Sealing properties of a new epoxy resin-based root-canal sealer

In this study a new epoxy-resin-based endodontic sealer, AH Plus, was tested in vitro for apical leakage. The conventional sealer AH26, for which information is already available, was used as the control. The root canals of 72 single-rooted teeth were prepared biomechanically using a stepback technique before lateral condensation of gutta-percha with one of the two sealers. Teeth were immersed in 5% methylene blue dye for 2, 4 or 10 days. The roots were split longitudinally so that the extent of dye penetration could be measured with a stereomicroscope. The mean extent at 2 days was 0.4 mm for AH26 and 1.4 mm for AH Plus. Neither material produced a complete apical seal and leakage increased with the duration of immersion in dye. The differences between observation periods as well as between materials with respect to dye penetration were statistically significant ANOVA, (P < 0.005).     

Effect of mechanical versus thermal removal of gutta-percha on the quality of the apical seal following post space preparation

The objective of this study was to compare the effects of a flame-heated endodontic plugger, an electrically-heated endodontic spreader, Peeso reamers, and GPX burs on the apical seal when gutta-percha was removed from the root canal for post space preparation. Eighty-nine human canines were instrumented and obturated with gutta-percha and sealer to a standardized working length of 15 mm. An 11-mm segment of gutta-percha was removed from the roots in each of the four experimental groups of 20 teeth to simulate post space preparation. The teeth were immersed in India ink for 7 days and rendered transparent. The extent of linear dye leakage was measured with a stereomicroscope. There was no statistically significant difference in linear dye leakage among any of the experimental groups when 4 mm of gutta-percha remained.     

Treatment of root fracture by CO2 and Nd:YAG lasers: an in vitro study

The purpose of this in vitro study was to use scanning electron microscopy and polarized light microscopy to evaluate the feasibility of using either the CO2 laser or an Nd:YAG laser in combination with air/water surface cooling to effect fusion of fractured tooth roots. The experimental unit consisted of 81 single-rooted teeth, each with an induced root fracture. Fifty-six teeth that had been reapproximated in dental stone and 25 teeth that had been reapproximated with C-clamps were assigned to untreated control groups or groups for treatment using CO2 and Nd:YAG lasers. Laser treatment consisted of multiple passes along the line of fracture, which was inspected using a dissecting microscope after each pass until a visual indication of fusion or irreparable damage resulted. Scanning electron microscopy evaluation of the treated lines revealed heat-induced fissures and cracks, areas of cementum meltdown and resolidification, crater formation, and separation of cementum from underlying dentin. In no instance-regardless of reapproximation technique, laser type, energy, and other parameters-did the treatment effect fusion of the fractured root halves.     

Assisted suicide in Switzerland: when is it permitted?

This study assessed in vitro apical leakage in root canals filled with gutta-percha and Ketac-Endo using different dentin conditioning and filling techniques. The root canals of 63 single-rooted teeth were instrumented and randomly divided into the following four groups: group A--canals were irrigated with 25% tannic acid and filled with Ketac-Endo and a standardized gutta-percha cone; group B--canals were irrigated with 1% NaOCl and filled as in group A; group C--canals were irrigated with 25% tannic acid and filled with Ketac-Endo and a chloroform-softened gutta-percha cone adapted to the canal walls; group D--canals were irrigated with 1% NaOCl and filled with Grossman's sealer and laterally condensed gutta-percha. After storage for 72 hours at 37 degrees C and 100% humidity, the gutta-percha was removed to a level 4 mm short of the working length, using a Peeso reamer. Teeth were immersed in India ink for 48 hours and cleared, and the coronal extent of dye penetration examined under a binocular dissecting microscope at x 15 magnification. The mean value of leakage for group A was 0.86 mm, for group B 2.23 mm, for group C 2.34 mm, and for group D 0.56 mm. Tukey's multiple comparison test disclosed significant differences (P < 0.05) between group A and groups B and C, and between group D and groups B and C. Differences between groups A and D, as well as between groups B and C, were not significant.     

An in-vitro investigation of microleakage and gap size of glass ionomer/composite resin "sandwich" restorations in primary teeth

Eighty extracted primary molars were divided into four groups of twenty teeth. Class II cavities were prepared in all teeth with equal numbers of proximal boxes having cavosurface margins either in enamel, or dentin/cementum. Each group was allocated to an open or closed sandwich technique using glass ionomer as a lining. Following the placement of the composite resin restorations, the gap size measured at the proximal box was greatest for the closed sandwich group with the cavosurface margin on enamel (0.203 microns) or dentin/cementum (0.174 microns). Microleakage scores were measured at the proximal box and were greatest for the closed sandwich group with the cavosurface margin on dentin/cementum. The best result was obtained for the open sandwich group with the cavosurface margin on enamel.     

The role of the centrifugal pump in hemolysis during neonatal extracorporeal support

A study was conducted to evaluate coronal microleakage of Super EBA and Ketac-Endo when used as sealers with single-cone gutta-percha (GP) root canal obturation. The root canals of 24 extracted human teeth were instrumented with flared preparations to a minimum #40 master apical file size. Ten teeth were obturated with a single GP cone and Super EBA as the sealer and ten teeth were obturated with a single GP cone and Ketac-Endo as the sealer. Four teeth were used as controls. Salivary bacterial microleakage studies were conducted to determine whether these sealers could prevent coronal microleakage through the root canal in the absence of a coronal tooth restoration. There was no bacterial penetration through the apical foramen for either sealer tested during the 60-day test period.     

In vitro permeability of furcation dentin in permanent teeth

Extracted unerupted permanent third molars with the occlusal half of the crown and apical half of the roots removed were cemented to Plexiglas blocks. Using a positive pressure system in which the movement of fluid across the dental tubules could be measured, the permeability of furcation dentin was measured before and after alteration of the furcation thickness. Subsequently, measurements of reduction in thickness of cementum and dentin were performed. Furcation dentin permeability was found to increase as the cementum and dentin thickness was reduced and the smear layer removed. The permeability values obtained for the furcation dentin were similar to those found in radicular dentin in general, indicating that root dentin has a low permeability and that it has good barrier properties. The data would suggest that any bone resorption seen under the furcation region of permanent molars is more likely to be due to the presence of accessory canals than due to permeation directly through furcation hard tissues.     

Effect of two obturation techniques on the filling of lateral canals and the main canal

The three-dimensional obturation of the root canal system is widely accepted as a key factor for successful endodontic therapy. The purpose of this study was to evaluate the obturation of lateral canals and the main canal using cold lateral condensation versus the gutta-percha coated rigid carrier. Thirty epoxy blocks with five lateral canals placed at varying angles from the main canal were used. Each experimental group was obturated by a board certified endodontist with clinical experience in the respective obturation technique. The length of gutta-percha and sealer in the lateral canals was measured under a microscope (x30, Unitron) to the nearest 0.5 mm. The blocks were sectioned with an Isomet Plus precision saw (Buehler, Lake Bluff, IL) and copious water irrigation perpendicular to the main canal at the apex, the height of contour, and at 0.8, 1.6 and 2.4 mm from the canal apex. A microscope (x100, Leitz, Switzerland) was used to determine voids. There was significantly (p < .001) more gutta-percha in the lateral canals with the gutta-percha coated rigid carrier technique. In contrast, the cold lateral condensation technique had significantly (p < .001) more sealer in the lateral canals. However, there was no significant (p < .05) difference, in gutta-percha-plus-sealer filling of the lateral canals, between the two techniques. In the apical 1 mm of the main canal there were significantly (p < .011) fewer voids with the gutta-percha coated rigid carrier technique compared to the cold lateral condensation. In the model chosen, the gutta-percha coated rigid carrier technique and the cold lateral condensation technique were equally effective in filling lateral canals. In filling the main canal, however, the coated rigid carrier technique was more effective.     

An in vitro comparison of thermoplasticised gutta-percha obturation techniques with cold lateral condensation

This study compared the apical sealing ability, obturation time and extrusion of gutta-percha and sealer when root canals were obturated using either cold lateral condensation or one of the three methods using thermoplasticised gutta-percha (Alpha Seal, Thermafil or JS Quick Fill) in vitro. One hundred and thirty-one root canals from 78 extracted human teeth were used; 116 canals were divided into five groups so that they were balanced with respect to prepared canal anatomy, and the remaining 15 canals were used as positive and negative controls. The canals in the first four groups were prepared with hand files using the step-down technique to a standard apical size and flare. The last group was prepared using engine-driven rotary nickel-titanium files (McSpadden) to a similar apical size and flare. One of the four obturating techniques was used to fill the canals in each of the first four groups. The fifth group was obturated using the Alpha Seal technique. The roots were immersed in india ink, demineralised and rendered transparent to assess the extent of maximum lincar dye penetration. The Alpha Seal groups had the highest number of specimens without any leakage. There was a significant difference in the proportions of specimens that did not leak when the Alpha Seal (P < 0.01) and cold lateral condensation groups (P < 0.05) were compared with JS Quick Fill. Cold lateral condensation had a higher proportion of specimens with leakage in canals with curvature greater than 20 degrees than in canals with curvatures less than 20 degrees (P < 0.05). The curvature of canals had no effect on the sealing ability of the other techniques. The method of canal preparation had no effect on the sealing ability of Alpha Seal. Alpha Seal, Thermafil and JS Quick Fill were significantly quicker to perform than cold lateral condensation.     

Ultrasonic preparation and obturation of root-end cavities

This study evaluated the preparation of root-end cavities using an ultrasonically activated file, and the obturation of such cavities. In the first part, the root canals of 40 extracted teeth were prepared to size 40 and irrigated with NaOCl and EDTA. The root ends were resected and the teeth inoculated with Enterococcus faecalis, incubated for 10 days and divided into four groups: control; saline; irrigation; hand instrumentation performed via a retrograde approach up to size 50 using saline irrigant; ultrasonic instrumentation with prebent size 40 K-flex file inserted into a Piezon Master using saline irrigant. The teeth were fixed, sectioned longitudinally and viewed under scanning electron microscopy. Bacterial and smear layer scores were obtained at 1, 3, and 5 mm from the resected end. The bacterial scores for control and saline groups were similar; the scores for each instrumentation group were significantly lower than the control group (P<0.001). In addition, there were significantly fewer bacteria in the ultrasonic group compared with the hand instrument group (P<0.001). The smear layer scores for control and saline groups were similar, and significantly lower than in either instrumentation group (P<0.001). In the second part, root-end cavities were ultrasonically prepared in 20 extracted teeth. Ten cavities were filled with amalgam, and 10 with thermoplasticized gutta-percha and Grossman's sealer. After 24-h storage, the root ends were immersed in dye for 48 h. Cross-sectional slices of the obturated part of the root were evaluated using both light and confocal microscopy for dye leakage along the interface of filling material and dentine. There were no statistical differences between the leakage of amalgam and gutta-percha root-end fillings, nor between the two methods of microscopy.     

Fracture resistance of endodontically treated roots after restoration

This study evaluated the shear strength resistance of endodontically treated roots that were restored by two different techniques. Twenty-seven recently extracted single-rooted teeth with similar anatomic characteristics were sectioned to obtain the same length for all specimens. Group I (GI) consisted of 14 roots restored with cast post-core (nickel-chromium alloy) and cemented using zinc phosphate cement; group II (GII) consisted of 13 roots restored with steel prefabricated posts (FKG) cemented with zinc phosphate cement and rotated with caution for anchorage. The crown portion of this group was made using a hybrid composite resin (Prisma APH). Results showed that on all specimens of GI the fracture occurred in the cervical root structure while in GII the composite resin fractured in all specimens. Statistical analysis showed a significantly higher resistance to fracture for GI than GII. The specimens were sectioned longitudinally for stereoscopic microscope analysis (63x) and did not show fracture lines in the dentin anchorage post area for any of the specimens.     

"Carious" and "noncarious" lesions of the hard dental tissues. Ultrastructural (SEM) and microanalytical (EDS) analyses of teeth from the 3rd century B.C

The study was carried out on 80 teeth (70 of permanent dentition and 10 of primary one) of mandibular and maxillary bones. The teeth owned to subjects lived in the III c.b.C. in Sicily, and they were found in Naxos necropolis. The teeth were examined as far as carious and non carious lesions, then they were prepared for instrumental analyses by Scanning Electron Microscopy (SEM) and Energy dispersed X ray spectrometry (EDS). To an objective examination of the sample no caries were detected in the teeth sample apart one tooth, on the other hand there was an extensive occlusal abrasion, from a macroscopic point of view there were no difference as far teeth morphology. SEM examination pointed out all around dentinal tubules a circle of sclerotic dentin as reaction to occlusal wear. The amelocemental junction showed from a ultramicroscopic point of view an overlap of cementum onto enamel. EDS analysis pointed out a higher P concentration on the crown versus the root in all the teeth of the sample.     

Strength of core build-up materials in endodontically treated teeth

PURPOSE: To compare the in vitro strength of a reinforced glass ionomer and a light-cured glass ionomer used as an alternative to amalgam in core construction to restore endodontically treated mandibular molar teeth. MATERIALS AND METHODS: The root canals of 120 extracted human mandibular molar teeth were prepared chemomechanically and obturated with laterally condensed cold gutta-percha. The crown of each tooth was sectioned leaving only one cusp standing. Gutta-percha was removed from the pulp chamber in all teeth. The volume of the pulp chamber was measured and the teeth ranked in ascending order of chamber volume. The specimens were divided into six groups of 20, allocating teeth with similar chamber volumes into each group. In three of the groups, gutta-percha was removed from the coronal 3-4 mm of each root canal. The teeth were restored with one of three materials, a cermet cement (Ketac-Silver), a resin-reinforced glass ionomer (Vitremer), or amalgam (Contour). Core preparation was carried out after 48 hours, reducing each core height to 6 mm. The specimens were thermocycled for 24 hours and then mounted in dental stone. A control group of 20 unrestored human mandibular molars was mounted in cold cure acrylic. Each tooth was tested in a Nene machine with a compressive load applied at 90 degrees to the occlusal surface at a crosshead speed of 5 mm/minute. RESULTS: There was no statistically significant difference between the experimental groups (P > 0.05), but the control group was significantly stronger (P < 0.001). Extension of core material into the coronal root canal system did not increase the fracture resistance of any of the experimental materials. Regression analysis of the results revealed no correlation between the volume of the pulp chamber and the load to fracture.     

Area-metric analysis of dye leakage for evaluation of sealing ability of root canal obturation techniques

Root canal sealing ability of obturation techniques has been assessed in vitro with various methods. The majority of the methods employ microleakage tracers and particularly dyes. In vitro measurements of dye penetration are either linear or volumetric. Area-metric analysis is a three dimensional registration method of dye leakage. The purpose of the present study was to evaluate in cleared teeth area-metric analysis as opposed to linear analysis of dye penetration. Forty freshly extracted single rooted human teeth were used. Instrumentation was carried out using Hedstroem files with a step back technique. The root canals were obturated using Roth sealer and qutta-percha cones and lateral condensation technique. The roots were then subjected to dye leakage tests under vacuum of 50 mmHg for 20 min. India ink was used as the tracer. The roots were randomly divided in two groups. In Group A the roots were cleared and linear measurements of the dye penetration were recorded The roots in Group B were ground stepwise transversally and subjected to area metric analysis. The results showed that area-metric analysis enabled sufficient recordings of the dye leakage patterns and the volume of the dye penetration could also be calculated.     

Analysis of the botulinum neurotoxin type F gene clusters in proteolytic and nonproteolytic Clostridium botulinum and Clostridium barati

The purpose of this in vitro study was to compare both apical and coronal dye penetration when Ketac-Endo and AH-26 sealers were used with laterally condensed gutta percha. Crowns were removed from 28 teeth and the root canals were biomechanically prepared. The teeth were divided into two groups of 12-teeth each and a control group of 4 teeth. Root canals in the two experimental groups were filled with laterally condensed gutta percha and either Ketac-Endo or AH-26 sealer. The Ketac-Endo group had the coronal 3 mm of gutta percha and sealer removed and the resultant cavity was filled with Ketac-Endo alone. After the sealers had set, the root surfaces were coated with nail varnish except at the apex and at the coronal end. Positive controls had no root fillings and were coated with nail varnish in the same manner while the negative controls were sealed apically and coronally with Cavit prior to sealing the entire external root surface with nail varnish. Specimens were placed in 2% methylene blue dye in a vacuum of 660 mm of mercury for five minutes and then left immersed for a further two days. The roots were vertically sectioned to determine the following mean levels of dye penetration: Ketac-Endo, 1.08 mm apically and 6.29 mm coronally; AH-26, 0.75 mm apically and 6.67 mm coronally. Positive controls had total leakage and negative controls had no leakage. This study demonstrated that the apical and coronal seals obtained with Ketac-Endo and AH-26 were not significantly different although the apical seal obtained with each material was significantly better than the corresponding coronal seal.     

Microleakage of cervical restorations etched with a weak organic acid

This in-vitro study evaluated the microleakage of Class V restorations prepared using 10 per cent maleic acid and a composite resin. Thirty human premolar teeth were evenly distributed and randomly assigned to three groups. Conventional retentive preparations, etched with 10 per cent maleic acid for either 15, 30, or 60 seconds, were cut in the enamel on the facial surface of each tooth to a 1.5 mm depth (dentin). All teeth were restored with Z-100, a small particle composite resin. The teeth were then stored in deionized water for seven days, thermocycled, stained with methylene blue dye, invested, and sectioned vertically through the centre of the restoration. Leakage was established along each wall of the sectioned restoration. Analysis of variance (ANOVA) tests indicate that the restored teeth in Group 1 (15-second etch) had significantly greater microleakage (p < 0.05) on the enamel wall than the restored teeth in Group 2 (30-second etch) or Group 3 (60-second etch). In addition, Group 1 restorations had significantly greater overall microleakage (p < 0.05) than Group 2 or Group 3 restorations. Although the results were not statistically significant, it would appear that etching with 10 per cent maleic acid for 30 seconds could be clinically significant. Since a 30-second etch time was found to produce the least amount of microleakage (not statistically significant), it can be assumed that this etch time would also be optimal for etching enamel and dentin. Similarly, since Group 1 revealed the most overall microleakage, it can be assumed that a 15-second etch would be inadequate for etching enamel and dentin. Restorations in Groups 2 and 3 displayed statistically significant lower overall microleakage results.     

Apical sealing using two thermoplasticized gutta-percha techniques compared with lateral condensation

This study was conducted to compare the apical sealing capacity of three filling techniques, a multiphase gutta-percha obturation technique, JS Quickfill, and lateral gutta-percha condensation. A four-stage stepback preparation was executed with circumferential filing in a total of 70 recently extracted permanent maxillary incisors and canines. Three experimental groups (20 teeth in each group) and two control groups (5 teeth in each group) were formed at random. Each experimental group was obturated with a different technique. The positive control group was not obturated. In the negative control group, the whole root was covered with two full nail varnish layers. Teeth were immersed in India ink for 48 h, demineralized, cleared with methyl salicylate, and examined with a stereomicroscope. None of the specimens obturated with the multiphase gutta-percha obturation system showed any penetration of India ink beyond the end of the preparation. In the groups of teeth obturated by JS Quickfill or lateral gutta-percha condensation, leakage was detected in one specimen from each group. No statistically significant differences were seen among groups. We conclude that the newer thermoplasticized filling techniques can be used successfully to obturate root canals in large, straight roots.     

Nature and attachment of cementum formed under guided conditions in human teeth. An electron microscopic study

In an attempt at characterizing the nature and attachment of cementum formed under conditions of guided tissue regeneration (GTR) in humans, front teeth from 4 patients aged 42 to 72 years were examined at the electron microscopic level. All teeth were affected by complex periodontitis associated with advanced loss of periodontal support. Roots were surgically planed and notched, but not chemically conditioned. Either the mesial or distal surface of each tooth represented the experimental site and was covered with a biodegradable polyglactin 910 barrier, while the opposite approximal surface served as control. Following 3 months of healing, teeth were removed together with surrounding periodontal tissues including some alveolar bone. These blocks were fixed histologically, decalcified, embedded in epoxy, and sectioned for examination in the scanning (backscatter mode) and transmission electron microscope. Both experimental and control sites disclosed 2 types of regenerative cementum that seemed to be formed by cells resembling cementoblasts. The first type was characterized by a thin fringe of collagen fibrils which were arranged perpendicular to the root surface and appeared mineralized in a zone extending about 1 to 3 microm from the dentin. The second type occurred as thick patches which revealed scattered cementocytes and sheets of collagen fibrils oriented mainly parallel to the root surface, running both circularly and axially. In both situations, a continuous, thin, electrondense layer was interposed between newly formed cementum and preexisting radicular hard tissues. Interdigitation of collagen fibrils from cementum and dentin, such as observed along the natural cemento-dentinal junction, did not occur. Thus, regenerative cementum laid down in humans under guided conditions on previously diseased and planed, but not otherwise treated root surfaces shares some morphologic features with cementum formed during spontaneous repair of root resorptions. However, unlike in the course of such repair, a fibrous attachment of new cementum resembling the natural cemento-dentinal junction does not seem to be regenerated under guided conditions.     

Bond strengths and SEM evaluation of Clearfil Liner Bond 2

PURPOSE: To evaluate a dental adhesive system that uses a single conditioning/primer agent. MATERIALS AND METHODS: Twenty-five flat enamel and dentin bonding sites were prepared to 600 grit on human molar teeth. The Clearfil Liner Bond 2 adhesive system was used to bond Clearfil AP-X composite to both enamel and dentin. After 24 hours of water storage, shear bond strengths were determined using an Instron testing machine. Fifty V-shaped cavity preparations were prepared in human molar teeth with an enamel and cementum margin. Composite restorations were placed using the new adhesive system. The teeth were stored for 24 hours, thermocycled, stained with AgNO3 , sectioned and examined for microleakage. SEM examinations were also completed to evaluate the effects of the treatment steps on enamel and dentin surfaces. RESULTS: Mean shear bond strengths for the experimental adhesive to enamel and dentin were 28.2 +/- 4.9 and 19.4 +/- 3.1 MPa. A t-test revealed that the enamel bond strength was significantly greater (P<0.05) than the dentin strength. No marginal leakage was observed from the enamel margins of the restorations. Three restorations showed minimal leakage from the cementum margins. SEM examinations showed resin penetration into both the conditioned enamel and dentin surfaces. The adhesive system produced high bond strengths to both enamel and dentin, exhibited very minimal microleakage and was easy to use.     

-Apatite rheumatism, unusual aspects-

OBJECTIVES: The goal of this study was to evaluate the effects of cryopreservation of teeth on dentin bond strength as a function of remaining dentin thickness. METHODS: Flat occlusal surfaces of human dentin were prepared in 54 freshly extracted teeth and 54 thawed, cryopreserved teeth. In each group, 18 bonds were performed in superficial dentin, 18 in mid-coronal, and 18 in deep dentin. A resin composite cylinder, 3 mm in diameter and in height, was bonded orthogonally to the surface. After storage in distilled water at room temperature for 1 wk, the bonded cylinders underwent shear testing at a crosshead speed of 0.5 mm min-1. The mean remaining dentin thickness was calculated after longitudinally sectioning the debonded samples through the center of the bonded area. Non-parametric statistical analyses were used to correlate the shear bond strength with the remaining dentin thickness among the storage modes and within the different dentin regions. RESULTS: The lowest shear bond strength values were found in the deep dentin of both fresh and cryopreserved dentin, while the values in deep and mid-coronal dentin were not significantly different in fresh and cryopreserved dentin. In the superficial and mid-coronal dentin of cryopreserved samples, the shear bond strength values were identical. There was a significant difference between the shear bond strength values in the superficial dentin of fresh teeth compared to the values for cryopreserved teeth. SIGNIFICANCE: According to the experimental conditions, tooth cryopreservation shows some promise as a substitute for freshly extracted teeth, provided that the experiments are performed in midcoronal and deep dentin.