Influence of minimally invasive access cavities on load capacity of root-canal-treated teeth: A systematic review and meta-analysis.

This systematic review (PROSPERO-CRD42020147333) aimed to compare the effects of conservative, ultraconservative and truss access cavities with traditional access cavities on the load capacity of root-canal-treated teeth. Online databases were searched until December 2021, and 25 ex vivo studies in which the effects of different access cavities on load capacity of permanent teeth had been investigated were included. Quality assessment was completed using a modified risk of bias tool for in vitro studies adapted from previous studies. Meta-analysis was performed using the maximum-likelihood-based random-effects model with similar groups. Conservative access cavities significantly improved the load capacity of maxillary premolars (p < 0.01 [-1.32, -0.028]) and molars (p < 0.05 [-0.89, -0.02]) compared to traditional access cavities. Additionally, truss access cavities significantly improved the load capacity of mandibular molars with (p < 0.05, [-1.18, -0.02]) mesio-occluso-distal cavity preparations. Higher levels of evidence are needed to determine the long-term implications of minimal preparations for treatment outcomes.

The impact of platelet-rich fibrin (PRF) on delayed tooth replantation: A preliminary animal study.

The aim of this study was to evaluate the effect of platelet-rich fibrin (PRF) placed in delayed replantation of mature extracted teeth. Sixteen intentionally extracted teeth in two mature beagle dogs were selected. In one quadrant of each jaw, the extraction sockets were filled with PRF prior to replantation, and the other quadrant served as control without PRF. All extracted teeth underwent endodontic treatment and dried for 60 min. Thereafter, they were replanted with a flexible splint. After 8 weeks, the animals were euthanised, and the histological sections examined. Less inflammatory root resorption was noted in the PRF group compared to the control (P = 0.031). However, there was no significant difference between the two groups with regard to new bone formation, inflammatory status, connective tissue healing and replacement resorption (P > 0.05). Using PRF in the extracted socket before delayed replantation did not provide any significant benefit other than reduced inflammatory root resorption.

Effect of Rotary and Reciprocating Instrumentation Motions on Postoperative Pain Incidence in Non-Surgical Endodontic Treatments: A Systematic Review and Meta-Analysis.

OBJECTIVE: A systematic review and meta-analysis were conducted to determine whether there are postoperative pain differences resulting from rotary and reciprocation engine-driven instrumentation motions in non-surgical endodontic treatment or retreatment at 12, 24, and 48 hours. METHODS: Four electronic databases (PubMed, Embase, Cochrane Library, and Scopus) were searched to identify randomised controlled trials that compared the effects of rotary and reciprocating instrumentation motions on postoperative pain. Two authors independently screened the search results, extracted the data, and assessed the quality using the Cochrane risk of bias tool. Due to numerous variables across studies, the random effect inverse variance method for meta-analysis was applied. When significant heterogeneity among studies was present, the random effects multi-variable meta-regression analysis was performed to determine the source of heterogeneity. RESULTS: At all time intervals, the incidence of postoperative pain was higher in the reciprocating instrumentation group, but was not statistically significant. There was no significant difference in the analgesic intake between groups. Meta-regression analysis determined study population sizes as a significant heterogeneous factor, while significance was not observed for preoperative pain or the pulpal diagnosis. CONCLUSION: There was no difference in postoperative pain at 12, 24, and 48 hours after non-surgical root canal treatment and retreatment, using reciprocating or rotary instrumentation motions.

Impact of Access Cavity Design and Root Canal Taper on Fracture Resistance of Endodontically Treated Teeth: An Ex Vivo Investigation.

INTRODUCTION: The susceptibility of endodontically treated teeth (ETT) to fracture is mainly associated with the loss of tooth structure. This study evaluated the effect of the access cavity design and taper preparation of root canals on ETT fracture resistance of maxillary molars. METHODS: For tapering assessment, 30 sound distobuccal roots of maxillary molars were randomly assigned to 1 of 3 groups (n = 10): a .04 taper, a .06 taper, or a .08 taper. Endodontic canal preparations were performed using the Twisted Files rotary system (Kerr Co, Glendora, CA). In addition, 48 intact maxillary first and second molars were randomly assigned to 1 of 3 groups (n = 16) for cavity preparation approaches: intact teeth, traditional access cavity (TAC), or conservative access cavity (CAC). Fracture resistance was tested using a universal testing machine. For statistical analysis, the level of significance was P ≤ .05. RESULTS: The .04 taper instrumentation had the highest fracture resistance (259.61 ± 52.06), and the .08 taper had the lowest (168.43 ± 59.63). The .04 and .06 groups did not differ significantly (P > .05); however, these groups differed significantly from the .08 group (P ≤ .05). Regarding the cavity preparation approaches, the 3 groups of intact teeth, CAC, and TAC showed fracture resistance mean values of 2118.85 ± 336.97, 1705.69 ± 591.51, and 1471.11 ± 435.34, respectively, with no significant difference between the CAC and TAC groups (P > .05). CONCLUSIONS: Increasing the taper of the root canal preparation can reduce fracture resistance. Moreover, access cavity preparation can reduce resistance; however, CAC in comparison with TAC had no significant impact.

Nonsurgical Management of an Immature Maxillary Central Incisor with Type III Dens Invaginatus Using MTA Plug: A Case Report.

Dens invaginatus is a developmental anomaly, caused by deepening of the enamel organ into the dental papilla before calcification of the dental tissues. Teeth with dens invagination are susceptible to early caries and pulp necrosis within a few years of eruption or even before root end closure. This article reports two immature maxillary central incisors with type I and III dens invaginatus which had necrotic pulp and a large periradicular lesion, that were treated successfully by nonsurgical root canal treatment. After apical plug placement, the remaining space was backfilled using warm vertical gutta-percha technique and the crowns were restored by composite restoration. At 6 months of follow up the patient was asymptomatic and probing depths were less than 3 mm. In addition, the reduction in the size of apical radiolucencies was observed by radiographic examinations. This case report revealed that even type III des invaginatus with an open apex and large periapical lesion, can be treated non-surgically using MTA as an apical plug. Although this case report presents a favorable result, further studies with long term follow-up periods are encouraged to support the use of nonsurgical endodontic treatment for type III dens invaginatus.

Antimicrobial Activity of Nanoparticle Calcium Hydroxide against Enterococcus Faecalis: An In Vitro Study.

INTRODUCTION: Enterococcus faecalis (E. faecalis) has the ability to invade the dentinal tubules and resist high pH levels. As a result, calcium hydroxide (CH) is not much effective on this bacterium. In theory, nanoparticle calcium hydroxide (NCH) has smaller size and high surface area that enables it to penetrate into the deeper layers of dentin and be more effective on E. faecalis. This in vitro study was designed to compare the antimicrobial activity of NCH and CH against E. faecalis. METHODS AND MATERIALS: The antimicrobial activity of NCH against E. faecalis was evaluated by two independent tests: the minimum inhibitory concentration (MIC) of intracanal medicament and agar diffusion test (ADT). The efficiency of the medicament in dentinal tubules was evaluated on 23 human tooth blocks that were inoculated with E. faecalis. The tooth blocks were assigned to one control group (saline irrigation) and two experimental groups receiving CH and NCH as intracanal medication. The optical density in each group was assessed with spectrophotometer after collecting samples from dentin depths of 0, 200 and 400 µm. Data were analyzed by SPSS software ANOVA, Kruskal-Wallis and Dunnett's test. RESULTS: The MIC for NCH was 1/4 of the MIC for CH. NCH with distilled water (DW) produced the greatest inhibition zone in agar diffusion test. NCH had greater antimicrobial activity in dentin samples from depths of 200 and 400 µm compared to CH. CONCLUSION: The antimicrobial activity of NCH was superior to CH in culture medium. In dentinal tubules the efficacy of NCH was again better than CH on the 200- and 400-µm samples.

Root-end filling with cement-based materials: An in vitro analysis of bacterial and dye microleakage.

BACKGROUND: One ideal property of a root-end filling material is its apical sealing ability. The aim of this in vitro study was to assess bacterial and dye microleakage of white and gray mineral trioxide aggregate (WMTA and GMTA), Portland cement and calcium-enriched mixture (CEM) cement used as root-end filling material, and to assess the agreement between these two test methods. MATERIALS AND METHODS: Fifty-four single-rooted teeth were used. The roots were randomly divided into four study and two control groups. After decoronation, root canals were instrumented and filled with gutta-percha and AH26 sealer. Root-ends were resected 3 mm above the root-end and 3 mm deep cavities were prepared. Root-end cavities were filled with each material. Enterococcus faecalis and methylene blue dye were used for determination of bacterial and dye leakage respectively. Data were analyzed using Fisher's Exact Test, one-way ANOVA, Kaplan-Meier analysis, and Cohen's Kappa. RESULTS: There was 100% bacterial leakage in Portland cement and CEM cement, 58.3% in GMTA, and 91.7% in WMTA. GMTA showed significantly less bacterial leakage than Portland cement and CEM cement (P < 0.05). In those samples with leakage occurrence, times of observation of leakage were not significantly different; however, by survival analysis, the results of the GMTA group were significantly different from those of the CEM cement and Portland groups. The difference in complete dye leakage was not significant. There was poor agreement between dye and bacterial leakage methods. CONCLUSION: CEM cement provides leakage results comparable to other commonly used root-end filling materials such as WMTA.

Comparison of bacterial and dye microleakage of different root-end filling materials.

INTRODUCTION: The provision of an effective apical seal is an essential factor when choosing an appropriate material for success of root-end surgeries. Root-end resection, preparation and obturation should provide an adequate apical seal. The aim of this in vitro study was to investigate bacterial and dye microleakage of four different root-end filling materials and compare the efficacy of these two methods. MATERIALS AND METHODS: Fifty-six single-rooted teeth with intact and straight roots were randomly assigned into four study groups of 12 each and two control groups of three each. After decoronation, root canals were prepared up to file size #40 using step back technique; then, they were filled with gutta-percha and AH26 sealer. Root-ends were resected 3 mm above the root-end and 3 mm deep cavities were prepared. Root-end cavities were filled with amalgam, Root Mineral Trioxide Aggregate (Root MTA), White ProRoot MTA (WMTA), and calcium enriched mixture (CEM) cement. Bacterial leakage was investigated in Trypticase Soy Broth (containing Enterococcus faecalis) after 70 days and 1% methylene blue dye leakage was assessed after 72 hours. Complete dye leakage was checked using stereomicroscope (×40). Data were statistically analyzed using Fisher Exact test. For pair comparison between the two methods Kapa agreement was utilized. RESULTS: After 70 days there was 100% bacterial leakage in amalgam, and CEM cement, 91.7% in WMTA, and 75% in Root MTA. This difference was not significantly different. The difference in complete dye leakage was also not significant (WMTA and CEM cement 16.7%, Amalgam and Root MTA 33.3%). CONCLUSION: There was no significant measure of agreement between dye and bacterial penetration along root-end fillings. CEM cement was not significantly different from currently used retrofilling materials e.g. WMTA.

Presence of leptin in chronic periapical lesions.

INTRODUCTION: Studies have shown the regulatory role of Leptin in bone formation, its expression in adipose tissue as well as increased levels in circulation following the adminstration of inflammatory stimuli such as lipopolysaccharides (LPS). However, there is little data evaluating the role of Leptin in inflammatory periapical lesions. The aim of this study was to evaluate the presence and concentration of Leptin in chronic periapical lesions. MATERIALS AND METHODS: Chronic periapical lesions with different sizes were collected during periapical surgery of the mandibular molars from twenty patients and cultured for 72 hours. The ELISA method determined the concentration of Leptin in supernatant fluids of explants cultures. Statistical analysis was performed using non-parametric tests (Mann-Whitney U, Chi-Square and Spearman's Correlation Coefficient). RESULTS: Leptin was found in all samples with the average concentration of 405.55±102.98 (pg/mL). There was no significant correlation between the concentration of Leptin and BMI, and the diameters of lesions. CONCLUSION: Leptin can be considered an inflammatory mediator and is likely to have a role during the early phases of dental periapical lesions.