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Volume 47 (2); May 2022
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Review Article
Deep proximal margin rebuilding with direct esthetic restorations: a systematic review of marginal adaptation and bond strength
Hoda S. Ismail, Ashraf I. Ali, Rabab El. Mehesen, Jelena Juloski, Franklin Garcia-Godoy, Salah H. Mahmoud
Restor Dent Endod 2022;47(2):e15.   Published online March 4, 2022
DOI: https://doi.org/10.5395/rde.2022.47.e15
AbstractAbstract PDFPubReaderePub

This review aimed to characterize the effect of direct restorative material types and adhesive protocols on marginal adaptation and the bond strength of the interface between the material and the proximal dentin/cementum. An electronic search of 3 databases (the National Library of Medicine [MEDLINE/PubMed], Scopus, and ScienceDirect) was conducted. Studies were included if they evaluated marginal adaptation or bond strength tests for proximal restorations under the cementoenamel junction. Only 16 studies met the inclusion criteria and were included in this review. These studies presented a high degree of heterogeneity in terms of the materials used and the methodologies and evaluation criteria of each test; therefore, only a descriptive analysis could be conducted. The included studies were individually evaluated for the risk of bias following predetermined criteria. To summarize the results of the included studies, the type of restorative material affected the test results, whereas the use of different adhesive protocols had an insignificant effect on the results. It could be concluded that various categories of resin-based composites could be a suitable choice for clinicians to elevate proximal dentin/cementum margins, rather than the open sandwich technique with resin-modified glass ionomers. Despite challenges in bonding to proximal dentin/cementum margins, different adhesive protocols provided comparable outcomes.

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Research Articles
Comparison of the cyclic fatigue resistance of One Curve, F6 Skytaper, Protaper Next, and Hyflex CM endodontic files
Charlotte Gouédard, Laurent Pino, Reza Arbab-Chirani, Shabnam Arbab-Chirani, Valérie Chevalier
Restor Dent Endod 2022;47(2):e16.   Published online March 4, 2022
DOI: https://doi.org/10.5395/rde.2022.47.e16
AbstractAbstract PDFPubReaderePub
Objectives

This study compared the cyclic fatigue resistance of One Curve (C wire) and F6 Skytaper (conventional austenite nickel-titanium [NiTi]), and 2 instruments with thermo-mechanically treated NiTi: Protaper Next X2 (M wire) and Hyflex CM (CM wire).

Materials and Methods

Ten new instruments of each group (size: 0.25 mm, 6% taper in the 3 mm tip region) were tested using a rotary bending machine with a 60° curvature angle and a 5 mm curvature radius, at room temperature. The number of cycles until fracture was recorded. The length of the fractured instruments was measured. The fracture surface of each fragment was examined with a scanning electron microscope (SEM). The data were analyzed using one-way analysis of variance and the post hoc Tukey test. The significance level was set at 0.05.

Results

At 60°, One Curve, F6 Skytaper and Hyflex CM had significantly longer fatigue lives than Protaper Next X2 (p < 0.05). No statistically significant differences were found in the cyclic fatigue lives of One Curve, F6 Skytaper, and Hyflex CM (p > 0.05). SEM images of the fracture surfaces of the different instruments showed typical features of fatigue failure.

Conclusions

Within the conditions of this study, at 60° and with a 5 mm curvature radius, the cyclic fatigue life of One Curve was not significantly different from those of F6 Skytaper and Hyflex CM. The cyclic fatigue lives of these 3 instruments were statistically significantly longer than that of Protaper Next.

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Effects of calcium silicate cements on neuronal conductivity
Derya Deniz-Sungur, Mehmet Ali Onur, Esin Akbay, Gamze Tan, Fügen Daglı-Comert, Taner Cem Sayın
Restor Dent Endod 2022;47(2):e18.   Published online March 7, 2022
DOI: https://doi.org/10.5395/rde.2022.47.e18
AbstractAbstract PDFPubReaderePub
Objectives

This study evaluated alterations in neuronal conductivity related to calcium silicate cements (CSCs) by investigating compound action potentials (cAPs) in rat sciatic nerves.

Materials and Methods

Sciatic nerves were placed in a Tyrode bath and cAPs were recorded before, during, and after the application of test materials for 60-minute control, application, and recovery measurements, respectively. Freshly prepared ProRoot MTA, MTA Angelus, Biodentine, Endosequence RRM-Putty, BioAggregate, and RetroMTA were directly applied onto the nerves. Biopac LabPro version 3.7 was used to record and analyze cAPs. The data were statistically analyzed.

Results

None of the CSCs totally blocked cAPs. RetroMTA, Biodentine, and MTA Angelus caused no significant alteration in cAPs (p > 0.05). Significantly lower cAPs were observed in recovery measurements for BioAggregate than in the control condition (p < 0.05). ProRoot MTA significantly but transiently reduced cAPs in the application period compared to the control period (p < 0.05). Endosequence RRM-Putty significantly reduced cAPs.

Conclusions

Various CSCs may alter cAPs to some extent, but none of the CSCs irreversibly blocked them. The usage of fast-setting CSCs during apexification or regeneration of immature teeth seems safer than slow-setting CSCs due to their more favorable neuronal effects.

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Morphotypes of the apical constriction of maxillary molars: a micro-computed tomographic evaluation
Jeffrey Wen-Wei Chang, Kuzhanchinathan Manigandan, Lakshman Samaranayake, Chellapandian NandhaKumar, Pazhamalai AdhityaVasun, Johny Diji, Angambakkam Rajasekharan PradeepKumar
Restor Dent Endod 2022;47(2):e19.   Published online March 24, 2022
DOI: https://doi.org/10.5395/rde.2022.47.e19
AbstractAbstract PDFPubReaderePub
Objectives

The aim of this study was to evaluate and compare the apical constriction (AC) and apical canal morphology of maxillary first and second molars, using micro-computed tomography (micro-CT).

Materials and Methods

The anatomical features of 313 root canals from 41 maxillary first molars and 57 maxillary second molars of patients with known age and sex were evaluated using micro-CT, with a resolution of 26.7 µm. The factors evaluated were the presence or absence of AC, the morphotypes, bucco-lingual dimension, mesio-distal dimension, and the profile (shape) of AC and the apical root canal. The apical root canal dimensions, location of the apical foramen (AF), AC to AF distance, and presence of accessory canals in the apical 5 mm were also assessed. Descriptive and analytical statistics were used for data evaluation.

Results

AC was present in all 313 root canals. Patients’ age and sex did not significantly impact either AC or the apical canal dimensions. The most common AC morphotype detected was the traditional (single) constriction (52%), followed by the parallel (29%) morphotype. The mean AC dimensions in maxillary first molars were not significantly different from those in maxillary second molars. Sixty percent of AF were located within 0.5 mm from the anatomic apex.

Conclusions

The most common morphotype of AC detected was the traditional constriction. Neither patients’ age nor sex had a significant impact on the dimensions of the AC or the apical root canal. The majority of AF (60%) were located within 0.5 mm from the anatomic apex.

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Difficulties experienced by endodontics researchers in conducting studies and writing papers
Betul Aycan Alim-Uysal, Selin Goker-Kamali, Ricardo Machado
Restor Dent Endod 2022;47(2):e20.   Published online March 15, 2022
DOI: https://doi.org/10.5395/rde.2022.47.e20
AbstractAbstract PDFPubReaderePub
Objectives

The study investigated the difficulties experienced by endodontics researchers around the world in conducting studies and writing papers.

Materials and Methods

A survey consisting of 18 questions on the difficulties experienced by endodontics researchers in performing studies and writing papers was e-mailed to academics in the field of endodontics working at 202 universities. The independent risk factors were analyzed using binary logistic regression at a significance level of 0.05.

Results

A total of 581 individuals (10.7%) agreed to participate in the study. Almost half the participants (48.2%) reported that they had received some type of training in conducting studies and writing papers. In response to the question, “Do you get help from a statistician to perform the statistical analyses of your studies?,” 77.1% answered “yes.” Around 40% of the participants stated that the need to obtain ethical approval negatively affected their desire to conduct studies. The participants’ regions had no effect on the reported difficulties associated with writing papers in English or conducting statistical analyses (p > 0.05). Most participants (81.8%) reported difficulties in writing the Discussion section, regardless of their region, academic degrees, or years of experience.

Conclusions

The participants stated they experienced difficulties in many areas, such as conducting statistical analyses, finding new ideas, and writing in English. Engaging in a detailed examination of ethics committee rules, expanding biostatistics education, increasing the number of institutions providing research funding, and increasing the number of endodontics journals can increase the enthusiasm of endodontics researchers to publish papers.

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Bonding effects of cleaning protocols and time-point of acid etching on dentin impregnated with endodontic sealer
Tatiane Miranda Manzoli, Joissi Ferrari Zaniboni, João Felipe Besegato, Flávia Angélica Guiotti, Andréa Abi Rached Dantas, Milton Carlos Kuga
Restor Dent Endod 2022;47(2):e21.   Published online April 6, 2022
DOI: https://doi.org/10.5395/rde.2022.47.e21
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to investigate the bonding effects of cleaning protocols on dentin impregnated with endodontic sealer residues using ethanol (E) or xylol (X). The effects of dentin acid etching immediately (I) or 7 days (P) after cleaning were also evaluated. For bonding to dentin, universal adhesive (Scotchbond Universal; 3M ESPE) was used. The persistence of sealer residues, hybrid layer formation and microshear bond strength were the performed analysis.

Materials and Methods

One hundred and twenty bovine dentin specimens were allocated into 4 groups (n = 10): G1 (E+I); G2 (X+I); G3 (E+P); and G4 (X+P). The persistence of sealer residues was evaluated by SEM. Confocal laser scanning microscopy images were taken to measure the formed hybrid layer using the Image J program. For microshear bond strength, 4 resin composite cylinders were placed over the dentin after the cleaning protocols. ANOVA followed by Tukey test and Kruskal-Wallis followed by Dunn test were used for parametric and non-parametric data, respectively (α = 5%).

Results

G2 and G4 groups showed a lower persistence of residues (p < 0.05) and thicker hybrid layer than the other groups (p < 0.05). No bond strength differences among all groups were observed (p > 0.05).

Conclusions

Dentin cleaning using xylol, regardless of the time-point of acid etching, provided lower persistence of residues over the surface and thicker hybrid layer. However, the bond strength of the universal adhesive system in etch-and-rinse strategy was not influenced by the cleaning protocols or time-point of acid etching.

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Effectiveness and safety of rotary and reciprocating kinematics for retreatment of curved root canals: a systematic review of in vitro studies
Lucas Pinho Simões, Alexandre Henrique dos Reis-Prado, Carlos Roberto Emerenciano Bueno, Ana Cecília Diniz Viana, Marco Antônio Húngaro Duarte, Luciano Tavares Angelo Cintra, Cleidiel Aparecido Araújo Lemos, Francine Benetti
Restor Dent Endod 2022;47(2):e22.   Published online April 6, 2022
DOI: https://doi.org/10.5395/rde.2022.47.e22
AbstractAbstract PDFPubReaderePub
Objectives

This systematic review (register-osf.io/wg7ba) compared the efficacy and safety of rotary and reciprocating kinematics in the removal of filling material from curved root canals.

Materials and Methods

Only in vitro studies evaluating both kinematics during retreatment were included. A systematic search (PubMed/MEDLINE, Scopus, and other databases, until January 2021), data extraction, and risk of bias analysis (Joanna Briggs Institute checklist) were performed. Efficacy in filling removal was the primary outcome.

Results

The search resulted in 2,795 studies, of which 15 were included. Efficacy was measured in terms of the remaining filling material and the time required for this. Nine studies evaluated filling material removal, of which 7 found no significant differences between rotary and reciprocating kinematics. Regarding the time for filling removal, 5 studies showed no difference between both kinematics, 2 studies showed faster results with rotary systems, and other 2 showed the opposite. No significant differences were found in apical transportation, centering ability, instrument failure, dentin removed and extruded debris. A low risk of bias was observed.

Conclusions

This review suggests that the choice of rotary or reciprocating kinematics does not influence the efficacy of filling removal from curved root canals. Further studies are needed to compare the kinematics safety in curved root canals.

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Is dentin biomodification with collagen cross-linking agents effective for improving dentin adhesion? A systematic review and meta-analysis
Julianne Coelho Silva, Edson Luiz Cetira Filho, Paulo Goberlânio de Barros Silva, Fábio Wildson Gurgel Costa, Vicente de Paulo Aragão Saboia
Restor Dent Endod 2022;47(2):e23.   Published online May 6, 2022
DOI: https://doi.org/10.5395/rde.2022.47.e23
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Objectives

The aim of this investigation was to evaluate the effectiveness of collagen cross-linking agents (CCLAs) used in combination with the adhesive technique in restorative procedures.

Materials and Methods

In this systematic review, the authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. An electronic search was performed using PubMed, Scopus, Web of Science, Cochrane Library, LILACS, and DOSS, up to October 2020. The gray literature was also researched. Only randomized clinical trials were selected.

Results

The selection process yielded 3 studies from the 838 retrieved. The addition of CCLAs in the retention of restorations increased the number of events. The postoperative sensitivity scores and marginal adaptation scores showed no significant difference between the CCLA and control groups, and the marginal pigmentation scores showed a significant increase in the CCLA group. There were no caries events in any group throughout the evaluation period.

Conclusions

This systematic review showed that there is no clinical efficacy to justify the use of CCLAs in the protocols performed.

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Clinical and radiographic outcomes of regenerative endodontic treatment performed by endodontic postgraduate students: a retrospective study
Hadi Rajeh Alfahadi, Saad Al-Nazhan, Fawaz Hamad Alkazman, Nassr Al-Maflehi, Nada Al-Nazhan
Restor Dent Endod 2022;47(2):e24.   Published online May 9, 2022
DOI: https://doi.org/10.5395/rde.2022.47.e24
AbstractAbstract PDFPubReaderePub
Objectives

Regenerative endodontic treatment is a clinical procedure aimed at biologically regenerating damaged root canal tissue of immature permanent teeth. This study aimed to report the outcomes of regenerative endodontic treatment performed by endodontic postgraduate students.

Materials and Methods

Clinical and radiographic data of 27 patients, aged 10–22 years, who underwent regenerative treatment of immature permanent teeth from 2015 to 2019 were followed up, wherein clinical and radiographic examinations were performed for each patient. Postoperative success rate and tooth survival were analyzed, and the postoperative radiographic root area changes were quantified.

Results

A total of 23 patients attended the dental appointments, showing that all teeth survived and were asymptomatic. Specifically, 7 periapical pathosis cases were completely healed, 12 were incompletely healed, and 4 cases failed. Moreover, significant differences were found between discolored and non-discolored teeth, and between the presence or absence of periapical radiolucency. Additionally, 3 anterior teeth showed complete closure of the apical foramen, while the apical foramen width was reduced in 17 teeth and failed in 3 teeth. Root length was also found to have been increased in 7 anterior and 4 posterior teeth, and the average length ranged from 4.00–0.63 mm in the anterior teeth, 2.85–1.48 mm of the mesial root, and 2.73–2.16 mm of the molar teeth distal root. Furthermore, calcified tissue deposition was observed in 7 teeth.

Conclusions

A favorable outcome of regenerative endodontic treatment of immature permanent teeth with necrotic pulp was achieved with a high survival rate.

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Case Report
Leukocyte platelet-rich fibrin in endodontic microsurgery: a report of 2 cases
Mariana Domingos Pires, Jorge N. R. Martins, Abayomi Omokeji Baruwa, Beatriz Pereira, António Ginjeira
Restor Dent Endod 2022;47(2):e17.   Published online March 4, 2022
DOI: https://doi.org/10.5395/rde.2022.47.e17
AbstractAbstract PDFPubReaderePub

Endodontic microsurgery is a predictable treatment option when orthograde treatment or retreatment is unsuccessful or unfeasible. However, when there is a gross compromise of periapical bone, achievement of bone regeneration after the surgical procedure may be hampered. In such cases, the application of guided tissue regeneration principles, with adjunctive use of leukocyte platelet-rich fibrin to fill the bone defect as a bone substitute and as a membrane to cover the site, provides a cost-effective solution with the benefits of accelerated physiological healing and reduced post-surgical pain and discomfort. This case report presents 2 cases of endodontic microsurgery of the upper lateral incisors with loss of buccal cortical plate, where platelet-rich fibrin was successfully applied.

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