A comparison of different irrigation systems and gravitational effect on final extrusion of the irrigant.

BACKGROUND: The aim of this study was to compare manual needle irrigation (MNI), RinsEndo (RE), and passive ultrasonic irrigation (PUI), and assess the effect of gravity on extrusion from the apex in vitro. MATERIAL AND METHODS: The distobuccal roots of molars were used and the canals were instrumented up to F2. Teeth were mounted on models, which permitted visualization and manipulation of the apices for necessary procedures. The models were placed in articulator to simulate the jaw. Six groups (G) were formed as: G1, G2 and G3 represented mandibular positioning of teeth and were irrigated with MNI, RE, and PUI, respectively, while G4, G5, and G6 represented maxillary positioning of teeth and were also irrigated in same sequence. Prior to the final irrigation, 72 cube-shaped foam pieces covered with aluminum foil were weighed and the values were recorded as the initial weights. The cubes were then placed on the apical part of each sample. Final irrigation was performed with distilled water and the cubes were weighed again to determine their final weight. Data were analyzed using Kruskal-Wallis and Mann-Whitney U post-hoc test (p<0.05). RESULTS: Irrespective of the irrigation technique used, the amount of irrigant extruded from the apex showed a statistically significant difference related to the effect of gravity (p<0.05). There was no statistically significant difference between irrigation methods (p>0.05). When the irrigation systems were compared to examine the effect of gravity, the significant difference was found between G2 and G5 (p<0.05). CONCLUSIONS: Within the limitations of this study, MNI and PUI were found to be reliable irrigation systems. Caution should be exercised when using RinsEndo. Key words:Final irrigation, manual needle irrigation, passive ultrasonic irrigation, RinsEndo.

Evaluation of Root Canal Preparation Using Rotary System and Hand Instruments Assessed by Micro-Computed Tomography.

BACKGROUND: Complete mechanical preparation of the root canal system is rarely achieved. Therefore, the purpose of this study was to evaluate and compare the root canal shaping efficacy of ProTaper rotary files and standard stainless steel K-files using micro-computed tomography. MATERIAL AND METHODS: Sixty extracted upper second premolars were selected and divided into 2 groups of 30 teeth each. Before preparation, all samples were scanned by micro-computed tomography. Thirty teeth were prepared with the ProTaper system and the other 30 with stainless steel files. After preparation, the untouched surface and root canal straightening were evaluated with micro-computed tomography. The percentage of untouched root canal surface was calculated in the coronal, middle, and apical parts of the canal. We also calculated straightening of the canal after root canal preparation. Results from the 2 groups were statistically compared using the Minitab statistical package. RESULTS: ProTaper rotary files left less untouched root canal surface compared with manual preparation in coronal, middle, and apical sector (p<0.001). Similarly, there was a statistically significant difference in root canal straightening after preparation between the techniques (p<0.001). CONCLUSIONS: Neither manual nor rotary techniques completely prepared the root canal, and both techniques caused slight straightening of the root canal.

Cytotoxic effect of endodontic irrigants in vitro.

BACKGROUND: Cytotoxicity of root canal irrigants is important due to their close contact with host tissues. The aim of this study was to assess the cytotoxic effect of NaOCl 3%, Chx 2%, and MTAD on rat periodontal ligament fibroblasts, at 0.1 and 100 µl/mL, using WST-1 colorimetric method. MATERIAL AND METHODS: Rat ligamental fibroblasts were exposed to the irrigants and their viability was assessed after 1, 24, 48, and 72 h. The measurements were determined using WST-1 assay, using a micro ELISA reader. RESULTS: At 100 ml/L all 3 irrigants were strongly cytotoxic, although CHX was less so than NaOCl and MTAD. At the 0.1 ml/L concentration, NaOCl and MTAD were only moderately cytotoxic, whereas Chx was highly deleterious to cell viability at all time points. There was a significant influence of the dilution rate of the substance, because the odds ratio for cell viability being over 50% was increased 51 times between the 100 ml/L and 0.1 ml/L dilutions. CONCLUSIONS: It seems that irrigating solutions should be used at lower concentrations to enhance cell viability.

Effects of preparation techniques on root canal shaping assessed by micro-computed tomography.

BACKGROUND: Root canal shaping without any procedural error is of the utmost preference. Therefore, the purpose of this study was to use micro-computed tomography to evaluate and compare the root canal shaping efficacy of ProTaper rotary files and standard stainless steel K-files. MATERIAL AND METHODS: Sixty extracted upper second premolars were selected and were divided into 2 groups of 30. Before preparation, all samples were scanned by micro-CT. Then, 30 teeth were prepared with stainless steel files and the remaining 30 with ProTaper rotary files. Canal transportation and centering ability before and after root canal shaping were assessed using micro-CT. The amount and direction of canal transportation and the centering ratio of each instrument were determined in the coronal, middle, and apical parts of the canal. The 2 groups were statistically compared using one-way ANOVA. RESULTS: ProTaper rotary files gave less transportation (p<0.001) and better centering ability (p<0.00001) compared with stainless steel files. CONCLUSIONS: The manual technique for preparation of root canals with stainless steel files produces more canal transportation, whereas rotary files remain more centered in the canal.

Effectiveness of a new canal brushing technique in removing calcium hydroxide from the root canal system: A scanning electron microscope study.

AIM: To evaluate the effectiveness of Canal Brush technique removal Ca(OH)(2) from the root canal system using Scanning Electron Microscope (SEM). MATERIALS AND METHODS: Eighteen teeth were instrumented up to #40 and dressed with Ca(OH)(2). Ca(OH)(2) was removed with master apical file (MAF) (Group 1, n:6) and CanalBrush technique (Group 2, n:6). Six teeth served as positive and negative controls. The roots were splited in the buccolingual direction and prepared for SEM examination. Two examiners evaluated the wall cleanliness then statistical analysis was performed by Mann-Whitney U and Friedman tests. RESULTS: Differences in cleanliness were observed between Group 1 and Group 2 in the apical thirds (P=0.002). In the coronal and middle thirds, there were no differences between the two groups. CONCLUSIONS: It is essential to re-instrument the root canal walls using instrumentation techniques while irrigating with NaOCl and EDTA combination. The Canal Brush technique results in the packing effect of the Ca(OH)(2) through to the apex.

A comparison of three rotary systems and hand instrumentation technique for the elimination of Enterococcus faecalis from the root canal.

The aim of this study was to compare the in vitro reduction of a bacterial population in a root canal by mechanical instrumentation using three rotary systems and hand instrumentation technique. The root canals contaminated with a suspension of Enterococcus faecalis were instrumented using ProTaper, K3, HeroShaper and K-file hand instrumentation technique. Later the root canals were sampled. After serial dilutions, samples were incubated in culture media for 24 h. Bacterial colonies were counted and the results were given as number of colony-forming units per millilitre. The results showed that all the canal instrumentation systems reduced the number of bacterial cells in the root canals. Statistically, ProTaper instruments were more effective in reducing the number of bacteria than the other rotary files or hand instruments.

Spontaneously healed root fractures: two case reports.

We report on two undiagnosed horizontal root fractures of two maxillary right central incisors in two different patients caused by dental trauma which occurred several years ago. These fractures were discovered during a routine full-mouth radiographic examination. While, in case one, the fracture was located in the middle-third of the root, it was in the cervical-third of the root in case two. The fractured teeth were observed to have healed spontaneously without any sign or symptom, and tested as vital to electric pulp test.

Cytotoxic effects of four different endodontic materials in human periodontal ligament fibroblasts.

The purpose of this study was to compare the cytotoxicity, induced apoptosis and/or necrosis, and apoptotic mechanisms in human periodontal ligament (PDL) fibroblasts treated with four different endodontic materials: White ProRoot mineral trioxide aggregate (MTA) (MTA/Dentsply; Tulsa Dental, Memphis, TN), Diaket (ESPE, Seefeld, Germany), Endion (VOCO, Cuxhaven, Germany), and CYMED 8410 (NANO, Kaohsiung, Taiwan). The effects of these four materials on the viability of PDL fibroblasts were determined by MTT (3-(4,5-dimethyl-thiazoyl)-2,5-diphenyl-SH-tetrazolium bromide) assay. Apoptotic pathways were evaluated via several mechanisms. Exposure to MTA for 24, 48, and 72 hours resulted in no significant differences in MTT reduction and viable cell number compared with controls. However, treatment of PDL fibroblasts with Diaket, Endion, and CYMED 8410 for 24, 48, and 72 hours resulted in cytotoxicity with MTT and a reduction of viable cell number with trypan blue dye exclusion test compared with controls (from p < 0.05 to p < 0.001). Annexin V-FITC/PI staining showed that Diaket, Endion, and CYMED 8410 induced higher percentages of apoptosis and/or necrosis than in controls (45.6%, 25.5%, and 6.3%, respectively). Results of cell-cycle analyses were concordant with annexin V-FITC/PI staining findings. These results suggest that MTA is a very biocompatible filling material. However, Diaket, Endion, and CYMED 8410 are toxic to PDL fibroblasts in vitro. The main form of cell death induced by these filling materials was determined to be apoptosis and/or necrosis.

Substantive antimicrobial activity in chlorhexidine-treated human root dentin.

OBJECTIVE: The aim of this in vitro study was to assess the substantive antimicrobial activity of different medicaments in human root dentin. STUDY DESIGN: Canals of 98 roots were enlarged to standard size and medicated for 7 days with the following: (1) 2% chlorhexidine (CHX) gel, (2) 0.2% CHX gel, (3) 2% CHX solution, (4) Ca(OH)(2), (5) Ca(OH)(2)+ 0.2% CHX gel, (6) 2% CHX solution + a 25% CHX-containing controlled-release device, (7) saline, and (8) gel vehicle. After medication, canals were inoculated with Enterococcus faecalis for 21 days. Dentin samples were collected with Gates-Glidden burs into brain heart infusion broth, and bacterial growth was assessed with spectrophotometric analysis of optical density after 72 hours of incubation. RESULTS: Mean optical densities were significantly lower for groups with 2% CHX (1, 3, and 6) when compared with those of the controls (P < .05, analysis of variance with the Tukey test). Other groups did not differ significantly from the controls. CONCLUSIONS: Canal dressing for 1 week with 2% CHX may provide residual antimicrobial activity against E faecalis.