The Influence of Adalimumab on the Healing of Apical Periodontitis in Ferrets

Introduction

Given the increasing use of anti–tumor necrosis factor α (anti-TNFα) biologic medications, and their interferences with the immune-inflammatory response, this study evaluated the effect of adalimumab (anti-TNFα), on healing and healing time of apical periodontitis (AP) in ferrets.

Cone-beam Computed Tomographic and Micro–computed Tomographic Evaluations of the Root Apexes of Teeth with Posttreatment Apical Periodontitis

IntroductionThis study evaluated the association of different variables that may influence the outcome of root canal treatment through cone-beam computed tomographic (CBCT) and micro–computed tomography (micro-CT) assessments of root apexes obtained by endodontic microsurgery of teeth with posttreatment apical periodontitis (AP), the agreement between CBCT and micro-CT findings, and the association of these variables with symptoms or lesion size.MethodsClinical and CBCT records and root apexes obtained by endodontic microsurgery from 11 cases of symptomatic AP and 22 cases of asymptomatic AP were available. Apical root specimens were further scanned using micro-CT imaging. CBCT parameters included periapical radiolucency size, apical extent/density of root canal filling, and occurrence of procedural errors. Micro-CT images evaluated the same parameters plus the presence of filling material in lateral canals and ramifications, the volume of the filled/nonfilled apical root canal, and the percentage of the nonfilled canal space. The agreement between CBCT/micro-CT observations was evaluated.ResultsMandibular teeth, a lesion size <5 mm, a nonfilled volume <0.04 mm³, and the decreased percentage of the nonfilled canal volume were significantly associated with symptomatic AP. Maxillary teeth and inadequate apical filling density were significantly associated with larger lesions. Agreement between CBCT/micro-CT scores varied from fair (procedural errors) to satisfactory (extent/density of filling).ConclusionsTooth location, lesion size, the nonfilled apical canal volume, and the percentage of the nonfilled apical canal volume were associated with symptomatic AP. In addition, lesion size was significantly associated with tooth location and apical root canal filling density. CBCT imaging may not provide a reliable evaluation of procedural errors associated with posttreatment disease.     

Is Panoramic Radiography an Accurate Imaging Technique for the Detection of Endodontically Treated Asymptomatic Apical Periodontitis?

Introduction

This study aimed to evaluate the diagnostic accuracy of panoramic radiography (PAN) for the detection of clinically/surgically confirmed apical periodontitis (AP) in root canal–treated teeth using cone-beam computed tomographic (CBCT) imaging as the reference standard.

Effect of pretreatments on the metal–ceramic bonding strength of a Pd–Ag alloy

Objectives

The purpose of this study was to evaluate the efficacy of surface treatments on the bonding properties between a metal and ceramic.

Methods

Sixty metal specimens were divided equally into four groups of 15 samples each. These groups received different treatments (Gr1: 250 μm Al₂O₃ + preoxidation; Gr2: 250 μm Al₂O₃ + degassing; Gr3: 120 μm Al₂O₃ + preoxidation; Gr4: 120 μm Al₂O₃ + degassing). Bond strengths were evaluated using a three-point bending test. The results were analyzed using 2-way ANOVA and Tukey's test. Scanning electron microscopy and energy dispersive spectroscopy were used to observe the microscopic features, elemental compositions and distributions, and diffusion in the specimens. Mechanical profiler was used to measure the roughness of metal surface.

Results

The bond strengths of the four groups ranged from 45.00 ± 3.63 MPa to 51.61 ± 5.91 MPa, with significant differences (P < .05). The specimen that received the pretreatment of 250 μm Al₂O₃ air-particle abrasion + degassing had the highest bond strength. Heating under different oxygen partial pressures caused the final Pd–Ag alloys to have varying degrees of internal oxidation and different quantities of metallic nodules. None of the elements in either the ceramic or the Pd–Ag alloy layer diffused into the other layer.

Conclusions

The metal–ceramic specimen subjected to air-particle abrasion with 250 μm Al₂O₃ and degassed before porcelain firing had significantly higher bond strength than specimens treated differently.     

Healing of Apical Periodontitis in Patients with Inflammatory Bowel Diseases and under Anti–tumor Necrosis Factor Alpha Therapy

Introduction

We evaluated healing after nonsurgical primary/secondary endodontic treatment of apical periodontitis (AP) in patients with inflammatory bowel diseases (IBDs) treated with anti–tumor necrosis factor alpha biologic medications (BMs).

Prevalence of Apical Periodontitis in Root Canal–Treated Teeth From an Urban French Population: Influence of the Quality of Root Canal Fillings and Coronal Restorations

This cross-sectional study determined the prevalence of apical periodontitis in 1035 root canal–treated teeth from adult French patients and investigated the influence of the quality of canal fillings and coronal restorations on the periradicular status. Periapical radiographs were used for analyses, and teeth were classified as healthy or diseased according to the periapical index scoring system. Overall, the prevalence of apical periodontitis in root canal–treated teeth was 33%. Only 19% of the teeth had endodontic treatments rated as adequate. The success rate (number of healthy teeth) for cases with adequate endodontic treatment was 91%, which was significantly higher when compared with teeth with inadequate treatment (61%). Teeth with adequate restorations had significantly decreased prevalence of apical periodontitis (29%) as compared with teeth with inadequate restorations (41%). The combination of adequate endodontic treatment and adequate restorations yielded the highest success rate (93.5%). The quality of the endodontic treatment was the most important factor for success, although the quality of the coronal restoration also influenced the treatment outcome.     

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.     

Can Apical Periodontitis Modify Systemic Levels of Inflammatory Markers? A Systematic Review and Meta-analysis

Introduction

This systematic review and meta-analysis investigated evidence to support whether apical periodontitis (AP) can modify the systemic levels of inflammatory markers (IM) in humans.

Methods

The MEDLINE, Embase, Cochrane, and PubMed databases were searched between 1948 and 2012, with no language restriction. Additionally, the bibliography of all relevant articles and textbooks were manually searched. Based on inclusion and exclusion criteria, 2 reviewers independently rated the quality of each study based on the Newcastle-Ottawa Scale. The primary outcome variable for meta-analysis was determined by the serum levels of IMs in AP subjects versus healthy controls or in AP subjects before versus after treatment intervention.

Results

Among the 531 initially identified articles, 20 comprised the final analysis. Thirty-one different IMs were analyzed, with immunoglobulin (Ig) A, IgM, IgG, and C-reactive protein (CRP) being the most commonly investigated. CRP, interleukin (IL)-1, IL-2, IL-6, asymmetrical dimethylarginine, IgA, IgG, and IgM were shown to be increased in patients with AP compared with controls in most studies. Meta-analyses showed that serum levels of IgA (P = .001), IgG (P = .04), and IgM (P < .00001) were increased in humans with AP compared with healthy controls and serum levels of CRP, IgA, IgE, IgG, and IgM were not significantly different between patients with AP before and after treatment (P > .05).

Conclusions

Available evidence is limited but consistent, suggesting that AP is associated with increased levels of CRP, IL-1, IL-2, IL-6, asymmetrical dimethylarginine, IgA, IgG, and IgM in humans. These findings suggest that AP may contribute to a systemic immune response not confined to the localized lesion, potentially leading to increased systemic inflammation.     

Effect of different surface treatments on the composite–composite repair bond strength

The aim of this study was to investigate the effect of different mechanical and adhesive treatments on the bond strength between pre-existing composite and repair composite using two aging times of the composite to be repaired. Standardized cylinders were made of a microhybrid composite (Spectrum TPH) and stored in saline at 37°C for 24 h (n = 140) or 6 months (n = 140). Three types of mechanical roughening were selected: diamond-coated bur followed by phosphoric acid etching, mini sandblaster with 50-μm aluminum oxide powder, and 30-μm silica-coated aluminum oxide powder (CoJet Sand), respectively. Adhesive treatment was performed with the components of a multi-step bonding system (OptiBond FL) or with a one-bottle primer–adhesive (Excite). In the CoJet Sand group, the effect of a silane coupling agent (Monobond-S) was also investigated. The repair composite (Spectrum TPH) was applied into a mould in three layers of 1 mm, each separately light-cured for 40 s. Repair tensile bond strengths were determined after 24-h storage. Mechanical and adhesive treatment had significant effects on repair bond strength (P < 0.001). The age of the pre-existing composite had no significant effect (P = 0.955). With one exception (CoJet Sand/OptiBond FL Adhesive), adhesive treatments significantly increased repair bond strengths to 6-month-old composite when compared to the controls without adhesive. Adhesive treatment of the mechanically roughened composite is essential for achieving acceptable repair bond strengths. The more complicated use of silica-coated particles for sandblasting followed by a silane coupling agent had no advantage over common bonding systems.     

Effect of Ag on the corrosion behavior of Ti–Ag alloys in artificial saliva solutions

ObjectivesThe purpose of this study was to investigate the corrosion behavior of Ti–Ag alloys in artificial saliva solutions.MethodsThe corrosion behavior of experimental Ti–Ag alloys in artificial saliva was examined by means of potentiodynamic polarization measurements. The surface passive film formed was analyzed by means of X-ray photoelectron spectroscopy (XPS) and X-ray diffraction (XRD) methods.ResultsThe alloys were found to develop surface passive films after immersion for 1.8 × 10³ s. In comparison with commercially pure Ti, the Ti–Ag alloys exhibited better corrosion resistance with lower anodic current densities, larger polarization resistances, and higher open-circuit potentials. The passive film formed was predominantly composed of TiO₂, as determined by XPS. When fluoride ions were added in the solution, the TiO₂ passive film was destroyed and Na₂TiF₆ was formed.SignificanceAddition of Ag was found to be effective in reducing the corrosion current density and increasing the open circuit potential of titanium in artificial saliva environment. Addition of fluoride ions in the solution severely reduced the corrosion resistance of Ti–Ag alloys.     

Effect of the implant–abutment interface on peri-implant tissues: A systematic review

Objective. The aim of the present systematic review was to determine the peri-implant tissue response to different implant abutment materials and designs available and to assess the impact of tissue biotype. Materials and methods. Relevant literature published between December 2009 and August 2012 was searched to identify studies dealing with different implant abutment designs and materials, as well as the response of different tissue biotypes. The search terms used, in simple or multiple conjunctions, were ‘implant abutment', ‘interface', ‘material', ‘peri-implant', ‘soft tissue' and ‘esthetic'. Studies were selected according to pre-determined inclusion and exclusion criteria. Results. The initial search yielded 2449 titles. After a subsequent filtering process, 23 studies were finally selected. The included studies revealed different factors responsible for the stability of peri-implant tissue and the esthetic outcome. These factors include tissue biotype and architecture, implant abutment material and implant abutment design. Several designs were suggested to prevent marginal bone loss and soft tissue recession. These included scalloped implants, platform-switched implants and gingivally converged or concave implant abutments. Due to the limited number of studies and the heterogeneity in their designs, it was not possible to perform a statistical analysis of the data. Conclusions. The current literature provides insufficient evidence about the effectiveness of different implant abutment designs and materials in the stability of peri-implant tissues.     

Effects of Root Canal Preparation on Apical Geometry Assessed by Micro–Computed Tomography

IntroductionPrevious micro–computed tomography analyses of root canal preparation provided data that were usually averaged over canal length. The aim of this study was to compare preparation effects on apical root canal geometry.MethodsSixty extracted maxillary molars (180 canals) used in prior studies were reevaluated for analyses of the apical 4 mm. Teeth were scanned by using micro–computed tomography before and after canal shaping with FlexMaster, GT-Rotary, Lightspeed, ProFile, ProTaper, instruments or nickel-titanium K-files for hand instrumentation. Apical preparation was to a size #40 in mesiobuccal and distobuccal and #45 in palatal canals except for GT (#20) and ProTaper (#25 in mesiobuccal and distobuccal and #30 in palatal canals, respectively). Data for canal volume changes, the structure model index (quantifying canal cross sections), and untreated surface area were contrasted by using analysis of variance and Scheffé tests.ResultsMean mesiobuccal, distobuccal, and palatal canal volumes increased after preparation (P < .05), but differences were noted for preparation techniques. GT rendered the smallest (0.20 ± 0.14 mm³); K-files and ProFile showed the largest volume increases (0.51 ± 0.20 mm³ and 0.45 ± 021 mm³, P < .05). All canals were slightly rounder in the apical 4 mm after preparation indicated by nonsignificant increases in structure model index. Untreated areas ranged from 4%–100% and were larger in mesiobuccal and palatal canals than in distobuccal ones. Preparation with GT left significantly larger untreated areas in all canal types (P < .05); among root canal types, distobuccal canals had the least amounts of untreated surface areas.ConclusionsApical canal geometry was affected differently by 6 preparation techniques; preparations with GT instruments to an apical size #20 left more canal surface untouched, which might affect the ability to disinfect root canals in maxillary molars.     

Immunocolocalization of Interferon Regulatory Factory 5 with Tumor Necrosis Factor Receptor–associated Factor 6 and AKT2 in Human Apical Periodontitis

IntroductionInterferon regulatory factor 5 (IRF5) is critical for the regulation of immune and inflammatory responses in health and diseases. However, the presence of IRF5 in human apical periodontitis remains unknown. This study aimed to explore the expression and colocalization of IRF5 with tumor necrosis factor receptor–associated factor 6 (TRAF6) and AKT2 in human apical periodontitis.MethodsA total of 39 human periapical tissues, including healthy gingival tissues (n = 12), periapical granulomas (PGs, n = 13), and radicular cysts (RCs, n = 14), were used in this study. The inflammatory infiltrates of lesions were evaluated by hematoxylin-eosin staining. The expression of IRF5 was detected by immunohistochemistry. Double immunofluorescence assessment was performed to colocalize IRF5 with CD68, TRAF6, and AKT2, respectively. Data were analyzed using the Kruskal-Wallis test.ResultsImmunohistochemistry revealed significantly higher expressions of IRF5 in PGs and RCs than the healthy control group. IRF5-CD68 double-positive cells were more predominant in RCs and PGs than the healthy control group. Significant differences of the IRF5-TRAF6 and IRF5-AKT2 double-positive cells were detected in periapical lesions compared with the healthy control tissues.ConclusionsIRF5 was highly expressed in macrophages of human periapical tissues and was colocalized with TRAF6 or AKT2 in human periapical tissues. These findings may provide new clues for understanding the pathogenesis of periapical diseases.     

Does the Endodontic Education Level Affect Decision-Making for Endodontically Treated Teeth With Apical Periodontitis? A Web-Based Survey

ObjectivesThe management of endodontically treated teeth with apical periodontitis is debated among clinicians. The aim of this study was to evaluate treatment choices for endodontically treated teeth with different sizes of periapical lesions among endodontists, endodontics postgraduate students, general dental practitioners, and undergraduate students who had fulfilled their theoretical and clinical training in endodontics.Materials and MethodsPeriapical lesion images (no periapical lesion and 1-mm, 3-mm, and 5-mm periapical lesions) were formed on 4 different radiographs with a software program, and the survey included 16 radiographs that were emailed to 1881 participants. Treatment options included extraction, surgical or nonsurgical retreatment, and wait and see. The χ² test was used to compare the responses of the participants.ResultsThe survey was returned by 1039 participants (55.23%). There were statistically significant differences among the responses of all participants for all cases (P < .05), except a case with a broken file and no lesion (P = .918). All participants decided to extract at an increased size from a 1-mm periapical lesion to a 5-mm periapical lesion. At all lesion sizes, general dental practitioners planned retreatment less when compared with other groups.ConclusionsThis survey study showed that there was a positive correlation between endodontic education level and retreatment decision-making. Dentists who confront seemingly hopeless endodontically treated teeth such as an instrument fracture, a missing canal, or a large periapical lesion should consult with an endodontist before making the decision to extract the tooth.     

Effect of Acid Etching Procedures on the Compressive Strength of 4 Calcium Silicate–based Endodontic Cements

Introduction

The purpose of this study was to evaluate the effect of acid etching on the compressive strength of 4 calcium silicate–based cements.

Methods

One gram of each corresponding powder of ProRoot MTA (Dentsply Tulsa Dental, Johnson City, TN), MTA Angelus (Angelus, Londrina, PR, Brazil), and CEM cement (BioniqueDent, Tehran, Iran) and a 0.33-g aliquot of liquid were placed in a plastic mixing capsule that was then mechanically mixed for 30 seconds at 4500 rpm in an amalgamator. For the preparation of Biodentine (Septodont, Saint Maur-des-Fossés, France), the liquid provided was added to the powder within the plastic capsule supplied by the manufacturer and then mechanically mixed for 30 seconds at 4500 rpm using the amalgamator. The resulting slurries were then placed incrementally into 40 cylindrical molds to give a total of 160 specimens that were incubated at 37°C for a week. Twenty specimens of each material were then subjected to the acid etch procedure. The compressive strength of the samples was then calculated in megapascals using a universal testing machine. The results were then subjected to 2-way analysis of variance analysis of variance followed by the Tukey post hoc test.

Results

The application of acid etch significantly reduced (P < .0001) the compressive strength of Angelus MTA and CEM cement; however, it did not reduce the compressive strength of ProRoot MTA or Biodentine. Regardless of the acid etch application, Biodentine showed significantly higher compressive strength values than the other materials (P < .0001), whereas CEM cement had the lowest compressive strength values. There was no significant difference between CEM cement and MTA Angelus. The compressive strength of ProRoot MTA was significantly lower (P < .0001) than Biodentine but significantly higher (P < .0001) than MTA Angelus and CEM cement in both the test and control groups.

Conclusions

When the application of acid etchants is required, Biodentine and ProRoot MTA seem to be better options than MTA Angelus or CEM cement.     

Radiographic Identification of Separated Instruments Retained in the Apical Third of Root Canal–filled Teeth

Introduction

The aim of the study was to compare the diagnostic ability to radiographically detect separated stainless steel (SS) versus nickel-titanium (NiTi) instruments located at the apical third of filled root canals with either AH 26 (Dentsply DeTrey GmbH, Konstanz, Germany) or Roth sealer (Roth International Ltd, Chicago, IL).

Methods

Sixty single-rooted extracted human teeth with 1 straight root canal were instrumented to a size 25 apical diameter. In 40 teeth, apical 2-mm segments of SS (n = 20) or NiTi (n = 20) files were intentionally fractured in the apical part of the root canal. The remaining 20 teeth without fractured files served as a control group. Subsequently, the root canals were filled using laterally condensed gutta-percha and either AH 26 sealer (AH) or Roth sealer (Roth). All teeth were radiographed using conventional Kodak film (Eastman Kodak Co, Rochester, NY) and a charge-coupled device digital sensor. The evaluation of the images for the presence of a fractured instrument was performed independently by 2 blinded observers. The data were statistically analyzed using McNemar and Fisher exact tests.

Results

The kappa values were 0.76 and 0.615 for the first and second observers, respectively, and 0.584 between the observers. There were no significant differences in the diagnostic ability between digital and conventional radiography or the different root canal sealers (AH vs Roth, P > .05). The sensitivity to detect fractured SS was significantly higher than NiTi (P < .05).

Conclusions

It may be difficult to radiographically detect a retained separated instrument. It is easier to radiographically detect fractured SS than NiTi instruments retained at the apical third of the root canal.     

Anemia of Chronic Disease and Chronic Periodontitis: Does Periodontal Therapy Have an Effect on Anemic Status?

Background: As the periodontal tissues mount an immune inflammatory response to bacteria and their products, the systemic challenge with these agents also induces a major vascular response. Certain inflammatory cytokines produced during periodontal inflammation can depress erythropoietin production leading to the development of anemia. The aim of this study is to investigate whether patients with chronic periodontitis have an anemic status, and subsequently, to analyze the effect of non‐surgical periodontal therapy on the anemic status of subjects over a 6‐month period. Methods: A total of 187 patients with chronic periodontitis participated in the study. After red blood cell analyses, 60 patients with hemoglobin concentrations below reference ranges entered into the second part of the study in which patients were treated with non‐surgical periodontal therapy. Clinical parameters and red blood cell analyses were repeated at 3 and 6 months. Results: In the first part of the study, 33.6% of patients had hemoglobin concentrations below normal reference ranges. In the second part of the study, all red blood cell parameters and clinical parameters showed statistical improvements over a 6‐month period. Conclusion: The present study strengthens the hypothesis that chronic periodontitis may lead to anemia and provides evidence that non‐surgical periodontal therapy can improve the anemic status of patients with chronic periodontitis with greater improvement in females.     

Evaluation of the Periodontal Disease Effect on Pulp Volume

Introduction

The success of periodontal and endodontic treatments depends on the total recovery from both conditions regardless of their occurrence as independent or combined lesions. There is strong presumptive evidence that teeth with periodontal disease may cause pulpal inflammation and degeneration. Therefore, the goal of this study was to establish a correlation between periodontitis and pulp volume.