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Volume 44 (2); May 2019
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Research Articles
Influence of silver nanoparticles on resin-dentin bond strength durability in a self-etch and an etch-and-rinse adhesive system
Zahra Jowkar, Fereshteh Shafiei, Elham Asadmanesh, Fatemeh Koohpeima
Restor Dent Endod 2019;44(2):e13.   Published online March 29, 2019
DOI: https://doi.org/10.5395/rde.2019.44.e13
AbstractAbstract PDFPubReaderePub
Objectives

This study evaluated the effect of dentin pretreatment with silver nanoparticles (SNPs) and chlorhexidine (CHX) on the microshear bond strength (µSBS) durability of different adhesives to dentin.

Materials and Methods

Occlusal surfaces of 120 human molars were ground to expose flat dentin surfaces. The specimens were randomly assigned to six groups (n = 20). Three groups (A, B, and C) were bonded with Adper Single Bond 2 (SB) and the other groups (D, E, and F) were bonded with Clearfil SE Bond (SEB). Dentin was pretreated with CHX in groups B and E, and with SNPs in groups C and F. The specimens were restored with Z250 composite. Half of the bonded surfaces in each group underwent µSBS testing after 24 hours and the other half was tested after 6 months of water storage.

Results

SNP application was associated with a higher µSBS than was observed in the CHX and control groups for SEB after 24 hours (p < 0.05). A significantly lower µSBS was observed when no dentin pretreatment was applied compared to dentin pretreatment with CHX and SNPs for SB after 24 hours (p < 0.05). The µSBS values of the 6-month specimens were significantly lower than those obtained from the 24-hour specimens for all groups (p < 0.05). This decrease was much more pronounced when both adhesives were used without any dentin pretreatment (p < 0.05).

Conclusions

SNPs and CHX reduced the degradation of resin-dentin bonds over a 6-month period for both adhesive systems.

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Critical evaluation of fracture strength testing for endodontically treated teeth: a finite element analysis study
Emel Uzunoglu-Özyürek, Selen Küçükkaya Eren, Oğuz Eraslan, Sema Belli
Restor Dent Endod 2019;44(2):e15.   Published online April 18, 2019
DOI: https://doi.org/10.5395/rde.2019.44.e15
AbstractAbstract PDFPubReaderePub
Objectives

The aim of this study was to investigate whether the diameter and direction of the plunger and simulation of the periodontal ligament (PDL) affected the stress distribution in endodontically treated premolars.

Methods

A fracture strength test was simulated via finite element analysis. A base model was set up, and the following parameters were modified: plunger diameter (3 mm vs. 6 mm), plunger direction (vertical vs. 135° angular to the central fossa), and PDL simulation. The analysis was conducted using the CosmosWorks structural analysis program, and the results are presented in terms of von Mises stresses.

Results

The smaller plunger increased the stresses at the contact area of the crown, but the plunger diameter had no effect on the stress distribution within the root. An angular plunger direction increased stresses within the root, as well as at the buccal cusp of the crown, compared with the vertical direction. Simulation of the PDL caused higher stress accumulation, especially in the cervical region of the root.

Conclusions

The plunger diameter had no effect on the stress distribution in the roots, whereas the plunger direction and PDL simulation did affect the stress distribution. More stringent standards can be established by taking such parameters into account when performing fracture testing in future studies.

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Fused roots of maxillary molars: characterization and prevalence in a Latin American sub-population: a cone beam computed tomography study
Maytté Marcano-Caldera, Jose Luis Mejia-Cardona, María del Pilar Blanco-Uribe, Elena Carolina Chaverra-Mesa, Didier Rodríguez-Lezama, Jose Hernán Parra-Sánchez
Restor Dent Endod 2019;44(2):e16.   Published online April 22, 2019
DOI: https://doi.org/10.5395/rde.2019.44.e16
AbstractAbstract PDFPubReaderePub
Objectives

The upper molars generally have three roots; therefore, different combinations of fusion can occur, increasing the possibility of finding more complex root canal systems. The purpose of this study was to evaluate the prevalence and characterization of fused roots in first and second maxillary molars using cone-beam computed tomography (CBCT) in a Colombian population.

Materials and Methods

A total of 1274 teeth were evaluated, of which 534 were maxillary first molars and 740 were maxillary second molars. Axial sections were made at the cervical, middle, and apical levels to determine the prevalence of root fusion and the types of fusion.

Results

Overall, 43% of the molars (n = 551) presented some type of fused root. Root fusion was present in 23.4% of the maxillary first molars. The most frequent type of fused root was type 3 (distobuccal-palatal; DB-P) (58.9%). Root fusion was observed in 57.6% of the maxillary second molars, and the most prevalent type of fused root was type 6 (cone-shaped) (45.2%). Of the maxillary molars, 12.5% were classified as C-shaped.

Conclusion

Within the limitations of this study, there was a high prevalence of fused roots in maxillary molars in the Colombian population, mainly in the maxillary second molars. In first molars, the most common type of fused root was type 3 (DB-P) and in second molars, the most common type was type 6 (cone-shaped). Additionally, molars with root fusion presented variation at different levels of the radicular portion, with implications for treatment quality.

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Effects of the cathepsin K inhibitor with mineral trioxide aggregate cements on osteoclastic activity
Hee-Sun Kim, Soojung Kim, Hyunjung Ko, Minju Song, Miri Kim
Restor Dent Endod 2019;44(2):e17.   Published online April 23, 2019
DOI: https://doi.org/10.5395/rde.2019.44.e17
AbstractAbstract PDFPubReaderePub
Objectives

Root resorption is an unexpected complication after replantation procedures. Combining anti-osteoclastic medicaments with retrograde root filling materials may avert this resorptive activity. The purpose of this study was to assess effects of a cathepsin K inhibitor with calcium silicate-based cements on osteoclastic activity.

Methods

MC3T3-E1 cells were cultured for biocompatibility analyses. RAW 264.7 cells were cultured in the presence of the receptor activator of nuclear factor-kappa B and lipopolysaccharide, followed by treatment with Biodentine (BIOD) or ProRoot MTA with or without medicaments (Odanacatib [ODN], a cathepsin inhibitor and alendronate, a bisphosphonate). After drug treatment, the cell counting kit-8 assay and Alizarin red staining were performed to evaluate biocompatibility in MC3T3-E1 cells. Reverse-transcription polymerase chain reaction, tartrate-resistant acid phosphatase (TRAP) staining and enzyme-linked immunosorbent assays were performed in RAW 264.7 cells to determine the expression levels of inflammatory cytokines, interleukin (IL)-1β, IL-6, tumor necrosis factor-α (TNF-α) and prostaglandin E2 (PGE2). Data were analyzed by one-way analysis of variance and Tukey's post hoc test (p < 0.05).

Results

Biocompatibility results showed that there were no significant differences among any of the groups. RAW 264.7 cells treated with BIOD and ODN showed the lowest levels of TNF-α and PGE2. Treatments with BIOD + ODN were more potent suppressors of inflammatory cytokine expression (p < 0.05).

Conclusion

The cathepsin K inhibitor with calcium silicate-based cement inhibits osteoclastic activity. This may have clinical application in preventing inflammatory root resorption in replanted teeth.

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A micro-computed tomographic study of remaining filling materials of two bioceramic sealers and epoxy resin sealer after retreatment
KyungJae Kim, Da Vin Kim, Sin-Young Kim, SungEun Yang
Restor Dent Endod 2019;44(2):e18.   Published online April 26, 2019
DOI: https://doi.org/10.5395/rde.2019.44.e18
AbstractAbstract PDFPubReaderePub
Objective

This study evaluated the presence of residual root canal filling material after retreatment using micro-computed tomography (micro-CT).

Materials and Methods

Extracted human teeth (single- and double-rooted, n = 21/each; C-shaped, n = 15) were prepared with ProFile and randomly assigned to three subgroups for obturation with gutta-percha and three different sealers (EndoSeal MTA, EndoSequence BC sealer, and AH Plus). After 10 days, the filling material was removed and the root canals were instrumented one size up from the previous master apical file size. The teeth were scanned using micro-CT before and after retreatment. The percentage of remaining filling material after retreatment was calculated at the coronal, middle, and apical thirds. Data were analyzed using the Kruskal-Wallis test and Mann-Whitney U test with Bonferroni post hoc correction.

Results

The tested sealers showed no significant differences in the percentage of remaining filling material in single- and double-rooted teeth, although EndoSeal MTA showed the highest value in C-shaped roots (p < 0.05). The percentage of remaining filling material of AH Plus and EndoSeal MTA was significantly higher in C-shaped roots than in single- or double-roots (p < 0.05), while that of BC sealer was similar across all root types. EndoSeal MTA showed the highest values at the apical thirds of single- and double-roots (p < 0.05); otherwise, no significant differences were observed among the coronal, middle, and apical thirds.

Conclusions

Within the limitations of this study, a large amount of EndoSeal MTA remained after retreatment, especially in C-shaped root canals.

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Cyclic fatigue, bending resistance, and surface roughness of ProTaper Gold and EdgeEvolve files in canals with single- and double-curvature
Wafaa A. Khalil, Zuhair S. Natto
Restor Dent Endod 2019;44(2):e19.   Published online April 26, 2019
DOI: https://doi.org/10.5395/rde.2019.44.e19
AbstractAbstract PDFPubReaderePub
Objectives

The purpose of this study was to evaluate the cyclic fatigue, bending resistance, and surface roughness of EdgeEvolve (EdgeEndo) and ProTaper Gold (Dentsply Tulsa Dental Specialties) nickel-titanium (NiTi) rotary files.

Materials and Methods

The instruments (n = 15/each) were tested for cyclic fatigue in single- (60° curvature, 5-mm radius) and double-curved (coronal curvature 60°, 5-mm radius, and apical curvature of 30° and 2-mm radius) artificial canals. The number of cycles to fracture was calculated. The bending resistance of both files were tested using a universal testing machine where the files were bent until reach 45°. Scanning electron microscopy and x-ray energy-dispersive spectrometric analysis were used for imaging the fractured segments, while the atomic force microscope was used to quantify the surface roughness average (Ra).

Results

EdgeEvolve files exhibited higher cyclic fatigue resistance than ProTaper Gold files in single- and double-curved canals (p < 0.05) and both files were more resistant to cyclic fatigue in single-curved canals than double-curved canals (p < 0.05). EdgeEvolve files exhibited significantly more flexibility than did ProTaper Gold files (p < 0.05). Both files had approximately similar Ni and Ti contents (p > 0.05). EdgeEvolve files showed significantly lower Ra values than ProTaper Gold files (p < 0.05).

Conclusions

Within the limitation of this study, EdgeEvolve files exhibited significantly higher cyclic fatigue resistance than ProTaper Gold files in both single- and double-curved canals.

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Development of a mouse model for pulp-dentin complex regeneration research: a preliminary study
Sunil Kim, Sukjoon Lee, Han-Sung Jung, Sun-Young Kim, Euiseong Kim
Restor Dent Endod 2019;44(2):e20.   Published online May 7, 2019
DOI: https://doi.org/10.5395/rde.2019.44.e20
AbstractAbstract PDFPubReaderePub
Objectives

To achieve pulp-dentin complex regeneration with tissue engineering, treatment efficacies and safeties should be evaluated using in vivo orthotopic transplantation in a sufficient number of animals. Mice have been a species of choice in which to study stem cell biology in mammals. However, most pulp-dentin complex regeneration studies have used large animals because the mouse tooth is too small. The purpose of this study was to demonstrate the utility of the mouse tooth as a transplantation model for pulp-dentin complex regeneration research.

Materials and Methods

Experiments were performed using 7-week-old male Institute of Cancer Research (ICR) mice; a total of 35 mice had their pulp exposed, and 5 mice each were sacrificed at 1, 2, 4, 7, 9, 12 and 14 days after pulp exposure. After decalcification in 5% ethylenediaminetetraacetic acid, the samples were embedded and cut with a microtome and then stained with hematoxylin and eosin. Slides were observed under a high-magnification light microscope.

Results

Until 1 week postoperatively, the tissue below the pulp chamber orifice appeared normal. The remaining coronal portion of the pulp tissue was inflammatory and necrotic. After 1 week postoperatively, inflammation and necrosis were apparent in the root canals inferior to the orifices. The specimens obtained after experimental day 14 showed necrosis of all tissue in the root canals.

Conclusions

This study could provide opportunities for researchers performing in vivo orthotopic transplantation experiments with mice.

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Effect of intracanal medications on the interfacial properties of reparative cements
Andrea Cardoso Pereira, Mariana Valerio Pallone, Marina Angélica Marciano, Karine Laura Cortellazzi, Marcos Frozoni, Brenda P. F. A. Gomes, José Flávio Affonso de Almeida, Adriana de Jesus Soares
Restor Dent Endod 2019;44(2):e21.   Published online May 9, 2019
DOI: https://doi.org/10.5395/rde.2019.44.e21
AbstractAbstract PDFPubReaderePub
Objectives

The purpose of the present study was to evaluate the effect of calcium hydroxide with 2% chlorhexidine gel (HCX) or distilled water (HCA) compared to triple antibiotic paste (TAP) on push-out bond strength and the cement/dentin interface in canals sealed with White MTA Angelus (WMTA) or Biodentine (BD).

Materials and Methods

A total of 70 extracted human lower premolars were endodontically prepared and randomly divided into 4 groups according to the intracanal medication, as follows: group 1, HCX; group 2, TAP; group 3, HCA; and group 4, control (without intracanal medication). After 7 days, the medications were removed and the cervical third of the specimens was sectioned into five 1-mm sections. The sections were then sealed with WMTA or BD as a reparative material. After 7 days in 100% humidity, a push-out bond strength test was performed. Elemental analysis was performed at the interface, using energy-dispersive spectroscopy. The data were statistically analyzed using analysis of variance and the Tukey test (p < 0.05).

Results

BD presented a higher bond strength than WMTA (p < 0.05). BD or WMTA in canals treated with calcium hydroxide intracanal medications had the highest bond strength values, with a statistically significant difference compared to TAP in the WMTA group (p < 0.05). There were small amounts of phosphorus in samples exposed to triple antibiotic paste, regardless of the coronal sealing.

Conclusions

The use of intracanal medications did not affect the bond strength of WMTA and BD, except when TAP was used with WMTA.

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Effect of glide path preparation with PathFile and ProGlider on the cyclic fatigue resistance of WaveOne nickel-titanium files
Gülşah Uslu, Uğur İnan
Restor Dent Endod 2019;44(2):e22.   Published online May 9, 2019
DOI: https://doi.org/10.5395/rde.2019.44.e22
AbstractAbstract PDFPubReaderePub
Objectives

The aim of this study was to investigate the effect of glide path preparation with PathFile and ProGlider nickel-titanium (NiTi) files on the cyclic fatigue resistance of WaveOne NiTi files.

Materials and Methods

Forty-four WaveOne Primary files were used and divided into four groups (n = 11). In the first group (0 WaveOne), the WaveOne Primary files served as a control group and were not used on acrylic blocks. In the 1 WaveOne Group, acrylic blocks were prepared using only WaveOne Primary files, and in the PF+WaveOne group and PG+WaveOne groups, acrylic blocks were first prepared with PathFile or ProGlider NiTi files, respectively, followed by the use of WaveOne Primary files. All the WaveOne Primary files were then subjected to cyclic fatigue testing. The number of cycles to failure was calculated and the data were statistically analyzed using one-way analysis of variance (ANOVA) and the Tukey honest significant difference multiple-comparison test at a 5% significance level.

Results

The highest number of cycles to failure was found in the control group, and the lowest numbers were found in the 1 WaveOne group and the PF+WaveOne group. Significant differences were found among the 1 WaveOne, PF+WaveOne, and control groups (p < 0.05). No statistically significant differences were found between the PG+WaveOne group and the other three groups (p > 0.05).

Conclusion

Glide path preparation with NiTi rotary files did not affect the cyclic fatigue resistance of WaveOne Primary files used on acrylic blocks.

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Case Report
Oral manifestation and root canal therapy of the patient with mucopolysaccharidosis
Ji-Hye Yoon, Hyo-Il Lee, Ji-Hyun Jang, Sung-Hyeon Choi, Hoon-Sang Chang, Yun-Chan Hwang, In-Nam Hwang, Bin-Na Lee, Won-Mann Oh
Restor Dent Endod 2019;44(2):e14.   Published online April 4, 2019
DOI: https://doi.org/10.5395/rde.2019.44.e14
AbstractAbstract PDFPubReaderePub

Mucopolysaccharidosis (MPS) is an inherited metabolic disorder caused by a deficiency in enzymes that participate in the degradation of glycosaminoglycans (GAGs) such as heparin sulfate and dermatan sulfate. Left untreated, patients show progressive mental and physical deterioration due to deposition of GAGs in organs. Death often occurs due to cardiac or respiratory failure before patients reach their early twenties. MPS has several oral and dental manifestations. An enlarged head, short neck, and open mouth associated with a large tongue are major characteristics of MPS patients. Dental complications can be severe, including unerupted dentition, dentigerous cyst-like follicles, malocclusions, condylar defects, and gingival hyperplasia. A 21-year-old female patient with MPS was described in this article, with special emphasis on oral manifestations and dental treatment.

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