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Volume 45 (2); May 2020
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Review Article
Age-dependent root canal instrumentation techniques: a comprehensive narrative review
Michael Solomonov, Hyeon-Cheol Kim, Avi Hadad, Dan Henry Levy, Joe Ben Itzhak, Oleg Levinson, Hadas Azizi
Restor Dent Endod 2020;45(2):e21.   Published online March 4, 2020
DOI: https://doi.org/10.5395/rde.2020.45.e21
AbstractAbstract PDFPubReaderePub

The aim of this article was to review age-dependent clinical recommendations for appropriate root canal instrumentation techniques. A comprehensive narrative review of canal morphology, the structural characteristics of dentin, and endodontic outcomes at different ages was undertaken instead of a systematic review. An electronic literature search was carried out, including the Medline (Ovid), PubMed, and Web of Science databases. The searches used controlled vocabulary and free-text terms, as follows: ‘age-related root canal treatment,’ ‘age-related instrumentation,’ ‘age-related chemo-mechanical preparation,’ ‘age-related endodontic clinical recommendations,’ ‘root canal instrumentation at different ages,’ ‘geriatric root canal treatment,’ and ‘pediatric root canal treatment.’ Due to the lack of literature with practical age-based clinical recommendations for an appropriate root canal instrumentation technique, a narrative review was conducted to suggest a clinical algorithm for choosing the most appropriate instrumentation technique during root canal treatment. Based on the evidence found through the narrative review, an age-related clinical algorithm for choosing appropriate instrumentation during root canal treatment was proposed. Age affects the morphology of the root canal system and the structural characteristics of dentin. The clinician’s awareness of root canal morphology and dentin characteristics can influence the choice of instruments for root canal treatment.

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Research Articles
Micro-computed tomographic evaluation of the flow and filling ability of endodontic materials using different test models
Fernanda Ferrari Esteves Torres, Juliane Maria Guerreiro-Tanomaru, Gisselle Moraima Chavez-Andrade, Jader Camilo Pinto, Fábio Luiz Camargo Villela Berbert, Mario Tanomaru-Filho
Restor Dent Endod 2020;45(2):e11.   Published online January 8, 2020
DOI: https://doi.org/10.5395/rde.2020.45.e11
AbstractAbstract PDFPubReaderePub
Objectives

This study compared the flow and filling of several retrograde filling materials using new different test models.

Materials and Methods

Glass plates were manufactured with a central cavity and 4 grooves in the horizontal and vertical directions. Grooves with the dimensions used in the previous study (1 × 1 × 2 mm; length, width, and height respectively) were compared with grooves measuring 1 × 1 × 1 and 1 × 2 × 1 mm. Biodentine, intermediate restorative material (IRM), and mineral trioxide aggregate (MTA) were evaluated. Each material was placed in the central cavity, and then another glass plate and a metal weight were placed over the cement. The glass plate/material set was scanned using micro-computed tomography. Flow was calculated by linear measurements in the grooves. Central filling was calculated in the central cavity (mm3) and lateral filling was measured up to 2 mm from the central cavity.

Results

Biodentine presented the least flow and better filling than IRM when evaluated in the 1 × 1 × 2 model. In a comparison of the test models, MTA had the most flow in the 1 × 1 × 2 model. All materials had lower lateral filling when the 1 × 1 × 2 model was used.

Conclusions

Flow and filling were affected by the size of the test models. Higher grooves and materials with greater flow resulted in lower filling capacity. The test model measuring 1 × 1 × 2 mm showed a better ability to differentiate among the materials.

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Influence of modeling agents on the surface properties of an esthetic nano-hybrid composite
Zeynep Bilge Kutuk, Ecem Erden, Damla Lara Aksahin, Zeynep Elif Durak, Alp Can Dulda
Restor Dent Endod 2020;45(2):e13.   Published online January 29, 2020
DOI: https://doi.org/10.5395/rde.2020.45.e13
AbstractAbstract PDFPubReaderePub
Objective

The aim of this study was to evaluate the influence of different modeling agents on the surface microhardness (Vickers hardness number; VHN), roughness (Ra), and color change (ΔE) of a nano-hybrid composite with or without exposure to discoloration by coffee.

Materials and Methods

Sixty-four cylinder-shaped nano-hybrid composite specimens were prepared using a Teflon mold. The specimens' surfaces were prepared according to the following groups: group 1, no modeling agent; group 2, Modeling Liquid; group 3, a universal adhesive (G-Premio Bond); and group 4, the first step of a 2-step self-adhesive system (OptiBond XTR). Specimens were randomly allocated into 2 groups (n = 8) according to the storage medium (distilled water or coffee). VHN, Ra, and ΔE were measured at 24 hours, 1 week, and 6 weeks. The Kruskal-Wallis test followed by the Bonferroni correction for pairwise comparisons was used for statistical analysis (α = 0.05).

Results

Storage time did not influence the VHN of the nano-hybrid composite in any group (p > 0.05). OptiBond XTR Primer application affected the VHN negatively in all investigated storage medium and time conditions (p < 0.05). Modeling Liquid application yielded improved Ra values for the specimens stored in coffee at each time point (p < 0.05). Modeling Liquid application was associated with the lowest ΔE values in all investigated storage medium and time conditions (p < 0.05).

Conclusion

Different types of modeling agents could affect the surface properties and discoloration of nano-hybrid composites.

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Comparative evaluation of the effectiveness of ultrasonic tips versus the Terauchi file retrieval kit for the removal of separated endodontic instruments
Preeti Jain Pruthi, Ruchika Roongta Nawal, Sangeeta Talwar, Mahesh Verma
Restor Dent Endod 2020;45(2):e14.   Published online February 6, 2020
DOI: https://doi.org/10.5395/rde.2020.45.e14
AbstractAbstract PDFPubReaderePub
Objective

The aim of this study was to perform a comparative evaluation of the effectiveness of ultrasonic tips versus the Terauchi file retrieval kit (TFRK) for the removal of broken endodontic instruments.

Materials and Methods

A total of 80 extracted human first mandibular molars with moderate root canal curvature were selected. Following access cavity preparation canal patency was established with a size 10/15 K-file in the mesiobuccal canals of all teeth. The teeth were divided into 2 groups of 40 teeth each: the P group (ProUltra tips) and the T group (TFRK). Each group was further subdivided into 2 smaller groups of 20 teeth each according to whether ProTaper F1 rotary instruments were fractured in either the coronal third (C constituting the PC and TC groups) or the middle third (M constituting the PM and TM groups). Instrument retrieval was performed using either ProUltra tips or the TFRK.

Results

The overall success rate at removing the separated instrument was 90% in group P and 95% in group T (p > 0.05) The mean time for instrument removal was higher with the ultrasonic tips than with the TFRK (p > 0.05).

Conclusion

Both systems are acceptable clinical tools for instrument retrieval but the loop device in the TFRK requires slightly more dexterity than is needed for the ProUltra tips.

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Top 50 cited articles on dental stem cell research
Konstantinos Kodonas, Anastasia Fardi, Christos Gogos, Nikolaos Economides
Restor Dent Endod 2020;45(2):e17.   Published online February 11, 2020
DOI: https://doi.org/10.5395/rde.2020.45.e17
AbstractAbstract PDFPubReaderePub
Objectives

Citation analysis provides a unique insight into how scientific interests and research trends have changed over time. The aim of this study was to report on the 50 top-cited papers in dental stem cell research using the Science Citation Index Expanded provided by the Web of Science database to determine the academic importance of each contribution.

Materials and Methods

After the screening, article title and type, total citations and citations per year, publication journal, publication year, first and senior authors, country of origin, institution, and university of reprint author were documented for the 50 top-cited articles in dental stem cell research. Keyword analysis was performed to determine which keywords were most/least popular.

Results

Top 50-cited articles were cited between 179 to 2,275 times. The majority of papers were published in 2008 and originated from the United States with the highest contribution from the National Institute of Dental & Craniofacial Research. Journal of Dental Research published the highest number of top-cited articles, followed by Stem Cells and Journal of Endodontics. The greatest number of articles was published by two individual authors, Shi and Gronthos. Among 197 unique keywords, dental pulp stem cells and mesenchymal stem cells were the most frequently used. Thirty-eight of the 50 most cited articles were original articles, and 37 of them were in the field of basic science.

Conclusions

Basic science studies in dental stem cell research published in high impact factor journals had the highest citation rates.

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A micro-computed tomographic evaluation of root canal filling with a single gutta-percha cone and calcium silicate sealer
Jong Cheon Kim, Maung Maung Kyaw Moe, Sung Kyo Kim
Restor Dent Endod 2020;45(2):e18.   Published online February 12, 2020
DOI: https://doi.org/10.5395/rde.2020.45.e18
AbstractAbstract PDFPubReaderePub
Objectives

The purpose of this study was to evaluate the void of root canal filling over time when a calcium silicate sealer was used in the single gutta-percha cone technique.

Materials and Methods

Twenty-four J-shaped simulated root canals and twenty-four palatal root canals from extracted human maxillary molars were instrumented with ProFile Ni-Ti rotary instruments up to size 35/0.06 or size 40/0.06, respectively. Half of the canals were filled with Endoseal MTA and the other half were with AH Plus Jet using the single gutta-percha cone technique. Immediately after and 4 weeks after the root canal filling, the samples were scanned using micro-computed tomography at a resolution of 12.8 μm. The scanned images were reconstructed using the NRecon software and the void percentages were calculated using the CTan software, and statistically analyzed by 1-way analysis of variance, paired t-test and Tukey post hoc test.

Results

After 4 weeks, there were no significant changes in the void percentages at all levels in both material groups (p > 0.05), except at the apical level of the AH Plus Jet group (p < 0.05) in the simulated root canal showing more void percentage compared to other groups. Immediately after filling the extracted human root canals, the Endoseal MTA group showed significantly less void percentage compared to the AH Plus Jet group (p < 0.05).

Conclusions

Under the limitations of this study, the Endoseal MTA does not seem to reduce the voids over time.

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Effect of ultrasonic cleaning on the bond strength of fiber posts in oval canals filled with a premixed bioceramic root canal sealer
Fernando Peña Bengoa, Maria Consuelo Magasich Arze, Cristobal Macchiavello Noguera, Luiz Felipe Nunes Moreira, Augusto Shoji Kato, Carlos Eduardo Da Silveira Bueno
Restor Dent Endod 2020;45(2):e19.   Published online February 20, 2020
DOI: https://doi.org/10.5395/rde.2020.45.e19
AbstractAbstract PDFPubReaderePub
Objective

This study aimed to evaluate the effect of ultrasonic cleaning of the intracanal post space on the bond strength of fiber posts in oval canals filled with a premixed bioceramic (Bio-C Sealer [BIOC]) root canal sealer.

Materials and Methods

Fifty premolars were endodontically prepared and divided into 5 groups (n = 10), based on the type of root canal filling material used and the post space cleaning protocol. A1: gutta-percha + AH Plus (AHP) and post space preparation with ultrasonic cleaning, A2: gutta-percha + BIOC and post space preparation with ultrasonic cleaning, B1: gutta-percha + AHP and post space preparation, B2: gutta-percha + BIOC and post space preparation, C: control group. Fiber posts were cemented with a self-adhesive luting material, and 1 mm thick slices were sectioned from the middle and cervical third to evaluate the remaining filling material microscopically. The samples were subjected to a push-out test to analyze the bond strength of the fiber post, and the results were analyzed with the Shapiro-Wilk, Bonferroni, Kruskal-Wallis, and Mann-Whitney tests (p < 0.05). Failure modes were evaluated using optical microscopy.

Results

The results showed that the fiber posts cemented in canals sealed with BIOC had lower bond strength than those sealed with AHP. The ultrasonic cleaning of the post space improved the bond strength of fiber posts in canals sealed with AHP, but not with BIOC.

Conclusions

BIOC decreased the bond strength of fiber posts in oval canals, regardless of ultrasonic cleaning.

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Influence of pain-relieving therapies on inflammation and the expression of proinflammatory neuropeptides after dental bleaching treatment
Livia Maria Alves Valentim da Silva, Luciano Tavares Angelo Cintra, Marjorie de Oliveira Gallinari, Francine Benetti, Vanessa Rahal, Edilson Ervolino, Sibele de Alcântara, André Luiz Fraga Briso
Restor Dent Endod 2020;45(2):e20.   Published online February 28, 2020
DOI: https://doi.org/10.5395/rde.2020.45.e20
AbstractAbstract PDFPubReaderePub
Objectives

To minimize the tooth sensitivity caused by in-office bleaching, many dentists use non-steroidal anti-inflammatory drugs and topical desensitizing gels containing potassium nitrate and sodium fluoride. This study aimed to evaluate the influence of these substances on inflammation and the expression of substance P and calcitonin gene-related peptide in pulp nerve fibers.

Materials and Methods

Seventy-two rats were divided into 6 groups as follows: GI, control; GII, only dental bleaching; GIII, only ibuprofen; GIV, ibuprofen administered 30 minutes before and after the bleaching treatment and every 12 hours until the analysis; GV, only topical application of a desensitizing agent; and GVI, topical application of a desensitizing agent before dental bleaching. Placebo gel was applied to the upper left jaw and the bleaching agent was applied to the upper right jaw in all groups. Subsequently, the groups were divided into 3 subgroups based on the time of analysis: 0, 24, and 48 hours after bleaching (n = 8). The rats were euthanized and the maxillae were processed and evaluated by histopathological and immunohistochemical analyses. The data were analyzed using the Kruskal-Wallis test, followed by the Dunn test (p < 0.05).

Results

In the bleaching groups, the inflammatory process and expression of neuropeptides decreased over time. The animals in which a desensitizing agent was applied showed better results within 24 hours.

Conclusions

The use of a desensitizing agent had positive effects on inflammation and pain-related neuropeptide expression, minimizing the painful effects of dental bleaching treatment.

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Influence of glide path size and operating kinetics on time to reach working length and fracture resistance of Twisted File adaptive and Endostar E3 nickel-titanium file systems
Tamilkumaran Ramyadharshini, Inbaraj Anand Sherwood, V Shanmugham Vigneshwar, Prakasam Ernest Prince, Murugadoss Vaanjay
Restor Dent Endod 2020;45(2):e22.   Published online March 5, 2020
DOI: https://doi.org/10.5395/rde.2020.45.e22
AbstractAbstract PDFPubReaderePub
Objectives

This study investigated the influence of glide path size and operating kinetics on the time to reach the working length and the fracture resistance of Twisted File (TF) and Endostar E3 files.

Materials and Methods

A total of 120 mandibular single-rooted premolars were selected. Two methods of kinetic motion (TF adaptive and continuous rotary motion) and file systems (TF and Endostar E3) were employed. The files were used in root canals prepared to apical glide path sizes of 15, 20, and 25. The time taken to reach the working length and the number of canals used before the instrument deformed or fractured were noted. Fractured instruments were examined with scanning electron microscopy.

Results

The TF system took significantly more time to reach the working length than the Endostar E3 system. Both systems required significantly more time to reach the working length at the size 15 glide path than at sizes 20 and 25. A greater number of TFs than Endostar E3 files exhibited deformation, and a higher incidence of instrument deformation was observed in adaptive than in continuous rotary motion; more deformation was also observed with the size 15 glide path. One TF was fractured while undergoing adaptive motion.

Conclusions

No significant difference was observed between continuous rotary and adaptive motion. The TF system and adaptive motion were associated with a higher incidence of deformation and fracture. Apical glide path sizes of 20 and 25 required significantly less time to reach the working length than size 15.

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Antimicrobial efficacy of QMix on Enterococcus faecalis infected root canals: a systematic review of in vitro studies
Benjamin Syek Hur Lim, Abhishek Parolia, Margaret Soo Yee Chia, Jayakumar Jayaraman, Venkateshbabu Nagendrababu
Restor Dent Endod 2020;45(2):e23.   Published online March 11, 2020
DOI: https://doi.org/10.5395/rde.2020.45.e23
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to summarize the outcome of in vitro studies comparing the antibacterial effectiveness of QMix with other irrigants against Enterococcus faecalis.

Materials and Methods

The research question was developed by using population, intervention, comparison, outcome, and study design framework. The literature search was performed using 3 electronic databases: PubMed, Scopus, and EBSCOhost until October 2019. The additional hand search was performed from the reference list of the eligible studies. The risk of bias of the studies was independently appraised using the revised Cochrane Risk of Bias tool (RoB 2.0).

Results

Fourteen studies were included in this systematic review. The overall risk of bias for the selected studies was moderate. QMix was found to have a higher antimicrobial activity compared to 2% sodium hypochlorite (NaOCl), 17% ethylenediaminetetraacetic acid (EDTA), 2% chlorhexidine (CHX), mixture of tetracycline isonomer, an acid and a detergent (MTAD), 0.2% Cetrimide, SilverSol/H2O2, HYBENX, and grape seed extract (GSE). QMix had higher antibacterial efficacy compared to NaOCl, only when used for a longer time (10 minutes) and with higher volume (above 3 mL).

Conclusions

QMix has higher antibacterial activity than 17% EDTA, 2% CHX, MTAD, 0.2% Cetrimide, SilverSol/H2O2, HYBENX, GSE and NaOCl with lower concentration. To improve the effectiveness, QMix is to use for a longer time and at a higher volume.

Trial Registration

PROSPERO International prospective register of systematic reviews Identifier: CRD42018096763

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Dentin moisture conditions strongly influence its interactions with bioactive root canal sealers
Esin Ozlek, Hüseyin Gündüz, Elif Akkol, Prasanna Neelakantan
Restor Dent Endod 2020;45(2):e24.   Published online March 24, 2020
DOI: https://doi.org/10.5395/rde.2020.45.e24
AbstractAbstract PDFPubReaderePub
Objectives

It is known that bioactive materials interact with the dentin to undergo biomineralization. The exact role of moisture in this interaction is unknown. Here, we investigate the effects of dentin moisture conditions on the dislocation resistance of two bioactive root canal sealers (MTA Fillapex [Angelus Solucoes Odontologicas] and GuttaFlow BioSeal [Colténe/Whaledent AG]) at 3 weeks and 3 months after obturation.

Materials and Methods

Mandibular premolars (n = 120) were prepared and randomly divided into 3 groups based on the dentin condition: group 1, dry dentin; group 2, moist dentin; group 3, wet dentin. Each group was divided into 2 subgroups for root canal filling: MTA Fillapex and GuttaFlow BioSeal. Dislocation resistance was evaluated by measuring the push-out bond strength at 3 weeks and 3 months. Failure modes were examined under a stereomicroscope. Data were statistically analyzed by Kruskal-Wallis test with a significance level of 5%.

Results

Moist dentin resulted in higher bond strength values for both materials at both time points. This was significantly higher than wet and dry dentin for both the sealers at the 3 months (p < 0.05), while at 3 weeks it was significant only for GuttaFlow Bioseal. The different moisture conditions demonstrated similar trends in their effects on the dislocation resistance of the 2 root canal sealers.

Conclusions

The dentin moisture conditions had a significant impact on its interaction with the bioactive materials tested. Maintaining moist dentin, but not dry or wet dentin, may be advantageous before the filling root canals with bioactive sealers.

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Influence of autoclave sterilization procedures on the cyclic fatigue resistance of heat-treated nickel-titanium instruments: a systematic review
Emmanuel João Nogueira Leal Silva, Mayara Zanon, Fernanda Hecksher, Felipe Gonçalves Belladonna, Rafaela Andrade de Vasconcelos, Tatiana Kelly da Silva Fidalgo
Restor Dent Endod 2020;45(2):e25.   Published online March 31, 2020
DOI: https://doi.org/10.5395/rde.2020.45.e25
AbstractAbstract PDFPubReaderePub
Objectives

This systematic review evaluated the influence of autoclave sterilization procedures on the cyclic fatigue resistance of heat-treated nickel-titanium (NiTi) instruments.

Materials and Methods

A systematic search without restrictions was conducted in the following electronic databases: PubMed, Scopus, Web of Science, ScienceDirect, Cochrane, and Open Grey. The hand search was also performed in the main endodontic journals. The eligible studies were submitted to the methodological assessment and data extraction.

Results

From 203 abstracts, a total of 10 articles matched the eligible criteria. After reading the full articles, 2 were excluded because of the absence of the heat-treated instruments in the experimental design and 3 due to the lack of a control group using heat-treated instruments without autoclave sterilization. From the 5 included studies, 1 presented a low risk of bias, 3 presented moderate and 1 high risk. It was observed heterogeneous findings in the included studies, with autoclave sterilization cycles increasing, decreasing or not affecting the cyclic fatigue life of heat-treated NiTi instruments. However, the retrieved studies evaluating the cyclic fatigue resistance of endodontic instruments presented different protocols and assessing outcomes, this variability makes the findings less comparable within and also between groups and preclude the establishment of an unbiased scientific evidence base.

Conclusions

Considering the little scientific evidence and considerable risk of bias, it is still possible to conclude that autoclave sterilization procedures appear to influence the cyclic fatigue resistance of heat-treated NiTi instruments.

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Case Reports
Observation of an extracted premolar 2.5 years after mineral trioxide aggregate apexification using micro-computed tomography
Gayeon Lee, Chooryung Chung, Sunil Kim, Su-Jung Shin
Restor Dent Endod 2020;45(2):e4.   Published online November 22, 2019
DOI: https://doi.org/10.5395/rde.2020.45.e4
AbstractAbstract PDFPubReaderePub

Although numerous studies have been conducted on apexification using mineral trioxide aggregate (MTA), direct observation of extracted human teeth after the procedure has been rarely reported. This case report describes a mandibular premolar treated 2.5 years ago and extracted recently for orthodontic treatment. The tubercle of the right mandibular premolar of a 12-year-old boy with dens evaginatus was fractured and the pulp was exposed. The tooth was diagnosed with pulp necrosis and asymptomatic periapical abscess. During the first visit, copious irrigation was performed with 2.5% sodium hypochlorite. Calcium hydroxide paste was placed as an intracanal medicament. The sinus tract had disappeared at the second visit after 3 weeks. MTA was applied on to the bleeding point as a 4-mm-thick layer, followed by a 3-mm-thick gutta-percha filling and resin core build-up. After 2.5 years, the tooth and three other premolars were extracted for orthodontic treatment. The right and left mandibular premolars were scanned with micro-computed tomography to determine the root shape and canal anatomy. Irregular root growth was observed and the root outline of the right mandibular premolar differed from that of the contralateral tooth. Apexification with MTA leads to the formation of roots with irregular morphology, without any pulpal space.

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Chair-side CAD/CAM fabrication of a single-retainer resin bonded fixed dental prosthesis: a case report
Carlos Alberto Jurado, Akimasa Tsujimoto, Hidehiko Watanabe, Jose Villalobos-Tinoco, Jorge Luis Garaicoa, Mark David Markham, Wayne Walter Barkmeier, Mark Andrew Latta
Restor Dent Endod 2020;45(2):e15.   Published online February 6, 2020
DOI: https://doi.org/10.5395/rde.2020.45.e15
AbstractAbstract PDFPubReaderePub

This clinical report describes designing and fabricating a single-retainer resin-bonded fixed dental prosthesis with a chair-side computer-aided design/computer-aided manufacturing system. The whole procedure, from tooth extraction to final placement of the prosthesis, was completed in one day, and a single clinic visit. No clinical complications were found at the 2-year follow-up after placement of the restoration, and satisfactory functional and esthetic results were achieved.

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