Laser light passage through restored and carious posterior teeth.

Laser Doppler flowmetry (LDF) has been used to investigate pulpal blood flow as a means of pulp vitality testing. Transmission of laser light from the tooth surface to the pulp space may be influenced by caries and restorations. One hundred and twenty-two first and second molars that had caries into dentine, restorations or significant loss of coronal tissue were sectioned in half axio-bucco-lingually. The two sections were illuminated with a laser from their buccal and lingual aspects 2 mm coronal to the amelocemental junction. Light reaching the pulp space was recorded. Buccal and lingual illumination sites were equally effective for 67 teeth (55%). Buccal sites alone were effective for 35 teeth (29%), despite over one-third of these surfaces being restored or featuring enamel or dentine caries. A lingual position alone was effective for 20 teeth (16%). Caries affected light transmission, but for over half the teeth, the pulp could be illuminated from all four probe positions. No effect was found when the influence of mesial and distal restorations on transmission into the corresponding tooth section was examined. The pulp spaces of most (84%) restored, and carious posterior teeth could be illuminated by laser light from their buccal aspect and these teeth could potentially be vitality tested using LDF.

Effect of restorations on pulpal blood flow in molars measured by laser Doppler flowmetry.

AIM: To: (i) compare laser Doppler pulpal blood flow (PBF) signals from restored and unrestored first molar teeth, (ii) investigate PBF in teeth with large and small restorations, and (iii) to relate PBF to pulp chamber dimensions on radiographs. METHODOLOGY: Bitewing radiographs of young adults with restored first molars were obtained and pulp chamber dimensions measured. Subjects were divided into 2 groups: group A with a restored tooth and an unrestored contralateral (43 subjects) and group B, those with a molar with a small (usually occlusal) restoration whilst the contralateral tooth had an extensive occlusal restoration (or restorations) or restored proximal surface(s) and/or cuspal overlay (31 subjects). The 148 teeth responded to electric pulp testing, and their PBF was recorded using a laser Doppler flowmeter. Data were analysed using Student's t-test. RESULTS: In group A the PBF in the restored teeth was significantly lower than in unrestored contralaterals (P = 0.028) and the total pulp chamber area and that in the clinical crown were smaller (P = 0.039 and 0.021 respectively). The group B molars with large restorations had significantly lower PBF than contralaterals with small restorations (P = 0.001), and their total pulp chamber area and pulp chamber width at cervix were reduced significantly (P = 0.003 and 0.032 respectively). CONCLUSIONS: In molars the size of the pulp chamber was influenced by the presence of restorations and the PBF was reduced when restorations were present. Size and extent of restorations had a significant effect on PBF.

Histological, ultrastructural and quantitative investigations on the response of healthy human pulps to experimental capping with mineral trioxide aggregate: a randomized controlled trial.

AIM: To investigate the pulpal response to direct pulp capping in healthy human teeth with mineral trioxide aggregate (MTA) as against calcium hydroxide cement (Dycal) as control. METHODOLOGY: Twenty healthy human third molars had iatrogenic pulpotomy and direct pulp capping with MTA. Another 13 teeth were capped with Dycal as controls. The teeth were restored, with IRM, clinically reviewed and extracted after a number of pre-determined intervals (1 week, 1 month and 3 months). The specimens were fixed, decalcified, subdivided axially into two halves in the oro-buccal (lingual-buccal) plane, embedded in plastic, serial sectioned and evaluated qualitatively and quantitatively by correlative light and transmission electron microscopy with appropriate statistical evaluation of the quantitative data. RESULTS: Iatrogenic pulpal wounds treated with MTA were mostly free from inflammation after 1 week and became covered with a compact, hard tissue barrier of steadily increasing length and thickness within 3 months following capping. Control teeth treated with Dycal revealed distinctly less consistent formation of a hard tissue barrier that had numerous tunnel defects. The presence of pulpal inflammation up to the longest observation period (3 months) after capping, was a common feature in Dycal specimens. CONCLUSIONS: The MTA was clinically easier to use as a direct pulp-capping agent and resulted in less pulpal inflammation and more predictable hard tissue barrier formation than Dycal. Therefore, MTA or equivalent products should be the material of choice for direct pulp capping procedures instead of hard setting calcium hydroxide cements.

The penetration of RealSeal primer and Tubliseal into root canal dentinal tubules: a confocal microscopic study.

AIM: To compare penetration depth into dentinal tubules of RealSeal with that of a well-established endodontic sealer (Tubliseal) by means of confocal microscopy. METHODOLOGY: Twenty sound extracted, single-rooted premolars were selected. Following completion of root canal instrumentation, the teeth were divided into two groups using a stratified sampling method, ranking teeth according to size. In group 1, 10 teeth were filled with Gutta-percha and Tubliseal using cold lateral condensation. In group 2, 10 teeth were filled with RealSeal. Both sealers were labelled with Rhodamine B dye. The teeth were sectioned parallel to their long axis resulting in 20 specimens per group. Confocal microscopy was used to assess the penetration depths of the sealers at three sites for each specimen (coronal, middle and apical). Data were analysed statistically using Stata Release 9.1. RESULTS: The penetration depth of RealSeal in each one of the thirds of the root canal was found to be higher than that of Tubliseal (P < 0.05). The penetration depths of the two sealers was found to be significantly different (P = 0.001). The mean penetration value for the RealSeal group was 908.8 microm whereas the mean value for the Tubliseal group was 139.5 microm. CONCLUSIONS: The penetration depth of RealSeal into the root dentinal tubules is significantly greater than that of Tubliseal.

The potential association between smoking and endodontic disease.

The aim of this review was to analyse the literature to assess the possibility of an association between smoking and endodontic disease and the prognosis of endodontically treated teeth. The review of the prognosis of endodontically treated teeth involved taking account of any potential associations with smoking and endodontic disease and marginal periodontitis, and smoking and prosthodontic outcomes. In addition, the role of smoking in implant failure and surgical wound healing was analysed with a view to drawing parallels regarding the possible implications of smoking on the outcome of surgical endodontics. A MEDLINE and Cochrane library search including smoking and various endodontic keyword searches identified three papers which discussed the variables, and did not just mention them separately in the text. The literature demonstrates a paucity of evidence relating smoking with endodontic disease and prognosis, but nevertheless presents evidence of a possible influence on the prognosis of endodontically treated teeth in smokers and a likely increase in surgical complications. The possible merits of a smoking cessation protocol prior to surgical endodontics are also discussed.

The effect of temperature on viscosity of root canal sealers.

AIM: To test the hypothesis that there was no significant (alpha = 0.05) change in viscosity of commercially available root canal sealers with increase in temperature using a high-performance Advanced Rheometric Expansion System (ARES) rheometer. METHODOLOGY: Materials tested were Apexit, Tubliseal EWT, Grossman's, AH Plus and Ketac-endo. Cone-and-plate geometry was used (25-mm diameter, 0.1 radian and gap 0.051 mm). Measurements were carried out for steady-state viscosity at 25 and 37 degrees C in the shear rate range of 0.001-50 s(-1) at standardized relative humidity and within 30 min from the start of mixing. Five samples were taken for each sealer at each temperature. RESULTS: At 25 degrees C all sealers demonstrated shear thinning. At 37 degrees C Grossman's (powder : liquid ratio 2 : 1 and 3 : 1) and Ketac-endo had a rapid rise in viscosity and early set whereas the other sealers were shear thinning. On increasing temperature from 25 degrees C to 37 degrees C, Apexit, Tubliseal and AH Plus had reduced viscosity whereas Grossman's 2 : 1, Grossman's 3 : 1 and Ketac-endo had increased viscosity, which varied with the shear rate. The change in viscosity with change in temperature was significant (P < 0.05) for all sealers except AH Plus. CONCLUSIONS: There was a variation in the effect of increasing temperature on each sealer depending on the shear rate. With the exception of AH Plus, a significant (P < 0.05) change in viscosity was found, and the null hypothesis was rejected.

Mineral trioxide aggregate: a review of the constituents and biological properties of the material.

This paper reviews the literature on the constituents and biocompatibility of mineral trioxide aggregate (MTA). A Medline search was conducted. The first publication on the material was in November 1993. The Medline search identified 206 papers published from November 1993 to August 2005. Specific searches on constituents and biocompatibility of mineral trioxide aggregate, however, yielded few publications. Initially all abstracts were read to identify which fitted one of the two categories required for this review, constituents or biocompatibility. Based on this assessment and a review of the papers, 13 were included in the constituent category and 53 in the biocompatibility category. Relatively few articles addressed the constituents of MTA, whilst cytological evaluation was the most widely used biocompatibility test.

Hand and nickel-titanium root canal instrumentation performed by dental students: a micro-computed tomographic study.

The aim of this study was to evaluate root canals instrumented by dental students using the modified double-flared technique, nickel-titanium (NiTi) rotary System GT files and NiTi rotary ProTaper files by micro-computed tomography (MCT). A total of 36 root canals from 18 mesial roots of mandibular molar teeth were prepared; 12 canals were prepared with the modified double-flared technique, using K-flexofiles and Gates-Glidden burs; 12 canals were prepared using System GT and 12 using ProTaper rotary files. Each root was scanned using MCT preoperatively and postoperatively. At the coronal and mid-root sections, System GT and ProTaper files produced significantly less enlarged canal cross-sectional area, volume and perimeter than the modified double-flared technique (P < 0.05). In the mid-root sections there was significantly less thinning of the root structure towards the furcation with System GT and ProTaper (P < 0.05). The rotary techniques were both three times faster than the modified double-flared technique (P < 0.05). Qualitative evaluation of the preparations showed that both ProTaper and System GT were able to prepare root canals with little or no procedural error compared with the modified double-flared technique. Under the conditions of this study, inexperienced dental students were able to prepare curved root canals with rotary files with greater preservation of tooth structure, low risk of procedural errors and much quicker than with hand instruments.

The chemical constitution and biocompatibility of accelerated Portland cement for endodontic use.

AIM: To evaluate the biocompatibility of mineral trioxide aggregate and accelerated Portland cement and their eluants by assessing cell metabolic function and proliferation. METHODOLOGY: The chemical constitution of grey and white Portland cement, grey and white mineral trioxide aggregate (MTA) and accelerated Portland cement produced by excluding gypsum from the manufacturing process (Aalborg White) was determined using both energy dispersive analysis with X-ray and X-ray diffraction analysis. Biocompatibility of the materials was assessed using a direct test method where cell proliferation was measured quantitatively using Alamar Blue dye and an indirect test method where cells were grown on material elutions and cell proliferation was assessed using methyltetrazolium assay as recommended by the International standard guidelines, ISO 10993-Part 5 for in vitro testing. RESULTS: The chemical constitution of all the materials tested was similar. Indirect studies of the eluants showed an increase in cell activity after 24 h compared with the control in culture medium (P<0.05). Direct cell contact with the cements resulted in a fall in cell viability for all time points studied (P<0.001). CONCLUSIONS: Biocompatibility testing of the cement eluants showed the presence of no toxic leachables from the grey or white MTA, and that the addition of bismuth oxide to the accelerated Portland cement did not interfere with biocompatibility. The new accelerated Portland cement showed similar results. Cell growth was poor when seeded in direct contact with the test cements. However, the elution made up of calcium hydroxide produced during the hydration reaction was shown to induce cell proliferation.

A study of the rheological properties of endodontic sealers.

AIM: To test the hypothesis that there would be no statistically significant difference in viscosity-related measures of endodontic sealers or change in these with strain rate, internal diameter or powder : liquid ratio in a capillary system. METHODOLOGY: Materials used were Apexit, Tubliseal EWT, Grossman's sealer and Ketac-endo. Viscosity-related measures were tested in a two-plate test, and in a capillary rheometer. The mean values (n = 12) for thickness and diameter of material formed between two glass plates were tested with one-way analysis of variance. Pressure was applied to a capillary rheometer at strain rates 5 and 10 mm min(-1) in tubes of internal diameter 0.6 and 1.2 mm. RESULTS: Tubliseal EWT had a thinner film thickness than the other sealers (alpha = 0.05). The difference in diameter between Tubliseal EWT and the other sealers was significant apart from Apexit. Increased strain rate gave a significant increase (alpha = 0.05) in the flow of all sealers. Narrower tubes produced increased velocity, which was significant for all sealers, and reduced volumetric flow, which was significant for all sealers except Grossman's 2 : 1 (Wilcoxon signed rank test). Reduction in powder : liquid ratio of Grossman's significantly increased flow in narrow tubes and at higher strain rate (Mann-Whitney test). CONCLUSION: There was a significant difference between the flow of Tubliseal EWT and the other sealers tested in the two-plate test; capillary flow was affected by sealer, internal diameter, strain rate and powder : liquid ratio. The null hypotheses were rejected.

The isthmuses of the mesial root of mandibular molars: a micro-computed tomographic study.

AIM: To investigate the prevalence of root canal isthmuses in the apical 5 mm of the mesial root of mandibular molars by means of micro-computed tomography (MCT) and to describe the morphology of the isthmuses. METHODOLOGY: Twenty extracted mandibular first molars that had fully formed roots were selected. The mesial roots were sectioned from the distal roots and subjected to MCT. The number of sections showing isthmuses in each of the apical 5 mm of the root canals was recorded. In each one of the apical 5 mm of the 20 roots examined, 40 sections were observed, giving a total of 800 sections observed in each group. Data were analysed as a contingency table using the chi-square statistic to test the null hypothesis that location of the sections in each of the apical 5 mm and presence of the isthmus were independent. RESULTS: Isthmuses were found to be present at all levels with prevalence figures between 17.25 and 50.25%. The chi-square test indicated a significant difference in the distribution of isthmuses with section (P = 0.001). It was found that sections in the first millimetre from the apex had fewer isthmuses than expected and that sections in the third millimetre from the apex had more isthmuses than expected under the null hypothesis. Calcifications were found to be present in most isthmuses, occasionally lateral canals originated from the central part of the isthmuses. CONCLUSIONS: Isthmuses were present in the vast majority of roots observed. The third millimetre from the apex showed more isthmuses than expected. The results of clinical and surgical endodontic procedures performed in the mesial root of mandibular molars may be affected by this aspect of the root canal anatomy.

Biocompatibility of two commercial forms of mineral trioxide aggregate.

AIM: To examine the biocompatibility of two commercial forms of mineral trioxide aggregate (MTA), by evaluating the morphology of an established cell line. METHODOLOGY: The two cements were cast on glass cover slips and cured for 1 or 28 days. Saos-2 osteosarcoma cells were trypsinized and seeded at a density of 1 x 10(5) cells and were then placed in medium over the material-coated coverslips for 1, 5 and 7 days. After these time intervals the media were discarded and the cells fixed. Cell morphological investigation was performed by scanning electron microscopy at various magnifications ranging from x 250 to x 500. The biocompatibility of cement constituents, alusilicate flux and bismuth oxide was also investigated. RESULTS: All cement samples cured for 1 day showed a confluent cell monolayer after 5 and 7 days. The response to both materials was similar. Materials cured for 28 days showed incomplete cell confluence after 1 and 5 days. Alusilicate flux and bismuth oxide did not demonstrate biocompatibility. CONCLUSIONS: The 1-day cured samples of two commercial forms of MTA showed good biocompatibility. However, the 28-day cured samples were less biocompatible after 1 and 5 days.

Pulp size in molars: underestimation on radiographs.

The aim was to determine whether radiographs provide a clinically useful indication of pulp size in diseased/restored human first molar teeth, and to investigate accessibility of pulp tissue for diagnostic testing using laser Doppler flowmetry (LDF). Extracted teeth of known age were collected. Restorative materials were removed and teeth with evidence of pulp exposures excluded. Fifty-six teeth were radiographed from buccal and mesial aspects, and then their crowns were sectioned axiobuccolingually and photographed. Images were digitally scanned and measurements made of the total pulp area (above a line across the most superior part of the pulpal floor) and the pulp area in the clinical crown (superior to a line between the amelocemental junctions). The pulp width at the cervix and the highest point of the pulp were also recorded. Data were analysed using Pearson correlations. Pulp areas within the clinical crowns were significantly larger than indicated by radiographs, by 23% in the case of the clinically attainable buccal view (P < 0.05). Pulps may be more accessible to flowmeter testing than they appear. Absence of pulp tissues in the crown was recorded in equal numbers of teeth on radiographs and sections, but with agreement for only one tooth. Sixteen per cent of the teeth had no pulp area in the clinical crown when sectioned, but might still be suitable for testing using LDF.