Articaine and Lidocaine Mandibular Buccal Infiltration Anesthesia: A Prospective Randomized Double-Blind Cross-Over Study
Mohammad Dib Kanaa, MPhil, DDS, John Martin Whitworth, PhD, BChD, Ian Porter Corbett, PhD, BDS, John Gerard Meechan, PhD, BDS
This randomized crossover double-blind trial compared the efficacy of buccal infiltration with 4% articaine and 2% lidocaine (both with 1:100,000 epinephrine) in securing mandibular first molar pulp anesthesia. Injections were given at least 1 week apart in 31 healthy adult volunteers. Electronic pulp testing was undertaken at baseline and at 2 minute intervals until 30 minutes postinjection. A successful outcome was recorded in the absence of pulp sensation on two consecutive maximal pulp tester stimulations (80 μA). 64.5% of articaine and 38.7% of lidocaine infiltrations were successful (p = 0.008). Articaine infiltration produced significantly more episodes of no response to maximum stimulation in first molars than lidocaine (236 and 129, respectively, p < 0.001). Mandibular buccal infiltration is more effective with 4% articaine with epinephrine compared to 2% lidocaine with epinephrine. Both injections were associated with mild discomfort.
Treatment Outcome in Endodontics: The Toronto Study. Phase III: Initial Treatment
Vincent L. Marquis, DMD, MSc, Thuan Dao, DMD, MSc, PhD, Mahsa Farzaneh, DDS, MSc, Sarah Abitbol, DDS, MSc, Shimon Friedman, DMD
The 4- to 6-year outcome of initial endodontic treatment was assessed for phase III (1998-1999) of the Toronto Study. Of the 532 teeth treated, 248 were from discontinuers (excluded), 142 from dropouts, 10 extracted, and 132 (50% recall) examined for outcome: healed (no apical periodontitis [AP], signs, symptoms) or diseased. Phase III was analyzed alone and combined with phases I, II (n = 373 teeth). Logistic regression performed on the combined phases I-III sample identified significant (p ≤ 0.05) outcome predictors: preoperative AP (OR = 3.5; CI 1.7-7.2; healed: absent, 93%; present, 80%), number of roots (OR = 2.2; CI 1.0-4.7; healed: 1 - 92%; ≥2 - 83%), and intraoperative complications (OR = 2.2; CI 1.1-4.5; healed: absent, 88%; present, 76%). Treatment technique (OR = 2.8; CI 1.3-6.1; healed: Schilder, 89%; alternative, 73%) was suggested as an outcome predictor in teeth with AP, requiring confirmation from randomized controlled trials.
Roentgenographic In Vitro Investigation of Frequency and Location of Curvatures in Human Maxillary Premolars
Brita Willershausen, DDS, PhD, Haki Tekyatan, DDS, Adrian Kasaj, DDS, Benjamin Briseño Marroquín, DDS, PhD
The aim of this study was to determine the location of the root canal curvature and measure the distance from the CEJ to the first curvature using in vitro methods. Extracted maxillary premolars (n = 358) were fixed and digitally radiographed using the parallel technique. Excluded from further analysis were teeth with root caries, artificial crowns, extensive fillings, or endodontic treatments. The results were descriptively analyzed and the cumulative frequencies were calculated. The median values of the distance between CEJ and first curvature were for the first right premolars 8.4 mm (buccal) and 8.5 mm (palatal), for the first left premolars 9.1 mm (buccal) and 8.9 mm (palatal). The median distances in the second premolars were 10.7 mm (right side) and 10.2 mm (left side). The results showed that a high number of maxillary premolars had a curvature with a median value of 8 mm apically from the CEJ. Our findings suggest that such measurements may be useful to consider during endodontic treatment and post insertion.
Autoaggregation and Coaggregation of Bacteria Associated with Acute Endodontic Infections
Saengusa Khemaleelakul, DDS, John Craig Baumgartner, DDS, PhD, Sumalee Pruksakom, BS, MS, PhD
Biofilms and microbial aggregates are a common mechanism for the survival of bacteria in nature. Microbial aggregates have been associated with intraradicular and extraradicular endodontic disease. One objective of this study was to assess bacteria isolated from acute endodontic infections for autoaggregation and coaggregation. Another objective was to use both a conventional visual assay and a novel fluorescent dye-staining technique to study bacterial aggregation. Sixty-two strains of bacteria were isolated from 10 clinical samples of endodontic abscesses or cellulitis. Autoaggregation was detected in 35/62 (56.45%) of the bacteria using the visual assay. Coaggregation of bacteria from each of the samples was demonstrated for 29/183 (15.85%) bacterial pairs using the visual assay and 148/183 (80.87%) using the dye-staining assay. Coaggregation was observed for each of the 15 genera assayed, especially Prevotella, Streptococcus, and Fusobacterium. The dye-staining assay using a confocal microscope was a highly sensitive method to detect aggregation of bacteria.
Local Opioids in the Inflamed Dental Pulp
Angela Suzanne Mudie, DDS, Graham Rex Holland, PhD
We have looked for the presence of β-endorphin and somatostatin in normal and inflamed pulps. In 25 adult rats, under anesthesia, small openings were made into the pulp on the mesial surface of both first molars on one side. One week later all four first molars were removed, half were processed for immunohistochemistry using specific antibodies to β-endorphin, somatostatin, and CD3, a marker for T lymphocytes. The pulps of the remainder were removed, solubilized, and subjected to enzyme-linked immunosorbent assay for somatostatin and β-endorphin. Many cells that labeled for β-endorphin and somatostatin in the injured pulps also stained for CD3. The levels of both β-endorphin and somatostatin, were higher in the exposed than in the uninjured pulps (t test, p < 0.05). β-endorphin and somatostatin are both produced in increased amounts in the dental pulp during inflammation attributable, at least in part, to the presence of T lymphocytes producing these substances.
Comparison of the Sealing of Resilon, Pro Root MTA, and Super-EBA as Root-End Filling Materials: A Bacterial Leakage Study
Christos Maltezos, DDS, Gerald N. Glickman, DDS, MS, Paul Ezzo, DDS, PhD, Jianing He, DMD, PhD
The purpose of this in vitro study was to compare the root-end sealing of the Resilon/Epiphany system (RES) to Pro Root MTA and Super-EBA using a bacterial leakage system. Fifty-five extracted teeth were instrumented and root-ends were resected and ultrasonically prepared. Test materials were placed in the root-end preparations; Streptococcus salivarius was introduced coronally and the apical 4 mm were immersed in BHI culture medium with phenol red indicator. Bacterial leakage was monitored every 24 h for 4 wk. All positive controls leaked within 24 h; none of the negative controls leaked. Based on χ2 analysis (p < 0.05), RES and MTA leaked significantly less than Super-EBA. There was no statistical difference between RES and MTA. RES may be a viable option as a root-end filling material with good surgical isolation.
Fracture Resistance of Upper and Lower Incisors Restored with Glass Fiber Reinforced Posts
Marc Schmitter, Dr. med. Dent, Claudia Huy, Brigitte Ohlmann, Dr. med. Dent, Olaf Gabbert, Herbert Gilde, Prof. Dr., Peter Rammelsberg, Prof. Dr.
The aim of this in vitro study was to evaluate the fracture resistance of upper and lower incisors restored with glass fiber reinforced posts (FRP). There were 32 upper and 32 lower incisors endodontically treated and FRPs were cemented, using pretreated (Rocatec) and non-pretreated posts. Crowns were fabricated and cemented with Ketac-cem or Panavia. Additionally, eight upper and lower incisors with intact natural crowns were used as control groups. Mandibular incisors restored with FRPs attain fracture strengths comparable to those of natural teeth. The fracture strength of all teeth was increased by using Rocatec. Cementation of the crowns using Panavia only increased the fracture strength in upper incisors. Rocatec used to pretreat the posts and crowns cemented using an adhesive cement appear to reduce the risk of clinical failure.
In Vitro Antifungal Efficacy of Four Irrigants as a Final Rinse
Melissa L. Ruff, DMD, MS, Scott B. McClanahan, DDS, MS, Britta S. Babel, BSMT
Abstract
The purpose of this study was to compare the antifungal efficacy of 6% sodium hypochlorite (NaOCl), 2% chlorhexidine gluconate (CHX), 17% ethylene-diaminetetraacetic acid (EDTA), and BioPure MTAD as a final rinse on Candida albicans in vitro. Forty-eight, single rooted teeth were randomly divided into four groups each with a positive and a negative control. After root canal preparation, experimental teeth were inoculated with Candida albicans (ATCC 60193) and incubated for 72 hours. The groups were rinsed as follows: 1 ml of 6% NaOCl, 0.2 ml of 2% CHX, 1 ml of 17% EDTA, and 5 ml of BioPure MTAD. Aliquots from the experimental teeth were plated on Sabouraud 4% dextrose agar plates and colony-forming units were counted as a measure of antifungal activity. The results showed that 6% NaOCl and 2% CHX were equally effective and statistically significantly superior to BioPure MTAD and 17% EDTA (p < 0.05) in antifungal activity.
Effect of Setting Conditions on Mineral Trioxide Aggregate Flexural Strength
Mary P. Walker, DDS, PhD, Adam Diliberto, Charles Lee, DDS
This study evaluated the effect of setting conditions (time and hydration) on mineral trioxide aggregate (MTA) flexural strength. MTA beam specimens were allowed to set for either 24 or 72 hours with specimens exposed to moisture on either one or two specimen surfaces. These moisture conditions were used to simulate MTA setting with only external tissue moisture (one-sided moisture) versus tissue moisture in combination with a moistened intracanal cotton pellet (two-sided moisture). Ten specimens were stored at 37°C under each of the four experimental setting conditions (1) 24-hour/moist/2-sided; (2) 24-hour/moist/1-sided; (3) 72-hour/moist/2-sided; (4) 72-hour/moist/1-sided. After storage at respective setting conditions, MTA specimens were tested to failure with three-point bend test to measure flexural strength. Flexural strength of the 24h/moist/2-sided specimens, 14.27 ± 1.96 MPa, was significantly higher (p ≤ 0.05) than the flexural strength values associated with conditions two, three, and four, respectively, 10.77 ± 1.44, 11.16 ± 0.96, 11.18 ± 0.99 MPa, which were not significantly different from each other (p > 0.05). Clinically, these results suggest that a moistened cotton pellet should be placed on the intracanal MTA surface under a temporary restoration; and if possible, to optimize flexural strength, the moistened pellet should only remain in place for 24 hours.
Furcation Perforation Repair Comparing Gray and White MTA: A Dye Extraction Study
Hatim A. Hamad, DDS, MS, Patricia A. Tordik, DMD, Scott B. McClanahan, DDS, MS
The purpose of this study was to evaluate the ability of gray and white ProRoot MTA to seal furcation perforations in mandibular molars using a dye extraction leakage model. Sixty-four mandibular molars were randomly divided into four experimental groups. Six teeth with perforations were used as positive controls and six teeth without perforations were used as negative controls. Perforations in groups 1 and 2 were repaired with white MTA. Groups 3 and 4 were repaired with gray MTA. Dye leakage was tested from an orthograde direction (groups 1 and 3) and a retrograde direction (groups 2 and 4). After dye extraction, absorbance was measured on a spectrophotometer at 550 nm. No statistically significant difference in leakage was found between gray and white MTA when used as a furcation perforation repair material. However, there was significantly more leakage when the perforations were challenged from the orthograde than the retrograde direction (p < 0.001).
Efficacy of Retreatment Techniques for a Resin-Based Root Canal Obturation Material
Elie Ezzie, DDS, Alex Fleury, DDS, MS, Eric Solomon, DDS, MA, Robert Spears, PhD, Jianing He, DMD, PhD
Resilon/Epiphany obturation system is emerging as an alternative to gutta-percha (GP). The efficacy of retreatment techniques for Resilon removal has not been determined. The purpose of this study was to evaluate two commonly used retreatment techniques in the removal of Resilon. Sixty single-canal teeth were instrumented and obturated with either Resilon/Epiphany or GP/AH Plus. Each canal was randomly allocated to receive one of the two retreatment techniques—ProFile 0.06 rotary files combined with heat or chloroform. The time required to remove the obturation material was recorded and the cleanliness of canal walls was determined by stereomicroscope and electron microscopy. The results demonstrated that chloroform combined with rotary files was more efficient in material removal compared to heat (p < 0.05). Resilon was faster to remove than GP. Both techniques resulted in cleaner canal walls in the apical third of the teeth obturated with Resilon when compared to GP (p < 0.05).
Antibacterial Effect of Selected Root-End Filling Materials
Ayce Unverdi Eldeniz, Hasan Huseyin Hadimli, Hanife Ataoglu, Dag Ørstavik
The purpose of this study was to evaluate the antibacterial activity of leachable components of selected root-end filling materials: amalgam, ProRoot MTA (mineral trioxide aggregate), Intermediate Restorative Material (IRM), Super Bond C&B, Geristore, Dyract, Clearfil APX composite with SE Bond, or Protect Bond. The direct contact test (DCT) with Staphylococcus aureus, Enterococcus faecalis, and Pseudomonas aeruginosa, was used. The materials were tested immediately after application to the microtiter wells (fresh samples) and after setting for 3 days (set samples). Ten microliters of bacterial suspension was added to each well for direct contact with each material for 1 h at 37°C. Growth of surviving bacteria was then measured in a microplate spectrophotometer hourly at 620 nm for 15 h. Twelve uncoated wells using identical inoculum size served as positive controls. The data obtained at the end of 15 h was subjected to one-way ANOVA and post hoc comparisons were done using Tamhane’s T2 test. Fresh samples of all materials showed a 3-h delay in exponential growth of both E. faecalis and S. aureus, and a 5-h delay in growth of P. aeruginosa. Set samples of IRM and ProRoot MTA cements showed generally greater antibacterial activity than the other materials: both completely inhibited P. aeruginosa, and both delayed or limited growth of E. faecalis. The DCT, by being quantitative and virtually independent of solubility and diffusion, was found suitable to assay solid root-end filling materials. IRM and ProRoot MTA were generally more potent inhibitors of bacterial-growth than the other tested materials.
Reinforcement of Immature Roots with a New Resin Filling Material
Charles H. Stuart, DDS, Scott A. Schwartz, DDS, Thomas J. Beeson, DDS
The purpose of this study was to compare the reinforcement and strengthening ability of Resilon, gutta-percha, and a self-curing composite resin (Bisfil 2B) in endodontically treated roots of immature teeth. Sixty single rooted teeth were divided into five groups of 12 teeth each. Teeth in all groups except the negative controls were prepared with a #5 Peeso (1.5 mm) through the apex (simulating immature roots) and root ends were filled with a 4 mm barrier of MTA. After smear layer removal, canals in the three experimental groups were backfilled with gutta-percha, Resilon, or Bisfil 2B. The remaining canal space in the positive control group was left unfilled. Negative controls received no treatment. A horizontal fracture was created in the root of each specimen using an Instron and the mean peak loads to fracture were recorded. ANOVA revealed no significant difference between any of the treatment groups. Based on the results of this study, canal wall reinforcement of teeth with a canal diameter of 1.5 mm or less may not be necessary.
Potential Iatrogenic Tetracycline Staining of Endodontically Treated Teeth via NaOCl/MTAD Irrigation: A Preliminary Report
Franklin R. Tay, Annalisa Mazzoni, David H. Pashley, Thomas E. Day, Emmanuel C. Ngoh, Lorenzo Breschi
This study reported red-purple staining of light-exposed, root-treated dentin when root canals were rinsed with 1.3% NaOCl as initial rinse followed by the use of BioPure MTAD as final rinse. This intrinsic dentin staining occurred irrespective of whether the root canals were filled, and could be observed even in crown dentin when the latter was sequentially immersed in NaOCl and MTAD. Bench-top reproductions of the phenomenon revealed that the exothermic reaction is not an acid-base reaction. Conversely, the reaction is of a redox nature that highly resembled the previously reported mechanism of tetracycline staining, in which photo-oxidation of tetracycline resulted in a red-purple tetracycline degradation product that has a high affinity for hydroxyapatite. This photo-oxidative degradation process is probably triggered by the use of NaOCl as an oxidizing agent, and may be prevented by rinsing the NaOCl-treated dentin with ascorbic acid, a reducing agent, before the application of MTAD.
Evaluation of Cutting Efficiency of Ultrasonic Tips Used in Orthograde Endodontic Treatment
Yu-heng Lin, DDS, MSD, André K. Mickel, DDS, MSD, Jefferson J. Jones, DMD, Thomas A. Montagnese, DDS, MS, Alvaro F. González, BDS, DMD, MSD
The purpose of the present study was to evaluate the cutting efficiency of the three different ultrasonic tips for orthograde endodontic treatment: stainless steel, zirconium nitride-coated, and diamond-coated tips. An ultrasonic handpiece was mounted on a custom-made automated balance, and each tip repeatedly penetrated dental stone blocks to a depth of 3 mm for 10 times. The amount of time taken to penetrate 3 mm of stone was measured. The diamond-coated tips showed significantly greater cutting efficiency than either stainless steel tips or zirconium-nitride coated tips. The stainless steel tips showed initial better cutting efficiency, but over time Table 1, there is no significant difference between the cutting efficiency of the stainless steel tips and the zirconium nitride coated tips. The diamond coated tips were the only group that showed breakage in this study.
Comparison Between Gutta-Percha and Resilon Removal Using Two Different Techniques in Endodontic Retreatment
Daniel Pinto de Oliveira, DDS, MSc, Joao Vicente Baroni Barbizam, DDS, MSc, Martin Trope, BDS, DMD, Fabricio B. Teixeira, DDS, MSc, PhD
This study compared the remaining filling material and working time when removing gutta-percha/AH 26 and Resilon/Epiphany from root filled extracted teeth. The root fillings were removed using chloroform and two different rotary systems (K3 and Liberator files). The amount of residual filling material on the canal walls was imaged and measured using image analyzer software. The group filled with Resilon/Epiphany and retreated with K3 files demonstrated the least residual filling material on the walls (p < 0.05). There was no statistically significant difference between the gutta-percha/AH26 and Resilon/Epiphany groups when the Liberator files were used (p > 0.05). In the groups filled with Resilon/Epiphany, the filling was removed faster than groups filled with gutta-percha/AH 26 (p < 0.05). K3 rotary system was faster than Liberator to remove both gutta-percha and Resilon (p < 0.05). Resilon/Epiphany was effectively removed with K3 or Liberator rotary files.
Comparison of Antifungal Activity of White-Colored and Gray-Colored Mineral Trioxide Aggregate (MTA) at Similar Concentrations Against Candida albicans
Khalid Al-Hezaimi, BDS, Jafar Naghshbandi, DDS, Samuel Oglesby, DDS, James H.S. Simon, DDS, Ilan Rotstein, DDS
Abstract
The killing effect of similar concentrations of white-colored MTA and gray-colored MTA against Candida albicans was assessed in vitro using the tube dilution test. A direct correlation was found between MTA concentration and its killing effect on C. albicans. At time period zero, both white-colored and gray-colored MTA samples showed Candida growth regardless of the concentration. Tubes containing gray-colored MTA in concentrations of 50, 25, 12.5, 6.25, and 3.125 mg/ml and tubes containing white-colored MTA in concentrations of 50 and 25 mg/ml did not show C. albicans growth at any of the other time periods tested. Tubes containing white-colored MTA in concentrations of 12.5 mg/ml or less showed Candida growth at all the time periods tested. Statistically, a significant difference was found between tubes containing either 50 mg/ml or 25 mg/ml and tubes containing lower concentrations of white-colored MTA (p < 0.001). A significant difference was also found between tubes containing gray-colored MTA in concentrations of 12.5 mg/ml or less and tubes containing similar concentrations of white-colored MTA (p < 0.001). It appears that both gray-colored and white-colored MTA in concentrations of 50 mg/ml and 25 mg/ml are effective in killing C. albicans for periods of up to 1 wk. Lower concentrations of gray-colored MTA may still be effective while lower concentrations of white-colored MTA may not.
Leakage of Bovine Serum Albumin in Root Canals Obturated with Super-EBA and IRM
Ana Malcic, DDS, Silvana Jukic, DDS, PhD, Valentina Brzovic, DDS, Ivana Miletic, DDS, PhD, Ivica Anic, DDS, PhD
The aim of this study was to determine the leakage of SuperEBA and intermediate restorative material (IRM) in root canal samples, with or without orthograde filling, by evaluating bovine serum albumin (BSA) microleakage using spectrophotometry. Thirty-five single-rooted teeth were divided into five groups, instrumented, and had apices resected. Root-end cavities in groups I and II were filled with SuperEBA and IRM. The samples from the groups III, IV, and V were filled with gutta-percha and sealer. In groups IV and V, root-end cavities were filled with SuperEBA and IRM. After 60 days, the greatest microleakage of BSA was observed in group II (4.1 ± 0.0011 ng), followed by group III (3.4 ± 0.0064 ng), and then group I (2.6 ± 0.0019 ng). Samples from groups IV and V leaked the least (0.7 ± 0.0014 ng). Significantly less leakage (p < 0.05) occurred in samples filled with orthograde and root-end fillings than did in samples filled only with an orthograde approach and the samples with IRM root-end fillings.
Comparative Study of Torsional and Bending Properties for Six Models of Nickel-Titanium Root Canal Instruments with Different Cross-Sections
Xuejun Xu, M. Eng, Yufeng Zheng, D. Eng
This study investigated the influence of cross-section profile on the mechanical behaviors of six commercial nickel-titanium (NiTi) root canal instruments using the finite element method. The nonlinear mechanical characteristics of the NiTi alloy were taken into account. The six root canal instruments studied were ProTaper, Hero642, Mtwo, ProFile, Quantec, and NiTiflex. Mathematical models for these instruments were constructed and their performances were analyzed under equal torque conditions. The ProTaper and Hero642 models achieved the lowest stress levels that made them the most torque-resistant while the NiTiflex model was the poorest. The maximum stress value and the stress distribution in a model were found strongly influenced by the cross-section profile. Factors affecting the stress distribution include the cross-sectional inertia, depth of the flute, area of the inner core, radial land, and peripheral surface ground. As the area of the inner core of the cross-section increased, the model was more torque-resistant.
Bleaching Teeth Treated Endodontically: Long-Term Evaluation of a Case Series
Massimo Amato, MD, DDS, Maria Serena Scaravilli, Mauro Farella, DDS, PhD, Francesco Riccitiello, MD, DDS
The chromatic stability of nonvital discolored teeth, subjected to the combined intracoronal bleaching technique and to endodontic treatment, was evaluated at a distance of 16 yr (1989-2005). The series comprised 50 patients (age range 7-30 yr) selected from among those attending the Dental Clinic at “Federico II” University, Naples, between 1987 and 1989. After 16 yr, only 35 cases could be evaluated: in 22 of these cases (62.9%) the color had remained stable and was similar to that of adjacent teeth, indicating a successful outcome of the combined bleaching technique. There were 13 cases (37.1%) classified as failures because of marked color relapse. Radiology showed none of the cases re-examined to have undergone internal or external root resorption. These results confirm the validity of the combined intracoronal bleaching technique in terms of efficacy, rapid esthetic result, and safety.