Ahmet Serper

Time-dependent effects of EDTA on dentin structures.

The purpose of this study was to evaluate the effects of EDTA on smear layer removal and on the structure of dentin, after 1 and 10 min of application. Six extracted single-rooted teeth were instrumented to #60. Apical and coronal thirds of each root were removed, leaving a 5 mm middle third that was then cut longitudinally into two equal segments. Using 10 ml of 17% EDTA solution, halves belonging to the same root were irrigated for 1 and 10 min, respectively. All specimens were subjected to irrigation with 10 ml of 5% NaOCl. Then all the specimens were prepared for SEM evaluation. The results showed that 1 min EDTA irrigation is effective in removing the smear layer. However a 10-min application of EDTA caused excessive peritubular and intertubular dentinal erosion. Therefore we suggest that this procedure should not be prolonged >1 min during endodontic treatment.

Dentinal tubule penetration of root canal sealers after root canal dressing with calcium hydroxide.

The purpose of this study was to evaluate the dentinal tubule penetration of root canal sealers after root canal dressing with calcium hydroxide (Ca(OH)2). Forty-two single-rooted teeth were instrumented to size 60. Six teeth served as the control group, and the remaining teeth were assigned to two groups. Root canals of the first group were filled with the Ca(OH)2 paste; the second group was filled with TempCanal, and all were incubated for 7 days. The samples were either irrigated with only NaOCl or with EDTA, followed by NaOCl to remove Ca(OH)2. All of the teeth were obturated with CRCS, AH26, and Ketac Endo by a lateral condensation technique. The specimens were then kept at the same conditions for another 7 days, and then all of the roots were prepared for scanning electron microscopic evaluation. Scanning electron microscopic examination revealed that Ca(OH)2 was not completely removed from the root canal surfaces, and root canal sealers did not penetrate into the dentinal tubules when only NaOCl was used. EDTA followed by NaOCl irrigation resulted in complete removal of Ca(OH)2 and root canal sealers penetrated into the dentinal tubules.

The demineralizing effects of EDTA at different concentrations and pH.

The purpose of this study was to compare the effects of concentration and pH variations of EDTA on dentin demineralization. Twenty extracted, human permanent teeth with single canals were used in this study. Demineralizing effects of EDTA solutions at 10% and 17% concentrations at pH 7.5 and 9.0 were determined by measuring the amount of liberated phosphorus 1, 3, 5,10, and 15 min after exposure. The results showed that the amount of phosphorus liberated from dentin was greater with increased EDTA concentration and increased time of exposure, and it was more effective at neutral pH than pH 9.0. The pH of the EDTA solutions did not display any significant alterations during the demineralization process.

Accidental Sodium Hypochlorite-Induced Skin Injury During Endodontic Treatment

A case of accidental skin injury caused by leakage of sodium hypochlorite solution from the rubber dam during root canal preparation is reported. After placement of a rubber dam and initiation of root canal treatment, the patient complained of a burning sensation with sodium hypochlorite irrigation. The complaints were ignored by the practitioner, and a skin rash developed on and around the patients chin, followed by scab formation. The patient required medical treatment with topical Hamamelis virginiana extract for 2 weeks, with full recovery.

Debris and irrigant extrusion potential of 2 rotary systems and irrigation needles

The purpose of this study was to compare the amount of apically extruded irrigant using 2 Ni-Ti rotary systems. Forty mandibular premolars with single canals were randomly assigned into 4 groups. Flower arrangement foam cubes were weighed with a precision balance before being attached to the apical portions of all teeth. In group 1, preparation was completed with ProTaper files. In group 2 canals were prepared with RaCe files. In groups 1 and 2, the irrigant was delivered with a 30-gauge conventional dental needle. In groups 3 and 4, teeth were prepared as in groups 1 and 2 with the exception that the irrigant was delivered with a side-vented irrigation needle. The weight of the extruded material (irrigant and debris) for each group was calculated by comparing the pre- and postinstrumentation weights of the foams used for periapical modeling. Obtained data were analyzed by Kruskal-Wallis and Mann-Whitney U tests, with P equals .05 as the level for statistical significance. ProTaper files used with regular needle irrigation had the highest fluid extrusion. The lowest irrigant extrusion was observed with the RaCe system combined with a side-vented irrigation needle. Within the limitations of this study, it can be concluded that irrigation needle and rotary instruments have an effect on the amount of extruded root canal irrigant.

Comparative neurotoxic effects of root canal filling materials on rat sciatic nerve.

The neurotoxic effects of the root canal filling materials--Endomethasone, N2 Universal, Traitement SPAD, Sealapex, and Calciobiotic Root Canal Sealer (CRCS)--were investigated on isolated rat sciatic nerves after local application. All of the canal filling materials reversibly inhibited the compound action potential (cAP) amplitudes. N2 Universal produced a 50% inhibition in 4.2 +/- 0.2 min. Traitement SPAD, Endomethasone, and CRCS produced the same inhibition in 6.4 +/- 0.3, 6.5 +/- 0.2, and 6.6 +/- 1.1 min, and Sealapex in 9.2 +/- 2.0 min. The inhibitory effect of Sealapex decreased fastest, and 43% recovery of cAP amplitude was observed in 60 to 70 min. The inhibitory effects of Endomethasone, CRCS, and N2 Universal were more pronounced, and 10 to 20% recovery in cAP amplitudes were observed in 2 h. The inhibitory effect of Traitement SPAD was more persistent with 4% recovery in 2.5 h.

pH changes and calcium ion diffusion from calcium hydroxide dressing materials through root dentin.

The purpose of this study was to evaluate Ca2+ and OH- diffusion properties through root dentin by using different calcium hydroxide (CH) dressing materials. Twenty-eight single-rooted teeth were instrumented and external defects were created on the root surface. 17% EDTA was used to eliminate the smear layer. All surfaces except the external defects were sealed, and the teeth were placed in normal saline. Ca2+ concentrations and the pH in the saline were determined for 3 days as the control period. After removing the teeth from normal saline, they were filled with: (i) DT Temporary Dressing CH; (ii) CH powder and normal saline; (iii) TempCanal; and (iv) CH points. The teeth were then placed in normal saline, and Ca2+ concentrations and pH values were measured at 1, 3, 7, 14, and 28 days. Nonsetting CH pastes gradually released Ca2+, whereas this increase was absent from CH points. None of the test materials induced a pH increase in the media during the observation period. This study demonstrated that, when nonsetting CH pastes are applied to the root canal, diffusion of Ca2+ without an increase in pH to the surrounding media occurs. This implies that these type of material are more suitable than CH points for treatment of external root resorption.

Evaluation of the cytotoxicity of calcium phosphate root canal sealers by MTT assay.

The purpose of this study was to evaluate the cytotoxicity of some calcium phosphate-based sealers (Sankin apatite root canal sealers (SARCS) types 1 to 3) in comparison with currently used sealers (CRCS, Ketac Endo, AH26, and Endomethasone) by using MTT assay on L929 cells. Monolayer cell cultures were prepared on 96-well plates. After incubation at 37 degrees C in a humidified 5% CO2-containing air atmosphere for 24 h in the presence of each sealer extracts, 25 microliters of 5 mg/ml of MTT in saline were added into each well and incubated a further 3 h at 37 degrees C. A solubilization buffer consisting of 23% sodium dodecyl sulfate in 50% N,N-dimethylformamide (pH 4.7) was used to dissolve formazan precipitate. The optical densities of the plates were then read by a microplate spectrophotometer at 570 nm. Greater magnitude of optical density due to intense blue coloring is regarded as showing a higher percentage of cell viability. Among the different types of sealers, SARCS types 1 to 3 and CRCS did not exert any cytotoxic effects, whereas AH26, Ketac Endo, and Endomethasone produced some cytotoxicity.

Effect of smear layer and root-end cavity thickness on apical sealing ability of MTA as a root-end filling material: a bacterial leakage study.

OBJECTIVE The aim of this study was to investigate the effect of the cavity thickness and smear layer on apical sealing ability of mineral trioxide aggregate (MTA) as a root-end filling material. STUDY DESIGN Seventy single-rooted maxillary central teeth were used in this study. All teeth were instrumented to size 50 using a step-back technique. The selected teeth were randomly divided into 4 groups, each containing 15 experimental samples and 5 positive and 5 negative control samples. In the first and second groups (smear+), the teeth were irrigated with only 5.25% NaOCl. In the third and fourth groups (smear-), the teeth were irrigated with 17% EDTA and 5.25% NaOCl to remove the smear layer. Also, in the first and third groups, cavities were prepared as 3 mm. In the second and fourth groups, cavities were prepared as 5 mm. All the root-end cavities were then filled with MTA. Nail varnish was applied to all external root surfaces to the level of the resected root-ends to prevent lateral microleakage. Samples were sterilized in an ethylene oxide sterilizer for 12 hours. The apical 3-4 mm of the roots were immersed in brain heart infusion culture medium with phenol red indicator within culture chambers. The coronal access of each specimen was inoculated every 48 hours with a suspension of Enterococcus faecalis. Bacterial leakage was monitored every 24 hours for 4 weeks. The data obtained were analyzed using a chi-squared test, with alpha = .05 as the level for statistical significance. RESULTS There were no statistically significant differences in rate of bacterial leakage among the experimental groups at 1-4 weeks (P > .05). Also, there was no difference between the groups when the 2 thickness groups were combined (P > .05). However, there was statistically significant differences when the 2 smear groups were combined for 4-week observation periods (P < .05). Removal of the smear layer caused significantly more apical microleakage than when the smear layer was left intact for 4 weeks. CONCLUSION The thickness of root-end cavity (3 or 5 mm) had no influence in the bacterial leakage of the root end filled with MTA. Removing the smear layer may not be necessary in root-end cavities filled with MTA.

Comparison of the sealing ability of three filling techniques in canals shaped with two different rotary systems: A bacterial leakage study

OBJECTIVE This study compared the sealing ability of 3 current filling techniques in root canals shaped with 2 different rotary systems. STUDY DESIGN Eighty human extracted mandibular premolars were divided randomly into 2 similar groups of 40 each and instrumented with either ProTaper (Dentsply Maillefer, Tulsa, OK; group A) or Mtwo (VDW; Antaeos, Munich, Germany; group B) rotary systems. Each group was divided into 3 subgroups (n = 10) and 2 control groups (n = 5). Canals were filled either with the tapered single-cone technique (SC; subgroups A1 and B1), with lateral condensation (LC; subgroups A2 and B2), or warm vertical compaction (WVC; subgroups A3 and B3). AH Plus was used as a root canal sealer in all groups. Samples were sterilized in an ethylene oxide sterilizer for 12 hours. The apical 3-4 mm of the roots were immersed in brain-heart infusion culture medium with phenol red indicator within culture chambers. The coronal access of each specimen was inoculated every 48 hours with a suspension of Enterococcus faecalis. Bacterial leakage was monitored every 24 hours for 8 weeks. The data obtained were analyzed using a chi-squared test, and P was set at .05. RESULTS In group A, 70% of the specimens filled with SC (subgroup A1), 50% of the specimens filled with LC (subgroup A2), and 20% of the specimens filled with WVC (subgroup A3) leaked. There was no statistically significant difference between the subgroups (P > .05). In group B, bacterial leakage was observed in 50% of SC samples (subgroup B1), 40% of LC samples (subgroup B2), and 50% of WVC samples (subgroup B3). There was no statistically significant difference between subgroups B1, B2, and B3 (P > .05). There was also no statistically significant difference between group A and group B (P > .05). CONCLUSION Filling with SC, LC, and WVC techniques in canals treated with ProTaper or Mtwo rotary instruments showed similar levels of sealing efficacy.