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Volume 43 (3); August 2018
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Open Lecture on Statistics
Statistical notes for clinical researchers: simple linear regression 2 – evaluation of regression line
Hae-Young Kim
Restor Dent Endod 2018;43(3):e34.   Published online August 9, 2018
DOI: https://doi.org/10.5395/rde.2018.43.e34
PDFPubReaderePub
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Review Article
Triple antibiotic paste: momentous roles and applications in endodontics: a review
Ardavan Parhizkar, Hanieh Nojehdehian, Saeed Asgary
Restor Dent Endod 2018;43(3):e28.   Published online June 20, 2018
DOI: https://doi.org/10.5395/rde.2018.43.e28
AbstractAbstract PDFPubReaderePub

This study investigated the latest findings and notions regarding ‘triple antibiotic paste’ (TAP) and its applications in dentistry, particularly endodontics. TAP is a combination of 3 antibiotics, ciprofloxacin, metronidazole, and minocycline. Despite the problems and pitfalls research pertaining to this paste has unveiled, it has been vastly used in endodontic treatments. The paste's applications vary, from vital pulp therapy to the recently introduced regeneration and revascularisation protocol. Studies have shown that the paste can eliminate the root canal microorganisms and prepare an appropriate matrix for further treatments. This combination is able to remove diverse groups of obligate and facultative gram-positive and gram-negative bacteria, providing an environment for healing. In regeneration protocol cases, this allows the development, disinfection, and possible sterilization of the root canal system, so that new tissue can infiltrate and grow into the radicular area. Moreover, TAP is capable of creating a discipline in which other wanted and needed treatments can be successfully performed. In conclusion, TAP, as an antibacterial intracanal medication, has diverse uses. Nevertheless, despite its positive effects, the paste has shown drawbacks. Further research concerning the combined paste and other intracanal medications to control microbiota is a must.

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Research Articles
Retention of BioAggregate and MTA as coronal plugs after intracanal medication for regenerative endodontic procedures: an ex vivo study
Suzan Abdul Wanees Amin, Shaimaa Ismail Gawdat
Restor Dent Endod 2018;43(3):e18.   Published online April 26, 2018
DOI: https://doi.org/10.5395/rde.2018.43.e18
AbstractAbstract PDFPubReaderePub
Objectives

This study compared the retention of BioAggregate (BA; Innovative BioCeramix) and mineral trioxide aggregate (MTA; Angelus) as coronal plugs after applying different intracanal medications (ICMs) used in regenerative endodontics.

Materials and Methods

One-hundred human maxillary central incisors were used. The canals were enlarged to a diameter of 1.7 mm. Specimens were divided into 5 groups (n = 20) according to the ICM used: calcium hydroxide (CH), 2% chlorhexidine (CHX), triple-antibiotic paste (TAP), double-antibiotic paste (DAP), and no ICM (control; CON). After 3 weeks of application, ICMs were removed and BA or MTA were placed as the plug material (n = 10). The push-out bond strength and the mode of failure were assessed. The data were analyzed using 2-way analysis of variance, the Tukey's test, and the χ2 test; p values < 0.05 indicated statistical significance.

Results

The type of ICM and the type of plug material significantly affected bond strength (p < 0.01). Regardless of the type of ICM, BA showed a lower bond strength than MTA (p < 0.05). For MTA, CH showed a higher bond strength than CON, TAP and DAP; CHX showed a higher bond strength than DAP (p < 0.01). For BA, CH showed a higher bond strength than DAP (p < 0.05). The mode of failure was predominantly cohesive for BA (p < 0.05).

Conclusions

MTA may show better retention than BA. The mode of bond failure with BA can be predominantly cohesive. BA retention may be less affected by ICM type than MTA retention.

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Effects of four novel root-end filling materials on the viability of periodontal ligament fibroblasts
Makbule Bilge Akbulut, Pembegul Uyar Arpaci, Ayce Unverdi Eldeniz
Restor Dent Endod 2018;43(3):e24.   Published online May 25, 2018
DOI: https://doi.org/10.5395/rde.2018.43.e24
AbstractAbstract PDFPubReaderePub
Objectives

The aim of this in vitro study was to evaluate the biocompatibility of newly proposed root-end filling materials, Biodentine, Micro-Mega mineral trioxide aggregate (MM-MTA), polymethylmethacrylate (PMMA) bone cement, and Smart Dentin Replacement (SDR), in comparison with contemporary root-end filling materials, intermediate restorative material (IRM), Dyract compomer, ProRoot MTA (PMTA), and Vitrebond, using human periodontal ligament (hPDL) fibroblasts.

Materials and Methods

Ten discs from each material were fabricated in sterile Teflon molds and 24-hour eluates were obtained from each root-end filling material in cell culture media after 1- or 3-day setting. hPDL fibroblasts were plated at a density of 5 × 103/well, and were incubated for 24 hours with 1:1, 1:2, 1:4, and 1:8 dilutions of eluates. Cell viability was evaluated by XTT assay. Data was statistically analysed. Apoptotic/necrotic activity of PDL cells exposed to material eluates was established by flow cytometry.

Results

The Vitrebond and IRM were significantly more cytotoxic than the other root-end filling materials (p < 0.05). Those cells exposed to the Biodentine and Dyract compomer eluates showed the highest survival rates (p < 0.05), while the PMTA, MM-MTA, SDR, and PMMA groups exhibited similar cell viabilities. Three-day samples were more cytotoxic than 1-day samples (p < 0.05). Eluates from the cements at 1:1 dilution were significantly more cytotoxic (p < 0.05). Vitrebond induced cell necrosis as indicated by flow cytometry.

Conclusions

This in vitro study demonstrated that Biodentine and Compomer were more biocompatible than the other root-end filling materials. Vitrebond eluate caused necrotic cell death.

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Light transmittance of CAD/CAM ceramics with different shades and thicknesses and microhardness of the underlying light-cured resin cement
Zahra Jafari, Homayoon Alaghehmand, Yasaman Samani, Mina Mahdian, Soraya Khafri
Restor Dent Endod 2018;43(3):e27.   Published online June 4, 2018
DOI: https://doi.org/10.5395/rde.2018.43.e27
AbstractAbstract PDFPubReaderePub
Objectives

The aim of this in vitro study was to evaluate the effects of the thickness and shade of 3 types of computer-aided design/computer-aided manufacturing (CAD/CAM) materials.

Materials and Methods

A total of 120 specimens of 2 shades (A1 and A3) and 2 thicknesses (1 and 2 mm) were fabricated using VITA Mark II (VM; VITA Zahnfabrik), IPS e.max CAD (IE; IvoclarVivadent), and VITA Suprinity (VS; VITA Zahnfabrik) (n = 10 per subgroup). The amount of light transmission through the ceramic specimens was measured by a radiometer (Optilux, Kerr). Light-cured resin cement samples (Choice 2, Bisco) were fabricated in a Teflon mold and activated through the various ceramics with different shades and thicknesses using an LED unit (Bluephase, IvoclarVivadent). In the control group, the resin cement sample was directly light-cured without any ceramic. Vickers microhardness indentations were made on the resin surfaces (KoopaPazhoohesh) after 24 hours of dark storage in a 37°C incubator. Data were analyzed using analysis of variance followed by the Tukey post hoc test (α = 0.05).

Results

Ceramic thickness and shade had significant effects on light transmission and the microhardness of all specimens (p < 0.05). The mean values of light transmittance and microhardness of the resin cement in the VM group were significantly higher than those observed in the IE and VS groups. The lowest microhardness was observed in the VS group, due to the lowest level of light transmission (p < 0.05).

Conclusion

Greater thickness and darker shades of the 3 types of CAD/CAM ceramics significantly decreased the microhardness of the underlying resin cement.

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Do universal adhesives promote bonding to dentin? A systematic review and meta-analysis
Ali A. Elkaffas, Hamdi H. H. Hamama, Salah H. Mahmoud
Restor Dent Endod 2018;43(3):e29.   Published online June 18, 2018
DOI: https://doi.org/10.5395/rde.2018.43.e29
AbstractAbstract PDFPubReaderePub
Objectives

The aims of this study were to conduct a systematic review of the microtensile bond strength (µTBS) of multi-mode adhesives to dentin and to perform a meta-analysis to assess the significance of differences in the µTBS of one of the most commonly used universal adhesives (Scotchbond Universal, 3M ESPE) depending on whether the etch-and-rinse or self-etch mode was used.

Materials and Methods

An electronic search was performed of MEDLINE/PubMed, ScienceDirect, and EBSCOhost. Laboratory studies that evaluated the µTBS of multi-mode adhesives to dentin using either the etch-and-rinse or self-etch mode were selected. A meta-analysis was conducted of the reviewed studies to quantify the differences in the µTBS of Scotchbond Universal adhesive.

Results

Only 10 studies fulfilled the inclusion criteria for the systematic review. Extensive variation was found in the restorative materials, testing methodologies, and failure mode in the reviewed articles. Furthermore, variation was also observed in the dimensions of the microtensile testing beams. The meta-analysis showed no statistically significant difference between the etch-and-rinse and self-etch modes for Scotchbond Universal adhesive (p > 0.05).

Conclusions

Multi-mode ‘universal’ adhesives can achieve substantial bonding to dentin, regardless of the used modes (either etch-and-rinse or self-etch).

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Bacterial leakage and micro-computed tomography evaluation in round-shaped canals obturated with bioceramic cone and sealer using matched single cone technique
Kallaya Yanpiset, Danuchit Banomyong, Kanet Chotvorrarak, Ratchapin Laovanitch Srisatjaluk
Restor Dent Endod 2018;43(3):e30.   Published online July 5, 2018
DOI: https://doi.org/10.5395/rde.2018.43.e30
AbstractAbstract PDFPubReaderePub
Objectives

To evaluate sealing ability of root canals obturated with bioceramic-impregnated gutta percha cone (BCC) or gutta percha (GP), with bioceramic sealer (BCS) or AH Plus (AH; Dentsply-Maillefer), in roundly-prepared canals using matched single-cone technique, based on bacterial leakage test, and to analyze obturation quality using micro-computed tomography (CT) analysis.

Materials and Methods

Ninety-two distobuccal roots of maxillary molars were prepared using nickel-titanium files to apical size 40/0.06. The roots were divided into 4 groups (n = 20) that were obturated with a master cone and sealer: GP/AH, BCC/AH, GP/BCS, and BCC/BCS. Bacterial leakage model using Enterococcus faecalis was used to evaluate sealing ability for 60-day period. Obturated samples from each group (n = 4) were analyzed using micro-CT.

Results

All groups showed bacterial leakage at 20%–45% of samples with mean leakage times of 42–52 days. There were no significant differences in bacterial leakage among the groups. Micro-CT showed minimal gaps and voids in all groups at less than 1%.

Conclusions

In roundly-prepared canals, the single cone obturation with BCC/BCS was comparable to GP/AH for bacterial leakage at 60 days.

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Effects of a bleaching agent on properties of commercial glass-ionomer cements
Fernanda Lúcia Lago de Camargo, Ailla Carla Lancellotti, Adriano Fonseca de Lima, Vinícius Rangel Geraldo Martins, Luciano de Souza Gonçalves
Restor Dent Endod 2018;43(3):e32.   Published online July 5, 2018
DOI: https://doi.org/10.5395/rde.2018.43.e32
AbstractAbstract PDFPubReaderePub
Objectives

This study evaluated the effects of a bleaching agent on the composition, mechanical properties, and surface topography of 6 conventional glass-ionomer cements (GICs) and one resin-modified GIC.

Materials and Methods

For 3 days, the specimens were subjected to three 20-minute applications of a 37% H2O2-based bleaching agent and evaluated for water uptake (WTK), weight loss (WL), compressive strength (CS), and Knoop hardness number (KHN). Changes in surface topography and chemical element distribution were also analyzed by energy-dispersive X-ray spectroscopy and scanning electron microscopy. For statistical evaluation, the Kruskal-Wallis and Wilcoxon paired tests (α = 0.05) were used to evaluate WTK and WL. CS specimens were subjected to 2-way analysis of variance (ANOVA) and the Tukey post hoc test (α = 0.05), and KH was evaluated by one-way ANOVA, the Holm-Sidak post hoc test (α = 0.05), and the t-test for independent samples (α = 0.05).

Results

The bleaching agent increased the WTK of Maxxion R, but did not affect the WL of any GICs. It had various effects on the CS, KHN, surface topography, and the chemical element distribution of the GICs.

Conclusions

The bleaching agent with 37% H2O2 affected the mechanical and surface properties of GICs. The extent of the changes seemed to be dependent on exposure time and cement composition.

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CBCT study of mandibular first molars with a distolingual root in Koreans
Hee-Ho Kim, Hyoung-Hoon Jo, Jeong-Bum Min, Ho-Keel Hwang
Restor Dent Endod 2018;43(3):e33.   Published online July 30, 2018
DOI: https://doi.org/10.5395/rde.2018.43.e33
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to investigate the prevalence of a separate distolingual root and to measure the thickness of the buccal cortical bone in mandibular first molars in Koreans using cone-beam computed tomography (CBCT) images.

Materials and Methods

High-quality CBCT data from 432 patients were analyzed in this study. The prevalence of a separate distolingual root of the mandibular first molar was investigated. The distance from the distobuccal and distolingual root apices to the outer surface of the buccal cortical bone was measured. We also evaluated the thickness of the buccal cortical bone.

Results

The prevalence of a separate distolingual root (2 separate distal roots with 1 canal in each root; 2R2C) was 23.26%. In mandibular first molars with 2R2C, the distance from the distobuccal root apex to the outer surface of the buccal cortical bone was 5.51 mm. Furthermore, the distance from the distolingual root apex to the outer surface of the buccal cortical bone was 12.09 mm. In mandibular first molars with 2R2C morphology, the thickness of the buccal cortical bone at the distobuccal root apex of the mandibular first molar was 3.30 mm. The buccal cortical bone at the distobuccal root apex was significantly thicker in the right side (3.38 mm) than the left side (3.09 mm) (p < 0.05).

Conclusions

A separate distolingual root is not rare in mandibular first molars in the Korean population. Anatomic and morphologic knowledge of the mandibular first molar can be useful in treatment planning, including surgical endodontic treatment.

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Case Reports
Revitalization of necrotic mature permanent incisors with apical periodontitis: a case report
Emre Nagas, M. Ozgur Uyanik, Zafer C. Cehreli
Restor Dent Endod 2018;43(3):e31.   Published online July 5, 2018
DOI: https://doi.org/10.5395/rde.2018.43.e31
AbstractAbstract PDFPubReaderePub

Despite considerable focus on the regenerative endodontic treatment of immature teeth with necrotic infected pulps and apical periodontitis, little data exist with regard to its possible implementation in necrotic permanent teeth with complete apical and radicular development. The present report describes the procedures and outcome of a regenerative endodontic treatment approach in 2 previously-traumatized incisors with closed apex with apical periodontitis. A 2-visit treatment procedure was employed. At initial visit, the root canals were copiously irrigated, followed by placement of a triple antibiotic paste containing ciprofloxacin, metronidazole, and clindamycin into the root canals. After 4 weeks, the antibiotic paste was removed, and apical bleeding was initiated with size 10 hand files beyond the apices. The root canals were coronally sealed with mineral trioxide aggregate, and the access cavities were restored with bonded resin composite. At post-operative 60 months, both teeth were remained asymptomatic, with the recall radiographs showing complete resolution of apical radiolucency and reestablishment of periradicular tissues. In both teeth, the dimensions of root space remained unchanged as verified by image analysis. The revitalization protocol utilizing root canal disinfection and induced apical bleeding in necrotic, closed-apex incisors may offer a clinically acceptable alternative to conventional root canal treatment.

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Management of a permanent maxillary first molar with unusual crown and root anatomy: a case report
Prateeksha Chowdhry, Pallavi Reddy, Mamta Kaushik
Restor Dent Endod 2018;43(3):e35.   Published online August 7, 2018
DOI: https://doi.org/10.5395/rde.2018.43.e35
AbstractAbstract PDFPubReaderePub

The aim of this article was to showcase the endodontic management of a maxillary first molar with an unusual crown and root anatomy. Clinical diagnosis of the roots and root canal configuration was confirmed by a cone-beam computed tomography (CBCT) and the detection of the canals was made using a dental operating microscope. CBCT images revealed the presence of 5 roots with Vertucci type I canal configuration in all, except, in the middle root which had 2 canals with type IV configuration. The 6 canal orifices were clinically visualized under the dental operating microscope. Clinicians should familiarize themselves with the latest technologies to get additional information in endodontic practice in order to enhance the outcomes of endodontic therapy.

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