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Volume 40 (3); August 2015
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Review Article
A review of the regenerative endodontic treatment procedure
Bin-Na Lee, Jong-Wook Moon, Hoon-Sang Chang, In-Nam Hwang, Won-Mann Oh, Yun-Chan Hwang
Restor Dent Endod 2015;40(3):179-187.   Published online March 16, 2015
DOI: https://doi.org/10.5395/rde.2015.40.3.179
AbstractAbstract PDFPubReaderePub

Traditionally, apexification has been used to treat immature permanent teeth that have lost pulp vitality. This technique promotes the formation of an apical barrier to close the open apex so that the filling materials can be confined to the root canal. Because tissue regeneration cannot be achieved with apexification, a new technique called regenerative endodontic treatment was presented recently to treat immature permanent teeth. Regenerative endodontic treatment is a treatment procedure designed to replace damaged pulp tissue with viable tissue which restores the normal function of the pulp-dentin structure. After regenerative endodontic treatment, continued root development and hard tissue deposition on the dentinal wall can occur under ideal circumstances. However, it is difficult to predict the result of regenerative endodontic treatment. Therefore, the purpose of this study was to summarize multiple factors effects on the result of regenerative endodontic treatment in order to achieve more predictable results. In this study, we investigated the features of regenerative endodontic treatment in comparison with those of other pulp treatment procedures and analyzed the factors that have an effect on regenerative endodontic treatment.

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Research Articles
Effect of organic acids in dental biofilm on microhardness of a silorane-based composite
Sedighe Sadat Hashemikamangar, Seyed Jalal Pourhashemi, Mohammad Talebi, Nazanin Kiomarsi, Mohammad Javad Kharazifard
Restor Dent Endod 2015;40(3):188-194.   Published online June 2, 2015
DOI: https://doi.org/10.5395/rde.2015.40.3.188
AbstractAbstract PDFPubReaderePub
Objectives

This study evaluated the effect of lactic acid and acetic acid on the microhardness of a silorane-based composite compared to two methacrylate-based composite resins.

Materials and Methods

Thirty disc-shaped specimens each were fabricated of Filtek P90, Filtek Z250 and Filtek Z350XT. After measuring of Vickers microhardness, they were randomly divided into 3 subgroups (n = 10) and immersed in lactic acid, acetic acid or distilled water. Microhardness was measured after 48 hr and 7 day of immersion. Data were analyzed using repeated measures ANOVA (p < 0.05). The surfaces of two additional specimens were evaluated using a scanning electron microscope (SEM) before and after immersion.

Results

All groups showed a reduction in microhardness after 7 day of immersion (p < 0.001). At baseline and 7 day, the microhardness of Z250 was the greatest, followed by Z350 and P90 (p < 0.001). At 48 hr, the microhardness values of Z250 and Z350 were greater than P90 (p < 0.001 for both), but those of Z250 and Z350 were not significantly different (p = 0.095). Also, the effect of storage media on microhardness was not significant at baseline, but significant at 48 hr and after 7 day (p = 0.001 and p < 0.001, respectively). Lactic acid had the greatest effect.

Conclusions

The microhardness of composites decreased after 7 day of immersion. The microhardness of P90 was lower than that of other composites. Lactic acid caused a greater reduction in microhardness compared to other solutions.

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Chelating and antibacterial properties of chitosan nanoparticles on dentin
Aldo del Carpio-Perochena, Clovis Monteiro Bramante, Marco Antonio Hungaro Duarte, Marcia Regina de Moura, Fauze Ahmad Aouada, Anil Kishen
Restor Dent Endod 2015;40(3):195-201.   Published online March 30, 2015
DOI: https://doi.org/10.5395/rde.2015.40.3.195
AbstractAbstract PDFPubReaderePub
Objectives

The use of chitosan nanoparticles (CNPs) in endodontics is of interest due to their antibiofilm properties. This study was to investigate the ability of bioactive CNPs to remove the smear layer and inhibit bacterial recolonization on dentin.

Materials and Methods

One hundred bovine dentin sections were divided into five groups (n = 20 per group) according to the treatment. The irrigating solutions used were 2.5% sodium hypochlorite (NaOCl) for 20 min, 17% ethylenediaminetetraacetic acid (EDTA) for 3 min and 1.29 mg/mL CNPs for 3 min. The samples were irrigated with either distilled water (control), NaOCl, NaOCl-EDTA, NaOCl-EDTA-CNPs or NaOCl-CNPs. After the treatment, half of the samples (n = 50) were used to assess the chelating effect of the solutions using portable scanning electronic microscopy, while the other half (n = 50) were infected intra-orally to examine the post-treatment bacterial biofilm forming capacity. The biovolume and cellular viability of the biofilms were analysed under confocal laser scanning microscopy. The Kappa test was performed for examiner calibration, and the non-parametric Kruskal-Wallis and Dunn tests (p < 0.05) were used for comparisons among the groups.

Results

The smear layer was significantly reduced in all of the groups except the control and NaOCl groups (p < 0.05). The CNPs-treated samples were able to resist biofilm formation significantly better than other treatment groups (p < 0.05).

Conclusions

CNPs could be used as a final irrigant during root canal treatment with the dual benefit of removing the smear layer and inhibiting bacterial recolonization on root dentin.

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Effects of solvent volatilization time on the bond strength of etch-and-rinse adhesive to dentin using conventional or deproteinization bonding techniques
José Aginaldo de Sousa Júnior, Márcia Luciana Carregosa Santana, Fabricio Eneas Diniz de Figueiredo, André Luis Faria-e-Silva
Restor Dent Endod 2015;40(3):202-208.   Published online March 17, 2015
DOI: https://doi.org/10.5395/rde.2015.40.3.202
AbstractAbstract PDFPubReaderePub
Objectives

This study determined the effect of the air-stream application time and the bonding technique on the dentin bond strength of adhesives with different solvents. Furthermore, the content and volatilization rate of the solvents contained in the adhesives were also evaluated.

Materials and Methods

Three adhesive systems with different solvents (Stae, SDI, acetone; XP Bond, Dentsply De Trey, butanol; Ambar, FGM, ethanol) were evaluated. The concentrations and evaporation rates of each adhesive were measured using an analytical balance. After acid-etching and rinsing, medium occlusal dentin surfaces of human molars were kept moist (conventional) or were treated with 10% sodium hypochlorite for deproteinization. After applying adhesives over the dentin, slight air-stream was applied for 10, 30 or 60 sec. Composite cylinders were built up and submitted to shear testing. The data were submitted to ANOVA and Tukey's test (α = 0.05).

Results

Stae showed the highest solvent content and Ambar the lowest. Acetone presented the highest evaporation rate, followed by butanol. Shear bond strengths were significantly affected only by the factors of 'adhesive' and 'bonding technique' (p < 0.05), while the factor 'duration of air-stream' was not significant. Deproteinization of dentin increased the bond strength (p < 0.05). Stae showed the lowest bond strength values (p < 0.05), while no significant difference was observed between XP Bond and Ambar.

Conclusions

Despite the differences in content and evaporation rate of the solvents, the duration of air-stream application did not affect the bond strength to dentin irrespective of the bonding technique.

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Do conventional glass ionomer cements release more fluoride than resin-modified glass ionomer cements?
Maria Fernanda Costa Cabral, Roberto Luiz de Menezes Martinho, Manoel Valcácio Guedes-Neto, Maria Augusta Bessa Rebelo, Danielson Guedes Pontes, Flávia Cohen-Carneiro
Restor Dent Endod 2015;40(3):209-215.   Published online May 26, 2015
DOI: https://doi.org/10.5395/rde.2015.40.3.209
AbstractAbstract PDFPubReaderePub
Objectives

The aim of this study was to evaluate the fluoride release of conventional glass ionomer cements (GICs) and resin-modified GICs.

Materials and Methods

The cements were grouped as follows: G1 (Vidrion R, SS White), G2 (Vitro Fil, DFL), G3 (Vitro Molar, DFL), G4 (Bioglass R, Biodinâmica), and G5 (Ketac Fil, 3M ESPE), as conventional GICs, and G6 (Vitremer, 3M ESPE), G7 (Vitro Fil LC, DFL), and G8 (Resiglass, Biodinâmica) as resin-modified GICs. Six specimens (8.60 mm in diameter; 1.65 mm in thickness) of each material were prepared using a stainless steel mold. The specimens were immersed in a demineralizing solution (pH 4.3) for 6 hr and a remineralizing solution (pH 7.0) for 18 hr a day. The fluoride ions were measured for 15 days. Analysis of variance (ANOVA) and Tukey's test with 5% significance were applied.

Results

The highest amounts of fluoride release were found during the first 24 hr for all cements, decreasing abruptly on day 2, and reaching gradually decreasing levels on day 7. Based on these results, the decreasing scale of fluoride release was as follows: G2 > G3 > G8 = G4 = G7 > G6 = G1 > G5 (p < 0.05).

Conclusions

There were wide variations among the materials in terms of the cumulative amount of fluoride ion released, and the amount of fluoride release could not be attributed to the category of cement, that is, conventional GICs or resin-modified GICs.

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Evaluation of the effects of two novel irrigants on intraradicular dentine erosion, debris and smear layer removal
Melahat Görduysus, Selen Küçükkaya, Nursel Pekel Bayramgil, Mehmet Ömer Görduysus
Restor Dent Endod 2015;40(3):216-222.   Published online July 3, 2015
DOI: https://doi.org/10.5395/rde.2015.40.3.216
AbstractAbstract PDFPubReaderePub
Objectives

To evaluate the effects of copolymer of acrylic acid and maleic acid (Poly[AA-co-MA]) and calcium hypochlorite (Ca(OCl)2) on root canal dentin using scanning electron microscope (SEM).

Materials and Methods

Twenty-four single-rooted teeth were instrumented and the apical and coronal thirds of each root were removed, leaving the 5 mm middle thirds, which were then separated into two pieces longitudinally. The specimens were randomly divided into six groups and subjected to each irrigant for 5 min as follows: G1, Ca(OCl)2; G2, Poly(AA-co-MA); G3, Ca(OCl)2 + Poly(AA-co-MA); G4, sodium hypochlorite (NaOCl); G5, ethylenediaminetetraacetic acid (EDTA); G6, NaOCl+EDTA. The specimens were prepared for SEM evaluation. Smear layer, debris and erosion scores were recorded by two blinded examiners. One image from G3 was analyzed with energy dispersive spectroscopy (EDS) on suspicion of precipitate formation. Data were analyzed using the Kruskal-Wallis and Dunn tests.

Results

G1 and G4 showed the presence of debris and smear layer and they were statistically different from G2, G3, G5 and G6 where debris and smear layer were totally removed (p < 0.05). In G1 and G4, erosion evaluation could not be done because of debris and smear layer. G2, G3 and G5 showed no erosion, and there was no significant difference between them. G6 showed severe erosion and was statistically different from G2, G3 and G5 (p < 0.05). EDS microanalysis showed the presence of Na, P, and Ca elements on the surface.

Conclusions

Poly(AA-co-MA) is effective in removing the smear layer and debris without causing erosion either alone or with Ca(OCl)2.

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Changes in SIRT gene expression during odontoblastic differentiation of human dental pulp cells
Young-Eun Jang, Su-Hee Go, Bin-Na Lee, Hoon-Sang Chang, In-Nam Hwang, Won-Mann Oh, Yun-Chan Hwang
Restor Dent Endod 2015;40(3):223-228.   Published online July 15, 2015
DOI: https://doi.org/10.5395/rde.2015.40.3.223
AbstractAbstract PDFPubReaderePub
Objectives

The aim of this study was to investigate the expression of 7 different sirtuin genes (SIRT1-SIRT7) in human dental pulp cells (HDPCs), and to determine the role of SIRTs in the odontoblastic differentiation potential of HDPCs.

Materials and Methods

HDPCs were isolated from freshly extracted third molar teeth of healthy patients and cultulred in odontoblastic differentiation inducing media. Osteocalcin (OCN) and dentin sialophosphoprotein (DSPP) expression was analyzed to evaluate the odontoblastic differentiation of HDPCs by reverse transcription-polymerase chain reaction (RT-PCR), while alizarin red staining was used for the mineralization assay. To investigate the expression of SIRTs during odontoblastic differentiation of HDPCs, real time PCR was also performed with RT-PCR.

Results

During the culture of HDPCs in the differentiation inducing media, OCN, and DSPP mRNA expressions were increased. Mineralized nodule formation was also increased in the 14 days culture. All seven SIRT genes were expressed during the odontogenic induction period. SIRT4 expression was increased in a time-dependent manner.

Conclusions

Our study identified the expression of seven different SIRT genes in HDPCs, and revealed that SIRT4 could exert an influence on the odontoblast differentiation process. Further studies are needed to determine the effects of other SIRTs on the odontogenic potential of HDPCs.

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Fracture resistance of upper central incisors restored with different posts and cores
Maryam Rezaei Dastjerdi, Kamran Amirian Chaijan, Saeid Tavanafar
Restor Dent Endod 2015;40(3):229-235.   Published online July 24, 2015
DOI: https://doi.org/10.5395/rde.2015.40.3.229
AbstractAbstract PDFPubReaderePub
Objectives

To determine and compare the fracture resistance of endodontically treated maxillary central incisors restored with different posts and cores.

Materials and Methods

Forty-eight upper central incisors were randomly divided into four groups: cast post and core (group 1), fiber-reinforced composite (FRC) post and composite core (group 2), composite post and core (group 3), and controls (group 4). Mesio-distal and bucco-lingual dimensions at 7 and 14 mm from the apex were compared to ensure standardization among the groups. Twelve teeth were prepared for crown restoration (group 4). Teeth in other groups were endodontically treated, decoronated at 14 mm from the apex, and prepared for posts and cores. Resin-based materials were used for cementation in groups 1 and 2. In group 3, composite was used directly to fill the post space and for core build-up. All samples were restored by standard metal crowns using glass ionomer cement, mounted at 135° vertical angle, subjected to thermomechanical aging, and then fractured using a universal testing machine. Kruskal-Wallis and Mann-Whitney U tests were used to analyze the data.

Results

Fracture resistance of the groups was as follows: Control (group 4) > cast post and core (group 1) > fiber post and composite core (group 2) > composite post and core (group 3). All samples in groups 2 and 3 fractured in restorable patterns, whereas most (58%) in group 1 were non-restorable.

Conclusions

Within the limitations of this study, FRC posts showed acceptable fracture resistance with favorable fracture patterns for reconstruction of upper central incisors.

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Case Reports
Autotransplantation combined with orthodontic treatment: a case involving the maxillary central incisors with root resorption after traumatic injury
Manuel Marques Ferreira, Hugo M. Ferreira, Filomena Botelho, Eunice Carrilho
Restor Dent Endod 2015;40(3):236-240.   Published online May 26, 2015
DOI: https://doi.org/10.5395/rde.2015.40.3.236
AbstractAbstract PDFPubReaderePub

Traumatic dental injury can result in avulsion of anterior teeth. In young patients, it is a challenge to the dental professional because after replantation, late complications such as ankylosis require tooth extraction. Although prosthetic and orthodontic treatment, and implant placement have been described as the options for intervention, autogenous tooth transplantation could be an effective procedure in growing patients if there is a suitable donor tooth available. This case presents the treatment of a patient who suffered a traumatic injury at 9 years old with avulsion of tooth 21, which had been replanted, and intrusion of tooth 11. Both teeth ankylosed; thus they were removed and autotransplantation of premolars was carried out. After transplantation, the tooth underwent root canal treatment because of pulpal necrosis. Orthodontic treatment began 3 months after transplantation and during 7 years' follow-up the aesthetics and function were maintained without signs of resorption.

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Endodontic management of a maxillary first molar with three roots and seven root canals with the aid of cone-beam computed tomography
Gurudutt Nayak, Kamal Krishan Singh, Rhitu Shekhar
Restor Dent Endod 2015;40(3):241-248.   Published online June 3, 2015
DOI: https://doi.org/10.5395/rde.2015.40.3.241
AbstractAbstract PDFPubReaderePub

Variation in root canal morphology, especially in maxillary first molar presents a constant challenge for a clinician in their detection and management. This case report describes the successful root canal treatment of a three rooted right maxillary first molar presenting with three canals each in the mesiobuccal and distobuccal roots and one canal in the palatal root. The clinical detection of this morphologic aberration was made using a dental operating microscope, and the canal configuration was established after correlating and computing the clinical, radiographic and cone-beam computed tomography (CBCT) scan findings. CBCT images confirmed the configuration of the canals in the mesiobuccal and distobuccal roots to be Al-Qudah and Awawdeh type (3-2) and type (3-2-1), respectively, whereas the palatal root had a Vertucci type I canal pattern. This report reaffirms the importance of careful examination of the floor of the pulp chamber with a dental operating microscope and the use of multiangled preoperative radiographs along with advanced diagnostic aids such as CBCT in identification and successful management of aberrant canal morphologies.

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Open Lecture on Statistics
Statistical notes for clinical researchers: Type I and type II errors in statistical decision
Hae-Young Kim
Restor Dent Endod 2015;40(3):249-252.   Published online June 30, 2015
DOI: https://doi.org/10.5395/rde.2015.40.3.249
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Readers' Forum
Safe root canal preparation using reciprocating nickel-titanium instruments
Jung-Hong Ha
Restor Dent Endod 2015;40(3):253-254.   Published online June 30, 2015
DOI: https://doi.org/10.5395/rde.2015.40.3.253
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