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Volume 49 (2); May 2024
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Review Articles
Can carbamide peroxide be as effective as hydrogen peroxide for in-office tooth bleaching and cause less sensitivity? A systematic review
Patrick Wesley Marques de Boa, Kaiza de Sousa Santos, Francisca Jennifer Duarte de Oliveira, Boniek Castillo Dutra Borges
Restor Dent Endod 2024;49(2):e14.   Published online March 20, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e14
AbstractAbstract PDFPubReaderePub

This study aimed to answer the question through a systematic review: Can carbamide peroxide be as effective as hydrogen peroxide and cause less in-office bleaching sensitivity? A literature survey was performed in PubMed/MEDLINE, Embase, Scopus, ISI Web of Science, and gray literature. Primary clinical trials that compared the efficacy or the in-office bleaching sensitivity between carbamide and hydrogen peroxides were included. The risk of bias was evaluated using the RoB2. The certainty of the evidence was assessed using the GRADE approach. DPI training significantly improved the mean scores of the dental undergraduates from 7.53 in the pre-DPI-training test to 9.01 in the post-DPI-training test (p < 0.001). After 6 weeks, the mean scores decreased marginally to 8.87 in the retention test (p = 0.563). DPI training increased their confidence level from 5.68 pre-DPI training to 7.09 post-DPI training. The limited evidence suggests that the 37% carbamide peroxide may be similarly effective to the 35% hydrogen peroxide for bleaching teeth in-office and causes less bleaching sensitivity. However, more well-designed split-mouth clinical trials are necessary to strengthen the evidence.

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The prevalence of apical periodontitis in patients prior to hematopoietic cell transplantation: a systematic review
Letícia Tainá de Oliveira Lemes, Carolina Horn Troian-Michel, Theodoro Weissheimer, Marcus Vinicius Reis Só
Restor Dent Endod 2024;49(2):e22.   Published online May 9, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e22
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Objectives

This systematic review addressed the question: “What is the prevalence of apical periodontitis in patients prior to hematopoietic cell transplantation?”

Materials and Methods

A systematic search was conducted in MEDLINE/PubMed, Cochrane Library, Scopus, Web of Science, Embase, and Grey Literature Report. Eligibility criteria were based on the condition, content, and population strategy: the condition was the radiographic prevalence of apical periodontitis, the content comprised patients scheduled for hematopoietic stem cell transplantation, and the population consisted of adult and pediatric patients. The revised Risk of Bias in Nonrandomized Studies of Exposure tool was used to assess the quality of studies. The Grading Recommendations Assessments, Development, and Evaluation (GRADE) tool was used to assess the quality of evidence.

Results

Eight studies were included in this review. The average number of patients with apical periodontitis was 15.65% (range, 2.1%–43.34%). One study was classified as having a very high risk of bias, 1 with a high risk of bias, and 6 with some concern for bias. GRADE analysis showed a very low certainty of evidence. Significant limitations concerning the absence of control over confounding variables were identified.

Conclusions

With the caveat of the very low quality of evidence in the studies reviewed, there was a low to moderate prevalence of apical periodontitis in patients prior to undergoing hematopoietic cell transplantation.

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Research Articles
Impact of different agitation methods on smear layer cleaning of mesial canals with accentuated curvature
Abel Teves Cordova, Murilo Priori Alcalde, Michel Espinosa Klymus, Leonardo Rigoldi Bonjardim, Rodrigo Ricci Vivan, Marco Antonio Hungaro Duarte
Restor Dent Endod 2024;49(2):e12.   Published online March 4, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e12
AbstractAbstract PDFPubReaderePub
Objectives

This study evaluated the impact of different methods of irrigant agitation on smear layer removal in the apical third of curved mesial canals of 3 dimensionally (D) printed mandibular molars.

Materials and Methods

Sixty 3D-printed mandibular second molars were used, presenting a 70° curvature and a Vertucci type II configuration in the mesial root. A round cavity was cut 2 mm from the apex using a trephine of 2 mm in diameter, 60 bovine dentin disks were made, and a smear layer was formed. The dentin disks had the adaptation checked in the apical third of the teeth with wax. The dentin disks were evaluated in environmental scanning electron microscope before and after the following irrigant agitation methods: G1(PIK Ultrasonic Tip), G2 (Passive Ultrasonic Irrigation with Irrisonic– PUI), G3 (Easy Clean), G4 (HBW Ultrasonic Tip), G5 (Ultramint X Ultrasonic tip), and G6 (conventional irrigation-CI) (n = 10). All groups were irrigated with 2.5% sodium hypochlorite and 17% ethylenediaminetetraacetic acid.

Results

All dentin disks were 100% covered by the smear layer before treatment, and all groups significantly reduced the percentage of the smear layer after treatment. After the irrigation protocols, the Ultra-X group showed the lowest coverage percentage, statistically differing from the conventional, PIK, and HBW groups (p < 0.05). There was no significant difference among Ultramint X, PUI-Irrisonic, and Easy Clean (p > 0.05). None of the agitation methods could remove the smear layer altogether.

Conclusions

Ultramint X resulted in the most significant number of completely clean specimens.

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Single-session associative protocol for dentin hypersensitivity management: a 1-year randomized, blinded clinical study
Thayna Carolina Zeni, Poliana Maria de Faveri Cardoso, Rafael da Silva Vanolli, Márcio José Mendonça, Julio Katuhide Ueda, Veridiana Camilotti
Restor Dent Endod 2024;49(2):e15.   Published online March 20, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e15
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to establish a single-session associative protocol for non-restorative management of dentin hypersensitivity (DH).

Materials and Methods

Twenty-four individuals with DH and a minimum sensitivity level of 4 on the visual analog scale (VAS) were selected. The study was conducted in a split-mouth design, with each participant (n = 20) having at least 1 affected tooth in all quadrants. The management protocols consisted of control group: universal adhesive, Neural Desensitizing Protocol group: 5% potassium nitrate, Mixed Desensitizing Protocol (PAM) group: 5% sodium fluoride and 5% potassium nitrate, Remineralizing Desensitizing Protocol (PDR) group: surface-partially reacted glass technology photopolymerizable varnish. Evaluations were performed immediately after application, at 1 week, 1 month, 2 months, and 12 months using the VAS sensitivity test.

Results

The scores were subjected to statistical analysis using the Friedman test (p < 0.05), Durbin-Conover test (p < 0.05), and Wilcoxon test (p < 0.05). At the 12-month evaluation, all groups showed statistically significant differences compared to the initial assessment. For the evaluation after 12 months, there was a statistically significant difference between the PAM group, the control group, and the PDR group.

Conclusions

It can be concluded that all groups were effective in controlling DH, but there were significant results in the control group and PDR group. The clinical relevance of this study is to demonstrate that the application of single-session desensitizing protocols can be effective in controlling DH for up to 12 months.

Trial Registration

Brazilian Clinical Trials Registry Identifier: RBR-4r63d7s

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Prevalence of apical periodontitis and quality of root canal treatment in an adult Kuwaiti sub-population: a cross-sectional study
Abdulrahman A. Alhailaa, Saad A Al-Nazhan, Mazen A Aldosimani
Restor Dent Endod 2024;49(2):e16.   Published online March 22, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e16
AbstractAbstract PDFPubReaderePub
Objectives

This cross-sectional study evaluated the prevalence of apical periodontitis (AP) and the technical quality of root canal fillings in an adult Kuwaiti subpopulation using cone-beam computed tomography (CBCT) images.

Materials and Methods

Two experienced examiners analyzed 250 CBCT images obtained from Kuwaiti patients aged 15–65 years who attended government dental specialist clinics between January 2019 and September 2020. The assessment followed the radiographic scoring criteria proposed by De Moor for periapical status and the technical quality of root canal filling. Chi-square and Fisher’s exact tests were used for statistical analysis, with significance level set at p < 0.05.

Results

Among the 2,762 examined teeth, 191 (6.91%) exhibited radiographic signs of AP, and 176 (6.37%) had undergone root canal filling. AP prevalence in root canal-treated teeth was 32.38%, with a significant difference between males and females. Most of the endodontically treated teeth exhibited adequate root canal filling (71.5%).

Conclusions

The study demonstrated a comparable prevalence of AP and satisfactory execution of root canal treatment compared to similar studies in different countries.

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Pulp stones: any relevance with the levels of serum calcium, parathyroid hormone, vitamin D and uric acid
Ceyda Gürhan, Ercan Saruhan
Restor Dent Endod 2024;49(2):e17.   Published online March 26, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e17
AbstractAbstract PDFPubReaderePub
Objectives

This study evaluated the effect of serum calcium, parathyroid hormone (PTH), vitamin D, and uric acid levels on pulp stone formation.

Materials and Methods

Patients who were admitted to the Muğla Sıtkı Koçman University, Faculty of Dentistry, Department of Oral and Maxillofacial Radiology for dental complaints were registered. Among these patients, individuals who had routine biochemical tests at the same period in the Outpatient Clinics of Muğla Sıtkı Koçman University Training and Research Hospital were included in the study. The patients with at least 1 pulp stone on panoramic radiographs recorded as the “pulp stone group” while patients without any pulp stones were the “control group”. Demographic data and serum levels of calcium, PTH, vitamin D, and uric acid were retrospectively evaluated in both groups. Student t-test or Mann-Whitney U test was used to evaluate the differences between the groups.

Results

Among 151 patients, dental pulp stone was detected in 53.6% of patients, and 82.7% of these patients were female. Female sex and pulp stone formation were significantly associated (p = 0.001). The mean age of the pulp stone group was 43.9, while it was 39.9 in the control group, without any significant correlation between age and pulp stone (p > 0.05). Similarly, there were no significant differences in serum levels of PTH, vitamin D, uric acid and calcium between groups (p > 0.05).

Conclusions

According to the present study, the effect of dental factors rather than systemic factors should be considered primarily in pulp stone formation.

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Effects of a relined fiberglass post with conventional and self-adhesive resin cement
Wilton Lima dos Santos Junior, Marina Rodrigues Santi, Rodrigo Barros Esteves Lins, Luís Roberto Marcondes Martins
Restor Dent Endod 2024;49(2):e18.   Published online March 27, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e18
AbstractAbstract PDFPubReaderePub
Objectives

This study was conducted to evaluate the mechanical properties of relined and non-relined fiberglass posts when cemented to root canal dentin using a conventional dual-cure resin cement or a self-adhesive resin cement.

Materials and Methods

Two types of resin cements were utilized: conventional and self-adhesive. Additionally, 2 cementation protocols were employed, involving relined and non-relined fiberglass posts. In total, 72 bovine incisors were cemented and subjected to push-out bond strength testing (n = 10) followed by failure mode analysis. The cross-sectional microhardness (n = 5) was assessed along the root canal, and interface analyses (n = 3) were conducted using scanning electron microscopy (SEM). Data from the push-out bond strength and cross-sectional microhardness tests were analyzed via 3-way analysis of variance and the Bonferroni post-hoc test (α = 0.05).

Results

For non-relined fiberglass posts, conventional resin cement exhibited higher push-out bond strength than self-adhesive cement. Relined fiberglass posts yielded comparable results between the resin cements. Type II failure was the most common failure mode for both resin cements, regardless of cementation protocol. The use of relined fiberglass posts improved the cross-sectional microhardness values for both cements. SEM images revealed voids and bubbles in the incisors with non-relined fiberglass posts.

Conclusions

Mechanical properties were impacted by the cementation protocol. Relined fiberglass posts presented the highest push-out bond strength and cross-sectional microhardness values, regardless of the resin cement used (conventional dual-cure or self-adhesive). Conversely, for non-relined fiberglass posts, the conventional dual-cure resin cement yielded superior results to the self-adhesive resin cement.

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Nanoleakage of apical sealing using a calcium silicate-based sealer according to canal drying methods
Yoon-Joo Lee, Kyung-Mo Cho, Se-Hee Park, Yoon Lee, Jin-Woo Kim
Restor Dent Endod 2024;49(2):e20.   Published online April 19, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e20
AbstractAbstract PDFPubReaderePub
Objectives

This study investigated the nanoleakage of root canal obturations using calcium silicate-based sealer according to different drying methods.

Materials and Methods

Fifty-two extracted mandibular premolars with a single root canal and straight root were selected for this study. After canal preparation with a nickel-titanium rotary file system, the specimens were randomly divided into 4 groups according to canal drying methods (1: complete drying, 2: blot drying/distilled water, 3: blot drying/NaOCl, 4: aspiration only). The root canals were obturated using a single-cone filling technique with a calcium silicate–based sealer. Nanoleakage was evaluated using a nanoflow device after 24 hours, 1 week, and 1 month. Data were collected twice per second at the nanoscale and measured in nanoliters per second. Data were statistically analyzed using the Kruskal-Wallis and Mann–Whitney U-tests (p < 0.05).

Results

The mean flow rate measured after 24 hours showed the highest value among the time periods in all groups. However, the difference in the flow rate between 1 week and 1 month was not significant. The mean flow rate of the complete drying group was the highest at all time points. After 1 month, the mean flow rate in the blot drying group and the aspiration group was not significantly different.

Conclusions

Within the limitations of this study, the canal drying method had a significant effect on leakage and sealing ability in root canal obturations using a calcium silicate-based sealer. Thus, a proper drying procedure is critical in endodontic treatment.

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Statistical Research Article
An elaboration on sample size determination for correlations based on effect sizes and confidence interval width: a guide for researchers
Mohamad Adam Bujang
Restor Dent Endod 2024;49(2):e21.   Published online May 2, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e21
AbstractAbstract PDFPubReaderePub
Objectives

This paper aims to serve as a useful guide for sample size determination for various correlation analyses that are based on effect sizes and confidence interval width.

Materials and Methods

Sample size determinations are calculated for Pearson’s correlation, Spearman’s rank correlation, and Kendall’s Tau-b correlation. Examples of sample size statements and their justification are also included.

Results

Using the same effect sizes, there are differences between the sample size determination of the 3 statistical tests. Based on an empirical calculation, a minimum sample size of 149 is usually adequate for performing both parametric and non-parametric correlation analysis to determine at least a moderate to an excellent degree of correlation with acceptable confidence interval width.

Conclusions

Determining data assumption(s) is one of the challenges to offering a valid technique to estimate the required sample size for correlation analyses. Sample size tables are provided and these will help researchers to estimate a minimum sample size requirement based on correlation analyses.

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Case Report
Garre’s osteomyelitis of the mandible managed by nonsurgical re-endodontic treatment
Heegyun Kim, Jiyoung Kwon, Hyun-Jung Kim, Soram Oh, Duck-Su Kim, Ji-Hyun Jang
Restor Dent Endod 2024;49(2):e13.   Published online March 18, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e13
AbstractAbstract PDFPubReaderePub

Chronic osteomyelitis with proliferative periostitis, known as Garre’s osteomyelitis, is a type of osteomyelitis characterized by a distinctive gross thickening of the periosteum of bones. Peripheral reactive bone formation can be caused by mild irritation or infection. Garre’s osteomyelitis is usually diagnosed in children and young adults, and the mandible is more affected than the maxilla. The following is a case report of a 12-year-old female patient with Garre’s osteomyelitis of the mandible due to an infection of a root canal-treated tooth. Without surgical intervention, the patient’s symptoms were relieved through nonsurgical root canal re-treatment with long-term calcium hydroxide placement. A cone-beam computed tomography image obtained 6 months after treatment completion displayed complete healing of the periapical lesion and resolution of the peripheral reactive buccal bone. Due to the clinical features of Garre's osteomyelitis, which is characterized by thickening of the periosteum, it can be mistaken for other diseases such as fibrous dysplasia. It is important to correctly diagnose Garre's osteomyelitis based on its distinctive clinical features to avoid unnecessary surgical intervention, and it can lead to minimally invasive treatment options.

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Letter to the Editor
It is normal to be “not-normal”: reporting of correct descriptive statistics in dental research
Snigdho Das
Restor Dent Endod 2024;49(2):e19.   Published online April 12, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e19
PDFPubReaderePub
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