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Volume 44 (1); February 2019
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Open Lecture on Statistics
Statistical notes for clinical researchers: simple linear regression 3 – residual analysis
Hae-Young Kim
Restor Dent Endod 2019;44(1):e11.   Published online February 12, 2019
DOI: https://doi.org/10.5395/rde.2019.44.e11
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Editorial
Appreciations to peer reviewers in 2018: contributions to the journal, Restorative Dentistry & Endodontics
Byeong-Hoon Cho, Su-Jung Shin
Restor Dent Endod 2019;44(1):e12.   Published online February 18, 2019
DOI: https://doi.org/10.5395/rde.2019.44.e12
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Review Article
Endodontic biofilms: contemporary and future treatment options
Yeon-Jee Yoo, Hiran Perinpanayagam, Soram Oh, A-Reum Kim, Seung-Hyun Han, Kee-Yeon Kum
Restor Dent Endod 2019;44(1):e7.   Published online January 31, 2019
DOI: https://doi.org/10.5395/rde.2019.44.e7
AbstractAbstract PDFPubReaderePub

Apical periodontitis is a biofilm-mediated infection. The biofilm protects bacteria from host defenses and increase their resistance to intracanal disinfecting protocols. Understanding the virulence of these endodontic microbiota within biofilm is essential for the development of novel therapeutic procedures for intracanal disinfection. Both the disruption of biofilms and the killing of their bacteria are necessary to effectively treat apical periodontitis. Accordingly, a review of endodontic biofilm types, antimicrobial resistance mechanisms, and current and future therapeutic procedures for endodontic biofilm is provided.

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Research Articles
Finishing and polishing effects of multiblade burs on the surface texture of 5 resin composites: microhardness and roughness testing
Elodie Ehrmann, Etienne Medioni, Nathalie Brulat-Bouchard
Restor Dent Endod 2019;44(1):e1.   Published online November 26, 2018
DOI: https://doi.org/10.5395/rde.2019.44.e1
AbstractAbstract PDFPubReaderePub
Objectives

The aim of this in vitro study was to test the effect of 2 finishing–polishing sequences (QB, combining a 12/15-fluted finishing bur and an EVO-Light polisher; QWB, adding a 30-fluted polishing bur after the 12/15-fluted finishing bur used in the QB sequence) on 5 nanotech-based resin composites (Filtek Z500, Ceram X Mono, Ceram X Duo, Tetric Evoceram, and Tetric Evoceram Bulk Fill) by comparing their final surface roughness and hardness values to those of a Mylar strip control group (MS).

Materials and Methods

Twelve specimens of each nanocomposite were prepared in Teflon moulds. The surface of each resin composite was finished with QB (5 samples), QWB (5 samples), or MS (2 samples), and then evaluated (60 samples). Roughness was analysed with an optical profilometer, microhardness was tested with a Vickers indenter, and the surfaces were examined by optical and scanning electron microscopy. Data were analysed using the Kruskal-Wallis test (p < 0.05) followed by the Dunn test.

Results

For the hardness and roughness of nanocomposite resin, the QWB sequence was significantly more effective than QB (p < 0.05). The Filtek Z500 showed significantly harder surfaces regardless of the finishing–polishing sequence (p < 0.05).

Conclusions

QWB yielded the best values of surface roughness and hardness. The hardness and roughness of the 5 nanocomposites presented less significant differences when QWB was used.

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The top 10 most-cited articles on the management of fractured instruments: a bibliometric analysis
Lora Mishra, Hyeon-Cheol Kim, Naomi Ranjan Singh, Priti Pragati Rath
Restor Dent Endod 2019;44(1):e2.   Published online December 26, 2018
DOI: https://doi.org/10.5395/rde.2019.44.e2
AbstractAbstract PDFPubReaderePub
Objectives

The purpose of this research was to identify the top 10 most-cited articles on the management of fractured or broken instruments and to perform a bibliometric analysis thereof.

Materials and Methods

Published articles related to fractured instruments were screened from online databases, such as Web of Science, Scopus, PubMed, and ScienceDirect, and highly cited papers, with at least 50 citations since publication, were identified. The most-cited articles were selected and analysed with regard to publication title, authorship, the journal of publication, year, institution, country of origin, article type, and number of citations.

Results

The top 10 most-cited articles were from various journals. Most were published in the Journal of Endodontics, followed by the International Endodontic Journal, and Dental Traumatology. The leading countries were Australia, Israel, Switzerland, the USA, and Germany, and the leading institution was the University of Melbourne. The majority of articles among the top 10 articles were clinical research studies (n = 8), followed by a basic research article and a non-systematic review article.

Conclusions

This bibliometric analysis revealed interesting information about scientific progress in endodontics regarding fractured instruments. Overall, clinical research studies and basic research articles published in high-impact endodontic journals had the highest citation rates.

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Effect of cooling water temperature on the temperature changes in pulp chamber and at handpiece head during high-speed tooth preparation
Ra'fat I. Farah
Restor Dent Endod 2019;44(1):e3.   Published online December 24, 2018
DOI: https://doi.org/10.5395/rde.2019.44.e3
AbstractAbstract PDFPubReaderePub
Objectives

It was the aim of this study to evaluate the effect of cooling water temperature on the temperature changes in the pulp chamber and at the handpiece head during high-speed tooth preparation using an electric handpiece.

Materials and Methods

Twenty-eight intact human molars received a standardized occlusal preparation for 60 seconds using a diamond bur in an electric handpiece, and one of four treatments were applied that varied in the temperature of cooling water applied (control, with no cooling water, 10°C, 23°C, and 35°C). The temperature changes in the pulp chamber and at the handpiece head were recorded using K-type thermocouples connected to a digital thermometer.

Results

The average temperature changes within the pulp chamber and at the handpiece head during preparation increased substantially when no cooling water was applied (6.8°C and 11.0°C, respectively), but decreased significantly when cooling water was added. The most substantial drop in temperature occurred with 10°C water (−16.3°C and −10.2ºC), but reductions were also seen at 23°C (−8.6°C and −4.9°C). With 35°C cooling water, temperatures increased slightly, but still remained lower than the no cooling water group (1.6°C and 6.7ºC).

Conclusions

The temperature changes in the pulp chamber and at the handpiece head were above harmful thresholds when tooth preparation was performed without cooling water. However, cooling water of all temperatures prevented harmful critical temperature changes even though water at 35°C raised temperatures slightly above baseline.

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Inhibition of nicotine-induced Streptococcus mutans biofilm formation by salts solutions intended for mouthrinses
Abdulrahman A. Balhaddad, Mary Anne S. Melo, Richard L. Gregory
Restor Dent Endod 2019;44(1):e4.   Published online January 16, 2019
DOI: https://doi.org/10.5395/rde.2019.44.e4
AbstractAbstract PDFPubReaderePub
Objectives

Biofilm formation is critical to dental caries initiation and development. The aim of this study was to investigate the effects of nicotine exposure on Streptococcus mutans (S. mutans) biofilm formation concomitantly with the inhibitory effects of sodium chloride (NaCl), potassium chloride (KCl) and potassium iodide (KI) salts. This study examined bacterial growth with varying concentrations of NaCl, KCl, and KI salts and nicotine levels consistent with primary levels of nicotine exposure.

Materials and Methods

A preliminary screening experiment was performed to investigate the appropriate concentrations of NaCl, KCl, and KI to use with nicotine. With the data, a S. mutans biofilm growth assay was conducted using nicotine (0–32 mg/mL) in Tryptic Soy broth supplemented with 1% sucrose with and without 0.45 M of NaCl, 0.23 M of KCl, and 0.113 M of KI. The biofilm was stained with crystal violet dye and the absorbance measured to determine biofilm formation.

Results

The presence of 0.45 M of NaCl, 0.23 M of KCl, and 0.113 M of KI significantly inhibited (p < 0.05) nicotine-induced S. mutans biofilm formation by 52%, 79.7%, and 64.1%, respectively.

Conclusions

The results provide additional evidence regarding the biofilm-enhancing effects of nicotine and demonstrate the inhibitory influence of these salts in reducing the nicotine-induced biofilm formation. A short-term exposure to these salts may inhibit S. mutans biofilm formation.

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The push-out bond strength of BIOfactor mineral trioxide aggregate, a novel root repair material
Makbule Bilge Akbulut, Durmus Alperen Bozkurt, Arslan Terlemez, Melek Akman
Restor Dent Endod 2019;44(1):e5.   Published online January 28, 2019
DOI: https://doi.org/10.5395/rde.2019.44.e5
AbstractAbstract PDFPubReaderePub
Objectives

The aim of this in vitro study was to evaluate the push-out bond strength of a novel calcium silicate-based root repair material-BIOfactor MTA to root canal dentin in comparison with white MTA-Angelus (Angelus) and Biodentine (Septodont).

Materials and Methods

The coronal parts of 12 central incisors were removed and the roots were embedded in acrylic resin blocks. Midroot dentin of each sample was horizontally sectioned into 1.1 mm slices and 3 slices were obtained from each root. Three canal-like standardized holes having 1 mm in diameter were created parallel to the root canal on each dentin slice with a diamond bur. The holes were filled with MTA-Angelus, Biodentine, or BIOfactor MTA. Wet gauze was placed over the specimens and samples were stored in an incubator at 37°C for 7 days to allow complete setting. Then samples were subjected to the push-out test method using a universal test machine with the loading speed of 1 mm/min. Data was statistically analyzed using Friedman test and post hoc Wilcoxon signed rank test with Bonferroni correction.

Results

There were no significant differences among the push-out bond strength values of MTA-Angelus, Biodentine, and BIOfactor MTA (p > 0.017). Most of the specimens exhibited cohesive failure in all groups, with the highest rate found in Biodentine group.

Conclusions

Based on the results of this study, MTA-Angelus, Biodentine, and BIOfactor MTA showed similar resistances to the push-out testing.

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Evaluation of the effects of whitening mouth rinses combined with conventional tooth bleaching treatments
Jaqueline Costa Favaro, Omar Geha, Ricardo Danil Guiraldo, Murilo Baena Lopes, Andreza Maria Fábio Aranha, Sandrine Bittencourt Berger
Restor Dent Endod 2019;44(1):e6.   Published online January 30, 2019
DOI: https://doi.org/10.5395/rde.2019.44.e6
AbstractAbstract PDFPubReaderePub
Objectives

The aim of the present study was to evaluate the effect of whitening mouth rinses alone and in combination with conventional whitening treatments on color, microhardness, and surface roughness changes in enamel specimens.

Materials and Methods

A total of 108 enamel specimens were collected from human third molars and divided into 9 groups (n = 12): 38% hydrogen peroxide (HP), 10% carbamide peroxide (CP), 38% HP + Listerine Whitening (LW), 10% CP + LW, 38% HP + Colgate Plax Whitening (CPW), 10% CP + CPW, LW, CPW, and the control group (CG). The initial color of the specimens was measured, followed by microhardness and roughness tests. Next, the samples were bleached, and their color, microhardness, and roughness were assessed. Data were analyzed through 2-way analysis of variance (ANOVA; microhardness and roughness) and 1-way ANOVA (color change), followed by the Tukey post hoc test. The Dunnett test was used to compare the roughness and microhardness data of the CG to those of the treated groups.

Results

Statistically significant color change was observed in all groups compared to the CG. All groups, except the LW group, showed statistically significant decreases in microhardness. Roughness showed a statistically significant increase after the treatments, except for the 38% HP group.

Conclusions

Whitening mouth rinses led to a whitening effect when they were used after conventional treatments; however, this process caused major changes on the surface of the enamel specimens.

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In vitro evaluation of octenidine as an antimicrobial agent against Staphylococcus epidermidis in disinfecting the root canal system
Jia Da Chum, Darryl Jun Zhi Lim, Sultan Omer Sheriff, Shaju Jacob Pulikkotil, Anand Suresh, Fabian Davamani
Restor Dent Endod 2019;44(1):e8.   Published online February 8, 2019
DOI: https://doi.org/10.5395/rde.2019.44.e8
AbstractAbstract PDFPubReaderePub
Objectives

Irrigants are imperative in endodontic therapy for the elimination of pathogens from the infected root canal. The present study compared the antimicrobial efficacy of octenidine dihydrochloride (OCT) with chlorhexidine (CHX) and sodium hypochlorite (NaOCl) against Staphylococcus epidermidis (S. epidermidis) for root canal disinfection.

Materials and Methods

The minimum inhibitory concentration (MIC) was obtained using serial dilution method. The agar diffusion method was then used to determine the zones of inhibition for each irrigant. Lastly, forty 6-mm dentin blocks were prepared from human mandibular premolars and inoculated with S. epidermidis. Samples were randomly divided into 4 groups of 10 blocks and irrigated for 3 minutes with saline (control), 2% CHX, 3% NaOCl, or 0.1% OCT. Dentin samples were then collected immediately for microbial analysis, including an analysis of colony-forming units (CFUs).

Results

The MICs of each tested irrigant were 0.05% for CHX, 0.25% for NaOCl, and 0.0125% for OCT. All tested irrigants showed concentration-dependent increase in zones of inhibition, and 3% NaOCl showed the largest zone of inhibition amongst all tested irrigants (p < 0.05). There were no significant differences among the CFU measurements of 2% CHX, 3% NaOCl, and 0.1% OCT showing complete elimination of S. epidermidis in all samples.

Conclusions

This study showed that OCT was comparable to or even more effective than CHX and NaOCl, demonstrating antimicrobial activity at low concentrations against S. epidermidis.

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Comparison of postoperative pain intensity after using reciprocating and continuous rotary glide path systems: a randomized clinical trial
Mehmet Adıgüzel, Koray Yılmaz, Pelin Tüfenkçi
Restor Dent Endod 2019;44(1):e9.   Published online February 12, 2019
DOI: https://doi.org/10.5395/rde.2019.44.e9
AbstractAbstract PDFPubReaderePub
Objectives

The aim of this study was to compare postoperative pain intensity after root canal treatment with One G (OG) vs. R-Pilot (RP) files used for glide path preparation.

Materials and Methods

Ninety-three single-canaled mandibular premolar teeth with asymptomatic non-vital pulp were randomly assigned into 3 groups (n = 31): OG, RP, or without glide path (WGP). After creating the glide path, the root canals were prepared using sequential Mtwo rotary files to size 30/0.05. One endodontic specialist carried out single-visit endodontic treatment. The patients were asked to rate the severity of postoperative pain on a visual analogue scale at 24, 48, and 72 hours after the visit. They were also asked to record their intake of prescribed analgesics taken. The data were analyzed using the χ2, Friedman, Kruskal-Wallis, and Mann-Whitney U tests.

Results

In all 3 groups, postoperative pain decreased significantly at each time interval (p < 0.05). At 24 hours, the OG group had less postoperative pain than the WGP group (p < 0.05). However, no significant difference was found between the RP group and the others. No statistically significant difference was found among the WGP, OG, and RP groups in postoperative pain intensity at 48 or 72 hours or in analgesic tablet intake at the 3 assessed time intervals.

Conclusions

The OG group had less postoperative pain than the WGP group in the first 24 hours. The OG and RP systems were similar regarding postoperative pain intensity and analgesic intake.

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Discoloration of teeth due to different intracanal medicaments
Farzaneh Afkhami, Sadaf Elahy, Alireza Mahmoudi Nahavandi, Mohamad Javad Kharazifard, Aidin Sooratgar
Restor Dent Endod 2019;44(1):e10.   Published online February 12, 2019
DOI: https://doi.org/10.5395/rde.2019.44.e10
AbstractAbstract PDFPubReaderePub
Objectives

The objective of this study was to assess coronal discoloration induced by the following intracanal medicaments: calcium hydroxide (CH), a mixture of CH paste and chlorhexidine gel (CH/CHX), and triple antibiotic paste (3Mix).

Materials and Methods

Seventy extracted single-canal teeth were selected. Access cavities were prepared and each canal was instrumented with a rotary ProTaper system. The specimens were randomly assigned to CH, CH/CHX, and 3Mix paste experimental groups (n = 20 each) or a control group (n = 10). Each experimental group was randomly divided into 2 subgroups (A and B). In subgroup A, medicaments were only applied to the root canals, while in subgroup B, the root canals were completely filled with medicaments and a cotton pellet dipped in medicament was also placed in the pulp chamber. Spectrophotometric readings were obtained from the mid-buccal surface of the tooth crowns immediately after placing the medicaments (T1) and at 1 week (T2), 1 month (T3), and 3 months (T4) after filling. The ∆E was then calculated. Data were analyzed using 2-way analysis of variance (ANOVA), 3-way ANOVA, and the Scheffé post hoc test.

Results

The greatest color change (ΔE) was observed at 3 months (p < 0.0001) and in 3Mix subgroup B (p = 0.0057). No significant color change occurred in the CH (p = 0.7865) or CH/CHX (p = 0.1367) groups over time, but the 3Mix group showed a significant ΔE (p = 0.0164).

Conclusion

Intracanal medicaments may induce tooth discoloration. Use of 3Mix must be short and it must be carefully applied only to the root canals; the access cavity should be thoroughly cleaned afterwards.

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