Shaping ability of reciprocating motion in curved root canals: a comparative study with micro-computed tomography

Introduction

Recently, root canal shaping with reciprocating motion has been postulated to reduce the possibility of unexpected file fractures. However, there has been little information on the shaping capability of this reciprocating motion preparation technique. Therefore, the purpose of this study was to evaluate the shaping ability of reciprocating motion when compared with continuous rotation motion in curved root canals.

Methods

The mesiobuccal and distobuccal canals of 20 extracted maxillary molars with curvatures of 20-45 degrees were instrumented with a series of ProTaper rotary files. The canals in the continuous rotation motion (CM) group (n = 20) were prepared by using continuous rotation with pecking motion, whereas the canals in the reciprocating motion (RM) group (n = 20) were prepared with reciprocating motion (clockwise 140 degrees and counterclockwise 45 degrees). Basic geometric parameters such as curvature, root canal volume, surface area, and structure model index (SMI) before and after canal shaping were evaluated by using micro-computed tomography. The degrees and directions of transportation were also measured, and statistical analysis was carried out with one-way analysis of variance and Tukey post hoc tests.

Results

There were no significant differences between the 2 groups in canal curvature, volume, surface area, and SMI categories measured before preparation (P > .05). Changes in curvature, root canal volume, surface area, and SMI were not affected by the instrumentation technique used (P > .05). There were no significant differences in the degrees and directions of transportation between CM and RM groups (P > .05).

Conclusions

The application of reciprocating motion during instrumentation did not result in increased apical transportation when compared with continuous rotation motion, even in the apical part of curved canals. Reciprocating motion might be an attractive alternative method to prevent procedural errors during root canal shaping.     

Sonicated extract of Enterococcus faecalis induces irreversible cell cycle arrest in phytohemagglutinin-activated human lymphocytes

The purpose of this study was to examine whether the sonicated extract of Enterococcus faecalis (SEF) alters the cell cycle transition of lymphocytes and thus regulates the fate of the arrested cells. Human lymphocytes were activated by phytohemagglutinin in the presence or absence of SEF, and cell cycle was assessed by flow cytometry. Seventy-two hours after activation with phytohemagglutinin, cells were activated from G0/G1 to S (6.1%) and G2/M (3.8%) phases of the cell cycle. In contrast, pretreatment with SEF resulted in 90.5% of cells remaining in G0/G1, and cell cycle progression to the S and G2/M phases was consequently inhibited. Caspase assay demonstrated that SEF-treated cells exhibited significantly increased apoptosis (56.7%) compared with phytohemagglutinin alone (28.1%). We propose that if this irreversible cell cycle arrest induced by E. faecalis occurs in vivo, it may result in local immunosuppression and contribute to the pathogenesis of endodontic failure. Our findings that E. faecalis can inhibit lymphocyte responses may be of particular relevance to the pathogenesis of endodontic failure. Although the immunologic mechanism involved in the pathogenesis of persistent periapical lesion is not clearly defined, it is reasonable to predict that the altered immune reaction may be linked to the immunosuppressive potential of E. faecalis or other oral bacteria.     

Effects of sonicated Enterococcus faecalis extracts on interleukin-2 and interleukin-4 production by human T cells

In the present authors' previous study, sonicated Enterococcus faecalis extracts were shown to suppress the cell cycle progression of human lymphocytes. To study the effect of this microorganism on the function of lymphocytes, the authors investigated the levels of interleukin-2 (IL-2) and interleukin-4 (IL-4) production by T lymphocytes before and after the addition of sonicated E. faecalis extracts. In this study, levels of IL-2 and IL-4 produced from T cells were evaluated by using the quantitative sandwich enzyme immunoassay technique. In response to phytohemagglutinin (PHA) stimulation, T cells produced increased levels of IL-2 and IL-4. However, the expressions of both cytokines were significantly inhibited when PHA-activated T cells were preexposed to 12.5 microg/ml and 25 microg/ml of sonicated E. faecalis extracts (p < 0.05). This effect was concentration-dependent, because the levels of IL-2 and IL-4 expressions were not affected by the addition of a low concentration (5 microg/ml) of sonicated extract. These findings suggest that Th1 and Th2 immunosuppression mediated by E. faecalis could be a part of the pathogenic mechanism of the endodontic failure associated with this microorganism.     

Long-term observation of the mineral trioxide aggregate extrusion into the periapical lesion:a case series

One-step apexification using mineral trioxide aggregate(MTA) has been reported as an alternative treatment modality with more benefits than the use of long-term calcium hydroxide for teeth with open apex.However,orthograde placement of MTA is a challenging procedure in terms of length control.This case series describes the sequence of events following apical extrusion of MTA into the periapical area during a one-step apexification procedure for maxillary central incisor with an infected immature apex.Detailed long-term observation revealed complete resolution of the periapical radiolucent lesion around the extruded MTA.These cases revealed that direct contact with MTA had no negative effects on healing of the periapical tissues.However,intentional MTA overfilling into the periapical lesion is not to be recommended.     

Chlorhexidine Gluconate Attenuates the Ability of Lipoteichoic Acid from Enterococcus faecalis to Stimulate Toll-like Receptor 2

Chlorhexidine gluconate (CHX) has been widely used as a canal irrigant or an intracanal medicament on account of its antibacterial substantivity. This in vitro study aimed to determine if CHX attenuates the inflammatory activity of Enterococcus faecalis and its major virulence factor, lipoteichoic acid (LTA). An enzyme-linked immunosorbent assay showed that CHX-killed E. faecalis was less potent than heat-killed E. faecalis in the production of tumor necrosis factor α (TNF-α) by a murine macrophage cell line, RAW 264.7 (p < 0.05). Interestingly, pretreatment of LTA with 2% CHX for 6 hours or with 0.2% CHX for 24 hours almost eliminated the TNF-α inducibility (p < 0.05). Furthermore, CHX abrogated the ability of LTA to stimulate Toll-like receptor 2, resulting in the attenuated induction of TNF-α expression. Collectively, our results suggest that CHX can inactivate LTA of E. faecalis leading to the alleviation of inflammatory responses induced by E. faecalis and its LTA.     

Making three-dimensional Monson's sphere using virtual dental models

ObjectivesThe Monson's sphere and curve of Wilson can be used as reference for prosthetic reconstructions or orthodontic treatments. This study aimed to generate and measure the three-dimensional (3-D) Monson's sphere and curve of Wilson using virtual dental models and custom software.MethodsMandibular dental casts from 79 young adults of Korean descent were scanned and rendered as virtual dental models using a 3-D digitizing scanner. 26 landmarks were digitized on the virtual dental models using a custom made software program. The Monson's sphere was estimated by fitting a sphere to the cusp tips using a least-squares method. Two curves of Wilson were generated by finding the intersecting circle between the Monson's sphere and two vertical planes orthogonal to a virtual occlusal plane. Non-parametric Mann–Whitney and Kruskal–Wallis tests were performed to test for difference between sex and in cusp number within tooth position.ResultsThe mean radius of Monson's sphere was 110.89 ± 25.75 mm. There were significant differences between males and females in all measurements taken (p < 0.01), within 16.87–17.27 mm. Furthermore, morphological variation derived from variability in cusp number in the second premolar and second molar were not found to influence occlusal curvature (p > 0.05).ConclusionsThis study describes a best-fit algorithm for generating 3-D Monson's sphere using occlusal curves quantified from virtual dental models. The radius of Monson's sphere in Korean subjects was greater than the original four-inch value suggested by Monson.Clinical significanceThe Monson's sphere and curve of Wilson can be used as a reference for prosthetic reconstruction and orthodontic treatment. The data found in this study may be applied to improve dental treatment results.     

Effect of reciprocation usage of nickel‐titanium rotary files on the cyclic fatigue resistance

The use of reciprocating motion for a nickel‐titanium file has been claimed to increase its resistance to fatigue in comparison to continuous rotation. The purpose of this study was to investigate the effect using a reciprocating motion instead of continuous rotation for nickel‐titanium files on their cyclic fatigue resistance. Cyclic fatigue tests simulating clinical use with ProTaper F2 and ProFile #25/.06 instruments were carried out in an artificial stainless‐steel root canal with a 1.5 mm inner diameter, 5 mm radius and 60° angle of curvature. The instruments were driven using either continuous rotation or reciprocation until fracture. For the reciprocation, the rotation angles were set to 140° clockwise and 45° counterclockwise. The number of cycles to fracture was determined by measuring the time to fracture. Statistical analysis was performed using two‐way anova . There were no significant differences in the fracture cycles due to the use of reciprocation or continuous rotation for either instrument. The results found using reciprocation were comparable to those found using continuous rotation with regard to the cyclic fatigue resistance of nickel‐titanium rotary files.     

In vitro evaluation of the sealing ability of newly developed calcium phosphate-based root canal sealer

This study compared the sealing ability of newly developed calcium phosphate-based root canal sealers (CAPSEAL I, CAPSEAL II) with other calcium phosphate-based sealer (Sankin Apatite Root Canal Sealer: SARCS I, SARCS III), a resin-based sealer (AH Plus), a ZOE-based sealer (Pulp Canal Sealer EWT), and a calcium hydroxide-based sealer (Sealapex) by using an anaerobic bacterial leakage model with Prevotella nigrescens during a 90-day observation period (n=15/group). SARCS I and III had significantly greater leakage with P. nigrescens than all other groups (P<.05). There was no other statistical difference between the sealers. Field emission-scanning electron microscope observations showed that both CAPSEAL I and II sealers were well-adapted to the canal wall and infiltrated into the dentinal tubules.     

The expression of alpha4 integrins by human polymorphonuclear neutrophils in response to sonicated extracts of Enterococcus faecalis

This study was undertaken to investigate immunopathologic mechanism of Enterococcus faecalis in relation to persistent apical periodontitis. We monitored the expression levels of alpha4 integrin in human polymorphonuclear neutophils (PMNs) after stimulated with sonicated extracts of E. faecalis (SEF) and compared with lipopolycaccarides (LPS) of Escherichia coli for various incubation time. Venous blood was collected from healthy volunteers and then PMNs were isolated and cultured with various concentrations of SEF for different periods of time. The levels of alpha4 integrin were measured by flow cytometry analysis. E. coli LPS group was used as a positive control and untreated PMNs as a negative control. Results showed that the expressions levels of alpha4 integrin were increased in human PMNs stimulated with E. coli LPS in comparison with unstimulated control cells (p < 0.05). In case of SEF stimulated group, the expression levels were decreased in time-dependent manner in comparison to E. coli LPS group (p < 0.05). Notably, after 12 h for incubation with SEF, the expression of alpha4 integrin was decreased in dose-dependent manner (p < 0.05). These findings suggest that E. faecalis seem to suppress PMNs recruiting activity by down-regulating alpha4 integrin expression, providing the possible mechanism that E. faecalis may play a crucial role in persistent apical periodontitis.