Clinical comparison of silver diamine fluoride (SDF) or silver-modified atraumatic restorative technique (SMART) on hypomineralised permanent molars with initial carious lesions: 3-year results of a prospective, randomised trial.

OBJECTIVES: This study aimed to assess the clinical outcomes of utilizing silver diamine fluoride + potassium iodide (SDF + KI) treatment and Silver-Modified Atraumatic Restorative Technique (SMART/SDF + KI + Glass Ionomer Cement) over a three-year period on hypomineralised permanent molars with initial carious lesions. METHODS: 112 hypomineralised permanent molars with ICDAS 1 or 2 lesions were selected in 48 children. The teeth were randomized into SDF + KI and SMART (SDF + KI + GIC) groups (n = 56 teeth/group) in a split-mouth design. Hypersensitivity and caries development were evaluated in both groups. Schiff Cold Air Sensitivity Scale (SCASS) was used for evaluation of hypersensitivity, and the modified USPHS criteria were utilised for clinical assessments of SMART sealants at 1,6,12,18,24 and 36 months. Fisher's Exact test, Kaplan-Meier Survival Curves, Log-rank test, Mann Whitney U test, and Friedman test was performed for the statistical analysis. RESULTS: The caries preventive effect was 100 %, 67.9 % and 65.4 % for SDF + KI-treated teeth; and 100 %, 97.6 % and 94.7 % for SMART(SDF + KI + GIC)-treated teeth at 12, 24 and 36 months, respectively. The mean survival probabilities for caries-preventive effect were significantly lower in SDF + KI-treated teeth (31.01 months) than SMART-treated teeth (35.61 months), (p < 0.001). Twenty-six molars with initial hypersensitivity due to hypomineralization demonstrated a significant reduction at all evaluation periods compared to baseline SCASS scores (p < 0.001). Additionally, there was no significant difference in hypersensitivity scores between the groups during the re-call periods, and none of the teeth exhibited hypersensitivity at the 18-month and beyond evaluations. CONCLUSIONS: During the three-year assessment, both groups demonstrated effectiveness in reducing sensitivity in hypomineralised molars. However, SMART (SDF + KI + GIC) sealants offered better protection against tooth decay over time, despite experiencing gradual retention loss. CLINICAL SIGNIFICANCE: Both SMART (SDF + KI + GIC) sealants and SDF + KI proved effective in alleviating hypersensitivity in hypomineralised molars for up to three years. SMART (SDF + KI + GIC) sealants showed greater caries-preventive effect compared to SDF + KI. However, continuous long-term monitoring is crucial due to the gradual decline in retention of SMART (SDF + KI + GIC) sealants. CLINICALTRIALS REGISTRATION NUMBER: NCT03862014.

Clinical and radiographic performance of preformed zirconia crowns and stainless-steel crowns in permanent first molars: 18-month results of a prospective, randomized trial.

BACKGROUND: The treatment of young permanent first molars with extensive carious tissue loss may often require restoration with preformed crowns. This study compared the clinical and radiographic performance of stainless-steel crowns (SSCs) and preformed zirconia crowns (ZCs). METHODS: Forty-eight molar incisor hypomineralisation (MIH)- or caries-affected permanent molars in 20 healthy patients between 6-13-year-old were randomly divided into ZC and SSC groups (n = 24 teeth/group) in a split-mouth design. The oral hygiene levels of patients were assessed using Greene and Vermillion simplified oral hygiene index (OHI-S). Plaque accumulation and gingival health were evaluated using the Silness&Löe plaque index (PI) and Löe&Silness gingival index (GI), respectively. Clinical retention, marginal extension level, marginal adaptation of crowns and wear of the antagonist teeth were assessed at baseline, 1, 6, 12 and 18 months. The radiological assessments for evaluating the marginal adaptation of crowns and periapical pathology of crowned teeth were performed at 6 and 12 months. The data were analyzed using Kaplan-Meier analysis, Mann-Whitney U test, and two-way ANOVA. RESULTS: A total of forty teeth in 17 children were evaluated for 18 months. ZCs had significantly lower gingival and plaque index values than teeth restored with SSCs during all evaluation periods (p < 0.05). Neither crown type resulted in clinically-detectable wear on opposing dentition or periapical pathology. One ZC was lost at 13 months, while all SSCs survived in function clinically. The cumulative survival rates of ZCs and SSCs were 95.2% and 100% respectively. CONCLUSIONS: Both ZCs and SSCs showed high clinical retention rates in young permanent molars. ZCs had lower plaque accumulation and better gingival health than SSCs, which were consistently associated with mild gingival inflammation. CLINICAL TRIAL REGISTRATION NUMBER: NCT05049694.

Ten-year follow up of previously traumatized immature permanent incisors sustaining second and third traumatic injuries after revascularization treatment: Case reports.

The long-term prognosis of previously traumatized immature permanent teeth treated with guided endodontic repair is well documented, but little is known about how these teeth respond to further traumatic injury after treatment. This case report presents the 10-year clinical and radiographic findings of two patients with traumatized maxillary incisors who underwent guided endodontic repair treatment and sustained two further traumatic injuries. Three crown-fractured maxillary central incisors with pulp necrosis were treated with a protocol that used 2.5% NaOCl irrigation, 3-4 weeks medication with calcium hydroxide or ciprofloxacin-metronidazole paste, induction of apical bleeding, and coronal sealing with mineral trioxide aggregate. One tooth sustained subluxation and a crown fracture after 20 months and 7 years, respectively. Two other teeth had a luxation injury at 9 months and subluxation 6.5 years after the repair treatment. One subluxated and one luxated tooth remained free of symptoms for 10 years with radiographic evidence of progressive root canal calcification, while the other luxated incisor required root canal treatment after 7.5 years. Although teeth treated with the so-called "regenerative" endodontic techniques do not possess true pulp tissue, the reparative tissue may respond to traumatic injuries in a similar manner to teeth with normal pulps.

Combined conventional and regenerative treatment in molars with coexistent closed and open apices: A case series.

Regenerative endodontic treatment (RET) may not be suitable in some necrotic young permanent molars due to coexistent roots with closed and open apices, and/or inadequate apical bleeding in one or more roots. Here, we present a combined treatment approach utilising conventional root canal treatment in the closed-apex roots and RET on the open-apex roots of necrotic young molars. The closed-apex roots of 8 molars received root fillings, and their open-apex roots were treated with a regenerative endodontic procedure. In another molar, the failed RET on one root was retreated by conventional root canal filling, preserving other revitalised roots. After 4-6 years, all teeth showed periapical healing in the absence of clinical symptoms. The combined conventional and regenerative treatment approach can yield favourable healing outcomes in necrotic, young molar roots with different levels of apical closure. Likewise, failed revitalised roots can be retreated separately with conventional root filling.

Deciduous Tooth Pulp Autotransplantation for the Regenerative Endodontic Treatment of Permanent Teeth With Pulp Necrosis: A Case Series.

INTRODUCTION: In young individuals, deciduous tooth pulp might be used as a natural, biologic scaffold for the regenerative endodontic treatment (RET) of young permanent teeth with necrotic pulps and apical periodontitis. The present case series demonstrates the clinical and radiographic outcomes of a novel RET using deciduous pulp autotransplantation in traumatized, necrotic young permanent incisors. METHODS: Five previously traumatized maxillary incisors of four 8- to 11.5-year-old patients were treated with a RET protocol that used 2.5% NaOCl irrigation and placement of calcium hydroxide dressing in the first visit. After 4 weeks, the intracanal medication was removed, and the whole pulp tissue harvested from the neighboring maxillary deciduous canine was transplanted into the disinfected root canal without induced apical bleeding. Following placement of a mineral trioxide aggregate coronal barrier, the access cavities were restored with acid-etch resin composite. The root canals of donor primary canines were filled with calcium hydroxide-iodoform paste and were restored as with the permanent incisors. RESULTS: Three patients were followed-up for 24 months, and 1 patient for 12 months. All teeth demonstrated radiographic evidence of complete periapical healing, slight increase in dentinal wall thickness, and continued apical closure in the absence of clinical symptoms. A positive response to cold test was obtained in 1 incisor at 12 months and 2 at 24 months. CONCLUSIONS: Based on 12- and 24-month clinical and radiographic findings, the present cases demonstrate a favorable outcome of a RET protocol using deciduous pulp autotransplantation in young permanent incisors with pulp necrosis.

Clinical Comparison of Preformed Zirconia and Composite Strip Crowns in Primary Maxillary Incisors: 18-Month Results of a Prospective, Randomized Trial.

Purpose: The purpose of this study was to evaluate the clinical performance of composite strip crowns (SCs) and zirconia crowns (ZCs) on primary maxillary incisors affected by early childhood caries over 18 months. Methods: A total of 111 primary maxillary anterior teeth were included in 25 three-to five-year-old children. In each patient, the teeth were randomized to the SC and ZC groups (n equals 43 teeth/group) and sound teeth as the control group (n equals 25) in a split-mouth design. Patients' oral hygiene and clinical variables, including gingival health, plaque accumulation, pulpal health, secondary caries, retention, color match, and material loss, were assessed at baseline and at one, six, 12, and 18 months. Data were statistically analyzed using Fisher's exact test, the Friedman test, and the Kruskal-Wallis test. Results: Zirconia crowns had significantly lower plaque index values than strip crowns and controls during all recalls (P<0.05). The gingival index scores of both crowns improved after six months, while mild inflammation persisted in both groups due to increased exfoliation mobility. ZCs had better color match and retention (P<0.05) than SCs, with the latter being 100 percent for ZCs and 77.8 percent for SCs. Both crowns had similar and high pulp survival at 18 months (ZC equals 93.1 percent; SC equals 95.4 percent). Conclusions: Zirconia crowns had better clinical performance than composite strip crowns in terms of retention, restoration failure, and color change but similar gingival and pulpal health after 18 months. ZCs showed the lowest plaque accumulation when compared with sound teeth and SCs.

Conservative management of a cervical horizontal root fracture by long-term stabilisation: A case report.

Cervical root fractures are often more difficult to manage than fractures of the apical and middle third of the root, due to the weak chance of healing with dental hard tissue between fragments, and the likelihood of subsequent infection of the root canal system. This case report describes the management of a cervical horizontal root fracture by repositioning the coronal fragment of a maxillary central incisor, and long-term splinting using a bonded lingual orthodontic retainer wire. Throughout the 7-year stabilisation period with clinical and radiographic follow-up, the tooth has remained asymptomatic with radiographic evidence of progressive pulp canal obliteration. In applicable cases, long-term stabilisation of the fractured coronal fragment with a fixed orthodontic retainer may offer a minimally invasive solution to maintain pulp vitality, function and aesthetics until cessation of growth or until a more comprehensive, multidisciplinary approach is required.

Management of initial carious lesions of hypomineralized molars (MIH) with silver diamine fluoride or silver-modified atraumatic restorative treatment (SMART): 1-year results of a prospective, randomized clinical trial.

OBJECTIVES: This study evaluated and compared the effect of silver diamine fluoride (SDF) and silver-modified atraumatic restorative treatment (SMART) sealants for the treatment of initial carious lesions of permanent molars affected by molar incisor hypomineralization (MIH). METHODS: One hundred and twelve hypomineralized permanent molars with ICDAS 1 or 2 lesions were selected in 48 children. The teeth were randomized into SDF and SMART sealant groups (n = 56 teeth/group) in a split-mouth fashion. Hypersensitivity, formation of caries, and enamel breakdown were evaluated in both groups. Hypersensitivity was assessed by Schiff Cold Air Sensitivity Scale (SCASS), and clinical assessments of SMART sealants were performed according to modified USPHS criteria at 1, 6, and 12 months. The data were analyzed statistically using Fisher's exact test, Kaplan-Meier analysis, Mann-Whitney U test, and Friedman test. RESULTS: Twenty-six hypomineralized molars with marked baseline hypersensitivity showed significantly lower SCASS scores at all evaluation periods (p < 0.001). There was no significant difference in hypersensitivity scores between the groups at the repeated applications of SDF at 1, 6, and 12 months. The cumulative survival rates of SMART sealants on occlusal and palatal surfaces were 88.7% and 58.8%, respectively. CONCLUSIONS: In hypomineralized molars, both SDF and SMART sealants showed favorable short-term prevention against dental caries while providing effective desensitization. Marginal discoloration was the most common side effect of the SMART sealants as a result of SDF application. CLINICAL SIGNIFICANCE: Both SDF and SMART sealants showed similar short-term effectiveness as non-aerosol procedures in arresting enamel caries and reducing hypersensitivity in hypomineralized molars. TRIAL REGISTRATION: Clinical Trials Registration Number: NCT03862014.

Tooth Discoloration Induced by Different Calcium Silicate-Based Cements: A Two-Year Spectrophotometric and Photographic Evaluation in Vitro.

OBJECTIVE: Calcium silicate-based cements (CSCs) may lead to coronal staining in young permanent teeth over the time. The purpose of this study was to evaluate and compare the long-term tooth discoloration induced by different CSCs. STUDY DESIGN: Ninety freshly-extracted human molars were assigned randomly into 6 groups (n=15/group) according to the CSC used as a pulpotomy material: ProRoot MTA, MTA Angelus, NeoMTA, EndoSequence Putty, Biodentine and Negative control (No cement). The color was assessed at baseline, and thereafter at 3, 6, 12 and 24 months by using both a spectrophotometer and digital images taken with and without a cross-polarizing filter. The time-dependent changes in color (ΔE) were compared within and among groups using Analysis of Variance. RESULTS: Angelus MTA and ProRooT MTA showed severe coronal discoloration (p>0.05) starting at 3 months. ΔE values of NeoMTA, EndoSequence Bioceramic Putty and Biodentine were below the perceptibility threshold, with Biodentine showing greater ΔE values than NeoMTA and EndoSequence Putty in the absence of statistical significance (p>0.05). CONCLUSIONS: Discoloration elicited by CSCs may develop soon after placement, and continue to increase for up to two years. Angelus MTA and ProRooT MTA cannot be recommended for vital pulp therapies in the esthetic zone of young individuals.

The International Association of Dental Traumatology ToothSOS mobile app: A 2-year report.

BACKGROUND/AIM: The shift in health care and technology calls for innovation through mobile applications as free educational resources for the masses. The International Association of Dental Traumatology (IADT) created ToothSOS, an app (software application for mobile devices) to provide dental trauma information for patients and professionals. The app contains information on the emergency management and prevention of dental injuries, as well as treatment guidelines for dental practitioners. The aim of this study was to assess public utilization of the ToothSOS app in the first 2 years since its launch. METHODS: The ToothSOS app was launched by the IADT in the first week of April 2018. Data regarding the number of downloads and usage of the app in the first 2 years (from April 2018 to May 2020) were collected and analyzed. RESULTS: The total number of ToothSOS downloads over the 2 years was 47 725. The number of downloads peaked in the first month when the app was initially released. Thereafter, the number of downloads decreased to an average of 1423 ± 363 downloads every month. Europe was the territory with the greatest number of downloads followed by the United States and Canada, Asia, Latin America and the Caribbean, and Africa, the Middle East, and India. CONCLUSIONS: Within as short a period as 2 years, the ToothSOS app continues to gain public interest. Further attempts and public campaigns should be made in order to increase the visibility of the app. Dental professionals should encourage patients and communities to use the app in order to increase awareness for the prevention and proper emergency management of traumatic dental injuries.

The effect of ethanol wet bonding technique on postoperative hypersensitivity of Class II composite restorations: A randomized trial.

BACKGROUND: To evaluate the effect of Ethanol Wet Bonding Technique (EWBT) on postoperative hypersensitivity (POH) of composite restorations in premolar teeth. MATERIALS AND METHODS: In this randomized trial, 24 patients with at least three proximal carious lesions with similar axial depth and position of gingival floor in their premolars were enrolled. Following cavity preparation, the teeth were randomly assigned to one of three groups: (1) Class II resin-based composite (RBC) restoration using an etch-and-rinse adhesive + wet bonding technique (Control); (2) RBC restoration using EWBT + hydrophobic adhesive; and (3) RBC restoration using EWBT + hydrophilic adhesive. Tooth hypersensitivity was evaluated before and 1, 3, 7, 14 and 30 days after treatment according to the Visual Analog Scale. Data were analyzed statistically with Kruskal-Wallis and Friedman tests (P = 0.05). RESULTS: All teeth showed similar levels of hypersensitivity after treatment (both P > 0.05). Furthermore, there was no difference between POH levels of the test and control groups at any control period (P < 0.05). Friedman test indicated that the POH significantly reduced within time in all groups (P < 0.05). CONCLUSION: Application of ethanol-wet bonding technique, either with hydrophobic or hydrophilic adhesives did not affect the POH of Class II composite restorations in premolars.

International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations.

Traumatic dental injuries (TDIs) of permanent teeth occur frequently in children and young adults. Crown fractures and luxations of these teeth are the most commonly occurring of all dental injuries. Proper diagnosis, treatment planning, and follow up are important for achieving a favorable outcome. Guidelines should assist dentists and patients in decision making and in providing the best care possible, both effectively and efficiently. The International Association of Dental Traumatology (IADT) has developed these Guidelines as a consensus statement after a comprehensive review of the dental literature and working group discussions. Experienced researchers and clinicians from various specialties and the general dentistry community were included in the working group. In cases where the published data did not appear conclusive, recommendations were based on the consensus opinions of the working group. They were then reviewed and approved by the members of the IADT Board of Directors. These Guidelines represent the best current evidence based on literature search and expert opinion. The primary goal of these Guidelines is to delineate an approach for the immediate or urgent care of TDIs. In this first article, the IADT Guidelines cover the management of fractures and luxations of permanent teeth. The IADT does not, and cannot, guarantee favorable outcomes from adherence to the Guidelines. However, the IADT believes that their application can maximize the probability of favorable outcomes.

International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth.

Avulsion of permanent teeth is one of the most serious dental injuries. Prompt and correct emergency management is essential for attaining the best outcome after this injury. The International Association of Dental Traumatology (IADT) has developed these Guidelines as a consensus statement after a comprehensive review of the dental literature and working group discussions. It represents the current best evidence and practice based on that literature search and expert opinions. Experienced researchers and clinicians from various specialties and the general dentistry community were included in the working group. In cases where the published data did not appear conclusive, recommendations were based on consensus opinions or majority decisions of the working group. They were then reviewed and approved by the members of the IADT Board of Directors. The purpose of these Guidelines is to provide clinicians with the most widely accepted and scientifically plausible approaches for the immediate or urgent care of avulsed permanent teeth. The IADT does not, and cannot, guarantee favorable outcomes from adherence to the Guidelines. However, the IADT believes that their application can maximize the probability of favorable outcomes.

International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 3. Injuries in the primary dentition.

Traumatic injuries to the primary dentition present special problems that often require far different management when compared to that used for the permanent dentition. The International Association of Dental Traumatology (IADT) has developed these Guidelines as a consensus statement after a comprehensive review of the dental literature and working group discussions. Experienced researchers and clinicians from various specialties and the general dentistry community were included in the working group. In cases where the published data did not appear conclusive, recommendations were based on the consensus opinions or majority decisions of the working group. They were then reviewed and approved by the members of the IADT Board of Directors. The primary goal of these Guidelines is to provide clinicians with an approach for the immediate or urgent care of primary teeth injuries based on the best evidence provided by the literature and expert opinions. The IADT cannot, and does not, guarantee favorable outcomes from strict adherence to the Guidelines; however, the IADT believes their application can maximize the probability of favorable outcomes.

A micro-computed tomographic assessment of root canal preparation with conventional and different rotary files in primary teeth and young permanent teeth.

BACKGROUND: Root canals of primary teeth are commonly prepared with endodontic files that are originally manufactured for permanent teeth. AIM: This micro-computed tomography (micro-CT) study evaluated and compared the changes in root canal morphology after preparation with different conventional and rotary files in primary teeth and young permanent teeth. DESIGN: Seventy-two extracted primary and permanent molars were selected and randomly assigned to three subgroups according to the file systems used (n = 12/each). After pre-scanning of teeth with micro-CT, root canals were prepared with One Shape and Revo-S rotary systems and conventional endodontic files. After rescanning procedure, changes in canal volume, surface area, uninstrumented surface area, and apical transportation were evaluated. Mann-Whitney U test, Kruskal-Wallis test, and Conover's multiple comparison test were used for statistical analysis (P = .05). RESULTS: Instrumentation with rotary files resulted in significantly greater volume and surface area of root canals and less uninstrumented areas (P < .001) than with manual files (P < .001). Primary molars showed significantly less apical transportation than permanent teeth (P < .001). CONCLUSIONS: Preparation of canals with rotary files could be a viable alternative to conventional files in primary teeth. Regardless of the file system used, uninstrumented areas still exist in both primary teeth and permanent teeth.

Dentinal Tubule Penetration and Retreatability of a Calcium Silicate-based Sealer Tested in Bulk or with Different Main Core Material.

INTRODUCTION: The aim of this study was 2-fold: to evaluate the penetration of a tricalcium silicate-based endodontic sealer (EndoSequence BC Sealer; Brasseler USA, Savannah, GA) into dentinal tubules without a core material (sealer) or with .02 or .04 tapered bioceramic gutta-percha points and to compare the time required to remove the root fillings . METHODS: Roots of extracted human mandibular incisors (N = 60) were prepared with 0.04 taper nickel-titanium rotary files to #35 and randomly assigned into 3 groups (n = 10/group) according to the obturation method used: 1. obturating with sealer only, 2. sealer + .02 point, and 3. sealer + .04 point. The sealer was labeled with rhodamine B for analyzing dentinal tubule penetration under a confocal laser scanning microscope. The remaining specimens (n = 30) were used to measure the time for removal of the root canal fillings with retreatment files. The data were analyzed using 1-way analysis of variance and post hoc Games-Howell tests for dentinal tubule penetration and the Kruskal-Wallis test for retreatment time. RESULTS: Significantly greater sealer penetration and sealer-penetrated area was achieved when the sealer was used with a .04 gutta point (P < .05), whereas there was no difference between the sealer and .02 gutta point groups (P > .05). All test groups showed a similar depth of sealer penetration (P > .05). Groups with the gutta-percha points required a similar time to remove root filling (P > .05), whereas the working length could not be achieved in the sealer group. CONCLUSIONS: The use of a matched-taper bioceramic gutta-percha point enhanced the dentinal tubule penetration of the tested tricalcium silicate-based sealer. The use of a core material in conjunction with sealer facilitates removal of the root filling to the working length.

Effect of Light Cure Methods for Intermediate Adhesive Layer on Microleakage of Sealants. An in Vitro Study.

Background: The objective of this study was to determine the effect of an adhesive layer and its photopolymerization on the microleakage of sealants. Study design: 0.5mm-deep standardized fissurectomies were performed on extracted molars (n = 72). Teeth were randomly assigned to 3 different sealant materials (n = 24/group). Teeth were further divided to receive sealants with or without an adhesive layer. Each sealant with adhesive was also divided into two groups: adhesive was light-cured separately or light cured together with the sealant. Following thermocycling, microleakage was assessed using dye penetration and image analysis. Data was analyzed using ANOVA and Tukey's studentized ranged HSD tests. Results: Microleakage was not affected by type of sealant material (p>0.05) but was significantly influenced by application (p<0.05). Overall, placement of sealants without adhesive displayed greater microleakage than sealants with uncured adhesive (p<0.05). Within individual sealant types, this difference was only significant for Ultraseal XT (p<0.05). Sealants bonded with and without prior light curing did not show a significant difference in levels of leakage (Tukey's Studentized Range Test, p>0.05). Conclusion: An adhesive layer should be placed beneath sealants, but whether it should be light cured or left uncured before sealant placement varies by the sealant type.

Evaluation of Blood Clot, Platelet-rich Plasma, Platelet-rich Fibrin, and Platelet Pellet as Scaffolds in Regenerative Endodontic Treatment: A Prospective Randomized Trial.

INTRODUCTION: Regenerative endodontic procedures (REPs) using autologous platelet concentrates as scaffolds can improve the biologic outcome of treatment. This prospective, randomized trial compared the clinical and radiographic performance of REPs using platelet-rich plasma (PRP), platelet-rich fibrin (PRF), a platelet pellet (PP), and an induced blot clot (BC). METHODS: Sixty-seven healthy children (aged 8-11 years) with 88 immature necrotic incisors were included. After the root canal disinfection step, the teeth were randomly assigned into 1 of the following groups (n = 22/group) according to the scaffold used: PRP, PRF, PP, and BC. In the PRP, PRF, and PP groups, the platelet concentrates were introduced into the root canal without prior induction of apical bleeding. Treatment outcomes were assessed using a combined clinical and radiographic scoring system, whereas the changes in root dimensions were compared using linear measurements of root length and width with ImageJ (National Institutes of Health, Bethesda, MD) and Turboreg (Biomedical Imaging Group, Swiss Federal Institute of Technology, Lausanne, Switzerland) and planar measurements using the radiographic root area (RRA) and radiographic canal area (RCA) techniques. One-way analysis of variance, the Duncan multiple range test, the Kruskal-Wallis test, the Mann-Whitney U test, and chi-square dependency tests were used for statistical analysis of data (all P = .05). RESULTS: Except for 2 teeth in the PRF and BC groups, all teeth showed similar and high success scores (periapical healing, radiographic root development, and positive response to sensitivity tests) after an average follow-up time of 28.25 ± 1.2 months. Of all teeth, 73.9% showed complete apical closure with similar closure rates among groups (P > .05) and a greater tendency for conical-shaped apical closure than a blunt apex. Although linear measurements indicated a similar increase in root length and width among all groups (P > .05), the RRA of the BC group was significantly greater than those of the PRF and PP groups, and the RCA of the BC group was significantly greater than PRP, PRF, and PP (all P < .05) when the follow-up time was not used as a factor. Eighty-six percent of the teeth showed a positive response to sensitivity tests with similar initial response times (P > .05). CONCLUSIONS: PRP, PRF, and PP can yield similar clinical and radiographic outcomes to BC without the need for prior apical bleeding and with significantly less tendency for root canal obliteration. RRA and RCA may reveal minor differences that cannot be determined by linear measurements.

Effect of phytic acid on the setting times and tensile strengths of calcium silicate-based cements.

This study aimed to evaluate and compare the effect of 1% phytic acid as a mixing medium on the setting times and diametral tensile strengths of different calcium silicate-based cements. Specimens for four experimental groups (n = 20/each) were fabricated by mixing ProRoot MTA® (Dentsply) and Biodentine® (Septodont) powders with their original liquids or with 1% phytic acid. Half of the samples in each group were immediately subjected to setting time tests, whereas the remaining half was subjected to the diametral tensile strength test after 3 weeks. When mixed with their original liquids, the setting time of MTA was significantly longer than that of Biodentine® (P < 0.05). When mixed with phytic acid, the initial and final setting times of both test materials significantly decreased (P < 0.05). The diametral tensile strength of Biodentine® was significantly greater than that of MTA (P < 0.05). However, phytic acid had no effect on this outcome (P > 0.05).