Bilge Hakan Şen

Antifungal effects of sodium hypochlorite and chlorhexidine in root canals.

The purpose of this study was to evaluate the antifungal properties of 0.12% chlorhexidine, 1% NaOCl, and 5% NaOCl. Root sections were enlarged and the smear layer was removed in half of the specimens. The specimens were fixed in the wells of tissue culture plates. Each root canal was dispensed with an inoculum of Candida albicans. After 10 days, the root sections were treated with 3 ml of either disinfectant solution for 1 min, 5 min, 30 min, and 1 h. Then, root sections were incubated in test tubes having Sabourauds Dextrose Broth at 37 degrees C for 24 h. In the presence of the smear layer, antifungal activity was observed only in 1-h treatment groups for all solutions. However, in the absence of the smear layer, 5% NaOCl alone started to show antifungal activity after 30 min. The antimicrobial effectiveness of irrigating solutions should be re-evaluated, particularly in patients predisposed to oral candidiasis.

Colonization of Candida albicans on cleaned human dental hard tissues

Candida albicans is a fungus that commonly infects oral mucosal surfaces. Limited data exist on biofilm formation by C. albicans on dental surfaces. Human premolar teeth were infected with C. albicans for 10 days and hard-tissue surfaces were examined with a scanning electron microscope. Enamel, cementum and dentine, in the absence or presence of a smear layer, were readily colonized by this micro-organism. Hyphae penetrated into cracks, followed the ridges of the cavities and migrated into dentinal tubules. Blastospores and hyphae were embedded in an extracellular material. These findings suggest that dental hard tissues may be invaded by C. albicans and thus can potentially present a reservoir for disseminating candidal infections.

Growth patterns of Candida albicans in relation to radicular dentin

UNLABELLED Candida albicans is the most common fungal pathogen isolated from the oral cavity. The role of this organism as an endodontic pathogen is poorly understood. OBJECTIVES The aim of this study was to observe the interaction of C. albicans with root canal walls and the growth patterns of this microorganism in relation to radicular dentin. STUDY DESIGN Fifteen root sections were infected with C. albicans grown in calf serum and incubated for various periods. The sections were fixed in glutaraldehyde, split into two halves, and evaluated by scanning electron microscopy. RESULTS Blastospores and hyphal structures were observed on the root canal walls of all specimens. Filamentous hyphal form was dominant in 5-day specimens. Most of the hyphae and blastospores showed penetration into dentinal tubules. The body of germinating mother cells and hyphae demonstrated collapsed cell walls as a result of vacuole formation. CONCLUSIONS With this invasive affinity to dentinal structures, C. albicans may be considered a dentinophilic microorganism.

The effect of different concentrations of EDTA on instrumented root canal walls.

OBJECTIVE The purpose of this study was to investigate smear layer removal and erosive capacity of different concentrations of EDTA on instrumented root canal walls. STUDY DESIGN Forty single-rooted teeth were instrumented using step-back technique and 2.5% NaOCl. The teeth were randomly divided into 4 groups, and final flushes were preformed with different concentrations of EDTA (15%, 10%, 5%, and 1%). All specimens were prepared for scanning electron microscope evaluation. RESULTS The results showed that there was no significant difference on the smear layer removal between different concentrations of EDTA (P = .1959). Only coronal versus apical thirds showed significant difference regarding presence of smear layer (P = .0176). Whereas 15%, 10%, and 5% EDTA solutions demonstrated similar erosion patterns on the root canal walls (P > .05), 1% EDTA caused restricted erosion (P < .0001). There was no significant difference among the regions in terms of erosion (P = .6399). CONCLUSION Lower concentrations of EDTA can be recommended for clinical usage to avoid excessive erosion of root canal dentin.

The effect of 4% titanium tetrafluoride solution on root canal walls—A preliminary investigation

The aim of the present study was to evaluate the effect of 4% titanium tetrafluoride (TiF4) solution on root canal walls by scanning electron microscopy. Twenty four root canals with or without a smear layer were treated with 4% TiF4 solution. Scanning electron microscopic observation of the smeared canal walls showed that TiF4 solution modified the smear layer and produced a massive structure. In smear-free group, a granular coating was formed on intertubular and intratubular dentin. The stability of this layer was tested further with EDTA and/or NaOCl irrigations on 20 additional specimens. It was observed that none of the solutions was able to remove this modified smear layer. These results may indicate that this extremely stable structure may be advantageous in endodontics, because it can prevent further infection of root canal dentin by sealing off the tubules permanently, and can reduce microleakage by preventing further dissolution and disintegration of the smear layer.

Morphologic effects on L929 fibroblasts of titanium tetrafluoride application

OBJECTIVE The aim of this study was to investigate the effect of titanium tetrafluoride solution on L929 fibroblasts by scanning electron microscopy. Titanium tetrafluoride was then compared with sodium fluoride and acidulated phosphate fluoride. STUDY DESIGN Cells were treated with fluoride solutions for 1 minute either directly, through a filter membrane with a pore size of 0.4-micron, or indirectly, through dentin disks; they were then investigated at an electron microscopic level. RESULTS Fluoride application on smeared dentin disks showed fewer cytotoxic effects on fibroblasts than application on nonsmeared dentin disks. Acidulated phosphate fluoride and titanium tetrafluoride appeared to be more cytotoxic than sodium fluoride. Because all fluoride solutions used in this study contained the same fluoride concentration, pH was considered to be the main factor causing the higher toxicity. CONCLUSION Because these solutions demonstrated toxicity in vitro, they must be further evaluated under in vivo conditions to ascertain their clinical safety.

Permeability changes of dentine treated with titanium tetrafluoride

OBJECTIVES The aim of this research was to evaluate the effect of titanium tetrafluoride on dentine permeability in comparison with sodium fluoride and acidulated phosphate fluoride to determine their contribution to acid resistance of dentine. METHODS Thirty-two dentine discs were prepared from extracted mandibular molars. The hydraulic conductance of all discs was measured before and after the formation of smear layer. The discs were then randomly divided into five experimental and one-control groups. Coronal surfaces of dentine discs were treated with either fluoride solutions of NaF, APF, 1% TiF4, 0.5% TiF4 and 0.1% TiF4 or de-ionised water. Following the measurement of hydraulic conductance, treated surfaces were subjected to 25% citric acid application. Then, final permeability measurements were made. The data were statistically analysed using ANOVA and Tukeys HSD multiple comparisons. RESULTS While smear layer formation considerably reduced dentinal permeability of dentine discs, fluoride or de-ionised water application to smeared surfaces did not cause any significant change in hydraulic conductance (p > 0.05). After citric acid application, control and NaF groups showed higher permeability values than 1%, 0.5% and 0.1% TiF4 and APF groups (p < 0.01). CONCLUSION Clinical use of acidic solutions of titanium tetrafluoride in dentine cavities may be considered since smeared dentine surfaces are modified to a stabile and acid-resistant state.

Idiopathic root resorption of the entire permanent dentition: systematic review and report of a case

A rare case of idiopathic root resorption affecting the entire dentition was described. Root resorptions of all of the maxillary and mandibular teeth were coincidentally diagnosed on patients radiographic examination. The patients medical and dental findings were non-contributory, other than the increased mobility of upper incisors. No significant familial findings could be identified. Detailed radiographic examination revealed resorption affecting the apical part of the roots, resulting in vertical shortening of the teeth. The character of the resorption was as if a tapering occurred throughout the lateral root surfaces. Involved teeth were endodontically treated and the patient was subsequently followed-up for 18 months. Following endodontic therapy, all periapical lesions demonstrated clinical and radiographic evidence of healing. Endodontic therapy resulted in a high degree of success to stop resorption process and maintain the dentition.

effects of etching and adhesive applications on the bond strength between composite resin and glass-ionomer cements

Objective This study determined the effects of various surface treatment modalities on the bond strength of composite resins to glass-ionomer cements. Material and Methods Conventional (KetacTM Molar Quick ApplicapTM) or resin-modified (PhotacTM Fil Quick AplicapTM) glass-ionomer cements were prepared. Two-step etch-rinse & bond adhesive (AdperTM Single Bond 2) or single-step self-etching adhesive (AdperTM PromptTM L-PopTM) was applied to the set cements. In the etch-rinse & bond group, the sample surfaces were pre-treated as follows: (1) no etching, (2) 15 s of etching with 35% phosphoric acid, (3) 30 s of etching, and (4) 60 s of etching. Following the placement of the composite resin (FiltekTM Z250), the bond strength was measured in a universal testing machine and the data obtained were analyzed with the two-way analysis of variance (ANOVA) followed by the Tukeys HSD post hoc analysis (p=0.05). Then, the fractured surfaces were examined by scanning electron microscopy. Results The bond strength of the composite resin to the conventional glass-ionomer cement was significantly lower than that to the resin-modified glass-ionomer cement (p<0.001). No significant differences were determined between the self-etching and etch-rinse & bond adhesives at any etching time (p>0.05). However, a greater bond strength was obtained with 30 s of phosphoric acid application. Conclusions The resin-modified glass-ionomer cement improved the bond strength of the composite resin to the glass-ionomer cement. Both etch-rinse & bond and self-etching adhesives may be used effectively in the lamination of glass-ionomer cements. However, an etching time of at least 30 s appears to be optimal.

Influence of fiber-reinforced composites on the resistance to fracture of vertically fractured and reattached fragments.

INTRODUCTION The aim of this in vitro study was to evaluate the fracture type and test the effects of 2 different fibers on fracture strength of roots with reattached fragments. The null hypothesis was that adding suitable fibers to the content of dual-cure adhesive resin cement increases the fracture resistance of reattached fragments under vertical forces. METHODS Root canals of 45 teeth were prepared, and the teeth were intentionally fractured into 2 separate fragments. Control groups (n = 7 each) consisted of unfractured teeth with instrumented and obturated or only instrumented root canals. The fractured teeth were divided into 3 groups (n = 15 each), and separated fragments were reattached by using (1) dual-cured resin cement (Clearfil SA), (2) dual-cured resin cement + polyethylene fiber (Construct), or (3) dual-cured resin cement + glass fiber (Stick-Net). Force was applied at a constant speed of 0.5 mm/min to the root until fracture. Mean load was recorded and analyzed statistically by using Kruskal-Wallis and Dunn tests (P = .05). Fracture types were analyzed by using χ(2) analysis with Yates correction. RESULTS Stick-Net demonstrated the lowest fracture resistance (P < .05), whereas Construct and Clearfil SA had similar fracture strengths (P > .05). The roots in the control group showed the highest fracture resistance. However, there was no statistically significant difference between the Construct, Clearfil SA, and control groups (P > .05). CONCLUSIONS Separated fragments of vertically fractured teeth can be reattached by using a dual-cured resin or by adding polyethylene fiber (Construct).