Emre Nagas

Dentin moisture conditions affect the adhesion of root canal sealers.

INTRODUCTION The purpose of this study was to evaluate the effects of intraradicular moisture conditions on the push-out bond strength of root canal sealers. METHODS Eighty root canals were prepared using rotary instruments and, thereafter, were assigned to 4 groups with respect to the moisture condition tested: (1) ethanol (dry): excess distilled water was removed with paper points followed by dehydration with 95% ethanol, (2) paper points: the canals were blot dried with paper points with the last one appearing dry, (3) moist: the canals were dried with low vacuum by using a Luer adapter for 5 seconds followed by 1 paper point for 1 second, and (4) wet: the canals remained totally flooded. The roots were further divided into 4 subgroups according to the sealer used: (1) AH Plus (Dentsply-Tulsa Dental, Tulsa, OK), (2) iRoot SP (Innovative BioCeramix Inc, Vancouver, Canada), (3) MTA Fillapex (Angelus Indústria de Produtos Odontológicos S/A, Londrina, Brasil), and (4) Epiphany (Pentron Clinical Technologies, Wallingford, CT). Five 1-mm-thick slices were obtained from each root sample (n = 25 slices/group). Bond strengths of the test materials to root canal dentin were measured using a push-out test setup at a cross-head speed of 1 mm/min. The data were analyzed statistically by two-way analysis of variance and Tukey tests at P = .05. RESULTS Irrespective of the moisture conditions, iRoot SP displayed the highest bond strength to root dentin. Statistical ranking of bond strength values was as follows: iRoot SP > AH Plus > Epiphany ≥ MTA Fillapex. The sealers displayed their highest and lowest bond strengths under moist (3) and wet (4) conditions, respectively. CONCLUSIONS The degree of residual moisture significantly affects the adhesion of root canal sealers to radicular dentin. For the tested sealers, it may be advantageous to leave canals slightly moist before filling.

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.

Effect of ethylenediaminetetraacetic acid on root fracture with respect to concentration at different time exposures.

INTRODUCTION The objective of this study was to evaluate the effect of ethylenediaminetetraacetic acid (EDTA) on root fracture with respect to various concentrations at different time exposures. METHODS A total of 48 mandibular incisors were selected. Eight nonprepared roots were selected as a negative control. The remaining 40 specimens were instrumented with rotary files and randomly assigned to one of the following groups for final irrigation: (1) 10 mL distilled water for 10 minutes (positive control); (2) 10 mL of 17% EDTA for 1 minute + 10 mL of 1% NaOCl for 1 minute; (3) 10 mL of 5% EDTA for 1 minute + 10 mL of 1% NaOCl for 1 minute; (4) 10 mL of 17% EDTA for 10 minutes + 10 mL of 1% NaOCl for 1 minute; (5) 10 mL of 5% EDTA for 10 minutes + 10 mL of 1% NaOCl for 1 minute. Thereafter, the root canals were filled by using AH26 root canal sealer with a single-cone technique. The specimens were loaded vertically at 1 mm/min crosshead speed until vertical root fracture occurred. Results were evaluated statistically with 1-way analysis of variance and Students t test. RESULTS Statistically significant differences were detected among the groups (P < .05). The highest mean fracture resistance was obtained from the group treated with 5% EDTA for 10 minutes. This is about 2 times more than the weakest mean fracture resistance, which was obtained from the 17% EDTA-10 minute group. CONCLUSIONS The fracture resistances of endodontically treated roots were found to be differently affected by the various concentrations of EDTA at different time exposures.

The effect of master point taper on bond strength and apical sealing ability of different root canal sealers.

OBJECTIVE The aim of this study was to compare the bond strength and apical sealing ability of master gutta-percha points with different tapers, as used in conjunction with different root canal sealers. STUDY DESIGN Roots of extracted human maxillary incisors (n = 135) were prepared with 0.06-taper nickel-titanium rotary files to final size 30. The roots were then randomly divided into 3 groups according to the root canal sealer used: 1) AH Plus; 2) Ketac-Endo; and 3) EndoREZ. Each sealer was combined with 1 of the following obturation techniques: 0.02-tapered gutta-percha master cone using lateral condensation, 0.04-tapered gutta-percha master cone using lateral condensation, or 0.06-tapered gutta-percha as a single cone. The bond strength and apical sealing ability were measured with the push-out test and dye penetration test, respectively. The data were statistically analyzed by using Kruskal-Wallis test with Bonferroni correction at P = .05. RESULTS Both the taper of the gutta-percha point and root canal sealers had significant effects on push-out bond strength (P < .001). According to the microleakage data, AH Plus exhibited significantly lower overall leakage, whereas no difference was found between master cone points (P = .093). CONCLUSIONS The use of matched-taper gutta-percha points in canals prepared with tapered rotary instruments may be advocated to improve bond strength ability of root canal filling material. Furthermore, AH Plus may be preferable to EndoRez and Ketac-Endo in terms of improved sealing and bonding quality of filling material.

Effect of several intracanal medicaments on the push-out bond strength of ProRoot MTA and Biodentine

AIM To evaluate the effect of prior application of several intracanal medicaments on the push-out bond strength of ProRoot MTA and Biodentine. METHODOLOGY Sixty freshly extracted maxillary anterior teeth were sectioned below the cementoenamel junction, and the root canals instrumented using rotary files. Thereafter, a parallel post drill was used to obtain a standardized root canal dimension. The roots were randomly assigned into one of the following groups with respect to the intracanal medicament applied: group 1: calcium hydroxide (CH) powder (Merck, Darmstadt, Germany) mixed with distilled water; group 2: a mixture of metronidazole, ciprofloxacin and minocycline (triple antibiotic paste); group 3: a combination of amoxicillin and clavulanic acid (Augmentin; Champs Pharmacy, San Antonio, TX, USA); group 4: an antibiotic-corticoid compound paste (Ledermix; Riemser, Greifswald, Germany); and group 5: no medicament (control). Following removal of medicaments with instrumentation and irrigation, the roots were cut into 1-mm-thick parallel transverse sections in a coronal-to-apical direction (5 slices/tooth). Thereafter, the specimens were divided into two subgroups according to the calcium silicate cement applied (n = 30/group): (i) ProRoot MTA (Dentsply Tulsa Dental, Tulsa, OK, USA) and (ii) Biodentine (Septodont, Saint-Maur-des-Fosses, France). A push-out test was performed, and the data were analysed statistically using two-way anova and Tukeys post hoc test. RESULTS Regardless of the type of intracanal medicament used, Biodentine had significantly higher bond strength than MTA (P < 0.05). The highest push-out bond strength results were obtained in CH-treated dentine. Compared with other medicaments, this value was only significantly higher than that of Ledermix (P < 0.05). In both the MTA and Biodentine groups, pairwise comparisons between other medicaments showed similar debonding values (P > 0.05). CONCLUSIONS Biodentine had a higher bond strength to root canal dentine than ProRoot MTA. Prior CH in distilled water intracanal placement increased the dislodgment resistance of both calcium silicate cements.

Effects of different irrigation regimens on the sealing properties of repaired furcal perforations

OBJECTIVE The pulp chamber is inevitably exposed to irrigants during endodontic therapy. This study aimed to investigate whether different irrigation regimens would alter the sealing ability of repaired furcal perforations. STUDY DESIGN Pulp chambers of 90 extracted human molars were accessed, after which standardized diamond bur-cut perforations were created in the center of the pulp chamber floor. The canal orifices and the apical end of roots were sealed with acid-etch composite resin. Eighty teeth were randomly divided into 2 groups (n = 40/group) according to the material used for repairing the perforation defects: (1) Mineral trioxide aggregate (MTA), (2) Super-EBA. The remaining teeth (n = 10) served as controls. The specimens were further subgrouped according to the irrigation regimens applied over the repair site (n = 10/group): (a) 5.25% NaOCl, (b) 5.25% NaOCl + EDTA, (c) 5.25% NaOCl + MTAD, and (d) No irrigation. Coronal leakage was measured by the fluid-filtration method at 1 day and 1 week. RESULTS Fluid conductance was not affected by the type of repair material (P = .964) or time (P = .726), but was affected significantly by the irrigation regimens in the following ranking: (P < .001): NaOCl < or = No Irrigation < NaOCl + MTAD < or = NaOCl + EDTA. CONCLUSION The sealing ability of furcal perforations repaired with MTA or Super-EBA were differentially affected by exposure to the tested irrigation regimens.

Comparison between regional micropush-out and microtensile bond strength of resin composite to dentin.

Objective. In this study we compared the micropush-out (µ-PO) and microtensile (µ-TBS) test methods for resin composites on different levels and surfaces of dentin. Material and Methods. Thirty-four sound human molars were divided into two groups in accordance with the dentin surface used (occlusal (O) or mesio-distal (M)), then subdivided into a further two groups in accordance with the test method (µ-PO (P) or µ-TBS (T)). In groups OP and OT, teeth were ground occlusally perpendicular to their axis, and in groups MP and MT, mesio-distally parallel to their axis to expose dentin. Dentin disks were prepared from different regions of the teeth either in an occluso-cervical (group OP) (n=5) or mesio-distal direction (group MP) (n=5) (S, superficial; M, middle; D, deep). One-hundred-and-twenty standardized occlusal cavities were prepared in these dentin disks using a conical-shaped diamond rotary cutting instrument. The adhesive (Adper Scotchbond Multi-Purpose Dental Adhesive) and a composite material (Filtek Z250 Universal Restorative) were applied and polymerized with a LED light curing unit (Elipar FreeLight 2). The disks (n=20/per group) were tested in a universal testing machine and pushed out with a cross-head speed of 1.0 mm/min. In groups OT (n=12) and MT (n=12), the teeth were ground to expose superficial, middle, and deep dentin. Build-ups of resin composite were constructed with the same materials. The specimens were serially sectioned and trimmed to hour-glass shapes, then tested with the µ-TBS tester at a rate of 1 mm/min. Failure modes were examined using a stereomicroscope and scanning electron microscope. Results. ANOVA revealed significant differences among the groups (p<0.001). With the push-out test, no premature failure occurred, the variability of the data distribution was acceptable, and regional differences in bond strength among dentin levels could be assessed. Conclusions. The µ-PO test method could be an alternative to the µ-TBS technique.

A comparison of three rotary systems and hand instrumentation technique for the elimination of Enterococcus faecalis from the root canal.

The aim of this study was to compare the in vitro reduction of a bacterial population in a root canal by mechanical instrumentation using three rotary systems and hand instrumentation technique. The root canals contaminated with a suspension of Enterococcus faecalis were instrumented using ProTaper, K3, HeroShaper and K-file hand instrumentation technique. Later the root canals were sampled. After serial dilutions, samples were incubated in culture media for 24 h. Bacterial colonies were counted and the results were given as number of colony-forming units per millilitre. The results showed that all the canal instrumentation systems reduced the number of bacterial cells in the root canals. Statistically, ProTaper instruments were more effective in reducing the number of bacteria than the other rotary files or hand instruments.

Effect of plunger diameter on the push-out bond values of different root filling materials.

AIMS To evaluate the effect of plunger diameter on the push-out bond strength of different root filling materials to root canal dentine. METHODOLOGY Freshly extracted human incisors (n=90) were decoronated, and the root canals were enlarged with post drills. Prepared roots were placed into a custom alignment apparatus to embed the roots vertically within self-curing acrylic resin. The specimens were randomly assigned into three groups according to the root filling system used: gutta-percha/AH Plus; Resilon/Epiphany; and fibre-reinforced composite (FRC)/Duolink resin cement. After filling, the specimens were further subdivided according to the diameter of the plunger used to employ the debonding force: 0.75, 1 and 1.25 mm. Intra-radicular bond strength was measured using the push-out test at a cross-head speed of 1 mm min(-1) . The data were analysed statistically using Kruskal-Wallis test with Bonferroni correction at P = 0.05. RESULTS Regardless of the plunger diameter, FRC yielded the highest bond strength, followed by gutta-percha and Resilon, respectively (P<0.001). In all groups, greater plunger diameter resulted in an apparent increased bond strength, but the differences were only significant in the FRC group, with the 1.25-mm plunger generating higher debonding values compared with that of its 0.75- and 1-mm versions (P<0.001). In the gutta-percha and Resilon groups, the majority of specimens had adhesive failures. Roots filled with FRC exhibited more cohesive failures than those of the other test groups. CONCLUSIONS Different plunger diameters are associated with significantly different intra-radicular push-out bond strengths of root filling systems.

Effect of different intraorifice barriers on the fracture resistance of roots obturated with Resilon or gutta-percha.

INTRODUCTION This study investigated and compared the root reinforcement potential of 3 different intraorifice barriers (mineral trioxide aggregate [MTA], resin-modified glass ionomer cement [Vitremer], and fiber-reinforced composite [FRC]) placed over root canals obturated with gutta-percha or Resilon. METHODS Crowns of 80 extracted human mandibular premolars were sectioned off to obtain 14-mm-long root specimens. After preparation of root canals with nickel-titanium rotary files, the roots were obturated with either the Resilon/Epiphany system or gutta-percha + AH Plus sealer. In both obturation groups, specimens were further subgrouped with respect to the intraorifice barrier material placed after removal of 3-mm coronal portion of the root fillings: (1) MTA, (2) Vitremer, and (3) FRC. The specimens were loaded vertically at 1 mm/min crosshead speed until vertical root fracture occurred. Results were evaluated statistically with two-way analysis of variance and Tukey tests. RESULTS Fracture resistance of roots was significantly affected by the type of intraorifice barrier (P < .05), but not by the type of obturation system used (P > .05). CONCLUSIONS The use of Vitremer and FRC significantly improved the fracture resistance, whereas MTA did not exhibit any reinforcing effect as an intraorifice barrier.