Evaluation of postoperative pain/discomfort after intracanal use of Nd:YAG and diode lasers in patients with symptomatic irreversible pulpitis and asymptomatic necrotic pulps: a randomized control trial.

OBJECTIVES: This study aimed to investigate the ability of the diode and Nd:YAG lasers to decrease postoperative pain/discomfort after intracanal application in vital and devital endodontic cases. MATERIAL AND METHODS: One hundred two patients with symptomatic irreversible pulpitis and asymptomatic necrotic pulps were selected and randomly divided into three groups. After chemomechanical preparation, Nd:YAG and diode laser was applied to first and second groups for final treatment of the root canals. In the control group, no further disinfection protocol was performed upon traditional procedures. Then all the teeth were obturated in the same appointment. Pre- and postoperative pain were recorded using the VAS at 0, 12th, 24th, 48th, and 72nd hours following the treatment Kruskal-Wallis and Dunn test. RESULTS: VAS scores were significantly the most at 12-h period compared with other time periods after treatment for all groups. There was no significant difference among Nd:YAG laser, diode laser, and control groups in non-vital cases (p > 0.05). In vital cases, Nd:YAG laser group represented significantly fewer scores compared with diode laser and control groups at 48-h period (p < 0.05). CONCLUSIONS: The processes involving the use of Nd:YAG and diode lasers after chemomechanical preparation was found to be equivalent in terms of postoperative pain intensity after completion of treatment in one session both in vital or non-vital cases except in vital cases in Nd:YAG group at 48 h. CLINICAL RELEVANCE: Adjunct clinical use of Nd:YAG or diode lasers to traditional chemomechanical preparation did not cause any improvement or deterioration on postoperative discomfort and pain in patients with symptomatic irreversible pulpitis and asymptomatic necrotic pulps.

Detection of Second Mesiobuccal Canals in Maxillary First Molars Using a New Angle of Cone Beam Computed Tomography.

BACKGROUND: The localization of the additional canal orifice is one of the primary factors influencing the success of endodontic treatment. To deal with this problem, several techniques that each have their own advantages and disadvantages have been discussed in the literature. OBJECTIVES: The aim of the present in vitro study was to review a new approach to localizing second mesiobuccal (MB2) canals in maxillary first molars using cone beam computed tomography (CBCT). PATIENTS AND METHODS: The CBCT scans of 296 patients who were referred to the department of dentomaxillofacial radiology were included in the study. The presence of MB2 canals, the angle formed by the mesiobuccal, distobuccal, and palatal root canal orifices (∠MDP), and the angle formed by the mesiobuccal, distobuccal, and MB2 canal orifices (∠MDMB2) were evaluated on the axial section. Pearson correlation and multiple linear regression methods were used for all predictions. All of the analyses were performed using SPSS for windows version 22.0. A two-sided P value < 0.05 was defined as statistically significant. RESULTS: Of the 468 first molars, MB2 canals were observed in 296 subjects (141 females and 155 males). There were no statistically significant differences between females and males (P = 0.300). The ∠MDP and ∠MDMB2 were detected and evaluated. A moderate positive correlation was found between the ∠MDP and the ∠MDMB2. To predict the ∠MDMB2 values, it was shown that the ∠MDMB2 increased by 0.420 degrees when the ∠MDP increased by 1 degree. If the ∠MDP was greater than 90.95 degrees, there was a 78% probability that MB2 canals could be found. CONCLUSION: The determination of the presence of MB2 in the maxillary first molars may be carried out using CBCT scans. If the ∠MDP was 91 degrees or greater, there was considered to be a higher probability that MB2 canals would be found in the endodontic cavity. Due to the positive correlation between the ∠MDP and the ∠MDMB2, the localization of MB2 canals may be easily performed in relation to the main MB canal.

Effects of voxel size and resolution on the accuracy of endodontic length measurement using cone beam computed tomography.

An accurate determination of the working length is indispensable for successful endodontic treatment. The aim of this study was to determine the influence of the voxel size and resolution of CBCT on measuring root canal working length. Thirty extracted single-rooted permanent teeth were used for this study. The working lengths of the teeth were determined by a researcher inserted a K-file into each canal until the tip became visible through the major foramen. The file was withdrawn until its tip was seen at the level of the coronal-most border of the major foramen under. The rubber stop was adjusted to the occlusal reference and the distance from the stop to the false tip was measured with digital calipers and recorded as the actual working length. The CBCT images were obtained with a Planmeca ProMax 3D Mid (Planmeca, Helsinki, Finland) using four sets of settings: from voxel size 0.5mm to voxel size 1.0mm. These measurements were compared with actual lengths (as a control group) using Analysis of Variance and the Dunnett Post Hoc Test. The Pearson correlation coefficient (r) and 95% confidence intervals were calculated to compare all measurement methods. The significance level was set at P<0.05. No significant difference was found among CBCT groups and working length. A highest correlation was found between the actual length and smallest voxel size and highest CBCT measurements (r=0.94). CBCT imaging can be used endodontic working length measurement and the smallest voxel size and highest resolution yielded more accurate results.

Effect of fibre-reinforced composite on the fracture resistance of endodontically treated teeth.

The aim of this study is to evaluate the fracture resistance of root-filled teeth restored with fibre-reinforced composite (everX posterior). Fifty mandibular molars were divided into five groups (n = 10). Group 1: no treatment was applied (intact teeth). Group 2-5: canals were prepared and root filled. Group 2: no coronal restoration was placed. Group 3: teeth were coronally restored with composite. Group 4: composite restorations were performed following polyethylene fibre insertion at the cavity base. Group 5: composite resin placed over everX posterior. After thermocycling (5-55°C, 5000×), fracture resistance was measured. Mean force load for each sample was recorded in Newtons (N). Results were statistically analysed with one-way analysis of variance and post hoc Tukey's tests. The mean force required to fracture samples and standard deviations are as follows: group 1: 2859.5 ± 551.27 N, group 2: 318.97 ± 108.67 N, group 3: 1489.5 ± 505.04 N, group 4: 1958.3 ± 362.94 N, group 5: 2550.7 ± 586.1 N. everX posterior (group 5) was higher than groups 2, 3 and 4 (P < 0.05). There were no significant differences between everX posterior and intact teeth (P > 0.05). Placing fibre-reinforced composite under composite increased the fracture strength of root-filled teeth to the level of intact teeth.

In vitro evaluation of Root ZX and Raypex 6 in teeth with different apical diameters.

BACKGROUND: There is a growing interest about electronic apex locators for working length determination. There are several studies dealing with their performance in different conditions. AIMS: The aim of this study is to evaluate the accuracy of Root ZX and Raypex 6 in teeth with different apical diameters. MATERIALS AND METHODS: Actual working length (AWL) of 80 single rooted teeth were determined as 0.5 mm short of apical foramen. The teeth were divided into 4 groups (n = 20). First group (G 0) included teeth with mature apices. Root canals of the other groups (G 32, G 57 and G 72) were enlarged until apical sizes of 0.32, 0.57 and 0.72 mm were obtained. Samples were embedded in alginate and electronic measurements (EM) were performed. STATISTICAL ANALYSIS: was achieved with Fisher exact test. RESULTS: Both devices revealed a high rate of success in G 0 and G 32. Their accuracy decreased significantly in G 57 and G 72 groups (P < 0.05). Intra-group results of Root ZX and Raypex 6 were similar (P > 0.05). CONCLUSIONS: Root ZX and Raypex 6 are reliable in teeth with mature apices. At foramen diameters exceeding 0.57 mm, their accuracy is susceptible.

Effect of ethylenediaminetetraacetic acid gel on the incidence of dentinal cracks caused by three novel nickel-titanium systems.

The aim of this study is to evaluate the incidence of crack formation while using Reciproc, WaveOne and Twisted File Adaptive with and without ethylenediaminetetraacetic acid (EDTA) gel. Seventy extracted mandibular premolars were included. The teeth were decoronated until roots of 16 mm were obtained. Samples were distributed into seven groups: group 1, no canal preparation (control); other groups were instrumented so; group 2, Reciproc; group 3, Reciproc + EDTA; group 4, WaveOne; group 5, WaveOne + EDTA; group 6, Twisted File Adaptive; group 7, Twisted File Adaptive + EDTA. Roots were horizontally sectioned from 3, 6 and 9 mm from apex and observed under stereomicroscope. The number and the incidence of cracks were recorded and statistically analysed with chi-squared and Kruskal-Wallis tests. Control group did not reveal any cracks. Crack formation with three novel Ni-Ti instruments was similar. Using EDTA gel did not reduce crack occurrence.

The effect of a diode laser and traditional irrigants on the bond strength of self-adhesive cement.

PURPOSE: The purpose of this study was to compare the effect of a diode laser and traditional irrigants on the bond strength of self-adhesive cement. MATERIALS AND METHODS: Fifty-five incisors extracted due to periodontal problems were used. All teeth were instrumented using a set of rotary root canal instruments. The post spaces were enlarged for a No.14 (diameter, 1.4 mm) Snowlight (Abrasive technology, OH, USA) glass fiber reinforced composite post with matching drill. The teeth were randomly divided into 5 experimental groups of 11 teeth each. The post spaces were treated with the followings: Group 1: 5 mL 0.9% physiological saline; Group 2: 5 mL 5.25% sodium hypochlorite; Group 3: 5 mL 17% ethylene diamine tetra acetic acid (EDTA), Group 4: 37% orthophosphoric acid and Group 5: Photodynamic diode laser irradiation for 1 minute after application of light-active dye solution. Snowlight posts were luted with self-adhesive resin cement. Each root was sectioned perpendicular to its long axis to create 1 mm thick specimens. The push-out bond strength test method was used to measure bond strength. One tooth from each group was processed for scanning electron microscopic analysis. RESULTS: BOND STRENGTH VALUES WERE AS FOLLOW: Group 1 = 4.15 MPa; Group 2 = 3.00 MPa; Group 3 = 4.45 MPa; Group 4 = 6.96 MPa; and Group 5 = 8.93 MPa. These values were analysed using one-way ANOVA and Tukey honestly significant difference test (P<.05). Significantly higher bond strength values were obtained with the diode laser and orthophosphoric acid (P<.05). There were no differences found between the other groups (P>.05). CONCLUSION: Orthophosphoric acid and EDTA were more effective methods for removing the smear layer than the diode laser. However, the diode laser and orthophosphoric acid were more effective at the cement dentin interface than the EDTA, Therefore, modifying the smear layer may be more effective when a self-adhesive system is used.

The effect of post surface treatments on the bond strength of fiber posts to root surfaces.

The aim of the present study was to evaluate the influence of post surface treatment methods on the push-out bond strength of adhesively luted quartz fiber posts. Thirty freshly extracted and endodontically treated human incisor teeth were prepared for quartz fiber posts. The posts were submitted to three different surface treatments (n = 10), including no treatment, 50-µm aluminum-oxide (Al(2)O(3)) airborne-particle abrasion and Er:YAG laser (10 Hz, 150 mJ) irradiation. The posts were luted with resin cement. Each root was sectioned perpendicularly to its long axis to create specimens of 1-mm thickness. After the specimens were stored in distilled water at 37°C for 24 h, their push-out bond strength was tested using a universal testing machine at a crosshead speed of 1 mm/min. The data were analyzed by two-way ANOVA (α = .05). The two-way ANOVA indicated that push-out test values did not vary significantly according to surface treatments applied (control, airborne particle abrasion, Er:YAG laser irradiation) (p > 0.05), however, values varied according to the root segments (cervical, middle, and apical) (p < 0.01). The push-out bond strength values of the coronal root sections were the highest (p < 0.05) and there were no significant differences between the middle and apical root sections in push-out bond strength of fiber posts (p > 0.05). Air-borne particle abrasion or Er:YAG laser irradiation applied on the quartz fiber posts did not affect the push-out bond strengths relative to the root surfaces. The highest bond strength was observed in the cervical third of the roots in all groups.

Antimicrobial efficiency of photodynamic therapy with different irradiation durations.

OBJECTIVE: This study aimed to evaluate the antimicrobial efficiency of PDT and the effect of different irradiation durations on the antimicrobial efficiency of PDT. MATERIALS AND METHODS: Sixty freshly extracted human teeth with a single root were decoronated and distributed into five groups. The control group received no treatment. Group 1 was treated with a 5% sodium hypochlorite (NaOCl) solution. Groups 2, 3, and 4 were treated with methylene-blue photosensitizer and 660-nm diode laser irradiation for 1, 2, and 4 min, respectively. The root canals were instrumented and irrigated with NaOCl, ethylenediamine-tetraacetic acid, and a saline solution, followed by autoclaving. All the roots were inoculated with an Enterococcus faecalis suspension and brain heart infusion broth and stored for 21 days to allow biofilm formation. Microbiological data on microorganism load were collected before and after the disinfection procedures and analyzed with the Wilcoxon ranged test, the Kruskal-Wallis test, and the Dunn's test. RESULTS: The microorganism load in the control group increased. The lowest reduction in the microorganism load was observed in the 1-min irradiation group (Group 2 = 99.8%), which was very close to the results of the other experimental groups (99.9%). There were no significant differences among the groups. CONCLUSIONS: PDT is as effective as conventional 5% NaOCl irrigation with regard to antimicrobial efficiency against Enterococcus faecalis.

Temperature increase beneath etched dentin discs during composite polymerization.

OBJECTIVE: The purpose of this in vitro study was to measure the temperature increase during the polymerization of a composite resin beneath acid-etched or laser-etched dentin discs. BACKGROUND DATA: The irradiation of dentin with an Er:YAG laser may have a positive effect on the thermal conductivity of dentin. This technique has not been studied extensively. MATERIALS AND METHODS: Forty dentin discs (5 mm in diameter and 0.5 or 1 mm in height) were prepared from extracted permanent third molars. These dentin discs were etched with 20% orthophosphoric acid or an Er:YAG laser, and were then placed on an apparatus developed to measure temperature increases. The composite resin was polymerized with a high-intensity quartz tungsten halogen (HQTH) or light-emitting diode unit (LED). The temperature increase was measured under the dentin disc with a J-type thermocouple wire that was connected to a data logger. Five measurements were made for each dentin disc, curing unit, and etching system combination. Differences between the initial and the highest temperature readings were taken, and the five calculated temperature changes were averaged to determine the value of the temperature increase. Statistical analysis was performed with a three-way ANOVA and Tukey HSD tests at a 0.05 level of significance. Further SEM examinations were performed. RESULTS: The temperature increase values varied significantly, depending on etching systems (p < 0.05), dentin thicknesses (p < 0.05), and curing units (p < 0.05). Temperature increases measured beneath laser-etched discs were significantly higher than those for acid-etched dentin discs (p < 0.05). The HQTH unit induced significantly higher temperature increases than the LED unit (p < 0.05). The LED unit induced the lowest temperature change (5.2°C) in the 1-mm, acid-etched dentin group. The HQTH unit induced the highest temperature change (10.4°C) for the 0.5-mm, laser-etched dentin group. CONCLUSION: The risk of heat-induced pulpal damage should be taken into consideration during the polymerization of composite resin after laser etching when the dentin thickness is less than 0.5 mm.

Effect of immediate and delayed post preparation on apical microleakage by using methacrylate-based EndoREZ sealer with or without accelerator.

The purpose of this study was to evaluate the effect of immediate and delayed post space preparation on the apical sealing ability of EndoREZ, a methacrylate-based dual-cured resin sealer, with or without accelerator. Fifty extracted human teeth were endodontically prepared and randomly divided into 6 groups. Teeth in experimental groups 1, 2, 3, and 4 (n = 10) were filled with resin-coated gutta-percha and either EndoREZ with accelerator (A+) or EndoREZ without accelerator (A-) by the lateral compaction technique. In group1 (A+) and group2 (A-), the post space was prepared immediately at the time of obturation. In groups 3 (A+) and 4 (A-), the post space was prepared after storage in 100% humidity at 37 degrees C for 1 week. Groups 5 and 6 (n = 5) represented positive and negative control groups, respectively. Leakage was determined by computerized fluid filtration device. Complete leakage was observed in group 5, and no leakage was evident in group 6 (P = 1.000). In experimental groups, mean apical microleakage values (microL/cmH(2)O/min(-1)) were as follows: group 1, 2.77 +/- 0.79(a); group 2, 2.88 +/- 1.38(a); group 3, 19.95 +/- 7.85(c); group 4, 6.20 +/- 2.09(b) (different letters indicate significantly different groups, P < .005). Immediate post space preparation achieved better sealing than delayed post preparation at the apical end, regardless of whether the EndoREZ accelerator was used. There was no significant difference between the (A+) and (A-) in immediate post space preparation. However, more leakage was found when using (A+) than (A-) in delayed post preparation. Under the conditions of this study, it was concluded that EndoREZ accelerator seems not to provide clinicians with any advantage for rapid transition from endodontic treatment to post-endodontic restorative procedures immediately after completion of root canal therapy.

The effect of fiber placement or flowable resin lining on microleakage in Class II adhesive restorations.

PURPOSE: The aim of this in vitro study was to evaluate the effect of two fibers (polyethylene or glass) and a flowable resin liner on microleakage in Class II adhesive restorations. MATERIALS AND METHODS: Class II adhesive cavities were prepared on mesial and distal surfaces of 40 extracted sound human molars. The cavity margins were below or above the CEJ. The teeth were randomly divided into four groups according to the restoration technique: group 1: restored with a resin composite (AP-X, Kuraray) in bulk after SE Bond (Kuraray) treatment; group 2: flowable resin liner (Protect Liner F, Kuraray) was used before composite restoration; in group 3, a polyethylene fiber (Ribbond) and in group 4, a glass fiber (everStick NET, StickTech) was placed into the bed of flowable resin before composite restoration. Samples were finished, stored in distilled water for 7 days at room temperature, and then thermocycled for 300 cycles between 5 degrees C and 55 degrees C. After sealing the apices, the teeth were varnished within 1 mm of the margins and placed in 0.5% basic fuchsin dye for 24 h at 37 degrees C. After rinsing, the teeth were sectioned longitudinally through the restorations and microleakage was evaluated with a stereomicroscope. Marginal penetration was scored on a 0 to 4 scale, and the data were statistically analyzed using Kruskal-Wallis and the Mann-Whitney U-test. RESULTS: Flowable resin, everStick NET, and Ribbond THM used in combination with flowable resin significantly reduced leakage at occlusal margins in cavities with enamel margins (p < 0.05). When the leakage values on cervical dentin margins were evaluated, there was no statistically significant difference among the tested groups (p > 0.05). CONCLUSION: Use of flowable composite alone or in combination with polyethylene or glass fibers reduces occlusal leakage in Class II adhesive cavities with enamel margins.