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Volume 41 (1); February 2016
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Research Articles
Comparison of canal transportation in simulated curved canals prepared with ProTaper Universal and ProTaper Gold systems
Emmanuel João Nogueira Leal Silva, Brenda Leite Muniz, Frederico Pires, Felipe Gonçalves Belladonna, Aline Almeida Neves, Erick Miranda Souza, Gustavo De-Deus
Restor Dent Endod 2016;41(1):1-5.   Published online February 4, 2016
DOI: https://doi.org/10.5395/rde.2016.41.1.1
AbstractAbstract PDFPubReaderePub
Objectives

The purpose of this study was to assess the ability of ProTaper Gold (PTG, Dentsply Maillefer) in maintaining the original profile of root canal anatomy. For that, ProTaper Universal (PTU, Dentsply Maillefer) was used as reference techniques for comparison.

Materials and Methods

Twenty simulated curved canals manufactured in clear resin blocks were randomly assigned to 2 groups (n = 10) according to the system used for canal instrumentation: PTU and PTG groups, upto F2 files (25/0.08). Color stereomicroscopic images from each block were taken exactly at the same position before and after instrumentation. All image processing and data analysis were performed with an open source program (FIJI). Evaluation of canal transportation was obtained for two independent canal regions: straight and curved levels. Student's t test was used with a cut-off for significance set at α = 5%.

Results

Instrumentation systems significantly influenced canal transportation (p < 0.0001). A significant interaction between instrumentation system and root canal level (p < 0.0001) was found. PTU and PTG systems produced similar canal transportation at the straight part, while PTG system resulted in lower canal transportation than PTU system at the curved part. Canal transportation was higher at the curved canal portion (p < 0.0001).

Conclusions

PTG system produced overall less canal transportation in the curved portion when compared to PTU system.

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An in vitro evaluation of the accuracy of four electronic apex locators using stainless-steel and nickel-titanium hand files
Paras Mull Gehlot, Vinutha Manjunath, Mysore Krishnaswamy Manjunath
Restor Dent Endod 2016;41(1):6-11.   Published online January 4, 2016
DOI: https://doi.org/10.5395/rde.2016.41.1.6
AbstractAbstract PDFPubReaderePub
Objectives

The purpose of this in vitro study was to evaluate the accuracy of working length (WL) determination of four electronic apex locators (EALs), namely, Root ZX (RZX), Elements diagnostic unit and apex locator (ELE), SybronEndo Mini Apex locator (MINI) and Propex pixi (PIXI) using Stainless steel (SS) and nickel-titanium (NiTi) hand files. The null hypothesis was that there was no difference between canal length determination by SS and NiTi files of 4 EALs.

Materials and Methods

Sixty extracted, single rooted human teeth were decoronated and the canal orifice flared. The actual length (AL) was assessed visually, and the teeth were embedded in an alginate model. The electronic length (EL) measurements were recorded with all four EALs using SS and NiTi files at '0.5' reading on display. The differences between the AL and EL were compared.

Results

The results obtained with each EAL with SS and NiTi files were compared with AL. A paired sample t test showed that there was a statistical significant difference between EAL readings with SS and NiTi files for RZX and MINI (p < 0.05). The accuracy of RZX, ELE, MINI and PIXI within ± 0.5 mm of AL with SS/NiTi files were 93.3%/70%, 90%/91.7%, 95%/68.3%, and 83.3%/83.3%, respectively.

Conclusions

The results of this study indicate that Root ZX was statistically more accurate with NiTi files compared to SS files, while MINI was statistically more accurate with SS files compared to NiTi files. ELE and PIXI were not affected by the alloy type of the file used to determine WL.

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Effect of acidic solutions on the microhardness of dentin and set OrthoMTA and their cytotoxicity on murine macrophage
Soram Oh, Hiran Perinpanayagam, Yoon Lee, Jae-Won Kum, Yeon-Jee Yoo, Sang-Min Lim, Seok Woo Chang, Won-Jun Shon, Woocheol Lee, Seung-Ho Baek, Kee-Yeon Kum
Restor Dent Endod 2016;41(1):12-21.   Published online December 1, 2015
DOI: https://doi.org/10.5395/rde.2016.41.1.12
AbstractAbstract PDFPubReaderePub
Objectives

To evaluate the effects of three acids on the microhardness of set mineral trioxide aggregate (MTA) and root dentin, and cytotoxicity on murine macrophage.

Materials and Methods

OrthoMTA (BioMTA) was mixed and packed into the human root dentin blocks of 1.5 mm diameter and 5 mm height. Four groups, each of ten roots, were exposed to 10% citric acid (CA), 5% glycolic acid (GA), 17% ethylenediaminetetraacetic acid (EDTA), and saline for five minutes after setting of the OrthoMTA. Vickers surface microhardness of set MTA and dentin was measured before and after exposure to solutions, and compared between groups using one-way ANOVA with Tukey test. The microhardness value of each group was analyzed using student t test. Acid-treated OrthoMTA and dentin was examined by scanning electron microscope (SEM). Cell viability of tested solutions was assessed using WST-8 assay and murine macrophage.

Results

Three test solutions reduced microhardness of dentin. 17% EDTA demonstrated severe dentinal erosion, significantly reduced the dentinal microhardness compared to 10% CA (p = 0.034) or 5% GA (p = 0.006). 10% CA or 5% GA significantly reduced the surface microhardness of set MTA compared to 17% EDTA and saline (p < 0.001). Acid-treated OrthoMTA demonstrated microporous structure with destruction of globular crystal. EDTA exhibited significantly more cellular toxicity than the other acidic solutions at diluted concentrations (0.2, 0.5, 1.0%).

Conclusions

Tested acidic solutions reduced microhardness of root dentin. Five minute's application of 10% CA and 5% GA significantly reduced the microhardness of set OrthoMTA with lower cellular cytotoxicity compared to 17% EDTA.

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Quality of root canal fillings using three gutta-percha obturation techniques
Edith Siu Shan Ho, Jeffrey Wen Wei Chang, Gary Shun Pan Cheung
Restor Dent Endod 2016;41(1):22-28.   Published online January 4, 2016
DOI: https://doi.org/10.5395/rde.2016.41.1.22
AbstractAbstract PDFPubReaderePub
Objectives

The goal of this study was to compare the density of gutta-percha root fillings obturated with the following techniques: cold lateral (CL) compaction, ultrasonic lateral (UL) compaction, and warm vertical (WV) compaction.

Materials and Methods

Thirty-three extracted mandibular first molars, with two separate mesial canals in each, were selected. After instrumentation, the canals were stratified into three groups based on canal length and curvature, and underwent obturation with one of the techniques. No sealer was used in order to avoid masking any voids. The teeth were imaged pre- and post-obturation using micro-computed tomography. The reconstructed three-dimensional images were analyzed volumetrically to determine the amount of gutta-percha present in every 2 mm segment of the canal. P values < 0.05 were considered to indicate statistical significance.

Results

The overall mean volume fraction of gutta-percha was 68.51 ± 6.75% for CL, 86.56 ± 5.00% for UL, and 88.91 ± 5.16% for WV. Significant differences were found between CL and UL and between CL and WV (p < 0.05), but not between UL and WV (p = 0.526). The gutta-percha density of the roots treated with WV and UL increased towards the coronal aspect, but this trend was not noted in the CL group.

Conclusions

WV compaction and UL compaction produced a significantly denser gutta-percha root filling than CL compaction. The density of gutta-percha was observed to increase towards the coronal aspect when the former two techniques were used.

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Evaluation of reparative dentin formation of ProRoot MTA, Biodentine and BioAggregate using micro-CT and immunohistochemistry
Jia Kim, Young-Sang Song, Kyung-San Min, Sun-Hun Kim, Jeong-Tae Koh, Bin-Na Lee, Hoon-Sang Chang, In-Nam Hwang, Won-Mann Oh, Yun-Chan Hwang
Restor Dent Endod 2016;41(1):29-36.   Published online January 4, 2016
DOI: https://doi.org/10.5395/rde.2016.41.1.29
AbstractAbstract PDFPubReaderePub
Objectives

The purpose of this study was to assess the ability of two new calcium silicate-based pulp-capping materials (Biodentine and BioAggregate) to induce healing in a rat pulp injury model and to compare them with mineral trioxide aggregate (MTA).

Materials and Methods

Eighteen rats were anesthetized, cavities were prepared and the pulp was capped with either of ProRoot MTA, Biodentine, or BioAggregate. The specimens were scanned using a high-resolution micro-computed tomography (micro-CT) system and were prepared and evaluated histologically and immunohistochemically using dentin sialoprotein (DSP).

Results

On micro-CT analysis, the ProRoot MTA and Biodentine groups showed significantly thicker hard tissue formation (p < 0.05). On H&E staining, ProRoot MTA showed complete dentin bridge formation with normal pulpal histology. In the Biodentine and BioAggregate groups, a thick, homogeneous hard tissue barrier was observed. The ProRoot MTA specimens showed strong immunopositive reaction for DSP.

Conclusions

Our results suggest that calcium silicate-based pulp-capping materials induce favorable effects on reparative processes during vital pulp therapy and that both Biodentine and BioAggregate could be considered as alternatives to ProRoot MTA.

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Marginal and internal fit of nano-composite CAD/CAM restorations
So-Hyun Park, Yeon-Jee Yoo, Yoo-Jin Shin, Byeong-Hoon Cho, Seung-Ho Baek
Restor Dent Endod 2016;41(1):37-43.   Published online January 19, 2016
DOI: https://doi.org/10.5395/rde.2016.41.1.37
AbstractAbstract PDFPubReaderePub
Objectives

The purpose of this study was to compare the marginal and internal fit of nano-composite CAD-CAM restorations.

Materials and Methods

A full veneer crown and an mesio-occluso-distal (MOD) inlay cavity, which were prepared on extracted human molars, were used as templates of epoxy resin replicas. The prepared teeth were scanned and CAD-CAM restorations were milled using Lava Ultimate (LU) and experimental nano-composite CAD/CAM blocks (EB) under the same milling parameters. To assess the marginal and internal fit, the restorations were cemented to replicas and were embedded in an acrylic mold for sectioning at 0.5 mm intervals. The measured gap data were pooled according to the block types and measuring points for statistical analysis.

Results

Both the block type and measuring point significantly affected gap values, and their interaction was significant (p = 0.000). In crowns and inlays made from the two blocks, gap values were significantly larger in the occlusal area than in the axial area, while gap values in the marginal area were smallest (p < 0.001). Among the blocks, the restorations milled from EB had a significantly larger gap at all measuring points than those milled from LU (p = 0.000).

Conclusions

The marginal and internal gaps of the two nano-composite CAD/CAM blocks differed according to the measuring points. Among the internal area of the two nano-composite CAD/CAM restorations, occlusal gap data were significantly larger than axial gap data. The EB crowns and inlays had significantly larger gaps than LU restorations.

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Antioxidant therapy enhances pulpal healing in bleached teeth
Adriano Fonseca Lima, Marcelo Rocha Marques, Diana Gabriela Soares, Josimeri Hebling, Giselle Maria Marchi, Carlos Alberto de Souza Costa
Restor Dent Endod 2016;41(1):44-54.   Published online February 1, 2016
DOI: https://doi.org/10.5395/rde.2016.41.1.44
AbstractAbstract PDFPubReaderePub
Objectives

The purpose of this study was to evaluate the histopathological effects of an antioxidant therapy on the pulp tissue of rat teeth exposed to a bleaching gel with 35% hydrogen peroxide.

Materials and Methods

Forty rats were subjected to oral ingestion by gavage of distilled water (DW) or ascorbic acid (AA) 90 min before the bleaching therapy. For the bleaching treatment, the agent was applied twice for 5 min each to buccal surfaces of the first right mandibular molars. Then, the animals were sacrificed at 6 hr, 24 hr, 3 day, or 7 day post-bleaching, and the teeth were processed for microscopic evaluation of the pulp tissue.

Results

At 6 hr, the pulp tissue showed moderate inflammatory reactions in all teeth of both groups. In the DW and AA groups, 100% and 80% of teeth exhibited pulp tissue with significant necrosis and intense tissue disorganization, respectively. At 24 hr, the AA-treated group demonstrated a greater regenerative capability than the DW group, with less intense inflammatory reaction and new odontoblast layer formation in 60% of the teeth. For up to the 7 day period, the areas of pulpal necrosis were replaced by viable connective tissue, and the dentin was underlined by differentiated odontoblast-like cells in most teeth of both groups.

Conclusions

A slight reduction in initial pulpal damage during post-bleaching was promoted by AA therapy. However, the pulp tissue of AA-treated animals featured faster regenerative potential over time.

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Analysis of C-shaped root canal configuration in maxillary molars in a Korean population using cone-beam computed tomography
Hyoung-Hoon Jo, Jeong-Bum Min, Ho-Keel Hwang
Restor Dent Endod 2016;41(1):55-62.   Published online January 29, 2016
DOI: https://doi.org/10.5395/rde.2016.41.1.55
AbstractAbstract PDFPubReaderePub
Objectives

The purpose of this study was to investigate the incidence of root fusion and C-shaped root canals in maxillary molars, and to classify the types of C-shaped canal by analyzing cone-beam computed tomography (CBCT) in a Korean population.

Materials and Methods

Digitized CBCT images from 911 subjects were obtained in Chosun University Dental Hospital between February 2010 and July 2012 for orthodontic treatment. Among them, a total of selected 3,553 data of maxillary molars were analyzed retrospectively. Tomography sections in the axial, coronal, and sagittal planes were displayed by PiViewstar and Rapidia MPR software (Infinitt Co.). The incidence and types of root fusion and C-shaped root canals were evaluated and the incidence between the first and the second molar was compared using Chi-square test.

Results

Root fusion was present in 3.2% of the first molars and 19.5% of the second molars, and fusion of mesiobuccal and palatal root was dominant. C-shaped root canals were present in 0.8% of the first molars and 2.7% of the second molars. The frequency of root fusion and C-shaped canal was significantly higher in the second molar than the first molar (p < 0.001).

Conclusions

In a Korean population, maxillary molars showed total 11.3% of root fusion and 1.8% of C-shaped root canals. Furthermore, root fusion and C-shaped root canals were seen more frequently in the maxillary second molars.

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Case Reports
Accidental injury of the inferior alveolar nerve due to the extrusion of calcium hydroxide in endodontic treatment: a case report
Yooseok Shin, Byoung-Duck Roh, Yemi Kim, Taehyeon Kim, Hyungjun Kim
Restor Dent Endod 2016;41(1):63-67.   Published online January 6, 2016
DOI: https://doi.org/10.5395/rde.2016.41.1.63
AbstractAbstract PDFPubReaderePub

During clinical endodontic treatment, we often find radiopaque filling material beyond the root apex. Accidental extrusion of calcium hydroxide could cause the injury of inferior alveolar nerve, such as paresthesia or continuous inflammatory response. This case report presents the extrusion of calcium hydroxide and treatment procedures including surgical intervention. A 48 yr old female patient experienced Calcipex II extrusion in to the inferior alveolar canal on left mandibular area during endodontic treatment. After completion of endodontic treatment on left mandibular first molar, surgical intervention was planned under general anesthesia. After cortical bone osteotomy and debridement, neuroma resection and neurorrhaphy was performed, and prognosis was observed. But no improvement in sensory nerve was seen following surgical intervention after 20 mon. A clinician should be aware of extrusion of intracanal medicaments and the possibility of damage on inferior alveolar canal. Injectable type of calcium hydroxide should be applied with care for preventing nerve injury. The alternative delivery method such as lentulo spiral was suggested on the posterior mandibular molar.

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Endodontic treatment of a C-shaped mandibular second premolar with four root canals and three apical foramina: a case report
Thikamphaa Bertrand, Sahng Gyoon Kim
Restor Dent Endod 2016;41(1):68-73.   Published online January 19, 2016
DOI: https://doi.org/10.5395/rde.2016.41.1.68
AbstractAbstract PDFPubReaderePub

This case report describes a unique C-shaped mandibular second premolar with four canals and three apical foramina and its endodontic management with the aid of cone-beam computer tomography (CBCT). C-shaped root canal morphology with four canals was identified under a dental operating microscope. A CBCT scan was taken to evaluate the aberrant root canal anatomy and devise a better instrumentation strategy based on the anatomy. All canals were instrumented to have a 0.05 taper using 1.0 mm step-back filing with appropriate apical sizes determined from the CBCT scan images and filled using a warm vertical compaction technique. A C-shaped mandibular second premolar with multiple canals is an anatomically rare case for clinicians, yet its endodontic treatment may require a careful instrumentation strategy due to the difficulty in disinfecting the canals in the thin root area without compromising the root structure.

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Open Lecture on Statistics
Statistical notes for clinical researchers: Sample size calculation 1. comparison of two independent sample means
Hae-Young Kim
Restor Dent Endod 2016;41(1):74-78.   Published online December 30, 2015
DOI: https://doi.org/10.5395/rde.2016.41.1.74
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Readers' Forum
Predictable management of the cracked tooth
Sin-Young Kim
Restor Dent Endod 2016;41(1):79-79.   Published online December 23, 2015
DOI: https://doi.org/10.5395/rde.2016.41.1.79
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Letter to Editor
Questioning the spot light on Hi-tech endodontics
Jojo Kottoor, Denzil Albuquerque
Restor Dent Endod 2016;41(1):80-82.   Published online December 23, 2015
DOI: https://doi.org/10.5395/rde.2016.41.1.80
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