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Surgical management of a failed internal root resorption treatment: a histological and clinical report.

Saeed ASGARY ; Mohammad Jafar EGHBAL ; Leili MEHRDAD ; Sanam KHEIRIEH ; Ali NOSRAT

Restorative Dentistry & Endodontics.2014;39(2):137-142. doi:10.5395/rde.2014.39.2.137

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

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Endodontic management of a mandibular second molar with radix entomolaris: a case report.

Rosaline HANNAH ; Deivanayagam KANDASWAMY ; Nachimuthu JAYAPRAKASH

Restorative Dentistry & Endodontics.2014;39(2):132-136. doi:10.5395/rde.2014.39.2.132

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*

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Healing after horizontal root fractures: 3 cases with 2-year follow-up.

Yoorina CHOI ; Sung Ok HONG ; Seok Ryun LEE ; Kyung San MIN ; Su Jung PARK

Restorative Dentistry & Endodontics.2014;39(2):126-131. doi:10.5395/rde.2014.39.2.126

Among dental traumas, horizontal root fractures are relatively uncommon injuries. Proper initial management and periodical evaluation is essential for the successful treatment of a root-fractured tooth. If pulpal necrosis develops, endodontic treatment is indicated, exclusively for the coronal fragment. Fragment diastases exert a great influence on healing at the fracture line and on pulpal necrosis. An adequately treated root-fractured tooth has a good prognosis. This case report describes the treatment and 2-yr follow up of 3 maxillary central incisors, first with horizontal root fracture, second with horizontal root fracture and avulsion, and third with horizontal root fracture and lateral luxation. All three cases were treated with mineral trioxide aggregate (ProRoot, Dentsply). During 2 yr of follow-up evaluation, the root-fractured teeth of the present patients were well retained in the arch, showing periodontal healing, even after endodontic treatment.
Follow-Up Studies* ; Humans ; Incisor ; Necrosis ; Prognosis ; Tooth ; Tooth Fractures

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Biodentine-a novel dentinal substitute for single visit apexification.

Gurudutt NAYAK ; Mohammad Faiz HASAN

Restorative Dentistry & Endodontics.2014;39(2):120-125. doi:10.5395/rde.2014.39.2.120

Use of an apical plug in management of cases with open apices has gained popularity in recent years. Biodentine, a new calcium silicate-based material has recently been introduced as a dentine substitute, whenever original dentine is damaged. This case report describes single visit apexification in a maxillary central incisor with necrotic pulp and open apex using Biodentine as an apical barrier, and a synthetic collagen material as an internal matrix. Following canal cleaning and shaping, calcium hydroxide was placed as an intracanal medicament for 1 mon. This was followed by placement of small piece of absorbable collagen membrane beyond the root apex to serve as matrix. An apical plug of Biodentine of 5 mm thickness was placed against the matrix using pre-fitted hand pluggers. The remainder of canal was back-filled with thermoplasticized gutta-percha and access cavity was restored with composite resin followed by all-ceramic crown. One year follow-up revealed restored aesthetics and function, absence of clinical signs and symptoms, resolution of periapical rarefaction, and a thin layer of calcific tissue formed apical to the Biodentine barrier. The positive clinical outcome in this case is encouraging for the use of Biodentine as an apical plug in single visit apexification procedures.
Apexification* ; Calcium ; Calcium Hydroxide ; Collagen ; Crowns ; Dentin* ; Esthetics ; Follow-Up Studies ; Gutta-Percha ; Hand ; Incisor ; Membranes

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Management of failed periodontal surgical intervention for a furcal lesion with a nonsurgical endodontic approach.

Saeed ASGARY ; Mahta FAZLYAB

Restorative Dentistry & Endodontics.2014;39(2):115-119. doi:10.5395/rde.2014.39.2.115

As long as the prognosis of teeth remains a matter of concern, the endodontic-periodontal relationship will be considered a challenge for the clinician. Many etiologic factors, including bacteria, fungi, and viruses, plus other contributing factors, such as trauma, root resorptions/perforations, and dental malformations, play a role in the co-occurrence of endodontic and periodontal lesions. Whatever the cause, a correct diagnosis on which to base the treatment plan is the key to successful maintenance of the tooth. This article reports the successful endodontic management of a furcation lesion in a mandibular molar that was nonresponsive to a previous periodontal surgical graft. The case had presented a diagnostic challenge for the clinicians, and this article reviews the key points that can lead to a correct diagnosis and treatment planning.
Bacteria ; Diagnosis ; Fungi ; Molar ; Prognosis ; Tooth ; Transplants

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Antibacterial properties of composite resins incorporating silver and zinc oxide nanoparticles on Streptococcus mutans and Lactobacillus.

Shahin KASRAEI ; Lida SAMI ; Sareh HENDI ; Mohammad Yousef ALIKHANI ; Loghman REZAEI-SOUFI ; Zahra KHAMVERDI

Restorative Dentistry & Endodontics.2014;39(2):109-114. doi:10.5395/rde.2014.39.2.109

OBJECTIVES: Recurrent caries was partly ascribed to lack of antibacterial properties in composite resin. Silver and zinc nanoparticles are considered to be broad-spectrum antibacterial agents. The aim of the present study was to evaluate the antibacterial properties of composite resins containing 1% silver and zinc-oxide nanoparticles on Streptococcus mutans and Lactobacillus. MATERIALS AND METHODS: Ninety discoid tablets containing 0%, 1% nano-silver and 1% nano zinc-oxide particles were prepared from flowable composite resin (n = 30). The antibacterial properties of composite resin discs were evaluated by direct contact test. Diluted solutions of Streptococcus mutans (PTCC 1683) and Lactobacillus (PTCC 1643) were prepared. 0.01 mL of each bacterial species was separately placed on the discs. The discs were transferred to liquid culture media and were incubated at 37degrees C for 8 hr. 0.01 mL of each solution was cultured on blood agar and the colonies were counted. Data was analyzed with Kruskall-Wallis and Mann-Whitney U tests. RESULTS: Composites containing nano zinc-oxide particles or silver nanoparticles exhibited higher antibacterial activity against Streptococcus mutans and Lactobacillus compared to the control group (p < 0.05). The effect of zinc-oxide on Streptococcus mutans was significantly higher than that of silver (p < 0.05). There were no significant differences in the antibacterial activity against Lactobacillus between composites containing silver nanoparticles and those containing zinc-oxide nanoparticles. CONCLUSIONS: Composite resins containing silver or zinc-oxide nanoparticles exhibited antibacterial activity against Streptococcus mutans and Lactobacillus.
Agar ; Anti-Bacterial Agents ; Composite Resins* ; Culture Media ; Lactobacillus* ; Nanoparticles* ; Silver* ; Streptococcus mutans* ; Streptococcus* ; Tablets ; Zinc Oxide* ; Zinc*

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Effect of passive ultrasonic agitation during final irrigation on cleaning capacity of hybrid instrumentation.

Marcilene Coelho VINHORTE ; Eduardo Hideki SUZUKI ; Maira Sousa DE CARVALHO ; Andre Augusto Franco MARQUES ; Emilio Carlos SPONCHIADO JUNIOR ; Lucas da Fonseca Roberti GARCIA

Restorative Dentistry & Endodontics.2014;39(2):104-108. doi:10.5395/rde.2014.39.2.104

OBJECTIVES: To evaluate the effect of passive ultrasonic agitation on the cleaning capacity of a hybrid instrumentation technique. MATERIALS AND METHODS: Twenty mandibular incisors with mesiodistal-flattened root shape had their crowns sectioned at 1 mm from the cementoenamel junction. Instrumentation was initiated by catheterization with K-type files (Denstply Maillefer) #10, #15, and #20 at 3 mm from the working length. Cervical preparation was performed with Largo bur #1 (Dentsply Maillefer) followed by apical instrumentation with K-type files #15, #20 and #25, and finishing with ProTaper F2 file (Denstply Maillefer). All files were used up to the working length under irrigation with 1 mL of 2.5% sodium hypochlorite (Biodynamica) at each instrument change. At the end of instrumentation, the roots were randomly separated into 2 groups (n = 10). All specimens received final irrigation with 1 mL of 2.5% sodium hypochlorite. The solution remained in the root canals in Group 1 for one minute; and ultrasonic agitation was performed in Group 2 for one minute using a straight tip inserted at 1 mm from working length. The specimens were processed histologically and the sections were analyzed under optic microscope (x64) to quantify debris present in the root canal. RESULTS: The samples submitted to ultrasonic agitation (Group 2) presented significant decrease in the amount of debris in comparison with those of Group 1 (p < 0.05). CONCLUSIONS: The hybrid instrumentation technique associated with passive ultrasonic agitation promoted greater debris removal in the apical third of the root canals.
Catheterization ; Catheters ; Crowns ; Dental Pulp Cavity ; Dihydroergotamine* ; Incisor ; Sodium Hypochlorite ; Tooth Cervix ; Ultrasonics*

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Pull-out bond strength of a self-adhesive resin cement to NaOCl-treated root dentin: effect of antioxidizing agents.

Maryam KHOROUSHI ; Marzieh KACHUEI

Restorative Dentistry & Endodontics.2014;39(2):95-103. doi:10.5395/rde.2014.39.2.95

OBJECTIVES: This study evaluated the effect of three antioxidizing agents on pull-out bond strengths of dentin treated with sodium hypochlorite. MATERIALS AND METHODS: Root canals of 75 single-rooted human teeth were prepared. Fifteen teeth were irrigated with normal saline for a negative control group, and the remaining 60 teeth (groups 2 - 5) with 2.5% NaOCl. The teeth in group 2 served as a positive control. Prior to post cementation, the root canals in groups 3 - 5 were irrigated with three antioxidizing agents including 10% rosmarinic acid (RA, Baridge essence), 10% hesperidin (HPN, Sigma), and 10% sodium ascorbate hydrogel (SA, AppliChem). Seventy-five spreaders (#55, taper .02, Produits Dentaires S.A) were coated with silica and silanized with the Rocatec system and ceramic bond. All the prepared spreaders were cemented with a self-adhesive resin cement (Bifix SE, Voco Gmbh) in the prepared canals. After storage in distilled water (24 h/37degrees C), the spreaders were pulled out in a universal testing machine at a crosshead speed of 1.0 mm/min. Pull-out strength values were analyzed by one-way ANOVA and Tukey's HSD test (alpha = 0.05). RESULTS: There were significant differences between study groups (p = 0.016). The highest pull-out strength was related to the SA group. The lowest strength was obtained in the positive control group. CONCLUSIONS: Irrigation with NaOCl during canal preparation decreased bond strength of resin cement to root dentin. Amongst the antioxidants tested, SA had superior results in reversing the diminishing effect of NaOCl irrigation on the bond strength to root dentin.
Antioxidants ; Ascorbic Acid ; Cementation ; Ceramics ; Dental Pulp Cavity ; Dentin* ; Hesperidin ; Humans ; Hydrogel ; Resin Cements* ; Silicon Dioxide ; Sodium Hypochlorite ; Tooth ; Water

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Cytotoxicity and physical properties of tricalcium silicate-based endodontic materials.

Young Eun JANG ; Bin Na LEE ; Jeong Tae KOH ; Yeong Joon PARK ; Nam Eok JOO ; Hoon Sang CHANG ; In Nam HWANG ; Won Mann OH ; Yun Chan HWANG

Restorative Dentistry & Endodontics.2014;39(2):89-94. doi:10.5395/rde.2014.39.2.89

OBJECTIVES: The aim of this study was to evaluate the cytotoxicity, setting time and compressive strength of MTA and two novel tricalcium silicate-based endodontic materials, Bioaggregate (BA) and Biodentine (BD). MATERIALS AND METHODS: Cytotoxicity was evaluated by using a 2,3-bis(2-methoxy-4-nitro-5-sulfophenyl)-5-((phenylamino)carbonyl)-2H-tetrazolium hydroxide (XTT) assay. Measurements of 9 heavy metals (arsenic, cadmium, chromium, copper, iron, lead, manganese, nickel, and zinc) were performed by inductively coupled plasma-mass spectrometry (ICP-MS) of leachates obtained by soaking the materials in distilled water. Setting time and compressive strength tests were performed following ISO requirements. RESULTS: BA had comparable cell viability to MTA, whereas the cell viability of BD was significantly lower than that of MTA. The ICP-MS analysis revealed that BD released significantly higher amount of 5 heavy metals (arsenic, copper, iron, manganese, and zinc) than MTA and BA. The setting time of BD was significantly shorter than that of MTA and BA, and the compressive strength of BA was significantly lower than that of MTA and BD. CONCLUSIONS: BA and BD were biocompatible, and they did not show any cytotoxic effects on human periodontal ligament fibroblasts. BA showed comparable cytotoxicity to MTA but inferior physical properties. BD had somewhat higher cytotoxicity but superior physical properties than MTA.
Cadmium ; Cell Survival ; Chromium ; Compressive Strength ; Copper ; Fibroblasts ; Humans ; Iron ; Manganese ; Metals, Heavy ; Nickel ; Periodontal Ligament ; Spectrum Analysis ; Water ; Pemetrexed

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Biologic response of local hemostatic agents used in endodontic microsurgery.

Youngjune JANG ; Hyeon KIM ; Byoung Duck ROH ; Euiseong KIM

Restorative Dentistry & Endodontics.2014;39(2):79-88. doi:10.5395/rde.2014.39.2.79

Appropriate use of local hemostatic agent is one of the important factors on the prognosis of endodontic microsurgery. However, most investigations to date focus on the hemostatic efficacy of the agents, whereas their biologic characteristics have not received enough attention. The purpose of this paper was to review the biologic response of local hemostatic agents, and to provide clinical guidelines on their use during endodontic microsurgery. Electronic database (PUBMED) was screened to search related studies from 1980 to 2013, and 8 clinical studies and 18 animal studies were identified. Among the materials used in these studies, most widely-investigated and used materials, epinephrine, ferric sulfate (FS) and calcium sulfate (CS), were thoroughly discussed. Influence of these materials on local tissue and systemic condition, such as inflammatory and foreign body reaction, local ischemia, dyspigmentation, delayed or enhanced bone and soft tissue healing, and potential cardiovascular complications were assessed. Additionally, biological property of their carrier materials, cotton pellet and absorbable collagen, were also discussed. Clinicians should be aware of the biologic properties of local hemostatic agents and their carrier materials, and should pay attention to the potential complications when using them in endodontic microsurgery.
Animals ; Calcium Sulfate ; Collagen ; Epinephrine ; Foreign-Body Reaction ; Hemostatics ; Ischemia ; Microsurgery* ; Population Characteristics ; Prognosis

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