OBJECTIVES: This study evaluated the effects of intraradicular moisture on the pushout bond strength of a fibre post luted with several self-adhesive resin cements. MATERIALS AND METHODS: Endodontically treated root canals were treated with one of three luting cements: (1) RelyX U100, (2) Clearfil SA, and (3) G-Cem. Roots were then divided into four subgroups according to the moisture condition tested: (I) dry: excess water removed with paper points followed by dehydration with 95% ethanol, (II) normal moisture: canals blot-dried with paper points until appearing dry, (III) moist: canals dried by low vacuum using a Luer adapter, and (IV) wet: canals remained totally flooded. Two 1-mm-thick slices were obtained from each root sample and bond strength was measured using a push-out test setup. The data were analysed using a two-way analysis of variance and the Bonferroni post hoc test with p = 0.05. RESULTS: Statistical analysis demonstrated that moisture levels had a significant effect on the bond strength of luting cements (p < 0.05), with the exception of G-Cem. RelyX U100 displayed the highest bond strength under moist conditions (III). Clearfil SA had the highest bond strength under normal moisture conditions (II). Statistical ranking of bond strength values was as follows: RelyX U100 > Clearfil SA > G-Cem. CONCLUSIONS: The degree of residual moisture significantly affected the adhesion of luting cements to radicular dentine.
Dehydration ; Dental Pulp Cavity ; Dentin* ; Ethanol ; Nerve Fibers, Myelinated* ; Resin Cements* ; Vacuum ; Water

OBJECTIVES: The purpose of the study was to evaluate human dental pulp response to pulpotomy with calcium hydroxide (CH), mineral trioxide aggregate (MTA), and calcium enriched mixture (CEM) cement. MATERIALS AND METHODS: A total of nine erupted third molars were randomly assigned to each pulpotomy group. The same clinician performed full pulpotomies and coronal restorations. The patients were followed clinically for six months; the teeth were then extracted and prepared for histological assessments. The samples were blindly assessed by an independent observer for pulp vitality, pulp inflammation, and calcified bridge formation. RESULTS: All patients were free of clinical signs/symptoms of pulpal/periradicular diseases during the follow up period. In CH group, one tooth had necrotic radicular pulp; other two teeth in this group had vital uninflamed pulps with complete dentinal bridge formation. In CEM cement and MTA groups all teeth had vital uninflamed radicular pulps. A complete dentinal bridge was formed beneath CEM cement and MTA in all roots. Odontoblast-like cells were present beneath CEM cement and MTA in all samples. CONCLUSIONS: This study revealed that CEM cement and MTA were reliable endodontic biomaterials in full pulpotomy treatment. In contrast, the human dental pulp response to CH might be unpredictable.
Aluminum Compounds ; Biocompatible Materials* ; Calcium Compounds ; Calcium Hydroxide* ; Calcium* ; Dental Pulp ; Dentin ; Drug Combinations ; Follow-Up Studies ; Glutamates ; Guanine ; Humans ; Hydroxides ; Inflammation ; Molar, Third ; Oxides ; Pulpotomy* ; Silicates ; Tooth ; Pemetrexed

OBJECTIVES: The aim of this study was to assess the influence of operator experience level on the lifespan of the WaveOne Primary file (Dentsply Maillefer, Ballaigues, Switzerland) in extracted teeth. MATERIALS AND METHODS: Moderately curved canals of extracted maxillary and mandibular molars were randomly distributed into 2 groups: experienced and inexperienced operators. Ten files were allocated to each group (n = 10). Each canal was prepared until the working length was reached, and the same file was used to prepare additional canals until it separated. The number of canals prepared before file separation was recorded. The fragment length of each file was measured, and the location of the fragment in the canal was determined. Data were statistically analysed using the independent 2-sample t-test. RESULTS: The 2 operators prepared a total of 324 moderately curved canals of maxillary and mandibular molars. There was no significant intergroup difference in the mean number of canals prepared (p = 0.27). The average lifespan of the WaveOne Primary file was 17.1 and 15.3 canals, and the longest lifespan was 25 and 20 canals, when used by experienced and inexperienced operators, respectively. There were no statistically significant intergroup differences in separated fragment length and location. CONCLUSIONS: Within the limitations of this study, operator experience level appears to have no effect on the lifespan of the WaveOne Primary file in preparation of moderately curved canals. Single teeth with multiple canals can be prepared safely even by a novice operator by using a single file.
Molar ; Tooth*

OBJECTIVES: To determine the retentive strength and failure mode of undercut composite post, glass fiber post and polyethylene fiber post luted with flowable composite resin and resin-cement. MATERIALS AND METHODS: Coronal parts of 120 primary canine teeth were sectioned and specimens were treated endodontically. The teeth were randomly divided into 6 groups (n = 20). Prepared root canals received intracanal retainers with a short composite post, undercut composite post, glass fiber post luted with flowable resin or resin-cement, and polyethylene fiber post luted with flowable resin or resin-cement. After crown reconstruction, samples were tested for retentive strength and failure mode. Statistical analysis was done with one-way ANOVA and Tukey tests (p < 0.05). RESULTS: There were statistically significant differences between groups (p = 0.001). Mean bond strength in the undercut group was significantly greater than in the short composite post (p = 0.030), and the glass fiber post (p = 0.001) and the polyethylene fiber post group luted with resin-cement (p = 0.008). However, the differences between the undercut group and the groups with flowable composite as the luting agent were not significant (p = 0.068, p = 0.557). Adhesive failure was more frequent in the fiber post groups. CONCLUSIONS: Although the composite post with undercutting showed the greatest resistance to dislodgement, fiber posts cemented with flowable composite resin provided acceptable results in terms of retentive strength and fracture mode.
Adhesives ; Composite Resins ; Crowns ; Cuspid ; Dental Cements ; Dental Pulp Cavity ; Glass ; Polyethylene ; Resin Cements ; Tooth ; Tooth, Deciduous*

OBJECTIVES: This study aimed to evaluate the capacity of 2% chlorhexidine gel associated with 8% papain gel in comparison with 5.25% sodium hypochlorite in bovine pulp tissue dissolution. MATERIALS AND METHODS: Ninety bovine pulps of standardized sizes were used and fragmented into 5-mm sizes. The fragments were removed from the root middle third region. They were divided into 6 experimental groups (n = 15), 1) 8% papain; 2) 2% chlorhexidine; 3) 2% chlorhexidine associated with 8% papain; 4) 0.9% saline solution; 5) 2.5% sodium hypochlorite; and 6) 5.25% sodium hypochlorite. The pulp fragments were weighed and put into immobile test tubes for dissolution for time intervals of 30, 60, 90, and 120 min. RESULTS: The 5.25% sodium hypochlorite had greater dissolution potential than the pure papain, and when associated with chlorhexidine, both promoted greater dissolution than did the saline solution and 2% chlorhexidine groups (p < 0.05). The 2.5% sodium hypochlorite promoted dissolution to a lesser extent than the groups with papain within a period of 30 min (p < 0.05), but, was comparable to the saline solution and chlorhexidine. After 120 min, the 2.5% and 5.25% sodium hypochlorite promoted dissolution of 100% of the pulp fragments, and papain, 61%, while chlorhexidine associated with papain and chlorhexidine alone dissolved only 55% and 3%, respectively. CONCLUSIONS: The 8% papain in gel, both alone and in association with chlorhexidine, was able to dissolve bovine pulp tissue, but to a lesser extent than did 5.25% sodium hypochlorite.
Chlorhexidine* ; Endodontics ; Papain* ; Sodium Chloride ; Sodium Hypochlorite

OBJECTIVES: The objective of this in vitro study was to evaluate and compare the cytotoxicity of four different root canal sealers i.e. Apexit Plus (Ivoclar Vivadent), Endomethasone N (Septodont), AH-26 (Dentsply) and Pulpdent Root Canal Sealer (Pulpdent), on a mouse fibroblast cell line (L929). MATERIALS AND METHODS: Thirty two discs for each sealer (5 mm in diameter and 2 mm in height) were fabricated in Teflon mould. The sealer extraction was made in cell culture medium (Dulbecco's Modified Eagle's Medium, DMEM) using the ratio 1.25 cm2/mL between the surface of the sealer samples and the volume of medium in a shaker incubator. Extraction of each sealer was obtained at 24 hr, 7th day, 14th day, and one month of interval. These extracts were incubated with L929 cell line and 3-(4,5-dimethylthiazol-2yl)-2,5-diphenyltetrazolium bromide (MTT) assay was done. Two-way ANOVA for interaction effects between sealer and time and Post-hoc multiple comparison using Tukey's test across all the 16 different groups were used for statistical analysis. RESULTS: Apexit Plus root canal sealer was significantly less toxic than other sealers (p < 0.05) and showed higher cellular growth than control. Endomethasone N showed mild cytotoxicity. AH-26 showed severe toxicity which became mild after one month while Pulpdent Root Canal Sealer showed severe to moderate toxicity. CONCLUSIONS: Apexit Plus was relatively biocompatible sealer as compared to other three sealers which were cytotoxic at their initial stages, however, they became biocompatible with time.
Animals ; Bismuth ; Calcium Hydroxide ; Cell Culture Techniques ; Cell Line ; Dental Pulp Cavity* ; Dexamethasone ; Drug Combinations ; Epoxy Resins ; Fibroblasts ; Formaldehyde ; Hydrocortisone ; Incubators ; Mice ; Polytetrafluoroethylene ; Root Canal Filling Materials ; Silver ; Thymol ; Titanium

OBJECTIVES: To investigate the effect of enamel matrix derivative (EMD) on periodontal healing of replanted teeth in animal models. MATERIALS AND METHODS: The authors searched MEDLINE, PubMed, EMBASE, Cochrane Library, Web of Knowledge and Scopus for articles published up to Oct 2012. Animal studies in which EMD was applied in transplanted or replanted teeth with adequate controls and histological data were considered. Normal periodontal healing or root resorption determined by histology after EMD was applied in replanted teeth with adequate controls was used as outcome measures. The following search strategy was used: ('Emdogain' OR 'enamel matrix proteins' OR 'enamel matrix derivative') AND ('avulsion' OR 'transplantion' OR 'autotransplantation' OR 'replantation'). RESULTS: Six animal studies were included in the final review. There was great heterogeneity in study design among included studies. Two studies with similar study designs were identified and analyzed by a meta-analysis. The pooled estimates showed a significantly higher normal healing and surface resorption and significantly less inflammatory and replacement resorption in EMD-treated groups compared with non-EMD-treated groups. CONCLUSIONS: With the limitations of this systematic review, the use of EMD led to greater normal periodontal healing and surface root resorption and less inflammatory and replacement root resorption in the presence of periodontal ligaments. However, no definite conclusion could be drawn with regard to the effect of EMD on periodontal healing and root resorption when no periodontal ligaments exist.
Animals* ; Dental Enamel Proteins ; Dental Enamel* ; Models, Animal* ; Outcome Assessment (Health Care) ; Periodontal Ligament ; Population Characteristics ; Replantation ; Root Resorption ; Tooth* ; Transplants

Epinephrine is one of the most widely-used vasoconstrictors in dental treatment including endodontic microsurgery. However, the systemic safety of epinephrine has been in debate for many years because of its potential risk to cause cardiovascular complications. The purpose of this review was to assess the cardiovascular effect of epinephrine use in endodontic microsurgery. Endodontic microsurgery directly applies epinephrine into the bone cavity, and the amount is reported to be much larger than other dental surgeries. Moreover, when considering that systemic potency of intraosseous application is reported to be comparable to intravenous application, the systemic influence of epinephrine could be increased in endodontic microsurgery. Besides, pre-existing cardiovascular complications or drug interactions can enhance its systemic influence, resulting in increased susceptibility to cardiovascular complications. Although clinical studies have not reported significant complications for patients without severe systemic complications, many epinephrine-induced emergency cases are warning the cardiovascular risk related with pre-existing systemic disease or drug interactions. Epinephrine is a dose-sensitive drug, and its hypersensitivity reaction can be fatal to patients when it is related to cardiovascular complications. Therefore, clinicians should recognize the risk, and the usage of pre-operative patient evaluation, dose control and patient monitoring are required to ensure patient's safety during endodontic microsurgery.
Cardiovascular Diseases ; Drug Interactions ; Emergencies ; Epinephrine* ; Hemostasis ; Humans ; Hypersensitivity ; Microsurgery* ; Monitoring, Physiologic ; Vasoconstrictor Agents

This article presents the successful surgical management of a failed mineral trioxide aggregate (MTA) orthograde obturation of a tooth with a history of impact trauma and perforated internal root resorption. A symptomatic maxillary lateral incisor with a history of perforation due to internal root resorption and nonsurgical repair using MTA was referred. Unintentional overfill of the defect with MTA had occurred 4 yr before the initial visit. The excess MTA had since disappeared, and a radiolucent lesion adjacent to the perforation site was evident radiographically. Surgical endodontic retreatment was performed using calcium enriched mixture (CEM) cement as a repair material. Histological examination of the lesion revealed granulation tissue with chronic inflammation, and small fragments of MTA encapsulated within fibroconnective tissue. At the one and two year follow up exams, all signs and symptoms of disease had resolved and the tooth was functional. Complete radiographic healing of the lesion was observed two years after the initial visit. This case report illustrates how the selection of an appropriate approach to treatment of a perforation can affect the long term prognosis of a tooth. In addition, extrusion of MTA into a periradicular lesion should be avoided.
Calcium ; Follow-Up Studies ; Granulation Tissue ; Incisor ; Inflammation ; Prognosis ; Retreatment ; Root Resorption* ; Tooth ; Pemetrexed

The presence of radix entomolaris (RE) in a mandibular first molar is a common occurrence in certain ethnic groups, but the presence of RE in a mandibular second molar is a rare occurrence. In the present case, RE was identified from preoperative radiographs and confirmed using cone-beam computed tomography (CBCT). The access cavity was modified to locate the RE. Cleaning and shaping were performed with nickel-titanium rotary instruments. Obturation was completed with gutta-percha cones using AH Plus (Dentsply Detrey GmbH) as sealer. From the CBCT axial images, the RE was determined to have a Type III curvature by the De Moor classification, Type B separate RE by the Carlsen and Alexandersen classification, and radiographically, a Type i image by the Wang classification. The presence of RE in the mandibular second molar makes it essential to anticipate and treat the distolingual root canal. This case report highlights the usefulness of CBCT for assessing RE in the mandibular second molar, which can help the clinician in making a confirmatory diagnosis and assessing the morphology of the root canal.
Classification ; Cone-Beam Computed Tomography ; Dental Pulp Cavity ; Diagnosis ; Ethnic Groups ; Gutta-Percha ; Humans ; Molar*