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Case Report
Ingestion and surgical retrieval of an endodontic file: a case report
Devon Marta Ptak, Elinor Alon, Robert Bruce Amato, Julia Tassinari, Adrian Velasquez
Restor Dent Endod 2023;48(4):e32.   Published online September 2, 2023
DOI: https://doi.org/10.5395/rde.2023.48.e32
AbstractAbstract PDFPubReaderePub

Ingestions and aspirations of foreign bodies are rare, but do occasionally occur during dental treatment. Although reports exist, few include photos demonstrating the extensive surgical intervention that may be necessary to manage such events. Perhaps this lack of visualization, and associated lack of awareness, is one of the reasons some clinicians still provide non-surgical root canal therapy (NSRCT) without a rubber dam. This case report outlines the medical treatment of a 30-year-old male who initially presented to a general dentist’s office (not associated with the authors) for NSRCT of their mandibular right first molar. A rubber dam was not used for this procedure, during which the accidental ingestion of an endodontic K-file occurred. The patient was subsequently hospitalized for evaluation and treatment, consisting of numerous imaging studies, endoscopic evaluation, and surgical removal of the file from his small intestine. The ingestion of foreign bodies, and the associated complications, can be reduced through the routine use of a rubber dam, which is considered the standard of care for NSRCT. This case graphically illustrates the potential consequences associated with deviating from the standard of care and should remind clinicians that a rubber dam is necessary for all cases of NSRCT.

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Research Articles
Radiographic patterns of periosteal bone reactions associated with endodontic lesions
Poorya Jalali, Jessica Riccobono, Robert A. Augsburger, Mehrnaz Tahmasbi-Arashlow
Restor Dent Endod 2023;48(3):e23.   Published online June 8, 2023
DOI: https://doi.org/10.5395/rde.2023.48.e23
AbstractAbstract PDFPubReaderePub
Objectives

The formation of new bone by periosteum due to an insult is called periosteal bone reaction (PBR). This study assessed the cone beam computed tomography (CBCT) patterns of periosteal bone reactions associated with periapical inflammatory lesion (apical periodontitis/periapical rarefying osteitis).

Materials and Methods

Twenty-two small field of view CBCT images of patients with PBR were selected from a database of a private practice limited to endodontics. The volume of the periapical inflammatory lesion, the presence of cortical fenestration, the distance of the root apices to the affected cortex, and the location, pattern, and longest diameter of the periosteal reaction were recorded. Statistical analysis was performed using Wilcoxon Ranksum, Fischer’s exact, Spearman Correlation Coefficient, and paired t-test.

Results

In all cases, periosteal bone reaction manifested as either parallel (90.9%) or irregular (9.1%). No correlation was found between periapical inflammatory lesion volume and the periosteal reaction's longest diameter (p > 0.05). Cortical fenestration was noted in 72.7% of the cases. In addition, the findings showed that periosteal reactions were located mostly on the buccal and were present 53.8% and 100% of the time in the mandible and maxilla, respectively.

Conclusions

The periosteal reactions of endodontic origin had a nonaggressive form (i.e., parallel or irregular), and none of the lesions resulted in a periosteal reaction with an ominous Codman’s triangle or spicule pattern.

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Influence of CBCT parameters on image quality and the diagnosis of vertical root fractures in teeth with metallic posts: an ex vivo study
Larissa Pereira Lagos de Melo, Polyane Mazucatto Queiroz, Larissa Moreira-Souza, Mariana Rocha Nadaes, Gustavo Machado Santaella, Matheus Lima Oliveira, Deborah Queiroz Freitas
Restor Dent Endod 2023;48(2):e16.   Published online April 27, 2023
DOI: https://doi.org/10.5395/rde.2023.48.e16
AbstractAbstract PDFPubReaderePub
Objectives

The aim of this study was to evaluate the influence of peak kilovoltage (kVp) and a metal artifact reduction (MAR) tool on image quality and the diagnosis of vertical root fracture (VRF) in cone-beam computed tomography (CBCT).

Materials and Methods

Twenty single-rooted human teeth filled with an intracanal metal post were divided into 2 groups: control (n = 10) and VRF (n = 10). Each tooth was placed into the socket of a dry mandible, and CBCT scans were acquired using a Picasso Trio varying the kVp (70, 80, 90, or 99), and the use of MAR (with or without). The examinations were assessed by 5 examiners for the diagnosis of VRF using a 5-point scale. A subjective evaluation of the expression of artifacts was done by comparing random axial images of the studied protocols. The results of the diagnoses were analyzed using 2-way analysis of variance and the Tukey post hoc test, the subjective evaluations were compared using the Friedman test, and intra-examiner reproducibility was evaluated using the weighted kappa test (α = 5%).

Results

The kVp and MAR did not influence the diagnosis of VRF (p > 0.05). According to the subjective classification, the 99 kVp protocol with MAR demonstrated the least expression of artifacts, while the 70 kVp protocol without MAR led to the most artifacts.

Conclusions

Protocols with higher kVp combined with MAR improved the image quality of CBCT examinations. However, those factors did not lead to an improvement in the diagnosis of VRF.

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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 Article
The effect of thermocycling on the degree of conversion and mechanical properties of a microhybrid dental resin composite
Mehrsima Ghavami-Lahiji, Melika Firouzmanesh, Hossein Bagheri, Tahereh S. Jafarzadeh Kashi, Fateme Razazpour, Marjan Behroozibakhsh
Restor Dent Endod 2018;43(2):e26.   Published online April 26, 2018
DOI: https://doi.org/10.5395/rde.2018.43.e26
AbstractAbstract PDFPubReaderePub
Objective

The purpose of this study was to investigate the degree of conversion (DC) and mechanical properties of a microhybrid Filtek Z250 (3M ESPE) resin composite after aging.

Method

The specimens were fabricated using circular molds to investigate Vickers microhardness (Vickers hardness number [VHN]) and DC, and were prepared according to ISO 4049 for flexural strength testing. The initial DC (%) of discs was recorded using attenuated total reflectance-Fourier transforming infrared spectroscopy. The initial VHN of the specimens was measured using a microhardness tester under a load of 300 g for 15 seconds and the flexural strength test was carried out with a universal testing machine (crosshead speed, 0.5 mm/min). The specimens were then subjected to thermocycling in 5°C and 55°C water baths. Properties were assessed after 1,000–10,000 cycles of thermocycling. The surfaces were evaluated using scanning electron microscopy (SEM). Data were analyzed using 1-way analysis of variance followed by the Tukey honest significant difference post hoc test.

Results

Statistical analysis showed that DC tended to increase up to 4,000 cycles, with no significant changes. VHN and flexural strength values significantly decreased upon thermal cycling when compared to baseline (p < 0.05). However, there was no significant difference between initial and post-thermocycling VHN results at 1,000 cycles. SEM images after aging showed deteriorative changes in the resin composite surfaces.

Conclusions

The Z250 microhybrid resin composite showed reduced surface microhardness and flexural strength and increased DC after thermocycling.

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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 Article
Fracture resistance of upper central incisors restored with different posts and cores
Maryam Rezaei Dastjerdi, Kamran Amirian Chaijan, Saeid Tavanafar
Restor Dent Endod 2015;40(3):229-235.   Published online July 24, 2015
DOI: https://doi.org/10.5395/rde.2015.40.3.229
AbstractAbstract PDFPubReaderePub
Objectives

To determine and compare the fracture resistance of endodontically treated maxillary central incisors restored with different posts and cores.

Materials and Methods

Forty-eight upper central incisors were randomly divided into four groups: cast post and core (group 1), fiber-reinforced composite (FRC) post and composite core (group 2), composite post and core (group 3), and controls (group 4). Mesio-distal and bucco-lingual dimensions at 7 and 14 mm from the apex were compared to ensure standardization among the groups. Twelve teeth were prepared for crown restoration (group 4). Teeth in other groups were endodontically treated, decoronated at 14 mm from the apex, and prepared for posts and cores. Resin-based materials were used for cementation in groups 1 and 2. In group 3, composite was used directly to fill the post space and for core build-up. All samples were restored by standard metal crowns using glass ionomer cement, mounted at 135° vertical angle, subjected to thermomechanical aging, and then fractured using a universal testing machine. Kruskal-Wallis and Mann-Whitney U tests were used to analyze the data.

Results

Fracture resistance of the groups was as follows: Control (group 4) > cast post and core (group 1) > fiber post and composite core (group 2) > composite post and core (group 3). All samples in groups 2 and 3 fractured in restorable patterns, whereas most (58%) in group 1 were non-restorable.

Conclusions

Within the limitations of this study, FRC posts showed acceptable fracture resistance with favorable fracture patterns for reconstruction of upper central incisors.

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Case Report
Endodontic management of a maxillary first molar with three roots and seven root canals with the aid of cone-beam computed tomography
Gurudutt Nayak, Kamal Krishan Singh, Rhitu Shekhar
Restor Dent Endod 2015;40(3):241-248.   Published online June 3, 2015
DOI: https://doi.org/10.5395/rde.2015.40.3.241
AbstractAbstract PDFPubReaderePub

Variation in root canal morphology, especially in maxillary first molar presents a constant challenge for a clinician in their detection and management. This case report describes the successful root canal treatment of a three rooted right maxillary first molar presenting with three canals each in the mesiobuccal and distobuccal roots and one canal in the palatal root. The clinical detection of this morphologic aberration was made using a dental operating microscope, and the canal configuration was established after correlating and computing the clinical, radiographic and cone-beam computed tomography (CBCT) scan findings. CBCT images confirmed the configuration of the canals in the mesiobuccal and distobuccal roots to be Al-Qudah and Awawdeh type (3-2) and type (3-2-1), respectively, whereas the palatal root had a Vertucci type I canal pattern. This report reaffirms the importance of careful examination of the floor of the pulp chamber with a dental operating microscope and the use of multiangled preoperative radiographs along with advanced diagnostic aids such as CBCT in identification and successful management of aberrant canal morphologies.

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Basic Research
The study of fractural behavior of repaired composite
Sang-Soon Park, Wook Nam, Ah-Hyang Eom, Duck-Su Kim, Gi-Woon Choi, Kyoung-Kyu Choi
J Korean Acad Conserv Dent 2010;35(6):461-472.   Published online November 30, 2010
DOI: https://doi.org/10.5395/JKACD.2010.35.6.461
AbstractAbstract PDFPubReaderePub
Objectives

This study evaluated microtensile bond strength (µTBS) and short-rod fracture toughness to explain fractural behavior of repaired composite restorations according to different surface treatments.

Materials and Methods

Thirty composite blocks for µTBS test and sixty short-rod specimens for fracture toughness test were fabricated and were allocated to 3 groups according to the combination of surface treatment (none-treated, sand blasting, bur roughening). Each group was repaired immediately and 2 weeks later. Twenty-four hours later from repair, µTBS and fracture toughness test were conducted. Mean values analyzed with two-way ANOVA / Tukey's B test (α = 0.05) and correlation analysis was done between µTBS and fracture toughness. FE-SEM was employed on fractured surface to examine the crack propagation.

Results

The fresh composite resin showed higher µTBS than the aged composite resin (p < 0.001). Mechanically treated groups showed higher bond strength than non-mechanically treated groups except none-treated fresh group in µTBS (p < 0.05). The fracture toughness value of mechanically treated surface was higher than that of non-mechanically treated surface (p < 0.05). There was no correlation between fracture toughness and microtensile bond strength values. Specimens having high KIC showed toughening mechanism including crack deviation, microcracks and crack bridging in FE-SEM.

Conclusions

Surface treatment by mechanical interlock is more important for effective composite repair, and the fracture toughness test could be used as an appropriate tool to examine the fractural behavior of the repaired composite with microtensile bond strength.

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Original Article
Aging effect on the microtensile bond strength of self-etching adhesives
JS Park, JS Kim Kim, HH Son, HC Kwon, BH Cho
J Korean Acad Conserv Dent 2006;31(6):415-426.   Published online November 30, 2006
DOI: https://doi.org/10.5395/JKACD.2006.31.6.415
AbstractAbstract PDFPubReaderePub

In this study, the changes in the degree of conversion (DC) and the microtensile bond strength (MTBS) of self-etching adhesives to dentin was investigated according to the time after curing. The MTBS of Single Bond (SB, 3M ESPE, USA), Clearfil SE Bond (SE, Kuraray, Japan), Xeno-III (XIII, Dentsply, Germany), and Adper Prompt (AP, 3M ESPE, USA) were measured at 48h, at 1 week and after thermocycling for 5,000 cycles between 5℃ and 55℃. The DC of the adhesives were measured immediately, at 48h and at 7 days after curing using a Fourier Transform Infra-red Spectrometer. The fractured surfaces were also evaluated with scanning electron microscope. The MTBS and DC were significantly increased with time and there was an interaction between the variables of time and material (MTBS, 2-way ANOVA, p = 0.018; DC, Repeated Measures ANOVA, p < 0.001). The low DC was suggested as a cause of the low MTBS of self-etching adhesives, XIII and AP, but the increase in the MTBS of SE and AP after 48h could not be related with the changes in the DC. The microscopic maturation of the adhesive layer might be considered as the cause of increasing bond strength.

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