Management of root resorption with mineral trioxide aggregate complicated by a luxation injury: report of a case with six-year follow-up.

Trauma to the oral region occurs frequently, comprising 5% of all injuries. The most common dental injuries are lateral luxations which can be seen with a prevalence of up to 27% among dental injuries. Ectopic eruption of maxillary canines can lead to root resorption on maxillary lateral incisors especially on apical and middle thirds of the roots. Half of these resorbed lateral incisors show severe resorption, in which the pulp is exposed. This case report describes non-surgical treatment with mineral trioxide aggregate (MTA) and a six-year follow-up of a maxillary lateral incisor, resorbed by ectopic eruption of the canine and affected by lateral luxation injury. The tooth was asymptomatic, and radiographic examination showed that the resorbed region had been successfully repaired with new hard tissue deposition within the six-year follow-up. MTA can be considered an effective repair material in nonsurgical treatment of this type of root resorption.

Effects of different cusp coverage restorations on the fracture resistance of endodontically treated maxillary premolars.

STATEMENT OF PROBLEM: Cusp coverage restorations for the restoration of endodontically treated teeth represent a conservative approach in terms of function and esthetics. However, limited scientific data are available regarding the optimum reduction design and thicknesses. PURPOSE: The purpose of this in vitro study was to evaluate the fracture resistance and fracture patterns of cusp coverage restorations with different cusp reduction designs and reduction thicknesses on endodontically treated maxillary premolars (ETMPs) with mesio-occluso-distal (MOD) cavities. MATERIAL AND METHODS: One hundred sixty-five extracted intact human maxillary premolars were divided into 11 groups: G1-10 (test groups) and G11 (intact group). In the test groups, all of the teeth were restored with composite resin after canal treatments with MOD cavities. However, the cusps of the G1-9 teeth were reduced with combinations of different thicknesses (1.5, 2.5, and 3.5 mm) and designs (beveled, horizontal, and anatomic). The specimens were subjected to 10(5) cycles of 50 N mechanical loading. Next, the specimens were subjected to a compressive load at a crosshead speed of 0.5 mm/min until fracture. The fractured specimens were analyzed to determine the fracture pattern. Two-way ANOVA followed by the Fisher least significant difference (LSD) test was used to analyze the interaction between groups. RESULTS: The fracture resistance values increased with increases in the cusp reductions. The fracture resistance values of the G6 (2.5 mm, anatomic) and G9 (3.5 mm, anatomic) groups were significantly greater than that of the MOD group. However, the G6, G8 (3.5 mm, horizontal), and G9 groups were comparable with G11. The highest restorable fracture rates were observed in G6 and G9. CONCLUSIONS: Cusp reduction design and thickness influenced the fracture resistance and fracture patterns of cusp coverage restorations of ETMPs with MOD cavities. The teeth restored with anatomic cusp reduction designs with reduction thicknesses of at least 2.5 mm exhibited greater fracture resistance and more frequent restorable fractures.

Influence of different Er,Cr:YSGG laser parameters on long-term dentin bond strength of self-etch adhesive.

The aim of the present study was to evaluate the effects of erbium, chromium: yattrium-scandium-gallium-garnet (Er,Cr:YSGG) laser frequency on microtensile bond strength (µTBS) of a self-etch adhesive to dentin after 15-month water storage. The Er,Cr:YSGG laser can safely be used on dental hard tissue. However, no study has compared the effects of Er,Cr:YSGG laser parameters and aging by water storage on the bonding effectiveness of self-etch adhesives to dentin. Thirty-five bovine teeth were randomly assigned to the following seven groups (n = 5): group I (diamond bur with high-speed handpiece (control)), group II (Er,Cr:YSGG laser 3 W/50 Hz), group III (Er,Cr:YSGG laser 3 W/35 Hz), group IV (Er,Cr:YSGG laser 3 W/20 Hz), group V (Er,Cr:YSGG laser 6 W/50 Hz), group VI (Er,Cr:YSGG laser 6 W/35 Hz), and group VII (Er,Cr:YSGG laser 6 W/20 Hz). Clearfil SE Bond was applied to the prepared dentin, and the composites were placed and cured. Resin-dentin sticks with an approximate cross-sectional area of 0.8 mm(2) were obtained, and bond strength tests were performed at 24 h and 15 months of water storage after bonding. Data were analyzed with Kruskal-Wallis and Mann-Whitney U tests (p < 0.05). Laser irradiation resulted in significantly lower bond strengths when compared to bur treating. Fifteen-month water storage reduced bond strength for all groups. There was no significant difference among the effects of different laser frequencies on bond strength. It can be concluded that Er,Cr:YSGG laser used at the tested parameters may alter the dentin bond durability of self-etch adhesive.

Effects of Er,Cr:YSGG laser parameters on dentin bond strength and interface morphology.

Previous studies have shown the effects of Er,Cr:YSGG laser irradiation on the dentin bond strength; but there are few reports that show the significance of the irradiation with different laser parameters on dentin bond strength and interface morphology. This in-vitro study attempted to evaluate the microtensile bond strength (µTBS) and interface morphology of resin-dentin interfaces, either followed by treatment with Er,Cr:YSGG laser irradiation with different parameters or not. The flattened dentin samples of 35 bovine teeth were embedded into acrylic blocks and randomly divided into seven groups according to surface treatments using Er,Cr:YSGG lasers with different parameters: 3 W/20 Hz, 3 W/35 Hz, 3 W/50 Hz, 1.5 W/20 Hz, 1.5 W/35 Hz, 1.5 W/50 Hz, or no laser treatment (n = 5). Composite buildups were done over bonded surfaces and stored in water (24 hours at 37°C). Specimens were sectioned into sticks that were subjected to µTBS testing and observed under FE-SEM. Control groups (27.70 ± 7.0) showed statistically higher values than laser-irradiated groups. There were no significant differences among laser groups. Despite that, increasing the pulse frequency yielded slightly higher bond strength. Depending on laser settings, Er,Cr:YSGG laser irradiation caused interfacial gaps and resin tags with wings morphology. With the parameters used in this study, Er,Cr:YSGG laser irradiation promoted morphological changes within resin-dentin interfaces and negatively influenced the bond strength of adhesive systems.

Effect of simplified ethanol-wet bonding on dentin bonding durability of etchand-rinse adhesives.

This in vitro study evaluated the effects of simplified ethanol-wet bonding technique on dentin bonding durability of two etchand-rinse adhesives to bovine dentin. Sixteen freshly extracted bovine incisors were divided into four groups according to bonding technique (water-wet or ethanol-wet bonding) and adhesive (Single Bond 2 or Prime & Bond NT). After etching and rinsing, dentin surfaces were left either water-moist or immersed in ethanol. Following adhesive application and composite build-up, bonded teeth were sectioned into sticks for microtensile bond strength (µTBS) testing conducted after 24-h and 12-month water storage. There were no significant differences in bond strength among the groups at 24 h. At 12 months, the bond strengths of adhesives to dentin were significantly decreased (p<0.05). Simplified ethanol-wet bonding did not improve the resin-dentin bonding durability of tested etch-and-rinse adhesives.

In vitro bonding effectiveness of new self-adhering flowable composite to calcium silicate-based material.

The purpose of this study was to compare in vitro bonding effectiveness of Vertise Flow (VF), a new self-adhering flowable composite (FC), and Ultimate Flow (UF), a conventional FC, to BioAggregate (BA), and to investigate whether the use of self-etch or etch-andrinse adhesive improved the bond strength of VF to BA. Shear bond strengths of FC to BA were measured for this reason. Data were analyzed using Wilcoxon and Mann-Whitney U-tests (p=0.05). There were significant differences of bond strengths after 24- and 72-h (p<0.05, p<0.001). After 72-h, self-adhering FC may be used successfully with BA and no other adhesive, as an alternative to the combined use of conventional FC and self-etch adhesives. The use of etch-and-rinse adhesives with self-adhering FC may improve adhesion to BA.

Evaluation of the radiopacity of luting cements by digital radiography.

PURPOSE: The aim of this study was to evaluate the radiopacity of eight contemporary luting cements using direct digital radiography. MATERIALS AND METHODS: Ten specimens, (5 mm diameter, 1 mm high) were prepared for each material tested (RelyX ARC, RelyX U100, RelyX Unicem, Nexus 2, Nexus 3, Metacem, Breeze, Adhesor zinc phosphate). The specimens were stored in a moist chamber at 37°C until completely set, then radiographed using a Kodak digital sensor and an aluminum step wedge with variable thicknesses (1 to 13 mm in 1-mm increments) used for reference. A Kodak 2100 intraoral X-ray unit was operated at 60 kV, 7 mA, and 0.20 seconds. According to international standards, the radiopacity of the specimens was compared with that of the aluminum step wedge using the equal-density area tool of the Kodak Dental Imaging software (ver. 6.7). Data were analyzed by ANOVA and Tukey's test. RESULTS: Adhesor zinc phosphate cement showed the highest radiopacity of all materials and dentin. Breeze showed the lowest radiopacity (p < 0.05). No significant difference in radiopacity was observed between dentin and RelyX ARC, Nexus 2, or Metacem (p > 0.05). The radiopacities of Nexus 3 and RelyX Unicem were significantly higher than those of other resin cements and dentin (p < 0.05). CONCLUSIONS: All materials showed radiopacity above the minimum recommended by the International Organization for Standardization and the American National Standards/American Dental Association. Breeze had less radiopacity than dentin.

Use of mineral trioxide aggregate in the treatment of large periapical lesions: reports of three cases.

Pulpal and periradicular pathosis are the result of microbial, mechanical, or chemical invasion. Microorganisms are the main irritants of pulpal and periapical tissues. The goal of the obturation is to obtain a fluid-tight seal of the root canal system from its coronal aspect through its apical extent to preserve from the irritants.. Root apices have morphological irregularities in teeth with periapical lesions. Therefore, it is more difficult to produce hermetically apical stop with conventional guttapercha obturation techniques. This case report describes the treatment and six years follow-up of the teeth with large periapical lesion using MTA as apical filling material.

Effect of smear layer and root-end cavity thickness on apical sealing ability of MTA as a root-end filling material: a bacterial leakage study.

OBJECTIVE: The aim of this study was to investigate the effect of the cavity thickness and smear layer on apical sealing ability of mineral trioxide aggregate (MTA) as a root-end filling material. STUDY DESIGN: Seventy single-rooted maxillary central teeth were used in this study. All teeth were instrumented to size 50 using a step-back technique. The selected teeth were randomly divided into 4 groups, each containing 15 experimental samples and 5 positive and 5 negative control samples. In the first and second groups (smear+), the teeth were irrigated with only 5.25% NaOCl. In the third and fourth groups (smear-), the teeth were irrigated with 17% EDTA and 5.25% NaOCl to remove the smear layer. Also, in the first and third groups, cavities were prepared as 3 mm. In the second and fourth groups, cavities were prepared as 5 mm. All the root-end cavities were then filled with MTA. Nail varnish was applied to all external root surfaces to the level of the resected root-ends to prevent lateral microleakage. Samples were sterilized in an ethylene oxide sterilizer for 12 hours. The apical 3-4 mm of the roots were immersed in brain heart infusion culture medium with phenol red indicator within culture chambers. The coronal access of each specimen was inoculated every 48 hours with a suspension of Enterococcus faecalis. Bacterial leakage was monitored every 24 hours for 4 weeks. The data obtained were analyzed using a chi-squared test, with alpha = .05 as the level for statistical significance. RESULTS: There were no statistically significant differences in rate of bacterial leakage among the experimental groups at 1-4 weeks (P > .05). Also, there was no difference between the groups when the 2 thickness groups were combined (P > .05). However, there was statistically significant differences when the 2 smear groups were combined for 4-week observation periods (P < .05). Removal of the smear layer caused significantly more apical microleakage than when the smear layer was left intact for 4 weeks. CONCLUSION: The thickness of root-end cavity (3 or 5 mm) had no influence in the bacterial leakage of the root end filled with MTA. Removing the smear layer may not be necessary in root-end cavities filled with MTA.

Retreatment of a resected tooth associated with a large periradicular lesion by using a triple antibiotic paste and mineral trioxide aggregate: a case report with a thirty-month follow-up.

INTRODUCTION: Trauma to the teeth and supporting structures is a frequent problem among children. Endodontic treatment is necessary for 41.3% of traumatized teeth. Two of the most important criteria for successful endodontic treatment are the elimination of microorganisms and apical sealing. A combination of antibiotic drugs (metranidozole, ciprofloxacin, and minocycline) is used to eliminate target bacteria, which are possible sources of endodontic lesions. For cases in which apical sealing is difficult, specific materials to plug the apical region have been advocated. Mineral trioxide aggregate (MTA) has become the material of choice because it is biocompatible and has bacteriostatic action. METHODS: This case report describes the nonsurgical retreatment of a traumatized tooth that had already undergone unsuccessful apical resection associated with a large periradicular lesion. A combination of antibiotic drugs was used as an intracanal medicament, and MTA was used to obtain a hermetic seal of the lateral tooth that had undergone unsuccessful apical resection. RESULTS: On follow up, the tooth was clinically and radiographically asymptomatic for 30 months. CONCLUSIONS: The results of this case show that MTA and triple antibiotic paste can be used clinically in the treatment of an unsuccessfully resected tooth associated with a large periradicular lesion.

Shear bond strength of conventional glass ionomer cements bound to mineral trioxide aggregate.

INTRODUCTION: This study measured the shear bond strength of conventional glass ionomer cements (GICs; Ketac Molar Easymix and Fuji IX) bonded to white mineral trioxide aggregate (WMTA) that had been allowed to set for 2 different time intervals. METHODS: Forty-eight WMTA specimens were prepared; half were stored for 45 minutes, and the remaining 24 specimens were stored for 72 hours at 37 degrees C and 100% humidity. Then each group was divided into 2 subgroups of 12 specimens, and each GIC was layered on each of the 2 WMTA preparations. The GIC-WMTA shear bond strengths were measured and were compared by using one-way analysis of variance. RESULTS: The shear bond strengths with the 45-minute and 72-hour WMTAs were 8.85 and 9.16 MPa, respectively, for Ketac Molar Easymix and 9.34 and 9.96 MPa, respectively, for Fuji IX. The GIC-WMTA bond strength was not different between GIC applications to WMTA that had set for 45 minutes versus 72 hours (P >.05). CONCLUSIONS: GICs might be used over MTA after the MTA has set for 45 minutes to allow single-visit procedures.

Comparison of the sealing ability of three filling techniques in canals shaped with two different rotary systems: a bacterial leakage study.

OBJECTIVE: This study compared the sealing ability of 3 current filling techniques in root canals shaped with 2 different rotary systems. STUDY DESIGN: Eighty human extracted mandibular premolars were divided randomly into 2 similar groups of 40 each and instrumented with either ProTaper (Dentsply Maillefer, Tulsa, OK; group A) or Mtwo (VDW; Antaeos, Munich, Germany; group B) rotary systems. Each group was divided into 3 subgroups (n = 10) and 2 control groups (n = 5). Canals were filled either with the tapered single-cone technique (SC; subgroups A1 and B1), with lateral condensation (LC; subgroups A2 and B2), or warm vertical compaction (WVC; subgroups A3 and B3). AH Plus was used as a root canal sealer in all groups. Samples were sterilized in an ethylene oxide sterilizer for 12 hours. The apical 3-4 mm of the roots were immersed in brain-heart infusion culture medium with phenol red indicator within culture chambers. The coronal access of each specimen was inoculated every 48 hours with a suspension of Enterococcus faecalis. Bacterial leakage was monitored every 24 hours for 8 weeks. The data obtained were analyzed using a chi-squared test, and P was set at .05. RESULTS: In group A, 70% of the specimens filled with SC (subgroup A1), 50% of the specimens filled with LC (subgroup A2), and 20% of the specimens filled with WVC (subgroup A3) leaked. There was no statistically significant difference between the subgroups (P > .05). In group B, bacterial leakage was observed in 50% of SC samples (subgroup B1), 40% of LC samples (subgroup B2), and 50% of WVC samples (subgroup B3). There was no statistically significant difference between subgroups B1, B2, and B3 (P > .05). There was also no statistically significant difference between group A and group B (P > .05). CONCLUSION: Filling with SC, LC, and WVC techniques in canals treated with ProTaper or Mtwo rotary instruments showed similar levels of sealing efficacy.

The evaluation of the influence of using MTA in teeth with post indication on the apical sealing ability.

OBJECTIVES: The aim of this study was to evaluate the influence of using MTA in teeth with post-core indication and to compare it with the immediate or delayed post space preparation on the integrity of apical seal in teeth filled with gutta-percha and sealer. STUDY DESIGN: Fifty-one single-rooted freshly extracted human maxillary incisor teeth were selected. The crowns of the teeth were removed to a length of 14 mm and canals were prepared by using K-files with the step-back technique. The teeth were randomly divided into 3 groups of 15 specimens each. Group A was filled with gutta-percha and sealer using lateral compaction, and post space was prepared immediately using a heated instrument. Specimens in Group B were filled with the same materials as Group A and post space was prepared after 1 week with Gates-Glidden drills. Group C was filled with MTA as an apical 5-mm filling. In all groups, materials were left in the root canals at the apical 5-mm level. The remaining 6 teeth were used as controls. The microleakage values of each group were measured after 1 month, using a computerized fluid filtration method. RESULTS: The MTA (Group C) showed less microleakage than immediate and delayed post space preparation methods (Group A, B) in 1 month, and this difference was found to be statistically significant (P < .005). Additionally, no statistically significant difference was determined between Group A and Group B (P > .05). CONCLUSION: These results suggest that MTA can be used in the root canals as apical filling material in teeth with post-core indication.

Treatment of horizontal root fractures using a triple antibiotic paste and mineral trioxide aggregate: a case report.

This case report describes the treatment of a horizontal root fracture in a maxillary central incisor (tooth #8) using a triple antibiotic paste and mineral trioxide aggregate. A nonsurgical endodontic treatment was performed to a coronal root canal fragment of tooth #8. During the treatment procedure, 1% sodium hypochlorite solution was used for irrigation and a triple antibiotic paste was used as an intracanal medicament. The coronal part of the canal was obturated with mineral trioxide aggregate totally. At follow-up examination after 12 months, the tooth was asymptomatic and radiographically showed repair of the fracture region. Healing was achieved without any need for further interventions.

Treatment of horizontal root fractures using MTA as apical plug: report of 3 cases.

Root fractures are rare occurrences through all dental injuries. They comprise only 0.5% to 7.0% of traumas affecting the permanent teeth. Generally the cervical and middle thirds of the roots are affected. The healing of these lesions depends on the health of the pulp, dentine, cementum, and alveolar bone. These case reports describe the management and 2-year follow-up of 3 maxillary central incisors with horizontal root fractures treated with mineral trioxide aggregate (MTA) as apical plug.

Nonsurgical endodontic treatment of Type III dens invaginatus in maxillary canine: an 18-month follow-up.

Dens invaginatus (DI) is a developmental variation resulting from an infolding of the outer enamel surface of a tooth into the interior. The greatest difficulty in the endodontic treatment of DI is in locating the rudimentary root canal, because of the atypical internal morphologic complexity. Invagination may also restrict sufficient cleaning and shaping. This case report describes a nonsurgical root canal treatment of Type 3 DI in a maxillary canine. Despite the complex anatomy of dens invaginatus, nonsurgical endodontic treatment was performed successfully and at follow-up examination after 18 month, healing was achieved without any need for further surgical intervention.

Use of mineral trioxide aggregate in the treatment of horizontal root fractures with a 5-year follow-up: report of a case.

Root fractures are those that involve dentin, cementum, and the pulp. They occur more frequently in children than adults. This case report describes the treatment and 5-year follow-up of two maxillary central incisors with horizontal root fractures using mineral trioxide aggregate and the application of intracoronal bleaching of the discolored tooth.

Long-term evaluation of the influence of smear layer on the apical sealing ability of MTA.

The aim of this in vitro study was to investigate the effect of the smear layer on apical microleakage in teeth obturated with mineral trioxide aggregate (MTA). Fifty single-rooted central maxillary teeth were used in this study. All teeth were instrumented to size 60 by using the step-back technique. The selected teeth were randomly divided into 2 groups (n = 20). In the first group (smear [+]), the teeth were irrigated with only NaOCl (5.25%). In the second group (smear [-]), the teeth were irrigated with ethylenediaminetetraacetic acid (EDTA) (17%) and NaOCl (5.25%) to remove the smear layer. The teeth were then filled with MTA. The computerized fluid filtration method was used for evaluation of apical microleakage. The quantitative apical leakage of each tooth was measured after 2, 30, and 180 days. Statistical analysis was done with the Mann-Whitney U and Wilcoxon signed ranks tests. At the end of this study there was no difference in 2 days between the groups, but removal of the smear layer caused significantly more apical microleakage than when the smear layer was left intact for 30 and 180 days (P < .005). Within the constraints of this study it can be concluded that the apical microleakage of MTA is less when the smear layer is present than when it is absent.

Evaluation of the radiopacity of new root canal paste/sealers by digital radiography.

The aim of the present study was to assess the radiopacity of new polydimethylsiloxane-based root canal filling paste (GuttaFlow; Coltène/Whaledent, Langenau, Germany) and resin-based root canal sealer (Adseal; Meta Biomed Co, Cheongju, Korea) and compare their radiopacity with three currently used root canal sealers (AH Plus [Dentsply DeTrey GmbH, Konstanz, Germany], Epiphany [Pentron, Wallingford, CT], and Diaket [3M ESPE AG, Seefeld, Germany]) by means of direct digital radiography. Six specimens, 5 mm in diameter and 1 mm high, were performed for each material tested. After the material set, radiographs were made by using a digital sensor and a graduated aluminum stepwedge varying in thickness from 1 to 14 mm. These samples were tested according to the international standards to compare their radiodensity to that of the aluminum stepwedge. Data were analyzed using analysis of variance and Tukey tests. The millimeters of aluminum values reported in this study were 10.41, 8.20, 6.50, 4.90, and 3.09 for AH Plus, Epiphany, Diaket, GuttaFlow, and Adseal, respectively. Although the materials evaluated had different radiopacities, all of them showed radiopacity above the minimum recommended by the International Organization for Standardization and the American National Standards/American Dental Association.

Comparative study of removal of current endodontic fillings.

The aim of the present study was to assess the removability of canal fillings performed by using current methods during re-treatment with rotary instruments. Seventy-two freshly extracted human anterior teeth with single straight root canals were instrumented with Mtwo rotary files. The teeth were randomly divided into 4 obturation groups of 18 specimens each as follows: group 1, Resilon and Epiphany; group 2, GuttaFlow obturation system; group 3, EndoTwinn obturation system; group 4, gutta-percha with AH Plus sealer. The filled canals were re-treated by using Mtwo-Retreatment instruments and Mtwo instruments. The time required to remove the obturation material was recorded. After splitting the roots, the amount of residual filling material on the canal walls was imaged and measured with image analyzer software. Statistical analysis was accomplished by Kruskal-Wallis and Mann Whitney U tests for the analysis of root canal cleanliness. There was no statistically significant difference among the 4 filling techniques regarding the amount of residual material in the apical, middle, and coronal thirds and inside the whole canal area (P > .05). Regarding the mean time of re-treatment, the fillings performed by using GuttaFlow and EndoTwinn methods were removed much more quickly compared with the other 2 methods (P < .001). It was observed that the fillings performed with the above canal filling methods were removed in a similar fashion with rotary instruments during re-treatment.