Comparison of Antimicrobial Effects of 445 and 970 nm Diode Laser Irradiation with Photodynamic Therapy and Triple Antibiotic Paste on Enterococcus faecalis in the Root Canal: an In Vitro Study.

Background and aim: Colonization of residual organisms in the root canal are major causes of root canal treatment failure. Therefore, the effective removal of organisms during root canal cleaning stages is of great importance. In this study, we aimed to investigate and compare the antimicrobial effects of several methods including high power laser irradiation, photodynamic therapy and triple antibiotic paste (TAP) on Enterococcus faecalis in the root canal. Materials and methods: For the present laboratory study, 80 anterior single canal teeth were randomly divided into seven experimental groups (970 nm diode laser irradiation, 445 nm diode laser irradiation, 660 nm photodynamic therapy with doxycycline as a photosensitizer, TAP, 970 nm diode laser combined with TAP, 445 nm diode laser combined with TAP and sodium hypochlorite groups), each containing 10 teeth, and two positive and negative control groups, each containing five teeth. Afterwards, an E. faecalis suspension was prepared and injected into the root canals of all groups (except the negative control group), and after using the desired lasers or drugs and incubating for the necessary time, the grown colonies were counted and significance level of less than 0.05 was considered. Results:Among seven experimental groups, in those that included triple antibiotic paste (TAP, 970 nm diode laser with TAP, and 445 nm diode laser with TAP groups), no bacteria grew, while the 970 nm and 445 nm diode laser groups had the highest bacterial growth. Statistically, all studied groups were effective, and the results showed a statistically significant difference between groups (P value < 0.05). Conclusion: The findings of the present study show that all of the above-mentioned methods were effective enough for bacterial reduction. Triple antibiotic paste was proved to achieve complete bacterial elimination. Photodynamic therapy with doxycycline as a photosensitizer was shown to provide significant results of bacterial reduction and diode laser irradiation at both wavelengths (970 nm and 445 nm) were also reported to have antibacterial effect, although slightly lower than the previous methods.

Atorvastatin mucoadhesive tablets in the management of recurrent aphthous stomatitis: a randomized clinical study.

BACKGROUND: Aphthous stomatitis is one of the most common oral mucosal diseases. Due to the commonness of recurrent aphthous stomatitis and considering the anti-inflammatory, analgesic, and tissue regenerative properties of atorvastatin and the lack of a study on the effect of statins on minor recurrent aphthous stomatitis, this study investigates the effect of atorvastatin mucoadhesive tablets as a topical treatment on reduction of symptoms and duration of this disease. METHODS: This study is a randomized, double-blinded clinical trial. Patients were divided into two groups, atorvastatin and, placebo; each of the patients received three mucoadhesive tablets daily in the morning, noon, and night. Finally, the patients were examined on days 0 (baseline), 3, 5, and 7 to determine the diameter of the inflammatory halo. The VAS scale was used to evaluate pain intensity for up to 7 days after each meal. The data was entered into SPSS 24 software and analyzed. RESULTS: The halo diameter did not significantly differ between the two groups on baseline (P > 0.05). However, on the study's third, fifth, and seventh days, the difference between the two groups was remarkable, so in the atorvastatin group, the size of the lesions decreased in shorter healing time (P < 0.05). In addition, the patient's pain intensity (VAS) also showed a significant decrease in the atorvastatin group except on the first, second, and seventh days of the study (P < 0.05). CONCLUSION: Atorvastatin mucoadhesive tablets effectively reduce the pain of patients with minor recurrent aphthous stomatitis and reduce the size and healing time of the lesions, so their application should be considered in treating minor recurrent aphthous stomatitis. The present study was approved by the Medical Ethics Committee of Mazandaran University of Medical Sciences with the ethics code IR.MAZUMS.REC.1400.8346. Also, this study received code IRCT20170430033722N4.

Comparison of Anaheal Plus and Ibuprofen's Analgesic Effect after Root Canal Treatment in Patients Referred to Amol Private Clinic: a Clinical Trial Study.

Background and purpose: Since pain control in dental treatments, including root canal treatment, is challenging, and no study has measured the appropriate pattern of Anaheal Plus drug consumption in reducing pain after root canal treatment, in this study the appropriate pattern of taking Anaheal Plus drug in reducing pain after root canal treatment was evaluated. Material and methods:The present study examined maxillary and mandibular molar teeth with irreversible pulpitis. Patients were divided into three groups: A) Anaheal Plus capsule; B) control; and C) ibuprofen. Teeth were treated in two sessions, pulpectomy treatment was performed and drugs were used between sessions. A visual analog scale questionnaire was used to assess pain. Patients were asked to record the pain score before the root canal treatment as well as eight hours, 48 hours and five days after root canal treatment. All procedures were done in Amol's private clinic, where root canal treatment was administered by a dentist, and the teeth were obturated after a week. Findings: This study examined 90 patients with an average age of 33.94 years. Rescue doses were reported only in the control group, and there was a significant difference between groups (p-value < 0.001). In all groups, pain had decreased significantly (p-value<0.001), but the average pain in groups A and C was lower than that of group B at all times, and there was no difference between them. Conclusion:Anaheal Plus significantly reduced pain after root canal treatment compared to the control group.

Comparison of Salivary Cortisol Level in Type 2 Diabetic Patients and Pre-Diabetics with Healthy People.

BACKGROUND: Cortisol is one of the important enzymes of saliva. Control of this hormone is an effective way to adjust the glucose level in diabetic patients. AIM: The aim of this research is to compare the salivary cortisol level in type 2 diabetic patients and pre-diabetics with healthy people. METHODS: In this case-control study (2018), the unstimulated salivary samples were collected from 44 patients with type 2 diabetes, 44 pre-diabetic people (case group), and 44 healthy subjects (control group), matched for age and gender. The samples were transferred to the laboratory, and salivary cortisol level was measured using ELISA. Data were analysed using SPSS 22 and Chi 2 tests. RESULTS: The mean salivary cortisol level in type 2 diabetic patients was 3.14 ± 1.17, in pre-diabetic cases was 1.83 ± 0.68, and in healthy controls was 0.86 ± 0.43 (P < 0.001). The mean DMFT in type 2 diabetic patients was 19.6 ± 6.5, in the pre-diabetic group was 13.43 ± 4.5, and in healthy controls was 9.38 ± 3.72 (P < 0.001). CONCLUSION: With regards to the results, salivary cortisol level in type 2 diabetic patients is more than pre-diabetic people, and in pre-diabetic people is more than healthy people. Also, there was a significant relation between salivary cortisol level and DMFT index.

Comparison of apical transportation and centering ability of Mtwo and Reciproc R25 in severely curved canals using cone-beam computed tomography.

BACKGROUND: Apical transportation (AT) of the root canal moves the physiologic canal terminus to a new location on the external root surface and results in the accumulation of debris and residual microorganisms due to inadequate cleaning and shaping of the canal end. This study aimed to assess the prevalence of AT following canal preparation with Mtwo and Reciproc R25 using cone-beam computed tomographic (CBCT). MATERIALS AND METHODS: In this in vitro study, 40 mesiobuccal root canals of the maxillary molars with 19-22 mm length and (>40°) taper were prepared in two groups using Mtwo and Reciproc R25 rotary systems along with irrigation with 2.5% NaOCl. CBCT scans were obtained of the canals before and after preparation under similar conditions, and the values were measured using the device software. The amount of AT was measured according to Gambill et al. Data were analyzed using SPSS 17 and Chi-square and t-tests. P < 0.05 was considered significant. RESULTS: Both systems caused some degrees of AT. No significant difference was found between the two systems in terms of the amount and direction of AT (P > 0.05); overall, the frequency of AT toward the mesial wall was greater than that toward the distal direction. However, this difference was not statistically significant. CONCLUSION: The mean amount of AT and the ability to keep the instruments in severely curved canals were not significantly different in canals prepared by Mtwo and Reciproc rotary systems. Thus, these systems can be used in the clinical setting with the lowest risk of AT.

Accuracy of conventional and digital radiography in detecting external root resorption.

INTRODUCTION: External root resorption (ERR) is associated with physiological and pathological dissolution of mineralized tissues by clastic cells and radiography is one of the most important methods in its diagnosis. The aim of this experimental study was to evaluate the accuracy of conventional intraoral radiography (CR) in comparison with digital radiographic techniques, i.e. charge-coupled device (CCD) and photo-stimulable phosphor (PSP) sensors, in detection of ERR. METHODS AND MATERIALS: This study was performed on 80 extracted human mandibular premolars. After taking separate initial periapical radiographs with CR technique, CCD and PSP sensors, the artificial defects resembling ERR with variable sizes were created in apical half of the mesial, distal and buccal surfaces of the teeth. Ten teeth were used as control samples without any resorption. The radiographs were then repeated with 2 different exposure times and the images were observed by 3 observers. Data were analyzed using SPSS version 17 and chi-squared and Cohen's Kappa tests with 95% confidence interval (CI=95%). RESULT: The CCD had the highest percentage of correct assessment compared to the CR and PSP sensors, although the difference was not significant (P=0.39). It was shown that the higher dosage of radiation increases the accuracy of diagnosis; however, it was only significant for CCD sensor (P=0.02). Also, the accuracy of diagnosis increased with the increase in the size of lesion (P=0.001). CONCLUSION: Statistically significant difference was not observed for accurate detection of ERR by conventional and digital radiographic techniques.

A comparative study of cone-beam computed tomography and digital periapical radiography in detecting mandibular molars root perforations.

PURPOSE: The aim of this in vitro study was to determine the sensitivity and specificity of cone-beam computed tomography (CBCT) and digital periapical radiography in the detection of mesial root perforations of mandibular molars. MATERIALS AND METHODS: In this in vitro study, 48 mandibular molars were divided into 4 groups. First, the mesial canals of all the 48 teeth were endodontically prepared. In 2 groups (24 teeth each), the roots were axially perforated in the mesiolingual canal 1-3 mm below the furcation region, penetrating the root surface ("root perforation"). Then, in one of these 2 groups, the mesial canals were filled with gutta-percha and AH26 sealer. Mesial canals in one of the other 2 groups without perforation (control groups) were filled with the same materials. The CBCT and periapical radiographs with 3 different angulations were evaluated by 2 oral and maxillofacial radiologists. The specificity and sensitivity of the two methods were calculated, and P<0.05 was considered significant. RESULTS: The sensitivity and specificity of CBCT scans in the detection of obturated root canal perforations were 79% and 96%, respectively, and in the case of three-angled periapical radiographs, they were 92% and 100%, respectively. In non-obturated root canals, the sensitivity and specificity of CBCT scans in perforation detection were 92% and 100%, respectively, and for three-angled periapical radiographs, they were 50% and 96%, respectively. CONCLUSION: For perforation detection in filled-root canals, periapical radiography with three different horizontal angulations would be trustworthy, but it is recommended that CBCT be used for perforation detection before obturating root canals.

Frequency of odontogenic periradicular lesions in diabetic patients.

BACKGROUND: Diabetic patients are more prone to oral infections and periradicular lesions due to changes in their immune system and qualitative and quantitative changes in normal flora of their mouth. The aim of this study was to evaluate the frequency of periradicular lesions in diabetic patients in Babol, North of Iran. METHODS: From October 2011 to March 2012, 135 diabetic patients who referred to the Iranian Diabetes Society - Babol Branch and Endocrinology Clinic of Babol University of Medical Sciences were studied. The demographic features as well as the duration of the diagnosis of diabetes (> 48 months was called long term and < 48 months short term) is the quality of control of their diabetes. For all the patients, panoramic and periapical radiography were performed for the presence of any radicular radiolucent lesions. Vitality test has been done for the recorded teeth except for the root treated ones and periodontal involvement necrotic teeth. The data were collected and analyzed. RESULTS: Periradicular lesions were seen on 90.37% of the patients. The frequency of periradicular lesions in long term patients was 85 (94.4%) and in short term was 37 (82.2%) (p=0.023). The mean of teeth with periradicular lesions in long and short term diabetic patients was 2.63±2.23 and 2.11±1.79, respectively (p=0.174). CONCLUSION: The results show that the frequency of periradicular lesions in diabetic patients is higher in long-term diabetic patients than the short-term diabetic patients.

Histopathologic Responses of the Dental Pulp to Calcium-Enriched Mixture (CEM) and Mineral Trioxide Aggregate (MTA) in Diabetic and Non-Diabetic Rats.

Diabetes mellitus is a chronic disease which affects the healing ability of the pulp and periodontium. The aim of the present study was to assess the histopathologic response of dental pulp to pulp capping using MTA or CEM cement in diabetic rats. Thirty two Wistar male rats aged between 8 and 10 weeks (weight: 200-250g) were divided into two groups of diabetic (n=16) and healthy (n=16) animals and then subdivided into MTA and CEM subgroups. In each group, 10 MTA treated, 10 CEM treated and 12 intact (without any intervention) teeth were analyzed. Intact teeth were considered as a baseline inflammation control. Then, class I cavity was made in the maxillary first molars teeth with pinpoint pulpal exposure. Either MTA or CEM cement was then placed over exposed pulp as pulp capping agent and the cavities were restored using resin- modified glass ionomer cement. Both teeth of rats in subgroups remained intact without any intervention. After four weeks, the rats were sacrificed and the teeth were subjected to histological evaluation in terms of inflammation intensity, dentin bridge formation and dentin bridge continuity. The CEM cement treated diabetic rats exhibited a significant higher inflammatory response when compared to healthy control group (P=0.004) whereas, MTA treated diabetic rats did not exhibit a significant higher inflammatory response in comparison to healthy controls. There was no significant difference between MTA and CEM cement in the induction of dentin bridge formation in diabetic and healthy controls. This preliminary study suggests that MTA is a superior dental material than CEM cement for pulp therapy in subjects with diabetes.

Comparison of tooth crown discoloration with Epiphany and AH26 sealer in terms of chroma and value: an in vitro study

Tooth crown discoloration may possess a heavy emotional burden and esthetic concern, especially when the anterior teeth are affected. Residue of sealers within the pulp chamber is a major contributor to the occurrence of tooth discoloration. Aim: The aim of this study was to evaluate the degree of crown discoloration when recently introduced sealer, Epiphany, is used. Methods: Forty human incisors were examined in vitro. Fifteen teeth were sealed with either AH26 or Epiphany sealer as experimental groups and root canals of the remaining 10 teeth with distilled water. Digital photographs of the buccal aspect of teeth were then examined in terms of brightness (value) and saturation (chroma) using Photoshop software at the beginning and consecutive 3, 6 and 9 months. Degree of brightness and saturation changes was defined as follows: less than 5% as slight, 10% to 15% as moderate and 15% to 20% as severe. Results: Fifteen, 14 and 10 teeth entered in Epiphany, AH26 and control groups, respectively. Significant brightness deterioration was noticed by time in both experimental groups [F (2, 8) =29.16, p<0.001], with no differences in Epiphany compared with AH26 (p=0.086). Saturation differed neither by time [F (2, 8) =0.129, p=0.881, nor by sealer type (p=0.136) during 9-month observation. At 9th month, crown segments (incisal, middle and cervical thirds) were not contrasted by the sealer type (p=0.982) or discoloration type (either brightness or saturation) (p=0.50). All changes in the experimental groups were significantly higher than the control group (p<0.001). Conclusions: Epiphany was equal to AH26 sealer in terms of relative long-term crown discoloration. One clinical correlation learned from the results of the present study is that Epiphany may safely be used interchangeably with the traditional AH26 sealer.

Endodontic re-treatment of maxillary second molar with two separate palatal roots: a case report.

Maxillary second molar with two palatal roots is a rare dental anatomy. The diagnosis and treatment of exceeded root may create challenge for clinicians. The authors discuss the retreatment of a maxillary second molar in which exceeded root was undiagnosed in previous treatment. The case report underlines the importance of complete knowledge about root canal morphology which achieved by careful clinical and radiographic examination. In retreatment procedures clinicians should consider missed canals.