Silvia Marchionni

Effectiveness of three different retreatment techniques in canals filled with compacted gutta-percha or Thermafil: a scanning electron microscope study.

INTRODUCTION This study evaluated the root canal wall morphology under scanning electron microscopy magnification after removal of 2 types of root canal fillings by using ultrasonic tips, nickel-titanium (NiTi) rotary instruments, and hand K-files. METHODS Thirty-six extracted roots were filled by using AH Plus (DeTrey-Dentsply, Konstanz, Germany) as a sealer with Thermafil (Tulsa Dental Products, Tulsa, OK) (18 roots) or warm vertically condensed gutta-percha (18 roots). All fillings were removed up to the middle third by using Gates Glidden drills. The retreatment was completed by using K-files (group 1), M-Two NiTi rotary instruments (group 2), or ESI ultrasonic tips (group 3) in 12 roots each. Root canals were irrigated by using 10% ethylenediaminetetraacetic acid and 2.5% NaOCl. The samples were split longitudinally and observed by scanning electron microscopy (100-2000x). The presence of smear layer, filling debris, and the surface profile was evaluated in each picture. Kruskal-Wallis (analysis of variance) and Mann-Whitney tests were used to evaluate the differences between the obturation techniques, the 3 retreatment methods, and the canal thirds (P < .05). RESULTS Resin sealer tags were observed inside dentinal tubules. No statistical differences (P > .05) were found among the 3 retreatment methods. No statistical differences were observed between Thermafil and vertically compacted warm gutta-percha for each group or between the coronal third used as control, middle, and apical thirds. CONCLUSIONS All retreatment techniques showed similar performances in terms of smear layer morphology, debris, and surface profile. None of them completely removed filling debris from dentinal tubules of apical third.

Evaluation of enamel surfaces after bracket debonding: An in-vivo study with scanning electron microscopy

INTRODUCTION The purposes of this in-vivo study were to compare the modes of failure of uncoated and adhesive precoated metal brackets by using the adhesive remnant index, and to assess the quality of the enamel surface after cleanup by using the enamel damage index. METHODS Twelve Victory brackets (group A) and 12 Victory adhesive precoated brackets (group B) (both, 3M Unitek, Monrovia, Calif) were bonded onto the maxillary second premolars of 12 volunteers. The uncoated brackets were bonded with Transbond XT adhesive resin (3M Unitek). Replicas of the teeth were made before bonding (T0), after bracket removal (T1), and after cleanup (T2). Scanning electron microscope images of all labial enamel surfaces were taken at T0, T1, and T2, and these were evaluated according to the adhesive remnant index and the enamel damage index. RESULTS Evaluation of the adhesive remnant index scores with the chi-square test showed no statistically significant difference between the groups. Evaluation of the enamel damage index grades with the sign test for paired samples showed a statistically significant difference (P <0.01) between T0 and T2. CONCLUSIONS Uncoated and precoated brackets exhibited similar debonding patterns. Additionally, the debonding method tested in this study did not restore the original enamel surface, although there was no clinically relevant enamel damage.

MIH Supplementation Strategies: Prospective Clinical and Laboratory Trial

The use of calcium-phosphate casein on hypomineralized molars (molar incisor hypomineralization, MIH) has been proposed but not clinically investigated. Qualitative and quantitative effects of supplementation with a calcium-phosphate casein product on MIH molars were monitored over a period of three years. Molar replicas, minimally invasive biopsies and their SEM microphotographs, plus ESEM/EDX semi-quantitative peaks of elements present in affected enamel were evaluated. Mineralization, morphology, and porosity appeared markedly improved, with calcium and phosphate levels reaching almost normal levels at three years’ follow-up. The hypothesis tested was rejected, since calcium-phosphate casein improved enamel morphology in vivo.

E-cigarettes induce toxicological effects that can raise the cancer risk

Electronic cigarettes (e-cigs) are devices designed to deliver nicotine in a vaping solution rather than smoke and without tobacco combustion. Perceived as a safer alternative to conventional cigarettes, e-cigs are aggressively marketed as lifestyle-choice consumables, thanks to few restrictions and a lack of regulatory guidelines. E-cigs have also gained popularity among never-smokers and teenagers, becoming an emergent public health issue. Despite the burgeoning worldwide consumption of e-cigs, their safety remains largely unproven and it is unknown whether these devices cause in vivo toxicological effects that could contribute to cancer. Here we demonstrate the co-mutagenic and cancer-initiating effects of e-cig vapour in a rat lung model. We found that e-cigs have a powerful booster effect on phase-I carcinogen-bioactivating enzymes, including activators of polycyclic aromatic hydrocarbons (PAHs), and increase oxygen free radical production and DNA oxidation to 8-hydroxy-2′-deoxyguanosine. Furthermore, we found that e-cigs damage DNA not only at chromosomal level in peripheral blood, such as strand breaks in leucocytes and micronuclei formation in reticulocytes, but also at gene level such as point mutations in urine. Our results demonstrate that exposure to e-cigs could endanger human health, particularly among younger more vulnerable consumers.

A SEM and Non-Contact Surface White Light Profilometry In Vivo Study of the Effect of a Creme Containing CPP-ACP and Fluoride on Young Etched Enamel

The aim of this in vivo study was to evaluate the short and a longer term effect on enamel of the application of a crème containing 10% CPP-ACP and 900 ppm fluoride, in orthodontically planned, high caries-risk patients. Epoxy resin replicas of upper lateral incisors were obtained from polyvinyl siloxane (PVS) impressions, before and after etching. The right incisors were left untreated in order to control saliva remineralizing potential. The upper left surfaces were coated with a pea-size amount of the crème. Replicas were obtained at 3 weeks and 6 months and analyzed by SEM and non-contact surface white light profilometry. In the treated sample the profilometric roughness parameters at 3 weeks were statistically significantly lower than the control group values (p < 0.05). At 3 weeks SEM images of the enamel surface showed fewer irregularities. After 6 months, differences between test and control groups were not present on SEM images and profilometric values. CPP-ACP and fluoride crème had positive in vivo effects on enamel surfaces. Significant differences in surface roughness existed after a 3-week period of crème use.

Interproximal enamel reduction: An in vivo study

The study aimed to investigate the morphology and composition of the interproximal reduced enamel after exposition to saliva and casein phosphopeptide amorphous calcium phosphate with sodium fluoride (CPP-ACPF). Fourteen patients undergoing an orthodontic treatment with 4 premolars extractions participated to the study. Interproximal enamel reduction (IER) was performed on mesial surfaces of 3 extractive premolars for each patient while 1 served as untreated control. Premolars were assigned to 4 groups: No-S group, sound enamel as control; S-Ex group, stripped and immediately extracted enamel; S-Sal group, stripped and exposed to saliva enamel; S-CPP group, stripped enamel treated with CPP-ACPF. Teeth were extracted at different times, depending on the group they were assigned to and sliced into mesial and distal halves. Mesial surfaces were subjected to environmental scanning electron microscopy with energy dispersive X-ray spectrometry (ESEM/EDX) and to scanning electron microscopy (SEM) analysis. ESEM/EDX investigations showed no statistically significant differences in the content of calcium and phosphate between the 4 groups. SEM observations showed no difference in the morphological appearance of stripped enamel after 30 days of exposure to saliva and CPP-ACPF. Saliva and CPP-ACPF effects on stripped enamel in vivo showed no difference after 30 days.

X-linked hypophosphatemic rickets: Enamel abnormalities and oral clinical findings

X-linked hypophosphatemia (XLH) is a genetic disorder related to alterations in bones and teeth formation, due to low levels of phosphate in blood. Oral findings in XLH have been enamel and dentine abnormalities, high pulp horns, large pulp chambers, and some cases of periapical abscesses related to teeth without caries or traumatic injuries. The aim of our study was to assess the presence of enamel alterations, such as microclefts and/or structure defects in patients with XLH and give guidelines of prevention of XLH dental complications. History taking, oral clinical and radiological examination in 10 young patients affected by XLH (average age of 9) and in 6 patients without XLH (average age of 8). Impressions were performed on the vestibular surfaces of teeth in order to obtain replicas. The replicas were analyzed using scanning electron microscope (SEM) and compared to replicas of control group. The images of replicas of XLH patients showed deep microclefts and irregular enamel surface structure compared to replicas of control group. The replica of a patient with spontaneous periapical abscesses showed numerous enamel crater-shaped depressions and deep microcleavages penetrating into the enamel thickness. In absence of caries or fractures, the abscesses pathogenesis may be related to microcleavages of the enamel and dentin, which allow bacterial invasion of the pulp. There could be a relationship between XLH disease and enamel abnormalities.

The effect of zinc-carbonate hydroxyapatite versus fluoride on enamel surfaces after interproximal reduction

The aim of this study was to qualitatively investigate the effects of a zinc-carbonate hydroxyapatite (Zn-CHA) containing toothpaste on stripped enamel morphology in a pH cycling model in vitro and to compare the efficacy of this toothpaste versus fluoride one which still represent the gold standard to remineralize early enamel lesions. Twenty-one extracted lower incisors underwent to interproximal enamel reduction with metal strips (Horico 80 µm) on both mesial and distal surfaces. They were then sliced into mesial and distal halves and the 42 samples obtained were randomly assigned to 3 groups of 14 enamel specimens each. For 8 days, teeth were placed in lactic acid solution for 2 h three times a day with 2 h distilled water preservation in between. After each demineralization bath, samples of Group A were brushed with Zn-CHA containing toothpaste while samples of Group B were brushed with 1,400 ppm fluoride dentifrice for 5 min before immersion into water. Group C of untreated samples served as control. All the samples were then prepared for scanning electron microscopy (SEM) analysis. A score rating system was used to perform a non-parametric statistical analysis. No statistically significant differences were found between the samples brushed with fluoride toothpaste and those untreated (Groups B and C) where the highest grade of damage was found, while the lowest grade was recorded in the samples brushed with Zn-CHA (Group A) and there was a statistically significant difference between this group and the other two groups.

Bracket base remnants after orthodontic debonding

OBJECTIVE To evaluate whether the debonding procedure leads to restitutio ad integrum of the enamel surface by investigating the presence of enamel within the bracket base remnants after debonding. MATERIALS AND METHODS Sixty patients who completed orthodontic treatment with fixed appliances were included. A total of 1068 brackets were microphotographed; the brackets presenting some remnants on the base (n = 818) were selected and analyzed with ImageJ software to measure the remnant area. From this population a statistically significant sample (n = 100) was observed under a scanning electron microscope to check for the presence of enamel within the remnants. Energy dispersive x-ray spectrometry was also performed to obtain quantitative data. RESULTS Statistically significant differences in the remnant percentage between arches were observed for incisor and canine brackets (P < .0001 and P = .022, respectively). From a morphologic analysis of the scanning electron micrographs the bracket bases were categorized in 3 groups: group A, bases presenting a thin enamel coat (83%); group B, bases showing sizable enamel fragments (7%); group C, bases with no morphologic evidence of enamel presence (10%). Calcium presence was noted on all evaluated brackets under energy dispersive x-ray spectrometry. No significant difference was observed in the Ca/Si ratio between group A (16.21%) and group B (18.77%), whereas the Ca/Si ratio in group C (5.40%) was significantly lower than that of the other groups (P < .323 and P = .0001, respectively). CONCLUSION The objective of an atraumatic debonding is not achieved yet; in some cases the damage could be clinically relevant.

A systematic method for predetermined scanning electron microscope analysis in dental science.

Scanning electron microscope evaluation could be criticized if the method adopted to correct for bias is not specified in the study design. Observers can draw conclusions from images unconsciously chosen to best support their research hypotheses, impairing the basic research principle of operators impartiality. In this study, a systematic observation method has been described and verified for repeatability. The number and the observation points on a certain specimen have been predetermined using a scheme along with observation rules previously established in the research protocol. When our instrument is used at an operating magnification between 500x and 1,000x (corresponding to a frame of 250x190 micro and 120x90 micro, respectively), the method allowed 100% repeatable observation frames, with linear frame errors in finding an observation point of 12.5% in length and 16.8% in height. With modifications to accommodate research objective and statistical requirements, the method could be applied to many SEM observation study.