Frank J. Vertucci

Root canal anatomy of the human permanent teeth

Two thousand four hundred human permanent teeth were decalcified, injected with dye, and cleared in order to determine the number of root canals and their different types, the ramifications of the main root canals, the location of apical foramina and transverse anastomoses, and the frequency of apical deltas.

Cytotoxicity of Endodontic Materials

An in vitro cell culture model of human gingival fibroblasts and L-929 cells was used to measure the cytotoxicity of currently used root canal sealers Endomet, CRCS, and AH26 and root-end filling materials Amalgam, Gallium GF2, Ketac Silver, mineral trioxide aggregate (MTA), and Super-EBA. Cytotoxic effects were assessed using the MTT assay for mitochondrial enzyme activity and the CV assay for cell numbers. Using inserts culture and L-929 fibroblasts. All-Bond-2 was also evaluated. The statistical analysis of results showed that CRCS was the least cytotoxic sealer followed by Endomet and AH26. Among root-end filling materials, MTA was not cytotoxic; Gallium GF2 displayed little cytotoxicity; and Ketac Silver, Super-EBA, and Amalgam showed higher levels of cytotoxicity. All Bond-2 also displayed a high degree of cytotoxicity. CRCS was the best root canal sealer and MTA the best root-end filling material. The outcome was favorable also for Gallium GF2 as a retrofilling material.

Apical leakage associated with retrofilling techniques: A dye study

This in vitro study utilized methylene blue dye to evaluate the extent of apical microleakage following reverse filling procedures. Forty human canine root canals were biomechanically prepared and obturated with laterally condensed gutta-percha and Roths 801 Elite grade zinc oxide and eugenol sealer. The surfaces of the specimens were covered with red enamel paint, leaving only the apical foramen in a patent condition. The roots were then apically resected and randomly placed into one of four groups. The specimens in each group received the following treatment: group A—cold-burnished gutta-percha; group B—reverse amalgam fillings without varnish; group C—reverse amalgam fillings with varnish in cavity preparation only; and group D—reverse amalgam fillings with varnish in cavity preparation and on beveled root surface. All roots were submerged in 1% methylene blue dye for 2 wk and sectioned longitudinally, and the depth of linear dye penetration was measured. Significantly less leakage occurred when the cavity preparation and the beveled root surface were coated with varnish prior to placement of an amalgam restoration.

Dentinal Tubule Disinfection Using Three Calcium Hydroxide Formulations

The objective of this study was to determine the antibacterial efficacy of three calcium hydroxide (CH) formulations using an in vitro model of Enterococcus faecalis dentinal tubule infection. CH mixed with water (CH), CH mixed with iodine-potassium iodide (CH+IKI), and CH mixed with iodoform and silicone oil (Metapex) were tested. Human cylindrical dentin specimens infected with E. faecalis were filled with disinfectants and incubated for 1 week. Dentin powder samples collected with ISO 018 burs showed a statistically significant reduction in E. faecalis for all three experimental groups in comparison with untreated control specimens. Statistically significant differences were also found between the three experimental groups. Metapex was the most effective dentinal tubule disinfectant, followed by CH+IKI and then CH. Similar results were observed at greater dentin tubule depths (ISO 021 burs) with the exception that intracanal treatment with CH resulted in significantly higher numbers of E. faecalis in comparison with untreated control specimens.

Furcation canals in the human mandibular first molar.

Abstract The presence of lateral canals from the floor of the pulp chamber to the furcation region has been demonstrated radiographically after obliteration of the root canal. Furthermore, pulpal inflammation can cause areas of rarefaction in the interradicular bone which normally resolve after routine endodontic procedures. These occurrences seem to indicate that there are direct avenues of communication between the pulp and periodontal tissues. In order to investigate this further, 100 human mandibular first molars were used in an in vitro study to determine the incidence of lateral canals in the furcation region.

A scanning electron microscopic investigation of accessory foramina in the furcation and pulp chamber floor of molar teeth

Observations of the pulp chamber floor and furcation surface of human maxillary and mandibular first and second molars were made with the scanning electron microscopic to determine the incidence, size, and location of patent accessory foramina. Accessory foramina on both the pulp chamber floor and the furcation surface were found in 36% of maxillary first molars, 12% of maxillary second molars, 32% of mandibular first molars, and 24% of mandibular second molars. Mandibular teeth had a higher incidence (56%) of foramina involving both the pulp chamber floor and furcation surface than did the maxillary teeth (48%).

Comparison of the apical seal obtained by a dual-cure resin based cement or an epoxy resin sealer with or without the use of an acidic primer.

This study compared the apical leakage of roots obturated with gutta-percha using either a dual-cure resin based cement (Panavia F) or an epoxy-resin sealer (Thermaseal plus) with or without the application of an acidic primer (ED Primer). Eighty-six single rooted canine teeth were decoronated, cleaned, and shaped by using hand and rotary instruments, randomly divided into four groups, and obturated as follows: group A (n = 20): ED Primer applied followed by thermoplastized obturation with gutta-percha and Thermaseal Plus sealer; group B (n = 20): thermoplastized obturation with gutta-percha and Thermaseal Plus; group C (n = 20): ED primer applied followed by thermoplastized obturation with gutta-percha and Panavia F; group D (n = 20): thermoplastized obturation with gutta-percha and Panavia F. Both a negative control (n = 3; entire root coated with wax) and a positive control (n = 3; obturated with only a fitted master cone) were included in the study. Groups A, B, C, D, and the controls were immersed in molten sticky wax, leaving the apical 2-mm exposed, and quickly chilled. All teeth were immersed in 1% methylene blue dye solution for 10 days, rinsed, and sectioned longitudinally. Apical dye penetration was measured stereomicroscopically at 10-fold magnification. The analysis of variance and Duncan Multiple Range were used for result analysis. The specimens obturated with gutta-percha and an epoxy-resin sealer (with or without an acidic primer) demonstrated significantly less linear dye penetration than specimens obturated with gutta-percha and the dual-cure, resin-based cement (with or without an acidic primer).

Management of a vertical root fracture

An incomplete buccolingual vertical fracture developed in the root of a maxillary left second premolar, probably as a result of restorative procedures. Surgical intervention, consisting of the removal of a major portion of the buccal half of the root and the application of a 20% citric acid solution for 5 min, produced a favorable result. However, the long-term prognosis remains guarded.

RAGE mRNA Expression and Its Correlation with Nuclear Factor Kappa Beta mRNA Expression in Inflamed Human Periradicular Tissues

Advanced glycation end products (AGEs) have been found to play a role in inflammation and vascular complications. The receptor for AGE (RAGE) is expressed on many cells and is up-regulated during inflammation. To date, RAGE expression or its correlation with nuclear factor kappa beta (NF-kappabeta) expression has not been demonstrated in inflammatory periapical lesions. In this study, periapical tissue was obtained from 38 patients and processed for RAGE and NF-kappabeta expression by using reverse transcriptase polymerase chain reaction. Various patient variables were examined as predictors for these novel protein expressions. The results demonstrated a statistically significant positive correlation between the expression of RAGE and NF-kappabeta (P = .001). When comparing whites and African Americans, a statistically significant difference was noted, with the African American group exhibiting a higher expression of RAGE (analysis of variance, F= 12.746, P = .002). A positive linear correlation of their presence was demonstrated in inflamed periradicular tissues. This study outlines the possible use of these proteins as potential markers for periapical inflammation.

The porcine jaw: An aid for teaching endodonticsurgery*

A variety of methods and aids have been and areused for teaching endodontic surgery techniques. This article presents the porcine mandible as an alternative method. It is readily available, realistic, economical, and provides for a meaningful labortory experience.