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Volume 42 (3); August 2017
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Review Article
Survival rates against fracture of endodontically treated posterior teeth restored with full-coverage crowns or resin composite restorations: a systematic review
Warattama Suksaphar, Danuchit Banomyong, Titalee Jirathanyanatt, Yaowaluk Ngoenwiwatkul
Restor Dent Endod 2017;42(3):157-167.   Published online July 31, 2017
DOI: https://doi.org/10.5395/rde.2017.42.3.157
AbstractAbstract PDFPubReaderePub

This systematic review aims to summarize the current clinical studies that investigated survival rates against fracture of endodontically treated posterior teeth restored with crowns or resin composite restorations. Literature search were performed using keywords. Publications from 1980 to 2016 were searched in PubMed, ScienceDirect, Web of Science, MEDLINE, and SCOPUS. Included studies were selected based on inclusion and exclusion criteria. Three clinical studies were included: 1 randomized controlled trial and 1 prospective and 1 retrospective cohort studies. Pooled survival rates ranged from 94%–100% and 91.9%–100% for crowns and resin composite, respectively. The majority of teeth had no more than 3 surface loss of tooth structure. The studies included were heterogeneous, and were not appropriate for further meta-analysis. Current evidence suggested that the survival rates against the fracture of endodontically treated posterior teeth restored with crowns or resin composites were not significantly different in the teeth with minimum to moderate loss of tooth structure.

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Research Articles
Comparing the effect of a desensitizing material and a self-etch adhesive on dentin sensitivity after periodontal surgery: a randomized clinical trial
Hila Hajizadeh, Atefeh Nemati-Karimooy, Sara Majidinia, Amir Moeintaghavi, Marjaneh Ghavamnasiri
Restor Dent Endod 2017;42(3):168-175.   Published online July 21, 2017
DOI: https://doi.org/10.5395/rde.2017.42.3.168
AbstractAbstract PDFPubReaderePub
Objectives

This double-blind randomized placebo-controlled clinical trial evaluated the ability of a desensitizing agent and a self-etch adhesive on cervical dentin sensitivity (CDS) after periodontal surgery.

Materials and Methods

Ninety hypersensitive teeth of 13 subjects were included in the study. After periodontal surgery, the teeth of each posterior sextant treated with one of the following materials: G1: Clearfil S3 Bond (Kuraray Dental), G2: Gluma Desensitizer (Heraeus Kulzer), and G3: placebo (water). The sensitivity was assessed using evaporative stimuli before treatment (baseline, T0), 1 day after treatment (T1), after 1 week (T2), and after 1 month (T3) according to visual analog scale (VAS).

Results

Following the treatment, all the 3 groups showed significant reduction of CDS in T1 compared to T0. Reduction of CDS between T1 and T2 was observed only in G1 but there was no significant difference between T2 and T3 in this group. Although we observed a significant difference in T3 compared to T1 and T2 in G2 and G3, comparison of treatment groups in each assessment time showed a significant difference only in T3. According to paired comparison, this was due to the difference between G2 and G3.

Conclusions

Dentin sensitivity following periodontal surgery will decrease spontaneously over time, but treating the sensitive teeth with Gluma Desensitizer and Clearfil S3 Bond can have some benefits.

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White mineral trioxide aggregate mixed with calcium chloride dihydrate: chemical analysis and biological properties
Hany Mohamed Aly Ahmed, Norhayati Luddin, Thirumulu Ponnuraj Kannan, Khairani Idah Mokhtar, Azlina Ahmad
Restor Dent Endod 2017;42(3):176-187.   Published online April 17, 2017
DOI: https://doi.org/10.5395/rde.2017.42.3.176
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to evaluate the chemical and biological properties of fast-set white mineral trioxide aggregate (FS WMTA), which was WMTA combined with calcium chloride dihydrate (CaCl2·2H2O), compared to that of WMTA.

Materials and Methods

Surface morphology, elemental, and phase analysis were examined using scanning electron microscope (SEM), energy dispersive X-ray microanalysis (EDX), and X-ray diffraction (XRD), respectively. The cytotoxicity and cell attachment properties were evaluated on human periodontal ligament fibroblasts (HPLFs) using methyl-thiazol-diphenyltetrazolium (MTT) assay and under SEM after 24 and 72 hours, respectively.

Results

Results showed that the addition of CaCl2·2H2O to WMTA affected the surface morphology and chemical composition. Although FS WMTA exhibited a non-cytotoxic profile, the cell viability values of this combination were lesser than WMTA, and the difference was significant in 7 out of 10 concentrations at the 2 time intervals (p < 0.05). HPLFs adhered over the surface of WMTA and at the interface, after 24 hours of incubation. After 72 hours, there were increased numbers of HPLFs with prominent cytoplasmic processes. Similar findings were observed with FS WMTA, but the cells were not as confluent as with WMTA.

Conclusions

The addition of CaCl2·2H2O to WMTA affected its chemical properties. The favorable biological profile of FS WMTA towards HPLFs may have a potential impact on its clinical application for repair of perforation defects.

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Effect of dentin biomodifiers on the immediate and long-term bond strengths of a simplified etch and rinse adhesive to dentin
Payal Singh, Rajni Nagpal, Udai Pratap Singh
Restor Dent Endod 2017;42(3):188-199.   Published online July 12, 2017
DOI: https://doi.org/10.5395/rde.2017.42.3.188
AbstractAbstract PDFPubReaderePub
Objectives

This in vitro study evaluated the effect of dentin biomodifiers on the immediate and long-term bond strengths of a simplified etch and rinse adhesive to dentin.

Materials and Methods

Flat coronal dentin surfaces were prepared in 120 extracted human molars. Teeth were randomly divided into 5 groups (n = 24) according to 5 different surface pre-treatments: No pre-treatment (control); 1M carbodiimide (EDC); 0.1% epigallocatechin-3-gallate (EGCG); 2% minocycline (MI); 10% sodium ascorbate (SA). After surface pre-treatment, adhesive (Adper Single Bond 2 [SB], 3M ESPE) was applied. Composite was applied into transparent plastic tubes (2.5 mm in diameter), which was placed over the bonded dentin surface. From each group, 10 samples were subjected to shear bond strength (SBS) evaluation at 24 hours (immediate) and remaining 10 samples were tested after 6 months (delayed). Additionally, 4 samples per group were subjected to scanning electron microscopic analysis for observation of resin-dentin interface. The data were statistically analysed with Shaperio‑Wilk W test, 2-way analysis of variance (ANOVA), and post hoc Tukey's test.

Results

At 24 hours, SBS of all surface pre-treatment groups were comparable with the control group, with significant differences found between EDC and SA groups only (p = 0.009). After 6 months storage, EDC, EGCG, and MI pre-treatments preserved the resin-dentin bond strength with no significant fall.

Conclusions

Dentin pre-treatment with all the dentin biomodifiers except SA resulted in significant preservation of resin-dentin bond over 6 months storage period, without negatively affecting the immediate bond strength of the etch and rinse adhesive tested.

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In vivo assessment of accuracy of Propex II, Root ZX II, and radiographic measurements for location of the major foramen
Fernanda Garcia Tampelini, Marcelo Santos Coelho, Marcos de Azevêdo Rios, Carlos Eduardo Fontana, Daniel Guimarães Pedro Rocha, Sergio Luiz Pinheiro, Carlos Eduardo da Silveira Bueno
Restor Dent Endod 2017;42(3):200-205.   Published online May 16, 2017
DOI: https://doi.org/10.5395/rde.2017.42.3.200
AbstractAbstract PDFPubReaderePub
Objectives

The aim of this in vivo study was to assess the accuracy of 2 third-generation electronic apex locators (EALs), Propex II (Dentsply Maillefer) and Root ZX II (J. Morita), and radiographic technique for locating the major foramen (MF).

Materials and Methods

Thirty-two premolars with single canals that required extraction were included. Following anesthesia, access, and initial canal preparation with size 10 and 15 K-flex files and SX and S1 rotary ProTaper files, the canals were irrigated with 2.5% sodium hypochlorite. The length of the root canal was verified 3 times for each tooth using the 2 apex locators and once using the radiographic technique. Teeth were extracted and the actual WL was determined using size 15 K-files under a × 25 magnification. The Biostat 4.0 program (AnalystSoft Inc.) was used for comparing the direct measurements with those obtained using radiographic technique and the apex locators. Pearson's correlation analysis and analysis of variance (ANOVA) were used for statistical analyses.

Results

The measurements obtained using the visual method exhibited the strongest correlation with Root ZX II (r = 0.94), followed by Propex II (r = 0.90) and Ingle's technique (r = 0.81; p < 0.001). Descriptive statistics using ANOVA (Tukey's post hoc test) revealed significant differences between the radiographic measurements and both EALs measurements (p < 0.05).

Conclusions

Both EALs presented similar accuracy that was higher than that of the radiographic measurements obtained with Ingle's technique. Our results suggest that the use of these EALs for MF location is more accurate than the use of radiographic measurements.

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Effects of air-abrasion pressure on the resin bond strength to zirconia: a combined cyclic loading and thermocycling aging study
Eman Z. Al-Shehri, Afnan O. Al-Zain, Alaa H. Sabrah, Sarah S. Al-Angari, Laila Al Dehailan, George J. Eckert, Mutlu Özcan, Jeffrey A. Platt, Marco C. Bottino
Restor Dent Endod 2017;42(3):206-215.   Published online June 5, 2017
DOI: https://doi.org/10.5395/rde.2017.42.3.206
AbstractAbstract PDFPubReaderePub
Objectives

To determine the combined effect of fatigue cyclic loading and thermocycling (CLTC) on the shear bond strength (SBS) of a resin cement to zirconia surfaces that were previously air-abraded with aluminum oxide (Al2O3) particles at different pressures.

Materials and Methods

Seventy-two cuboid zirconia specimens were prepared and randomly assigned to 3 groups according to the air-abrasion pressures (1, 2, and 2.8 bar), and each group was further divided into 2 groups depending on aging parameters (n = 12). Panavia F 2.0 was placed on pre-conditioned zirconia surfaces, and SBS testing was performed either after 24 hours or 10,000 fatigue cycles (cyclic loading) and 5,000 thermocycles. Non-contact profilometry was used to measure surface roughness. Failure modes were evaluated under optical and scanning electron microscopy. The data were analyzed using 2-way analysis of variance and χ2 tests (α = 0.05).

Results

The 2.8 bar group showed significantly higher surface roughness compared to the 1 bar group (p < 0.05). The interaction between pressure and time/cycling was not significant on SBS, and pressure did not have a significant effect either. SBS was significantly higher (p = 0.006) for 24 hours storage compared to CLTC. The 2 bar-CLTC group presented significantly higher percentage of pre-test failure during fatigue compared to the other groups. Mixed-failure mode was more frequent than adhesive failure.

Conclusions

CLTC significantly decreased the SBS values regardless of the air-abrasion pressure used.

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Effect of surface treatment on the mechanical properties of nickel-titanium files with a similar cross-section
Sang Won Kwak, Joo Yeong Lee, Hye-Jin Goo, Hyeon-Cheol Kim
Restor Dent Endod 2017;42(3):216-223.   Published online June 28, 2017
DOI: https://doi.org/10.5395/rde.2017.42.3.216
AbstractAbstract PDFPubReaderePub
Objectives

The aim of this study was to compare the mechanical properties of various nickel-titanium (NiTi) files with similar tapers and cross-sectional areas depending on whether they were surface-treated.

Materials and Methods

Three NiTi file systems with a similar convex triangular cross-section and the same ISO #25 tip size were selected for this study: G6 (G6), ProTaper Universal (PTU), and Dia-PT (DPT). To test torsional resistance, 5 mm of the straightened file's tip was fixed between polycarbonate blocks (n = 15/group) and continuous clockwise rotation until fracture was conducted using a customized device. To evaluate cyclic fatigue resistance, files were rotated in an artificial curved canal until fracture in a dynamic mode (n = 15/group). The torsional data were analyzed using 1-way analysis of variance and the Tukey post-hoc comparison test, while the cyclic fatigue data were analyzed using the Mann-Whitney U test at a significance level of 95%.

Results

PTU showed significantly greater toughness, followed by DPT and G6 (p < 0.05). G6 showed the lowest resistance in ultimate torsional strength, while it showed a higher fracture angle than the other files (p < 0.05). In the cyclic fatigue test, DPT showed a significantly higher number of cycles to failure than PTU or G6 (p < 0.05).

Conclusions

Within the limitations of this study, it can be concluded that the torsional resistance of NiTi files was affected by the cross-sectional area, while the cyclic fatigue resistance of NiTi files was influenced by the surface treatment.

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Comparison of cyclic fatigue life of nickel-titanium files: an examination using high-speed camera
Taha Özyürek, Neslihan Büşra Keskin, Fatma Furuncuoğlu, Uğur İnan
Restor Dent Endod 2017;42(3):224-231.   Published online August 3, 2017
DOI: https://doi.org/10.5395/rde.2017.42.3.224
AbstractAbstract PDFPubReaderePub
Objectives

To determine the actual revolutions per minute (rpm) values and compare the cyclic fatigue life of Reciproc (RPC, VDW GmbH), WaveOne (WO, Dentsply Maillefer), and TF Adaptive (TFA, Axis/SybronEndo) nickel-titanium (NiTi) file systems using high-speed camera.

Materials and Methods

Twenty RPC R25 (25/0.08), 20 WO Primary (25/0.08), and 20 TFA ML 1 (25/0.08) files were employed in the present study. The cyclic fatigue tests were performed using a dynamic cyclic fatigue testing device, which has an artificial stainless steel canal with a 60° angle of curvature and a 5-mm radius of curvature. The files were divided into 3 groups (group 1, RPC R25 [RPC]; group 2, WO Primary [WO]; group 3, TF Adaptive ML 1 [TFA]). All the instruments were rotated until fracture during the cyclic fatigue test and slow-motion videos were captured using high-speed camera. The number of cycles to failure (NCF) was calculated. The data were analyzed statistically using one-way analysis of variance (ANOVA, p < 0.05).

Results

The slow-motion videos were indicated that rpm values of the RPC, WO, and TFA groups were 180, 210, and 425, respectively. RPC (3,464.45 ± 487.58) and WO (3,257.63 ± 556.39) groups had significantly longer cyclic fatigue life compared with TFA (1,634.46 ± 300.03) group (p < 0.05). There was no significant difference in the mean length of the fractured fragments.

Conclusions

Within the limitation of the present study, RPC and WO NiTi files showed significantly longer cyclic fatigue life than TFA NiTi file.

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Light-emitting diode assessment of dentinal defects: the role of presumed extraction forces
Marcelo Santos Coelho, Steven J. Card, Peter Z. Tawil
Restor Dent Endod 2017;42(3):232-239.   Published online July 24, 2017
DOI: https://doi.org/10.5395/rde.2017.42.3.232
AbstractAbstract PDFPubReaderePub
Objectives

The evaluation of iatrogenic dentinal defects in extracted teeth may be influenced by extraction forces and prolonged dry times. The purpose of this study was to compare the presence of dentinal defects in freshly extracted, periodontally compromised teeth with those in a group of teeth with uncontrolled extraction forces and storage time.

Materials and Methods

The experimental group consisted of eighteen roots obtained from teeth extracted due to periodontal reasons with class II or III mobility. They were kept in saline and sectioned within 1 hour following extraction. The control group consisted of matched root types obtained from an anonymous tooth collection, consistent with previous dentinal defect studies. The slices were obtained at 3, 6, and 9 mm from the apex. The imaging process exposed all specimens to no more than 60 seconds of dry time. The × 12.8 magnification was used for the 9 mm slices and × 19.2 magnification for the 3 mm and 6 mm slices under light-emitting diode (LED) transillumination. The root canal spaces and periodontal tissues were masked to minimize extraneous factors that might influence the evaluators. Chi-square test was used for statistical analysis.

Results

Dentinal defects were detected in 17% of the experimental group teeth, compared to 61% of control teeth (p = 0.015).

Conclusions

LED transillumination assessment of freshly extracted roots with class II or III mobility showed smaller number of dentinal defects than roots with uncontrolled storage time and extraction forces. The use of freshly extracted roots with mobility should be considered for future dental defect assessment studies.

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Case Report
Management of large class II lesions in molars: how to restore and when to perform surgical crown lengthening?
Ana Belén Dablanca-Blanco, Juan Blanco-Carrión, Benjamín Martín-Biedma, Purificación Varela-Patiño, Alba Bello-Castro, Pablo Castelo-Baz
Restor Dent Endod 2017;42(3):240-252.   Published online August 3, 2017
DOI: https://doi.org/10.5395/rde.2017.42.3.240
AbstractAbstract PDFPubReaderePub

The restoration of endodontic tooth is always a challenge for the clinician, not only due to excessive loss of tooth structure but also invasion of the biological width due to large decayed lesions. In this paper, the 7 most common clinical scenarios in molars with class II lesions ever deeper were examined. This includes both the type of restoration (direct or indirect) and the management of the cavity margin, such as the need for deep margin elevation (DME) or crown lengthening. It is necessary to have the DME when the healthy tooth remnant is in the sulcus or at the epithelium level. For caries that reaches the connective tissue or the bone crest, crown lengthening is required. Endocrowns are a good treatment option in the endodontically treated tooth when the loss of structure is advanced.

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