Effect of access cavities on the biomechanics of mandibular molars: a finite element analysis.

INTRODUCTION: This study aimed to predict the fracture resistance of a mandibular first molar (MFM) with diverse endodontic cavities using finite element analysis (FEA). METHODS: Five experimental finite element models representing a natural tooth (NT) and 4 endodontically treated MFMs were generated. Treated MFM models were with a traditional endodontic cavity (TEC) and minimally invasive endodontic (MIE) cavities, including guided endodontic cavity (GEC), contracted endodontic cavity (CEC) and truss endodontic cavity (TREC). Three loads were applied, simulating a maximum bite force of 600 N (N) vertically and a normal masticatory force of 225 N vertically and laterally. The distributions of von Mises (VM) stress and maximum VM stress were calculated. RESULTS: The maximum VM stresses of the NT model were the lowest under normal masticatory forces. In endodontically treated models, the distribution of VM stress in GEC model was the most similar to NT model. The maximum VM stresses of the GEC and CEC models under different forces were lower than those of TREC and TEC models. Under vertical loads, the maximum VM stresses of the TREC model were the highest, while under the lateral load, the maximum VM stress of the TEC model was the highest. CONCLUSION: The stress distribution of tooth with GEC was most like NT. Compared with TECs, GECs and CECs may better maintain fracture resistance, TRECs, however, may have a limited effect on maintenance of the tooth resistance.

Role-play in Endodontic Teaching: a Case Study.

Objective: To investigate the role of the application of role-play in endodontic study in improving the communication skills of Chinese dental undergraduates prior to their direct interactions with patients at the Fourth Military Medical University's School of Stomatology, China. Methods: Students were recruited from the 5-year bachelor's programme (n = 36) and randomly divided into six groups, and from the 8-year DDS programme (n = 10) and randomly divided into two groups to participate in the role-play training. Cases selected randomly from the case pool were distributed to the groups. The teacher gave an outline of the roles in the simulation. Each member of each group randomly selected their own role for the role-play. Four types of surveys were distributed to students and faculty members at different points after the role-plays had taken place, to evaluate their attitude towards the use of role-plays in endodontic study. Frequency analysis and a one sample t test were used to describe and analyse students' acceptance of role-play as a teaching technique. The level of statistical significance was set at P < 0.05. Results: Students' performance and satisfaction as well as the supporting faculty responses were very favourable towards role-playing. In total, 93.5% of students responded favourably to the role-play, answering 'strongly agree' or 'agree' to the positive statements about their role-play performance. A total of 95.1% of students stated that they had benefited psychologically and technically from the role-play ('strongly agree' or 'agree') after their 1-year rotating internship. Conclusion: The application of role-play in endodontic study is an effective way of educating Chinese dental undergraduates and can be beneficial for their transition from students to dentists.

Melatonin attenuates inflammation of acute pulpitis subjected to dental pulp injury.

Acute pulpitis (AP), one of the most common diseases in the endodontics, usually causes severe pain to the patients, which makes the search for therapeutic target of AP essential in clinic. Toll-like receptor 4 (TLR4) signaling is widely involved in the mechanism of pulp inflammation, while melatonin has been reported to have an inhibition for a various kinds of inflammation. We hereby studied whether melatonin can regulate the expression of TLR4/NF-ĸB signaling in the pulp tissue of AP and in human dental pulp cells (HDPCs). Two left dental pulps of the adult rat were drilled open to establish the AP model, and the serum levels of melatonin and pro-inflammatory cytokines, including interleukin 1ß (IL-1ß), interleukin 18 (IL-18) and tumor necrosis factor α (TNF-α), were assessed at 1, 3 and 5 d post injury. At the same time points, the expression of TLR4 signaling in the pulp was explored by quantitative real-time PCR and immunohistochemistry. The AP rats were administered an abdominal injection of melatonin to assess whether melatonin rescued AP and TLR4/NF-ĸB signaling. Dental pulp injury led to an approximately five-day period acute pulp inflammation and necrosis in the pulp and a significant up-regulation of IL-1ß, IL-18 and TNF-α in the serum. ELISA results showed that the level of melatonin in the serum decreased due to AP, while an abdominal injection of melatonin suppressed the increase in serum cytokines and the percentage of necrosis at the 5 d of the injured pulp. Consistent with the inflammation in AP rats, TLR4, NF-ĸB, TNF-α and IL-1ß in the pulp were increased post AP compared with the baseline expression. And melatonin showed an inhibition on TLR4/NF-ĸB signaling as well as IL-1ß and TNF-α production in the pulp of AP rats. Furthermore, melatonin could also regulate the expression of TLR4/NF-ĸB signaling in LPS-stimulated HDPCs. These data suggested that dental pulp injury induced AP and reduced the serum level of melatonin and that supplementation with melatonin may have a protective effect on AP by modulating TLR4/NF-ĸB signaling in the pulp and in pulp cells.

[Defects in 2061 discarded ProTaper handfiles after clinical use].

PURPOSE: To explore the mechanism of failure of ProTaper NiTi handfiles during root canal preparation. METHODS: A total of 2061 discarded ProTaper handfiles were collected after clinical use. The files were studied under stero-microscope to determine the type of defect. The fractured files were photographed digitally and the pictures were analyzed by software Image-Pro Plus to measure the distance from the break point to the tip. The data were statistically analyzed by using SPSS 11.0 software package. RESULTS: Plastic deformation was observed in 166 files (8.2%), and the types of defects included unwinding, winding flutes, and plastic bending. Instrument separation occurred in 581 files (28.2%), and the fracture rate was the highest in the F2 file group (41.7%). The SX file group had the highest facture level, and the mean distance from the breakpoint to the file tip was (4.4±1.1) mm. CONCLUSIONS: For shaping files, especially at the apical level, the main cause of mental failure is overload of torque, whereas for finishing files, especially at the higher level, is cycle fatigue. Understanding the defect types of ProTaper handfiles is useful for avoiding file breakage during root canal therapy.

[A micro-computed tomographic analysis of the apical anatomy of permanent three-rooted mandibular first molars].

OBJECTIVE: To investigate the anatomic features of the root apexes of permanent three-rooted mandibular first molars. METHODS: A total of 122 permanent mandibular first molars of Han Chinese patients were collected. Twenty three-rooted and 25 two-rooted molars were scanned by micro-CT and then reconstructed three-dimensionally. The apical anatomy of the tooth models were analyzed in software Mimics 10.01. The long and short diameters of the apical constriction (AC), the distances between AC, apical foramen (AF) and apex were measured. One-way ANOVA and LSD-t tests were used to compare the groups in relation to AC diameter and the distances between the AC, AF and apex. RESULTS: The AF of the mesiobuccal (MB) canals most frequently presented at the distal side of the apex (10 cases in three-rooted and 6 cases in two-rooted group), and of the mesiolingual (ML) canals, most often at the lingual side (8 cases in each group). The AF of the distobuccal (DB) roots were frequently located at the distolingual (DL) side (10 cases), and those of the DL roots and distal canals of two-rooted molars were most often at the buccal (7 cases) and distal (11 cases) sides, respectively. The percentage of the "classical" singular AC was 53% (80/151). The average long(D) and short(d) diameters of the AC of the DB canals were (0.32 ± 0.09) mm and (0.25 ± 0.05) mm, respectively, significantly larger than the DL canals [D = (0.27 ± 0.08) mm, d = (0.22 ± 0.06) mm, P < 0.05] and the ML canals [D = (0.24 ± 0.06) mm, d = (0.19 ± 0.06) mm, P < 0.01). In three-rooted group, the mean distances between AC and AF, AF and apex, and AC and apex were (0.67 ± 0.32), (0.49 ± 0.28) and (1.01 ± 0.34) mm, respectively. CONCLUSIONS: The AF of three-rooted mandibular molars frequently deviate from the root apex, and the AC of the DB canal is wider than those of the other canals. The mean distances between AC, AF and the apex suggest that root canal therapy should terminate at 1 to 1.5 mm short of the radiographic apex.

[The use of dental papillae cells and millipore filter for bioengineered dentin].

OBJECTIVE: To observe the ability of SD rat dental papillae cells forming dentin-like structure induced by millipore filter combined with transforming growth factor-ß(1) (TGF-ß(1)). METHODS: The first passage SD rat dental papillae cells were enzymatically dissociated and centrifuged to obtain a cell mass. The cell mass was seeded on the millipore filter combined with TGF-ß(1). The complex was incubated for 6 d in vitro or transplanted under the renal capsule for 2 weeks. Then the differentiation of dental papillae cells on the filter and the formation of mineral tissue on the implant were analyzed. RESULTS: A layer of polarized columnar cells were observed along the surface of the millipore filter, with cell processes extending into the porous media. Dentin sialoprotein (DSP) and dentin matrix protein-1 (DMP-1) were positive in these cells. After 2 weeks, tubular dentin matrix was deposited on the surface of the aligned cells. Scanning electron microscopy showed that the thickness of newly formed tubular dentin was consistent. DSP and DMP-1 were expressed in columnar cells, tubular matrix and the dental papillae cells adjacent to the filter. CONCLUSIONS: The millipore filter combined with TGF-ß(1) could effectively recruit progenitors onto its surface and induce odontoblast differentiation, secrete matrix in a homogenous manner, leading to dentinogenesis.

The desensitizing efficacy of a novel stannous-containing sodium fluoride dentifrice: an 8-week randomized and controlled clinical trial.

PURPOSE: To assess the efficacy of a novel stannous-containing dentifrice in the reduction of dentin hypersensitivity when compared to a marketed positive control dentifrice. METHODS: An 8-week, single-center, randomized, parallel group, two-treatment, double-blind clinical study was conducted in a generally healthy adult population with moderate thermal and tactile dentin hypersensitivity. A total of 60 adults were enrolled into the study. Participants were stratified at baseline by age, gender, and cold air sensitivity scores, and randomly assigned to either an experimental stannous-containing sodium fluoride dentifrice or a marketed potassium nitrate positive control. Brushing was supervised on site after baseline and Week 4 examinations. All other product usage was unsupervised. Subjects brushed 2 minutes twice daily. At baseline, Week 4 and Week 8, efficacy outcomes were assessed for tactile sensitivity via the Yeaple Probe, and for thermal sensitivity with air-blast/SchiffAir Index. RESULTS: Fifty-eight subjects completed all evaluations. Both the experimental stannous-containing and positive control dentifrices provided significant (P< 0.05) reductions in both tactile and thermal dentin hypersensitivity compared to baseline at both Weeks 4 and 8. There were no significant differences in Yeaple Probe or Schiff Air Index results between the dentifrices with either efficacy measurement at Week 4 and Week 8 (P > or = 0.5375).

[Influence of luxS of Streptococcus mutans on biofilm of dental plaque].

OBJECTIVE: To construct luxS mutant aften luxS gene of Streptococcus mutans (S. mutans) was knocked out, and examine their ability of biofilm formation. METHODS: A recombinant plasmid containing the flanking fragment of luxS of S. mutans was transformed into S. mutans UA159, and selected by brain heart infusion (BHI) agar medium with kanamicin. The luxS mutant further confirmed via polymerase chain reaction (PCR) and the autoinducer-2 (AI-2) bioluminescence assay of Vibrio harveyi (V. harveyi), and ability of luxS mutant and S. mutans UA159 biofilm formation was examined in different phases, in BHI medium with 1% sucrose and 1% glycose by scanning electron microscopy (SEM). RESULTS: LuxS-deficient S. mutans strains were successfully constructed. Compared with S. mutans UA159, the luxS mutant maintained in BHI medium containing 1% sucrose displayed an apparent defect in biofilm formation, while they showed no significant deviation in BHI medium containing 1% glycose. CONCLUSION: luxS gene in S.mutans can play a role in dental plaque biofilm formation, and the luxS gene is possible to regulate sucrose-dependent biofilm formation.

[Establishment and application of an in vitro model for apatite crystal mineralization].

OBJECTIVE: To establish an in vitro model for the apatite crystal mineralization. To evaluate the influences of bovine serum albumin (BSA) and fluoride to the mineralization of apatite crystal. METHODS: The model was constructed using cation selective membrane (CMV) and dialysis membrane. Double distilled water (DDW), BSA, 5, 20, 100 mg x L(-1) fluoride were added into the reaction space of the model. Reaction was carried out at 37 degrees C for 3 days under gentle stirring. The crystals were identified by scanning electron microscope (SEM) and X-ray diffraction (XRD). RESULTS: The model was established successfully. When DDW and BSA were added respectively, the main component of the deposit was octacalcium phosphate (OCP), but the shape and size of the crystals differs from each other. When fluoride with different concentration were added, the main component of the crystal turned to rod-like and prism-like fluoroapatite (FAP) crystal. The size and crystallinity of the FAP increased with the increase of the fluoride concentration. CONCLUSION: It is an effective way to evaluate the influence factors of the apatite crystal mineralization by using the in vitro model.