Emel Olga Onay

Effect of adhesive system type and root region on the push-out bond strength of glass–fibre posts to radicular dentine

AIM To compare interfacial strength in different thirds of the root canal amongst glass-fibre posts luted with four different adhesive luting agents. METHODOLOGY A total of 44 extracted human single-rooted teeth were randomly divided in four groups and restored using glass-fibre posts and the following luting agents: All Bond SE/Duo-Link (ABSE), All Bond 3/Duo-Link (AB3), BisCem (BC), Clearfil ED primer II/Clearfil Esthetic Cement (CLF). One week after luting, the samples were thermocycled in water, and then embedded in acrylic resin. Three sections (cervical, middle and apical) of 2 mm thickness were prepared from each specimen, and the post in each section was subjected to a push-out test. One additional specimen for each group was prepared for scanning electron microscopy analysis and the bonding effectiveness to dentine was assessed. The data were analysed using the Kolmogorov-Smirnov test, two-way anova, one-way anova, and the Scheffe test (P < 0.05). RESULTS The push-out bond strength values for BC and ABSE were not significantly different (P > 0.05), but both were significantly higher than the means for AB3 and CLF (P < 0.05) in the cervical and middle regions. The same trend was observed in the apical region, except for the AB3 and ABSE which were not significantly different (P > 0.05) from each other. There were significant differences in bond strength amongst root thirds, with a reduction in values from the cervical to apical third (P < 0.05). CONCLUSIONS The use of BisCem and All Bond SE/Duo-Link combination with their simplified application procedures may be considered an alternative to the currently used systems for luting glass-fibre posts in root canal.

Push-out bond strength and SEM evaluation of new polymeric root canal fillings

OBJECTIVE The objective of this study was to compare the interfacial strengths and failure modes of new polymeric endodontic obturation systems consisting of different material combinations. STUDY DESIGN Extracted human single-rooted teeth (n = 105) were instrumented using HERO Shaper rotary instruments and obturated with different combinations of core and sealer as follows: group 1, RealSeal/Resilon; group 2, RealSeal/Herofill; group 3, Hybrid Root Seal/Resilon; group 4, Hybrid Root Seal/Herofill; group 5, MM-Seal/Resilon; group 6, MM-Seal/Herofill; group 7 (control). Failure modes of root slices (1.00 +/- 0.05-mm thick) after push-out testing were examined with stereomicroscope and scanning electron microscopy. RESULTS Hybrid Root Seal/Resilon combination had significantly greater bond strength than all the other groups (P < .001); RealSeal/Resilon combination proved to have the second highest bond strength (P < .001). Bond failure was mainly mixed failure in both adhesive and cohesive modes at the dentin/sealer interface. CONCLUSION The push-out bond strengths of methacrylate-based sealers (Hybrid Root Seal and RealSeal) and thermoplastic synthetic-polymer-based core material (Resilon) combinations were higher than epoxy-resin-based sealer (MM-Seal) and gutta-percha (Herofill) combination.

Intentional re‐plantation of a vertically fractured tooth repaired with an adhesive resin

AIM To present the successful treatment of a vertically fractured tooth by intentional re-plantation after root canal treatment and repair with an adhesive resin. SUMMARY Vertical root fracture is a challenging problem in respect of diagnosis and management options. In this case, a vertically fractured maxillary premolar was treated by intentional re-plantation after repairing it with 4-Methacryloxyethyl trimellitate anhyride/methacrylate-tri-n-butyl borane (4-META/MMA-TBB) resin cement. At the 36-month follow-up, the tooth was asymptomatic, radiographically sound with reduced deep periodontal pockets and vertical bone loss. KEY LEARNING POINTS • Intentional replantation after repairing fractured fragments with an adhesive resin extraorally is a treatment option. • Long-term follow-up is necessary to evaluate the outcome of this technique.

An in vitro evaluation of the apical sealing ability of new polymeric endodontic filling systems

OBJECTIVE The objective of this study was to compare the short-term sealing abilities of recently introduced polymeric endodontic filling systems. STUDY DESIGN Root canals of 120 extracted and decoronated human single-rooted teeth were instrumented using crown-down technique with HERO Shaper rotary instruments. The roots were divided randomly into 8 groups (6 experimental and 2 control groups of 15 roots each) and filled with different combinations of core and sealer as follows: group 1, RealSeal/Resilon; group 2, RealSeal/Herofill; group 3, Hybrid Root Seal/Resilon; group 4, Hybrid Root Seal/Herofill; group 5, MM-Seal/Resilon; group 6, MM-Seal/Herofill; group 7, positive controls (Herofill only); group 8, negative controls. Apical leakage quantity was evaluated after 1 week by using a fluid filtration model. For each sample, measurements of fluid movement were recorded at 2-minute intervals for a total of 8 minutes, and then averaged. The data were calculated and analyzed using the Kolmogorov-Smirnov test, 1-way analysis of variance (ANOVA), and the Tukey test. Significance was set at P less than .05. RESULTS Multiple paired comparisons (Tukey test) showed that, of all the groups, MM-Seal/Herofill combination exhibited the least microleakage, and RealSeal/Herofill combination ranked second in this regard. The mean leakage values for the RealSeal/Resilon and MM-Seal/Resilon combinations were both significantly higher than the means for the other 4 experimental groups (P < .01). Hybrid Root Seal combined with Resilon resulted in significantly less microleakage than Hybrid Root Seal combined with Herofill (P = .001). CONCLUSION The results suggest that the sealing properties of epoxy-resin-based sealer (MM-Seal) combined with gutta-percha (Herofill) are superior to those of methacrylate-based sealers (Hybrid Root Seal and Realseal) combined with Resilon.

Effect of Er,Cr:YSGG laser irradiation on the apical sealing ability of AH Plus/gutta-percha and Hybrid Root Seal/Resilon Combinations

OBJECTIVE The objective of this study was to evaluate the sealing ability of 2 different resin-based endodontic filling systems after smear layer removal with 2 different techniques. STUDY DESIGN Extracted human single-rooted teeth (n = 74) were instrumented using HERO Shaper rotary instruments and irrigated with 1 mL of 2.5% NaOCl between each instrument. Additionally, the canals received either an extra 3-minute rinse with 2 mL of 17% EDTA or a 40-second Er,Cr:YSGG laser treatment. The root canals were filled with either Hybrid Root Seal/Resilon combination or AH Plus/gutta-percha combination using lateral condensation technique (n = 11). Apical leakage quantity was measured with the computerized fluid filtration meter at 1 and 4 weeks. One root from each group, which was not submitted to the fluid filtration test, was selected for scanning electron microscopy (SEM) analysis. Statistical analysis was performed using 3-way ANOVA and the post hoc Tukey HSD test (α = 0.05). RESULTS A significant decrease was observed in the microleakage values of all the experimental groups tested with time (P < .0001). EDTA + AH Plus/gutta-percha combination exhibited the least microleakage, whereas laser irradiation + Hybrid Root Seal/Resilon combination showed the greatest microleakage at each of the 2 time periods. Each experimental combination exhibited architecture in SEM that seemed to correlate with its sealing performance. CONCLUSION Er,Cr:YSGG laser treatment does not enhance the sealing ability of the sealers compared with EDTA application. The root canal adaptation and sealing ability of the Hybrid Root Seal/Resilon combination is not superior to that of the AH Plus/gutta-percha combination.

Evaluation of antifungal efficacy of erbium, chromium: yttrium-scandium-gallium-garnet laser against Candida albicans.

OBJECTIVE The purpose of this in vitro study was to investigate the ability of Er,Cr:YSGG laser irradiation at different energy settings to eliminate Candida albicans, either with or without 5.25% sodium hypochlorite (NaOCl) treatment. METHODS In total, 90 extracted human single-rooted teeth were shaped by using a crown-down technique with HERO Shaper rotary instruments and irrigated with 1 mL of 2.5% NaOCl between each instrument. The specimens were autoclaved and incubated with a suspension of C. albicans (ATCC 90028). Then the specimens were divided into six treatment groups (n = 15 per group): group 1, NaOCl + 1-W laser; group 2, 1-W laser; group 3, NaOCl + 0.75-W laser; group 4, 0.75-W laser, group 5, NaOCl; and group 6, no treatment. Aliquots of the experimental teeth were transferred onto Sabourauds dextrose agar plates with paper points, and colony-forming units (CFUs) were counted as a measure of antifungal activity. One root from each group, which was not submitted to the sampling procedure, was fixed in glutaraldehyde, split into two halves, and evaluated with scanning electron microscopy (SEM). Statistical analysis was performed by using analysis of variance (ANOVA) and the Dunnett t test. Significance was set at alpha = 0.05. RESULTS All the treatment groups resulted in a significant reduction of C. albicans, but no sterilization, and all the groups were significantly different from each other (p < 0.0001). Group 1 (NaOCl and 1-W laser combination) exhibited the greatest reduction, whereas group 5 (NaOCl) resulted in a minimal reduction in CFUs of C. albicans. The SEM observations were in accordance with the microbiologic analysis. CONCLUSIONS The 5.25% NaOCl and 1-W laser treatment combination may be a valuable cleaning tool for root canals infected with C. albicans.

The evaluation of endodontic flare-ups and their relationship to various risk factors.

BackgroundTo evaluate the incidence of flare-ups and identify the risk factors including age, gender, tooth type, number of root canals, initial diagnosis, the type of irrigation regimen, treatment modality and the number of visits, in patients who received root canal treatment from January 2002 to January 2008.MethodsRecords of 1819 teeth belonging to 1410 patients treated by 1 endodontics specialist during 6-year period were kept. Patient, tooth, and treatment characteristics were evaluated and the relationships between these characteristics and flare-ups were studied. Statistical analysis was carried out by using Pearson Chi-square test, Fisher’s Exact test, and Binary Logistic regression analyses.ResultsThe incidence of flare-ups was 59 (3.2 %) out of 1819 teeth that received endodontic therapy. Pulpal necrosis without periapical pathosis was the most common indication for flare-up (6 %) (p < 0.01). Teeth undergoing multiple visits had a higher risk of developing flare-ups compared to those with single appointments (OR: 3.14, CI: 1.414–7.009, p < 0.01). There were also no statistically significant differences in the incidence of flare-ups regarding to age, gender, tooth type, number of root canals, treatment modality, and the irrigation solutions that used during the treatment.ConclusionsThe incidence of flare-up is minimal when teeth are treated in one visit. Absence of a periapical lesion in necrotic teeth is a significant risk factor for flare-ups.

Evaluating the potential key factors in assessing the morphology of mesiobuccal canal in maxillary first and second molars

The purpose of this study was to provide further information on the morphology of the root canals and pulp chambers of 100 maxillary first and 100 maxillary second molars, with particular reference to the anatomical relationship of the root canal patterns and the distance between mesiobuccal (MB) and mesiolingual (ML) orifices. Each transverse section was digitally imaged to measure the interorificial distance using a stereomicroscope. The angles of primary curvatures were determined in both buccolingual (clinic view, CV) and mesiodistal (proximal view, PV) directions and the canal configuration of the MB root was classified according to the Weine classification. The rhomboidal pulp chamber floor morphology predominated in each tooth type. The mean interorificial distance in both maxillary first and second molars was significantly shorter in type II compared with type III (P < 0.05). The interorificial distance was correlated with the primary curvature of MB canal in PV in maxillary first molars (P < 0.05), whereas the primary curvature of ML canal in CV was correlated with the primary curvature of ML canal in PV in maxillary second molars (P < 0.01). The evaluation of interorificial distance in both types of maxillary molars and the curvature of ML canal in CV in maxillary second molar can give valuable information to the clinician.

Sealing capacity of a flowable composite, as a protective base, with different conditioning methods in nonvital bleaching.

OBJECTIVE The purpose of this in vitro study was to determine the microleakage of a nano-flowable composite used as a protective base, applied with different conditioning methods in nonvital bleaching. MATERIALS AND METHODS Forty root-filled teeth were divided into four treatment groups (n = 10 per group): group 1--Er:YAG laser etching + Adper Single Bond 2; group 2-37% phosphoric acid + Adper Single Bond 2; group 3--Adper Prompt L-Pop; and group 4--No treatment. A nano-flowable composite (Filtek Supreme Flow) base was used in each group. For a 24-h period, 40% hydrogen peroxide solution was applied to the pulp chambers, and they were subsequently subjected to a dye (silver nitrate) challenge for 4 h. After the dye was washed out with water, each tooth was cut in half and both halves were exposed to sunlight for 2 h to promote oxidation of the dye, turning it black. Finally the sections were examined under 4x magnification to determine the degree of leakage as assessed with a four-point scale. Statistical analysis was performed with the Mann-Whitney U test. RESULTS There were no significant differences between groups 1, 2, and 3 (p > 0.05), but the teeth in group 4 had significantly higher microleakage scores than the teeth in the other groups (p < 0.05). CONCLUSION Self-etching adhesive application, Er:YAG laser etching, and phosphoric acid etching combined with an adhesive system all showed similar microleakge scores when a nano-flowable composite was applied as a protective base in nonvital bleaching.

Odontogenic effects of two calcium silicate-based biomaterialsin human dental pulp cells

BACKGROUND The goal of treating exposed pulp with an appropriate pulp capping material is to promote the dentinogenic potential of the pulpal cells. There have been recent attempts to develop more effective pulp-capping materials. OBJECTIVES The aim of this study was to evaluate the effect of newly developed calcium silicate-based material on odontogenic differentiation of primary human dental pulp cells (HDPCs), in comparison with a contemporary calcium silicate-based material. MATERIAL AND METHODS Human dental pulp cells isolated from dental pulps were cultured in standard culture conditions in Dulbeccos Modified Eagles Medium (DMEM) and then the effects of Micro-Mega mineral trioxide aggregate (MM-MTA) (Micro-Mega, Besançon, France) and ProRoot MTA (MTA) (Dentsply Sirona, Tulsa, USA) (positive control) were evaluated on HDPCs at 1, 7 and 14 days. Untreated cells were used as a negative control. Odontoblastic differentiation was assessed by alkaline phosphatase (ALP) activity. Runtrelated transcription factor 2 (RUNX2), alkaline phosphatase liver/bone/kidney (ALPL), bone morphogenetic protein 2 (BMP2), dentin sialophosphoprotein (DSPP), and Distal-less homeobox 3 (DLX3), as odontoblastic/ osteoblastic expression markers, were evaluated by semi-quantitative real-time polymerase chain reaction (RT-PCR) analysis. Calcium levels of culture media were also determined. RESULTS The MM-MTA group significantly increased the expression of BMP2 compared with that of the MTA group at 3 different time periods (p < 0.05). The up-regulation of ALPL between day 1 and 14 and the up-regulation of DSPP between day 7 and 14 were significant in both groups (p < 0.05). Micro-Mega MTA and MTA exhibited similar messenger RNA (mRNA) expression levels of ALPL, DSPP, RUNX2, DLX3, and ALP activities, as well as calcium levels. CONCLUSIONS Based on the cell responses observed in this study, MM-MTA might be used efficiently in dental pulp therapy as a potential alternative to MTA.