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Volume 49 (4); November 2024
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Review Articles
Success rate of direct pulp capping on permanent teeth using bioactive materials: a systematic review and meta-analysis of randomized clinical trials
Karem Paula Pinto, Gabriela Ribeiro da Silva, Cláudio Malizia Alves Ferreira, Luciana Moura Sassone, Emmanuel João Nogueira Leal da Silva
Restor Dent Endod 2024;49(4):e34.   Published online September 6, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e34
AbstractAbstract PDFSupplementary MaterialPubReaderePub

This systematic review and meta-analysis aimed to evaluate the success rate of direct pulp capping (DPC) on permanent teeth, comparing the use of MTA with calcium hydroxide and calcium silicate-based cements. A systematic search was carried out in 4 databases until July 2023. The selection was based on PICOS criteria and only randomized clinical trials were included. The risk of bias was assessed using RoB-2 tool, and meta-analyses were performed using RevMan 5.3 software. The overall quality of evidence was determined using the GRADE tool. Thirteen studies were included. Meta-analyses indicated significantly higher success rate for DPC using MTA compared to calcium hydroxide, while no significant difference was observed between MTA and Biodentine, showing a success rate from 80% to 100% even after 3 years of follow-up. Five studies were classified as having high risk of bias and the GRADE assessment revealed low certainty of evidence. DPC is highly effective for permanent teeth when using MTA or Biodentine. There is a need for future well-designed randomized clinical trials to evaluate the efficacy of DPC using newer bioceramic materials.

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Comparative evaluation of the biological response of conventional and resin modified glass ionomer cement on human cells: a systematic review
Shishir Singh, Gaurav Kulkarni, R S Mohan Kumar, Romi Jain, Ameya M Lokhande, Teena K Sitlaney, Musharraf H F Ansari, Navin S Agarwal
Restor Dent Endod 2024;49(4):e41.   Published online November 1, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e41
AbstractAbstract PDFPubReaderePub

This review aimed to evaluate and compare the biological response (biocompatibility and cytotoxicity) of resin modified glass ionomer cement (RMGIC) in contrast to conventional glass ionomer cement (GIC) on human cells. Articles reporting parallel and split-mouth clinical trials, randomized controlled trials, non-randomized controlled trials, prospective studies, and in vitro studies on human permanent teeth that assessed the biological response of GIC and RMGIC were included. The following electronic bibliographic databases were searched using the keywords: MEDLINE/PubMed, EBSCO, Cochrane Central Register of Controlled Trials, and Google Scholar. For the risk of bias MINORS tool and the modified scale of Animal Research: Reporting of In Vivo Experiments and Consolidated Standards of Reporting Trials were used. Initial screening identified 552 studies, of which 9 articles met the inclusion criteria and were included in the study. Different parameters such as odontoblastic changes, inflammatory response, tertiary dentin formation, presence of microorganisms, morphological changes, cell viability, number, and metabolism were used to evaluate the biological response of conventional GIC and RMGICs. Conventional GIC shows lower cytotoxicity compared to RMGIC in vital pulp therapy procedures. Further, in vivo studies and long-term clinical trials are needed to compare these observations for pulp therapy using the 2 test materials.

Trial Registration

PROSPERO Identifier: CRD42023426021

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Influence of disinfecting solutions on the surface topography of gutta-percha cones: a systematic review of in vitro studies
Lora Mishra, Gathani Dash, Naomi Ranjan Singh, Manoj Kumar, Saurav Panda, Franck Diemer, Monika Lukomska-Szymanska, Barbara Lapinska, Abdul Samad Khan
Restor Dent Endod 2024;49(4):e42.   Published online November 1, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e42
AbstractAbstract PDFSupplementary MaterialPubReaderePub

The surface integrity of gutta-percha cones is a crucial factor in the success of endodontic procedures. Disinfecting solutions play a pivotal role in sterilizing gutta-percha cones, but their influence on gutta-percha surface topography remains a subject of concern. This systematic review aimed to present a qualitative synthesis of available laboratory studies assessing the influence of disinfecting solutions on the surface topography of gutta-percha and offers insights into the implications for clinical practice. The present review followed PRISMA 2020 guidelines. An advanced database search was performed in PubMed, Google Scholar, Embase, Scopus, LILAC, non-indexed citations and reference lists of eligible studies in May 2024. Laboratory studies, in English language, were considered for inclusion. The quality (risk of bias) of the included studies was assessed using parameters for in vitro studies. A total of 28 studies were included in the qualitative synthesis. Based on the included in vitro studies, surface deposits and alterations in the physical properties of gutta-percha cones were observed after the disinfection protocol. A comprehensive review of the available literature indicates that the choice of disinfecting solution, its concentration, and immersion time significantly affect the surface topography of gutta-percha cones.

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Research Articles
Effects of different curing methods on the color stability of composite resins
Massimo Pisano, Alfredo Iandolo, Dina Abdellatif, Andrea Chiacchio, Marzio Galdi, Stefano Martina
Restor Dent Endod 2024;49(4):e33.   Published online September 5, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e33
AbstractAbstract PDFPubReaderePub
Objectives

The aim of this study was to compare the effects of different polymerization strategies and the effectiveness of finishing and polishing procedures of composite resins on color stability.

Materials and Methods

The samples were divided into 4 main groups according to the polymerization strategy, and all groups except the control group received surface treatment. Each group was subsequently divided into 3 subgroups respectively: Kuraray Clearfil Majesty ES-2 Classic, Premium and Universal. Approximately 24 hours after preparation of the samples, they were immersed for 7 days in a coffee solution. A first color measurement was performed after the preparation of the samples, the second measurement was performed after 7 days in the coffee solution. All measurements were carried out using a dental spectrophotometer to assess the CIE L* a* b* color parameters.

Results

There was a statistically significant difference between ΔE values for different procedures (p = 0.003); in particular, the differences were found only between the groups that received surface treatment and the control group. In addition, a statistically significant difference was observed between the values of ΔE for different composites in the different procedure groups.

Conclusions

Spectrophotometric analysis showed that the additional photopolymerization and oxygen inhibition procedures did not yield better results in relation to color stability. In addition, finishing and polishing provided better color stability compared to not performing these procedures.

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Predictive factors in the retrieval of endodontic instruments: the relationship between the fragment length and location
Ricardo Portigliatti, Eugenia Pilar Consoli Lizzi, Pablo Alejandro Rodríguez
Restor Dent Endod 2024;49(4):e35.   Published online September 9, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e35
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to relate the file fragment length and location in the root canal to the retrieval chances, the clinical time required and the occurrence of secondary fractures.

Materials and Methods

Sixty clinical cases of fractured instruments were included in this study. They were classified according to the instrument length and the location of the root canal. In each group, the success rate in the instrument retrieval, the clinical time required and the occurrence of secondary fractures were evaluated. The collected data were analyzed using the Kruskal-Wallis test on the basis of a 0.05 significance level.

Results

The fragment length showed no significant influence on the assessed variables (p > 0.05). The root third where the instrument was located resulted in an increased clinical time, with statistically significant differences (p < 0.05). However, the procedure success rate and the occurrence of secondary fractures showed no association with these variables.

Conclusions

In accordance with the findings of this study, the fractured fragment length did not influence any of the variables assessed, but it is suggested to focus on the fragment location inside the root canal to decide the retrieval of a fractured instrument.

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Physical-mechanical, chemical and biological properties of graphene-reinforced glass ionomer cements
Tatiane Ramos dos Santos Jordão, Laura Soares Viana Fernandes, Karla Lorene de França Leite, Adílis Alexandria, Emmanuel João Nogueira Leal Silva, Lucianne Cople Maia, Tatiana Kelly da Silva Fidalgo
Restor Dent Endod 2024;49(4):e37.   Published online October 10, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e37
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to evaluate the physical-mechanical, chemical, and biological properties of graphene-reinforced glass ionomer cements (GICs).

Materials and Methods

Different proportions of graphene powder were incorporated into 2 high-viscosity self-curing GIC, Ketac Molar (GKetac) and Fuji IX (GFuji), in 4 different concentrations: 0.5%, 1%, 2%, and 5%. The control groups included the GICs without graphene. Experiments were performed to analyze linear (Ra) and volumetric roughness (Sa), antimicrobial activity, radiopacity, fluoride release, microhardness, solubility, and water sorption. Data were analyzed using Kruskal-Wallis, Mann-Whitney, Wilcoxon, analysis of variance, and Tukey’s test (p ≤ 0.05).

Results

The GKetac 0% and GFuji0% groups presented higher Ra (4.05 and 2.72) and Sa (4.76 and 5.16), respectively. No inhibition zone was observed, and the incorporation of graphene reduced radiopacity. Moreover, there was no influence on the solubility and water sorption after 21 days. A greater fluoride release was observed in the period of 7 days for most of the groups. After 21 days, GKetac 5%, 2%, and 1% presented higher releasing than 0% and 0.5% (p ≤ 0.05).

Conclusions

The graphene incorporation improved the microhardness of GICs in lower concentrations. Graphene incorporation to GICs modified some physical-mechanical, and chemical, but not affected biological properties.

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Fracture resistance after root canal filling removal using ProTaper Next, ProTaper Universal Retreatment or hybrid instrumentation: an ex vivo study
Hadeel Hassan Hanafy, Marwa Mahmoud Bedier, Suzan Abdul Wanees Amin
Restor Dent Endod 2024;49(4):e38.   Published online October 11, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e38
AbstractAbstract PDFPubReaderePub
Objectives

This study evaluated the effect of ProTaper Next (PTN), ProTaper Universal Retreatment (PTR) and hybrid instrumentation (HI) for canal filling removal on the fracture resistance (FR), mode of failure (MoF), and filling removal time.

Materials and Methods

Ninety-six, mandibular premolars were decoronated and randomly divided into 6 groups (n = 16), as follows: sound (S), untreated canals; prepared teeth (P), canals only prepared to ProTaper Universal finishing instrument (F4); endodontically-treated (ET), prepared and obturated canals using the single-cone technique; and groups PTN, PTR, and HI where filling was removed using PTN, PTR, or HI respectively. FR under vertical loading; MoF and time were assessed. Data were analyzed (Significance level [α] = 0.05).

Results

There was a significant difference in FR among all groups (p < 0.001) (HI < P < PTN < S < ET < PTR). HI showed lower FR than S, ET and PTR, and P showed lower FR than PTR (p < 0.05). For experimental groups, there was a significant difference between every group pair (p < 0.05) No significant difference was found regarding MoF distribution (p > 0.05). HI required the highest filling removal time, while PTR required the least (p < 0.05 between every group pair).

Conclusions

The effect of filling removal on FR may depend on the filling removal technique/system used. PTR could be faster and protect against fracture followed by PTN; HI could adversely affect FR. FR may be associated with filling removal time.

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Histological evaluation of pulp response to alendronate and Biodentine as pulp capping agents: an animal study
Thangavel Boopathi, Sekar Manimaran, Joseline Charles Kerena, Mathew Sebeena, Kumaravadivel Karthick, Natesan Thangaraj Deepa
Restor Dent Endod 2024;49(4):e39.   Published online October 29, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e39
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to comparatively assess the histological response of the pulp toward alendronate and Biodentine in a direct pulp capping procedure.

Materials and Methods

Twenty-four anterior teeth from 6 New Zealand rabbits were used in this study. Firstly, all rabbits were anesthetized according to their weight. Class V cavities were prepared on the buccal surfaces of anterior teeth. A pin-point exposure of the pulp was then made using a small, sterile round carbide bur and bleeding was arrested with a saline-soaked, sterile cotton pellet. The teeth under study were divided into 2 groups (n = 12). The intentionally exposed pulp was capped with alendronate (Group 1) and Biodentine (Group 2), correspondingly. After 30 days, all rabbits were euthanized; the teeth under study were extracted and taken up for histological analysis.

Results

Biodentine showed an intact, very dense dentin bridge formation with a uniform odontoblast (OD) layer pattern and mild or absent inflammatory response whereas specimens capped with alendronate demonstrated a dense dentin bridge formation with non-uniform OD layer pattern and mild to moderate inflammatory response.

Conclusions

Biodentine showed more biocompatibility than alendronate. However, alendronate can initiate reparative dentin formation and may be used as an alternative pulp capping agent.

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Evaluation of mineral induction ability and cytotoxicity of carbonated hydroxyapatite for pulp tissue regeneration: an in vitro study
S. Swathi Priyadharshini, Chinnasamy Ragavendran, Anand Sherwood, J. Ramana Ramya, Jogikalmat Krithikadatta
Restor Dent Endod 2024;49(4):e40.   Published online October 29, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e40
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to evaluate carbonated hydroxyapatite (CHA)’s ability for mineral induction and its in vitro cytotoxicity with human dental pulp cells.

Materials and Methods

Precursors for the study include di-ammonium hydrogen phosphate and calcium nitrate tetrahydrate, with sodium hydrogen carbonate added to achieve different levels of carbonate substitution. The synthesized CHA samples are characterized using X-ray diffraction, Fourier transform infrared spectroscopy, and Raman spectroscopy. Scanning electron microscopy (SEM) was used to observe morphology. For 14 days at 37°C, samples were submerged in simulated body fluid to assess their mineral induction capabilities. SEM was used to confirm apatite formation on sample surfaces. The cytotoxicity assay was used to assess the vitality of the cells following their exposure to various concentrations of CHA.

Results

The Joint Committee on Powder Diffraction Standards data for HA aligned well with the results from X-ray diffraction analysis of CHA across 3 different concentrations, indicating strong agreement. Fourier transform infrared spectra indicated the presence of phosphate, hydroxyl, and carbonate groups within the samples. SEM and Energy-dispersive X-ray analysis show agglomerated and flaky nanoparticles. All the samples are bioactive, but the formation of apatite differs from one another. In vitro cytotoxicity assay showed that over 70% of cells maintain viability.

Conclusions

The results of this study may provide insight into the potential use of carbonated HA as a dental pulp-capping material for vital pulp therapy.

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Case Report
Straightforward replication of digital wax-up design into direct composite resin restorations in adolescents using a custom 3-dimensionally printed index
Ra’fat Ibrahim Farah, Sanaa Najeh Al-Haj Ali, Abdullah Alharbi, Bandar Alresheedi
Restor Dent Endod 2024;49(4):e36.   Published online October 10, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e36
AbstractAbstract PDFPubReaderePub

This case report introduces a straightforward, noninvasive approach for the esthetic rehabilitation of malformed anterior teeth in adolescents using direct composite restorations. The universal composite resin restorations are applied within a transparent 3-dimensionally printed rigid-resin index, which is individually customized from a digital wax-up. Compared to other methods, this technique streamlines the restoration process, significantly reducing chairside time while enhancing the predictability, accuracy, and patient acceptance of the aesthetic outcome.

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Restor Dent Endod : Restorative Dentistry & Endodontics
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