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Volume 41 (4); November 2016
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Review Article
Translucency changes of direct esthetic restorative materials after curing, aging and treatment
Yong-Keun Lee
Restor Dent Endod 2016;41(4):239-245.   Published online July 14, 2016
DOI: https://doi.org/10.5395/rde.2016.41.4.239
AbstractAbstract PDFPubReaderePub

The purpose of this article was to review the changes in translucency of direct esthetic restorative materials after curing, aging and treatment. As a criterion for the evaluation of clinical translucency changes, visual perceptibility threshold in translucency parameter difference (ΔTP) of 2 was used. Translucency changes after curing were perceivable depending on experimental methods and products (largest ΔTP in resin composites = 15.9). Translucency changes after aging were reported as either relatively stable or showed perceivable changes by aging protocols (largest ΔTP in resin composites = -3.8). Translucency changes after curing, aging and treatment were perceivable in several products and experimental methods. Therefore, shade matching of direct esthetic materials should be performed considering these instabilities of translucency in direct esthetic materials.

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Research Articles
Carbohydrate-electrolyte drinks exhibit risks for human enamel surface loss
Mary Anne Sampaio de Melo, Vanara Florêncio Passos, Juliana Paiva Marques Lima, Sérgio Lima Santiago, Lidiany Karla Azevedo Rodrigues
Restor Dent Endod 2016;41(4):246-254.   Published online August 16, 2016
DOI: https://doi.org/10.5395/rde.2016.41.4.246
AbstractAbstract PDFPubReaderePub
Objectives

The aim of this investigation was to give insights into the impact of carbohydrate-electrolyte drinks on the likely capacity of enamel surface dissolution and the influence of human saliva exposure as a biological protective factor.

Materials and Methods

The pH, titratable acidity (TA) to pH 7.0, and buffer capacity (β) of common beverages ingested by patients under physical activity were analyzed. Then, we randomly distributed 50 specimens of human enamel into 5 groups. Processed and natural coconut water served as controls for testing three carbohydrate-electrolyte drinks. In all specimens, we measured surface microhardness (Knoop hardness numbers) and enamel loss (profilometry, µm) for baseline and after simulated intake cycling exposure model. We also prepared areas of specimens to be exposed to human saliva overnight prior to the simulated intake cycling exposure. The cycles were performed by alternated immersions in beverages and artificial saliva. ANOVA two-way and Tukey HDS tests were used.

Results

The range of pH, TA, and β were 2.85 - 4.81, 8.33 - 46.66 mM/L and 3.48 - 10.25 mM/L × pH, respectively. The highest capacity of enamel surface dissolution was found for commercially available sports drinks for all variables. Single time human saliva exposure failed to significantly promote protective effect for the acidic attack of beverages.

Conclusions

In this study, carbohydrate-electrolyte drinks usually consumed during endurance training may have a greater capacity of dissolution of enamel surface depending on their physicochemical proprieties associated with pH and titratable acidity.

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Elemental analysis of caries-affected root dentin and artificially demineralized dentin
Young-Hye Sung, Ho-Hyun Son, Keewook Yi, Juhea Chang
Restor Dent Endod 2016;41(4):255-261.   Published online August 19, 2016
DOI: https://doi.org/10.5395/rde.2016.41.4.255
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to analyze the mineral composition of naturally- and artificially-produced caries-affected root dentin and to determine the elemental incorporation of resin-modified glass ionomer (RMGI) into the demineralized dentin.

Materials and Methods

Box-formed cavities were prepared on buccal and lingual root surfaces of sound human premolars (n = 15). One cavity was exposed to a microbial caries model using a strain of Streptococcus mutans. The other cavity was subjected to a chemical model under pH cycling. Premolars and molars with root surface caries were used as a natural caries model (n = 15). Outer caries lesion was removed using a carbide bur and a hand excavator under a dyeing technique and restored with RMGI (FujiII LC, GC Corp.). The weight percentages of calcium (Ca), phosphate (P), and strontium (Sr) and the widths of demineralized dentin were determined by electron probe microanalysis and compared among the groups using ANOVA and Tukey test (p < 0.05).

Results

There was a pattern of demineralization in all models, as visualized with scanning electron microscopy. Artificial models induced greater losses of Ca and P and larger widths of demineralized dentin than did a natural caries model (p < 0.05). Sr was diffused into the demineralized dentin layer from RMGI.

Conclusions

Both microbial and chemical caries models produced similar patterns of mineral composition on the caries-affected dentin. However, the artificial lesions had a relatively larger extent of demineralization than did the natural lesions. RMGI was incorporated into the superficial layer of the caries-affected dentin.

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Healing outcomes of root canal treatment for C-shaped mandibular second molars: a retrospective analysis
Hye-Ra Ahn, Young-Mi Moon, Sung-Ok Hong, Min-Seock Seo
Restor Dent Endod 2016;41(4):262-270.   Published online August 29, 2016
DOI: https://doi.org/10.5395/rde.2016.41.4.262
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to evaluate the healing rate of non-surgical endodontic treatment between C-shaped and non-C-shaped mandibular second molars.

Materials and Methods

Clinical records and radiological images of patients who had undergone endodontic treatment on mandibular second molars between 2007 and 2014 were screened. The periapical index scoring system was applied to compare healing outcomes. Information about preoperative and postoperative factors as well as the demographic data of the patients was acquired and evaluated using chi-square and multinomial logistic regression tests.

Results

The total healing rate was 68.4%. Healing rates for the mandibular second molar were 70.9% in C-shaped canals (n = 79) and 66.6% in non-C-shaped ones (n = 117). The difference was not statistically significant.

Conclusions

The presence of a C-shaped canal in the mandibular second molar did not have a significantly negative effect on healing after treatment. Instead, proper pulpal diagnosis and final restoration were indicated as having significantly greater influence on the healing outcomes of C-shaped and non-C-shaped canals, respectively.

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Effects of radiant exposure and wavelength spectrum of light-curing units on chemical and physical properties of resin cements
Adriano Fonseca Lima, Stephanie Ellen Ferreira Formaggio, Lígia França Aires Zambelli, Alan Rodrigo Muniz Palialol, Giselle Maria Marchi, Cintia Helena Coury Saraceni, Marcelo Tavares de Oliveira
Restor Dent Endod 2016;41(4):271-277.   Published online September 26, 2016
DOI: https://doi.org/10.5395/rde.2016.41.4.271
AbstractAbstract PDFPubReaderePub
Objectives

In this study, we evaluated the influence of different radiant exposures provided by single-peak and polywave light-curing units (LCUs) on the degree of conversion (DC) and the mechanical properties of resin cements.

Materials and Methods

Six experimental groups were established for each cement (RelyX ARC, 3M ESPE; LuxaCore Dual, Ivoclar Vivadent; Variolink, DMG), according to the different radiant exposures (5, 10, and 20 J/cm2) and two LCUs (single-peak and polywave). The specimens were made (7 mm in length × 2 mm in width × 1 mm in height) using silicone molds. After 24 hours of preparation, DC measurement was performed using Fourier transform infrared spectrometry. The same specimens were used for the evaluation of mechanical properties (flexural strength, FS; elastic modulus, E) by a three-point bending test. Data were assessed for normality, after which two-way analysis of variance (ANOVA) and post hoc Tukey's test were performed.

Results

No properties of the Variolink cement were influenced by any of the considered experimental conditions. In the case of the RelyX ARC cement, DC was higher when polywave LCU was used; FS and E were not influenced by the conditions evaluated. The LuxaCore cement showed greater sensitivity to the different protocols.

Conclusions

On the basis of these results, both the spectrum of light emitted and the radiant exposure used could affect the properties of resin cements. However, the influence was material-dependent.

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Comparative assessment of antibacterial activity of different glass ionomer cements on cariogenic bacteria
Rahul Gaybarao Naik, Arun Suresh Dodamani, Mahesh Ravindra Khairnar, Harish Chaitram Jadhav, Manjiri Abhay Deshmukh
Restor Dent Endod 2016;41(4):278-282.   Published online September 20, 2016
DOI: https://doi.org/10.5395/rde.2016.41.4.278
AbstractAbstract PDFPubReaderePub
Objectives

Glass ionomer cements (GICs), which are biocompatible and adhesive to the tooth surface, are widely used nowadays for tooth restoration. They inhibit the demineralization and promote the remineralization of the tooth structure adjacent to the restoration, as well as interfere with bacterial growth. Hence, the present study was conducted to assess and compare the antimicrobial activity of three commercially available GICs against two cariogenic bacteria.

Materials and Methods

An agar plate diffusion test was used for evaluating the antimicrobial effect of three different GICs (Fuji IX, Ketac Molar, and d-tech) on Streptococcus mutans (S. mutans) and Lactobacillus acidophilus (L. acidophilus). Thirty plates were prepared and divided into two groups. The first group was inoculated with S. mutans, and the second group was inoculated with L. acidophilus. These plates were then incubated at 37℃ for 24 hours. Zones of bacterial growth inhibition that formed around each well were recorded in millimeters (mm).

Results

The zones of inhibition for Fuji IX, Ketac Molar, and d-tech on S. mutans were found to be 10.84 ± 0.22 mm, 10.23 ± 0.15 mm, and 15.65 ± 0.31 mm, respectively, whereas those for L. acidophilus were found to be 10.43 ± 0.12 mm, 10.16 ± 0.11 mm, and 15.57 ± 0.13 mm, respectively.

Conclusions

D-tech cement performed better in terms of the zone of bacterial inhibition against the two test bacteria, than the other two tested glass ionomers.

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In vitro characterization of human dental pulp stem cells isolated by three different methods
Ji-Hyun Jang, Hyeon-Woo Lee, Kyu Min Cho, Hee-Woong Shin, Mo Kwan Kang, Sang Hyuk Park, Euiseong Kim
Restor Dent Endod 2016;41(4):283-295.   Published online October 12, 2016
DOI: https://doi.org/10.5395/rde.2016.41.4.283
AbstractAbstract PDFPubReaderePub
Objectives

In this study, we characterized human dental pulp cells (HDPCs) obtained by different culture methods to establish the most suitable methodology for dental tissue engineering and regenerative endodontic applications.

Materials and Methods

HDPCs were isolated by the outgrowth method (HDPCs-OG), the enzymatic digestion method (collagenase/dispase/trypsin, HDPCs-ED), or the combination of both methods (HDPCs-Combined). The expression of mesenchymal stem cell markers (CD105, CD90, and CD73) was investigated. In vitro differentiation capacities of HDPCs into adipogenic, osteogenic, and chondrogenic lineages were compared. Differentiation markers were analyzed by quantitative reverse-transcription polymerase chain reaction (RT-PCR) and western blotting.

Results

Our data indicated that whole HDPCs-ED, HPDCs-OG, and HDPCs-Combined could be differentiated into adipogenic, chrondrogenic, and osteogenic cell types. However, we found that the methods for isolating and culturing HDPCs influence the differentiation capacities of cells. HDPCs-OG and HDPCs-ED were preferably differentiated into adipogenic and osteogenic cells, respectively. Differentiation markers shown by RT-PCR and western blotting analysis were mostly upregulated in the treated groups compared with the control groups.

Conclusions

Our findings confirmed that cell populations formed by two different culture methods and the combined culture method exhibited different properties. The results of this study could provide an insight into regenerative endodontic treatment using HDPCs.

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Effects of proanthocyanidin, a crosslinking agent, on physical and biological properties of collagen hydrogel scaffold
Yoorina Choi, Hee-Jin Kim, Kyung-San Min
Restor Dent Endod 2016;41(4):296-303.   Published online October 4, 2016
DOI: https://doi.org/10.5395/rde.2016.41.4.296
AbstractAbstract PDFPubReaderePub
Objectives

The purpose of the present study was to evaluate the effects of proanthocyanidin (PAC), a crosslinking agent, on the physical properties of a collagen hydrogel and the behavior of human periodontal ligament cells (hPDLCs) cultured in the scaffold.

Materials and Methods

Viability of hPDLCs treated with PAC was measured using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. The physical properties of PAC treated collagen hydrogel scaffold were evaluated by the measurement of setting time, surface roughness, and differential scanning calorimetry (DSC). The behavior of the hPDLCs in the collagen scaffold was evaluated by cell morphology observation and cell numbers counting.

Results

The setting time of the collagen scaffold was shortened in the presence of PAC (p < 0.05). The surface roughness of the PAC-treated collagen was higher compared to the untreated control group (p < 0.05). The thermogram of the crosslinked collagen exhibited a higher endothermic peak compared to the uncrosslinked one. Cells in the PAC-treated collagen were observed to attach in closer proximity to one another with more cytoplasmic extensions compared to cells in the untreated control group. The number of cells cultured in the PAC-treated collagen scaffolds was significantly increased compared to the untreated control (p < 0.05).

Conclusions

Our results showed that PAC enhanced the physical properties of the collagen scaffold. Furthermore, the proliferation of hPDLCs cultured in the collagen scaffold crosslinked with PAC was facilitated. Conclusively, the application of PAC to the collagen scaffold may be beneficial for engineering-based periodontal ligament regeneration in delayed replantation.

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Screw-in forces during instrumentation by various file systems
Jung-Hong Ha, Sang Won Kwak, Sung-Kyo Kim, Hyeon-Cheol Kim
Restor Dent Endod 2016;41(4):304-309.   Published online November 8, 2016
DOI: https://doi.org/10.5395/rde.2016.41.4.304
AbstractAbstract PDFPubReaderePub
Objectives

The purpose of this study was to compare the maximum screw-in forces generated during the movement of various Nickel-Titanium (NiTi) file systems.

Materials and Methods

Forty simulated canals in resin blocks were randomly divided into 4 groups for the following instruments: Mtwo size 25/0.07 (MTW, VDW GmbH), Reciproc R25 (RPR, VDW GmbH), ProTaper Universal F2 (PTU, Dentsply Maillefer), and ProTaper Next X2 (PTN, Dentsply Maillefer, n = 10). All the artificial canals were prepared to obtain a standardized lumen by using ProTaper Universal F1. Screw-in forces were measured using a custom-made experimental device (AEndoS-k, DMJ system) during instrumentation with each NiTi file system using the designated movement. The rotation speed was set at 350 rpm with an automatic 4 mm pecking motion at a speed of 1 mm/sec. The pecking depth was increased by 1 mm for each pecking motion until the file reach the working length. Forces were recorded during file movement, and the maximum force was extracted from the data. Maximum screw-in forces were analyzed by one-way ANOVA and Tukey's post hoc comparison at a significance level of 95%.

Results

Reciproc and ProTaper Universal files generated the highest maximum screw-in forces among all the instruments while M-two and ProTaper Next showed the lowest (p < 0.05).

Conclusions

Geometrical differences rather than shaping motion and alloys may affect the screw-in force during canal instrumentation. To reduce screw-in forces, the use of NiTi files with smaller cross-sectional area for higher flexibility is recommended.

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Case Reports
Apicoectomy of maxillary anterior teeth through a piezoelectric bony-window osteotomy: two case reports introducing a new technique to preserve cortical bone
Viola Hirsch, Meetu R. Kohli, Syngcuk Kim
Restor Dent Endod 2016;41(4):310-315.   Published online July 5, 2016
DOI: https://doi.org/10.5395/rde.2016.41.4.310
AbstractAbstract PDFPubReaderePub

Two case reports describing a new technique of creating a repositionable piezoelectric bony window osteotomy during apicoectomy in order to preserve bone and act as an autologous graft for the surgical site are described. Endodontic microsurgery of anterior teeth with an intact cortical plate and large periapical lesion generally involves removal of a significant amount of healthy bone in order to enucleate the diseased tissue and manage root ends. In the reported cases, apicoectomy was performed on the lateral incisors of two patients. A piezoelectric device was used to create and elevate a bony window at the surgical site, instead of drilling and destroying bone while making an osteotomy with conventional burs. Routine microsurgical procedures - lesion enucleation, root-end resection, and filling - were carried out through this window preparation. The bony window was repositioned to the original site and the soft tissue sutured. The cases were re-evaluated clinically and radiographically after a period of 12 - 24 months. At follow-up, radiographic healing was observed. No additional grafting material was needed despite the extent of the lesions. The indication for this procedure is when teeth present with an intact or near-intact buccal cortical plate and a large apical lesion to preserve the bone and use it as an autologous graft.

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Microsurgical re-treatment of an endodontically treated tooth with an apically located incomplete vertical root fracture: a clinical case report
Silvio Taschieri, Massimo Del Fabbro, Ahmed El Kabbaney, Igor Tsesis, Eyal Rosen, Stefano Corbella
Restor Dent Endod 2016;41(4):316-321.   Published online June 21, 2016
DOI: https://doi.org/10.5395/rde.2016.41.4.316
AbstractAbstract PDFPubReaderePub

Although it is challenging, the early diagnosis of a vertical root fracture (VRF) is crucial in order to ensure tooth preservation. The purpose of this clinical case report was to describe reparative surgery performed to treat a tooth affected by an incomplete VRF. A 26 year old male patient was suspected to have a VRF in a maxillary left central incisor, and an exploratory flap was performed in order to confirm the diagnosis. After detecting the fracture, the lesion was surgically treated, the fracture and the infected root-end were removed, and a platelet-rich plasma membrane was used to cover the defect in order to prevent bacterial migration. A 24 month clinical and radiological follow-up examination showed that the tooth was asymptomatic and that the healing process was in progress. The surgical approach described here may be considered an effective treatment for a combined endodontic-periodontal lesion originating from an incomplete VRF and a recurrent periapical lesion.

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Radix mesiolingualis and radix distolingualis: a case report of a tooth with an unusual morphology
Gurudutt Nayak, Himanshu Aeran, Inderpreet Singh
Restor Dent Endod 2016;41(4):322-331.   Published online July 14, 2016
DOI: https://doi.org/10.5395/rde.2016.41.4.322
AbstractAbstract PDFPubReaderePub

Variation in the root and canal morphology of the maxillary first molars is quite common. The most common configuration is 3 roots and 3 or 4 canals. Nonetheless, other possibilities still exist. The presence of an additional palatal root is rather uncommon and has been reported to have an incidence of 0.06 - 1.6% in varying populations studied. Whenever two palatal roots exist, one of them is the normal palatal root, the other is a supernumerary structure which can be located either mesiolingually (radix mesiolingualis) or distolingually (radix distolingualis). This case report describes successful endodontic treatment of a maxillary first molar with radix mesiolingualis and radix distolingualis. Identification of this variation was done through clinical examination along with the aid of multiangled radiographs, and an accurate assessment of this morphology was made with the help of a cone-beam computed tomography imaging. In addition to the literature review, this article also discusses the epidemiology, classifications, morphometric features, guidelines for diagnosis, and endodontic management of a maxillary first molar with extra-palatal root.

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Mandibular bone necrosis after use of paraformaldehyde-containing paste
Chi-hwan Lee, Yoorina Choi, Sujung Park
Restor Dent Endod 2016;41(4):332-337.   Published online November 8, 2016
DOI: https://doi.org/10.5395/rde.2016.41.4.332
AbstractAbstract PDFPubReaderePub

Paraformaldehyde has been used in the past as a pulpotomy agent. However, it has a severe cytotoxic effect and may cause alveolar bone necrosis. Depulpin, a devitalizing agent containing 49% paraformaldehyde, is no longer used frequently due to its severe side effects. In the two cases described in the present study, Depulpin was used as a devitalizing agent during root canal treatment. It caused a gradual loss of sensibility in adjacent teeth, gingival necrosis, and osteomyelitis. This case report demonstrates the serious side effects of using a paraformaldehyde-containing paste as a devitalizing agent for pulp, particularly mandibular bone necrosis.

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Open Lecture on Statistics
Statistical notes for clinical researchers: Definition and comparison of risk and odds
Hae-Young Kim
Restor Dent Endod 2016;41(4):338-340.   Published online October 4, 2016
DOI: https://doi.org/10.5395/rde.2016.41.4.338
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Readers' Forum
Relationship between laboratory bond strengths and clinical performance of dentin adhesives
Young-Kyung Kim
Restor Dent Endod 2016;41(4):341-342.   Published online October 10, 2016
DOI: https://doi.org/10.5395/rde.2016.41.4.341
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