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.

Effect of Short-Term Aging on the Flexural Strength of a Novel Experimental CAD/CAM Fiber-Reinforced Composite Material: A Pilot Study.

PURPOSE: To investigate the three-point flexural strength of a novel CAD/CAM fiber-reinforced composite (FRC) material following different aging conditions. MATERIALS AND METHODS: The specimens were randomly assigned to one of five groups based on aging condition: (1) control (no treatment); (2) short-term water storage; (3) thermal degradation with autoclaving; (4) chemical degradation with hydrochloric acid; and (5) chemical degradation with citric acid (n = 10 per group). The specimens in the control group received no treatment. Following each treatment protocol, the three-point bending test was used to calculate the flexural strength. Data were statistically analyzed (α = .05), and scanning electron microscopy (SEM) analysis of the specimens was conducted. RESULTS: No significant differences in flexural strength were observed among the groups (P = .199). In addition, no distinct morphologic differences were detected in the SEM images of the specimens. CONCLUSION: The flexural strength of this novel CAD/CAM FRC material was unaffected by different aging methods.

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 Temperature of Sodium Hypochlorite on Cyclic Fatigue Resistance of Heat-treated Reciprocating Files.

INTRODUCTION: The aim of this study was to evaluate the effect of different temperatures of sodium hypochlorite (NaOCl) on the cyclic fatigue resistance of the heat-treated file systems. METHODS: The cyclic fatigue resistance of Reciproc 25 (VDW Dental, Munich, Germany), Reciproc Blue R25 (VDW), WaveOne Primary (Dentsply Maillefer, Ballaigues, Switzerland), WaveOne Gold Primary (Dentsply Maillefer), and One Shape (25.06; Micro Mega, Besançon, France) was tested in the following conditions: control (no immersion), immersion in distilled water (DW) at 37°C ± 1°C, immersion in DW at 60°C ± 1°C, immersion in NaOCl at 37°C ± 1°C, and immersion in NaOCl at 60°C ± 1°C. The immersion period was 5 minutes for all conditions. A stainless steel artificial canal with a curvature of 60° and a 5-mm radius was used. The time to failure and fragment lengths were recorded for each instrument, and data were subjected to statistical analysis. RESULTS: Reciproc Blue showed greater cyclic fatigue resistance in all conditions compared with the other systems (P < .05). Immersion in NaOCl at 60 °C negatively affected all instruments' cyclic fatigue resistance except Reciproc Blue. Immersion in DW at 60 °C increased the cyclic fatigue resistance of Reciproc Blue. Heat-treated files presented higher fatigue resistance than traditional files. CONCLUSIONS: A high temperature of NaOCl affected the cyclic fatigue life of the file systems. Instruments produced with heat treatment presented a longer fatigue life.

Effect of ultrasonic activation on dentinal tubule penetration of calcium silicate-based cements.

This study investigated the dentinal tubule penetration of mineral trioxide aggregate (MTA), NeoMTA Plus and Biodentine placed by either manual condensation or ultrasonic activation in simulated open apex model. Standardized divergent open apex models were created using palatal roots of 60 human maxillary molars and divided into six groups according to the used cements and activation methods (n = 10): MTA-manual condensation, MTA-ultrasonic activation, NeoMTA Plus-manual condensation, NeoMTA Plus-ultrasonic activation, Biodentine-manual condensation, Biodentine-ultrasonic activation. For the measurement of penetration, the cements were mixed with 0.1% Rhodamin B and 6-mm apical portions of each root canal were obturated in an orthograde direction. The roots were embedded into acrylic blocks, and 1-mm-thick sections were obtained at 3 mm from the apex. Specimens were mounted onto glass slides and scanned under a confocal laser scanning microscope (CLSM) and stereomicroscope. Dentinal tubule penetration areas, depth and percentage were measured using LSM and ImageJ software. The data were analyzed using two-way analysis of variance (anova) with Bonferroni correction (α = 0.05). No correlation was found between stereomicroscope and CLSM analyses (p > .05). CLSM analysis showed no significant differences between MTA, NeoMTA Plus, and Biodentine groups when manual condensation was used (p > .05). Ultrasonic activation did not increase the tubular penetration of MTA, NeoMTA Plus or Biodentine as compared to manual condensation of each material (p > .05). MTA, NeoMTA Plus and Biodentine showed similar tubular penetration when manual condensation was used. Ultrasonic activation of these cements had no effect on tubular penetration of each material as compared to the manual condensation counterparts.

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).

Revitalization of necrotic mature permanent incisors with apical periodontitis: a case report.

Despite considerable focus on the regenerative endodontic treatment of immature teeth with necrotic infected pulps and apical periodontitis, little data exist with regard to its possible implementation in necrotic permanent teeth with complete apical and radicular development. The present report describes the procedures and outcome of a regenerative endodontic treatment approach in 2 previously-traumatized incisors with closed apex with apical periodontitis. A 2-visit treatment procedure was employed. At initial visit, the root canals were copiously irrigated, followed by placement of a triple antibiotic paste containing ciprofloxacin, metronidazole, and clindamycin into the root canals. After 4 weeks, the antibiotic paste was removed, and apical bleeding was initiated with size 10 hand files beyond the apices. The root canals were coronally sealed with mineral trioxide aggregate, and the access cavities were restored with bonded resin composite. At post-operative 60 months, both teeth were remained asymptomatic, with the recall radiographs showing complete resolution of apical radiolucency and reestablishment of periradicular tissues. In both teeth, the dimensions of root space remained unchanged as verified by image analysis. The revitalization protocol utilizing root canal disinfection and induced apical bleeding in necrotic, closed-apex incisors may offer a clinically acceptable alternative to conventional root canal treatment.

Fracture resistance of simulated immature teeth after internal bleaching procedures.

The aim of this study was to evaluate the fracture resistance of simulated immature teeth after internal bleaching. The teeth were assigned as follows (n = 12/group); Group-1: The pulp chamber was filled with ProRootMTA and bleached intracoronally with sodium perborate mixed with 37% carbamide peroxide gel; Group-2: The pulp chamber was filled with ProRootMTA without bleaching; Group-3: The pulp chamber was filled with Biodentine and bleached intracoronally as Group-1; Group-4: The pulp chamber was filled with Biodentine without bleaching; and Group-5: Teeth received no intervention (control). The specimens were loaded vertically until root fracture occurred. The data were analysed with Kruskal-Wallis and Dunn tests. There was no significant difference between the fracture resistances of the experimental groups (P > 0.05). However, all experimental groups had significantly lower fracture resistance than the control group (P < 0.05). Neither the tested calcium silicate cements nor the bleaching procedures had a significant impact on fracture resistance values.

Effect of Laser-Activated Irrigation on the Push-Out Bond Strength of ProRoot Mineral Trioxide Aggregate and Biodentine in Furcal Perforations.

OBJECTIVE: The objective of the present study was to assess the effect of erbium, chromium: yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser-activated irrigation (LAI) of NaOCl on the push-out bond strength of furcal perforations repaired with ProRoot mineral trioxide aggregate (MTA) and Biodentine. BACKGROUND DATA: Several studies investigated the adhesion of calcium silicate-based cements after exposure to endodontic irrigants, while effect of LAI on bond strength remains to be elucidated. MATERIALS AND METHODS: Bur-cut furcal perforations with standard dimensions were created in 100 extracted human mandibular molars. Teeth were randomly distributed into two groups (n = 50/group) according to the repair material applied: (1) ProRoot MTA or (2) Biodentine. The specimens were further assigned into five subgroups according to the irrigation regimens used over the set materials: (a) distilled water with needle irrigation; (b) 5.25% NaOCl with needle irrigation; (c) distilled water with LAI; (d) 5.25% NaOCl with LAI; and (e) no irrigation (control). Bond strengths of the test materials were assessed by using push-out bond strength test. RESULTS: Biodentine showed significantly higher dislocation resistance than ProRoot MTA (p < 0.05). Laser activation of 5.25% NaOCl and distilled water did not significantly affect the push-out bond strength results (p > 0.05). CONCLUSIONS: Biodentine showed higher dislocation resistance than ProRoot MTA as a perforation repair material. Er,Cr:YSGG laser activation of irrigation aqueous solutions had no adverse effect on push-out bond strength of Biodentine and ProRoot MTA.

Effect of Laser-Activated Irrigation with Ethylene Diaminetetraacetic Acid and Phytic Acid on the Removal of Calcium Hydroxide and Triple Antibiotic Paste from Root Dentin.

OBJECTIVE: This study assessed the efficacy of erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser-activated irrigation (LAI) of ethylene diaminetetraacetic acid (EDTA) and phytic acid on the removal of calcium hydroxide (CH) and triple antibiotic paste (TAP) from root canals. BACKGROUND DATA: Although some studies investigated the efficacy of LAI of EDTA irrigation, no study has been conducted to investigate the efficacy of LAI of phytic acid in the removal of CH and TAP from root dentin. MATERIALS AND METHODS: Root canals of extracted maxillary incisors (n = 80) were instrumented using rotary files and thereafter were split longitudinally. Following preparation of a standardized groove in the apical region of one root half, the roots were randomly divided into two groups according to the intracanal medicaments placed into the grooves: (1) CH and (2) TAP. The roots were reassembled, and the specimens were further assigned into four groups (n = 10/group) defined by the final irrigation solution (EDTA and phytic acid) and irrigation technique (needle irrigation and LAI) used for removal of the medicaments. The data were analyzed statistically using Kruskal-Wallis and Mann-Whitney U tests. RESULTS: For both EDTA and phytic acid, LAI was more efficient than needle irrigation in removing both CH and TAP (p < 0.05), but none of the tested techniques completely removed CH. Irrespective of the tested irrigation solutions and techniques, significantly less TAP remained in canals (p = 0.0001), with TAP being completely removed by LAI. Irrigation with phytic acid showed better removal efficacy than EDTA in the absence of statistical significance. CONCLUSIONS: Er,Cr:YSGG LAI of EDTA and phytic acid completely removed TAP and effectively reduced CH on root dentin.

Reinforcing Effect of Glass Fiber-incorporated ProRoot MTA and Biodentine as Intraorifice Barriers.

INTRODUCTION: The purpose of this study was to investigate the fracture resistance of roots by using intraorifice barriers with glass fiber-incorporated ProRoot MTA and Biodentine. METHODS: The diametral tensile strength and compressive strength of ProRoot MTA and Biodentine were determined after incorporation of 5 wt% and 10 wt% alkali resistant (AR) glass fiber powder into both cements. On the basis of higher diametral tensile strength and compressive strength values, ProRoot MTA and Biodentine with 5 wt% AR glass fiber were selected for further testing as intraorifice barriers. The 14-mm-long root specimens obtained from extracted mandibular premolars (n = 60) were prepared with nickel-titanium rotary files and obturated with gutta-percha + AH Plus sealer. After removal of coronal 3 mm of root fillings, the roots were grouped with respect to the intraorifice barrier material (n = 12/group): (1) ProRoot MTA, (2) ProRoot MTA with 5 wt% AR glass fibers, (3) Biodentine, (4) Biodentine with 5 wt% AR glass fibers, and (5) control (no intraorifice barrier). The specimens were loaded vertically at 1 mm/min crosshead speed until vertical root fracture occurred. The data were evaluated statistically by using 2-way analysis of variance and Tukey tests. RESULTS: Both incorporation of glass fiber and the type of material significantly affected fracture resistance (both P = .002). Roots with glass fiber-reinforced Biodentine barriers showed the highest fracture strength (P = .000). CONCLUSIONS: Incorporation of 5 wt% AR glass fiber can significantly improve the reinforcement effect of ProRoot MTA and Biodentine when used as intraorifice barriers.

Effect of timing of post space preparation on the apical seal when using different sealers and obturation techniques.

BACKGROUND/PURPOSE: To prepare the post apace, some of the root-canal filling material has to be removed, which can affect the apical seal. The aim of this study was to compare the effect of immediate post space preparation to that of delayed post space preparation on apical sealing using three different endodontic sealers and obturation techniques. MATERIALS AND METHODS: In total, 90 decrowned single-rooted human teeth were studied. After root canals were prepared with 0.06 tapered nickel-titanium rotary files to size 30, the roots were categorized randomly into three experimental groups according to the obturation material: (1) AH plus/gutta-percha; (2) Sealite Ultra/gutta-percha; and (3) Epiphany/Resilon. Furthermore in all groups, specimens were categorized randomly into three subgroups according to the obturation technique (n = 10): (1) single cone; (2) cold lateral compaction; and (3) System B + Obtura. After root-canal filling, post space preparation was immediately performed in Group 1, after 24 hours in Group 2, and after 7 days in Group 3. Apical leakage was measured using the fluid-filtration method. Statistical analysis was performed using the Kruskal-Wallis test and Wilcoxon signed ranks test at P < 0.001. RESULTS: Regardless of the obturation technique and sealers used, significantly better (P < 0.001) sealing was achieved at the apical ends using delayed post space preparation than with immediate post preparation. The obturation techniques tested did not significantly affect leakage values. The following statistical ranking of fluid filtration values was obtained for the obturation materials: Epiphany/Resilon > Sealite Ultra/gutta-percha > AH plus/gutta-percha (P < 0.001). CONCLUSION: To reduce apical leakage, clinicians should use AH plus together with any of the obturation techniques after 7 days of obturation.

Effect of endodontic chelating solutions on the bond strength of endodontic sealers.

The purpose of this in vitro study was to evaluate the effect of various chelating solutions on the radicular push-out bond strength of calcium silicate-based and resin-based root canal sealers. Root canals of freshly-extracted single-rooted teeth (n = 80) were instrumented by using rotary instruments. The specimens were randomly divided into 4 groups according to the chelating solutions being tested: (1) 17% ethylenediaminetetraacetic acid (EDTA); (2) 9% etidronic acid; (3) 1% peracetic acid (PAA); and (4) distilled water (control). In each group, the roots were further assigned into 2 subgroups according to the sealer used: (1) an epoxy resin-based sealer (AH Plus) and (2) a calcium silicate-based sealer (iRoot SP). Four 1 mm-thick sections were obtained from the coronal aspect of each root (n = 40 slices/group). Push-out bond strength test was performed at a crosshead speed of 1 mm/min., and the bond strength data were analyzed statistically with two-way analysis of variance (ANOVA) with Bonferroni's post hoc test (p < 0.05). Failure modes were assessed quantitatively under a stereomicroscope. Irrespective of the irrigation regimens, iRoot SP exhibited significantly higher push-out bond strength values than AH Plus (p < 0.05). For both the sealers, the use of chelating solutions increased the bond strength, but to levels that were not significantly greater than their respective controls (p > 0.05). iRoot SP showed higher resistance to dislocation than AH Plus. Final irrigation with 17% EDTA, 9% Etidronic acid, and 1% PAA did not improve the bond strength of AH Plus and iRoot SP to radicular dentin.

Calcium hydroxide dressing residues after different removal techniques affect the accuracy of Root-ZX apex locator.

OBJECTIVES: This study compared the ability of several techniques to remove calcium hydroxide (CH) from the root canal and determined the influence of CH residues on the accuracy of the electronic apex locator. MATERIALS AND METHODS: Root canals of 90 human maxillary lateral incisors with confirmed true working length (TWL) were prepared and filled with CH. The teeth were randomly assigned to one of the experimental groups according to the CH removal technique (n = 14): 0.9% saline; 0.9% saline + master apical file (MAF); 17% ethylenediamine tetraacetic acid (EDTA); 17% EDTA + MAF; 5.25% sodium hypochlorite (NaOCl); 5.25% NaOCl + MAF. Six teeth were used as negative control. After CH removal, the electronic working length was measured using Root-ZX (Morita Corp.) and compared with TWL to evaluate Root-ZX accuracy. All specimens were sectioned longitudinally, and the area of remaining CH (CH) and total canal area were measured using imaging software. RESULTS: The EDTA + MAF and NaOCl + MAF groups showed better CH removal than other groups (p < 0.05). Root-ZX reliability to prevent overestimated working length to be > 85% within a tolerance of ± 1.0 mm (p < 0.05). There was strong negative correlation between amount of CH residues and EAL accuracy (r = -0.800 for ± 0.5 mm; r = -0.940 for ± 1.0 mm). CONCLUSIONS: The mechanical instrumentation improves the CH removal of irrigation solutions although none of the techniques removed the dressing completely. Residues of CH medication in root canals affected the accuracy of Root-ZX adversely.

Effect of endodontic chelating solutions on the bond strength of endodontic sealers

The purpose of this in vitro study was to evaluate the effect of various chelating solutions on the radicular push-out bond strength of calcium silicate-based and resin-based root canal sealers. Root canals of freshly-extracted single-rooted teeth (n = 80) were instrumented by using rotary instruments. The specimens were randomly divided into 4 groups according to the chelating solutions being tested: (1) 17% ethylenediaminetetraacetic acid (EDTA); (2) 9% etidronic acid; (3) 1% peracetic acid (PAA); and (4) distilled water (control). In each group, the roots were further assigned into 2 subgroups according to the sealer used: (1) an epoxy resin-based sealer (AH Plus) and (2) a calcium silicate-based sealer (iRoot SP). Four 1 mm-thick sections were obtained from the coronal aspect of each root (n = 40 slices/group). Push-out bond strength test was performed at a crosshead speed of 1 mm/min., and the bond strength data were analyzed statistically with two-way analysis of variance (ANOVA) with Bonferroni’s post hoc test (p < 0.05). Failure modes were assessed quantitatively under a stereomicroscope. Irrespective of the irrigation regimens, iRoot SP exhibited significantly higher push-out bond strength values than AH Plus (p < 0.05). For both the sealers, the use of chelating solutions increased the bond strength, but to levels that were not significantly greater than their respective controls (p > 0.05). iRoot SP showed higher resistance to dislocation than AH Plus. Final irrigation with 17% EDTA, 9% Etidronic acid, and 1% PAA did not improve the bond strength of AH Plus and iRoot SP to radicular dentin.

Bond strength of a calcium silicate-based sealer tested in bulk or with different main core materials.

The aim of this study was to evaluate the influence of a calcium silicate-based sealer (iRoot SP), with or without a core material, on bond strength to radicular dentin, in comparison with various contemporary root filling systems. Root canals of freshly extracted single-rooted teeth (n = 60) were instrumented using rotary instruments. The roots were randomly assigned to one of the following experimental groups: (1) a calcium silicate-based sealer without a core material (bulk-fill); (2) a calcium silicate-based sealer + gutta-percha; (3) a calcium silicate-based sealer + Resilon; (4) a methacrylate resin-based sealer (RealSeal SE) + Resilon; (5) an epoxy resin-based sealer (AH Plus) + gutta-percha, and (6) a mineral trioxide aggregate-based endodontic sealer (MTA Fillapex) + gutta-percha. Four 1-mm-thick sections were obtained from the coronal aspect of each root (n = 40 slices/group). Push-out bond strength testing was performed at a cross-head speed of 1 mm/min, and the bond strength data were analyzed statistically by one-way analysis of variance and Tukey tests (p < 0.05). The highest and lowest debonding values were obtained for the calcium silicate-based sealer bulk-fill and mineral trioxide aggregate-based endodontic sealer + gutta-percha groups, respectively (p < 0.05). It was concluded that the calcium silicate-based sealer showed higher resistance to dislocation in the bulk-filled form than in conjunction with the tested core filling materials. When the calcium silicate-based sealer was placed in bulk, its dislocation resistance was similar to that of commonly used sealer + core root filling systems. Thus, the concept of using a calcium silicate-based sealer in bulk can be more easily advocated in clinical practice.

Bond strength of mineral trioxide aggregate to root dentin after exposure to different irrigation solutions.

AIM: The aim of the study was to evaluate the regional push-out bond strength of mineral trioxide aggregate (MTA) after exposure to sodium hypochlorite (NaOCl), ethylenediaminetetraacetic (EDTA), and peracetic acid (PAA) irrigation solutions. MATERIALS AND METHODS: 1-mm-thick longitudinal slabs of root dentin were obtained from freshly extracted human canine teeth (n = 80). Simulated root perforation defects, 1 mm in diameter, were prepared in the coronal, middle, and apical thirds of radicular dentin. Mineral trioxide aggregate was placed into the cavities, and the specimens were stored for 1 week at 37°C. Thereafter, the specimens were randomly divided into four groups (n = 20) according to the irrigation solution applied over the repair sites: Group 1-10 ml of 5.25% NaOCl for 10 min; Group 2-10 ml of 5.25% NaOCl for 10 min, followed by 5 ml 17% EDTA for 5 min; Group 3-10 ml of 5.25% NaOCl for 10 min, followed by application of 5 ml 1% PAA for 5 min; and Group 4-no irrigation. Push-out test was performed at a crosshead speed of 1 mm/min. Debonding values were compared statistically using two-way analysis of variance and Tukey tests (P < 0.05). RESULTS: The push-out bond strength of MTA was not affected by the type of irrigation solution or location of the perforation defects (both P < 0.05). Stereomicroscopic inspection of the samples showed that the bond failure was predominantly adhesive. CONCLUSION: Exposure of repaired root perforations to 5.25% NaOCl, 17% EDTA, or 1% PAA does not alter the dislocation resistance of MTA at different locations of root dentin.

A comparison of residual smear layer and erosion following different endodontic irrigation protocols tested under clinical and laboratory conditions.

OBJECTIVE: To compare the smear layer removal efficacy and erosive effects of different irrigation protocols under clinical and laboratory conditions. MATERIALS AND METHODS: Mandibular third molars (n = 32) of 30-45 year-old patients were instrumented with rotary files and were randomly assigned to one of the following groups for final irrigation: (1) 5.25% NaOCl; (2) 17% EDTA; and (3) BioPure MTAD. Thereafter, the teeth were immediately extracted and processed for micromorphological investigation. In vitro specimen pairs were prepared by repeating the clinical experiments on freshly-extracted mandibular third molars. To compare open and closed systems, laboratory experiments were repeated on 32 additional teeth with enlarged apical foramen. The cleanliness of the root canals and the extent of erosion were assessed by environmental scanning electron microscopy. RESULTS: Specimens prepared under clinical and laboratory conditions had similar cleanliness and erosion scores (p > 0.05). Under both conditions, the tested solutions were more effective in removing the smear layer in the coronal and middle regions than in the apical one. Comparison of closed and open systems showed similar levels of cleanliness and erosion in all regions (p > 0.05), with the exception of 17% EDTA showing significantly higher levels of cleanliness and erosion in the apical third of open-end specimens. CONCLUSIONS: Based on clinical correlates of in vitro root canal cleanliness and erosion, laboratory testing of root canal irrigants on extracted teeth with closed apices can serve as a reliable method to simulate the clinical condition. EDTA was the most effective final irrigation solution in removing the smear layer at the expense of yielding the greatest erosive effect.

Translucency of flowable bulk-filling composites of various thicknesses.

OBJECTIVE: To evaluate the translucency characteristics of new flowable bulk-filling resin composites at various thicknesses. Experimental short fibre-reinforced composite was also tested. METHODS: Two new brands of flowable bulk composites (Venus Bulk Fill and SureFil SDR Flow), experimental short fibre-reinforced resin composite (FC) and, as control, conventional flow (Filtek Supreme Flow XT A3) and universal (Filtek Universal Supreme XTE A3B) resin composites were investigated. Translucency parameter was calculated for various thicknesses of composite (1, 2, 3, 4, 5 and 6 mm) over white and black backgrounds using spectrophotometry to determine the CIELAB values of each specimen. Data were statistically analysed with analysis of variance. RESULTS: Translucency values significantly correlated with thickness of resin composite specimens (P < 0.05). For the new types of flowable bulk-filling material, translucency was observed for thicknesses up to 5 to 6 mm, whereas for experimental FC composite, the effect was observed up to 4 to 5 mm, and for control flow and universal filling composites, up to 2 to 3 mm. CONCLUSION: New flowable bulk-filling resin composites have less masking ability than conventional universal filling resin composite materials, which should be taken into account when optimum colour match and aesthetic results are to be achieved.