Effect of Diabetes on Tubular Density and Push-out Bond Strength of Mineral Trioxide Aggregate to Dentin

IntroductionThis study compared the tubular density and push-out bond strength of mineral trioxide aggregate (MTA) to dentin in diabetic and nondiabetic patients.MethodsTen extracted single-rooted human teeth from diabetic and nondiabetic patients (n = 5 in each group) were decoronated, prepared up to a #5 Gates-Glidden drill, and sectioned horizontally at the midroot area to prepare 3 dentin slices, each measuring 2 mm in thickness (1 slice for the push-out test and 2 slices for the tubular density test). MTA was prepared and packed into the root canal space followed by incubation for 3 days. The push-out bond strength values were determined using a universal testing machine. Specimens were viewed under a stereomicroscope and a scanning electron microscope to determine the failure types at the cement-dentin interface. Ten slice specimens in each group were evaluated under SEM at 3 different sites to determine the tubular density. Comparisons were performed using the Mann-Whitney U test (P < .05).ResultsDiabetic patients exhibited significantly lower push-out bond strength of MTA to root canal dentin (P < .05). The pattern of failure at the MTA-dentin interface was different between the 2 groups. The tubular density was significantly higher in diabetic patients (P < .05).ConclusionsThe dentin in diabetic patients exhibited different physicochemical properties. The failure patterns and modes in diabetic patients might be explained by the changes in the push-out bond strength, the calcification mechanism of the dentin-pulp complex, a higher dentinal tubule density, and less peritubular dentin. These differences could explain the higher failure rate of root canal treatment in these patients.     

Evaluation of the Amount of Root Canal Dentin Removed and Apical Transportation Occurrence after Instrumentation with ProTaper Next,OneShape, and EdgeFile Rotary Systems

IntroductionThe aim of this study was to evaluate the amount of root canal dentin removed and apical transportation occurrence after instrumentation of mesiobuccal canals of maxillary molars with ProTaper Next (PTN [Dentsply Maillefer, Ballaigues, Switzerland]), OneShape (OS [MicroMega, Besançon, France]), and EdgeFile (EF [Edge Endo, Albuquerque, NM]) rotary systems.MethodsTwenty-seven mesiobuccal canals of maxillary molars were used. Canals were randomly divided into 3 groups for canal preparation: PTN, EF X3, or OS (n = 9 for each group). Micro–computed tomographic imaging was used to measure apical transportation (mm) and the volume of dentin removed (mm³). The amount of dentin removed was measured for the coronal portion and for the whole canal length. Superposition of pre- and postoperative cross-sectional apical slices were used to measure apical transportation at 1 mm from the apex; the differences were evaluated using the Kruskal-Wallis test and Wilcoxon analysis. The Spearman correlation coefficient was used to display the relationship between variables for each group. The significance level was set at P < .05.ResultsThe percentages of the amount of dentin removed on the coronal portion and the amount removed for the whole canal length were statistically similar between groups (P > .05). The average amount of apical transportation for the PTN, OS, and EF X3 were 0.197, 0.263, and 0.218 mm, respectively. Statistically, there were no significant differences between the 3 rotary instruments for apical transportation.ConclusionsThe amount of dentin removed for the coronal third portion and the whole canal length was similar for the PTN, OS, and EF X3 rotary instruments. Although there were differences in the sizes of apical enlargement, no apical transportation was observed in any of the instrumentation systems.     

Impact of Dentin Substrate Modification with Chitosan-Hydroxyapatite Precursor Nanocomplexes on Sealer Penetration and Tensile Strength

IntroductionThe purpose of this study was to evaluate the effect of dentin conditioning with chitosan-hydroxyapatite precursor (C-HA) nanocomplexes on the depth of tricalcium silicate sealer penetration into dentinal tubules and ultimate tensile strength (UTS).Methodssurface charge and size distribution for C-HA nanocomplex formulation was evaluated followed by bioactivity assessment of standardized films of C-HA nanocomplexes (n = 15) incubated in simulated body fluid. Mineralization potential was assessed with X-ray diffraction and Fourier-transform infrared spectroscopy, whereas scanning electron microscopy was used for ultrastructural evaluation. Static water contact angles and UTS were measured on dentin discs (n = 2/group) and dentin beams (n = 10/group) treated with/without sodium hypochlorite/EDTA and C-HA nanocomplex conditioning. In phase 2, the depth of sealer penetration after C-HA nanocomplex conditioning was evaluated using fluorescent imaging (n = 12/group). The percent area penetration and mean/maximum penetration depth were calculated at 4- and 6-mm levels from the root apex. Data from contact angle measurements, mechanical testing, and penetration assessment parameters were subjected to the independent samples t test with a significance level set at P < .05.ResultsA formulation of C-HA nanocomplexes (2 mg/mL) was chosen as a polyanionic, hydrophilic, nonaggregating concentration having bioactivity potential established through the formation of phosphate/carbonate bonds and the crystalline nature of the formed minerals. A significantly lower contact angle and higher UTS were registered for the C-HA nanocomplex–conditioned group (P < .05). Statistically significant (P < .05) greater sealer penetration was recorded at the 4-mm level for all assessment parameters and percent area penetration at 6 mm for the C-HA nanocomplex group.ConclusionsC-HA nanocomplex conditioning enhances dentin surface wettability to facilitate greater tricalcium silicate sealer penetration and UTS of dentin.     

Effect of Ultrasonic Activation of Endodontic Sealers on Intratubular Penetration and Bond Strength to Root Dentin

IntroductionThis study aimed to evaluate the effect of ultrasonic activation (UA) of endodontic sealers on dentin tubule penetration and the bond strength to root dentin.MethodOne hundred single-rooted teeth were prepared with 40.06 nickel-titanium instruments and divided into 2 groups: with or without UA. Three resin-based sealers (MTA Fillapex [Angelus Dental Solutions, Londrina, PR, Brazil], Sealer Plus [MK Life Medical and Dental Products, Porto Alegre, RS, Brazil], and AH Plus [Dentsply, DeTrey GmbH, Konstanz, Germany]; n = 20) and 2 calcium silicate–based sealers (Sealer Plus BC [MK Life Medical and Dental Products] and EndoSequence BC [Brasseler, Savannah, GA], n = 20) were used and subdivided (n = 10) according to the protocols. Fluo-3 (Thermo Fisher Scientific, Waltham, MA) and rhodamine B dyes were added to the calcium silicate- and resin-based sealers, respectively. In the UA groups, the activation was performed for 40 seconds followed by lateral compaction. Samples were transversely sectioned to evaluate the dentin tubule penetration and the bond strength to root dentin. The penetration data were analyzed with the Student t test, 1-factor analysis of variance, and Bonferroni tests. Bond strength was evaluated using the Student t test, Kruskal-Wallis, and Dunn post hoc test.ResultsResin-based sealers showed the highest tubule penetration without UA (P < .05). UA significantly enhanced MTA Fillapex and Endosequence BC dentin tubule penetration (P < .05). AH Plus and Sealer Plus BC improved their bond strength to root dentin after UA (P < .05). AH Plus/UA, Sealer Plus/UA, and Sealer Plus BC/UA presented the highest bond strength values (P < .05). Adhesive failures were predominant in all groups regardless of the use of ultrasound.ConclusionsUA interferes with tubule penetration and the bond strength to root dentin of resin- and calcium silicate–based sealers.     

Influence of Endodontic Procedure on the Adherence of Enterococcus faecalis

IntroductionThe purpose of this study was to investigate the effects of instrumentation and irrigation on the initial adherence of Enterococcus faecalis to root canal dentin and to explore initial microbial adhesion to root filling materials.MethodsThe following specimens were prepared: instrumented and uninstrumented dentin, dentin treated with different irrigation protocols, and root filling materials. The number of E. faecalis cells adhered on dentin was measured. The adhesion force of E. faecalis cells on different materials and the roughness of different surfaces were measured. The contact angle of the surfaces was recorded. The results were analyzed using the t test.ResultsInstrumented dentin specimens had a significantly higher amount of E. faecalis adherence than uninstrumented dentin. There were higher numbers of adhering bacteria on the dentin when EDTA was used alone (P < .05) compared with other irrigants alone. The use of chlorhexidine (CHX) as the last irrigant for a certain time resulted in a reduced number of adhering bacteria when the specimens were first exposed to sodium hypochlorite (NaOCl) followed by EDTA. EDTA used alone had the highest adhesion force followed by NaOCl alone and CHX alone (P < .05). Dentin treated with EDTA alone had the highest roughness and contact angle followed by NaOCl alone and CHX alone (P < .05). CHX added as the final irrigant after NaOCl with EDTA irrigation reduced the contact angle (P < .05). Larger amounts of adhering bacteria and higher adhesion force were detected on the surface of gutta-percha and sealer than on the dentin surface (P < .05).ConclusionsInstrumentation and irrigation alter the initial adherence of E. faecalis to root canal dentin and the surface properties of the dentin as well.     

The Effect of Primary Root Canal Treatment on Dentinal Tubule Penetration of Calcium Silicate–based Sealers during Endodontic Retreatment

IntroductionThe aim of this study was to evaluate the effect of previous root canal treatment on dentinal tubule penetration of calcium silicate–based sealers during endodontic retreatment and to compare 2 different (commonly used and modified) tubule penetration depth measurement techniques.MethodsThe crowns of mandibular premolar teeth were removed, and root canals were prepared (ProTaper Universal; Dentsply Sirona, York, PA) and obturated using AH Plus (AH; Dentsply DeTrey, Konstanz, Germany), MTA Fillapex (MTAF; Angelus, Londrina, Brazil), and WellRoot ST (WRST; Vericom, Gyeonggi-do, South Korea); 0.1% red Rhod-2 dye (Chemodex, St Gallen, Switzerland) was added to the sealers. After storage for 3 weeks (37°C, 100% humid), the following sealer combination subgroups were created (the sealer used during the primary root canal treatment/the sealer used during the retreatment, n = 8): AH/AH, AH/MTAF, and AH/WRST; MTAF/AH, MTAF/MTAF, and MTAF/WRST; and WRST/AH, WRST/MTAF, and WRST/WRST. Green Fluo-3 dye (0.1%) was added to the sealers during retreatment. Sealer penetration depths were measured at 8 points and averaged, and the ratio of the retreatment sealer to the initial sealer was recorded as the mean tubule penetration depth ratio in the first technique, whereas the percentage of the circumferential penetration area ratios of the retreatment and initial sealers was calculated in the second technique. Statistical analyses were performed using Kolmogorov-Smirnov, Kruskal-Wallis, and Mann-Whitney U tests.ResultsThe mean penetration depth of AH and MTFA was found to be higher at the coronal third region in the control groups (P < .05). Both methods showed a significant difference among the groups at the coronal and median regions (P < .05). The AH/WRST, MTAH/AH, MTAF/MTAF, MTAF/WRSTS, and WRST/WRST groups showed deeper tubule penetration (first technique, P = .01). Both techniques showed that the penetration depth of the sealers was the same at the apical region (P > .05), whereas a difference was found among the techniques at the coronal and median regions. The sealers used in the previous root canal treatment limited the penetration depth of the sealers used during the retreatment process (P < .05). When MTAF was used as the initial sealer, the penetration depth of the second sealer did not change, whereas if WRST was the initial sealer, the penetration depth of the sealers at the median and apical regions is negatively affected during the retreatment process (P < .05).ConclusionsPrevious root canal treatment affects the penetration depth of calcium silicate–based sealers. The use of AH Plus and MTA Fillapex during the retreatment process showed an advantage. Both measurement techniques showed similar performances at the apical region, whereas the results varied at the coronal and midcoronal regions; therefore, a more stable sealer penetration measurement technique is still necessary.     

Comparison of In Vitro Torque Generation during Instrumentation with Adaptive Versus Continuous Movement

IntroductionThe purpose of this in vitro study was to compare the torque generated by continuous and adaptive movements of 2 nickel-titanium rotary file systems.MethodsForty-five simulated resin blocks with an S-shaped canal were randomly divided into 3 groups (n = 15) according to the file system and kinematics: the K3XF rotary system (Kerr Endodontics, Orange, CA) with continuous rotary movement, the K3XF with adaptive movement, and the Twisted File (Kerr Endodontics) adaptive file with adaptive movement. After creating a glide path, the canal was instrumented to the same size (.04/#20 for K3XF or SM1 for the Twisted File with adaptive movement) before torque measurement. During the final instrumentation procedure with the .06/25 sized file (K3XF or SM2), the generated torque and the preparation time were recorded. The total torque experienced and the maximum torque value were calculated. The data were statistically analyzed using 1-way analysis of variance and the Tukey post hoc comparison test at a significance level of 95%.ResultsThe K3XF file system used with adaptive motion group showed significantly lower total and maximum torque values compared with the K3XF with continuous rotary movement group. The Twisted File adaptive file with adaptive motion showed significantly lower torque generation and shorter preparation time than the K3XF groups with adaptive or continuous rotation (P < .05).ConclusionsUnder the conditions of this study, adaptive movement for nickel-titanium files may reduce torque generation without increasing preparation time. Nickel-titanium files with a smaller cross-sectional area using adaptive movement may be helpful to reduce the potential risk of root dentin damage.     

Evaluation of Two Trephine Techniques for Removal of Fractured Rotary Nickel-titanium Instruments from Root Canals

IntroductionThe aim of this in vitro study was to evaluate the effects on root dentin of 2 trephining techniques using an ultrasonic tip or a trepan bur in the mesial canals of mandibular molars during attempts to remove fractured file fragments using micro–computed tomographic imaging.MethodsTwenty-one teeth with a similar anatomic configuration in mesial (buccal and lingual) canals were selected. A 4-mm apical segment of K3 file size 25/.06 was fractured in each mesiobuccal and mesiolingual canal 5 mm apically from the canal orifice. A staging platform was prepared at the coronal aspect of the broken instrument followed by either ultrasonics or a new trepan bur technique to expose a 1- to 1.5-mm length of the fragment. If the broken instrument could not be removed by exposing it either by ultrasound or the trepan bur, a microtube device was used to attach to and withdraw the fragment. Micro-CT scanning was performed before and after removing the broken instrument. Canal volume, diameter, and furcal root dentin thickness were measured by using image analysis software. The time required for the removal of the instrument fragments was recorded. The result was statistically analyzed using the paired t test.ResultsThe trepan bur technique had significantly less impact on canal volume, diameter, and furcal root dentin thickness change than the ultrasonic technique (P < .001). The time consumed for successful removal of the fragments was significantly less in the trepan bur group (8.9 ± 3.5 minutes) than in the ultrasonic group (25 ± 11.9 minutes) (P < .001).ConclusionsA new small-sized trepan bur technique was superior to the use of ultrasound with regard to the amount of dentin removed and the speed in the removal of fractured instruments from root canals.     

Free Water Loss–induced Heterogeneous Residual Strain and Reduced Fatigue Resistance in Root Dentin: A 3-dimensional Digital Image Correlation Analysis

IntroductionThis study evaluated free water loss–induced residual strain with and without axial compressive loading and assessed the mechanical effect of cyclic loading in fully hydrated and partially dehydrated root dentin.MethodsRoot dentin sections prepared from freshly extracted human premolars were used. Customized 3-dimensional digital image correlation was used to qualitatively and quantitatively analyze the residual strain induced by 2 hours of free water loss in different regions of root dentin. Residual strain in partially dehydrated root dentin during axial compressive loading was also analyzed using 3-dimensional digital image correlation. The effect of cyclic loading on load to fracture in fully hydrated and partially dehydrated dentin and their fractography were analyzed using micro–computed tomographic imaging.ResultsFree water loss resulted in a heterogeneous distribution of residual strain and an overall formation of residual compressive strain with areas of tensile strain localized to the root canal and outer dentin. More residual compressive strain was observed in the apical dentin compared with the cervical dentin (P < .05), and more residual shear strain was observed in outer dentin compared with inner dentin (P < .05). Axial loading resulted in an increase in the load-induced compressive strain in the direction perpendicular to dentinal tubules (P < .05). Fully hydrated roots displayed a higher mean (P < .05) and median (P < .05) number of cycles to fracture with microcracks characteristic of toughness.ConclusionsAfter free water loss, root dentin displayed an increased formation of heterogenous residual strain, which resulted in increased axial compressive load-induced strain and a decreased resistance to fatigue failure. The effect of free water loss in the loss of mechanical integrity of root-filled teeth needs further investigation.     

Dual function of quercetin as an MMP inhibitor and crosslinker in preventing dentin erosion and abrasion: An in situ/in vivo study

ObjectiveThe aim of the present study was to evaluate the in situ/in vivo effect of quercetin on dentin erosion and abrasion.MethodsHuman dentin blocks (2 × 2 × 2 mm) were embedded and assigned to 6 groups: 75 μg/mL, 150 μg/mL and 300 μg/mL quercetin (Q75, Q150, Q300); 120 μg/mL chlorhexidine (CHX, positive control); and deionized water and ethanol (the negative controls). The specimens were treated with the respective solutions for 2 min and then subjected to in situ/in vivo erosive/abrasive challenge for 7 d as follows: in vivo erosion 4 times a day and then in vivo toothbrush abrasion after the first and last erosive challenges of each day. Dentin loss was assessed by profilometry. An additional dentin specimen was used to evaluate the penetration depth of quercetin into dentin by tracking the spatial distribution of its characteristic Raman peak. Moreover, dentin blocks (7 × 1.7 × 0.7 mm) were used to detect the impact of quercetin on dentin-derived matrix metalloproteinase (MMP) inhibition by in situ zymography, and the inhibition percentage (%) was calculated. Additionally, the potential collagen crosslinking interactions with quercetin were detected by Raman spectroscopy, and the crosslinking degree was determined with a ninhydrin assay. Fully demineralized dentin beams (0.5 × 0.5 × 10 mm) were used to evaluate the impact of quercetin on the mechanical properties of dentin collagen fibre by the ultimate micro-tensile strength test (μUTS). The data were analysed by one-way analysis of variance and Tukey’s test (α = 0.05).ResultsCompared to the negative controls, all treatment solutions significantly reduced dentin loss. The dentin loss of Q150 and Q300 was significantly less than that of CHX (all P < 0.05). The amount of quercetin decreased with increasing dentin depth, and the maximum penetration depth was approximately 25–30 µm. In situ zymography showed that quercetin significantly inhibited the activities of dentin-derived MMPs. The inhibitory percentages of Q75 and Q150 were significantly lower than that of CHX (all P < 0.05), but no significant difference was found between Q300 and CHX (P = 0.58). The collagen crosslinking interactions with quercetin primarily involved hydrogen bonding and the degree of crosslinking increased in a concentration-dependent manner. Statistically significant increases in μUTS values were observed for demineralized dentin beams after quercetin treatment compared with those of the control treatments (all P < 0.05).SignificanceThis study provides the first direct evidence that quercetin could penetrate approximately 25–30 µm into dentin and further prevent dentin erosion and abrasion by inhibiting dentin-derived MMP activity as well as crosslinking collagen of the demineralized organic matrix.     

Effect of Shaft Length on the Torsional Resistance of Rotary Nickel–titanium Instruments

IntroductionThis study was conducted to evaluate the effect of file length on the torsional resistance of nickel-titanium rotary files.MethodsForty-five new files with a #25 tip size and variable taper for ProTaper Next (PTN; Dentsply Sirona, York PA), ProTaper Gold (PTG, Dentsply Sirona), and HyFlex CM (HCM; Coltene-Whaledent, Allstetten, Switzerland) were divided into 3 subgroups (n = 15) according to the file length (21, 25, and 31 mm). Torsional tests were performed using a custom-made device (AEndoS; DMJ System, Busan, Korea). The maximum torsional load and distortion angle were measured until file fracture occurred. The toughness was calculated using these data. All data were statistically analyzed using 2-way analysis of variance at a confidence level of 95%. One-way analysis of variance and Duncan post hoc comparison were also conducted to assess the difference among the independent variables, shaft length, and file system.ResultsA statistically significant interaction was observed between the file system and instrument length with respect to the maximum torsional load (P < .05). The 31-mm shaft length of HCM showed higher maximum torsional load than that of the 25- and 21-mm shaft length in the HCM groups (P < .05). Among the instrument systems, PTG showed the significantly highest maximum torsional load followed by PTN and HCM (P < .05). The 31-mm shaft length of PTG showed significantly higher toughness than that of the 21- and 25-mm shaft lengths (P < .05), whereas PTN and HCM did not show any difference in relation to the shaft length.ConclusionsWithin the limitations of this study, the instrument with a longer shaft may have higher maximum torsional load or toughness than that with a shorter shaft.     

TRUShape Versus XP-endo Shaper: A Micro–computed Tomographic Assessment and Comparative Study of the Shaping Ability—An In Vitro Study

IntroductionThe aim of this study was to evaluate and compare the shaping ability of XP-endo Shaper (XP; FKG Dentaire, La Chaux-de-Fonds, Switzerland) and TRUShape (TS; Dentsply/Tulsa Dental Specialties, Tulsa, OK) during the preparation of moderated curved root canals using micro–computed tomographic imaging.MethodsTwenty human maxillary premolars with 2 roots were randomly separated into 2 groups of 10 teeth, which were scanned before and after root canal preparation using the SkyScan 1275 X-ray microtomograph (Bruker micro-CT, Kontich, Belgium) at a nominal resolution of <4 μm. Premolars and irrigant were maintained at 37° before and during preparation; group 1 was treated using XP and group 2 with TS. After preparation, researchers measured the amount of dentin removed, untreated superficies of canal walls, root canal volume, degree of canal transportation, and centering ability. Values of central tendency and dispersion were calculated using Statgraphics Centurion XV software (StatPoint Technologies, Inc, Warrenton, VA); means and median were compared using the Mann-Whitney-Wilcoxon test. The level of significance was set at 5% (P < .05).ResultsNo significant statistical differences were observed between the 2 groups in shaping ability, untreated superficies of canal walls, degree of canal transportation, and centering ability (P > .05).ConclusionsInstrumentation of moderately curved root canals using the XP single file and the TS file system were equally effective. XP and TS maintained the original anatomy of the root canals and showed a similar percentage of untreated canal walls, centered ability, and minimal apical transportation.     

Composite removal by means of erbium,chromium:yttrium-scandium-gallium-garnet laser compared with rotary instruments

BackgroundComplete removal of existing composite restorations without unnecessary removal of tooth structure is challenging. The authors compared the amount of tooth structure removed and composite remaining in Class III preparations when using an erbium laser or a rotary instrument.MethodsMesiolingual and distolingual preparations were prepared in 14 extracted anterior teeth, restored with shade-matched composite, finished, and polished. One restoration was removed with an erbium, chromium:yttrium-scandium-gallium-garnet laser and the other with a rotary instrument (handpiece and carbide burs). Gypsum models made from vinyl polysiloxane impressions of the preparation and removal stages were scanned. The 2 scans were precisely aligned to calculate the amount of tooth structure removed and residual composite, which were statistically compared (t test) between the bur and laser groups.ResultsRotary instruments removed significantly more tooth structure than the laser in terms of mean depth (P = .0017) but not maximum depth (P = .0762). Although mean depth of tooth loss was smaller in the laser group, the area of tooth loss was significantly larger (P = .0004) because the rotary instrumentation left significantly more composite than the laser in terms of volume (P = .0104), mean depth (P = .0375), maximum depth (P = .0318), and area (P = .0056).Conclusions and Practical ImplicationsThe erbium, chromium:yttrium-scandium-gallium-garnet laser was more selective in removing existing composite restorations than a rotary instrument because it removed less tooth structure and left behind less composite. Unintentional loss of tooth structure and unnoticeable residual composite are inevitable when removing existing composites. Erbium lasers are alternative means of composite removal that may be more selective than a rotary instrument.     

Dentinal Tubule Penetration and Retreatability of a Calcium Silicate–based Sealer Tested in Bulk or with Different Main Core Material

IntroductionThe 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 .MethodsRoots 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, and3. 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.ResultsSignificantly 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.ConclusionsThe 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.     

Effects of Ultrasonic Removal of Fractured Files from the Middle Third of Root Canals on the Resistance to Vertical Root Fracture

IntroductionThis study aimed to analyze the effects of ultrasonic removal of fractured files from the middle third of root canals on the vertical root fracture resistance.MethodsThis study was an extension of a previous study assessing the effects of fractured file removal on dentinal microcracks. It included 18 bilaterally matched pairs of human mandibular incisors prepared and analyzed in the previous study. Briefly, 1 member of each pair was assigned to an ultrasonic or a control group. In the ultrasonic group, K-files were fractured in the middle third of canals followed by ultrasonic file removal and canal preparation. In the control group, the root canals were simply prepared. Micro–computed tomographic imaging was performed before and after treatment, and the cross-sectional root images were screened for microcracks. For the present study, 3-dimensional reconstruction was performed for volumetric assessments. The fracture resistance was measured using a universal testing machine. All data were statistically analyzed.ResultsFracture loads were significantly smaller in the ultrasonic group (P < .05). The percentage increase in the canal volume significantly influenced the root fracture resistance (P < .05), whereas microcracks had no significant effect (P > .05).ConclusionsUltrasonic removal of fractured instruments from the middle third of root canals lowers the vertical root fracture resistance, with increased dentin removal being the primary cause.     

Effects of Conservative Access and Apical Enlargement on Shaping and Dentin Preservation with Traditional and Modern Instruments: A Micro-computed Tomographic Study

IntroductionThis ex vivo study aimed to evaluate the shaping abilities and preservation of dentin with traditional and modern instruments after using sizes 25 and 40 in oval canals of mandibular incisors with conservative access.MethodThirty mandibular incisors with single straight oval canals were selected and assigned into 2 groups (n = 15) according to the instrument system used during preparation, Slim Shaper (SS) plus Apical Shaper (AS) and Protaper Gold (PG). The samples were subjected to micro-computed tomography before and after preparation with sizes 25 and 40. The shaping parameters evaluated included canal volume and surface area, amount of unprepared root canal walls, and reduction in pericervical dentin.ResultsCanal volume and surface area were significantly increased after enlargement with each instrument size (P < .01). The percentage of unprepared areas showed a significant intragroup decrease after using PG F2 and F4 or SS 3 and AS (P < .05). Intergroup comparison showed no significant differences. Pericervical dentin was reduced in all groups. The intragroup comparison only revealed a significant reduction (P < .01) between PG F2 and F4. In addition, a significant decrease in pericervical dentin (P < .05) was observed between PG F4 40/.06 and AS 40/.03. No significant differences were observed between PG F2 25/.08 and SS 3 25/.04.ConclusionIncreasing the instrumentation size from 25 to 40 significantly reduces the percentage of unprepared areas regardless of the system used. In addition, using a modern system with a regressive taper allows the maintenance of pericervical dentin without compromising shaping efficacy in the apical third of the mandibular incisors with oval canals and conservative access.     

Higher Speed and No Glide Path: A New Protocol to Increase the Efficiency of XP Shaper in Curved Canals—An In Vitro Study

IntroductionThis in vitro study compared the performance of the XP-endo Shaper (XP; FKG, La Chaux-de-Fonds, Switzerland) in curved canals when used with a higher speed (3000 rpm) without a glide path with the manufacturer's protocol.MethodsTwenty extracted mandibular molars with separate mesial curved canals were matched to obtain 2 standardized groups (n = 20). For the XP 1000 group, a glide path up to a size 15 hand file was performed followed by rotary instrumentation with the XP shaper at 1000 rpm, following the manufacturer's recommendations. For the canals in the XP 3000 group, the file was rotated at 3000 rpm after only negotiation the canal with a size 8 hand file (patency file). The operating time and the number of strokes taken to reach the working length (WL) and fit a 30/.04 gutta-percha cone to the WL were recorded. The shaping abilities were evaluated by micro–computed tomographic imaging and file deformation by scanning electron microscopy. Data were analyzed using analysis of variance and chi-square tests at a 5% significance level.ResultsThe XP 3000 group required less time and strokes to reach the WL (P < .05) and resulted in a higher percentage of adequate cone fit (P < .05). No difference was found between groups regarding the micro-CT parameters, except for the taper, which was larger in the XP 3000 group in the apical and middle thirds (P < .05). No difference was found regarding file deformation between the 2 groups.ConclusionsThe suggested protocol for the use of the XP (3000 rpm without a glide path) appears to be more efficient than the manufacturer's recommended protocol to prepare curved canals in vitro.     

Effect of Medicaments Used in Endodontic Regeneration Technique on the Chemical Structure of Human Immature Radicular Dentin: An In Vitro Study

IntroductionThe aim of this study was to investigate the effect of 3 intracanal medicaments used in pulp regeneration on the chemical structure of radicular dentin.MethodsHuman immature radicular dentin specimens were exposed to triple antibiotic paste (tripaste), double antibiotic paste (bipaste), calcium hydroxide [(Ca(OH)₂] paste, or deionized water (control) for 1, 2, or 4 weeks. After each time point, specimens were examined with attenuated total reflection Fourier transform infrared (ATR-FTIR) spectroscopy to analyze the relative loss of organic and inorganic components by using phosphate/amide I ratios. Data were analyzed by using analysis of variance followed by post hoc comparisons.ResultsPhosphate/amide ratios were significantly different between the 4 groups at all time points (P < .0001): Ca(OH)₂-treated dentin > untreated control dentin > bipaste-treated dentin > tripaste-treated dentin. For bipaste groups, 4-week treated dentin had significantly lower phosphate/amide I ratios than 1- and 2-week treated dentin (P < .05); however, phosphate/amide I ratios of 1- and 2-week treated dentin did not have a significant difference. For tripaste groups, 4-week treated dentin had a significantly higher phosphate/amide I ratio than 1- and 2-week treated dentin (P < .001), and phosphate/amide I ratio of 1-week treated dentin was significantly higher than that of 2-week treated dentin (P = .04). No significant time effect for Ca(OH)₂-treated dentin or untreated control dentin was found (P > .05).ConclusionsThe results suggested a superficial collagen degradation or demineralization of radicular dentin caused by Ca(OH)₂ or antibiotic pastes, respectively, after 1, 2, or 4 weeks of exposure.     

Evaluation of Root Canal Transportation,Centering Ratio,and Remaining Dentin Thickness Associated with ProTaper Next Instruments with and without Glide Path

IntroductionThe purpose of this study was to evaluate and compare the volume of removed dentin, transportation, and centering ability of ProTaper Next (PTN) system with and without glide path preparation by using cone-beam computed tomography (CBCT) imaging.MethodsSixty mesiobuccal canals of mandibular first molars with curvatures of 25°−35° were divided into 3 experimental groups (n = 20) according to the instrumentation technique as follows: group PG/PTN (glide path was created with ProGlider [PG]) and canals were shaped with PTN system), group PF/PTN (glide path was created with PathFile [PF]) and canals were shaped with PTN system), and group PTN (glide path was not performed and canals were shaped with PTN system only). Canals were scanned before and after instrumentation by using CBCT scanner to evaluate root canal transportation and centering ratio at 3, 5, and 7 mm from the apex and volumetric changes. Data were statistically analyzed, and the significance level was set at P < .05.ResultsThere was no significant difference among the tested groups regarding the volume of removed dentin and centering ratio (P > .05). At 3-mm and 5-mm levels, the PG/PTN group showed a significantly lower mean transportation value among the groups (P < .05). However, at 7-mm level, there was no significant difference in canal transportation among the groups (P > .05).ConclusionsPG/PTN instrumentation method revealed better performance with fewer canal aberrations when compared with instrumentation performed with PF/PTN or PTN only.     

Microtissue Engineering Root Dentin with Photodynamically Cross-linked Nanoparticles Improves Fatigue Resistance of Endodontically Treated Teeth

IntroductionMicrotissue engineering root canal dentin with biopolymeric nanoparticles has the potential to improve mechanical properties of iatrogenically compromised root dentin. This study aims to characterize the surface mechanical property, bulk biomechanical response, and fatigue resistance of microtissue-engineered root dentin using photodynamically (photodynamic-activated [PDA]) cross-linked chitosan nanoparticles (CSnps).MethodsExperiments were conducted in 3 parts: part 1, root canal dentin sections were subjected to nanoindentations before/after treatment with CSnps and chemically (1-ethyl-3-[3-dimethylaminopropyl]carbodiimide [EDC] cross-linked CSnps) and photodynamically cross-linked CSnps to determine the properties of treated surfaces (n = 84 points/group); part 2, root canal dentin specimens treated with PDA cross-linked CSnps were subjected to strain analysis using customized moiré interferometry (n = 5/group); and part 3, root canal dentin specimens treated with EDC cross-linked CSnps, PDA cross-linked CSnps, and instrumented controls were tested using an accelerated fatigue loading protocol to evaluate the sustained loads and cycles at failure (n = 15/group). Data were analyzed using the paired sample t test, trend analysis, and Kaplan-Meier with log-rank tests at a significance of .05 in each experiment.ResultsRoot dentin microtissue engineered with PDA cross-linked CSnps showed a 16.8% increase in elastic modulus and a conspicuous decrease in strain distribution in cervical root dentin (P < .01). There was a significant reduction in the tensile strain formed at the apical region of the instrumented root dentin after treatment (P < .05). Survival analysis showed a statistically significant difference (P < .05) among evaluated conditions in fatigue resistance (ie, PDA cross-linked CSnps > EDC cross-linked CSnps > control).ConclusionsThis study highlighted the potential of root canal dentin microtissue engineering with PDA cross-linked CSnps to diminish radicular strain distribution and improve resistance to fatigue loads in endodontically treated teeth.