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Volume 39 (1); February 2014
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Review Article
Platelet rich fibrin - a novel acumen into regenerative endodontic therapy
Kavita Hotwani, Krishna Sharma
Restor Dent Endod 2014;39(1):1-6.   Published online January 20, 2014
DOI: https://doi.org/10.5395/rde.2014.39.1.1
AbstractAbstract PDFPubReaderePub

Research into regenerative dentistry has added impetus onto the field of molecular biology. It can be documented as a prototype shift in the therapeutic armamentarium for dental disease. Regenerative endodontic procedures are widely being added to the current armamentarium of pulp therapy procedures. The regenerative potential of platelets has been deliberated. A new family of platelet concentrates called the platelet rich fibrin (PRF) has been recently used by several investigators and has shown application in diverse disciplines of dentistry. This paper is intended to add light on the various prospects of PRF and clinical insights to regenerative endodontic therapy.

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Research Articles
A comparison of dimensional standard of several nickel-titanium rotary files
Ki-Won Kim, Kyung-Mo Cho, Se-Hee Park, Ki-Yeol Choi, Bekir Karabucak, Jin-Woo Kim
Restor Dent Endod 2014;39(1):7-11.   Published online January 20, 2014
DOI: https://doi.org/10.5395/rde.2014.39.1.7
AbstractAbstract PDFPubReaderePub
Objectives

The aim of this study was to compare the dimensional standard of several nickel-titanium (Ni-Ti) rotary files and verify the size conformity.

Materials and Methods

ProFile (Dentsply Maillefer), RaCe (FKG Dentaire), and TF file (SybronEndo) #25 with a 0.04 and 0.06 taper were investigated, with 10 in each group for a total of 60 files. Digital images of Ni-Ti files were captured under light microscope (SZX16, Olympus) at 32×. Taper and diameter at D1 to D16 of each files were calculated digitally with AnalySIS TS Materials (OLYMPUS Soft Imaging Solutions). Differences in taper, the diameter of each level (D1 to D16) at 1 mm interval from (ANSI/ADA) specification No. 101 were statistically analyzed using one-way ANOVA and Scheffe's post-hoc test at 95% confidence level.

Results

TF was the only group not conform to the nominal taper in both tapers (p < 0.05). All groups except 0.06 taper ProFile showed significant difference from the nominal diameter (p < 0.05).

Conclusions

Actual size of Ni-Ti file, especially TF, was different from the manufacturer's statements.

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Bond strength of self-adhesive resin cements to composite submitted to different surface pretreatments
Victor Hugo dos Santos, Sandro Griza, Rafael Ratto de Moraes, André Luis Faria-e-Silva
Restor Dent Endod 2014;39(1):12-16.   Published online January 20, 2014
DOI: https://doi.org/10.5395/rde.2014.39.1.12
AbstractAbstract PDFPubReaderePub
Objectives

Extensively destroyed teeth are commonly restored with composite resin before cavity preparation for indirect restorations. The longevity of the restoration can be related to the proper bonding of the resin cement to the composite. This study aimed to evaluate the microshear bond strength of two self-adhesive resin cements to composite resin.

Materials and Methods

Composite discs were subject to one of six different surface pretreatments: none (control), 35% phosphoric acid etching for 30 seconds (PA), application of silane (silane), PA + silane, PA + adhesive, or PA + silane + adhesive (n = 6). A silicone mold containing a cylindrical orifice (1 mm2 diameter) was placed over the composite resin. RelyX Unicem (3M ESPE) or BisCem (Bisco Inc.) self-adhesive resin cement was inserted into the orifices and light-cured. Self-adhesive cement cylinders were submitted to shear loading. Data were analyzed by two-way ANOVA and Tukey's test (p < 0.05).

Results

Independent of the cement used, the PA + Silane + Adhesive group showed higher microshear bond strength than those of the PA and PA + Silane groups. There was no difference among the other treatments. Unicem presented higher bond strength than BisCem for all experimental conditions.

Conclusions

Pretreatments of the composite resin surface might have an effect on the bond strength of self-adhesive resin cements to this substrate.

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Evaluation of softening ability of Xylene & Endosolv-R on three different epoxy resin based sealers within 1 to 2 minutes - an in vitro study
Pratima Ramakrishna Shenoi, Gautam Pyarelal Badole, Rajiv Tarachand Khode
Restor Dent Endod 2014;39(1):17-23.   Published online January 20, 2014
DOI: https://doi.org/10.5395/rde.2014.39.1.17
AbstractAbstract PDFPubReaderePub
Objectives

This study evaluated the efficacy of Endosolv-R and Xylene in softening epoxy resin based sealer after 1 to 2 min exposure.

Materials and Methods

Sixty Teflon molds (6 mm × 1.5 mm in inner diameter and depth) were equally divided into 3 groups of 20 each. AH 26 (Dentsply/De Trey), AH Plus (Dentsply/De Trey), Adseal (Meta-Biomed) were manipulated and placed in the molds allotted to each group and allowed to set at 37℃ in 100% humidity for 2 wk. Each group was further divided into 2 subgroups according to the solvents used, i.e. Xylene (Lobachemie) and Endosolv-R (Septodont). Specimens in each subgroup were exposed to respective solvents for 1 and 2 min and the corresponding Vicker's microhardness (HV) was assessed. Data was analysed by Mauchly's test and two-way analysis of variance (ANOVA) with repeated measures, and one-way ANOVA.

Results

Initial hardness was significantly different among the three sealers with AH Plus having the greatest and Adseal having the least. After 2 min, Xylene softened AH Plus and Adseal sealer to 11% and 25% of their initial microhardness, respectively (p < 0.001), whereas AH 26 was least affected, maintaining 89.4% of its initial microhardness. After 2 min, Endosolv-R softened AH 26, AH Plus and Adseal to 12.7, 5.6 and 8.1% of their initial microhardness, respectively (p < 0.001).

Conclusions

Endosolv-R was a significantly more effective short term softener for all the tested sealers after 2 min whereas Xylene was an effective short term softener against AH plus and Adseal but less effective against AH 26.

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Micro-CT evaluation of internal adaptation in resin fillings with different dentin adhesives
Seung-Hoon Han, Sung-Ho Park
Restor Dent Endod 2014;39(1):24-31.   Published online January 20, 2014
DOI: https://doi.org/10.5395/rde.2014.39.1.24
AbstractAbstract PDFPubReaderePub
Objectives

The purpose of present study was to evaluate the internal adaptation of composite restorations using different adhesive systems.

Materials and Methods

Typical class I cavities were prepared in 32 human third molars. The teeth were divided into the following four groups: 3-step etch-and-rinse, 2-step etch-and-rinse, 2-step self-etch and 1-step self-etch system were used. After the dentin adhesives were applied, composite resins were filled and light-cured in two layers. Then, silver nitrate solution was infiltrated, and all of the samples were scanned by micro-CT before and after thermo-mechanical load cycling. For each image, the length to which silver nitrate infiltrated, as a percentage of the whole pulpal floor length, was calculated (%SP). To evaluate the internal adaptation using conventional method, the samples were cut into 3 pieces by two sectioning at an interval of 1 mm in the middle of the cavity and they were dyed with Rhodamine-B. The cross sections of the specimens were examined by stereomicroscope. The lengths of the parts where actual leakage was shown were measured and calculated as a percentage of real leakage (%RP). The values for %SP and %RP were compared.

Results

After thermo-mechanical loading, all specimens showed significantly increased %SP compared to before thermo-mechanical loading and 1-step self-etch system had the highest %SP (p < 0.05). There was a tendency for %SP and %RP to show similar microleakage percentage depending on its sectioning.

Conclusions

After thermo-mechanical load cycling, there were differences in internal adaptation among the groups using different adhesive systems.

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Antibacterial effect of self-etching adhesive systems on Streptococcus mutans
Seung-Ryong Kim, Dong-Hoon Shin
Restor Dent Endod 2014;39(1):32-38.   Published online January 20, 2014
DOI: https://doi.org/10.5395/rde.2014.39.1.32
AbstractAbstract PDFPubReaderePub
Objectives

In this study, we evaluated the antibacterial activity of self-etching adhesive systems against Streptococcus mutans using the agar diffusion method.

Materials and Methods

Three 2-step systems, Clearfil SE Bond (SE, Kuraray), Contax (CT, DMG), and Unifil Bond (UnB, GC), and three 1-step systems, Easy Bond (EB, 3M ESPE), U-Bond (UB, Vericom), and All Bond SE (AB, BISCO) were used. 0.12% chlorhexidine (CHX, Bukwang) and 37% phosphoric acid gel (PA, Vericom) were used as positive controls.

Results

The antibacterial activity of CHX and PA was stronger than that of the other groups, except SE. After light activation, the inhibition zone was reduced in the case of all 2-step systems except CT. However, all 1-step systems did not exhibit any inhibition zone upon the light activation.

Conclusions

SE may be better than CT or UnB among the 2-step systems with respect to antibacterial activity, however, 1-step systems do not exhibit any antibacterial activity after light curing.

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Cytotoxicity of newly developed pozzolan cement and other root-end filling materials on human periodontal ligament cell
Minju Song, Tae-Sun Yoon, Sue-Youn Kim, Euiseong Kim
Restor Dent Endod 2014;39(1):39-44.   Published online January 20, 2014
DOI: https://doi.org/10.5395/rde.2014.39.1.39
AbstractAbstract PDFPubReaderePub
Objectives

The purpose of this study was to evaluate in vitro cytotoxicity of the pozzolan cement and other root-end filling materials using human periodontal ligament cell.

Materials and Methods

Endocem (Maruchi), white ProRoot MTA (Dentsply), white Angelus MTA (Angelus), and Super EBA (Bosworth Co.) were tested after set completely in an incubator at 37℃ for 7 days, Endocem was tested in two ways: 1) immediately after mixing (fresh specimens) and 2) after setting completely like other experimental materials. The methods for assessment included light microscopic examination, cell counting and WST-1 assay on human periodontal ligament cell.

Results

In the results of microscopic examination and cell counting, Super EBA showed significantly lower viable cell than any other groups (p < 0.05). As the results of WST-1 assay, compared with untreated control group, there was no significant cell viability of the Endocem group. However, the fresh mixed Endocem group had significantly less cell viability. The cells exposed to ProRoot MTA and Angelus MTA showed the highest viability, whereas the cells exposed to Super EBA displayed the lowest viability (p < 0.05).

Conclusions

The cytotoxicity of the pozzolan cement (Endocem) was comparable with ProRoot MTA and Angelus MTA. Considering the difficult manipulation and long setting time of ProRoot MTA and Angelus MTA, Endocem can be used as the alternative of retrofilling material.

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Case Reports
Asymmetry in mesial root number and morphology in mandibular second molars: a case report
Gurudutt Nayak, Shashit Shetty, Rhitu Shekhar
Restor Dent Endod 2014;39(1):45-50.   Published online January 20, 2014
DOI: https://doi.org/10.5395/rde.2014.39.1.45
AbstractAbstract PDFPubReaderePub

Ambiguity in the root morphology of the mandibular second molars is quite common. The most common root canal configuration is 2 roots and 3 canals, nonetheless other possibilities may still exist. The presence of accessory roots is an interesting example of anatomic root variation. While the presence of radix entomolaris or radix paramolaris is regarded as a typical clinical finding of a three-rooted mandibular second permanent molar, the occurrence of an additional mesial root is rather uncommon and represents a possibility of deviation from the regular norms. This case report describes successful endodontic management of a three-rooted mandibular second molar presenting with an unusual accessory mesial root, which was identified with the aid of multiangled radiographs and cone-beam computed tomography imaging. This article also discusses the prevalence, etiology, morphological variations, clinical approach to diagnosis, and significance of supernumerary roots in contemporary clinical dentistry.

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Clinical effectiveness of combining platelet rich fibrin with alloplastic bone substitute for the management of combined endodontic periodontal lesion
Lata Goyal
Restor Dent Endod 2014;39(1):51-55.   Published online January 20, 2014
DOI: https://doi.org/10.5395/rde.2014.39.1.51
AbstractAbstract PDFPubReaderePub

The term "endo-perio" lesion has been proposed to describe the destructive lesion resulting from inflammatory products found in varying degrees in both the periodontium and the pulpal tissues. In most of the cases, clinical symptoms disappear following successful endodontic therapy. However failure after conventional root canal treatment calls for surgical intervention. A 35 year old male patient with endo-perio lesion in right maxillary lateral incisor was treated with platelet rich fibrin (PRF) and alloplastic bone substitute after conventional endodontic therapy. At the end of 6 months there was gain in clinical attachment, increased radiographic bone fill and reduction in probing depth which was maintained till 18 month follow-up. Present case report aims to evaluate the efficacy of PRF and alloplastic bone substitute in the management of intrabony defect associated with endo-perio lesion in maxillary lateral incisor because the healing potential of PRF and bone graft has not been widely studied in endodontics. The use of PRF allows the clinician to optimize tissue remodelling, wound healing and angiogenesis by the local delivery of growth factors and proteins. The novel technique described here enables the clinician to be benefited from the full regenerative capacity of this autologous biologic material.

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Diagnosis and treatment of teeth with primary endodontic lesions mimicking periodontal disease: three cases with long-term follow ups
Jae-Hyung Lim, Ji-Hyun Lee, Su-Jung Shin
Restor Dent Endod 2014;39(1):56-62.   Published online January 20, 2014
DOI: https://doi.org/10.5395/rde.2014.39.1.56
AbstractAbstract PDFPubReaderePub

A tooth with primary endodontic disease that demonstrates a periodontal defect might be extracted because of misdiagnosis as severe periodontal disease or a vertical root fracture. The aim of this case report was to demonstrate the long-term survival of endodontically treated teeth, which had been initially considered unsavable. With meticulous evaluation including the patient's dental history, clinical and radiographic examinations, teeth with primary endodontic lesions could be differentiated and saved after proper root canal treatment. Pain history, vitality test, and radiographic examinations, as well as a general periodontal condition check with periodontal probing on an affected tooth, might be the key methods to differentiate endodontic pathosis from that of periodontal disease.

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Chronic maxillary sinusitis caused by root canal overfilling of Calcipex II
Jin-Woo Kim, Kyung-Mo Cho, Se-Hee Park, Soh-Ra Park, Sang-Shin Lee, Suk-Keun Lee
Restor Dent Endod 2014;39(1):63-67.   Published online January 20, 2014
DOI: https://doi.org/10.5395/rde.2014.39.1.63
AbstractAbstract PDFPubReaderePub

This is a case report of chronic maxillary sinusitis caused by root canal overfilling of Calcipex II (Techno-Dent). A 60 year-old male complained of dull pain in the right maxillary molar area after complicated endodontic treatment using Calcipex II paste and was finally diagnosed with a chronic maxillary sinusitis through a clinical and radiological observation. In the biopsy examination, the periapical granuloma contained a lot of dark and translucent Calcipex II granules which were not stained with hematoxylin and eosin. They were usually engulfed by macrophages but rarely resorbed, resulting in scattering and migrating into antral mucosa. Most of the Calcipex II granules were also accumulated in the cytoplasms of secretory columnar epithelial cells, and small amount of Calcipex II granules were gradually secreted into sinus lumen by exocytosis. However, chronic granulomatous inflammation occurred without the additional recruitment of polymorphonuclear leukocytes (PMNs) and lymphocytes, and many macrophages which engulfed the Calcipex II granules were finally destroyed in the processes of cellular apoptosis. It is presumed that Calcipex II granules are likely to have a causative role to induce the granulomatous foreign body inflammation in the periapical region, and subsequently to exacerbate the chronic maxillary sinusitis in this study.

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Use of ultrasound Doppler to determine tooth vitality in a discolored tooth after traumatic injury: its prospects and limitations
Yong-Wook Cho, Sung-Ho Park
Restor Dent Endod 2014;39(1):68-73.   Published online January 20, 2014
DOI: https://doi.org/10.5395/rde.2014.39.1.68
AbstractAbstract PDFPubReaderePub

When a tooth shows discoloration and does not respond to the cold test or electric pulp test (EPT) after a traumatic injury, its diagnosis can be even more difficult due to the lack of proper diagnostic methods to evaluate its vitality. In these case reports, we hope to demonstrate that ultrasound Doppler might be successfully used to evaluate the vitality of the tooth after trauma, and help reduce unnecessary endodontic treatments. In all three of the present cases, the teeth were discolored after traumatic injuries and showed negative responses to the cold test and EPT. However, they showed distinctive vital reactions in the ultrasound Doppler test during the whole observation period. In the first case, the tooth color returned to normal, and the tooth showed a positive response to the cold test and EPT at 10 wk after the injury. In the second case, the tooth color had returned to its normal shade at 10 wk after the traumatic injury but remained insensitive to the cold test and EPT. In the third case, the discoloration was successfully treated with vital tooth bleaching.

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Open Lecture on Statistics
Analysis of variance (ANOVA) comparing means of more than two groups
Hae-Young Kim
Restor Dent Endod 2014;39(1):74-77.   Published online January 20, 2014
DOI: https://doi.org/10.5395/rde.2014.39.1.74
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Reader's Forum
Setting time of MTA
Yun-Chan Hwang
Restor Dent Endod 2014;39(1):78-78.   Published online January 20, 2014
DOI: https://doi.org/10.5395/rde.2014.39.1.78
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Restor Dent Endod : Restorative Dentistry & Endodontics
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