Comparison of bioceramic and epoxy resin sealers in terms of marginal adaptation and tubular penetration depth with different obturation techniques in premolar teeth: A scanning electron microscope and confocal laser scanning microscopy study.

Introduction and Objective: The proper performance of a sealer in root canal treatment depends on its physical properties. The aim of this study was to investigate the effect of two bioceramic and epoxy resin sealers in terms of marginal adaptation and tubular penetration depth in different obturation methods of human premolar teeth. Materials and Methods: A total of 82 premolar teeth extracted due to caries and gum disease were used in the present in vitro experimental study. Two types of sealers, epoxy resin (AH-Plus, Dentsply, Germany) and bioceramic (Endosequence BC sealer, Brasseler, Savannah, GA, USA), were used in this research. Lateral compaction and single-cone techniques were used for filling the teeth. Marginal adaptation and tubular penetration depth were measured by scanning electron microscopy (SEM) and confocal laser scanning microscope (CLSM), respectively. Statistical analysis of data was performed by repeated-measures ANOVA. The significance level was considered as P < 0.05. Results: The marginal adaptation and tubular penetration depth in all three coronal, middle, and apical regions were better in bioceramic sealer (P < 0.001). The marginal adaptation and tubular penetration depth in all regions were not affected by the filling method and the interaction between the sealer type and the obturation technique. Conclusion: Based on the results of this study, the use of bioceramic sealer caused better depth of tubular penetration and marginal adaptation compared to epoxy resin. Further studies and the use of different filling techniques are necessary to achieve a three-dimensional sealing in curved root canals.

An in Vitro Comparison of Coronal Discolouration Caused by White Mineral Trioxide Aggregate, Theracal, Calcium-Enriched Mixture and Biodentine.

OBJECTIVE: The use of calcium silicate-based cements has greatly increased in the past decade. This study compared coronal discolouration caused by white mineral trioxide aggregate (MTA), TheraCal (TC), calcium enriched mixture (CEM), and Biodentine (BD) on bovine enamel-dentin block. METHODS: In this in vitro, experimental study, enamel-dentin blocks (7x7x3.5 mm) were cut out of 60 extracted sound bovine central incisors. A cavity (2.5 mm diameter and 1 mm depth) was created at the center of each block with 1 mm distance from the labial surface. The blocks were randomly divided into four experimental groups (n=12) of MTA, CEM, BD, and TC and two groups of positive (blood) and negative (empty) controls. After filling cavities with experimental materials, the surfaces of the materials were covered with composite resin. The colour parameters were measured using a spectrophotometer, before (T0) and 1 week (T1), 1 month (T2), and 6 months (T3) after the application of the materials. The data was analysed using repeated measures ANOVA and the Kruskal-Wallis test. RESULTS: At 1 week and 1 month, a significant difference in ∆E was noted in the control groups compared to the experimental groups (P<0.001). The difference among the four cements was not significant (P=0.06) at 1 week but it was significant at 1 month. TC showed greater ∆E whereas BD showed lower ∆E in the six-month period (P<0.001). Colour change was significant over time in the MTA and TC groups (P<0.05). CONCLUSION: TheraCal caused greater discolouration in the bovine tooth blocks after 6 months, which may make it inappropriate for application in the aesthetic zone.

Effect of low-level laser therapy on postoperative pain after single-visit root canal retreatment of mandibular molars: A randomized controlled clinical trial.

AIM: To compare the effect of low-level laser therapy (LLLT) on postoperative pain after single-visit root canal retreatment on mandibular molars. METHODOLOGY: This randomized controlled clinical trial included 36 patients referred to the Department of Endodontics, Islamic Azad University, Tehran, Iran. Healthy patients who required root canal retreatment on symptomatic first or second mandibular molars, with a PAI index score of 2 or 3, preoperative tooth and percussion pain of <56 mm on a 170-mm visual analogue scale (VAS) were included. After local anaesthesia using inferior alveolar nerve block followed by rubber dam isolation and access cavity preparation, the D RaCe retreatment system was used to remove the existing root filling material, and after canal negotiation and gaining patency, working length was determined with an apex locator. Further canal enlargement was carried out with size 35, 0.04 taper, and size 40, 0.04 taper RaCe rotary instruments and then canals were filled using laterally compacted gutta-percha points and AH Plus sealer. The patients were randomly assigned to treatment groups: In the LLLT group, a 980-nm diode laser set at 6.89 W/cm2 energy density, 0.5 W power, and a tip diameter of 10 mm were activated from the buccal side on the mesial and distal root apices for 15 s. In the sham group, the laser handpiece was placed inside the patient's mouth at the same location, but the laser was not activated. Then patients were instructed to record their postoperative pain levels at 4, 8, 12 and 24 h and 2, 3 and 7 days after treatment on separate VAS scales. For data analysis, the independent sample t and the Mann-Whitney U tests were used. Nominal variables were analysed by using the chi-square test. RESULTS: In the LLLT group, the most intense pain was reported 24 and 48 h post-treatment [mean (SD) = 0.22 (0.54) for both], whereas in the sham group, the most intense pain level was observed 4 h post-treatment [mean (SD) = 0.78 (0.80)]. At the 4-h interval, pain intensity was significantly lower in the LLLT group (p = .016). CONCLUSIONS: Low-level laser therapy reduced postoperative pain after single-visit root canal retreatment of mandibular molars only four hours following the procedure.

In Vitro Comparison of Pushout Bond Strength of ProRoot MTA, Biodentine and TheraCal.

BACKGROUND: One problem encountered in vital pulp therapy is the dislodgment of biomaterial as the result of the application of mechanical condensation forces for the final restoration of the cavity or occlusal loads. MATERIAL AND METHODS: In this in vitro, experimental study, 90 dentin discs were prepared with Gates Glidden drills to have a 1.3 mm canal diameter. The specimens were divided into nine groups (n=10). ProRoot MTA, Biodentine, and TheraCal were applied in groups 1-3, 4-6, and 7-9, respectively. The PBS was measured after 15 minutes, four hours, and three days and mode of failure was determined. RESULTS: The interaction effect of time and material on PBS was statistically significant (P<0.003). The PBS of Biodentine and ProRoot MTA significantly increased over time (P=0.000). At 15 minutes and four hours, the PBS of TheraCal was higher than that of Biodentine and ProRoot MTA (P=0.000). Our results showed the predominant type of bond failures in Biodentine and Theracal groups was cohesive, whereas it was adhesive for ProRootMTA. CONCLUSIONS: Theracal showed higher values of bond strength than Biodentine and ProRootMTA at 15 minutes & four hours and may thus be better options for single session of VPT. Key words:Biodentine, Mineral Trioxide Aggregate, Pushout Bond Strength, TheraCal.

In vitro effect of XP-Endo finisher on the amount of residual debris and smear layer on the root canal walls.

BACKGROUND: A successful endodontic treatment depends on efficient cleaning and shaping and effective irrigation of root canals. The irrigating solution may not be effective in some areas in the canal. The manufacturer of XP-Endo finisher claims that it can effectively clean the root canals with complex morphology. This study aimed to assess the effect of XP-Endo finisher on the amount of residual debris and smear layer on the root canal walls of mandibular second premolars. MATERIALS AND METHODS: In this In vitro study Fifty extracted mandibular second premolars with a root curvature <20° were collected. Root canals were prepared using BioRaCe rotary system. The root canals were in contact with the file and different irrigating solutions for 1 min. The teeth were then randomly divided into four experimental (n = 10) and one positive control group as follows: (1) XPF + saline, (2) XPF + ethylenediaminetetraacetic acid (EDTA), (3) XPF + sodium hypochlorite (NaOCl), (4) XPF + EDTA + NaOCl and (control) EDTA + NaOCl. The teeth were longitudinally sectioned into two halves and the amount of debris and smear layer remaining in the coronal, middle, and apical thirds of the roots was quantified and scored under an electron microscope. The Kruskal-Wallis test was used to compare the groups, and P < 0.05 was considered statistically significant. RESULTS: The highest mean amount of residual debris (2.9 ± 1.13) was noted in XPF + saline group (P < 0.05). XPF + saline and XPF + NaOCl (3.8 ± 0.60) had the lowest efficacy for smear layer removal (P < 0.05) with no significant within-group difference. No significant difference was noted between Groups 2, 3, and 4 with the positive control group regarding debris removal. Groups 2 and 4 had no significant difference with the positive control group regarding smear layer removal. CONCLUSION: Use of XP-Endo finisher has no superiority to the standard protocol for the use of irrigating solutions (EDTA + NaOCl) for debris and smear layer removal, but in some cases, such as second appointment of regeneration treatment we cannot use NaOCl because of its destructive effects on stem cells; thus, we can benefit from the synergistic effects of XPF and EDTA for better smear layer removal.

The Effects of Three Bleaching Agents on Tooth Discoloration Caused by Mineral Trioxide Aggregate.

Introduction: Successful outcome of pulp capping treatment using mineral trioxide aggregate (MTA), often leads to tooth discoloration. This study aimed to compare the efficacy of external bleaching technique with three bleaching agents naming hydrogen peroxide, carbamide peroxide and sodium perborate for correction of tooth discoloration caused by MTA. Methods and Materials: This in vitro, experimental study used 36 tooth blocks prepared from 12 bovine central incisors. White ProRoot MTA was applied in cavities; drilled in blocks for 40 days to cause discoloration. Then, the blocks were assigned to three experimental groups (n=12). Following application of hydrogen peroxide, carbamide peroxide and sodium perborate, the color parameters were determined at baseline and at 1, 7 and 14 days, using a spectrophotometer. Data were analyzed using repeated measure ANOVA and Tukey's test. Results: No significant difference was noted in color change (∆E) immediately after bleaching with hydrogen peroxide and carbamide peroxide (P>0.05). However, these two groups had significant differences in ∆E with the sodium perborate group (P=0.001). Hydrogen peroxide group showed significantly higher ∆E at 1 week compared with other groups (P=0.01). The three groups were significantly different in ∆E at 2 weeks after bleaching (P=0.001). Pairwise comparisons revealed no significant difference between sodium perborate and carbamide peroxide in ∆E but they both had a significant difference with hydrogen peroxide (P=0.01). Conclusion: The three bleaching agents bleached the discoloured teeth effectively. Hydrogen peroxide had the highest efficacy whilst sodium perborate and carbamide peroxide had lower but similar efficacy.

Dental Pulp Response to RetroMTA after Partial Pulpotomy in Permanent Human Teeth.

INTRODUCTION: A lack of information exists regarding the efficacy of RetroMTA (BioMTA, Seoul, Korea) directly applied on the pulp in vital pulp therapy. This study was designed to examine the clinical efficacy of RetroMTA compared with ProRoot mineral trioxide aggregate (MTA) (Dentsply Tulsa Dental, Tulsa, OK) for partial pulpotomy. METHODS: Partial pulpotomy was performed in 22 healthy human maxillary and mandibular third molars planned for extraction. The teeth were randomly divided into 2 groups (n = 11) and underwent partial pulpotomy with RetroMTA and ProRoot MTA as the control. The teeth were then restored with glass ionomer cement. Clinical and electric pulp tests were performed after 1 and 8 weeks. The teeth were radiographed and extracted at 8 weeks. Histologic sections were prepared and analyzed for pulp inflammation and dentinal bridge formation. Data were analyzed using the Mann-Whitney U test. RESULTS: Clinical examination after 1 and 8 weeks showed no sensitivity to heat, cold, or palpation in the ProRoot MTA and RetroMTA groups. Periapical radiographs taken before the extraction of teeth showed no evidence of periapical pathology. Electric pulp testing revealed no sensitivity. Data comparisons using the Mann-Whitney U test showed no significant difference between the materials with regard to the pulp inflammation type, intensity and extension (P = .3), or bridge continuity (P = .12). However, these data revealed a significant difference between the 2 materials in pulp morphology (P < .05) and bridge thickness (P < .01). CONCLUSIONS: This is the first work to evaluate a RetroMTA histologic outcome in partial pulpotomy in human permanent teeth. It shows pulp disorganization, an absence of inflammation, and discontinuous mineralization, which may represent a potential drawback with RetroMTA in this indication.

In Vitro Comparison of Cytotoxicity and Genotoxicity of Three Vital Pulp Capping Materials.

INTRODUCTION: Direct pulp capping (DPC) is a treatment for maintaining pulp vitality and its biological function. Ideally, pulp capping agents are expected to induce pulp cells to form hard tissue. This in vitro study assessed the cytotoxicity and genotoxicity of three vital pulp capping (VPC) agents naming Biodentine (Septodont, Saint-Maur-des-Fosses, France), mineral trioxide aggregate (ProRoot MTA; Dentsply, Tulsa Dental, Tulsa, OK, USA) and TheraCal LC (Bisco Inc, Schamburg, IL, USA) on human dental pulp fibroblasts. METHODS AND MATERIALS: Human fibroblasts were exposed to 100 µL of ProRoot MTA, TheraCal LC and Biodentine in 0-1000 µg/mL concentrations and incubated at 37°C for 24 h. Their cytotoxicity and genotoxicity were assessed using the methyl thiazol tetrazolium (MTT) and the comet assays, respectively. The data were analyzed by Kruskal-Wallis test at the level of significance set at 0.05. RESULTS: None of the tested materials had cytotoxicity or genotoxicity. CONCLUSION: TheraCal LC, Biodentine and ProRoot MTA can be alternately used for VPC treatment of teeth.

Human Pulp Responses to Partial Pulpotomy Treatment with TheraCal as Compared with Biodentine and ProRoot MTA: A Clinical Trial.

INTRODUCTION: Questions exist regarding the efficacy of resin-containing materials such as TheraCal directly applied on the pulp. This study sought to investigate the clinical efficacy of TheraCal as compared with Biodentine and ProRoot mineral trioxide aggregate (MTA) for partial pulpotomy. METHODS: In this clinical trial, partial pulpotomy was performed for 27 sound human maxillary and mandibular third molars scheduled for extraction. The teeth were randomly divided into 3 groups (n = 9) and underwent partial pulpotomy with TheraCal, Biodentine, and ProRoot MTA. The teeth were then restored with glass ionomer cement. Clinical and electric pulp tests were performed after 1 and 8 weeks. The teeth were radiographed and extracted at 8 weeks. Histologic sections were prepared and analyzed for pulp inflammation and dentinal bridge formation. Data were analyzed by using one-way analysis of variance. RESULTS: Clinical examination showed no sensitivity to heat, cold, or palpation in ProRoot MTA and Biodentine groups. Two patients in TheraCal group (20%) reported significant pain at 1 week. Periapical radiographs showed no periapical pathology, and electric pulp test revealed a normal pulp response with no hypersensitivity. Inflammation was absent with all materials at 8 weeks. Normal pulp organization was seen in 33.33% of the teeth in ProRoot MTA, 11.11% in TheraCal, and 66.67% in Biodentine group (P = .06). Biodentine group showed complete dentinal bridge formation in all teeth, whereas this rate was 11% and 56% in TheraCal and ProRoot MTA groups, respectively (P = .001). CONCLUSIONS: Overall, Biodentine and MTA performed better than TheraCal when used as partial pulpotomy agent and presented the best clinical outcomes.

Nonsurgical Management of an Extensive Endodontic Periapical Lesion: A Case Report.

Long-term success of endodontic treatment is dependent on adequate and appropriate cleaning and shaping of the root canal along with proper and correct obturation of the entire prepared space. This article aims to report an exceptional non-surgical and orthograde endodontic treatment of maxillary right central incisor with an extensive radiolucent lesion in a 17-year-old male. Six and 20-month follow-ups showed significant changes, including bone formation and periapical healing within the lesion. The patient was asymptomatic. After 20 months, complete radiographic and clinical healing of the periapical lesion was observed.

In Vitro Spectrophotometry of Tooth Discoloration Induced by Tooth-Colored Mineral Trioxide Aggregate and Calcium-Enriched Mixture Cement.

INTRODUCTION: There are numerous factors that can lead to tooth discoloration after endodontic treatment, such as penetration of endodontic materials into the dentinal tubules during root canal treatment. The aim of this in vitro study was to compare discoloration induced by tooth colored mineral trioxide aggregate (MTA) and calcium-enriched mixture (CEM) cement in extracted human teeth. METHODS AND MATERIALS: Thirty two dentin-enamel cuboid blocks (7×7×2 mm) were prepared from extracted maxillary central incisors. Standardized cavities were prepared in the middle of each cube, leaving 1 mm of enamel and dentin on the labial surface. The specimens were randomly divided into two study groups (n=12) and two positive and negative control groups (n=4). In either study groups the cavities were filled with MTA or CEM cement. The positive and negative control groups were filled with blood or left empty, respectively. The cavities were sealed with composite resin and stored in normal saline. Color measurement was carried out by spectrophotometry at different time intervals including before (T0), and 1 week (T1), 1 month (T2) and 6 months (T3) after placement of materials. Repeated-measures ANOVA was used to compare the discoloration between the groups; the material type was considered as the inter-subject factor. The level of significance was set at 0.05. RESULTS: No significant differences were detected between the groups in all time intervals (P>0.05). CONCLUSION: Tooth discoloration was similarly detectable with both of the two experimental materials.

Craniofacial Pain as the Sole Sign of Prodromal Angina and Acute Coronary Syndrome: A Review and Report of a Rare Case.

Orofacial pain can arise from different regions and etiologies. Some of the most debilitating pain conditions arise from the structures innervated by the trigeminal system (head, face, masticatory musculature, temporomandibular joint and associated structures). The problem with referred pain is the misdiagnosis and unnecessary therapy directed to the pain location instead of its origin. When craniofacial pain is the sole sign of myocardial ischemia, failure to recognize its cardiac source can endanger the patient. In particular, apart from unnecessary dental treatments, patients with acute myocardial infarction who do not experience chest pain run a very high risk of misdiagnosis and death. As endodontists, each of us may face many patients complaining of pain sensation in the teeth with the main source being other craniofacial/visceral organs. This review plots a diagnostically challenging case paving the way for further literature presentation in this regard. The aim of this compendious review was to gain knowledge about the prevalence, clinical characteristics and possible mechanisms of craniofacial pain of cardiac origin, in order to improve the clinician's ability to make a correct diagnosis.

Nonsurgical management of an extensive perforative internal root resorption with calcium-enriched mixture cement.

Internal inflammatory root resorption (IIRR) is a rare condition of the root canal and if it is left untreated it may lead to destruction of the surrounding dental hard tissues. Odontoclasts are responsible for this situation which can potentially perforate the root. Many initiating factors have been mentioned for IIRR, almost all causing chronic inflammation in the vital pulp. IIRR is usually symptom free, but in cases of root perforation, a sinus tract usually forms. The prognosis of treatment depends on the size of lesion with small lesions being managed with good prognosis. However, in case of notable destruction of the tooth, the prognosis is poor and tooth extraction may become inevitable. This report represents the management of an extensive perforative IIRR that was successfully sealed with calcium-enriched mixture (CEM) cement. After 12 months the tooth was still symptomless and in function.