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A case series associated with different kinds of endo-perio lesions

Pulpal and periodontal problems are responsible for more than half of the tooth mortality. There are some articles published in the literature about this issue. Many of them are quite old. There has been also lack of knowledge about the effect of endodontic treatment on the periodontal tissue healing and suitable treatment interval between endodontic and periodontal treatments. In this case report, different kinds of endo-perio lesion were treated with sequential endodontic and periodontal treatment. The follow-up radiographs showed complete healing of the hard and soft tissue lesions. The tooth with endo-perio lesions should be evaluated thoroughly in terms of any cracks and fracture, especially furcation areas for a long term prognosis. In this case report, it was showed that 3 months treatment intervals between endodontic treatment and periodontal surgery has no harmful effect on periodontal tissue healing. Key words:Endo-perio lesion, furcation, mandibular molar, bone graft, crack line, treatment interval.

Efficacy of different irrigant protocols and application systems on sealer penetration using a stepwise CLSM analysis

This study compared several irrigation protocols and application systems for sealer penetration into dentinal tubules. Single‐rooted‐human teeth were divided into 5 experimental groups (n = 15) and a control group (n = 5), according to final irrigation protocols: standard needle irrigation (SNI); Vibringe; Vibringe + NaviTip FX (Vibringe NFX); Endo Spray (ES); and passive‐ultrasonic‐irrigation (PUI). Following obturation of the root canals, the percentage of the sealer penetration was measured at different depths using stepwise CLSM analysis. The sealer penetration in the experimental groups was significantly higher than the control group at all levels (p < .05). No significant differences were observed between Vibringe and SNI or Vibringe NFX, ES, and PUI at all depths (p > .05). The Vibringe NFX, ES, and PUI groups allowed deeper sealer penetration than SNI at 100, 250, and 500 μm levels (p < .05). The irrigant activation, the needle design, and the application form (syringe or spray) may impact the quality of the seal that is achieved with root canal filling.

Effect of a Low Surface Tension Vehicle on the Dentinal Tubule Penetration of Calcium Hydroxide and Triple Antibiotic Paste

Introduction: The purpose of this study was to evaluate dentinal tubule penetration (DTP) of calcium hydroxide (CH) and triple antibiotic paste (TAP) when performed with distilled water (DW) or a low surface tension liquid (ie, propylene glycol [PG]). Methods: Root apices of 40 single‐rooted premolars were removed to obtain 14‐mm roots in length. Root canals were enlarged to simulate immature teeth. After smear layer removal, the roots were randomly divided into 4 groups (n = 10) according to the root canal medicaments and the vehicles used: group 1:TAP + DW, group 2: TAP + PG, group 3: CH + DW, and group 4:CH + PG. Root canal medicaments were labeled with 0.1% rhodamine and applied into the canals using a Lentulo spiral. Specimens were molded into acrylic blocks, and 1‐mm‐thick sections were obtained from the middle third of each root. Specimens were mounted onto glass slides and scanned under a confocal laser scanning microscope. DTP depth, percentage, and area were measured using imaging software. Kruskal‐Wallis and Mann‐Whitney U tests were used for statistical analysis. The level of significance was set at P < .05. Results: No significant difference was found among the experimental groups in terms of both percentage and depth of DTP (P > .05). CH had a lower penetration area compared with TAP regardless of the vehicle used (P < .05). Conclusions: A low surface tension vehicle did not alter the penetration of CH and TAP. HighlightsCalcium hydroxide and triple antibiotic paste have a similar dentinal tubule penetration ability.Calcium hydroxide and triple antibiotic paste can reach up to 2.75 and 2.63 mm, respectively.The vehicle with a low surface tension did not raise the ability of penetration of the medicaments.

Effect of Instrumentation Techniques and Preparation Taper on Apical Extrusion of Bacteria

Introduction The aim of this in vitro study was to evaluate the effects of different root canal instrumentation techniques and preparation tapers on the amount of apically extruded bacteria. Methods The root canals of 98 extracted human mandibular incisors were contaminated with Enterococcus faecalis suspension. After incubation at 37°C for 24 hours, the root canals were instrumented with K3 rotary files in a crown‐down (CD) or full‐length linear instrumentation technique (FL) by using 3 different root canal tapers (0.02, 0.04, and 0.06). During instrumentation, apically extruded bacteria were collected into vials containing saline solution. The microbiological samples were taken from the vials and incubated in brain‐heart agar medium for 24 hours, and the numbers of colony‐forming units (CFUs) were determined. The obtained results were analyzed with t test and one‐way analysis of variance for the comparisons between the instrumentation techniques (CD and FL) and the preparation tapers (0.02, 0.04, and 0.06), respectively. Tukey honestly significant difference test was used for pairwise comparisons. Results The preparation taper had no effect on the number of CFUs when a FL instrumentation technique was used (P > .05). There was a statistically significant difference in the CFUs between FL and CD techniques when the preparation taper was 0.02 (P < .05). There was no statistically significant difference between the 0.04 and 0.06 preparation tapers in any of the instrumentation techniques (P > .05). Conclusions Using a 0.02 taper in a CD manner results in the least amount of bacterial extrusion. The instrumentation technique did not seem to affect the amount of bacterial extrusion when 0.04 and 0.06 taper instruments were used for cleaning and shaping the root canal space. HighlightsApical extrusion of intracanal bacteria occurs with all instrumentation techniques.CD and FL techniques showed similar bacterial extrusion regardless of taper.CD instrumentation with .02 files resulted in the lowest extrusion.

Concentration and time-dependent effect of initial sodium hypochlorite on the ability of QMix and ethylenediaminetetraacetic acid to remove smear layer

Aims: The aim of this study was to compare the ability of 17% ethylenediaminetetraacetic acid (EDTA) and QMix with different concentrations and time exposures of initial sodium hypochlorite (NaOCl) to remove the smear layer from the root canals. Materials and Methods: Eighty maxillary central incisors were used. After instrumentation, the teeth were divided into eight experimental groups according to the initial and final rinse. About 2.5% and 5% NaOCl were used during instrumentation and for 1 or 3 min was used as postinstrumentation initial irrigants, and 17% EDTA and QMix used as final irrigants. The apical and middle parts of the specimens were observed by scanning electron microscope. Statistical Analysis Used: Data were analyzed using the Kruskal–Wallis, Mann–Whitney, and Friedmans test. Results: Regardless of the type of final irrigant, QMix allowed more smear layer removal than EDTA after using 5% initial NaOCl for 3 min. In the apical part of the root canal walls, the smear layer was not completely removed. Conclusion: QMix and EDTA were similarly effective in smear layer removal at the middle parts of the root canal regardless of the concentration and time exposure of initial NaOCl, while none of the irrigation protocols was able to remove smear layer at the apical parts.

Comparison of triple antibiotic paste removal by different irrigation techniques

This study compared different irrigation techniques in triple antibiotic paste (TAP) removal from root canals. Fifty-six maxillaryanterior-teeth were filled with TAP for 28 days, and assigned into 5 experimental groups (n=10): Syringe irrigation (SI), NaviTip FX (NFX), Vibringe-Syringe irrigation (V-SI), NaviTip FX-Vibringe (V-NFX), passive ultrasonic irrigation (PUI) and positive and negative control groups (n=3 for each). Following the removal of the medicament, the remaining medicament was evaluated using 4-grade scoring-system. V-NFX and NFX showed similar performances (p>0.05) while V-NFX was significantly more efficient than SI and PUI (p<0.05) at all parts of root canals. VSI was less efficient at apical part when compared to NFX and V-NFX (p<0.05) while not significantly different from PUI and SI at all parts of the root canals (p>0.05). Regarding different parts of the root canals, V-SI and PUI were significantly less efficient at the apical part (p<0.05). In conclusion, the brush form of irrigation delivery with and without sonic activation improved the removal of TAP from the root canals when compared to ultrasonic activation, syringe irrigation or sonic activation alone.

A novel model for testing the efficiency of removal of calcium hydroxide from complex root canal anatomies

The purpose of this study was to evaluate the efficacy of several irrigation protocols in the removal of calcium hydroxide [Ca(OH)2 ] from simulated internal root resorption cavities in a complex root canal anatomy model. The 20° to 35° curved mesiobuccal roots of 94 maxillary molars were sectioned longitudinally; internal resorption cavities were prepared in the apical third of the canal walls. Calcium hydroxide was placed into the cavities and the root halves reassembled. Four teeth were used as controls, and 90 teeth were randomly divided into six experimental groups (n = 15), according to the irrigation protocols used: syringe irrigation; H2 O2 (HP); Navitip FX; Vibringe-syringe; Vibringe-NaviTip FX; ultrasonically activated irrigation (UAI) using an ultrasonic K-file. In the HP group, 2.5% NaOCl and 3% H2 O2 were used, while 2.5% NaOCl and 17% EDTA were used in the remaining groups. Stereomicroscope images and radiographs were used to measure the remaining Ca(OH)2 . The model proved to be suitable for simulating complex anatomy. Positive correlation was found between stereomicroscope and radiographic analyses (P < 0.05). UAI removed significantly more Ca(OH)2 than the other experimental groups (P < 0.05). The HP group was the least efficient protocol (P < 0.05). It would appear that a reliable model has been developed that simulates complex root canal anatomy. Irrigant activation protocols enhanced Ca(OH)2 removal.

Effects of QMix and ethylenediaminetetraacetic acid on decalcification and erosion of root canal dentin

The aim of this study was to evaluate the effect of initial NaOCl on the decalcification and erosion ability of EDTA and QMix. Sixty‐maxillary‐incisors were bisected longitudinally and the tooth‐halves were used. The experiment was conducted in two‐sets. In set‐I, 80‐tooth halves were treated in the presence or absence of initial NaOCl and EDTA. In set‐II, 40‐tooth halves were immersed in NaOCl and QMix. After each treatment, calcium‐ion release was determined with flame photometry. The erosion was imaged using SEM. Initial NaOCl led to concentration‐ and time‐dependent increase in calcium removal effect of 17% EDTA (p < .05). The rate of calcium removal and root canal wall erosion was considerably more severe with the use of 5% NaOCl for 3 min (p < .05). QMix as a final solution showed less decalcification and erosion than 17% EDTA when used 5% NaOCl as an initial irrigant (p < .05). Optimizing the concentration and application time of NaOCl can decrease the decalcification effect of chelating agents.

The undesirable outcomes of late-referral traumatized immature permanent teeth and root-end-closure with mineral trioxide aggregate apical plug technique

Dental traumatic injuries mostly occur in children and affect the anterior dental region. The immediate management of the injuries prevents the loss of dental and alveolar structures. The lack of natural apical constriction in immature permanent teeth due to the pulp necrosis is problematic to treat. Frequently, the apical plug technique is used to attain apical closure that provides the obturation of the root canals without extrusion of the obturation material. In this case report, the endodontic treatment was achieved using apical plug technique with mineral trioxide aggregate (MTA) while prosthetic crown retained with fiber-reinforced post was used to restore the traumatized crown fracture of maxillary incisors. This case report suggests that MTA is influential apical barrier and successively induce periapical healing. Clinical Relevance to Interdisciplinary Dentistry This article is the case report of a young 17-year-old boy with immature permanent teeth and crown fracture The treatment of necrotic traumatized permanent teeth using mineral trioxide aggregate apical plug technique on a short-time scale is successful to achieve apical seal and healing of apical periodontitis while motivating the patient to attend the treatment The crown fracture requires the use of fiber post that is suitable material for immature permanent root canals.