were higher (p < .05). Cross-sections became more rounded (p < .05), but not significant between groups (p > .05). Considering the removed dentin by TRN, it can be used in critical dentin thickness, such as the danger zone (DZ). PTN, WOG, and WOG kept the original canal course similarly. Untouched dentin by TRN (41%) was wider than PTN and WOG, consequently, meticulous irrigation is recommended. TRN, which provides a controlled increase in canal volume, can be used in thin dentin such as the DZ, however, its use should be supported by copious irrigation and brushing considering the rate of untouched dentin walls. RESEARCH HIGHLIGHTS: TRN presented a higher untouched dentin wall compared to PTN and WOG. Canal volume and surface changes were the lowest in the TRN group. The centering abilities were similar in PTN, WOG, and TRN.

Mental foramen and apical foramen: A dangerous anatomical proximity.

The study evaluated the spatial position of the mental foramen (MF) using 300 cone-beam computed tomography. The spatial position was analyzed with the horizontal location and relative location (distance between apical foramen and MF). The horizontal location was assessed through three positions (positions 1, 2, and 3). The relative location was determined with the x, y, and x coordinates of the root apex of mandibular premolars and the MF. Student's t-test and chi-square were performed. The most common horizontal location (52%) was position 2, which means between the premolars (p < 0.05). The relative location of the MF to the root apex of the second premolar was closer than the first premolar (p < 0.05). The distance between the root tip of the second premolar and the MF was 5.27 mm, with a minimum value of 1.87 mm. Clinicians should be aware of the possible neural results to the mental nerve of an endodontic infection and the extrusion of irrigation solutions.

Anatomic relationship between the root apex of maxillary molars and maxillary sinus in the presence of antagonist teeth: A Kwak's method with divisions.

OBJECTIVE: The purpose of the study was to evaluate the proximity between the root apices of maxillary molars and maxillary sinus floor using cone-beam computed tomography (CBCT) in the southern Turkish subpopulation. DESIGN: For the study, 246 CBCT images were analyzed. The absence of antagonist teeth was excluded. Kwak's types III and V were detailed with three divisions. Division M; the penetration of the mesial root only, Division D; the penetration of the distal root only, and Division MD; the penetration of both buccal roots. The distance between the maxillary sinus and the root apices was measured. Student's t-test, one-way ANOVA, and chi-square were used for statistical analysis. RESULTS: The penetration of maxillary molars was 24.40%. The highest prevalence belonging to Type I. Division MD was 44.35% for Type III and 40.42% for Type V. Division M was higher than Division D. The distances between the sinus and root apices were 1.35-2.41 mm in Type I. The distance decreased with age (p < 0.05). CONCLUSION: Both buccal root penetration into the sinus was higher than the single root penetration. The distance of the second molar root apices to the sinus was closer than the first molar. One-quarter of the first and second molars were inside the sinus. A greater likelihood of penetration of the root apices into the sinus with increased age.

The location of mandibular foramen relative to the occlusal plane: a study on anatolian dry mandible.

Purpose: The study aims to evaluate the location of mandibular foramen (MF) with respect to the occlusal plane (OP) and its location on the ramus using Anatolian dry mandibles. Materials and methods: A total of 115 dry mandibles with mandibular molars were analyzed. The distance between the MF and the OP was examined with a flat metal plate. Group A was above the OP; group L was at level, and group B was below the OP. The distances between the MF and anterior border (A-MF), sigmoid notch (U-MF), posterior border (P-MF), and lower border (L-MF) were measured. The symmetry between the two sides was examined. Pearson chi-square and Student's t-test were performed for statistical analysis. Results: According to the analysis, 50.23% of MF was located below the OP (p<0.05). The mean distances of Groups A and B were 3.45 and 4.78 mm, respectively. There was no difference between the left and right in groups (p>0.05). The distance A-MF was 14.71 mm. There was no statistical difference between the distances A-MF and P-MF or U-MF and L-MF. Conclusion: Half of the MF (50.23%) was located below the occlusal plane with a mean distance of 4.78 mm. It may be helpful to place the needle 3-4 mm above the OP and 1.5-2 mm back of the anterior border to obtain a successful inferior alveolar nerve block. The MF was located at the center of the medial surface of the ramus.

Shear bond strength of resin-modified glass ionomer cement bound to mineral trioxide aggregate after various disinfection protocols.

This study compared the effects of 3 different cavity disinfection protocols (CDP) on the shear bond strength (SBS) of resin-modified glass ionomer cement (RM-GIC) to mineral trioxide aggregate (MTA). One hundred eighty standard holes were prepared and filled with MTA. They then divided into 3 main groups based on the chosen time intervals (15 min, 24 h, and 72 h). Main groups were divided into 3 subgroups based on the CDP [chlorhexidine gluconate (CHX), ozone, laser, and control]. RM-GIC was applied on MTA after CDP for all groups. A universal testing device was then used for test and the data was statistically analysed. CHX showed significantly lower SBS values except ozone and laser than the control (p < 0.05). There were no statistically significant differences among the time intervals. As a result, CHX decreased the bond strength between the MTA and RM-GIC while ozone and laser had no negative effect.

Revisiting the measurement of keratinized gingiva: a cross-sectional study comparing an intraoral scanner with clinical parameters.

PURPOSE: The aim of this study was to investigate the relationships between gingival thickness (GT) and keratinized gingiva width (KGW), papilla height (PH), and crown ratio (CR) by employing transgingival probing and an intraoral scanner (IOS). METHODS: This cross-sectional study examined 360 maxillary anterior teeth from 60 patients. GT was assessed using transgingival probing with an endodontic spreader. KGW, CR, and PH were measured using an IOS. One-way analysis of variance, the Student's t-test, and Spearman correlation coefficients were employed for statistical analysis. RESULTS: Higher GT was significantly associated with thinner KGW in the central region (P=0.019). There was no statistically significant difference in GT between teeth (P=0.06). PH was lower in lateral teeth than in canines (P=0.047), with a PH of 2.99 mm in lateral teeth. The KGW was narrower in canines than in central teeth (P=0.007). A moderate correlation was observed between KGW and PH in the central region (P=0.01), while a weak negative correlation was found between KGW and CR (P=0.043). CONCLUSIONS: A moderate negative correlation was found between GT and KGW, as well as between PH and KGW in central teeth. In contrast, a weak negative correlation existed between CR and KGW. The PH (2.99 mm) was lower in lateral teeth than in canines. The traditional paradigm, which suggests a positive correlation between KGW and GT, was re-evaluated by measuring KGW using an IOS.

Fracture Resistance of the Bundle Post System and Conventional Fiber Post with Different Lengths.

This study compares the fracture strength of teeth restored with conventional round fiber post (CP) and bundle post (BP) in two different lengths. A total of 48 mandibular premolars were selected. Endodontic treatment was performed, and the premolars were divided into four groups (n = 12 per group): Group C9 = 9-mm CP; Group C5 = 5-mm CP; Group B9 = 9-mm BP; Group B5 = 5-mm BP. Post spaces were prepared, and posts were disinfected with alcohol. Silane was applied, and posts were placed with self-etch dual-cure adhesive. The core structures were created using dual-cure adhesive and standardized core-matrix. Specimens were embedded in acrylic, and the periodontal ligament was simulated with polyvinyl-siloxane impression material. Thermocycling was performed, and specimens were then loaded at a 45-degree angle to the long axis. The failure mode was analyzed with ×5 magnification, and statistical analyses were performed. No statistical difference was found between post systems and post lengths (P > .05). Chi-square test revealed no statistical difference in the failure mode (P > .05). BP did not affect fracture resistance compared to CP. For the restoration of extremely irregular canals with a fiber post, BP can be used as an alternative system because it does not reduce the fracture strength. If necessary, longer posts can be used without decreasing the fracture resistance.

Evaluation of facial alveolar bone thickness and fenestration of the maxillary premolars.

OBJECTIVE: The objective of this study was to retrospectively investigate the facial alveolar bone (FAB) thickness and fenestration rate of maxillary first and second premolars using cone-beam computed tomography (CBCT). DESIGN: A total of CBCT images of 66 patients were selected and 200 maxillary premolar (100 first and 100 second premolar) were included. The FAB thicknesses were measured at 1,3 and 5 mm apical to the alveolar bone peak. The prevalence of fenestration in maxillary premolars was recorded. The statistical analyses were performed. RESULTS: The FAB thicknesses of the second premolars (1.39 mm at 1 mm, 1.42 mm at 3 mm, and 1.22 mm at 5 mm) were significantly higher than the first premolars (1.11 mm at 1 mm, 0.70 mm at 3 mm, and 0.48 mm at 5 mm) at 1, 3, and 5 mm levels (p < 0.05). The lowest prevalence (1 %) of the thickness of FAB ≥ 2 mm was in the first premolar has at 5 mm apical of the alveolar bone peak. The overall prevalence of fenestration in maxillary premolars was found as 30.5 %. There was a statistically significant difference between first and second premolars (p < 0.05). CONCLUSION: The FAB thicknesses are lower in the first premolar than the second premolar. The lowest FAB thickness was in the first premolar at 5 mm apical of the bone crest as 0.42 mm. The prevalence of fenestration in maxillary premolars was higher in the Turkish subpopulation than in other populations. Fenestration was more common in the maxillary first premolar.

Dentin Thickness at Danger Zone and Canal Morphology of Maxillary Molars.

Objectives: Dentin thickness in concave areas of the root creates risk for complications such as strip perforation during endodontic treatment. The study aims to examine dentin thickness of the danger (DZ) and safety zone (SZ), canal configuration, and the presence of isthmus in the mesiobuccal root of maxillary molars. Material and Methods: Cone-beam Computed Tomography (CBCT) images of 1251 teeth belonging to 642 patients were retrospectively reviewed. The dentin thicknesses at DZ and SZ in maxillary molars with one (MB) or two mesiobuccal canals (MB1, MB2) were measured at the 3 mm apical to the furcation level. Vertucci's canal configurations and the isthmus rate were recorded. The Chi-square test andThe Student's t-test were performed. Results: MB2 rate was higher in maxillary first molars (61.68%) than second molars (39.36%). Isthmus rates were 27.3% and 44.11% in first and second molars. DZ thickness was thinner than the dentin thickness in the SZ in both first and second molars with one or two mesial canals (p< 0.05). In teeth with single canal, the mean DZ thickness was 0.88mm. In teeth with two canals, the mean DZ thicknesses were 0.83mm and 0.80mm for MB1 and MB2 canals, respectively. Conclusion: MB2 rate was higher in the first molar (61.68%), and the isthmus rate was higher in the second molar (44.11%). DZ and SZ were thinner in MB2 than in MB1 at the maxillary molars with two mesial canals. The results indicated that more conservative preparation must be applied to the MB2 canal in the maxillary molars.