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Volume 43 (4); November 2018
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Open Lecture on Statistics
Statistical notes for clinical researchers: analysis of covariance (ANCOVA)
Hae-Young Kim
Restor Dent Endod 2018;43(4):e43.   Published online October 22, 2018
DOI: https://doi.org/10.5395/rde.2018.43.e43
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Review Article
Unwanted effects due to interactions between dental materials and magnetic resonance imaging: a review of the literature
Sherin Jose Chockattu, Deepak Byathnal Suryakant, Sophia Thakur
Restor Dent Endod 2018;43(4):e39.   Published online August 30, 2018
DOI: https://doi.org/10.5395/rde.2018.43.e39
AbstractAbstract PDFPubReaderePub

Magnetic resonance imaging (MRI) is an advanced diagnostic tool used in both medicine and dentistry. Since it functions based on a strong uniform static magnetic field and radiofrequency pulses, it is advantageous over imaging techniques that rely on ionizing radiation. Unfortunately, the magnetic field and radiofrequency pulses generated within the magnetic resonance imager interact unfavorably with dental materials that have magnetic properties. This leads to unwanted effects such as artifact formation, heat generation, and mechanical displacement. These are a potential source of damage to the oral tissue surrounding the affected dental materials. This review aims to compile, based on the current available evidence, recommendations for dentists and radiologists regarding the safety and appropriate management of dental materials during MRI in patients with orthodontic appliances, maxillofacial prostheses, dental implants, direct and indirect restorative materials, and endodontic materials.

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Research Articles
Effects of the exposure site on histological pulpal responses after direct capping with 2 calcium-silicate based cements in a rat model
Panruethai Trongkij, Supachai Sutimuntanakul, Puangwan Lapthanasupkul, Chitpol Chaimanakarn, Rebecca Wong, Danuchit Banomyong
Restor Dent Endod 2018;43(4):e36.   Published online August 22, 2018
DOI: https://doi.org/10.5395/rde.2018.43.e36
AbstractAbstract PDFPubReaderePub
Objectives

Direct pulp capping is a treatment for mechanically exposed pulp in which a biocompatible capping material is used to preserve pulpal vitality. Biocompatibility tests in animal studies have used a variety of experimental protocols, particularly with regard to the exposure site. In this study, pulp exposure on the occlusal and mesial surfaces of molar teeth was investigated in a rat model.

Materials and Methods

A total of 58 maxillary first molars of Wistar rats were used. Forty molars were mechanically exposed and randomly assigned according to 3 factors: 1) the exposure site (occlusal or mesial), 2) the pulp-capping material (ProRoot White MTA or Bio-MA), and 3) 2 follow-up periods (1 day or 7 days) (n = 5 each). The pulp of 6 intact molars served as negative controls. The pulp of 12 molars was exposed without a capping material (n = 3 per exposure site for each period) and served as positive controls. Inflammatory cell infiltration and reparative dentin formation were histologically evaluated at 1 and 7 days using grading scores.

Results

At 1 day, localized mild inflammation was detected in most teeth in all experimental groups. At 7 days, continuous/discontinuous calcified bridges were formed at exposure sites with no or few inflammatory cells. No significant differences in pulpal response according to the exposure site or calcium-silicate cement were observed.

Conclusions

The location of the exposure site had no effect on rat pulpal healing. However, mesial exposures could be performed easily, with more consistent results. The pulpal responses were not significantly different between the 2 capping materials.

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Microtensile bond strength of CAD/CAM-fabricated polymer-ceramics to different adhesive resin cements
Leyla Sadighpour, Farideh Geramipanah, Zahra Ghasri, Mehrnoosh Neshatian
Restor Dent Endod 2018;43(4):e40.   Published online September 3, 2018
DOI: https://doi.org/10.5395/rde.2018.43.e40
AbstractAbstract PDFPubReaderePub
Objectives

This study evaluated the microtensile bond strength (µTBS) of polymer-ceramic and indirect composite resin with 3 classes of resin cements.

Materials and Methods

Two computer-aided design/computer-aided manufacturing (CAD/CAM)-fabricated polymer-ceramics (Enamic [ENA; Vita] and Lava Ultimate [LAV; 3M ESPE]) and a laboratory indirect composite resin (Gradia [GRA; GC Corp.]) were equally divided into 6 groups (n = 18) with 3 classes of resin cements: Variolink N (VAR; Vivadent), RelyX U200 (RXU; 3M ESPE), and Panavia F2 (PAN; Kuraray). The μTBS values were compared between groups by 2-way analysis of variance and the post hoc Tamhane test (α = 0.05).

Results

Restorative materials and resin cements significantly influenced µTBS (p < 0.05). In the GRA group, the highest μTBS was found with RXU (27.40 ± 5.39 N) and the lowest with VAR (13.54 ± 6.04 N) (p < 0.05). Similar trends were observed in the ENA group. In the LAV group, the highest μTBS was observed with VAR (27.45 ± 5.84 N) and the lowest with PAN (10.67 ± 4.37 N) (p < 0.05). PAN had comparable results to those of ENA and GRA, whereas the μTBS values were significantly lower with LAV (p = 0.001). The highest bond strength of RXU was found with GRA (27.40 ± 5.39 N, p = 0.001). PAN showed the lowest µTBS with LAV (10.67 ± 4.37 N; p < 0.001).

Conclusions

When applied according to the manufacturers' recommendations, the µTBS of polymer-ceramic CAD/CAM materials and indirect composites is influenced by the luting cements.

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Comparison of the ability of Reciproc and Reciproc Blue instruments to reach the full working length with or without glide path preparation
Mehmet Adıguzel, Pelin Tufenkci
Restor Dent Endod 2018;43(4):e41.   Published online November 1, 2018
DOI: https://doi.org/10.5395/rde.2018.43.e41
AbstractAbstract PDFPubReaderePub
Objectives

The purpose of the present study was to compare the mean preparation times and frequency with which Reciproc and Reciproc Blue instruments reached the full working length in mandibular molars, with or without glide path preparation.

Materials and Methods

Previously untreated mesiobuccal and mesiolingual canals with completely formed apices were randomly divided into 6 groups (n = 50) depending on the usage of Reciproc (RC; VDW), Reciproc Blue (RC Blue; VDW), C-Pilot (CP; VDW), and R-Pilot (RP; VDW) files: RC, RC Blue, RC + C-Pilot (RC-CP), RC-Blue + C-Pilot (RC Blue-CP), RC+R-Pilot (RC-RP), and RC Blue + R-Pilot (RC Blue-RP). A glide path was prepared using the hand-operated C-Pilot or the machine-operated R-Pilot instruments, respectively. The χ2 test, analysis of variance, and the Tukey post hoc test were used for statistical comparisons.

Results

No statistically significant differences were observed in the distribution of the frequency of reaching the full working length in the RC (94%), RC Blue (88%), RC-CP (94%), RC Blue-CP (90%), RC-RP (96%), and RC Blue-RP (92%) groups (p > 0.05).

Conclusions

Preparation of a glide path did not have a significant effect on reaching the full working length using these systems.

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C-shaped root canals of mandibular second molars in a Korean population: a CBCT analysis
Hee-Sun Kim, Daun Jung, Ho Lee, Yoon-Sic Han, Sohee Oh, Hye-Young Sim
Restor Dent Endod 2018;43(4):e42.   Published online November 1, 2018
DOI: https://doi.org/10.5395/rde.2018.43.e42
AbstractAbstract PDFPubReaderePub
Objectives

The purpose of this study was to investigate the C-shaped root canal anatomy of mandibular second molars in a Korean population.

Materials and Methods

A total of 542 teeth were evaluated using cone-beam computed tomography (CBCT). The canal shapes were classified according to a modified version of Melton's method at the level where the pulp chamber floor became discernible.

Results

Of the 542 mandibular second molars, 215 (39.8%) had C-shaped canals, 330 (53%) had 3 canals, 17 (3.3%) had 2 canals, 12 (2.2%) had 4 canals, and 8 (1.7%) had 1 canal. The prevalence of C-shaped canals was 47.8% in females and 28.4% in males. Seventy-seven percent of the C-shaped canals showed a bilateral appearance. The prevalence of C-shaped canals showed no difference according to age or tooth position. Most teeth with a C-shaped canal system presented Melton's type II (45.6%) and type III (32.1%) configurations.

Conclusions

There was a high prevalence of C-shaped canals in the mandibular second molars of the Korean population studied. CBCT is expected to be useful for endodontic diagnosis and treatment planning of mandibular second molars.

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Effect of casein phosphopeptide-amorphous calcium phosphate on fluoride release and micro-shear bond strength of resin-modified glass ionomer cement in caries-affected dentin
Jamila Nuwayji Agob, Neven Saad Aref, Essam El Saeid Al-Wakeel
Restor Dent Endod 2018;43(4):e45.   Published online October 30, 2018
DOI: https://doi.org/10.5395/rde.2018.43.e45
AbstractAbstract PDFPubReaderePub
Objectives

This study was conducted to evaluate fluoride release and the micro-shear bond strength of resin-modified glass ionomer cement (RMGIC) in casein phosphopeptide-amorphous calcium phosphate (CPP-ACP)-remineralized caries-affected dentin (CAD).

Materials and Methods

Exposed dentin surfaces of 30 human third molar teeth were divided into 2 equal groups for evaluating fluoride release and the micro-shear bond strength of RMGIC to CAD. Each group was subdivided into 3 equal subgroups: 1) control (sound dentin); 2) artificially demineralized dentin (CAD); 3) CPP-ACP remineralized dentin (remineralized CAD). To measure fluoride release, 15 disc-shaped specimens of RMGIC (4 mm in diameter and 2 mm in thickness) were bonded on one flat surface of the dentin discs of each group. Fluoride release was tested using ion chromatography at different intervals; 24 hours, 3, 5, 7 days. RMGIC micro-cylinders were built on the flat dentin surface of the 15 discs, which were prepared according to the assigned group. Micro-shear bond strength was measured after 24 hours water storage. Data were analyzed using 1- and 2-way analysis of variance and the post hoc least significant difference test (α = 0.05).

Results

Fluoride detected in solutions (at all intervals) and the micro-shear bond strength of RMGIC bonded to CPP-ACP-remineralized dentin were significantly higher than those bonded to artificial CAD (p < 0.05).

Conclusions

Demineralized CAD consumes more fluoride released from RMGIC into the solution for remineralization than CPP-ACP mineralized dentin does. CPP-ACP increases the micro-shear bond strength of RMGIC to CAD.

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Improved dentin disinfection by combining different-geometry rotary nickel-titanium files in preparing root canals
Marwa M. Bedier, Ahmed Abdel Rahman Hashem, Yosra M. Hassan
Restor Dent Endod 2018;43(4):e46.   Published online November 1, 2018
DOI: https://doi.org/10.5395/rde.2018.43.e46
AbstractAbstract PDFPubReaderePub
Objectives

This study was to evaluate the antibacterial effect of different instrumentation and irrigation techniques using confocal laser scanning microscopy (CLSM) after root canal inoculation with Enterococcus faecalis (E. faecalis).

Materials and Methods

Mesiobuccal and mesiolingual canals of extracted mandibular molars were apically enlarged up to a size 25 hand K-file, then autoclaved and inoculated with E. faecalis. The samples were randomly divided into 4 main groups according to the system of instrumentation and irrigation: an XP-endo Shaper (XPS) combined with conventional irrigation (XPS/C) or an XP-endo Finisher (XPF) (XPS/XPF), and iRaCe combined with conventional irrigation (iRaCe/C) or combined with an XPF (iRaCe/XPF). A middle-third sample was taken from each group, and then the bacterial reduction was evaluated using CLSM at a depth of 50 µm inside the dentinal tubules. The ratio of red fluorescence (dead cells) to green-and-red fluorescence (live and dead cells) represented the percentage of bacterial reduction. The data were then statistically analyzed using the Kruskal-Wallis test for comparisons across the groups and the Dunn test was used for pairwise comparisons.

Results

The instrumentation and irrigation techniques had a significant effect on bacterial reduction (p < 0.05). The iRaCe/XPF group showed the strongest effect, followed by the XPS/XPF and XPS/C group, while the iRaCe/C group had the weakest effect.

Conclusions

Combining iRaCe with XPF improved its bacterial reduction effect, while combining XPS with XPF did not yield a significant improvement in its ability to reduce bacteria at a depth of 50 µm in the dentinal tubules.

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Influence of thickness and incisal extension of indirect veneers on the biomechanical behavior of maxillary canine teeth
Victória Luswarghi Souza Costa, João Paulo Mendes Tribst, Eduardo Shigueyuki Uemura, Dayana Campanelli de Morais, Alexandre Luiz Souto Borges
Restor Dent Endod 2018;43(4):e48.   Published online November 12, 2018
DOI: https://doi.org/10.5395/rde.2018.43.e48
AbstractAbstract PDFPubReaderePub
Objectives

To analyze the influence of thickness and incisal extension of indirect veneers on the stress and strain generated in maxillary canine teeth.

Materials and Methods

A 3-dimensional maxillary canine model was validated with an in vitro strain gauge and exported to computer-assisted engineering software. Materials were considered homogeneous, isotropic, and elastic. Each canine tooth was then subjected to a 0.3 and 0.8 mm reduction on the facial surface, in preparations with and without incisal covering, and restored with a lithium disilicate veneer. A 50 N load was applied at 45° to the long axis of the tooth, on the incisal third of the palatal surface of the crown.

Results

The results showed a mean of 218.16 µstrain of stress in the in vitro experiment, and 210.63 µstrain in finite element analysis (FEA). The stress concentration on prepared teeth was higher at the palatal root surface, with a mean value of 11.02 MPa and varying less than 3% between the preparation designs. The veneers concentrated higher stresses at the incisal third of the facial surface, with a mean of 3.88 MPa and a 40% increase in less-thick veneers. The incisal cover generated a new stress concentration area, with values over 48.18 MPa.

Conclusions

The mathematical model for a maxillary canine tooth was validated using FEA. The thickness (0.3 or 0.8 mm) and the incisal covering showed no difference for the tooth structure. However, the incisal covering was harmful for the veneer, of which the greatest thickness was beneficial.

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Case Reports
Endocrown restorations for extensively damaged posterior teeth: clinical performance of three cases
Konstantinos Tzimas, Maria Tsiafitsa, Paris Gerasimou, Effrosyni Tsitrou
Restor Dent Endod 2018;43(4):e38.   Published online August 22, 2018
DOI: https://doi.org/10.5395/rde.2018.43.e38
AbstractAbstract PDFPubReaderePub

The restoration of endodontically treated teeth (ETT) with more than one cusp missing and thin remaining walls is challenging for the general practitioner. The use of posts combined with full coverage restorations is a well-established approach, yet not following the minimal invasive principles of adhesive dentistry. Endocrowns are indirect monoblock restorations that use the pulp chamber of the ETT for retention. In this study the fabrication of 4 endocrowns and their clinical performance will be discussed. Two clinical cases include computer-aided design/computer-aided manufacturing manufactured molar endocrowns (one feldspathic ceramic and one hybrid composite-ceramic restoration) and the other two are dental laboratory manufactured resin composite premolar endocrown restorations. The modified United States Public Health Service criteria were used to assess the clinical behavior of the restorations at different follow up periods. Endocrown restorations present a satisfactory clinical alternative, either by the use of resin composite or glass ceramic and hybrid materials. Specific guidelines with minimal alterations should be followed for an endocrown restoration to be successful. Due to limited evidence regarding the long term evaluation of this restorative technique, a careful selection of cases should be applied.

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Endodontic management of central incisor associated with large periapical lesion and fused supernumerary root: a conservative approach
Gautam P. Badole, Pratima R. Shenoi, Ameya Parlikar
Restor Dent Endod 2018;43(4):e44.   Published online October 26, 2018
DOI: https://doi.org/10.5395/rde.2018.43.e44
AbstractAbstract PDFPubReaderePub

Fusion and gemination are developmental anomalies of teeth that may require endodontic treatment. Fusion may cause various clinical problems related to esthetics, tooth spacing, and other periodontal complications. Additional diagnostic tools are required for the diagnosis and the treatment planning of fused tooth. The present case report describes a case of unilateral fusion of a supernumerary root to an upper permanent central incisor with large periapical lesion in which a conservative approach was used without extraction of supernumerary tooth and obturated with mineral trioxide aggregate to reach a favorable outcome.

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