Effect of Pulp Protection Technique on the Clinical Performance of Amalgam Restorations: Three-Year Results

This study evaluated the influence of the pulp protection technique on clinical performance of amalgam restorations after three years, with particular reference to post-operative sensitivity and secondary caries. One hundred and twenty (120) Class II amalgam restorations (68 premolars, 52 molars; 78 MOD, 42 OD/MO) were placed in 30 participants (four restorations per participant).The restorations were divided into four groups according to the pulp protection technique used: copal varnish; 2% neutral sodium fluoride; adhesive resin and no pulp protection. The parameters evaluated were post-operative sensitivity, staining of the dental structure, tooth vitality, partial or total loss of the restoration and secondary caries. One hundred and eight (108)restorations were available for evaluation after three years. No partial or total loss of restorations had occurred; all teeth were vital, no tooth structure staining or secondary caries was detected in any of the restored teeth. Post-operative sensitivity was observed only in two restorations at baseline and at seven-days. The three year clinical performance of teeth restored with a high copper dispersed phase amalgam was not affected by the choice of pulp protection technique

Outcomes of Primary Endodontic Therapy in Medicaid Enrollees

The objective of this study was to determine factors affecting survival of teeth after nonsurgical root canal therapy (NSRCT) among enrollees of Wisconsin Medicaid during the years 2001-2009. Only permanent teeth with NSRCTs and that had permanent restorations within 60 days after treatment completion were included in the analysis. Patients with less than 60 days of insurance coverage after treatment completion were excluded. NSRCTs and untoward events (extraction) were identified based on Code on Dental Procedures and Nomenclature (CDT). Kaplan-Meier methods were used to plot the survival distribution for the overall cohort and subgroups by age, gender, race, tooth location, geographic area (urban vs. rural), and restoration type (crown vs. other). Univariate and multivariable Cox proportional hazards regression were used to model time from root canal restoration to extraction. The multiple regression model included all baseline covariates: age, gender, race, tooth location, geography, and restoration type. After applying the inclusion and exclusion criteria, 14,281 teeth among 11,788 patients were included in the final analysis. The overall 5-year survival rate was 88.67%. Survival rates were higher among younger individuals, males, anterior teeth, and when post-operative restoration was a crown as opposed to a filling. This study concludes that the success of primary endodontic therapy in a Medicaid population can be significantly improved by using post-operative crown restorations

A review on the prevention of inflammatory periimplant diseases

Background: An impressive number of dental implants are inserted worldwide. Evolution in dental implants and simplification of surgical techniques allowed a significant increase in the number of dentists involved in implant surgery. Most of them are general dentists, are not always sufficiently formed and experienced, frequently use low-quality implants, do not adopt the proper patient selective criteria, do not adequately monitor and maintain the inserted implants, and do not report their own statistics to the dental community. Consequently, the incidence of inflammatory periimplant diseases (IPDs) has progressively increased to values significantly higher than those previously indicated by the scientific literature. Materials and Methods: Two main literature searches were undertaken in October 2018 in the PubMed Website database. Only articles written in English and published from 2008 onward were considered; 'Clinical Trial,' 'Meta analysis,' 'Observational study,' 'Review,' and 'Validation study' were selected as article type filters. The following keywords were used in the searches: 'Peri implantitis prevention' and 'Dental implant failure prevention.'Results: Preventive measures are analyzed according to the different factors that can favor the occurrence of an infection. The factors are divided into (i) implant dependent, (ii) patient dependent, and (iii) surgeon dependent. Conclusions: Scientific and clinical data confirm that when materials are selected with care, patients are carefully evaluated for factors of risk and attitude to adhere to the necessary maintenance program, and operative protocols and maintenance programs are respected dental implants can be attractive and effective tools for oral rehabilitation. Nevertheless, dentists and patients should have greater awareness that in many cases the decision to utilize dental implants cannot be taken lightly

Mineral Trioxide Aggregate Material Use in Endodontic Treatment: A Review of the Literature

Objective The purpose of this paper was to review the composition, properties, biocompatibility, and the clinical results involving the use of mineral trioxide aggregate (MTA) materials in endodontic treatment. Methods Electronic search of scientific papers from January 1990 to August 2006 was accomplished using PubMed and Scopus search engines (search terms: MTA, GMTA, WMTA, mineral AND trioxide AND aggregate). Results Selected exclusion criteria resulted in 156 citations from the scientific, peer-reviewed dental literature. MTA materials are derived from a Portland cement parent compound and have been demonstrated to be biocompatible endodontic repair materials, with its biocompatible nature strongly suggested by its ability to form hydroxyappatite when exposed to physiologic solutions. With some exceptions, MTA materials provide better microleakage protection than traditional endodontic repair materials using dye, fluid filtration, and bacterial penetration leakage models. In both animal and human studies, MTA materials have been shown to have excellent potential as pulp-capping and pulpotomy medicaments but studies with long-term follow-up are limited. Preliminary studies suggested a favorable MTA material use as apical and furcation restorative materials as well as medicaments for apexogenesis and apexification treatments; however, long-term clinical studies are needed in these areas. Conclusion MTA materials have been shown to have a biocompatible nature and have excellent potential in endodontic use. MTA materials are a refined Portland cement material and the substitution of Portland cement for MTA products is presently discouraged. Existing human studies involving MTA materials are very promising, however, insufficient randomized, double-blind clinical studies of sufficient duration exist involving MTA for all of its clinical indications. Further clinical studies are needed in these areas

Longitudinal study on the influence of Nd:YAG laser irradiation on microleakage associated of two filling techniques.

Objective: This study investigates the effects of Nd:YAG laser irradiation on apical and coronal seals, when used prior to two root canal filling techniques. Background Data: Limited information exists regarding the effects of morphologic changes to dentin walls following Nd: YAG laser irradiation on the sealing ability of root fillings. Methods: Two hundred forty teeth were analyzed by observing coronal and apical leakage of Indian ink (DL), and 60 were analyzed for through-and-through leakage using the fluid transport model (FTM). The Nd: YAG laser parameters were 1.5W, 100mJ, and 15Hz (four times for 5s at 20s intervals). Each group consisted of a lased and a nonlased subgroup: each subgroup had root fills done by either cold lateral condensation (CLC) or hybrid condensation (HC). Leakage was assessed after 48 h, and then at 1, 6, and 12 months. The DL group was divided into four groups of 15 teeth for each evaluation point. Through-and-through leakage (L in microliters/day) was measured for 48h under a pressure of 1.2 atm using FTM, and recorded as L = 0 (L1), 0 10 (L3). Results: Apical and coronal dye leakage was observed in all groups. Significant differences (p < 0.05) in apical leakage were found between HC and HC + Nd after 1, 6, and 12 months, and between CLC and CLC + Nd at 6 and 12 months. No significant differences were found between laser-irradiated and non-laser-irradiated groups with FTM. Conclusion: Pulsed Nd: YAG laser irradiation following root canal preparation may reduce apical leakage in association with hybrid gutta-percha condensation

Evaluation of the effect of adding micro-hydroxyapatite and nano-hydroxyapatite on the microleakage of conventional and resin-modified Glass-ionomer Cl V restorations

Pulpal reaction to restorative materials depends on marginal microleakage, which is a dynamic phenomenon that allows bacteria and fluids to traverse across the tooth-restoration interface. Glass-ionomer cement (GIC) exhibits low microleakage due to direct bonding to tooth structures. Hydroxyapatite (HAP) based on the similarity with tooth structure may decrease the microleakage. The aim of this in vitro study was to evaluate marginal microleakage of a mixture of conventional and resin-modified glass-ionomer (RMGI) with micro- and nano-HAP. In this in vitro study, 30 non-carious extracted human third molar teeth were used. Standard Cl V cavities were prepared on the buccal and lingual surfaces. The cavities were restored in six experimental groups as follows: group 1, conventional glass-ionomer cement (CGIC); group 2, CGIC with micro-HAP; group 3, CGIC with nano-HAP; group 4, RMGI; group 5, RMGI with micro-HAP; group 6, RMGI with nano-HAP. The restorations were finished and polished. The teeth were coated with nail polish, sealed with sticky wax, thermocycled and placed in a solution of 2% basic fuchsine for 24 hours. The teeth were sectioned and microleakage was measured. Kruskal-Wallis, Man-Whitney and Wilcoxon tests were used for data analysis (P<0.05). The data analysis revealed significantly lower microleakage in groups 5 and 6 at both occlusal and gingival margins. Also in these two groups the gingival microleakage was significantly lower than occlusal margin (P=0.009 and P=0.001 respectively), but in groups 1(CGIC) and 3(CGIC+ nano-HAP) and 4(RMGI) the microleakage of occlusal margin were significantly lower than that of gingival margin (P=0.001, P=0.007 and P=0.001 respectively). Mixing RMGI with nano-HAP and micro-HAP resulted in lower microleakage

Impact of Delayed Completion of Previously Initiated Therapy and Provider Type on Outcomes of Root Canal Treatment

Objective:if the provider type influences long-term outcomes in instances where NSRCT has been previously initiated. The primary purpose of this study was to determine if the period of time between previously initiated therapy and the completion of non-surgical root canal treatment (NSRCT) influences long-term outcomes. The secondary purpose of this study was to determineMaterials/Methods: Enrollment and claims data from Delta Dental of Wisconsin from2002-2014 was analyzed. Teeth that received NSRCT within 6 months after completionof pulpal debridement or pulpotomy procedures (identified by Codes of DentalProcedures and Nomenclature) and within a continuous insurance coverage period wereincluded. Teeth that did not receive definitive restorations within 180 days followingcompletion of NSRCT were excluded. Teeth were followed from the time of treatment tothe presence of a CDT code representing untoward events, which include retreatment,apicoectomy, or extraction. The impact of tooth location, age at time of NSRCTcompletion, and provider type on the outcome was also examined using Univariate andMultivariable Cox proportional hazards models. A total of 7,488 NSRCTs were includedin the analysis. Results:. Molar teeth were associated with a greater risk of an untoward event than anterior teeth with an adjusted hazard ratio of1.52 (p\u3c0.029). An increase in the risk of failure was observed in teeth from patients that were 55 and older with an adjusted hazard ratio 2.15 (p\u3c0.001). A significantly lower adjusted hazard ratio of 0.68 (p\u3c0.001) was observed when treatment was initiated by a general dentist and completed by an endodontist when compared to treatment that was both initiated and completed by a general dentist.Conclusion: Delayed completion of NSRCT after previously initiated therapy was not associated with unfavorable outcomes.No statistically significant difference was found among the varying time intervals between initiation and completion of NSRCT Improved outcomes were noted when previously

In vitro assessment of cytotoxicity of giomer on human gingival fibroblasts

Root coverage on restored root surfaces has been considered as a challenging issue. The evaluation of cytotoxic effects of restorative materials is a fundamental requirement for sustaining the cell attachment and the clinical success of root coverage. The aim of the present study was to compare the human gingival fibroblast cytotoxicity of the recently introduced giomer composite (GC) with resin ionomer (RI) restorative material. Discs (6x2 mm) of GC and RI restorative materials were prepared using sterile Teflon mold. Extracts from the materials were incubated to cell culture medium for 24, 48 and 72 h. Human gingival fibroblasts (HGF) were exposed to the extracts of the materials while the un-incubated media served as the control group. The cytotoxicity of the materials were evaluated by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. In order to compare the mean values of the measured parameters a Kruskal-Walis test was carried out. MTT assay indicated that human gingival fibroblasts proliferated well in the presence of GC extract. The proliferation rate was higher in cells incubated with GC compared to RI extracts but the differences were not statistically significant (p= 0.09). This in vitro study indicated that GC is a non-toxic material for HGF. However, further studies are needed to assess the other biologic and clinical behavior of this material prior to it being considered as a potentially suitable restorative material to restore the carious root lesions candidated to root coverage procedures

The Post–endodontic Adhesive Interface: Theoretical Perspectives and Potential Flaws

Introduction The aim of this review was to analyze the potential of successful bonds of endodontic posts to radicular dentin as well as the limitations of the post–endodontic adhesive interface. Methods The MEDLINE/PubMed and Web of Science electronic databases were searched. The search was augmented by a manual search of the pertinent bibliographies. Results The post–endodontic adhesive interface finds application in the endodontic cohesive units. Many techniques and materials exist to improve the bond between endodontic posts and resin-based materials as well as between resin-based materials and radicular dentin. Different techniques used for the adhesion of metallic and fiber-reinforced posts are discussed and critically analyzed. Conclusions Although adhesive cementation of endodontic posts is popular, a long-term predictable bond may be compromised because of procedures related to the endodontic treatment and/or the adhesive cementation procedures. Microleakage and degradation phenomena may further jeopardize the post–endodontic adhesive interface