The effect of the enzymes trypsin and DNase I on the antimicrobial efficiency of root canal irrigation solutions.

The purpose of this study was to evaluate the antibacterial efficacy of using 2.5% NaOCl, 2% chlorhexidine (CHX), Irritrol, and chitosan-coated silver nanoparticles (AgCNPs) alone or in combination with deoxyribonuclease I (DNase I) and trypsin pre-enzyme applications in dentin samples contaminated with Enterococcus faecalis (E. faecalis) by CLSM. 144 dentin blocks with confirmed E. faecalis biofilm formation were divided randomly according to the irrigation protocol (n = 12): NaOCl, CHX, Irritrol, AgCNPs, trypsin before NaOCl, CHX, Irritrol, AgCNPs, and DNase I before NaOCl, CHX, Irritrol, AgCNPs. Dentin blocks were stained with the Live/Dead BacLight Bacterial Viability Kit and viewed with CLSM after irrigation applications. The percentage of dead and viable bacteria was calculated using ImageJ software on CLSM images. At a significance level of p < 0.05, the obtained data were analyzed using one-way Anova and post-hoc Tukey tests. In comparison with NaOCl, CHX had a higher percentage of dead bacteria, both when no pre-enzyme was applied and when DNase I was applied as a pre-enzyme (p < 0.05). There was no difference in the percentage of dead bacteria between the irrigation solutions when trypsin was applied as a pre-enzyme (p > 0.05). AgCNPs showed a higher percentage of dead bacteria when trypsin was applied as a pre-enzyme compared to other irrigation solutions (p < 0.05), while the pre-enzyme application did not affect the percentage of dead bacteria in NaOCl, CHX, and Irritrol (p > 0.05). No irrigation protocol tested was able to eliminate the E. faecalis biofilm. While the application of trypsin as a pre-enzyme improved the antimicrobial effect of AgCNPs, it did not make any difference over other irrigation solutions.

Evaluation of the effect of different desensitizers on pulpal blood flow after full crown preparation using laser Doppler flowmetry: a randomized clinical trial.

This study aims to evaluate the effect of Teethmate, Bifluoride 12, and Copal Varnish on the treatment of dentin hypersensitivity and the pulpal blood flow using laser Doppler flowmetry (LDF) after full crown preparations. Eighteen patients with 42 teeth with dentine hypersensitivity after full crown preparations were randomly treated with Teethmate, Bifluoride 12, and Copal Varnish. Dentine hypersensitivity was measured using a visual analog scale (VAS) and Schiff air index (SAI). LDF was used to assess the pulpal blood flow and results were recorded in perfusion units (PU). All measurements were performed at baseline, 5 min, 7 days, and 1 month after the application of desensitizers. Data were statistically analyzed by Wilcoxon and two-way ANOVA tests (p < 0.05). There was no significant difference between the tested desensitizers regarding VAS and PU values. VAS values decreased significantly at 7 days and 1 month after the application of desensitizers compared to baseline in all groups. The decrease in PU values significantly differed only in the Copal Varnish group at 5 min and 7 days after the application of the desensitizer (p < 0.05). A statistically significant difference was found between different times regarding SAI scores in all groups (p < 0.05). Teethmate, Bifluoride 12, and Copal Varnish showed similar effectiveness on dentine hypersensitivity and pulpal blood flow. Long-term clinical trials with larger sample sizes and histological studies are needed to evaluate their impacts on pulpal status.

Contemporary research trends on nanoparticles in endodontics: a bibliometric and scientometric analysis of the top 100 most-cited articles.

Objectives: Advancements in nanotechnology have led to the widespread usage of nanoparticles in the endodontic field. This bibliometric study aimed to determine and analyze the top 100 most-cited articles about nanoparticles in endodontics from 2000 to 2022. Materials and Methods: A detailed electronic search was conducted on the "Clarivate Analytics Web of Science, All Databases" to receive the most-cited articles related to the topic. Articles were ranked in descending order based on their citation counts, and the first 100 were selected for bibliometric analysis. Parameters such as citation density, publication year, journal, country, institution, author, study design, study field, evidence level, and keywords were analyzed. Results: The top 100 most-cited articles received 4,698 citations (16-271) with 970.21 (1.91-181) citation density in total. Among decades, citations were significantly higher in 2011-2022 (p < 0.001). Journal of Endodontics had the largest number of publications. Canada and the University of Toronto made the highest contribution as country and institution, respectively. Anil Kishen was the 1 who participated in the largest number of articles. The majority of the articles were designed in vitro. The main study field was "antibacterial effect." Among keywords, "nanoparticles" followed by "Enterococcus faecalis" were used more frequently. Conclusions: Developments in nanotechnology had an impact on the increasing number of studies in recent years. This bibliometric study provides a comprehensive view of nanoparticle advances and trends using citation analysis.

Evaluation of the effectiveness of different treatment approaches in preventing coronal discoloration caused by regenerative endodontic treatment.

OBJECTIVES: This study aimed to evaluate the effectiveness of Teethmate desensitizer, a dentin bonding agent (DBA), Nd:YAG laser, and Er:YAG laser, which provides dentin tubule occlusion in the pulp chamber with different mechanisms, in preventing tooth discoloration due to regenerative endodontic treatment. MATERIALS AND METHODS: One hundred five extracted maxillary human incisors with single roots and single canals were included in the study. The apical third of each tooth was resected below the enamel-cementum junction (CEJ) to obtain a standard root length as 10 ± 1 mm. Root canal preparation was performed using the ProTaper Next files up to X5. Root canals were prepared with Gates Glidden (# 2-4) burs to simulate the immature root apex and an apical diameter of 1.1 ± 0.1 mm was obtained. The teeth were randomly divided into 7 groups (n = 15): DBA, Teethmate, Nd:YAG, Er:YAG, Biodentine, Blood, and Negative Control. Relevant dentin tubule occlusion methods were applied to DBA, Teethmate, Nd:YAG, and Er:YAG groups. Following dentin tubule occlusion procedures, Biodentine was placed on the blood clot after filling the root canals with blood up to 4 mm below the CEJ. No dentin tubule occlusion procedure was applied for Blood and Biodentine groups. Color measurement was performed with the spectrophotometer Vita Easyshade Advance before treatment, immediately after treatment, and at days 7, 30, and 90. Data were converted to L*a*b color values of Commission International de I'Eclairage (CIE L*a*b) and ΔE values were calculated. Two-way ANOVA and post hoc Tukey test (p = 0.05) were performed for statistical analysis. RESULTS: A clinically detectable color change was observed in all groups except for the negative control (ΔE ≥ 3,3). It was observed that Biodentine used alone has a potential for discoloration. It was determined that as the contact time with blood increased, tooth discoloration increased. However, no significant difference was found between dentin tubule occlusion methods in preventing color change (p > 0.05). CONCLUSIONS: It was determined that no dentin tubule occlusion method could 100% prevent discoloration caused by RET. CLINICAL RELEVANCE: DBA and Teethmate, which do not have a significant difference in terms of preventing color change, are considered to be suitable for dentin tubule occlusion due to their ease of application and low cost compared to Nd:YAG laser and Er:YAG laser.

Effect of Different Obturation Techniques on Sealer Penetration in Teeth with Artificial Internal Root Resorption: a Confocal Laser Microscope Analysis.

OBJECTIVE: To investigate the efficacy of different obturation techniques on sealer penetration in teeth with internal root resorption using confocal laser microscopy. METHODS: An artificial internal resorption cavity (3 mm deep and 1.2 mm in diameter) was formed in the round-shaped root canals of 45 single-rooted teeth at a distance of 7 mm from the apex, then roots were instrumented (size 40/.06). The samples were divided into three groups (n = 15) according to the obturation technique: lateral compaction (LC), warm vertical compaction (WVC) and carrier-based (CB). RESULTS: In the resorption regions, the sealer penetration depth in the CB and LC groups was significantly higher than that in the WVC group (P < 0.05). CONCLUSION: Within the limitations of this study, the penetration depth of the sealer in the resorption region was higher in the CB and LC groups as compared to that in the WVC group.

Effect of Different Irrigation Activation Techniques on Sealer Penetration: A Confocal Laser Microscopy Study.

OBJECTIVE: To compare the efficiency of a new sonic powered irrigation system named EDDY (VDW, Munich, Germany), passive ultrasonic irrigation (PUI) and conventional needle irrigation (CNI) in root canal sealer penetration. METHODS: A total of 45 mandibular premolars were instrumented up to size 30, 0.9 taper and randomly divided into three groups (n = 15) depending on the final irrigation activation technique: EDDY, PUI or CNI. After the final irrigation procedures, the root canals were obturated with labelled sealer mixed with 0.1% rhodamine B. Transverse sections at 3, 5 and 7 mm from the root apex were examined using confocal laser scanning microscopy. The maximum depth and total area and percentage of sealer penetration were measured using ImageJ analysis software (National Institutes of Health, Bethesda, MD, USA). RESULTS: In the EDDY group, the penetration depth was higher compared to the CNI group in the apical and middle sections and compared to the PUI group in the apical section (P ˂ 0.05). The penetration area in the EDDY group was higher compared to the CNI group in all sections and compared to the PUI group in the coronal section (P ˂ 0.05). The percentage of penetration was higher in the EDDY group compared to the CNI group in all sections and compared to the PUI group in the coronal section (P ˂ 0.05). CONCLUSION: In the present study, sealer penetration was superior in the EDDY group than the CNI group in the apical section. In the middle and coronal sections, sealer penetration was similar for the EDDY and PUI groups.

Determination of Root Canal Length Up to Perforation Area Using Different Electronic Apex Locators and CBCT Images Obtained at Different Voxel Sizes: A Comparative Ex Vivo Study.

OBJECTIVE: To compare the accuracy of electronic apex locators in the presence of blood and CBCT images obtained with two different voxel sizes (0.125 mm and 0.25 mm) in determining root canal length up to the perforation area. METHODS: Forty extracted, single-rooted human teeth were selected and an artificial root perforation (0.4 ± 0.1 or 1.0 ± 0.2 mm diameter) was created in the middle third of the root. The actual root canal length up to the perforation area was determined under a stereomicroscope. CBCT images were obtained with a voxel size of 0.125 mm and 0.25 mm. The root canal length up to the perforation area was measured on CBCT images and recorded as the radiographic length. The teeth were embedded in alginate and root canal length up to the perforation area was measured using two different EALs (DentaPort ZX [Morita, Tokyo, Japan] and Gold Reciproc motor [VDW, Munich, Germany]) and recorded as the electronic length. RESULTS: In teeth with an artificial root perforation 0.4 mm in diameter, the measurements obtained with DentaPort ZX were more accurate than with the Gold Reciproc motor (P ˂ 0.05), and on CBCT images, more accurate measurements were obtained with a voxel size of 0.125 mm compared to 0.25 mm (P ˂ 0.05). In teeth with an artificial root perforation 1.0 mm in diameter, the radiographic length was closer to actual length than the electronic length (P ˂ 0.05). CONCLUSION: In artificial root perforations with a diameter of 0.4 mm, CBCT gives more reliable results than EALs. Both EAL and CBCT measurements were closer to actual length in artificial perforations that were 1.0 mm in diameter.

Efficacy of different irrigation activation systems on bacterial extrusion.

The purpose of this study was to evaluate the quantity of extruded bacteria following with EndoVac, EDDY, EndoActivator (EA) and standard needle irrigation (SNI). Ninety teeth with a single root and canal were included in this study. Fifteen teeth were selected as the negative control group to confirm sterilization. Seventy-five teeth were contaminated with Enterococcus faecalis (E. faecalis) for 4 weeks. Teeth were prepared and divided into five groups (n:15): EndoVac, EDDY, EA, SNI and positive control groups. The extruded bacteria were cultured for bacterial quantification. The counts of extruded bacteria were lower in the EndoVac group compared to the EDDY group (P˂ 0.05). The counts of extrusion bacteria were not different in EA and SNI groups compared to EDDY and EndoVac groups (P > 0.05). Within the limits of this study, EndoVac was found to be more reliable irrigation systems than EDDY in terms of the bacterial extrusion.

Evaluation of different Apexification treatments of teeth with immature apices and apical periodontitis on the fractal dimensions of trabecular bone.

The aim of the present study was to investigate in the fractal dimension (FD) time-dependent changes of periapical bone after two different apexification treatments in teeth with immature apices and apical periodontitis. This study included 55 cases treated with apexification. Cases were divided into two groups: a calcium hydroxide group and a mineral trioxide aggregate group. In each case, the lesion area was evaluated by fractal analysis on periapical radiographs obtained before and 1-year after treatment via Image-J program. The FD of each region of interest on the radiographs was calculated using the fractal analysis method. The data were statistically analysed. In both groups, the FD values increased compare to initial at 1-year follow-up after treatment (P < .05). There was no statistically significant difference between the groups in terms of the time-dependent increase in FD values (P = 0.118). In the present study, time-dependent changes in FD were independent of the apexification method.

The impact of different voxels and exposure parameters of CBCT for the assessment of external root resorptions: A phantom study.

This study aimed to compare the effectiveness of the different voxel sizes and imaging parameters of cone beam computed tomography (CBCT) on the determination of external root resorption (ERR). ERRs were created in coronal, middle and apical regions. Depths (0.62-0.73 mm) and diameters (0.68-0.81 mm) of ERRs were measured using a digital calliper. Images were obtained in 0.125, 0.2, 0.25, 0.3 and 0.4 mm3 voxel sizes and at different currents. Data were analysed using Friedman and Wilcoxon signed-rank tests at a level of P < 0.05. There was a difference between the parameters in determining the size of the ERR in coronal and middle regions (P < 0.05), but there was no difference in the apical region (P > 0.05). The change in current and exposure time did not make a difference in determining the dimensions of the ERRs (P > 0.05). Some voxel dimensions were more reliable in determining the depth and diameter of ERR in the coronal and middle region.

Effects of root-end filling on the fractal dimension of the periapical bone after periapical surgery: retrospective study.

OBJECTIVE: The aim of this study was to investigate the effects of root-end filling after periapical surgery on the fractal dimension (FD) of the periapical bone. METHODS: Thirty-eight patients who underwent periapical surgery were included in this study. The cases were divided into two subgroups: (1) In the gutta-percha group, root cavity and root-end fillings were not performed after root resection. In this group, there were 14 female patients and 6 male patients. (2) In the mineral trioxide aggregate (MTA) group, the root end was filled with MTA after root resection. In this group, there were 13 female patients and 5 male patients. Each patient underwent two periapical radiographs, one shortly after periapical surgery (10-15 days) and another one 1 year after periapical surgery. Regions of interest (ROIs) located close to the infected root apex were selected for each radiograph. Periapical radiographs were digitized and processed with an FD analysis using the box-counting method. RESULTS: FD was significantly increased in both groups over time (p < 0.05). The increases in FD between groups were not significant (p > 0.05). CONCLUSIONS: Mathematical morphology combined with the box-counting method showed that the FD change was independent of the root-end filling at the 1-year follow-up after periapical surgery. CLINICAL RELEVANCE: Because of the complex anatomy of the root canal, orthograde endodontic treatment may be inadequate and periapical surgery becomes an alternative in these cases. In this study, the effect of root-end filling on the increase in trabecular bone after periapical surgery was investigated using fractal analysis.

Effect of Reciproc blue, XP-endo shaper, and WaveOne gold instruments on dentinal microcrack formation: A micro-computed tomographic evaluation.

The purpose of this study was to evaluate and compare the effect of Reciproc Blue (RPCB), XP-endo Shaper (XPS), and WaveOne Gold (WOG) single-files on dentinal microcrack formation using micro-computed tomography (micro-CT). Twenty-four mesial roots (24 mesio-buccal and 24 mesio-lingual canals) of mandibular molar teeth were prepared using RPCB, XPS, and WOG files (n = 8/each group). The samples were scanned with micro-CT in the pre- and post-preparation. Then, before preparation and after preparation cross-sectional images of the teeth were evaluated to detect the presence of microcracks. For each group, the number of microcracks was calculated as a percentage rate. The data were statistically analyzed using McNemar at 5% significance level (p < .05). Dentinal microcracks were observed in 25.99% (2,103 of 7,813), 31.99% (2,482 of 7,758), and 36.66% (2,836 of 7,731) of cross-sectional images of the XPS, WOG, and RPCB groups, respectively. In all the groups, all the dentinal microcracks seen in the post-treatment cross-sectional images were present in the corresponding pre-treatment images. Within the limitations of this study, the XPS, WOG, and RPCB files did not cause new dentinal microcrack formation or propagation of existing dentinal microcracks.

Relationship between the anatomic structures and mandibular posterior teeth for endodontic surgery in a Turkish population: a cone-beam computed tomographic analysis.

OBJECTIVE: The purpose of this study is to evaluate the relationship between anatomic structures and mandibular posterior region using cone-beam computed tomography (CBCT) in terms of endodontic surgery. METHODS: A total of 150 CBCT images were used to investigate the proximity of the anatomical structures and the mandibular posterior teeth. The buccal and lingual bone thickness overlying each root, buccolingual, and mesiodistal dimension of the roots were measured at the level of 3 mm apical resection, and the mental foramen (MF) distance to the premolar teeth and the distance of the mandibular canal (MC) to all the posterior teeth were measured. RESULTS: The thinnest part of the buccal cortical bone was measured in the first premolar teeth (1.70 mm) and in the mesial root of the first molar (2.25 mm) while the thickest region was measured in the distal root of the second molar tooth (6.95 mm). The maximum amount of substance to be removed was measured at the distal root of the second molar tooth (11.26 mm), and at least the first premolar tooth (5.52 mm) was measured for buccal resection. The distal root of the second molar tooth was found to be the closest tooth root to the MC with a mean of 2.75 mm, and the closest distance was measured as 0 mm. CONCLUSIONS: It is important to evaluate the parameters such as mandibular buccal and lingual bone thickness, location of the MC and the MF, and root size for atraumatic endodontic surgical approach. Evaluation of these data before endodontic surgery provides guidance to the clinician in the planning of endodontic surgery. CLINICAL RELEVANCE: The mandibular posterior region, which is difficult to reach with traditional surgical approach, is now easily reached using an operation microscope. For this reason, endodontic surgical procedures have become popular in mandibular posterior teeth. Therefore, the relationship between the mandibular posterior teeth and anatomical structures that are important in the planning of surgical access line is examined in this study.

Relationship Between Pulp Tooth Area Ratio and Chronological Age Using Cone-beam Computed Tomography Images.

This study investigated the relationship between chronological age and pulp tooth area ratio (PTR) in maxillary central teeth using cone-beam computed tomography (CBCT) images in the Turkish population. The sample consisted of CBCT images of 120 male and female subjects between 14 and 75 years old. The PTR of the maxillary central teeth was calculated using inVivo 5 software (Anatomage, San Jose, CA). Data were analyzed with independent t-test and Pearson's rank correlation test. There was a significant negative correlation between chronological age and PTR (r = -0.615). The results showed that the PTR of maxillary central teeth is a reliable method for age estimation in the Turkish population.

Assessment of toxicity and oxidative DNA damage of sodium hypochlorite, chitosan and propolis on fibroblast cells.

The objective of this study was to evaluate and compare the cytotoxicity and genotoxicity on human fibroblast cell lines of sodium hypochlorite (NaOCl), chitosan and propolis as root canal irrigating solutions. Human fibroblast cells were exposed to chitosan, propolis and NaOCl for 4 and 24 h. Cell viability was assessed by 2,3-bis-(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide, and oxidative DNA damage was assessed by determination of 8-hydroxydeoxyguanosine (8-OHdG) level with an ELISA kit. The data of cell cytotoxicity were analysed statistically using a test of one-way analysis of variance at a significance level of p < 0.05. In the NaOCI group, the 8-OHdG level was higher than in the chitosan group, but there was no statistical difference when compared with the other groups (p < 0.05). It was determined that the irrigation solutions were cytotoxic, depending on the dose and time. NaOCl was the most toxic solution after both 4 and 24 h of exposure (p < 0.05). Chitosan and propolis may be alternatives to NaOCl for irrigation solutions, because they are both less toxic and produce less oxidative DNA damage.

Assessment of toxicity and oxidative DNA damage of sodium hypochlorite, chitosan and propolis on fibroblast cells

Abstract The objective of this study was to evaluate and compare the cytotoxicity and genotoxicity on human fibroblast cell lines of sodium hypochlorite (NaOCl), chitosan and propolis as root canal irrigating solutions. Human fibroblast cells were exposed to chitosan, propolis and NaOCl for 4 and 24 h. Cell viability was assessed by 2,3-bis-(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide, and oxidative DNA damage was assessed by determination of 8-hydroxydeoxyguanosine (8-OHdG) level with an ELISA kit. The data of cell cytotoxicity were analysed statistically using a test of one-way analysis of variance at a significance level of p < 0.05. In the NaOCI group, the 8-OHdG level was higher than in the chitosan group, but there was no statistical difference when compared with the other groups (p < 0.05). It was determined that the irrigation solutions were cytotoxic, depending on the dose and time. NaOCl was the most toxic solution after both 4 and 24 h of exposure (p < 0.05). Chitosan and propolis may be alternatives to NaOCl for irrigation solutions, because they are both less toxic and produce less oxidative DNA damage.