In vitro antimicrobial activity of sodium hypochlorite, chlorhexidine gluconate and octenidine dihydrochloride in elimination of microorganisms within dentinal tubules of primary and permanent teeth.

The aim of this study was to evaluate the effectiveness of different irrigation solutions at different time intervals for the elimination of E. faecalis and C. albicans penetrated into the dentine tubules of primary and permanent teeth in vitro. The 4 mm primary and permanent teeth sections were sterilized and contaminated with a mixture of E. faecalis and C. albicans strains. After the application of different irrigation solutions (Sodium hypochlorite, Chlorhexidine gluconate, Octenidine Dihydrochloride, saline) to the contaminated tooth sections according to study groups, neutralizers were applied for inactivation of the solutions after 30 sec, 1 min and 5 min. Dentine shavings were placed into TSB and 10 µL from each tube was inoculated on agar plates, followed by an incubation period of 24 h at 37°C. The colonies were counted macroscopically. The results were compared by using Kruskal-Wallis and Mann Whitney U tests, with a significance level at p<0.05. Among the irrigation solutions that were tested against E. faecalis on primary and permanent teeth, the most effective one was found as 5-minute application of 0.1% Octenidine Dihydrochloride. The antibacterial effects of the tested solutions on the same time periods against C. albicans revealed no significant difference. There were no statistically significant differences between primary and permanent teeth with respect to the antimicrobial activity of the tested solutions. Moreover, Octenidine Dihydrochloride may be used as an alternative endodontic irrigant.

Accuracy of an electronic apex locator: a clinical evaluation in primary molars with and without resorption.

OBJECTIVE: The aim of this study was to evaluate the accuracy of electronic apex locator (Root ZX) in primary teeth with and without apical root resorption in vivo. STUDY DESIGN: The electronic working length was determined in 28 primary teeth (A total of 46 primary molar root canals with 24 roots without resorption and 22 roots with resorption) from twenty-eight healthy children using Root ZX. The teeth were then extracted. The actual length of each root was measured placing a K-File until the tip was visible at the apical foramen or the apical resorption level and approved with digital microscopic evaluation under 20x magnification and then withdrawn 1 mm. The distances from the file tip to the base of the rubber stop were measured and compared with the measurement obtained from apex locator. The data were evaluated with t test using standard statistical software (SPSS 13.0). The critical value of statistical significance was 5%. RESULTS: For root canals without resorption, the accuracy of Root ZX was 79.16% and 95.82% within +/- 0.5 and +/- 1 mm, respectively. For root canals with resorption, the accuracy of Root ZX was 63.63% and 86.35% within +/- 0.5 and +/- 1 mm, respectively. No statistically significant differences were detect between the electronically determined lengths and the actual lengths regardless of whether or not resorption. CONCLUSION: Using a Root ZX Electronic Apex Locator in primary teeth with or without resorption is recommended for the determination of working length.

Effectiveness of premedication agents administered prior to nitrous oxide/oxygen.

BACKGROUND AND OBJECTIVE: In paediatric dentistry, when anxiety, fear of dental procedures or behavioural impairment precludes the conduct of dental treatments, sedation procedures are required. However, sedation at the desired level might not be achieved despite administration of various agents. The present study aimed to evaluate the effectiveness of oral premedication with different agents on children scheduled for dental treatment under nitrous oxide/oxygen (N2O/O2) sedation. METHODS: The present research was approved by the Ethics Committee of Gazi University Faculty of Medicine. Sixty children aged between 5 and 8 years, ASA I or II, having no mental or motor retardation, requiring at least two-visit dental treatment, having no sedation or general anaesthesia experience, and incompliant with dental treatment (Frankl Behaviour Scale>or=3), were enrolled into the study after obtaining informed parental consent. The children were then randomly assigned to one of four groups. The treatment regimen according to the study groups was as follows: oral administration of 1 mg kg(-1) hydroxyzine hydrochloride suspension (Atarax) 1 h preoperatively (group I, n=15), oral administration of 0.7 mg kg(-1) midazolam (Dormicum) 15 min preoperatively (group II, n=15), oral administration of 3 mg kg(-1) ketamine (Ketalar) with 0.25 mg kg(-1) midazolam (Dormicum) 15 min preoperatively (group III, n=15), and no oral premedication administration [group IV (controls), n=15]. Peripheral oxygen saturation (SpO2) and heart rate were monitored with a pulse oximeter during treatment. The sedation level was monitored with the bispectral index. Following premedication, 40% N2O and 60% O2 was administered to all groups by means of a nasal mask. Sedation depth was evaluated using the Ramsay Sedation Scale and data were recorded at 5 min intervals. Sedation success and other sedation-related events were recorded. RESULTS: The evaluation of the findings of this study revealed that treatment procedures were completed without any serious complications. Achievement of sedation in terms of satisfactory/mid-level satisfactory/unsatisfactory was as follows: 13.3/53.3/33.3% in group I; 54/20/26% in group II; 33.3/33.3/33.3% in group III, and 6.7/60/33.3% in group IV, respectively. Ramsay Sedation Scale results revealed that the most effective medication was 0.7 mg kg(-1) midazolam. CONCLUSION: It is concluded that 0.7 mg kg(-1) midazolam is more effective than 0.25 mg kg(-1) midazolam with 3 mg kg(-1) ketamine and 1 mg kg(-1) hydroxyzine hydrochloride in terms of oral premedication prior to N2O/O2 sedation in children scheduled for dental treatments.

The effects of temperament and behaviour problems on sedation failure in anxious children after midazolam premedication.

BACKGROUND AND OBJECTIVE: Midazolam is one of the most frequently used agents for sedation in paediatric dentistry. It is unclear how temperament traits and behaviour problems are related to sedation failure in children. We investigated whether sedation failure after premedication with oral midazolam can be predicted by behaviour problems and temperament traits. METHODS: Sixty children (aged 4-8 years) referred for dental treatment under sedation (40/60% N2O/O2), who had a Frankl Behaviour Scale score of at least 3, were premedicated with oral midazolam (0.75 mg kg(-1)). The level of sedation was assessed at defined time intervals, according to the Houpt Sedation Rating Scale. Children's sedation success during dental treatment was classified as satisfactory or unsatisfactory. Heart rate and oxygen saturation were evaluated by an oxygen saturation monitor in the sedation period. On the treatment day, parents completed 'The Revised Conners' Parent Rating Scale' and 'Short Temperament Scale for Children' to assess their child's behaviour problems and temperament, respectively. RESULTS: The rates of sedation success were found to be satisfactory in 78.4% and unsatisfactory in 21.6%. Student's t-test demonstrated that in addition to the Short Temperament Scale for Children Inflexibility subscale being significant the Revised Conners' Parent Rating Scale: Long Form Psychosomatic subscale was also found to be a significant predictor of sedation failure. CONCLUSION: Psychosomatic behaviour problems and an inflexible temperament trait might contribute to sedation failure in children undergoing dental treatment under midazolam premedication and N2O/O2 sedation. Appropriate patient selection based on the evaluation of childhood behavioural problems and temperament characteristics might increase midazolam sedation success in children.

Microleakage of different temporary filling materials in primary teeth.

OBJECTIVE: The aim of this study was to compare the sealing properties of IRM, Coltosol, Cavit G, Adhesor and Clip, which used as temporary filling material in coronal access openings in extracted human primary teeth. STUDY DESIGN: Standardized access cavities of 2 x 2 mm were prepared in the eighty-four, caries-free human primary anterior teeth. The teeth were divided randomly into five groups of 16 teeth each. Temporary restorative materials Group A: IRM (Dentsply), Group B: Coltosol (Coltone), Group C: Cavit G (3M), Group D: Adhesor (Spofa Dental) and Group E: Clip (Voco) were applied according to the manufacturer's directions. The specimens were immersed silver nitrate and placed in film developer under fluorescent for 24 hours. The sectioned specimens were evaluated under a digital microscope at x 20 magnifications and blindly scored for microleakage. RESULTS: Clip presented the least microleakage value whereas; Adhesor and IRM presented the higher microleakage values. There were statistically significant differences between Clip and the others groups, while there were no statistically significant differences in microleakage between IRM, Adhesor, Coltosol and Cavit G. However the leakage scores of Clip and Cavit G were congruent (p = 0.454). CONCLUSION: Amongst the five materials, Clip exhibited a better sealing ability.

Effect of drinks that are added as flavoring in oral midazolam premedication on sedation success.

BACKGROUND: Midazolam is one of the most frequently used agents for sedation in pediatric dentistry. The injectable form of midazolam can also be given orally. However, its bad taste has negative effects on ingestion of the drug. In this study, we aimed to evaluate the effect of drinks which were added to mask the bitter taste of midazolam for drug acceptance and sedation. METHODS: In the laboratory; the pH values of 2.5 ml midazolam (15 mg x 3 ml(-1)) and the mixtures of Pepsi Cola, 10% sodium citrate, fresh pomegranate juice, and fresh grapefruit juice in equal volumes were measured. Seventy-five patients between 2 and 8 years of age who were assessed to have anxiety with the Frankl Behavior Scale and whose dental treatment was planned under sedation were randomly divided into five groups. Pepsi Cola (Group I), 10% sodium citrate (Group II), pomegranate juice (Group III), and grapefruit juice (Group IV) which were added to 0.75 mg x kg(-1) midazolam in equal volumes, and (Group V) 0.75 mg x kg(-1) midazolam given orally to children. The drug compliance of children was evaluated. After 15 min, 4-5 l x min(-1) of N(2)O : O(2) (40 : 60) inhalation was started via a nasal hood. During the procedure, heart rate, and SpO2 were monitored with pulse oximetry and sedation levels with the Ramsay Sedation Scale (RSS). Anesthetist, dentist, and parental satisfaction levels were recorded. RESULTS: The groups had similar demographics, drug ingestion was better in Groups I and II, but the mean RSS was the highest in Group II (P < 0.05). CONCLUSIONS: As well as making drug ingestion much simpler, the addition of sodium citrate to the midazolam administered orally to the children increased the effectiveness of sedation.

Premedication with melatonin vs midazolam in anxious children.

AIM: Failure of dental treatment caused by anxiety is a common problem in children. Oral midazolam has been the most commonly used premedication for pediatric patient but the use of midazolam may be associated with paradoxical reactions in children. Melatonin may induce a natural sleepiness and improve sedation. We have investigated premedication with melatonin compared with midazolam in children under nitrous oxide/oxygen (N(2)O/O(2)) sedation for dental treatment. METHODS: In a randomized study, 60 children received either 3 mg of melatonin [Melatonina (3 mg(R)) 60 min before the procedure (n = 15); group I], 0.5 mg.kg(-1) melatonin 60 min before the procedure (n = 15; group II), 0.75 mg.kg(-1) midazolam [Dormicum (15 mg/3 ml (R)) 15 min before the procedure (n = 15); group III] or 3 ml of 0.09 NaCl 15 min (n = 7) or 60 min before the procedure (n = 8; group IV) orally. The children were sedated with 40/60% N(2)O/O(2) inhalation. The heart rate and O(2) saturation were monitored during the treatment period. The level of sedation was assessed according to the Ramsay Sedation Scale. The children's sedation success during dental treatment was classified. The sedation success and other sedation-related events recorded. Comparisons among the four groups were made using one-way anova or Kruskal-Wallis test, and if any significant differences were noted, the Tukey's HSD or Mann-Whitney U-test were used for intergroup comparisons. All differences were considered significant at P < 0.05. RESULTS: The evaluation of sedation success was as follows: group I: satisfactory (n = 1), average satisfactory (n = 4), and unsatisfactory (n = 10); group II: satisfactory (n = 2), average satisfactory (n = 3), and unsatisfactory (n = 10); group III: satisfactory (n = 9), average satisfactory (n = 6); and group IV: satisfactory (n = 1), average satisfactory (n = 3), and unsatisfactory (n = 11). CONCLUSION: In these doses and clinical conditions, melatonin was similar to that of placebo and did not contribute to N(2)O/O(2) sedation of anxious children.

Clinical, radiographic, and histopathologic evaluation of Nd:YAG laser pulpotomy on human primary teeth.

The purpose of this study was to compare clinical, radiographic, and histopathologic effects of Nd:YAG laser pulpotomy to formocresol pulpotomy on human primary teeth. Patients with at least two vital primary molar teeth that required pulpotomy, because of pulpal exposure to caries, were selected for this study. After hemorrhage control, complete hemostasis into the canal orifice was achieved by exposure to Nd:YAG laser (1064 nm) and an He-Ne laser (the aiming beam of the Nd:YAG laser) in noncontact mode at 2 W, 20 Hz, 100 mJ, or was achieved by applying 1:5 dilution of formocresol. Forty-two teeth in two groups were to be followed up clinically and radiographic at 1, 3, 6, 9, and 12 months. Eighteen teeth planned for serial extractions were selected for histopathologic study. The teeth were extracted at 7 and 60 days. The teeth in the laser group had a clinical success rate of 85.71% and a radiographic success rate 71.42% at 12 months. The teeth in the formocresol group had a clinical and radiographic success rate of 90.47% at 12 months. There were no statistically significant differences between laser and formocresol group with regard to both clinical and radiographic success rates. There was a statistically significant difference between 7- and 60-day laser groups with regard to inflammatory cell response criteria. Dentin bridge was absent in all samples. No stained bacteria were observed in any of these samples. In conclusion, Nd:YAG laser may be considered as an alternative to formocresol for pulpotomies in primary teeth.

Comparison of the Potential Discoloration Effect of Bioaggregate, Biodentine, and White Mineral Trioxide Aggregate on Bovine Teeth: In Vitro Research.

INTRODUCTION: Tricalcium silicate cements can be used for pulp capping, pulpotomies, apical barrier formation in teeth with open apices, repair of root perforations, regenerative endodontics, and root canal filling. The aim of this study was to evaluate and compare the discoloration potential of 3 different tricalcium cements using a bovine tooth model. METHODS: Forty bovine anterior teeth have been used for the study. Crowns separated from the roots were randomly divided into 4 groups: the BioAggregate (IBC, Vancouver, Canada) group, the Biodentine (Septodont, Saint Maur des Fosses, France) group, the mineral trioxide aggregate Angelus (Angelus, Londrina, PR, Brazil) group, and the only blood group. Materials have been placed to the standardized cavities on the lingual surfaces of the crowns, and their contact with blood has been provided. The color values of the samples were measured with a digital tooth shade determinator (VITA Easyshade; VITA Zahnfabrik, Bad Sackingen, Germany) before the placement of the materials, after the placement of the materials, in the 24th hour, in the first week, in the first month, in the third month, and in the first year. The mean value of all groups was compared using the Tukey multiple comparison test (α = 0.05). RESULTS: All groups displayed increasing discoloration during a period of the first year. The "only blood group" showed the highest color change values, and it was followed as BioAggregate, mineral trioxide aggregate Angelus, and Biodentine, respectively. Statistically significant differences were found for Biodentine when compared with the only blood and BioAggregate groups (P < .05). CONCLUSIONS: Considering the results of the study, Biodentine is found to have the least discoloration potential among the tested materials.

The wand in pulp therapy: an alternative to inferior alveolar nerve block.

OBJECTIVES: The purpose of the study was to compare children's reactions to inferior alveolar nerve injection with traditional syringe and periodontal ligament injection with a computerized device (Wand); and to assess the efficacy of the anesthesia and their reaction after treatment. METHOD AND MATERIALS: Twenty-five children, aged 6 to 10 years, participated in the study. The contralateral primary mandibular second molars were treated in 2 separate visits with random use of either the Wand or traditional syringe injection. The pain perception levels for each step were assessed with Eland Color Scale during the preparation. A Mann-Whitney U test was performed to compare the results. The patients were asked their preference of technique after the treatment. RESULTS: When pain was measured immediately after injection, the traditional syringe was found to be more painful than injections with the Wand (P < .05). Pain scores with the Wand injections were found to be significantly (P < .05) higher than those with traditional inferior alveolar nerve injections at the end of the restoration. The overwhelming majority of patients favored the periodontal ligament injection with the Wand. CONCLUSION: The Wand technique provided significantly lower pain scores during the periodontal ligament injection. However, the pain scores during the treatment were significantly higher compared with the inferior alveolar nerve injections. Most of the patients stated that they preferred the periodontal ligament injection with the Wand to the traditional inferior alveolar nerve injection.

The efficacy of a fluoride chewing gum on salivary fluoride concentration and plaque pH in children.

OBJECTIVES: The purpose of this study was therefore to study the influence of different chewing times on the salivary F concentration and on the recovery of plaque pH directly after a sucrose rinse on both the chewing and the non-chewing side. METHODS: For this purpose, one piece of sugar free chewing gum was chewed to 10 healthy subjects (aged 8-10 years, 5 male and 5 female children). Subjects refrained from toothbrushing for 3 days. On the fourth day, they rinsed for 1 min with 10 microl of a 10% sucrose solutions. After 8 min, chewing gum was given and started to chew for either 5, 10, 20, 30, 45 min or control (sucrose rinse). Thus, altogether six test sessions were repeated at one week intervals. Measurements of F concentration in saliva and pH of approximal plaque were carried out at two contralateral sites for up to 60 min. RESULTS: Higher salivary F concentrations were found on the chewing side than on the non-chewing side (expressed as) (p<0.05). But, the difference between the chewing and the non-chewing side was not obvious for the plaque pH (expressed as AUC) (p>0.05). Therefore, this study showed that: (1) the F concentrations in saliva after chewing a F containing chewing gum had only small numerical differences among the various chewing times, with the exception for 5 min. All chewing time periods showed statistically significant differences between chewing and non-chewing side. (2) The prolonged chewing time increased the plaque pH recovery after a sucrose rinse (p<0.05) but there was no statistically significant difference on both of the chewing and non-chewing side (p>0.05). CONCLUSION: The results of this study indicated that a prolonged chewing time was favorable to the plaque pH recovery after a sucrose rinse and, to a certain extent, to the salivary fluoride concentration. Also it was shown that the F concentration in saliva was strongly dependent on which side the subject chewed on.

The effect of flowable resin composite on microleakage and internal voids in class II composite restorations.

This in vitro study evaluated the influence of two flowable resin composites on marginal microleakage and internal voids in Class II composite restorations with the margins below the cementoenamel junction (CEJ). Class II cavities randomly divided into four groups: Group I-Filtek with Filtek Flow lining; Group II-Filtek; Group III-Tetric Ceram with Tetric Flow lining; Group IV-Tetric Ceram. After thermocycling tests (5-60 x 1500) and dye soaking, the teeth were sectioned in a mesiodistal direction along their longitudinal axis. Gingival-marginal microleakage and internal voids in three separate portions of the restoration (interface, cervical and occlusal voids) were observed with a microscope. Statistical analyses indicated that the use of flowable resin composites (Groups I and III) provided a reduction in marginal microleakage and a reduction in some parts of the internal voids or total voids (p<0.05). The condensable material (Filtek) in combination with the flowable liner showed fewer voids (interface, occlusal, total) than the hybrid resin (Tetric) (p<0.05). There was a correlation between the number of internal voids or total voids and the marginal microleakage (p<0.05). It was concluded that a composite lining in a Class II resin composite with margins below the cementoenamel junction may reduce marginal microleakage and voids in the interface and the total number of voids in the restoration.

Effects of oxidative irrigants on root dentin structure: Attenuated Total Reflection Fourier Transform Infrared Spectroscopy study.

AIM: The aim of this study was to compare the effect of oxidative irrigants on the organic and inorganic structure of root canal dentin. METHODOLOGY: Fifty human 2nd premolar roots were used in the study. The dentin specimens prepared from those teeth were immersed in liquid nitrogen for 15 min. The frozen composition was titrated in a mixer and the obtained dentin powder was kept frozen at -70°C until use. Ten groups of 50mg dentin powder were immersed in agents (A: Ozone for 100 or 200 sec, B: 5.25% NaOCl, C: 2.25% NaOCl, D: 2% Chlorhexidine, E: 0.9% NaCl (control)) for 5 or 10 min. An Attenuated Total Reflection Fourier Transform Infrared Spectrophotometer (ATR FT-IR) was used to analyze dentin powder. The data were statistically analyzed by using Kruskall-Wallis analysis of variance. RESULTS: In all groups, collagen degradation was significantly increased compared to the control and 2% CHX groups (p<0.05). The use of ozone increased collagen degradation significantly compared to the use of 2.25% NaOCl and 2% Chlorhexidine for 5 min (p < 0.05). No significant differences were observed between ozone and 5.25% NaOCl-treated groups (p > 0.05). CONCLUSIONS: The structural composition of human dentin was significantly affected by the use of oxidative irrigants at higher concentrations.

Evaluation of the antimicrobial activities of chlorhexidine gluconate, sodium hypochlorite and octenidine hydrochloride in vitro.

The objective of this study was to compare the antimicrobial activity of sodium hypochlorite (NaOCl), chlorhexidine gluconate (CHX) and octenidine hydrochloride (OCT) in different concentrations against endodontic pathogens in vitro. Agar diffusion procedure was used to determine the antimicrobial activity of the tested materials. Enterococcus faecalis, Candida albicans and the mixture of these were used for this study. In the agar diffusion test, 5.25% NaOCl exhibited better antimicrobial effect than the other concentrations of NaOCl for all strains. All concentrations of OCT were effective against C. albicans and E. faecalis. Some 0.2% CHX was ineffective on all microorganisms. Antibacterial effectiveness of all experimental solutions decreased on the mixture of all strains. Decreasing concentrations of NaOCl resulted in significantly reduced antimicrobial effect.

Conversion degrees of a colored compomer in different colors utilized by various curing times.

PURPOSE: Compomers are widely used in primary teeth and are manufactured in different colors in order to make dental treatment acceptable in children. The aim of this in vitro study was to evaluate the degree of conversion (DC) of different colored compomers and of compomers with various curing times. METHODS: Sixty three cylindrical samples were prepared from a colored compomer (Twinky Star). These samples were of 7 different color groups, with 9 samples of each color. Each group was divided into 3 sub-groups, according to the curing time (20-30-40 seconds) with a light emitting diode light curing unit. The DC values from 3 different regions and depths were evaluated with a Fourier Transform Infrared Spectrometer before and after curing procedures for all groups. Data were calculated by using the baseline values; statistical analyses were done by using ANOVA test. RESULTS: Significant differences in DC results before and after curing were found among the groups (P<0.05). For all curing times, the silver colored samples showed the poorest DC results, which ranged from 13% to 18%. CONCLUSIONS: It was concluded that DC values of different colors were variable. The material properties could be improved by defining the proper polymerization time for each color.

Accuracy of two different apex locators in primary teeth with and without root resorption.

The objective of this study was to assess the accuracy of two frequency apex locators, Root ZX (Morita, Kyoto, Japan) and Endex (Osada, Tokyo, Japan) in primary teeth with and without root resorption in vitro. For this study, 90 sound extracted primary teeth (60 molars and 30 incisors; 93 roots with visible resorption and 51 roots without) were selected. A total of 144 root canals were included. After access preparation, root canal lengths were measured visually. The teeth were embedded in an alginate model developed specifically for testing apex locators. Electronic length was determined with two different frequency apex locators, Root ZX (Morita, Kyoto, Japan) and Endex (Osada, Tokyo, Japan). Statistical evaluation was performed using Mann-Whitney U and Wilcoxon W tests (p < 0.05). Results revealed that both apex locator devices did not show similar values to visual length measurements with statistically significant differences in primary teeth with root resorption (p < 0.05). For the teeth without root resorption, Endex showed similar values to visual length measurements with no statistically significant differences (p > 0.05), but Root ZX values were different than visual length and the differences were statistically significant (p < 0.05). There were no significant differences between the two apex locators considering the presence of root resorption. The two frequency apex locators can be recommended for use in root canal therapy for primary teeth with and without root resorption, only if electrical determination of root canal length is supported with other diagnostic measures.