The Effect of Die Spacer on Retention and Fitting of Complete Cast Crowns

PURPOSE: This study evaluated the effect of die spacer on the fit and retention of complete cast crowns by using three different cements. MATERIALS AND METHODS: Standardized full crown restoration preparations were completed on 99 extracted molar teeth, impressions were made with poly(vinyl siloxane), and stone dies were made. Dies were covered with four layers of die spacer using three techniques: (1) covering the occlusal and 1/3 of the axial surfaces, (2) covering the occlusal and 2/3 of the axial surfaces, and (3) covering the entire preparation except the apical 0.5 mm of the preparation. Complete metal crowns were cast using Pors-on 4 alloy. Crowns were then assigned to one of three luting agent groups: resin modified glass ionomer cement, resin cement, or zinc phosphate cement. The castings were placed on their respective teeth and the marginal opening was recorded by two methods: 72 specimens were examined before and after cementation using optical microscopy with 0.001 mm resolution, and 27 specimens were examined after cementation with scanning electron microscopy. After cementation, the teeth were thermocycled for 700 cycles between 5 degrees C and 55 degrees C. The tensile retentive strength was measured on a universal testing machine with a crosshead speed of 0.5 mm/min. The data obtained for the fitting were recorded in millimeters and the data for the tensile retentive strength were recorded in KgF. The statistical analysis was performed by analysis of variance and post hoc Tukey's test (p< 0.05). RESULTS: Before cementation, better marginal fit was obtained when the die spacer covered all but the area 0.5 mm short of the margin of the preparation; however, after cementation, the resin modified glass ionomer cement group had the best fit with the same application of die spacer. Castings luted with resin cement required the greatest tensile force to produce cement failure. CONCLUSIONS: Increasing the area of the die surface covered with spacer improved the fit of the cast restoration. After cementation, the resin modified glass ionomer showed better adaptation; however, the optical microscopy and scanning microscopy correlate well. Resin cement had the highest resistance to tensile forces.     

Root canal cleaning in roots with complex canals using agitated irrigation fluids

The internal topography of the root canal is complex, especially for the mesial root of the permanent first molar. In response to such challenges, enhanced irrigation protocols have been developed, using laser pulses to agitate fluids and enhance the removal of microbial deposits. The aim of this laboratory study was to assess the effectiveness of laser agitation of sodium hypochlorite in removing multispecies biofilms grown in the mesial root of the permanent first molars. The five agitation groups (N = 12 roots for each) were: 940 nm diode laser (superpulsed mode, 50 μs/pulses at 20 Hz using 20 mJ/pulse); 1064 nm Nd: YAG laser (200 μs/pulse at 20 Hz using 20 mJ/pulse); 2940 nm Er: YAG laser (50 μs/pulse at 15 Hz using a 400/14 conical tip in the SWEEPS protocol, with 20 mJ/pulse); passive ultrasonic agitation at 28 kHz (positive control); and irrigation with a 27-gauge side vented needle for 2 min per canal (negative control). Biofilm removal was assessed by confocal microscopic imaging of root slices at 1, 4 and 7 mm from the root apex. None of the tested methods were effective in completely eradicating biofilm from the most confined regions of the root canal system. The greatest challenge was cleaning the isthmus regions. There was a positive correlation between canal cleaning and isthmus cleaning, suggesting that increased effectiveness in cleaning root canal walls is associated with more effective isthmus cleaning. Wider and narrow isthmuses were cleaned better than long and narrow isthmuses.     

A comparison of endodontic referrals and treatment in the public and private sectors in Western Australia

The aim was to compare referral patterns and treatment provided by specialist Endodontists and Endodontic Registrars. A retrospective review was conducted of the clinical records of the first 25 patients seen by seven private endodontic clinicians and the equivalent number (175) of patients seen by five public sector endodontic clinicians from 1 January 2017. The average age and range of medical co-morbidities of patients in the public sector were statistically greater. Referred patients and referrers mainly worked in metropolitan Perth. The most frequent reasons for referral in both public and private sectors were to assess and manage non-painful endodontic pathosis, to manage pain, and to manage calcified canals. There was a wide range of cases referred to both sectors but with similar patterns suggesting that the training of specialists adequately prepares them for private practice. The results also indicate that Endodontists must be proficient in all aspects of the speciality.