Evaluation of ozonized calcium hydroxide as an effective intracanal medicament during root canal procedures: an in vitro observational study.

Achieving thorough disinfection is regarded as one of the pillars in endodontics. Although calcium hydroxide (CH) is one of the routinely used intracanal medicament in endodontics; alternative approaches are gaining popularity to mitigate endodontic pathology. However, CH has to be tested for its dissociation which is a rate-limiting attribute essential for its therapeutic action. The dissociation of CH into OH- and Ca2+ depends on the vehicle used to prepare the paste. This in-vitro study evaluated the use of ozonized olive oil in facilitating calcium ion release and change in pH when combined with CH. Fifty single rooted extracted human mandibular premolars were instrumented with NiTi rotary files (40/6). The teeth were divided into two groups (n = 25 per group) on the basis of vehicle: olive oil (CH + olive oil) and ozonized olive oil (CH + ozonized olive oil) groups. Both olive and ozonized olive oil vehicles allowed the diffusion of ions. However, pastes prepared with ozonized oil showed more ion diffusion, with marked calcium ion release after 15 days and alkalinity was maintained for complete period of 15 days, depicting better support for CH action. The change in calcium ion release and alkalinity were statistically significant in ozonized oil vehicle compared to olive oil vehicle. The present in-vitro study supports the use of ozonized olive oil as a vehicle to be used with CH as an intracanal medicament, considering its anti-microbial potential and sustainable release of calcium ions. The study was approved by the Institutional Ethical Committee of Manubhai Patel Dental College (approval No. MPDC_130/CONS-25/17) on June 4, 2018.

Combined effects of calcium hydroxide and photobiomodulation therapy on apexogenesis of immature permanent teeth in dogs.

Treatment of high-risk traumatic immature teeth due to incomplete root development is challenging. Apexogenesis is currently the ideal treatment option that allows normal root development. The purpose of this study was to evaluate the apexogenesis process of immature permanent teeth of dogs when co-administered with calcium hydroxide and photobiomodulation therapy (PBMT). A total of 36 immature permanent anterior and premolar teeth were selected from three 4-6-month-old dogs of Iranian mixed generation. The teeth were categorized into two groups, calcium hydroxide with laser irradiation (CHL) and calcium hydroxide without laser irradiation (CH). All the selected teeth received calcium hydroxide pulpotomy. After restoring teeth with amalgam, the CHL group received gallium­aluminum-arsenide (GaAlAs) diode laser (810 nm, 4.2 J/cm2, 0.3 W, 9 s,CW) on apical one-third of both buccal and lingual roots. The irradiation was repeated every 48 h for fourteen days. Intravenous tetracycline was used to observe newly formed dentin in the first, third, seventh, and fourteenth days. The distance between tetracycline lines (DTL) was examined by Fluorescence microscopy. Generalized estimating equations (GEE) were used for data analysis. In all assessments, the mean DTL were greater in the CHL group. However, the two groups had no significant differences in the amount of deposited dentin between the first and third, third and seventh, and first and seventh lines. Meanwhile, there was a significant difference between the two groups in terms of the distances between lines 7 and 14, 1 and 14 and also 3 to 14 (P < .001). In other words, from the 7th day onwards, there was a significant difference between the two groups. Within the limitation of this study, the combination therapy of PBMT and pulpotomy with calcium hydroxide accelerated apexogenesis in immature permanent dogs' teeth.

Influence of Intracanal Materials in Vertical Root Fracture Pathway Detection with Cone-beam Computed Tomography.

INTRODUCTION: Investigating the vertical root fracture (VRF) pathway under different clinical scenarios may help to diagnose this condition properly. We aimed to determine the capability and intrareliability of VRF pathway detection through cone-beam computed tomographic (CBCT) imaging as well as analyze the influence of different intracanal and crown materials. METHODS: VRFs were mechanically induced in 30 teeth, and 4 clinical situations were reproduced in vitro: no filling, gutta-percha, post, and metal crown. A Prexion (San Mateo, CA) 3-dimensional tomographic device was used to generate 104 CBCT scans. The VRF pathway was determined by using landmarks in the Avizo software (Version 8.1; FEI Visualization Sciences Group, Burlington, MA) by 1 observer repeated 3 times. Analysis of variance and post hoc tests were applied to compare groups. RESULTS: Intrareliability demonstrated an excellent agreement (intraclass correlation coefficient mean = 0.93). Descriptive analysis showed that the fracture line measurement was smaller in the post and metal crown groups than in the no-filling and gutta-percha groups. The 1-way analysis of variance test found statistically significant differences among the groups measurements. The Bonferroni correction showed statistically significant differences related to the no-filling and gutta-percha groups versus the post and metal crown groups. CONCLUSIONS: The VRF pathway can be accurately detected in a nonfilled tooth using limited field of view CBCT imaging. The presence of gutta-percha generated a low beam hardening artifact that did not hinder the VRF extent. The presence of an intracanal gold post made the fracture line appear smaller than it really was in the sagittal images; in the axial images, a VRF was only detected when the apical third was involved. The presence of a metal crown did not generate additional artifacts on the root surface compared to the intracanal gold post by itself.

Dentinal Tubule Penetration of a Calcium Silicate-based Root Canal Sealer with Different Obturation Methods.

INTRODUCTION: The purpose of this study was to investigate the depths of penetration of a calcium silicate-based sealer in dentinal tubules by using 3 different obturation methods. METHODS: One hundred extracted human permanent anterior teeth were endodontically prepared and divided equally into 3 experimental groups and 1 control group as follows: CPoint single cone (CPSC), gutta-percha single cone (GPSC), gutta-percha vertical condensation (GPVC), all with a calcium silicate-based sealer and calcium indicator Fluo-3, and CPoint single cone with a calcium indicator Fluo-3 (CPF3) without sealer as the control. The roots of the teeth in each group were axially cross-sectioned, and the surfaces were examined under confocal laser scanning microscopy at ×10 and ×20 magnifications. The sealer penetration depths were measured at their maximum depths and at 4 circumferential depths (12, 3, 6, and 9 o'clock) by using fluorescence. RESULTS: Statistical analyses by using one-way analysis of variance and repeated measures analysis with linear mixed models showed no statistically significant difference among the mean maximum depth measurements (CPSC, 283.83 µm; GPSC, 318.66 µm; and GPVC, 313.03 µm; P = .7553) and among the average depths across all points (CPSC, 111.24 µm; GPSC, 135.38 µm; and GPVC, 126.62 µm; P = .5304) for the 3 experimental groups. CONCLUSIONS: The pressure derived from hygroscopic expansion of CPoint or warm vertical condensation did not enhance penetration depths of the calcium silicate-based sealer. Sealer penetration into the dentinal tubules occurred independent of the obturation technique.

Persistence of epoxy-based sealer residues in dentin treated with different chemical removal protocols.

The presence of residual endodontic sealer in the pulp chamber may cause discoloration of the dental crown and interfere with the adhesion of restorative materials. The aim of this study was to compare the efficacy of different solvents in removing residues of an epoxy resin-based sealer (AH Plus) from the dentin walls of the pulp chamber, by scanning electron microscopy (SEM). Forty-four bovine incisor dental crown fragments were treated with 17% EDTA and 2.5% NaOCl. Specimens received a coating of AH Plus and were left undisturbed for 5 min. Then, specimens were divided in four groups (n = 10) and cleaned with one of the following solutions: isopropyl alcohol, 95% ethanol, acetone solution, or amyl acetate solution. Negative controls (n = 2) did not receive AH Plus, while in positive controls (n = 2) the sealer was not removed. AH Plus removal was evaluated by SEM, and a score system was applied. Data were analyzed by Kruskal-Wallis and Dunn tests. None of the solutions tested was able to completely remove AH Plus from the dentin of the pulp chamber. Amyl acetate performed better than 95% ethanol and isopropyl alcohol (p < 0.05), but not better than acetone (p > 0.05) in removing the sealer from dentin. No significant differences were observed between acetone, 95% ethanol, and isopropyl alcohol (p > 0.05). It was concluded that amyl acetate and acetone may be good options for cleaning the pulp chamber after obturation with AH Plus.

Bioactivity of EndoSequence root repair material and bioaggregate.

AIM: To evaluate the bioactivity of Bioaggregate (BA), EndoSequence Root Repair Material (ERRM), and white ProRoot Mineral trioxide aggregate (MTA). METHODOLOGY: Sixty horizontal root sections with standardized canal spaces were divided randomly into 3 groups (n = 20) and filled with white ProRoot MTA (groups 1 and 2), BA (groups 3 and 4) or ERRM putty (groups 5 and 6). The specimens of groups 1, 3 and 5 (each of 10) were immersed in phosphate-buffered saline (PBS) for 1 week and those of groups 2, 4 and 6 (each of 10) for 2 months. After the experimental periods, the specimens were processed for scanning electron microscopy (SEM) observations. Precipitation of apatite crystals on the surfaces of the cements and/or at the dentine-cement interface was evaluated and analysed elementally by energy dispersive X-ray (EDX) instrument. RESULTS: Analysis of specimens revealed various surface morphologies that were dependent on the material and immersion time in PBS. The formation of precipitates was observed on the surfaces of all materials at 1 week, which increased substantially over time. After 2 months, the surface of the cements was changed dramatically and consisted of a substantially greater amount of apatite aggregates. Interfacial layers in some areas of the dentine-cement interface were found only following 2 months of immersion. Precipitates on MTA revealed high peaks of Ca, Si and O after 1 week of immersion; after 2 months, high peaks of Ca, P and O were present. Precipitates on BA and ERRM displayed high Ca, P O peaks after both 1 week and 2 months. CONCLUSION: Exposure of MTA, BA and ERRM to PBS resulted in precipitation of apatite crystalline structures that increased over time. This suggests that the tested materials are bioactive.

Effect of disinfectant solutions on gutta-percha and resilon cones.

The aim of this study was to evaluate the effects of the 5.25% sodium hypochlorite (NaOCl), 2% chlorhexidine (CHX), and MTAD solutions on the surface of gutta-percha and Resilon cones by using atomic force microscopy (AFM). Accessory cones were washed and dried. The cones were randomly divided into six groups: gutta-percha immersed in NaOCl, CHX, and MTAD, and Resilon immersed in NaOCl, CHX, and MTAD. AFM images of the same area were made in different periods of time. JPK™ Image Processing Software was used to evaluate the images. The parameters used to evaluate the changes were RMS and line profiles. No statistically significant change was observed in the RMS values. The line profiles detected changes only for gutta-percha surfaces after immersion in NaOCl and MTAD solutions. In conclusion, 5.25% NaOCl and MTAD are associated with local changes in surface roughness of gutta-percha cones. No change was observed when 2% CHX was used. The use of all tested solutions did not produce any changes on Resilon surface.

Mineral trioxide aggregate induces bone morphogenetic protein-2 expression and calcification in human periodontal ligament cells.

INTRODUCTION: Mineral trioxide aggregate (MTA) is a therapeutic, endodontic repair material that is reported to exhibit calcified tissue-conductive activity although the mechanisms remain unclear. We hypothesize that the dissolution of calcium from MTA into the surrounding environment may play an important role in the osteoblastic/cementoblastic differentiation of human periodontal ligament cells (HPLCs). METHODS: Two populations of HPLCs were obtained from two patients, respectively, and were cultured in the presence or absence of MTA discs and/or CaCl(2) in order to investigate calcium release, calcification activity, calcium-sensing receptor (CaSR) gene expression and bone morphogenetic protein-2 (BMP-2), and BMP-2 receptor protein and gene expression. RESULTS: MTA released a substantial accumulation of calcium (4 mmol/L) within 14 days into culture media. After 4 weeks, the two populations of HPLCs independently exhibited calcification as well as BMP-2 distribution in the vicinity of MTA. HPLCs inherently expressed genes encoding for the CaSR and BMP-2 receptors. Exogenous CaCl(2) media supplementation induced CaSR gene expression in HPLCs and calcification and BMP-2 synthesis throughout the entire HPLC cultures, whereas MgCl(2) had no effect. Both MTA and CaCl(2) stimulated BMP-2 gene expression above that of baseline levels. CONCLUSION: Here we show the first report showing that HPLCs cocultured directly with MTA up-regulated BMP2 expression and calcification. These results may be through CaSR interactions that were potentially activated by the release of calcium from MTA into the culture environment.

Innovative silicate-based cements for endodontics: a study of osteoblast-like cell response.

Silicate-based filling materials were designed to obtain new endodontic sealers and root-end filling materials with adequate workability and consistency. Four different formulations (TC, TC 1%, TCf 1%, and TCf) were prepared incorporating calcium chloride as accelerant agent. A plasticizing compound (phyllosilicate) was added to TC 1% and TCf 1%. TC and TC 1% were prepared with water, whereas TCf and TCf 1% were mixed with a latex polymer as fluidizing agent. The aim of this study was to assess the in vitro biological compatibility of designed materials. White-MTA and AH Plus were tested as reference materials. Human osteoblast-like Saos-2 cells were challenged in short-term cultures (72 h) with solid materials and with material extracts in culture medium, and cell viability and number, cellular adhesion, and morphology were assessed. The new cements exerted no acute toxicity in the assay systems. Saos-2 like cells adhered and proliferated on solid samples of the experimental cements and MTA whilst AH Plus did not allowed cell growth. The extracts from the latex-containing cements showed some toxicity. By SEM analysis, osteoblast-like cells appeared adherent and spread on the new materials, and showed the maintenance of polygonal osteoblastic phenotype. Similar morphology was observed for cells on MTA, whereas only few cells were noted on the AH Plus surface. In conclusion, the new materials proved non toxic and supported the growth of bone-like cells, and resulted suitable to be used as endodontic sealers and root-end filling materials.

Susceptibility of a polycaprolactone-based root canal filling material to degradation. II. Gravimetric evaluation of enzymatic hydrolysis.

Polycaprolactone is susceptible to enzymatic biodegradation via ester bond cleavage. This study examined the susceptibility of Resilon, a polycaprolactone-based root filling material to enzymatic hydrolysis. Resilon, gutta-percha, and polycaprolactone disks, prepared by compression molding, were incubated in phosphate-buffered saline, lipase PS or cholesterol esterase at 37 degrees C for 96 h. They were retrieved at different time intervals for gravimetric analysis and scanning electron microscopy. The materials exhibited slight weight gains when incubated in phosphate-buffered saline that can be attributed to water sorption. Gutta-percha showed similar weight gains in the two enzymes. Conversely, Resilon and polycaprolactone exhibited extensive surface thinning and weight losses after incubation in lipase PS and cholesterol esterase. Glass filler particles in Resilon were exposed following surface dissolution of the polymer matrix, creating rough surface topography. Biodegradation of Resilon by bacterial and salivary enzymes warrants further investigation of their activities using cultures of endodontically relevant microbes and human saliva extracts.

Biocompatibility of human osteosarcoma cells to root end filling materials.

Ideal root end filling materials should have good physical and chemical properties, and the most important is that the material should be biocompatible with periradicular tissue. The biocompatibility of three root end filling materials, mineral trioxide aggregate, calcium hydroxide-based cement, and eugenol-based cement, were investigated in vitro by culturing extracts of these materials with human osteogenic sarcoma cells (U2OS). Extracts of each of the materials were made after incubation of the materials for 1 day and 1 week with complete McCoy's medium. The extracts were serially diluted and then incubated with U2OS cells for 24 and 48 h. Cell survival rates were assessed by means of a viability assay for mitochondrial dehydrogenase activity. Differences in mean cell survival rates were statistically assessed using one-way ANOVA. Results showed that the survival rates of U2OS cells were largest with mineral trioxide aggregate, followed by calcium hydroxide-based cement and eugenol-based cement at 24- and 48-h exposures using the 1-day and 1-week extracts. The duration of root end filling material extraction time and treatment time showed variable influence on the survival rates. The results suggest that mineral trioxide aggregate is more biocompatible than the other root end filling materials and is suitable for use in the clinical setting.

pH values of pulp-capping agents.

Calcium hydroxide has been used extensively in dentistry. Few investigators have reported the pH values of pulp-capping agents containing calcium hydroxide. The purpose of this study was to evaluate pH levels of eight pulp capping agents containing calcium hydroxide. The results indicate that the pH values of five capping agents tested are neutralized by the dentin wall, but that three of these capping agents are not neutralized.