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Volume 40 (1); February 2015
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Review Articles
Current perspectives of bio-ceramic technology in endodontics: calcium enriched mixture cement - review of its composition, properties and applications
Shivani Utneja, Ruchika Roongta Nawal, Sangeeta Talwar, Mahesh Verma
Restor Dent Endod 2015;40(1):1-13.   Published online November 3, 2014
DOI: https://doi.org/10.5395/rde.2015.40.1.1
AbstractAbstract PDFPubReaderePub

Advancements in bio-ceramic technology has revolutionised endodontic material science by enhancing the treatment outcome for patients. This class of dental materials conciliates excellent biocompatibility with high osseoconductivity that render them ideal for endodontic care. Few recently introduced bio-ceramic materials have shown considerable clinical success over their early generations in terms of good handling characteristics. Calcium enriched mixture (CEM) cement, Endosequence sealer, and root repair materials, Biodentine and BioAggregate are the new classes of bio-ceramic materials. The aim of this literature review is to present investigations regarding properties and applications of CEM cement in endodontics. A review of the existing literature was performed by using electronic and hand searching methods for CEM cement from January 2006 to December 2013. CEM cement has a different chemical composition from that of mineral trioxide aggregate (MTA) but has similar clinical applications. It combines the biocompatibility of MTA with more efficient characteristics, such as significantly shorter setting time, good handling characteristics, no staining of tooth and effective seal against bacterial leakage.

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Epigenetics: general characteristics and implications for oral health
Ji-Yun Seo, Yoon-Jung Park, Young-Ah Yi, Ji-Yun Hwang, In-Bog Lee, Byeong-Hoon Cho, Ho-Hyun Son, Deog-Gyu Seo
Restor Dent Endod 2015;40(1):14-22.   Published online November 13, 2014
DOI: https://doi.org/10.5395/rde.2015.40.1.14
AbstractAbstract PDFPubReaderePub

Genetic information such as DNA sequences has been limited to fully explain mechanisms of gene regulation and disease process. Epigenetic mechanisms, which include DNA methylation, histone modification and non-coding RNAs, can regulate gene expression and affect progression of disease. Although studies focused on epigenetics are being actively investigated in the field of medicine and biology, epigenetics in dental research is at the early stages. However, studies on epigenetics in dentistry deserve attention because epigenetic mechanisms play important roles in gene expression during tooth development and may affect oral diseases. In addition, understanding of epigenetic alteration is important for developing new therapeutic methods. This review article aims to outline the general features of epigenetic mechanisms and describe its future implications in the field of dentistry.

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Research Articles
Microtensile bond strength of silorane-based composite specific adhesive system using different bonding strategies
Laura Alves Bastos, Ana Beatriz Silva Sousa, Brahim Drubi-Filho, Fernanda de Carvalho Panzeri Pires-de-Souza, Lucas da Fonseca Roberti Garcia
Restor Dent Endod 2015;40(1):23-29.   Published online August 25, 2014
DOI: https://doi.org/10.5395/rde.2015.40.1.23
AbstractAbstract PDFPubReaderePub
Objectives

The aim of this study was to evaluate the effect of pre-etching on the bond strength of silorane-based composite specific adhesive system to dentin.

Materials and Methods

Thirty human molars were randomly divided into 5 groups according to the different bonding strategies. For teeth restored with silorane-based composite (Filtek Silorane, 3M ESPE), the specific self-etching adhesive system (Adhesive System P90, 3M ESPE) was used with and without pre-etching (Pre-etching/Silorane and Silorane groups). Teeth restored with methacrylate based-composite (Filtek Z250, 3M ESPE) were hybridized with the two-step self-etching system (Clearfil SE Bond, Kuraray), with and without pre-etching (Pre-etching/Methacrylate and Methacrylate groups), or three-step adhesive system (Adper Scotchbond Multi-Purpose, 3M ESPE) (Three-step/Methacrylate group) (n = 6). The restored teeth were sectioned into stick-shaped test specimens (1.0 × 1.0 mm), and coupled to a universal test machine (0.5 mm/min) to perform microtensile testing.

Results

Pre-etching/Methacrylate group presented the highest bond strength values, with significant difference from Silorane and Three-step/Methacrylate groups (p < 0.05). However, it was not significantly different from Preetching/Silorane and Methacrylate groups.

Conclusions

Pre-etching increased bond strength of silorane-based composite specific adhesive system to dentin.

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A study on the compatibility between one-bottle dentin adhesives and composite resins using micro-shear bond strength
Minju Song, Yooseok Shin, Jeong-Won Park, Byoung-Duck Roh
Restor Dent Endod 2015;40(1):30-36.   Published online September 26, 2014
DOI: https://doi.org/10.5395/rde.2015.40.1.30
AbstractAbstract PDFPubReaderePub
Objectives

This study was performed to determine whether the combined use of one-bottle self-etch adhesives and composite resins from same manufacturers have better bond strengths than combinations of adhesive and resins from different manufacturers.

Materials and Methods

25 experimental micro-shear bond test groups were made from combinations of five dentin adhesives and five composite resins with extracted human molars stored in saline for 24 hr. Testing was performed using the wire-loop method and a universal testing machine. Bond strength data was statistically analyzed using two way analysis of variance (ANOVA) and Tukey's post hoc test.

Results

Two way ANOVA revealed significant differences for the factors of dentin adhesives and composite resins, and significant interaction effect (p < 0.001). All combinations with Xeno V (Dentsply De Trey) and Clearfil S3 Bond (Kuraray Dental) adhesives showed no significant differences in micro-shear bond strength, but other adhesives showed significant differences depending on the composite resin (p < 0.05). Contrary to the other adhesives, Xeno V and BondForce (Tokuyama Dental) had higher bond strengths with the same manufacturer's composite resin than other manufacturer's composite resin.

Conclusions

Not all combinations of adhesive and composite resin by same manufacturers failed to show significantly higher bond strengths than mixed manufacturer combinations.

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Effects of applying antioxidants on bond strength of bleached bovine dentin
Hyo-Jin Whang, Dong-Hoon Shin
Restor Dent Endod 2015;40(1):37-43.   Published online October 13, 2014
DOI: https://doi.org/10.5395/rde.2015.40.1.37
AbstractAbstract PDFPubReaderePub
Objectives

Some antioxidants are believed to restore dentin bond strength after dental bleaching. This study was done to evaluate the influence of antioxidants on the bond strength of bleached bovine dentin.

Materials and Methods

Thirty incisors were randomly assigned to 10 groups (two unbleached control and eight bleached groups: immediate bonding IB, 4 wk delayed bonding DB, 10% sodium ascorbate treated SA, 10% α-tocopherol treated TP groups). Teeth in half of groups were subjected to thermal stress, whereas the remaining groups were not. Resin-dentin rods with a cross-sectional area of 2.25 mm2 were obtained and microtensile bond strength was determined at a crosshead speed of 1 mm/min. Fifteen specimens were prepared for SEM to compare the surface characteristics of each group. The change in dentin bond strength from thermal stress and antioxidant treatment was evaluated using two-way analysis of variance (ANOVA) and Sheffe's post hoc test at a significance level of 95%.

Results

The control group exhibited the highest bond strength values, whereas IB group showed the lowest value before and after thermocycling. The DB group recovered its bond strength similar to that of the control group. The SA and TP groups exhibited similar bond strength values with those of the control and DB groups before thermocycling. However, The TP group did not maintain bond strength with thermal stress, whereas the SA group did.

Conclusions

Applying a 10% sodium ascorbate solution rather than 10% α-tocopherol solution for 60 sec is recommended to maintain dentin bond strength when restoring non-vitally bleached teeth.

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Calcium hydroxide dressing residues after different removal techniques affect the accuracy of Root-ZX apex locator
Emel Uzunoglu, Ayhan Eymirli, Mehmet Özgür Uyanik, Semra Çalt, Emre Nagas
Restor Dent Endod 2015;40(1):44-49.   Published online November 5, 2014
DOI: https://doi.org/10.5395/rde.2015.40.1.44
AbstractAbstract PDFPubReaderePub
Objectives

This study compared the ability of several techniques to remove calcium hydroxide (CH) from the root canal and determined the influence of CH residues on the accuracy of the electronic apex locator.

Materials and Methods

Root canals of 90 human maxillary lateral incisors with confirmed true working length (TWL) were prepared and filled with CH. The teeth were randomly assigned to one of the experimental groups according to the CH removal technique (n = 14): 0.9% saline; 0.9% saline + master apical file (MAF); 17% ethylenediamine tetraacetic acid (EDTA); 17% EDTA + MAF; 5.25% sodium hypochlorite (NaOCl); 5.25% NaOCl + MAF. Six teeth were used as negative control. After CH removal, the electronic working length was measured using Root-ZX (Morita Corp.) and compared with TWL to evaluate Root-ZX accuracy. All specimens were sectioned longitudinally, and the area of remaining CH (CH) and total canal area were measured using imaging software.

Results

The EDTA + MAF and NaOCl + MAF groups showed better CH removal than other groups (p < 0.05). Root-ZX reliability to prevent overestimated working length to be > 85% within a tolerance of ± 1.0 mm (p < 0.05). There was strong negative correlation between amount of CH residues and EAL accuracy (r = -0.800 for ± 0.5 mm; r = -0.940 for ± 1.0 mm).

Conclusions

The mechanical instrumentation improves the CH removal of irrigation solutions although none of the techniques removed the dressing completely. Residues of CH medication in root canals affected the accuracy of Root-ZX adversely.

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Antimicrobial and cytotoxic activity of Ferula gummosa plant essential oil compared to NaOCl and CHX: a preliminary in vitro study
Abbas Abbaszadegan, Ahmad Gholami, Hosein Mirhadi, Mina Saliminasab, Aboozar Kazemi, Mahmood Reza Moein
Restor Dent Endod 2015;40(1):50-57.   Published online December 26, 2014
DOI: https://doi.org/10.5395/rde.2015.40.1.50
AbstractAbstract PDFPubReaderePub
Objectives

The usage of medicinal plants as natural antimicrobial agents has grown in many fields including dental medicine. The aim of this in vitro study was three-fold: (i) to determine the chemical compositions of the Ferula gummosa essential oil (FGEO), (ii) to compare the antimicrobial efficacy of the oil with sodium hypochlorite (NaOCl) and chlorhexidine (CHX), (iii) to assess the toxic behavior of FGEO in different concentrations compared to 5% NaOCl and 0.2% CHX.

Materials and Methods

Gas chromatography/mass spectrometry (GC/MS) was used to determine the chemical compositions of the oil. The disk diffusion method and a broth micro-dilution susceptibility assay were exploited to assess the antimicrobial efficacy against Enterococcus faecalis, Staphylococcus aureus, Streptococcus mitis, and Candida albicans. The cytocompatibility of the FGEO was assessed on L929 fibroblasts, and compared to that of NaOCl and CHX.

Results

Twenty-seven constituents were recognized in FGEO. The major component of the oil was β-pinene (51.83%). All three irrigants significantly inhibited the growth of all examined microorganisms compared to the negative control group. FGEO at 50 µg/mL was effective in lower concentration against Enterococcus faecalis than 5% NaOCl and 0.2% CHX, and was also more potent than 0.2% CHX against Candida albicans and Staphylococcus aureus. FGEO was a cytocompatible solution, and had significantly lower toxicity compared to 5% NaOCl and 0.2% CHX.

Conclusions

FGEO showed a promising biological potency as a root canal disinfectant. More investigations are required on the effectiveness of this oil on intracanal bacterial biofilms.

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Detection of root perforations using conventional and digital intraoral radiography, multidetector computed tomography and cone beam computed tomography
Abbas Shokri, Amir Eskandarloo, Maruf Noruzi-Gangachin, Samira Khajeh
Restor Dent Endod 2015;40(1):58-67.   Published online November 13, 2014
DOI: https://doi.org/10.5395/rde.2015.40.1.58
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to compare the accuracy of conventional intraoral (CI) radiography, photostimulable phosphor (PSP) radiography, cone beam computed tomography (CBCT) and multidetector computed tomography (MDCT) for detection of strip and root perforations in endodontically treated teeth.

Materials and Methods

Mesial and distal roots of 72 recently extracted molar were endodontically prepared. Perforations were created in 0.2, 0.3, or 0.4 mm diameter around the furcation of 48 roots (strip perforation) and at the external surface of 48 roots (root perforation); 48 roots were not perforated (control group). After root obturation, intraoral radiography, CBCT and MDCT were taken. Discontinuity in the root structure was interpreted as perforation. Two observers examined the images. Data were analyzed using Stata software and Chi-square test.

Results

The sensitivity and specificity of CI, PSP, CBCT and MDCT in detection of strip perforations were 81.25% and 93.75%, 85.42% and 91.67%, 97.92% and 85.42%, and 72.92% and 87.50%, respectively. For diagnosis of root perforation, the sensitivity and specificity were 87.50% and 93.75%, 89.58% and 91.67%, 97.92% and 85.42%, and 81.25% and 87.50%, respectively. For detection of strip perforation, the difference between CBCT and all other methods including CI, PSP and MDCT was significant (p < 0.05). For detection of root perforation, only the difference between CBCT and MDCT was significant, and for all the other methods no statistically significant difference was observed.

Conclusions

If it is not possible to diagnose the root perforations by periapical radiographs, CBCT is the best radiographic technique while MDCT is not recommended.

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Effect of additional etching and ethanol-wet bonding on the dentin bond strength of one-step self-etch adhesives
Joonghee Ahn, Kyoung-Hwa Jung, Sung-Ae Son, Bock Hur, Yong-Hoon Kwon, Jeong-Kil Park
Restor Dent Endod 2015;40(1):68-74.   Published online November 18, 2014
DOI: https://doi.org/10.5395/rde.2015.40.1.68
AbstractAbstract PDFPubReaderePub
Objectives

This study examined the effects of additional acid etching on the dentin bond strength of one-step self-etch adhesives with different compositions and pH. The effect of ethanol wetting on etched dentin bond strength of self-etch adhesives was also evaluated.

Materials and Methods

Forty-two human permanent molars were classified into 21 groups according to the adhesive types (Clearfil SE Bond [SE, control]; G-aenial Bond [GB]; Xeno V [XV]; Beauti Bond [BB]; Adper Easy Bond [AE]; Single Bond Universal [SU]; All Bond Universal [AU]), and the dentin conditioning methods. Composite resins were placed on the dentin surfaces, and the teeth were sectioned. The microtensile bond strength was measured, and the failure mode of the fractured specimens was examined. The data were analyzed statistically using two-way ANOVA and Duncan's post hoc test.

Results

In GB, XV and SE (pH ≤ 2), the bond strength was decreased significantly when the dentin was etched (p < 0.05). In BB, AE and SU (pH 2.4 - 2.7), additional etching did not affect the bond strength (p > 0.05). In AU (pH = 3.2), additional etching increased the bond strength significantly (p < 0.05). When adhesives were applied to the acid etched dentin with ethanol-wet bonding, the bond strength was significantly higher than that of the no ethanol-wet bonding groups, and the incidence of cohesive failure was increased.

Conclusions

The effect of additional acid etching on the dentin bond strength was influenced by the pH of one-step self-etch adhesives. Ethanol wetting on etched dentin could create a stronger bonding performance of one-step self-etch adhesives for acid etched dentin.

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Case Reports
Endodontic treatment of a mandibular first molar with 8 canals: a case report
Ankit Arora, Shashi Rashmi Acharya, Padmaja Sharma
Restor Dent Endod 2015;40(1):75-78.   Published online October 13, 2014
DOI: https://doi.org/10.5395/rde.2015.40.1.75
AbstractAbstract PDFPubReaderePub

Presented here is a case where 8 canals were located in a mandibular first molar. A patient with continuing pain in mandibular left first molar even after completion of biomechanical preparation was referred by a dentist. Following basic laws of the pulp chamber floor anatomy, 8 canals were located in three steps with 4 canals in each root. In both of the roots, 4 separate canals commenced which joined into two canals and exited as two separate foramina. At 6 mon follow-up visit, the tooth was found to be asymptomatic and revealed normal radiographic periapical area. The case stresses on the fact that understanding the laws of pulp chamber anatomy and complying with them while attempting to locate additional canals can prevent missing canals.

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Surgical endodontic management of infected lateral canals of maxillary incisors
Ji-Hyun Jang, Jung-Min Lee, Jin-Kyu Yi, Sung-Baik Choi, Sang-Hyuk Park
Restor Dent Endod 2015;40(1):79-84.   Published online October 10, 2014
DOI: https://doi.org/10.5395/rde.2015.40.1.79
AbstractAbstract PDFPubReaderePub

This case report presents surgical endodontic management outcomes of maxillary incisors that were infected via the lateral canals. Two cases are presented in which endodontically-treated maxillary central incisors had sustained lateral canal infections. A surgical endodontic treatment was performed on both teeth. Flap elevation revealed vertical bone destruction along the root surface and infected lateral canals, and microscopy revealed that the lateral canals were the origin of the lesions. After the infected lateral canals were surgically managed, both teeth were asymptomatic and labial fistulas were resolved. There were no clinical or radiographic signs of surgical endodontic management failure at follow-up visits. This case report highlights the clinical significance and surgical endodontic management of infected lateral canal of maxillary incisor. It is important to be aware of root canal anatomy variability in maxillary incisors. Maxillary central incisors infected via the lateral canal can be successfully managed by surgical endodontic treatment.

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Canal preparation with nickel-titanium or stainless steel instruments without the risk of instrument fracture: preliminary observations
Ghassan Yared
Restor Dent Endod 2015;40(1):85-90.   Published online November 13, 2014
DOI: https://doi.org/10.5395/rde.2015.40.1.85
AbstractAbstract PDFSupplementary MaterialPubReaderePub

This report introduces a novel technique that allows a safe and predictable canal negotiation, creation of a glide path and canal preparation with reciprocating nickel-titanium or stainless steel engine-driven instruments in canals where the use of rotary and the newly developed reciprocating instruments is contraindicated. In this novel technique, the instruments are used in reciprocating motion with very small angles. Hand files are not used regardless of the complexity of the canal anatomy. It also allows achieving predictable results in canal negotiation and glide path creation in challenging canals without the risk of instrument fracture.

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Open Lecture on Statistics
Statistical notes for clinical researchers: A one-way repeated measures ANOVA for data with repeated observations
Hae-Young Kim
Restor Dent Endod 2015;40(1):91-95.   Published online January 12, 2015
DOI: https://doi.org/10.5395/rde.2015.40.1.91
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Readers' Forum
Safe way for using NiTi rotary files
Seok-Woo Chang
Restor Dent Endod 2015;40(1):96-96.   Published online January 12, 2015
DOI: https://doi.org/10.5395/rde.2015.40.1.96
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