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Volume 46 (4); November 2021
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Research Articles
Laboratory model to evaluate efficacy of an experimental titanium oxide nanofibers bleaching agent
Clayton Tran, Ellin Choi, Brittany Watu, Udochukwu Oyoyo, Christopher Perry, So Ran Kwon
Restor Dent Endod 2021;46(4):e47.   Published online September 2, 2021
DOI: https://doi.org/10.5395/rde.2021.46.e47
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to use a laboratory model to evaluate the efficacy of an experimental bleaching agent.

Materials and Methods

The model used human extracted molars that were treated and measured for bleaching efficacy. Teeth (n = 50) were distributed into 5 groups: Negative control (NC): immersion in water for 8 hours; Nanofibers (NFs): Experimental titanium dioxide nanofibers with stirring and light activation for 8 hours; Whitestrips (WS): Crest 3D White Glamorous White Whitestrips, 2 applications daily for 30 minutes, 14 days; 1% hydrogen peroxide (HP) standard: 1% hydrogen peroxide for 8 hours; and 30% HP standard: 30% hydrogen peroxide for 8 hours. Instrumental measurements were performed using a spectrophotometer. Results were recorded at baseline, 1-day post-bleaching, and 1-week post-bleaching. Kruskal-Wallis procedure was used to determine differences in color change. Pearson correlation was used to evaluate the relationship between visual and instrumental measurements. Tests of hypotheses were 2-sided with alpha = 0.05.

Results

There was no significant difference in color parameters (L1, a1, b1, and shade guide units [SGU]) at baseline (p > 0.05). There was a significant difference among the groups for overall color change (ΔE*ab) and change in shade guide units (ΔSGU) at 1-day and 1-week post-bleaching (p < 0.05). The higher the HP concentration, the higher the color change as expressed in ΔSGU and ΔE*ab. The negative control exceeded the perceptibility threshold of ΔE* = 1.2 regardless of time point. NFs showed a decrease in chroma, but were not statistically different compared to the negative control.

Conclusions

The laboratory model was successful in screening an experimental bleaching agent.

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Bone repair in defects filled with AH Plus sealer and different concentrations of MTA: a study in rat tibiae
Jessica Emanuella Rocha Paz, Priscila Oliveira Costa, Albert Alexandre Costa Souza, Ingrid Macedo de Oliveira, Lucas Fernandes Falcão, Carlos Alberto Monteiro Falcão, Maria Ângela Area Leão Ferraz, Lucielma Salmito Soares Pinto
Restor Dent Endod 2021;46(4):e48.   Published online September 2, 2021
DOI: https://doi.org/10.5395/rde.2021.46.e48
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to evaluate the effects on bone repair of different concentrations of mineral trioxide aggregate (MTA) added to AH Plus.

Materials and Methods

Bone tissue reactions were evaluated in 30 rats (Rattus norvegicus) after 7 and 30 days. In the AH + MTA10, AH + MTA20, and AH + MTA30 groups, defects in the tibiae were filled with AH Plus with MTA in proportions of 10%, 20% and 30%, respectively; in the MTA-FILL group, MTA Fillapex was used; and in the control group, no sealer was used. The samples were histologically analyzed to assess bone union and maturation. The Kruskal-Wallis and Mann-Whitney tests were performed for multiple pairwise comparisons (p ≤ 0.05).

Results

At the 7-day time point, AH + MTA10 was superior to MTA-FILL with respect to bone union, and AH + MTA20 was superior to MTA-FILL with respect to bone maturity (p < 0.05). At the 30-day time point, both the AH + MTA10 and AH + MTA20 experimental sealers were superior not only to MTA-FILL, but also to AH + MTA30 with respect to both parameters (p < 0.05). The results of the AH + MTA10 and AH + MTA20 groups were superior to those of the control group for both parameters and experimental time points (p < 0.05).

Conclusions

The results suggest the potential benefit of using a combination of these materials in situations requiring bone repair.

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Fracture incidence of Reciproc instruments during root canal retreatment performed by postgraduate students: a cross-sectional retrospective clinical study
Liliana Machado Ruivo, Marcos de Azevedo Rios, Alexandre Mascarenhas Villela, Alexandre Sigrist de Martin, Augusto Shoji Kato, Rina Andrea Pelegrine, Ana Flávia Almeida Barbosa, Emmanuel João Nogueira Leal Silva, Carlos Eduardo da Silveira Bueno
Restor Dent Endod 2021;46(4):e49.   Published online September 9, 2021
DOI: https://doi.org/10.5395/rde.2021.46.e49
AbstractAbstract PDFPubReaderePub
Objectives

To evaluate the fracture incidence of Reciproc R25 instruments (VDW) used during non-surgical root canal retreatments performed by students in a postgraduate endodontic program.

Materials and Methods

From the analysis of clinical record cards and periapical radiographs of root canal retreatments performed by postgraduate students using the Reciproc R25, a total of 1,016 teeth (2,544 root canals) were selected. The instruments were discarded after a single use. The general incidence of instrument fractures and its frequency was analyzed considering the group of teeth and the root thirds where the fractures occurred. Statistical analysis was performed using the χ2 test (p < 0.01).

Results

Seven instruments were separated during the procedures. The percentage of fracture in relation to the number of instrumented canals was 0.27% and 0.68% in relation to the number of instrumented teeth. Four fractures occurred in maxillary molars, 1 in a mandibular molar, 1 in a mandibular premolar and 1 in a maxillary incisor. A greater number of fractures was observed in molars when compared with the number of fractures observed in the other dental groups (p < 0.01). Considering all of the instrument fractures, 71.43% were located in the apical third and 28.57% in the middle third (p < 0.01). One instrument fragment was removed, one bypassed, while in 5 cases, the instrument fragment remained inside the root canal.

Conclusions

The use of Reciproc R25 instruments in root canal retreatments carried out by postgraduate students was associated with a low incidence of fractures.

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Errors in light-emitting diodes positioning when curing bulk fill and incremental composites: impact on properties after aging
Abdulrahman A. Balhaddad, Isadora M. Garcia, Haifa Maktabi, Maria Salem Ibrahim, Qoot Alkhubaizi, Howard Strassler, Fabrício M. Collares, Mary Anne S. Melo
Restor Dent Endod 2021;46(4):e51.   Published online September 24, 2021
DOI: https://doi.org/10.5395/rde.2021.46.e51
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to evaluate the effect of improper positioning single-peak and multi-peak lights on color change, microhardness of bottom and top, and surface topography of bulk fill and incremental composites after artificial aging for 1 year.

Materials and Methods

Bulk fill and incremental composites were cured using multi-peak and single-peak light-emitting diode (LED) following 4 clinical conditions: (1) optimal condition (no angulation or tip displacement), (2) tip-displacement (2 mm), (3) slight tip angulation (α = 20°) and (4) moderate tip angulation (α = 35°). After 1-year of water aging, the specimens were analyzed for color changes (ΔE), Vickers hardness, surface topography (Ra, Rt, and Rv), and scanning electron microscopy.

Results

For samples cured by single-peak LED, the improper positioning significantly increases the color change compared to the optimal position regardless of the type of composite (p < 0.001). For multi-peak LED, the type of resin composite and the curing condition displayed a significant effect on ΔE (p < 0.001). For both LEDs, the Vickers hardness and bottom/top ratio of Vickers hardness were affected by the type of composite and the curing condition (p < 0.01).

Conclusions

The bulk fill composite presented greater resistance to wear, higher color stability, and better microhardness than the incremental composite when subjected to improper curing. The multi-peak LED improves curing under improper conditions compared to single-peak LED. Prevention of errors when curing composites requires the attention of all personnel involved in the patient's care once the clinical relevance of the appropriate polymerization reflects on reliable long-term outcomes.

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Effect of hydrogel-based antibiotic intracanal medicaments on crown discoloration
Rayan B. Yaghmoor, Jeffrey A. Platt, Kenneth J. Spolnik, Tien Min Gabriel Chu, Ghaeth H. Yassen
Restor Dent Endod 2021;46(4):e52.   Published online October 5, 2021
DOI: https://doi.org/10.5395/rde.2021.46.e52
AbstractAbstract PDFPubReaderePub
Objectives

This study evaluated the effects of low and moderate concentrations of triple antibiotic paste (TAP) and double antibiotic paste (DAP) loaded into a hydrogel system on crown discoloration and explored whether application of an adhesive bonding agent prevented crown discoloration.

Materials and Methods

Intact human molars (n = 160) were horizontally sectioned 1 mm apical to the cementoenamel junction. The crowns were randomized into 8 experimental groups (calcium hydroxide, Ca[OH]2; 1, 10, and 1,000 mg/mL TAP and DAP; and no medicament. The pulp chambers in half of the samples were coated with an adhesive bonding agent before receiving the intracanal medicament. Color changes (ΔE) were detected by spectrophotometry after 1 day, 1 week, and 4 weeks, and after 5,000 thermal cycles, with ΔE = 3.7 as a perceptible threshold. The 1-sample t-test was used to determine the significance of color changes relative to 3.7. Analysis of variance was used to evaluate the effects of treatment, adhesive, and time on color change, and the level of significance was p < 0.05.

Results

Ca(OH)2 and 1 and 10 mg/mL DAP did not cause clinically perceivable tooth discoloration. Adhesive agent use significantly decreased tooth discoloration in the 1,000 mg/mL TAP group up to 4 weeks. However, adhesive use did not significantly improve coronal discoloration after thermocycling when 1,000 mg/mL TAP was used.

Conclusions

Ca(OH)2 and 1 and 10 mg/mL DAP showed no clinical discoloration. Using an adhesive significantly improved coronal discoloration up to 4 weeks with 1,000 mg/mL TAP.

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Push-out bond strength and marginal adaptation of apical plugs with bioactive endodontic cements in simulated immature teeth
Maria Aparecida Barbosa de Sá, Eduardo Nunes, Alberto Nogueira da Gama Antunes, Manoel Brito Júnior, Martinho Campolina Rebello Horta, Rodrigo Rodrigues Amaral, Stephen Cohen, Frank Ferreira Silveira
Restor Dent Endod 2021;46(4):e53.   Published online October 20, 2021
DOI: https://doi.org/10.5395/rde.2021.46.e53
AbstractAbstract PDFPubReaderePub
Objectives

This study evaluates the bond strength and marginal adaptation of mineral trioxide aggregate (MTA) Repair HP and Biodentine used as apical plugs; MTA was used as reference material for comparison.

Materials and Methods

A total of 30 single-rooted teeth with standardized, artificially created open apices were randomly divided into 3 groups (n = 10 per group), according to the material used to form 6-mm-thick apical plugs: group 1 (MTA Repair HP); group 2 (Biodentine); and group 3 (white MTA). Subsequently, the specimens were transversely sectioned to obtain 2 (cervical and apical) 2.5-mm-thick slices per root. Epoxy resin replicas were observed under a scanning electron microscope to measure the gap size at the material/dentin interface (the largest and smaller gaps were recorded for each replica). The bond strength of the investigated materials to dentin was determined using the push-out test. The variable bond strengths and gap sizes were evaluated independently at the apical and cervical root dentin slices. Data were analyzed using descriptive and analytic statistics.

Results

The comparison between the groups regarding the variables' bond strengths and gap sizes showed no statistical difference (p > 0.05) except for a single difference in the smallest gap at the cervical root dentin slice, which was higher in group 3 than in group 1 (p < 0.05).

Conclusions

The bond strength and marginal adaptation to root canal walls of MTA HP and Biodentine cement were comparable to white MTA.

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Change of phase transformation and bond strength of Y-TZP with various hydrofluoric acid etching
Mi-Kyung Yu, Eun-Jin Oh, Myung-Jin Lim, Kwang-Won Lee
Restor Dent Endod 2021;46(4):e54.   Published online October 20, 2021
DOI: https://doi.org/10.5395/rde.2021.46.e54
AbstractAbstract PDFPubReaderePub
Objectives

The purpose of this study was to quantify phase transformation after hydrofluoric acid (HF) etching at various concentrations on the surface of yttria-stabilized tetragonal zirconia polycrystal (Y-TZP), and to evaluate changes in bonding strength before and after thermal cycling.

Materials and Methods

A group whose Y-TZP surface was treated with tribochemical silica abrasion (TS) was used as the control. Y-TZP specimens from each experimental group were etched with 5%, 10%, 20%, and 40% HF solutions at room temperature for 10 minutes. First, to quantify the phase transformation, Y-TZP specimens (n = 5) treated with TS, 5%, 10%, 20% and 40% HF solutions were subjected to X-ray diffraction. Second, to evaluate the change in bond strength before and after thermal cycling, zirconia primer and MDP-containing resin cement were sequentially applied to the Y-TZP specimen. After 5,000 thermal cycles for half of the Y-TZP specimens, shear bond strength was measured for all experimental groups (n = 10).

Results

The monoclinic phase content in the 40% HF-treated group was higher than that of the 5%, 10%, and 20% HF-treated groups, but lower than that of TS-treated group (p < 0.05). The 40% HF-treated group showed significantly higher bonding strength than the TS, 5%, and 10% HF-treated groups, even after thermal cycling (p < 0.05).

Conclusions

Through this experiment, the group treated with SiO2 containing air-borne abrasion on the Y-TZP surface showed higher phase transformation and higher reduction in bonding strength after thermal cycling compared to the group treated with high concentration HF.

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Adhesive systems applied to dentin substrate under electric current: systematic review
Carolina Menezes Maciel, Tatiane Cristina Vieira Souto, Bárbara de Almeida Pinto, Laís Regiane Silva-Concilio, Kusai Baroudi, Rafael Pino Vitti
Restor Dent Endod 2021;46(4):e55.   Published online November 5, 2021
DOI: https://doi.org/10.5395/rde.2021.46.e55
AbstractAbstract PDFPubReaderePub
Objectives

The purpose of this systematic review was to collect and discuss the technique of adhesive systems application on dentin substrate under electric current.

Materials and Methods

The first search strategy was based on data available at PubMed, LILACS, Scielo, Scopus, and Cochrane Library, using a combination of descriptors such as “dentin bond agents OR adhesive system AND electric current OR electrobond” or “dentin bonding agents OR dentin bonding agent application OR adhesive system AND electric current OR electrobond”, with no limit regarding the publication year. The second search strategy was based on the articles' references found previously. An additional search strategy was applied that concerned the proposed theme in the SBU-UNICAMP (Unicamp's Library System Institutional Repository).

Results

Twelve studies published between 2006 and 2020 were found. The analyses of the selected studies showed that the use of electric current during adhesive systems application on dentin, whether conventional or self-conditioning, increases resinous monomer infiltration in the dentin substrate, which improves the hybridization processes and the bond strength of the restorative material to dentin.

Conclusions

Despite the favorable results related to the use of this technique, there is still no specific protocol for the application of adhesive systems under electric current.

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Combination of a new ultrasonic tip with rotary systems for the preparation of flattened root canals
Karina Ines Medina Carita Tavares, Jáder Camilo Pinto, Airton Oliveira Santos-Junior, Fernanda Ferrari Esteves Torres, Juliane Maria Guerreiro-Tanomaru, Mario Tanomaru-Filho
Restor Dent Endod 2021;46(4):e56.   Published online October 27, 2021
DOI: https://doi.org/10.5395/rde.2021.46.e56
AbstractAbstract PDFPubReaderePub
Objectives

This study evaluated 2 nickel-titanium rotary systems and a complementary protocol with an ultrasonic tip and a small-diameter instrument in flattened root canals.

Materials and Methods

Thirty-two human maxillary second premolars with flattened canals (buccolingual diameter ≥4 times larger than the mesiodistal diameter) at 9 mm from the radiographic apex were selected. The root canals were prepared by ProDesign Logic (PDL) 30/0.01 and 30/0.05 or Hyflex EDM (HEDM) 10/0.05 and 25/0.08 (n = 16), followed by application of the Flatsonic ultrasonic tip in the cervical and middle thirds and a PDL 25/0.03 file in the apical third (FPDL). The teeth were scanned using micro-computed tomography before and after the procedures. The percentage of volume increase, debris, and uninstrumented surface area were analyzed using the Kruskal-Wallis, Dunn, Wilcoxon, analysis of variance/Tukey, and paired and unpaired t-tests (α = 0.05).

Results

No significant difference was found in the volume increase and uninstrumented surface area between PDL and HEDM (p > 0.05). PDL had a higher percentage of debris than HEDM in the middle and apical thirds (p < 0.05). The FPDL protocol resulted in less debris and uninstrumented surface area for PDL and HEDM (p < 0.05). This protocol, with HEDM, reduced debris in the middle and apical thirds and uninstrumented surface area in the apical third (p < 0.05).

Conclusions

High percentages of debris and uninstrumented surface area were observed after preparation of flattened root canals. The HEDM, Flatsonic tip, and 25/0.03 instrument protocol enhanced cleaning in flattened root canals.

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Porosity and pore size distribution in high-viscosity and conventional glass ionomer cements: a micro-computed tomography study
Aline Borburema Neves, Laísa Inara Gracindo Lopes, Tamiris Gomes Bergstrom, Aline Saddock Sá da Silva, Ricardo Tadeu Lopes, Aline de Almeida Neves
Restor Dent Endod 2021;46(4):e57.   Published online October 29, 2021
DOI: https://doi.org/10.5395/rde.2021.46.e57
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to compare and evaluate the porosity and pore size distribution of high-viscosity glass ionomer cements (HVGICs) and conventional glass ionomer cements (GICs) using micro-computed tomography (micro-CT).

Materials and Methods

Forty cylindrical specimens (n = 10) were produced in standardized molds using HVGICs and conventional GICs (Ketac Molar Easymix, Vitro Molar, MaxxionR, and Riva Self-Cure). The specimens were prepared according to ISO 9917-1 standards, scanned in a high-energy micro-CT device, and reconstructed using specific parameters. After reconstruction, segmentation procedures, and image analysis, total porosity and pore size distribution were obtained for specimens in each group. After checking the normality of the data distribution, the Kruskal-Wallis test followed by the Student-Newman-Keuls test was used to detect differences in porosity among the experimental groups with a 5% significance level.

Results

Ketac Molar Easymix showed statistically significantly lower total porosity (0.15%) than MaxxionR (0.62%), Riva (0.42%), and Vitro Molar (0.57%). The pore size in all experimental cements was within the small-size range (< 0.01 mm3), but Vitro Molar showed statistically significantly more pores/defects with a larger size (> 0.01 mm3).

Conclusions

Major differences in porosity and pore size were identified among the evaluated GICs. Among these, the Ketac Molar Easymix HVGIC showed the lowest porosity and void size.

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The effect of using nanoparticles in bioactive glass on its antimicrobial properties
Maram Farouk Obeid, Kareim Moustafa El-Batouty, Mohammed Aslam
Restor Dent Endod 2021;46(4):e58.   Published online October 29, 2021
DOI: https://doi.org/10.5395/rde.2021.46.e58
AbstractAbstract PDFPubReaderePub
Objectives

This study addresses the effect of using nanoparticles (np) on the antimicrobial properties of bioactive glass (BAG) when used in intracanal medicaments against Enterococcus faecalis (E. faecalis) biofilms.

Materials and Methods

E. faecalis biofilms, grown inside 90 root canals for 21 days, were randomly divided into 4 groups according to the antimicrobial regimen followed (n = 20; BAG-np, BAG, calcium hydroxide [CaOH], and saline). After 1 week, residual live bacteria were quantified in terms of colony-forming units (CFU), while dead bacteria were assessed with a confocal laser scanning microscope.

Results

Although there was a statistically significant decrease in the mean CFU value among all groups, the nano-group performed the best. The highest percentage of dead bacteria was detected in the BAG-np group, with a significant difference from the BAG group.

Conclusions

The reduction of particle size and use of a nano-form of BAG improved the antimicrobial properties of the intracanal treatment of E. faecalis biofilms

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Comparative analysis of bond strength to root dentin and compression of bioceramic cements used in regenerative endodontic procedures
Maykely Naara Morais Rodrigues, Kely Firmino Bruno, Ana Helena Gonçalves de Alencar, Julyana Dumas Santos Silva, Patrícia Correia de Siqueira, Daniel de Almeida Decurcio, Carlos Estrela
Restor Dent Endod 2021;46(4):e59.   Published online November 9, 2021
DOI: https://doi.org/10.5395/rde.2021.46.e59
AbstractAbstract PDFPubReaderePub
Objectives

This study compared the Biodentine, MTA Repair HP, and Bio-C Repair bioceramics in terms of bond strength to dentin, failure mode, and compression.

Materials and Methods

Fifty-four slices obtained from the cervical third of 18 single-rooted human mandibular premolars were randomly distributed (n = 18). After insertion of the bioceramic materials, the push-out test was performed. The failure mode was analyzed using stereomicroscopy. Another set of cylindrically-shaped bioceramic samples (n = 10) was prepared for compressive strength testing. The normality of data distribution was analyzed using the Shapiro-Wilk test. The Kruskal-Wallis and Friedman tests were used for the push-out test data, while compressive strength was analyzed with analysis of variance and the Tukey test, considering a significance level of 0.05.

Results

Biodentine presented a higher median bond strength value (14.79 MPa) than MTA Repair HP (8.84 MPa) and Bio-C Repair (3.48 MPa), with a significant difference only between Biodentine and Bio-C Repair. In the Biodentine group, the most frequent failure mode was mixed (61%), while in the MTA Repair HP and Bio-C Repair groups, it was adhesive (94% and 72%, respectively). Biodentine showed greater resistance to compression (29.59 ± 8.47 MPa) than MTA Repair HP (18.68 ± 7.40 MPa) and Bio-C Repair (19.96 ± 3.96 MPa) (p < 0.05).

Conclusions

Biodentine showed greater compressive strength than MTA Repair HP and Bio-C Repair, and greater bond strength than Bio-C Repair. The most frequent failure mode of Biodentine was mixed, while that of MTA Repair HP and Bio-C Repair was adhesive.

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Spectrophotometric evaluation of restorative composite shades and their match with a classical shade guide
Rafael Melara, Luciana Mendonça, Fábio Herrmann Coelho-de-Souza, Juliana Nunes Rolla, Luciano de Souza Gonçalves
Restor Dent Endod 2021;46(4):e60.   Published online November 12, 2021
DOI: https://doi.org/10.5395/rde.2021.46.e60
AbstractAbstract PDFPubReaderePub
Objectives

The aim of this study was to verify the match between 5 shades of composites from different manufacturers with a shade guide and among the systems using a portable spectrophotometer.

Materials and Methods

Shade measurements were performed on specimens of Z350 XT (3M ESPE), Charisma Diamond (Heraeus Kulzer GmbH), Esthet X-HD (Dentsply Caulk), and Empress Direct (Ivoclar-Vivadent) for shades A1, A2, A3, B1, and C3 using a Vita Easyshade spectrophotometer (Vita Zahnfabrik) against a white background. Corresponding shades of Vitapan Classical (Vita Zahnfabrik) guide were measured likewise and shade variation (ΔE) was calculated based on International Commission on Illumination L*a*b* parameters. The ΔE of the composites in each shade was compared by one-way analysis of variance and Tukey's post hoc test (α = 0.05).

Results

All composites presented ΔE > 3.7 compared with the shade guide. Variation in shades A3, B1, and C3 was significantly different for all composites. ΔE of Z350 XT was significantly lower for A1 than for the other shades, whereas ΔE of Z350 XT and Charisma Diamond were significantly lower for A2 than for the other shades.

Conclusions

No composite shade matched with the shade guide. Equivalent shades of the restorative composite from different manufacturers may show clinically noticeable ΔE.

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Case Report
Fiber-reinforced composite post removal using guided endodontics: a case report
Changgi Cho, Hyo Jin Jo, Jung-Hong Ha
Restor Dent Endod 2021;46(4):e50.   Published online September 23, 2021
DOI: https://doi.org/10.5395/rde.2021.46.e50
AbstractAbstract PDFPubReaderePub

Although several techniques have been proposed to remove fiber-reinforced composite (FRC) post, no safe and efficient technique has been established. Recently, a guided endodontics technique has been introduced in cases of pulp canal obliteration. This study describes 2 cases of FRC post removal from maxillary anterior teeth using this guided endodontics technique with a dental operating microscope. Optically scanned data set from plaster cast model was superimposed with the data set of cone-beam computed tomography. By implant planning software, the path of a guide drill was selected. Based on them, a customized stent was fabricated and utilized to remove the FRC post. Employing guided endodontics, the FRC post was removed quickly and safely with minimizing the loss of the remaining tooth structure. The guided endodontics was a useful option for FRC post removal.

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