Implications of specific gene expression patterns in enamel knot in tooth development

Enamel knot (EK)—a signaling center—refers to a transient morphological structure comprising epithelial tissue. EK is believed to regulate tooth development in early organogenesis without its own cellular alterations, including proliferation and differentiation. EKs show a very simple but conserved structure and share functions with teeth of recently evolved vertebrates, suggesting conserved signaling in certain organs, such as functional teeth, through the course of evolution. In this study, we examined the expression patterns of key EK-specific genes including Dusp26 , Fat4, Meis2, Sln , and Zpld1 during mice embryogenesis. Expression patterns of these genes may reveal putative differentiation mechanisms underlying tooth morphogenesis.

Ultrastructure of Substance P Immunopositive Axons in the Human Dental Pulp

There exists very little information on the ultrastructure of substance P immunopositive (+) fibers in the human dental pulp, which may help in understanding the mechanism for substance P associated pulpal inflammatory pain. To address this issue, we investigated the presence of substance P+ fibers in the human dental pulp by light- and electron-microscopic immunohistochemistry. Light microscopy revealed that substance P+ fibers ran within neurovascular bundles in the radicular pulp and in the core of coronal pulp. They were also frequently present in the peripheral pulp. Substance P+ fibers showed beads like swellings interconnected by thin axonal strand, in a manner similar to bouton en passants and interconnecting axonal strand in the spinal cord. Electron microscopy revealed that almost all the substance P+ axons were unmyelinated. The axonal swellings of the substance P+ contained numerous clear round vesicles (40–50 nm in diameter) and many large dense-cored vesicles (80–110 nm in diameter) as well as many mitochondria. The vesicles and mitochondria were rarely observed in the thin axonal strand interconnecting the swellings. Intimate interrelationship or synaptic structure between the swellings of substance P+ axon and nearby pulpal cells or axons was not found. These findings suggest co-release of substance P and glutamate from the substance P+ pulpal axons and its action on nearby structures in a paracrine manner.

Screw-in forces during instrumentation by various file systems

OBJECTIVES: The purpose of this study was to compare the maximum screw-in forces generated during the movement of various Nickel-Titanium (NiTi) file systems. MATERIALS AND METHODS: Forty simulated canals in resin blocks were randomly divided into 4 groups for the following instruments: Mtwo size 25/0.07 (MTW, VDW GmbH), Reciproc R25 (RPR, VDW GmbH), ProTaper Universal F2 (PTU, Dentsply Maillefer), and ProTaper Next X2 (PTN, Dentsply Maillefer, n = 10). All the artificial canals were prepared to obtain a standardized lumen by using ProTaper Universal F1. Screw-in forces were measured using a custom-made experimental device (AEndoS-k, DMJ system) during instrumentation with each NiTi file system using the designated movement. The rotation speed was set at 350 rpm with an automatic 4 mm pecking motion at a speed of 1 mm/sec. The pecking depth was increased by 1 mm for each pecking motion until the file reach the working length. Forces were recorded during file movement, and the maximum force was extracted from the data. Maximum screw-in forces were analyzed by one-way ANOVA and Tukey's post hoc comparison at a significance level of 95%. RESULTS: Reciproc and ProTaper Universal files generated the highest maximum screw-in forces among all the instruments while M-two and ProTaper Next showed the lowest (p < 0.05). CONCLUSIONS: Geometrical differences rather than shaping motion and alloys may affect the screw-in force during canal instrumentation. To reduce screw-in forces, the use of NiTi files with smaller cross-sectional area for higher flexibility is recommended.

Proximity of the mandibular molar root apex from the buccal bone surface: a cone-beam computed tomographic study

OBJECTIVES: The purpose of this study was to evaluate the proximity of the mandibular molar apex to the buccal bone surface in order to provide anatomic information for apical surgery. MATERIALS AND METHODS: Cone-beam computed tomography (CBCT) images of 127 mandibular first molars and 153 mandibular second molars were analyzed from 160 patients' records. The distance was measured from the buccal bone surface to the root apex and the apical 3.0 mm on the cross-sectional view of CBCT. RESULTS: The second molar apex and apical 3 mm were located significantly deeper relative to the buccal bone surface compared with the first molar (p < 0.01). For the mandibular second molars, the distance from the buccal bone surface to the root apex was significantly shorter in patients over 70 years of age (p < 0.05). Furthermore, this distance was significantly shorter when the first molar was missing compared to nonmissing cases (p < 0.05). For the mandibular first molars, the distance to the distal root apex of one distal-rooted tooth was significantly greater than the distance to the disto-buccal root apex (p < 0.01). In mandibular second molar, the distance to the apex of C-shaped roots was significantly greater than the distance to the mesial root apex of non-C-shaped roots (p < 0.01). CONCLUSIONS: For apical surgery in mandibular molars, the distance from the buccal bone surface to the apex and apical 3 mm is significantly affected by the location, patient age, an adjacent missing anterior tooth, and root configuration.

Preference of undergraduate students after first experience on nickel-titanium endodontic instruments

OBJECTIVES: This study aimed to compare two nickel-titanium systems (rotary vs. reciprocating) for their acceptance by undergraduate students who experienced nickel-titanium (NiTi) instruments for the first time. MATERIALS AND METHODS: Eighty-one sophomore dental students were first taught on manual root canal preparation with stainless-steel files. After that, they were instructed on the use of ProTaper Universal system (PTU, Dentsply Maillefer), then the WaveOne (WO, Dentsply Maillefer). They practiced with each system on 2 extracted molars, before using those files to shape the buccal or mesial canals of additional first molars. A questionnaire was completed after using each file system, seeking students' perception about 'Ease of use', 'Flexibility', 'Cutting-efficiency', 'Screwing-effect', 'Feeling-safety', and 'Instrumentation-time' of the NiTi files, relative to stainless-steel instrumentation, on a 5-point Likert-type scale. They were also requested to indicate their preference between the two systems. Data was compared between groups using t-test, and with Chi-square test for correlation of each perception value with the preferred choice (p = 0.05). RESULTS: Among the 81 students, 55 indicated their preferred file system as WO and 22 as PTU. All scores were greater than 4 (better) for both systems, compared with stainless-steel files, except for 'Screwing-effect' for PTU. The scores for WO in the categories of 'Flexibility', 'Screwing-effect', and 'Feeling-safety' were significantly higher scores than those of PTU. A significant association between the 'Screwing-effect' and students' preference for WO was observed. CONCLUSIONS: Novice operators preferred nickel-titanium instruments to stainless-steel, and majority of them opted for reciprocating file instead of continuous rotating system.

Esthetic enhancement of a traumatized anterior tooth with a combination of forced eruption and tooth alignment: a case report

Exposing sound structure of a subgingivally fractured tooth using orthodontic extrusion is considered to be a conservative way to re-establish biologic width without sacrificing esthetics or jeopardizing periodontal support of neighboring teeth. When a misaligned tooth is traumatically involved, a more comprehensive approach combining tooth extrusion and re-alignment may be necessary for a successful restorative outcome. This case report describes a successful esthetic management of a patient with complicated crown-root fracture on the maxillary right central incisor and pre-existing malocclusion in the maxillary anterior region. Forced eruption along with re-alignment of teeth by orthodontic movement seems to allow re-positioning of the fracture line to a favorable position and correction of crowding, providing a better esthetic result.

Effect of repetitive pecking at working length for glide path preparation using G-file

OBJECTIVES: Glide path preparation is recommended to reduce torsional failure of nickel-titanium (NiTi) rotary instruments and to prevent root canal transportation. This study evaluated whether the repetitive insertions of G-files to the working length maintain the apical size as well as provide sufficient lumen as a glide path for subsequent instrumentation. MATERIALS AND METHODS: The G-file system (Micro-Mega) composed of G1 and G2 files for glide path preparation was used with the J-shaped, simulated resin canals. After inserting a G1 file twice, a G2 file was inserted to the working length 1, 4, 7, or 10 times for four each experimental group, respectively (n = 10). Then the canals were cleaned by copious irrigation, and lubricated with a separating gel medium. Canal replicas were made using silicone impression material, and the diameter of the replicas was measured at working length (D0) and 1 mm level (D1) under a scanning electron microscope. Data was analysed by one-way ANOVA and post-hoc tests (p = 0.05). RESULTS: The diameter at D0 level did not show any significant difference between the 1, 2, 4, and 10 times of repetitive pecking insertions of G2 files at working length. However, 10 times of pecking motion with G2 file resulted in significantly larger canal diameter at D1 (p < 0.05). CONCLUSIONS: Under the limitations of this study, the repetitive insertion of a G2 file up to 10 times at working length created an adequate lumen for subsequent apical shaping with other rotary files bigger than International Organization for Standardization (ISO) size 20, without apical transportation at D0 level.

Effect of repetitive pecking at working length for glide path preparation using G-file

OBJECTIVES: Glide path preparation is recommended to reduce torsional failure of nickel-titanium (NiTi) rotary instruments and to prevent root canal transportation. This study evaluated whether the repetitive insertions of G-files to the working length maintain the apical size as well as provide sufficient lumen as a glide path for subsequent instrumentation. MATERIALS AND METHODS: The G-file system (Micro-Mega) composed of G1 and G2 files for glide path preparation was used with the J-shaped, simulated resin canals. After inserting a G1 file twice, a G2 file was inserted to the working length 1, 4, 7, or 10 times for four each experimental group, respectively (n = 10). Then the canals were cleaned by copious irrigation, and lubricated with a separating gel medium. Canal replicas were made using silicone impression material, and the diameter of the replicas was measured at working length (D0) and 1 mm level (D1) under a scanning electron microscope. Data was analysed by one-way ANOVA and post-hoc tests (p = 0.05). RESULTS: The diameter at D0 level did not show any significant difference between the 1, 2, 4, and 10 times of repetitive pecking insertions of G2 files at working length. However, 10 times of pecking motion with G2 file resulted in significantly larger canal diameter at D1 (p < 0.05). CONCLUSIONS: Under the limitations of this study, the repetitive insertion of a G2 file up to 10 times at working length created an adequate lumen for subsequent apical shaping with other rotary files bigger than International Organization for Standardization (ISO) size 20, without apical transportation at D0 level.

Safe root canal preparation using reciprocating nickel-titanium instruments

No abstract available.

Buckling resistance, bending stiffness, and torsional resistance of various instruments for canal exploration and glide path preparation

OBJECTIVES: This study compared the mechanical properties of various instruments for canal exploration and glide-path preparations. MATERIALS AND METHODS: The buckling resistance, bending stiffness, ultimate torsional strength, and fracture angle under torsional load were compared for C+ file (CP, Dentsply Maillefer), M access K-file (MA, Dentsply Maillefer), Mani K-file (MN, Mani), and NiTiFlex K-file (NT, Dentsply Maillefer). The files of ISO size #15 and a shaft length of 25 mm were selected. For measuring buckling resistance (n = 10), the files were loaded in the axial direction of the shaft, and the maximum load was measured during the files' deflection. The files (n = 10) were fixed at 3-mm from the tip and then bent 45degrees with respect to their long axis, while the bending force was recorded by a load cell. For measuring the torsional properties, the files (n = 10) were also fixed at 3-mm, and clockwise rotations (2-rpm) were applied to the files in a straight state. The torsional load and the distortion angle were recorded until the files succumbed to the torque. RESULTS: The CP was shown to require the highest load to buckle and bend the files, and the NT showed the least. While MA and MN showed similar buckling resistances, MN showed higher bending stiffness than MA. The NT had the lowest bending stiffness and ultimate torsional strength (p < 0.05). CONCLUSIONS: The tested instruments showed different mechanical properties depending on the evaluated parameters. CP and NT files were revealed to be the stiffest and the most flexible instruments, respectively.

Cyclic fatigue resistance tests of Nickel-Titanium rotary files using simulated canal and weight loading conditions

OBJECTIVES: This study compared the cyclic fatigue resistance of nickel-titanium (NiTi) files obtained in a conventional test using a simulated canal with a newly developed method that allows the application of constant fatigue load conditions. MATERIALS AND METHODS: ProFile and K3 files of #25/.06, #30/.06, and #40/.04 were selected. Two types of testing devices were built to test their fatigue performance. The first (conventional) device prescribed curvature inside a simulated canal (C-test), the second new device exerted a constant load (L-test) whilst allowing any resulting curvature. Ten new instruments of each size and brand were tested with each device. The files were rotated until fracture and the number of cycles to failure (NCF) was determined. The NCF were subjected to one-way ANOVA and Duncan's post-hoc test for each method. Spearman's rank correlation coefficient was computed to examine any association between methods. RESULTS: Spearman's rank correlation coefficient (rho = -0.905) showed a significant negative correlation between methods. Groups with significant difference after the L-test divided into 4 clusters, whilst the C-test gave just 2 clusters. From the L-test, considering the negative correlation of NCF, K3 gave a significantly lower fatigue resistance than ProFile as in the C-test. K3 #30/.06 showed a lower fatigue resistance than K3 #25/.06, which was not found by the C-test. Variation in fatigue test methodology resulted in different cyclic fatigue resistance rankings for various NiTi files. CONCLUSIONS: The new methodology standardized the load during fatigue testing, allowing determination fatigue behavior under constant load conditions.

Endodontic treatment of maxillary lateral incisors with anatomical variations

Maxillary lateral incisors usually exhibit a single root with a single canal. However, maxillary lateral incisor teeth with unusual morphology of root canal system are frequently reported. These cases of variable root canal anatomy can be treated well by nonsurgical endodontic methods. A detailed description of root canal morphology is fundamental for successful endodontic treatment. Treatment using an operating microscope, radiographs from different angles, and cone-beam computerized tomography (CBCT) can produce more predictable endodontic outcomes.

Influence of glide path on the screw-in effect and torque of nickel-titanium rotary files in simulated resin root canals

OBJECTIVES: The purpose of this study was to investigate the screw-in effect and torque generation depending on the size of glide path during root canal preparation. MATERIALS AND METHODS: Forty Endo-Training Blocks (REF A 0177, Dentsply Maillefer) were used. They were divided into 4 groups. For groups 1, 2, 3, and 4, the glide path was established with ISO #13 Path File (Dentsply Maillefer), #15 NiTi K-file NITIFLEX (Dentsply Maillefer), modified #16 Path File (equivalent to #18), and #20 NiTi K-file NITIFLEX, respectively. The screw-in force and resultant torque were measured using a custom-made experimental apparatus while canals were instrumented with ProTaper S1 (Dentsply Maillefer) at a constant speed of 300 rpm with an automated pecking motion. A statistical analysis was performed using one-way analysis of variance and the Duncan post hoc comparison test. RESULTS: Group 4 showed lowest screw-in effect (2.796 +/- 0.134) among the groups (p < 0.05). Torque was inversely proportional to the glide path of each group. In #20 glide path group, the screw-in effect and torque decreased at the last 1 mm from the apical terminus. However, in the other groups, the decrease of the screw-in effect and torque did not occur in the last 1 mm from the apical terminus. CONCLUSIONS: The establishment of a larger glide path before NiTi rotary instrumentation appears to be appropriate for safely shaping the canal. It is recommended to establish #20 glide path with NiTi file when using ProTaper NiTi rotary instruments system safely.

Diagnostic challenges of nonodontogenic toothache

The objective of this article was to present two nonodontogenic conditions that may mimic odontogenic toothache: trigeminal neuralgia and burning mouth syndrome. Two cases are presented in which one is related to the upper left second premolar and the other is related to the upper left first molar. Both showed pain when chewing. These two cases highlight the complexities involved in diagnosing nonodontogenic toothache. This article demonstrates the importance of having a thorough knowledge of both odontogenic and nonodontogenic toothache, as well as the need for careful evaluation of the nature of the pain and history, clinical and radiographic examinations.

Diastema closure using direct bonding restorations combined with orthodontic treatment: a case report

Closure of interdental spaces using proximal build-ups with resin composite is considered to be practical and conservative. However, a comprehensive approach combining two or more treatment modalities may be needed to improve esthetics. This case report describes the management of a patient with multiple diastemas, a peg-shaped lateral incisor and midline deviation in the maxillary anterior area. Direct resin bonding along with orthodontic movement of teeth allows space closure and midline correction, consequently, creating a better esthetic result.

Comparison of screw-in effect for several nickel-titanium rotary instruments in simulated resin root canal / 대한치과보존학회지

Screw-in effect is one of the unintended phenomena that occurs during the root canal preparation with nickel-titanium rotary files. The aim of this study was to compare the screw-in effect among various nickel-titanium rotary file systems. Six different nickel-titanium rotary instruments (ISO 20/.06 taper) were used: K3(TM) (SybronEndo, Glendora, CA, USA), Mtwo (VDW GmbH, Munchen, Germany), NRT with safe-tip and with active tip (Mani Inc., Shioya-gun, Japan), ProFile(R) (Dentsply-Maillefer, Ballaigues, Switzerland) and ProTaper(R) (Dentsply-Maillefer, Ballaigues, Switzerland). For ProTaper(R), S2 was selected because it has size 20. Root canal instrumentations were done in sixty simulated single-curved resin root canals with a rotational speed of 300 rpm and single pecking motion. A special device was designed to measure the force of screw-in effect. A dynamometer of the device recorded the screw-in force during simulated canal preparation and the recorded data was stored in a computer with designed software (LCV-USE-VS, Lorenz Messtechnik GmbH, Alfdorf, Germany). The data were subjected to one-way ANOVA and Tukey's multiple range test for post-hoc test. P value of less than 0.05 was regarded significant. ProTaper(R) produced significantly more screw-in effects than any other instruments in the study (p 0.05), and between NRT with active tip and NRT with safe one neither (p > 0.05). From the result of the present study, it was concluded, therefore, that there seems significant differences of screw-in effect among the tested nickel-titanium rotary instruments. The radial lands and rake angle of nickel-titanium rotary instrument might be the cause of the difference.

Influence of taper on the screw-in effect of nickel-titanium rotary files in simulated resin root canal / 대한치과보존학회지

OBJECTIVES: The introduction of nickel-titanium alloy endodontic instruments has greatly simplified shaping the root canal systems. However, these new instruments have several unexpected disadvantages. One of these is tendency to screw into the canal. In this study, the influence of taper on the screw-in effect of the Ni-Ti rotary instrument were evaluated. MATERIALS AND METHODS: A total of 20 simulated root canals with an S-shaped curvature in clear resin blocks were divided into two groups. ProFile .02, .04, .06 (Dentsply-Maillefer) and GT rotary files .08, .10, .12 (Dentsply) were used in Profile group, and K3 .04, .06, .08, .10, and .12 (SybronEndo, Glendora) were used in K3 group. Files were used with a single pecking motion at a constant speed of 300 rpm. A special device was made to measure the force of screw-in effect. A dynamometer of the device recorded the screw-in force during simulated canal preparation and the recorded data was stored in computer with designed software. The data were subjected to one-way ANOVA and Tukey's multiple range test for post-hoc test. p value of less than 0.05 was regarded significant. RESULTS: The more tapered instruments generated more screw-in forces in Profile group (p < 0.05). In K3 group, 0.08, 0.10. and 0.12 tapered instruments showed more screw-in force than 0.04 tapered one, and 0.08 and 0.12 tapered instruments showed more screw-in force than 0.06 tapered one (p < 0.05). CONCLUSIONS: The more tapered instruments seems to produce more screw-in force. To avoid this screw-in force during instrumentation, more attention may be needed when using more tapered instruments.

Influence of root canal curvature on the screw-in effect of nickel-titanium rotary files in simulated resin root canal / 대한치과보존학회지

OBJECTIVES: Nickel-titanium (Ni-Ti) rotary instruments have some unexpected disadvantages including the tendency to screw-in to the canal. The purpose of this study was to evaluate the influence of root canal curvatures on the screw-in effect of Ni-Ti rotary files. MATERIALS AND METHODS: A total of 80 simulated root canals in clear resin blocks were used in the study. Canals with curvature of 0, 10, 20 and 30 degrees were instrumented with ProTaper instruments SX, S1, S2 and a ProFile of #25/0.06 to 1.0-2.0 mm beyond the initial point of root curvature. The screw-in force was measured with a specially designed device while canal was instrumented with a ProFile of #30/0.06 at a constant speed of 300 rpm. The data were subjected to one-way ANOVA and Scheffe multiple range test for post-hoc test. RESULTS: Larger degree of canal curvature generated significantly lesser screw-in forces in all groups (p < 0.001). CONCLUSIONS: More attention needs to be paid when using rotary instruments in canals with less curvature than canals with more curvatures to prevent or reduce any accidental overinstrumentation.