Ertuğrul Ercan

Effect of Intracanal Medication with Calcium Hydroxide and 1% Chlorhexidine in Endodontic Retreatment Cases with Periapical Lesions: An In Vivo Study

BACKGROUND/PURPOSE Calcium hydroxide (Ca(OH)(2)) has been widely used as an intracanal medicament for endodontic retreatment, but very few studies used both Ca(OH)(2) and 1% chlorhexidine (CHX) as intracanal medicaments. The purpose of this study was to assess the in vivo effectiveness of a combination of Ca(OH)(2) and 1% CHX as intracanal medicaments in endodontic retreatment cases with periapical lesions. METHODS Previous cases of endodontically treated teeth with periapical pathosis in 70 patients (36 men and 34 women, age range 18-60 years) were included. Of these teeth, 59 had received root canal treatment and 11 had been subjected to previous apical surgery, indicating endodontic failure. Following the routine procedures, including canal reshaping and irrigation with 2% CHX, a canal medication material containing Ca(OH)(2) powder and a 1% CHX solution was placed into the root canals. Over a 6-week period, the intracanal medication was periodically changed until the teeth became asymptomatic. Patients were recalled at 3-month intervals for radiographic and clinical examination. RESULTS Our clinical and radiographic assessment of retreatment cases showed complete healing in 41 (64%) teeth, incomplete healing in 9 (14%) teeth, and failure in 14 (22%) teeth. For complete healing teeth, the healing time varied from 6 to 36 months. The size of the periapical lesions and previous surgical treatment had no influence on the prognosis. CONCLUSION Our results suggest that a combination of Ca(OH)(2) and 1% CHX can be successfully used as intracanal medicament for disinfection in endodontic retreatment cases with periapical lesions.

A field-trial of two restorative materials used with atraumatic restorative treatment in rural Turkey: 24-month results

Objective: The purpose of this study was to investigate the clinical performance of high-strength glass ionomer cement (HSGIC) and resin-modified glass ionomer (RMGIC) in single and multiple surface carious cavities in the field conditions. Material and Methods: A split-mouth design, including ninety-one fillings placed on contra lateral molar pairs of 37 children, was used in permanent dentition. As filling materials, a HSGIC (Ketac Molar/3M ESPE) and a RMGIC (Vitremer/ 3M ESPE) were used with the Atraumatic Restorative Treatment (ART). Baseline and 6, 12 and 24-month evaluations of the fillings were made with standard-ART and USPHS criteria by two examiners with kappa values of 0.92 and 0.87 for both criteria. Results: According to the USPHS criteria, the retention rates of RMGIC and HSGIC restorations were 100% and 80.9% for single surface, and 100% and 41.2% for multiple surface restorations after 24 months, respectively. Irrespective of surface number, RMGIC was significantly superior to HSGIC (p= 0.004), according to both standard-ART and USPHS criteria. Conclusion: The results indicate that RMGIC may be an alternative restorative technique in comparison to high-strength GIC applications in ART-field-trials. However, further clinical and field trials are needed to support this conclusion.

The effects of three different desensitizing agents on the shear bond strength of composite resin bonding agents

The aim of this study was to evaluate the effects of three desensitizing agents on the shear bond strengths of four different bonding agents used to bond composite resin to dentin. A total of 160 extracted human molars were sectioned parallel to the occlusal plane under water cooling, polished and randomly divided into 4 groups of 40. Each group was treated with a different desensitizing agent (Tooth Mousse, Ultra-EZ, Cervitec Plus), except for an untreated control group. Each group was then randomly subdivided into 4 groups of 10, and a different dentin bonding agent (XP Bond, AdheSE, Adper Prompt L-pop, GBond) was applied to each group in order to bond the specimens to a resin composite (Gradia Direct) built up using a plastic apparatus. A Universal Testing Machine was used to measure the shear bond strength of each specimen. Statistical analysis was performed using one-way ANOVA and Tukeys tests. With the exception of the Control/AdheSE and Ultra-EZ/XP Bond groups, no statistically significant differences were found in the shear bond strength values of the groups tested. These findings suggest that the use of different desensitizing agents does not affect the shear bond strength of various adhesive systems used to bond resin composite to dentin.

Effects of Different Chlorhexidine Formulations on Shear Bond Strengths of Orthodontic Brackets

OBJECTIVE To test the hypothesis that the application of different chlorhexidine formulations to the etched enamel will not affect shear bond strength (SBS). MATERIALS AND METHODS Forty-four freshly extracted human premolars were collected and stored in distilled water. The teeth were etched with 37% phosphoric and were rinsed and dried. The teeth then were divided into four equal groups. While Group 1 served as a control, Groups 2 to 4 were treated before bonding with a chlorhexidine formulation that included solution (2%), gel (1%), and mouthwash (0.2%). Orthodontic brackets were bonded with Transbond XT (3M Unitek, Monrovia, Calif). Bond strength results were evaluated with the use of one-way analysis of variance (ANOVA) (P < .05) and post hoc tests. Modes of failures were verified by means of scanning electron microscopy. RESULTS Although no statistically significant difference was observed between Groups 1 and 4 (P > .05), both were statistically superior to Groups 2 and 3 (P < .05). In this in vitro study, the observed measures for Groups 2 and 3 (14.5-10.6 MPa) were lower than those for Groups 1 and 4 (27.3-24.9 MPa), but these values were much higher than those required for clinical use (6-8 MPa). CONCLUSION The hypothesis is rejected. The application of chlorhexidine mouth rinse before bonding had no significant effect on the SBS value, and the application of chlorhexidine solution and gel significantly decreased SBS.

Effect of 1% chlorhexidine gel on the bonding strength to dentin

Background/Purpose The purpose of this in vitro study was to evaluate the effect of 1% chlorhexidine (CHX) gel on dentin bond strengths of posterior composite resin applied with two different adhesive systems. Material and methods In total, 75 extracted, caries-free human molars were used. The occlusal surface of each tooth was ground to create a flat dentin surface. Then, each tooth was mounted in acrylic. The dentin specimens were randomly assigned to five groups of 15 specimens each. In Group 1, Prime & Bond NT (PBNT) was applied; in Group 2, a 1% CHX gel + etching for 15 s + PBNT were applied; in Group 3, etching + 1% CHX gel + PBNT were applied; in Group 4, Clearfil S 3 Bond was applied; and in Group 5, 1% CHX gel + Clearfil S 3 Bond were applied. A dentine bonding system was applied to dentin surfaces, and composite cylinders were built up using a special device and then light-polymerized. Specimens were mounted and sheared using an Instron universal testing machine at a cross-head speed of 0.5 mm/min. Results: The results were recorded in megapascals. The sheared specimens were examined under a light microscope, and the type of failure (adhesive, cohesive or mixed) was recorded. Data were compared by one-way analysis of variance and Tukeys honestly significant difference tests. Means were 16.4 ± 4.1 MPa in Group 1, 16.2 ± 3.9 MPa in Group 2, 13.0 ± 4.5 MPa in Group 3, 11.9 ± 2.7 MPa in Group 4, and 11.5 ± 2.7 MPa in Group 5. The use of 1% CHX gel before acid etching was significantly higher than after etching on the shear bond strength of PBNT (P 0.05). Conclusion Within the limitations of the present in vitro study, it was concluded that 1% CHX gel application did not adversely affect the shear bond strengths of dentin-bonding agents.

Shear bond strength of bulk-fill and nano-restorative materials to dentin.

Objectives: Bulk-fill composite materials are being developed for preparation depths of up to 4 mm in an effort to simplify and improve the placement of direct composite posterior restorations. The aim of our study was to compare shear-bond strength of bulk-fill and conventional posterior composite resins. Materials and Methods: In this study, 60 caries free extracted human molars were used and sectioned parallel to occlusal surface to expose midcoronal dentin. The specimens were randomly divided into four groups. Total-etch dentine bonding system (Adper Scotchbond 1XT, 3M ESPE) was applied to dentin surface in all the groups to reduce variability in results. Then, dentine surfaces covered by following materials. Group I: SonicFill Bulk-Fill, Group II: Tetric EvoCeram (TBF), Group III: Herculite XRV Ultra, and Group IV: TBF Bulk-Fill, 2 mm × 3 mm cylindrical restorations were prepared by using application apparatus. Shear bond testing was measured by using a universal testing machine. Kruskal–Wallis and Mann–Whitney U-tests were performed to evaluate the data.Results: The highest value was observed in Group III (14.42 ± 4.34) and the lowest value was observed in Group IV (11.16 ± 2.76) and there is a statistically significant difference between these groups (P = 0.046). However, there is no statistically significant difference between the values of other groups. In this study, Group III was showed higher strength values. Conclusion: There is a need for future studies about long-term bond strength and clinical success of these adhesive and bulk-fill systems.

A Comparison of Microleakage Scores of Five Different Types of Composite Resins

ABSTRACT This study aimed to perform a comparative assessment of microleakage in Class V cavities among five different composite resins. For this purpose 100 fresh caries-free human permanent molars were randomly assigned to one of five groups (n=20). Clearfil Majesty Esthetic + Clearfil S3 Bond (Group I), TPH Spectrum + Xeno V (Group II), Gradia Direct Anterior + G Bond (GC) (Group III), Premise + Optibond All in One (Group IV) and Charisma + iBond (Group V) were applied and polymerized under LED. Specimens were varnished, immersed in 0.5% methylene and sectioned bucco-palatinally/lingually, and microleakage scores were determined. Gingival and occlusal microleakage scores among groups were statistically significant (p<0.05) (p=0.043, p=0.005). Occlusal microleakage scores for Clearfil Majesty Esthetic and Premise were lower than in the other groups. Charisma had the highest microleakage scores, with no difference among the other groups (p>0.05). In conclusion occlusal and gingival microleakage scores were satisfactory except for Charisma.

Cement Thickness of Inlay Restorations Made of Lithium Disilicate, Polymer-Infiltrated Ceramic and Nano-Ceramic CAD/CAM Materials Evaluated Using 3D X-Ray Micro-Computed Tomography

PURPOSE To evaluate the marginal and internal cement thicknesses of inlay restorations made of various CAD/CAM materials using 3D X-ray micro-computed tomography (micro-CT) technique. MATERIALS AND METHODS Caries-free extracted mandibular molars (N = 30) with similar size were randomly assigned to three groups (N = 10 per group). Mesio-occlusal-distal (MOD) cavities were prepared, and inlay restorations were obtained by milling out CAD/CAM materials namely, (a) IPS: monolithic lithium disilicate (control), (b) VE: polymer-infiltrated ceramic, and (c) CS: nano-ceramic using a CAM unit. Marginal and internal cement thicknesses were measured using 3D micro-CT. Data were analyzed using 1-way ANOVA and Tukeys tests (alpha = 0.05). RESULTS The mean marginal and internal cement thickness were not significant in all inlay materials (p > 0.05). Mean marginal cement thickness (μm) was the lowest for the IPS group (67.54 ± 10.16) followed by VE (84.09 ± 3.94) and CS (95.18 ± 10.58) (p > 0.05). The internal cement thickness (μm) was the lowest in the CS group (54.85 ± 6.94) followed by IPS (60.58 ± 9.22) and VE (77.53 ± 12.13) (p > 0.05). CONCLUSION Marginal and internal cement thicknesses of MOD inlays made of monolithic lithium disilicate, polymer-infiltrated ceramic, and nano-ceramic CAD/CAM materials were similar and all less than 100 μm, which could be considered clinically acceptable. CLINICAL SIGNIFICANCE MOD inlays made of different CAD/CAM materials presented similar cement thickness, less than 100 μm.

The effect of different adhesives and setting times on bond strength between Biodentine and composite

Background The aim of this study was to evaluate the effects of 3 different adhesives with different functional monomers, on the shear bond strength (SBS) of Biodentine®. Methods Acrylic blocks (n = 90) were prepared and a 2-mm height x 4-mm diameter hole was opened in each block. Every hole was completely restored with Biodentine®. Before preparation of composite restorations over the Biodentine® (2-mm height x 2-mm diameter), 3 different adhesives (Etch-37 (37%) w/BAC by Bisco & Prime Bond N&T, Clearfil S3 Bond and Adper Prompt L-Pop) were applied. SBS was evaluated using a universal testing machine, and failure mode for each sample was recorded. The results were statistically analyzed using 2-way ANOVA and post hoc Tukey test. Results When the megapascal values of all groups were compared, although there was no statistically significant difference in the different setting times (p>0.05), statistically significant differences were observed among all adhesive groups (p<0.05). Moreover, the highest SBS values were observed in the Clearfil S3 Bond group. Conclusions Clinical performance of Biodentine® may be affected by adhesive procedures and its setting time.

Evaluation of school-based prevention program in Turkey: Results of a 24-month study.

Objective: In this paper, cavity experiences of children with different levels of eruption and cavity activities that are enrolled at an elementary school with semi-rural characteristics in Kırıkkale Provincial center were monitored for 2 years after a variety of protective applications. Materials and Methods: Three hundred and twenty-two children at the age of 7–11 were included in this study. Children were grouped as follows according to their cavity experiences and applications done: Group 1 - control group (with or without cavities) – was given hygiene training only; Group 2 - with medium level cavity activity (2–4 cavities in average) – oral hygiene training + surface restoration applied; Group 3 - children with 2–4 cavities on average – oral hygiene training + professional flour gel applied; Group 4 - children with 2–4 cavities in average – oral hygiene training + flour gel applied with brush; Group 5 - children with extreme cavity activity (children with 5 or more cavities) – oral hygiene training + surface restoration + professional flour gel combination applied. Results: At the end of the 2nd year, 277 children were reached. The increase of number of cavities in permanent teeth was determined as 35%, 0%, 1%, 0%, and 7% in groups 1–5, respectively. The difference between groups was found to be significant (Chi-square analysis, Pearson Chi-square = 27.002, P < 0.01). Conclusion: These findings have showed that, in Kırıkkale Provincial center, some cavity-preventive measures such as surface restoration and gel applications, along with hygiene training, could provide optimum protection for school-age children.