Understanding the reason for an unsuccessful non-surgical endodontic treatment outcome, as well as the complex anatomy of the root canal system, is very important. This study examined the cross-sectional root canal structure of mandibular first molars confirmed to have failed non-surgical root canal treatment using digital images obtained during intentional replantation surgery, as well as the causative factors of the failed conventional endodontic treatments.
This study evaluated 115 mandibular first molars. Digital photographic images of the resected surface were taken at the apical 3 mm level and examined. The discolored dentin area around the root canal was investigated by measuring the total surface area, the treated areas as determined by the endodontic filling material, and the discolored dentin area.
Forty 2-rooted teeth showed discolored root dentin in both the mesial and distal roots. Compared to the original filled area, significant expansion of root dentin discoloration was observed. Moreover, the mesial roots were significantly more discolored than the distal roots. Of the 115 molars, 92 had 2 roots. Among the mesial roots of the 2-rooted teeth, 95.7% of the roots had 2 canals and 79.4% had partial/complete isthmuses and/or accessory canals.
Dentin discoloration that was not visible on periapical radiographs and cone-beam computed tomography was frequently found in mandibular first molars that failed endodontic treatment. The complex anatomy of the mesial roots of the mandibular first molars is another reason for the failure of conventional endodontic treatment.
The purpose of this study was to compare the marginal and internal fit of nano-composite CAD-CAM restorations.
A full veneer crown and an mesio-occluso-distal (MOD) inlay cavity, which were prepared on extracted human molars, were used as templates of epoxy resin replicas. The prepared teeth were scanned and CAD-CAM restorations were milled using Lava Ultimate (LU) and experimental nano-composite CAD/CAM blocks (EB) under the same milling parameters. To assess the marginal and internal fit, the restorations were cemented to replicas and were embedded in an acrylic mold for sectioning at 0.5 mm intervals. The measured gap data were pooled according to the block types and measuring points for statistical analysis.
Both the block type and measuring point significantly affected gap values, and their interaction was significant (
The marginal and internal gaps of the two nano-composite CAD/CAM blocks differed according to the measuring points. Among the internal area of the two nano-composite CAD/CAM restorations, occlusal gap data were significantly larger than axial gap data. The EB crowns and inlays had significantly larger gaps than LU restorations.
The aim of this paper was evaluating the ratios of electrical impedance measurements reported in previous studies through a correlation analysis in order to explicit it as the contributing factor to the accuracy of electronic apex locator (EAL).
The literature regarding electrical property measurements of EALs was screened using Medline and Embase. All data acquired were plotted to identify correlations between impedance and log-scaled frequency. The accuracy of the impedance ratio method used to detect the apical constriction (APC) in most EALs was evaluated using linear ramp function fitting. Changes of impedance ratios for various frequencies were evaluated for a variety of file positions.
Among the ten papers selected in the search process, the first-order equations between log-scaled frequency and impedance were in the negative direction. When the model for the ratios was assumed to be a linear ramp function, the ratio values decreased if the file went deeper and the average ratio values of the left and right horizontal zones were significantly different in 8 out of 9 studies. The APC was located within the interval of linear relation between the left and right horizontal zones of the linear ramp model.
Using the ratio method, the APC was located within a linear interval. Therefore, using the impedance ratio between electrical impedance measurements at different frequencies was a robust method for detection of the APC.
Genetic information such as DNA sequences has been limited to fully explain mechanisms of gene regulation and disease process. Epigenetic mechanisms, which include DNA methylation, histone modification and non-coding RNAs, can regulate gene expression and affect progression of disease. Although studies focused on epigenetics are being actively investigated in the field of medicine and biology, epigenetics in dental research is at the early stages. However, studies on epigenetics in dentistry deserve attention because epigenetic mechanisms play important roles in gene expression during tooth development and may affect oral diseases. In addition, understanding of epigenetic alteration is important for developing new therapeutic methods. This review article aims to outline the general features of epigenetic mechanisms and describe its future implications in the field of dentistry.
While it is reasonably well known that certain dental procedures increase the temperature of the tooth's surface, of greater interest is their potential damaging effect on the pulp and tooth-supporting tissues. Previous studies have investigated the responses of the pulp, periodontal ligament, and alveolar bone to thermal irritation and the temperature at which thermal damage is initiated. There are also many
In most retrospective studies, the clinical performance of restorations had not been considered in survival analysis. This study investigated the effect of including the clinically unacceptable cases according to modified United States Public Health Service (USPHS) criteria into the failed data on the survival analysis of direct restorations as to the longevity and prognostic variables.
Nine hundred and sixty-seven direct restorations were evaluated. The data of 204 retreated restorations were collected from the records, and clinical performance of 763 restorations in function was evaluated according to modified USPHS criteria by two observers. The longevity and prognostic variables of the restorations were compared with a factor of involving clinically unacceptable cases into the failures using Kaplan-Meier survival analysis and Cox proportional hazard model.
The median survival times of amalgam, composite resin and glass ionomer were 11.8, 11.0 and 6.8 years, respectively. Glass ionomer showed significantly lower longevity than composite resin and amalgam. When clinically unacceptable restorations were included into the failure, the median survival times of them decreased to 8.9, 9.7 and 6.4 years, respectively.
After considering the clinical performance, composite resin was the only material that showed a difference in the longevity (
This study evaluated the effects of adhesion variables such as the priming concepts of canal wall and the curing modes of adhesives on the sealing ability of a resin-based root canal filling system.
Apical microleakage of the Resilon-RealSeal systems filled with 3 different combinations of adhesion variables was compared with the conventional gutta-percha filling using a dye penetration method. Experimental groups were SEDC, Resilon (Resilon Research LLC) filling with self-etch RealSeal (SybronEndo) primer and dual-cure RealSeal sealer; NELC, Resilon filling with no etching, Scotchbond Multi-Purpose (3M ESPE) primer application and light-curing adhesive; and TELC, Resilon filling with Scotchbond Multi-Purpose primer and adhesive used under total etch / wet bonding and light-cure protocols. GPCS, gutta-percha filling with conventional AH26 plus sealer, was the control group.
The median longitudinal dye penetration length of TELC was significantly shorter than those of GPCS and SEDC (Kruskal-Wallis test,
When a resin-based root canal filling material was used, compared to the self-etching primer and the dual-cure sealer, the total etch/wet-bonding with primer and light-curing of adhesive showed improved apical sealing and was highly recommended.
Early detection of carious lesions increases the possibility of treatment without the need for surgical intervention. Optical coherence tomography (OCT) is an emerging three-dimensional imaging technique that has been successfully used in other medical fields, such as ophthalmology for optical biopsy, and is a prospective candidate for early caries detection. The technique is based on low coherence interferometry and is advantageous in that it is non-invasive, does not use ionizing radiation, and can render three-dimensional images. A brief history of the development of this technique and its principles are discussed in this paper. There have been numerous studies on caries detection, which were mostly
This study investigated the effects of the color components of light-cured composite resin before and after polymerization on degree of conversion (DC) and biaxial flexural strength (FS).
Four enamel shades (A1, A2, A3, A4) and two dentin shades (A2O, A3O) of Premisa (Kerr Co.) and Denfil (Vericom Co.) were evaluated on their CIE L*, a*, b* color components using the spectrophotometer before curing, after curing and at 7 day. The DC of same specimens were measured with Near-infrared spectrometer (Nexus, Thermo Nicolet Co.) at 2 hr after cure and at 7 day. Finally, the FS was obtained after all the other measurements were completed at 7 day. The correlations between each color component and DC and FS were evaluated.
The light-curing of composite resin resulted in color changes of Premisa in red-blue direction and Denfil in green-blue direction. The DC and FS were affected by product, time and shade (3-way ANOVA,
The DC and FS of the light-curing composite resin were affected by the color components of the material before and after polymerization.
This study investigated the effect of the strength and wetting characteristics of adhesives on the bond strength to dentin. The experimental adhesives containing various ratios of hydrophobic, low-viscosity Bis-M-GMA, with Bis-GMA and TEGDMA, were made and evaluated on the mechanical properties and bond strength to dentin.
Five experimental adhesives formulated with various Bis-GMA/Bis-M-GMA/TEGDMA ratios were evaluated on their viscosity, degree of conversion (DC), flexural strength (FS), and microtensile bond strength (MTBS). The bonded interfaces were evaluated with SEM and the solubility parameter was calculated to understand the wetting characteristics of the adhesives.
Although there were no significant differences in the DC between the experimental adhesives at 48 hr after curing (
To achieve a good dentin bond, a strong base monomer, such as Bis-GMA, cannot be completely replaced by Bis-M-GMA for maintaining mechanical strength. For compatible copolymerization between the adhesive and the primed dentin as well as dense cross-linking of the adhesive layer, at least 30% fraction of TEGDMA is also needed.
During a composite resin restoration, an anticipating contraction gap is usually tried to seal with low-viscosity resin after successive polishing, etching, rinsing and drying steps, which as a whole is called rebonding procedure. However, the gap might already have been filled with water or debris before applying the sealing resin. We hypothesized that microleakage would decrease if the rebonding agent was applied before the polishing step, i.e., immediately after curing composite resin. On the buccal and lingual surfaces of 35 extracted human molar teeth, class V cavities were prepared withthe occlusal margin in enamel and the gingival margin in dentin. They were restored with a hybrid composite resin Z250 (3M ESPE, USA) using an adhesive AdperTM Single Bond 2 (3M ESPE). As rebonding agents, BisCover LV (Bisco, USA), ScotchBond Multi-Purpose adhesive (3M ESPE) and an experimental adhesive were applied on the restoration margins before polishing step or after successive polishing and etching steps. The infiltration depth of 2% methylene blue into the margin was measured using an optical stereomicroscope. The correlation between viscosity of rebonding agents and mciroleakage was also evaluated. There were no statistically significant differences in the microleakage within the rebonding procedures, within the rebonding agents, and within the margins. However, when the restorations were not rebonded, the microleakage at gingival margin was significantly higher than those groups rebonded with 3 agents (p < 0.05). The difference was not observed at the occlusal margin. No significant correlation was found between viscosity of rebonding agents and microleakage, except very weak correlation in case of rebonding after polishing and etching at gingival margin (r = -0.326, p = 0.041).
Rapid polymerization of overlying composite resin causes high polymerization shrinkage stress at the adhesive layer. In order to alleviate the shrinkage stress, increasing the light intensity over the first 5 seconds was suggested as an exponential curing mode by an LED light curing unit (Elipar FreeLight2, 3M ESPE). In this study, the effectiveness of the exponential curing mode on reducing stress was evaluated with measuring microtensile bond strength of three adhesives after the overlying composite resin was polymerized with either continuous or exponential curing mode.
Scotchbond Multipurpose Plus (MP, 3M ESPE), Single Bond 2 (SB, 3M ESPE), and Adper Prompt (AP, 3M ESPE) were applied onto the flat occlusal dentin of extracted human molar. The overlying hybrid composite (Denfil, Vericom, Korea) was cured under one of two exposing modes of the curing unit. At 48h from bonding, microtensile bond strength was measured at a crosshead speed of 1.0 mm/min. The fractured surfaces were observed under FE-SEM.
There was no statistically significant difference in the microtensile bond strengths of each adhesive between curing methods (Two-way ANOVA, p > 0.05). The microtensile bond strengths of MP and SB were significantly higher than that of AP (p < 0.05). Mixed failures were observed in most of the fractured surfaces, and differences in the failure mode were not observed among groups.
The exponential curing method had no beneficial effect on the microtensile dentin bond strengths of three adhesives compared to continuous curing method.
This study evaluated the influence of the type of restoration and the amount of interdental spacing on the stress distribution in maxillary central incisors restored by means of porcelain laminate veneers and direct composite resin restorations.
Three-dimensional finite element models were fabricated to represent different types of restorations. Four clinical situations were considered. Type I, closing diastema using composite resin. Labial border of composite resin was extended just enough to cover the interdental space; Type II, closing diastema using composite resin without reduction of labial surface. Labial border of composite resin was extended distally to cover the half of the total labial surface; Type III, closing diastema using composite resin with reduction of labial surface. Labial border of the preparation and restored composite resin was extended distally two-thirds of the total labial surface; Type IV, closing diastema using porcelain laminate veneer with a feathered-edge preparation technique. Four different interdental spaces (1.0, 2.0, 3.0, 4.0 mm) were applied for each type of restorations.
For all types of restoration, adding the width of free extension of the porcelain laminate veneer and composite resin increased the stress occurred at the bonding layer. The maximum stress values observed at the bonding layer of Type IV were higher than that of Type I, II and III. However, the increasing rate of maximum stress value of Type IV was lower than that of Type I, II and III.
The purpose of this study was to evaluate the pulp tissue reaction to direct pulp capping of mechanically exposed beagle dogs'pulp with several capping materials. A total of 36 teeth of 2 healthy beagle dongs were used. The mechanically exposed pulps were capped with one of the followings: (1) Mineral Trioxide Aggregate (MTA: ProRoot® MTA, Dentsply, Tulsa, USA), (2) Clearfil SE Bond (Dentin adhesive system: Kuraray, Osaka, Japan), (3) Ultra-Blend (Photo-polymerized Calcium hydroxide: Ultradent, South Jordan, USA), (4) Dycal (Quick setting Calcium hydroxide: LD Caulk Co., Milford, USA) at 7, 30, and 90 days before sacrificing. The cavities were restored with Z350 flowable composite resin (3M ESPE, St. Paul. MN, USA). After the beagle dogs were sacrificed, the extracted teeth were fixed, decalcified, prepared for histological examination and stained with HE stain. The pulpal tissue responses to direct pulp capping materials were assessed.
In MTA, calcium hydroxide, and photo-polymerized calcium hydroxide groups, initial mild inflammatory cell infiltration, newly formed odontoblast-like cell layer and hard tissue bridge formation were observed. Compared with dentin adhesive system, these materials were biocompatible and good for pulp tissue regeneration.
In dentin adhesive system group, severe inflammatory cell infiltration, pulp tissue degeneration and pulp tissue necrosis were observed. It seemed evident that application of dentin adhesive system in direct pulp capping of beagle dog teeth cannot lead to acceptable repair of the pulp tissue with dentine bridge formation.
The aim of this study was to measure the dentinal tubular fluid flow (DFF) during and after amalgam and composite restorations. A newly designed fluid flow measurement instrument was made. A third molar cut at 3 mm apical from the CEJ was connected to the flow measuring device under a hydrostatic pressure of 15 cmH2O. Class I cavity was prepared and restored with either amalgam (Copalite varnish and Bestaloy) or composite (Z-250 with ScotchBond MultiPurpose: MP, Single Bond 2: SB, Clearfil SE Bond: CE and Easy Bond: EB as bonding systems). The DFF was measured from the intact tooth state through restoration procedures to 30 minutes after restoration, and re-measured at 3 and 7days after restoration.
Inward fluid flow (IF) during cavity preparation was followed by outward flow (OF) after preparation. In amalgam restoration, the OF changed to IF during amalgam filling and slight OF followed after finishing.
In composite restoration, application CE and EB showed a continuous OF and air-dry increased rapidly the OF until light-curing, whereas in MP and SB, rinse and dry caused IF and OF, respectively. Application of hydrophobic bonding resin in MP and CE caused a decrease in flow rate or even slight IF. Light-curing of adhesive and composite showed an abrupt IF. There was no statistically significant difference in the reduction of DFF among the materials at 30 min, 3 and 7 days after restoration (P > 0.05).
The purpose of this study was to investigate the effect of rigidity of post core systems on stress distribution by the theoretical technique, finite element stress-analysis method. Three-dimensional finite element models simulating an endodontically treated maxillary central incisor restored with a zirconia ceramic crown were prepared and 1.5 mm ferrule height was provided. Each model contained cortical bone, trabecular bone, periodontal ligament, 4 mm apical root canal filling, and post-and-core. Six combinations of three parallel type post (zirconia ceramic, glass fiber, and stainless steel) and two core (Paracore and Tetric ceram) materials were evaluated, respectively. A 50 N static occlusal load was applied to the palatal surface of the crown with a 60° angle to the long axis of the tooth. The differences in stress transfer characteristics of the models were analyzed. von Mises stresses were chosen for presentation of results and maximum displacement and hydrostatic pressure were also calculated. An increase of the elastic modulus of the post material increased the stress, but shifted the maximum stress location from the dentin surface to the post material. Buccal side of cervical region (junction of core and crown) of the glass fiber post restored tooth was subjected to the highest stress concentration. Maximum von Mises stress in the remaining radicular tooth structure for low elastic modulus resin core (29.21 MPa) was slightly higher than that for high elastic modulus resin core (29.14 MPa) in case of glass fiber post. Maximum displacement of glass fiber post restored tooth was higher than that of zirconia ceramic or stainless steel post restored tooth.
The purpose of this study was to assess the current materials, methods and difficulties according to the year of licence and educational background of Korean dentists in Class II direct composite resin restorations.
Total 17 questions were included in the questionnaire. Questions were broadly divided into two parts; first, operator's information, and second, the materials and methods used in Class II posterior composite restoration. The questionnaire was sent to dentists enrolled in Korean Dental Association via e-mail. Total 12,193 e-mails were distributed to dentists, 2,612 e-mails were opened, and 840 mails (32.2%) were received from respondents. The data was statically analyzed by chi-square test using SPSS(v. 12.0.1, SPSS Inc, Chicago, IL, USA).
Male dentists among respondents was 79%. 60.3% of the respondents acquired their licences recently (1998-2007), and 77% practiced in private offices. 83.4% have acquired their knowledge through school lectures, conferences and seminars.
For the Class II restorations, gold inlays were preferred by 65.7% of respondents, while direct composite resin restorations were used by 12.1% amalgam users were only 4.4% of respondents.
For the restorative technique, 74.4% of respondents didn't use rubber dam as needed. For the matrix, mylar strip (53.4%), metal matrix (33.8%) and Palodent system (6.5%) were used. 99.6% of respondents restored the Class II cavity by incremental layering.
Obtaining of the tight interproximal contact was considered as the most difficult procedure (57.2%) followed by field isolation (21%).
Among various bonding systems, 22.6% of respondents preferred SE Bond and 20.2% used Single Bond. Z-250 was used most frequently among a variety of composite resins.
The purpose of this study was to investigate the pulpal response to direct pulp capping with dentin sialo-protein (DSP) -derived synthetic peptide in teeth of dogs, and to compare its efficacy to capping substances Ca(OH)2 and white mineral trioxide aggregate (WMTA). A total of 72 teeth of 6 healthy male beagle dogs were used. The mechanically exposed pulps were capped with one of the following: (1) DSP-derived synthetic peptide (PEP group); (2) Ca(OH)2 (CH group); (3) a mixture paste of peptide and Ca(OH)2 (PEP+CH group); or (4) white MTA (WMTA group). The access cavity was restored with a reinforced glass ionomer cement. Two dogs were sacrificed at each pre-determined intervals (2 weeks, 1 month, and 3 months). After the specimens were prepared for standard histological processing, sections were stained with hematoxylin and eosin. Under a light microscope, inflammatory response and hard tissue formation were evaluated in a blind manner by 2 observers. In the PEP group, only 3 of 17 specimens showed hard tissue formation, indication that the DSP-derived synthetic peptide did not induce proper healing of the pulp. Compared with the CH group, the PEP group demonstrated an increased inflammatory response and poor hard tissue formation. The CH and WMTA groups showed similar results for direct pulp capping in mechanically exposed teeth of dogs.
Deterioration of long-term dentin adhesion durability is thought to occur by hydrolytic degradation within hydrophilic domains of the adhesive and hybrid layers. This study investigated the hypothesis that priming the collagen network with an organic solvent displace water without collapse and thereby obtain good bond strength with an adhesive made of hydrophobic monomers and organic solvents. Three experimental adhesives were prepared by dissolving two hydrophobic monomers, bisphenol-A-glycidylmethacrylate (Bis-GMA) and triethylenegly-col dimethacrylate (TEGDMA), into acetone, ethanol or methanol. After an etching and rinsing procedure, the adhesives were applied onto either wet dentin surfaces (wet bonding) or dentin surfaces primed with the same solvent (solvent-primed bonding). Microtensile bond strength (MTBS) was measured at 48 hrs, 1 month and after 10,000 times of thermocycles. The bonded interfaces were evaluated using a scanning electron microscope (SEM). Regardless of bonding protocols, well-developed hybrid layers were observed at the bonded interface in most specimens. The highest mean MTBS was observed in the adhesive containing ethanol at 48 hrs. With solvent-primed bonding, increased MTBS tendencies were seen with thermocycling in the adhesives containing ethanol or methanol. However, in the case of wet bonding, no increase in MTBS was observed with aging.
This study was aimed to investigate whether an oxygen inhibition layer (OIL) is essential for the interfacial bonding between resin composite layers or not.
A composite (Z-250, 3M ESPE) was filled in two layers using two aluminum plate molds with a hole of 3.7 mm diameter. The surface of first layer of cured composite was prepared by one of five methods as followings, thereafter second layer of composite was filled and cured: Group 1 - OIL is allowed to remain on the surface of cured composite; Group 2 - OIL was removed by rubbing with acetone-soaked cotton; Group 3 - formation of the OIL was inhibited using a Mylar strip; Group 4 - OIL was covered with glycerin and light-cured; Group 5 (control) - composite was bulk-filled in a layer. The interfacial shear bond strength between two layers was tested and the fracture modes were observed. To investigate the propagation of polymerization reaction from active area having a photo-initiator to inactive area without the initiator, a flowable composite (Aelite Flow) or an adhesive resin (Adhesive of ScotchBond Multipurpose) was placed over an experimental composite (Exp_Com) which does not include a photoinitiator and light-cured. After sectioning the specimen, the cured thickness of the Exp_Com was measured.
The bond strength of group 2, 3 and 4 did not show statistically significant difference with group 1. Groups 3 and 4 were not statistically significant different with control group 5. The cured thicknesses of Exp_Com under the flowable resin and adhesive resin were 20.95 (0.90) um and 42.13 (2.09), respectively.
The objective of this study was to compare dentin shear bond strength (DSBS) of dentin bonding agents (DBAs) cured with a plasma arc (PAC) light curing unit (LCU) and those cured with a light emitting diode (LED) LCU. Optical properties were also analyzed for Elipar freelight 2 (3M ESPE); LED LCU, Apollo 95E (DMT Systems); PAC LCU and VIP Junior (Bisco); Halogen LCU. The DBAs used for DSBS test were Scotchbond Multipurpose (3M ESPE), Singlebond 2 (3M ESPE) and Clearfil SE Bond (Kuraray). After DSBS testing, fractured specimens were analyzed for failure modes with SEM.
The total irradiance and irradiance between 450 nm and 490 nm of the LCUs were different. LED LCU showed narrow spectral distribution around its peak at 462 nm whereas PAC and Halogen LCU showed a broad spectrum. There were no significant differences in mean shear bond strength among different LCUs (P > 0.05) but were significant differences among different DBAs (P < 0.001)
The purpose of this study was: (1) to compare nanoleakage patterns of a conventional 3-step etch and rinse adhesive system and two experimental hydrophobic adhesive systems and (2) to investigate the change of the nanoleakage patterns after load cycling. Two kinds of hydrophobic experimental adhesives, ethanol containing adhesive (EA) and methanol containing adhesive (MA), were prepared. Thirty extracted human molars were embedded in resin blocks and occlusal thirds of the crowns were removed. The polished dentin surfaces were etched with a 35% phosphoric acid etching gel and rinsed with water. Scotchbond Multi-Purpose (MP), EA and MA were used for bonding procedure. Z-250 composite resin was built-up on the adhesive-treated surfaces. Five teeth of each dentin adhesive group were subjected to mechanical load cycling. The teeth were sectioned into 2 mm thick slabs and then stained with 50% ammoniacal silver nitrate. Ten specimens for each group were examined under scanning electron microscope in backscattering electron mode. All photographs were analyzed using image analysis software. Three regions of each specimen were used for evaluation of the silver uptake within the hybrid layer. The area of silver deposition was calculated and expressed in gray value. Data were statistically analyzed by two-way ANOVA and post-hoc testing of multiple comparisons was done with the Scheffe's test. Silver particles were observed in all the groups. However, silver particles were more sparsely distributed in the EA group and the MA group than in the MP group (p < .0001). There were no changes in nanoleakage patterns after load cycling.