R. N. Weller

Canal and isthmus debridement efficacies of two irrigant agitation techniques in a closed system

AIM To compare canal and isthmus debris debridement efficacies of the manual dynamic irrigation (MDI) and apical negative pressure (ANP) techniques in the mesial root of mandibular first molars with narrow isthmi, using a closed canal design. METHODOLOGY Micro-computed tomography was employed to select 20 teeth, each containing a narrow isthmus. Each root was sealed at the apex with hot glue and embedded in polyvinylsiloxane to simulate a closed canal system. The teeth were submitted to a standardized instrumentation protocol. Final irrigation was performed with either the MDI or the ANP technique using the EndoVac system (N=10). Masson trichrome-stained sections were prepared from completely demineralized roots at 10 canal levels between 1 and 2.8mm of the anatomical apices. Areas occupied by canals and isthmus of each root and debris in the corresponding regions were digitized by the NIH Image J software and statistically analysed using two-way repeated measures anova. RESULTS For the instrumented canals, there were no differences between the two groups (P=0.131) in the area occupied by debris at all canal levels (P=0.343). Conversely, for the isthmus, less debris was found in the ANP group (P<0.001) but no differences were seen in each group with respect to the 10 canal levels (P=0.352). CONCLUSION Neither technique completely removed debris from the isthmus regions. However, the EndoVac system, which encompasses the ANP concept, removed considerably more debris from narrow isthmi in mandibular mesial roots.

Effects of eugenol on resin bond strengths to root canal dentin.

The purpose of this study was to compare the regional bond strengths of C&B Metabond resin to root canal dentin, with or without treatment using a eugenol-containing endodontic sealer liquid. Eighteen extracted human canines were decoronated at the cementoenamel junction with a slow speed saw. The apical third of the root was removed leaving the cervical and middle dentin. The canal space was then enlarged with files, Gates-Glidden burs, and parapost drills. The teeth were ground on either the mesial or distal sides, permitting direct access to the entire canal. The cervical or middle third dentin was treated with Kerr Root Canal Sealer liquid, alternating between the middle and cervical thirds. Each tooth served as its own control. The adhesive resin was then luted directly to the prepared canal. Specimens, 1 x 1 x 8 mm, were prepared and mounted to a Vitrodyne testing machine enabling microtensile bond strengths to be measured. Data were analyzed using a two-way ANOVA and the least squares means test. The mean microtensile bond strengths for the cervical and middle third dentin treated with eugenol were 13.6 +/- 6.1 MPa (n = 33) and 14.8 +/- 3.9 MPa (n = 29), respectively. Without the eugenol, the mean bond strengths were 18.1 +/- 6.0 MPa (n = 31) and 17.3 +/- 4.6 MPa (n = 31) for the cervical and middle sections. The specimens treated with the eugenol liquid had significantly lower bond strengths than those without eugenol (p < 0.05) only in the cervical third. The region of the tooth tested had no effect on bond strength. That is, bond strength of the cervical third was not significantly different from bond strength on the middle third in either of the two groups (with or without eugenol) tested.

Effects of Calcium Silicate–based Materials on Collagen Matrix Integrity of Mineralized Dentin

INTRODUCTION Calcium silicate-based materials (CSMs) are used in various endodontic procedures. The present study examined whether prolonged contact of mineralized dentin with recently commercialized versions of these materials adversely affects dentin collagen matrix integrity. METHODS Dentin slabs prepared from extracted human third molars (7 × 3 × 0.3 mm) were divided into 3 groups on the basis of the material to which dentin was exposed (MTA Plus, Biodentine, untreated control dentin slabs) and the time period of exposure (24 hours, 1, 2, and 3 months; n = 6). Hydroxyproline assay was performed on each groups supernatant to quantify the collagen extraction amounts of each group per time period. Data were analyzed with two-factor repeated-measures analysis of variance and Holm-Sidak pair-wise comparisons (α = 0.05) to determine the effects of material and aging time on collagen extraction. Dentin slabs from the 3 months of aging group were demineralized for transmission electron microscopy examination of collagen matrix ultrastructural changes. RESULTS Material (P = .002), aging time (P < .001), and their interactions (P = .007) significantly affected the amount of hydroxyproline (pg/mg of mineralized dentin) extracted from mineralized dentin and were significantly correlated by power regression models. Collagen degradation was identified from the surface of dentin slabs that were in direct contact with CSMs. CONCLUSIONS Prolonged contact of mineralized dentin with CSMs has an adverse effect on the integrity of the dentin collagen matrix. However, the amount of collagen extracted was limited to the contact surface. Clinicians can continue to apply CSMs in endodontic procedures; however, caution is advised when these materials are applied to thin dentinal walls.

Microscopic appearance and apical seal of root canals filled with gutta-percha and ProRoot Endo Sealer after immersion in a phosphate-containing fluid

AIM To investigate the sealing quality of ProRoot Endo Sealer, a calcium silicate-based sealer and its morphologic characteristics after immersion in a phosphate-containing fluid (PCF). METHODOLOGY Single-rooted canals were filled with gutta-percha and either ProRoot Endo Sealer or two commercially available zinc oxide eugenol (ZOE)-based and epoxy resin-based sealers. The sealers were allowed to set for 6 days and the filled teeth were immersed in PCF for 24 h before fluid leakage evaluation. After initial leakage evaluation at the 7th day, each filled root was restored and reimmersed in PCF for 28 days before the second phase of leakage evaluation at 35 days. Cryofractured specimens of additional teeth filled with the three sealers were examined using scanning electron microscopy after immersion in PCF for the two periods. RESULTS One-way repeated measures anova and Tukey test revealed significant differences between the ZOE-based sealer at 35 days and the calcium silicate-based sealer at 35 days (P < 0.001), and between the ZOE-based sealer at 7 days and the calcium silicate-based sealer at 35 days (P = 0.001). No difference was found between the epoxy resin-based sealer and the calcium silicate-based sealer after both storage periods. Cryofractured calcium silicate-based sealer specimens demonstrated apatite-like crystalline deposits along the apical and middle thirds of the canal walls via transformation from amorphous calcium phosphate-like precursors. CONCLUSIONS ProRoot Endo Sealer is comparable in sealing quality to the epoxy resin-based sealer and seals better than the ZOE-based sealer after immersion in PCF. The calcium silicate-based sealer also demonstrates ex vivo bioactivity when it comes into contact with phosphate ions.

Effects of Calcium Silicate–based Materials on the Flexural Properties of Dentin

INTRODUCTION Prolonged exposure of root dentin to calcium hydroxide alters the fracture resistance of dentin. Calcium silicate-based materials (CSMs) used in endodontics release calcium hydroxide on setting. This study examined whether prolonged contact of dentin with CSMs adversely affects its mechanical properties. METHODS Dentin beams prepared from extracted human molars (7 × 3 × 0.3 mm) were divided into 3 groups on the basis of the material to which dentin was exposed (Biodentine, MTA Plus, and untreated control beams). Three-point flexure to failure was performed for each beam at designated exposure times (24 hours, 1, 2, and 3 months; n = 10). Data were analyzed with 2-factor repeated-measures analyses of variance to determine the effects of material and aging time on flexural modulus, flexural strength, and modulus of toughness (α = 0.05). RESULTS For flexural modulus, there was no significant difference for material (P = .947) or aging time (P = .064) when compared with baseline control. For flexural strength, significant differences were associated with aging time (P < .001) but not with material (P = .349). Flexural strength of dentin exposed to Biodentine decreased significantly after 2 and 3 months, whereas that exposed to MTA Plus decreased significantly after 3 months of aging (P < .05). For modulus of toughness, significant declines were observed for both material (P < .004) and aging time (P < .001). CONCLUSIONS Both CSMs alter material toughness more than the strength and stiffness of dentin after aging in 100% relative humidity. Because dentin toughness is attributed to its collagen matrix, the amount of collagen extracted from mineralized dentin and changes in collagen ultrastructure should be further examined after exposure of dentin to CSMs.