Simone Grandini

In vivo and in vitro Permeability of One-step Self-etch Adhesives

Adhesive dentistry should effectively restore the peripheral seal of dentin after enamel removal. We hypothesize that non-rinsing, simplified, one-step self-etch adhesives are effective for minimizing dentin permeability after tooth preparation procedures. Crown preparations in vital human teeth were sealed with Adper Prompt, Xeno III, iBond, or One-Up Bond F. Epoxy resin replicas were produced from polyvinyl siloxane impressions for SEM examination. Dentin surfaces from extracted human teeth were bonded with these adhesives and connected to a fluid-transport model for permeability measurements and TEM examination. Dentinal fluid droplets were observed from adhesive surfaces in resin replicas of in vivo specimens. In vitro fluid conductance of dentin bonded with one-step self-etch adhesives was either similar to or greater than that of smear-layer-covered dentin. TEM revealed water trees within the adhesives that facilitate water movement across the polymerized, highly permeable adhesives. Both in vitro and in vivo results did not support the proposed hypothesis.

Critical Review on Methacrylate Resin–based Root Canal Sealers

INTRODUCTION Four generations of methacrylate resin-based sealers have been available commercially. Three of these were introduced during the last 5 years when the concept of simultaneous bonding of root canal sealers to root filling materials and dentin was popularized. METHODS This article presents an overview of methacrylate resin-based sealers, with the objectives of clarifying the behavior of these materials and delineating their limitations in clinical application. RESULTS The first generation sealer was introduced in the mid-1970s. The initial enthusiasm associated with its use eventually diminished as a result of its suboptimal physical, biologic, and clinical properties. With advances in self-etching adhesive technology acquired from adhesive dentistry, methacrylate resin-based sealers were reintroduced in the beginning of the 21st century to support the introduction of bondable root canal filling materials. Three different generations of these sealers have since been available commercially. Although some in vitro studies on the sealing ability, self-etching potential, biocompatibility, and removability of the sealers showed better potential over conventional nonbonding sealers, accomplishing the ideal goal of a monoblock in the root canal space with these materials is still regarded as a major challenge. CONCLUSIONS On the basis of the in vitro and in vivo data available to date, there appears to be no clear benefit with the use of methacrylate resin-based sealers in conjunction with adhesive root filling materials at this point in their development.

Post Placement Affects Survival of Endodontically Treated Premolars

Clinical evidence is lacking regarding the influence of the amount of residual coronal dentin and of post placement on the failure risk of endodontically compromised teeth. The aim of this prospective clinical trial was to assess whether these factors significantly affect the two-year survival of restored pulpless premolars. A sample of 210 individuals provided six experimental groups of 40 premolars in need of endodontic treatment. Groups were defined based on the amount of dentin left at the coronal level. Within each group, in half of the teeth selected at random, a fiber post was inserted inside the root canal, whereas in the remaining half of the premolars, no post was placed. All teeth were covered with a crown. The Cox regression analysis revealed that post placement resulted in a significant reduction of failure risk (p < 0.001). Failure risk was increased for teeth under the “no ferrule” (p = 0.001) and “ferrule effect” conditions (p = 0.004).

In vivo Fluid Movement through Dentin Adhesives in Endodontically Treated Teeth

Fluid transudation through simplified dentin adhesives can occur in bonded vital crown dentin, since these adhesives behave as permeable membranes after polymerization. The effect of adhesive permeability in endodontically treated teeth is unknown. This study examined the hypothesis that in vivo fluid movement through simplified adhesives occurs when they are applied to root canals. Dowel spaces were prepared in endodontically treated teeth with single root canals. Six adhesives were applied to the intra-radicular dentin of canal walls. Impressions were obtained with polyvinyl siloxane, and replicas were fabricated with the use of polyether impression material. Replica hemisections were gold-coated for SEM examination. Fluid transudation was evident on the adhesive surfaces of all simplified total-etch and self-etch adhesives. Conversely, most of the specimens bonded with the control three-step total-etch adhesive were devoid of fluid droplets. Permeability of simplified adhesives results in water movement, even in root-treated dentin. This may adversely affect the coupling of auto-/dual-cured resin cements.

Final Rinse Optimization: Influence of Different Agitation Protocols

INTRODUCTION This study examined the effect of different root canal irrigant agitation protocols in the penetration of an endodontic irrigant into dentinal tubules. METHODS Fifty-six human single-rooted teeth were shaped with nickel-titanium instruments, and a final rinse of 5% sodium hypochlorite labeled with 0.2% alizarin red was performed. Specimens were assigned to 7 groups (N = 8) and submitted to the following rinse activation protocols: no agitation (control group), K-File or gutta-percha agitation, or different sonic (EndoActivator [Advanced Endodontics, Santa Barbara, CA] and Plastic Endo, Lincolnshire, IL) and ultrasonic (Satelec [Acteongroup, Merignac, France] and EMS, Nyon, Switzerland) agitations. Specimens were sectioned at 1, 3, and 5 mm from the apex in 1-mm-thick slabs, ground, and prepared for fluorescence microscopy at 100x with a wavelength of 450 milliseconds. Irrigant penetration into dentinal tubules was analyzed by using Kruskal-Wallis analysis of variance followed by post-hoc comparisons. RESULTS Groups were ranked in the following order: control = K-file = gutta-percha < EndoActivator = Plastic Endo < Satelec = EMS. At 1 mm from the apex, the highest score was found for the EMS group compared with the control, K-file, gutta-percha, EndoActivator, and Plastic Endo groups, whereas no difference was found with the Satelec group. CONCLUSION The results support the use of an ultrasonic agitation to increase the effectiveness of the final rinse procedure in the apical third of the canal walls.

Evaluation of Glyde File Prep in combination with sodium hypochlorite as a root canal irrigant.

The purpose of this study using a scanning electron microscope was to investigate the efficacy of four different irrigation techniques after canal preparation with Profile Ni-Ti rotary instruments. A modified technique for the use of Glyde File Prep is proposed. Forty anterior teeth were divided into four groups, instrumented, and irrigated as follows: physiological solution (group A), 2.5% sodium hypochlorite (group B), 2.5% sodium hypochlorite and Glyde File Prep (group C), and 2.5% sodium hypochlorite and Glyde File Prep applied at the end of the preparation with sterile paper points (group D). After scanning electron microscopic evaluation at three different levels, debris, smear layer, and dentinal tubules were scored. Groups A and B had significantly more smear layer and less open tubules on the canal walls compared with the group C and group D samples. Differences in the mean amount of debris between group A samples and other irrigation regimes were statistically significant.

Comparison of the surface tension of 5.25% sodium hypochlorite solution with three new sodium hypochlorite‐based endodontic irrigants

AIM To investigate the surface tension characteristics of 5.25% sodium hypochlorite and three recently introduced sodium hypochlorite solutions, which had been modified to reduce their surface tension: Chlor-Xtra, Hypoclean A and Hypoclean B. METHODOLOGY Freshly produced MilliQ water was used as a reference liquid. All measurements of surface tension were taken by the Wilhelmy plate technique, using a Cahn DCA-322 Dynamic Contact Angle Analyzer at the temperature of 22 °C. A glow-discharge cleaned glass slide was immersed in 5 mL of the test liquid in a beaker cleaned with hot chromic acid, rinsed with MilliQ water and finally air plasma-cleaned in a glow-discharge reactor. The force on the glass slide was recorded continuously by the instrument software as the beaker was raised and withdrawn at the constant speed of 40 micron/s, until at least 1 cm of the glass slide was immersed. The typical accuracy was 0.5 mJ m(-2). For each sample, fifteen measurements were taken, and mean values were calculated. A Kruskal-Wallis anova analysis, followed by Mann-Whitneys U rank sum test for pair-wise comparisons, was used to compare surface tension values. Statistical significance was set at α = 0.05. RESULTS MilliQ water (72.13 mJ m(-2)) and 5.25% sodium hypochlorite (48.90 mJ m(-2) ) had the highest surface tension values (P < 0.01) compared to Chlor-Xtra (33.14 mJ m(-2)), Hypoclean B (30.00 mJ m(-2) ) and Hypoclean A (29.13 mJ m(-2)). Hypoclean A had the lowest surface tension (P < 0.01). CONCLUSIONS The new 5.25% sodium hypochlorite solutions modified with surfactants, Hypoclean A and Hypoclean B, had surface tension values that were significantly lower (P < 0.01) than Chlor-Xtra and 5.25% NaOCl. Because of their low surface tension and increased contact with dentinal walls, these new irrigants have the potential to penetrate more readily into uninstrumented areas of root canal system as well as allow a more rapid exchange with fresh solution, enabling greater antimicrobial effectiveness and enhanced pulp tissue dissolution ability.

Efficacy of two Ni‐Ti systems and hand files for removing gutta‐percha from root canals

AIM   To compare the effectiveness of two Ni-Ti systems and hand files for removing gutta-percha and sealer from root canals. METHODOLOGY   The root canals of 60 single-rooted human teeth were prepared, filled with gutta-percha and sealer (Pulp Canal Sealer; SybronEndo, Orange, CA, USA). Specimens were then divided into three groups (n=20), and root filling material was removed using MTwo Retreatment Files (group 1); R-Endo (group 2); K-files and Gates-Glidden drills (group 3). After retreatment, the efficacy of each technique was assessed using radiographs that were later digitized and the images analysed using AutoCAD 2004. The percentage of residual gutta-percha was calculated for the whole canal as well as for the coronal, middle and apical thirds. Time required, apically extruded debris and the number of fractured instruments were also recorded. Data were statistically analysed using Kruskal-Wallis and Mann-Whitney U-tests. RESULTS   All instrumentation techniques left gutta-percha and sealer remnants inside the root canals. Ni-Ti systems were significantly faster (P < 0.05) than the manual technique and significantly more effective (P < 0.05) in removing gutta-percha particularly from the middle and apical thirds of the root canal. R-Endo instrumentation was significantly more effective (P < 0.05) than MTwo retreatment files in removing gutta-percha from the middle and apical thirds. R-Endo instruments were associated with the least number of cases of apical extrusion. One MTwo instrument fractured. CONCLUSIONS   The Ni-Ti systems were more effective and faster than hand files, although all techniques left gutta-percha and sealer remnants on the root canals.

Translucent fiber post cementation using light- and dual- curing adhesive techniques and a self-adhesive material: Push-out test

OBJECTIVES To compare, by means of the push-out test, the interfacial strength of two dual resin cements and one light-curing cement when used in translucent fiber post cementation. METHODS Thirty-nine, endodontically treated, single canal, extracted human bicuspids were selected. Translucent fiber posts (RelyX Fiber Post) were luted into the root canal using three resinous luting systems (n=13). Dual-curing technique (DC): the specimens were treated with Excite DSC and RelyX ARC, which were light-cured simultaneously through the post for 60s. Self-adhesive dual-curing technique (SADC): the specimens were treated with RelyX Unicem, which was light-cured through the post for 60s. Light-curing technique (LC): the specimens were treated with Excite DSC and Tetric Flow, which were simultaneously light-cured through the post for 60s. The specimens were transversally sectioned into six slices in order to perform the push-out test. Data were analyzed by two-way ANOVA followed by the Tukey-Kramer test for post-hoc comparisons at alpha=0.05. RESULTS At every region, results did not show any statistical difference between the DC and LC techniques. With the LC technique bond strength values were lower at the apical region than those recorded at the coronal and middle regions. At the coronal and middle regions, bond strength values for the SADC technique were lower than those resulting when using the other two techniques. At the apical region, there was not significant difference in bond strength between the luting techniques tested. CONCLUSIONS The interfacial strength between light-curing cement and root canal is equivalent to the interfacial strength between dual-curing cement and root canal.

Comparison of Two Techniques for Assessing the Shaping Efficacy of Repeatedly Used Nickel-Titanium Rotary Instruments

INTRODUCTION The shaping capacity of nickel-titanium (NiTi) rotary instruments is often assessed by photographic or micro-computed tomography (micro-CT) measurements, and these instruments are often used more than once clinically. This study was conducted to compare photographic and micro-CT measurements and to assess if the repeated use of NiTi instruments affected the shape of canal preparation. METHODS Ten new sets of ProTaper Universal instruments (Dentsply-Maillefer, Ballaigues, Switzerland) were used in 60 resin blocks simulating curved root canals. Groups 1 to 6 (n=10) represented the first to sixth use of the instrument, respectively. Digitized images of the prepared blocks were taken in both mesiodistal (MD) and buccolingual (BL) directions and area measurements (mm(2)) were calculated using AutoCAD (Autodesk Inc, San Rafael, CA). The volumes of the same prepared canals were measured using micro-CT (mm(3)). Statistical analysis was performed to detect differences between photographic and volumetric measurements and differences between uses. RESULTS Two-way repeated-measures analysis of variance revealed significant differences between groups (P < .001). Regarding measurement type, there were no significant differences between BL and MD measurements, but there were significant differences between micro-CT and BL measurements (P < .001) and micro-CT and MD measurements (P=.001). Significant differences were also noted between uses. CONCLUSIONS Within the limitations of the present study, micro-CT scanning is more discriminative of the changes in canal space associated with repeated instrument use than photographic measurements. Canal preparations are significantly smaller after the third use of the same instrument.