Bacterial leakage through temporary fillings in core buildup composite material - an in vitro study

PURPOSE: To evaluate the ability of the provisional filling material Cavit-W alone or in combination with different restorative materials to prevent bacterial leakage through simulated access cavities in a resin buildup material. MATERIALS AND METHODS: LuxaCore resin cylinders were subdivided into 4 experimental groups (n = 30), plus a positive (n = 5) and a negative (n = 30) control group. One bore hole was drilled through each cylinder, except those in the negative control group (G1). The holes were filled with Cavit-W (G2), Cavit-W and Ketac-Molar (glassionomer cement, G3), Cavit-W and LuxaCore bonded with LuxaBond (G4), Cavit-W and LuxaCore (G5), or left empty (G6). Specimens were mounted in a two-chamber leakage setup. The upper chamber was inoculated with E. faecalis. An enterococci-selective broth was used in the lower chamber. Leakage was assessed for 60 days and compared using Fisher's exact test (α < 0.05) corrected for multiple testing. RESULTS: Bacteria penetrated specimens in the positive control group within 24 h. All specimens in the negative control group resisted bacterial leakage for 60 days. Twenty-seven specimens in G2, 26 in G3, and 16 specimens in G5 showed bacterial leakage by the end of the experiment. G4 prevented bacterial penetration completely. The statistical comparison revealed significant differences between G4 and all other experimental groups. CONCLUSION: Under the current conditions, Cavit-W alone or combined with a glass-ionomer cement did not prevent bacterial leakage through a resin buildup material for two months. In contrast, covering Cavit-W with a bonded resin material resulted in a bacteria-tight seal for two months

Reduction of hard-tissue debris accumulation during rotary root canal instrumentation by etidronic acid in a sodium hypochlorite irrigant

INTRODUCTION: Hard-tissue debris is accumulated during rotary instrumentation. This study investigated to what extent a calcium-complexing agent that has good short-term compatibility with sodium hypochlorite (NaOCl) could reduce debris accumulation when applied in an all-in-one irrigant during root canal instrumentation. METHODS: Sixty extracted mandibular molars with isthmuses in the mesial root canal system were selected based on prescans using a micro-computed tomography system. Thirty teeth each were randomly assigned to be instrumented with a rotary system and irrigated with either 2.5% NaOCl or 2.5% NaOCl containing 9% (wt/vol) etidronic acid (HEBP). Using a side-vented irrigating tip, 2 mL of irrigant was applied by 1 blinded investigator to the mesial canals after each instrument. Five milliliters of irrigant was applied per canal as the final rinse. Mesial root canal systems were scanned at high resolution before and after treatment, and accumulated hard-tissue debris was calculated as vol% of the original canal anatomy. Values between groups were compared using the Student's t test (α < .05). RESULTS: Irrigation with 2.5% NaOCl resulted in 5.5 ± 3.6 vol% accumulated hard-tissue debris compared with 3.8 ± 1.8 vol% when HEBP was contained in the irrigant (P < .05). CONCLUSIONS: A hypochlorite-compatible chelator can reduce but not completely prevent hard-tissue debris accumulation during rotary root canal instrumentation

Wound Lavage in Studies on Vital Pulp Therapy of Permanent Teeth with Carious Exposures: A Qualitative Systematic Review

The aim of this study was to systematically review pulp wound lavage in vital pulp therapy (VPT). A search was conducted in six life science databases to identify clinical trials carried out on permanent teeth with a carious pulp exposure and a recall interval of at least six months. Twenty-seven trials of low to moderate risk of bias (RoB-2 and ROBINS-I) were included. Data was extracted and analyzed regarding study characteristics and methods used for pulp wound lavage. The agent used for pulp wound lavage was specified in all included trials. Most of the identified trials (23/27) randomized the pulp capping material. Many (14/27) reported the use of sodium hypochlorite (NaOCl); ten used only saline or water. One trial was identified that compared pulp wound lavage with 2.5% (NaOCl) to saline, another compared 5% glutaraldehyde to water, both in immature molar pulpotomies. Both studies were underpowered. Neither showed a significant difference between treatments. The use of NaOCl was positively correlated to recent year of publication and use of hydraulic calcium silicate cements for pulp capping (p < 0.05). In conclusion, despite a lack of well-designed trials on pulp wound lavage in VPT, a trend towards using NaOCl for this purpose was observed

Untersuchung der Korrelation zwischen dem klinisch diagnostizierten Entzündungszustand und dem periapikalen Index bei Zähnen mit akuten Schmerzen endodontischer Ursache

Zielsetzung: Die Untersuchung und Korrelation von drei unterschiedlichen akut schmerzhaften entzündlichen Zuständen endodontischer Ursache und ihrer – anhand des Periapikalen Index-Scores (PAI) bestimmten – Erscheinung im Einzelzahnröntgenbild. Methodik: Über einen Zeitraum von 15 Monaten wurden am Zentrum für Zahnmedizin der Universität Zürich 368 Patienten mit akuten Zahnschmerzen untersucht, bei denen der Verdacht auf eine endodontisch bedingte Ursache bestand. Davon wurden Fälle (ein Zahn pro Patient) ausgewählt, welche mit starken Schmerzen einhergingen (Numerical Rating Scale-11 [NSR-11] > 6) und eindeutige pulpale/periapikale Diagnosen aufwiesen (n = 162). Die Zähne wurden entsprechend dem klinisch diagnostizierten (Haupt-)Ort des Entzündungsprozesses in drei Gruppen eingeteilt: Ebene 1: Pulpa (positive Reaktion auf den Kältetest), Ebene 2: Parodont (keine Reaktion auf Kälte, ohne Schwellung) und Ebene 3: periapikale Gewebe (keine Reaktion auf Kälte, mit Schwellung). Zur Diagnostik wurden digitale Einzelzahnaufnahmen angefertigt und von zwei kalibrierten Untersuchern beurteilt (PAI). Für die Ebene 2 (n = 76), welche die höchste PAI-Varianz aufwies, wurden die PAI-Werte zusätzlich auf ihre Abhängigkeit von den Faktoren „Zahnlokalisation“ und „Schmerzdauer“ untersucht. Die Daten wurden statistisch mit dem Chi-Quadrat-Test und nichtparametrischen Tests (α = 0,05) ausgewertet. Ergebnisse: Die bestimmten PAI-Werte korrelierten insgesamt gut mit der klinisch diagnostizierten Hauptlokalisation der Entzündung (Spearman‘s Rho = 0,5131, P < 0,001), wobei die Ebene 1 die mit Abstand niedrigsten PAI-Werte aufwies (P < 0,001) und die Ebene 2 im Vergleich zu Ebene 3 signifikant niedrigere Werte zeigte (P < 0,05). Ein PAI-Wert von 5 wurde lediglich bei drei Zähnen gefunden und in der Gruppe der Ebene 2 war bei 49 % der Zähne keine deutliche röntgenologische Aufhellung vorhanden (PAI < 3). Bei den Zähnen der Ebene 2 waren die PAI-Werte nicht von der Position des Zahnes (Oberkiefer/Unterkiefer/Frontzahn/Seitenzahn) abhängig, aber deutlich (P < 0,001) erhöht bei Zähnen, welche mehr als eine Woche Schmerzen verursacht hatten, sowie bei wurzelgefüllten Zähnen. Schlussfolgerungen: Bei den untersuchten aufgrund endodontischer Entzündung akut schmerzhaften Zähnen reflektierte der Periapikale Index-Score den klinisch diagnostizierten Ort der Entzündung. Die PAI-Werte wurden nicht signifikant durch anatomisches Rauschen beeinflusst, unterschätzten aber in einigen Fällen die klinische Situation. Keywords: apikale Parodontitis, dentale Radiologie, Periapikaler Index, Schmerz, Pulpiti

Comparison of vehicles to collect dentinal fluid for molecular analysis

OBJECTIVES To test the hypothesis that a material with higher water absorption than polyvinylidene fluoride (PVDF) could increase the yield of target molecules from exposed dentine. METHODS In a series of standard tests, different cellulose membranes were compared to a PVDF counterpart for their ability to absorb water and release protein. In a subsequent randomized clinical trial, the cellulose material with the most favourable values was compared to PVDF regarding the levels of MMP-2 that could be collected from exposed dentine of healthy human teeth during filling replacement. MMP-2 levels were determined by enzyme-linked immunosorbent assay (ELISA). Data from the laboratory experiments were compared between materials using the appropriate parametric tests. The frequency of cases yielding quantifiable levels of MMP-2 was compared between materials by Fisher's exact test. The level of significance was set at 5%. RESULTS The cellulose membrane with the largest pore size (12-15μm) absorbed significantly (P<0.05) more water than PVDF. It showed a protein release that was similar to that of PVDF, while the cellulose membranes with smaller pore size retained significantly more protein (P<0.05). Using the large-pore cellulose membrane, MMP-2 could be collected at a quantifiable level from the dentine of healthy teeth in 9 of 13 cases, compared to 1 of 13 with the PVDF membrane (P<0.05). CONCLUSIONS Under the current conditions, a large-pore cellulose membrane yielded more of a molecule of diagnostic value compared to a standard PVDF membrane. CLINICAL SIGNIFICANCE Molecular diagnostics of dentinal fluid are hampered by low yields. In the current study, it was shown that cellulose membranes are more useful to collect MMP-2 from dentinal fluid than PVDF membranes

Pain levels and typical symptoms of acute endodontic infections: a prospective, observational study

BACKGROUND: This study aimed to identify key symptoms that could be associated with the diagnosis of acute forms of symptomatic apical periodontitis (SAP) and symptomatic irreversible pulpitis (SIP), and to identify a diagnostic algorithm based on these symptoms. METHODS: In this prospective, observational study 173 emergency patients diagnosed with acute pain of endodontic origin and no swelling or fistula were included. Patients were asked 11 specific questions from a checklist with a possible discerning value between acute SAP and acute SIP. Pain levels were recorded using the numeric rating scale (NRS-11). Subsequently, the painful tooth was diagnosed. Logistic regression was used to evaluate the checklist regarding its differentiation between SAP (N = 103) and SIP (N = 70). Moreover, a decision tree was constructed based on recursive partitioning to identify a hierarchy in differentiating symptoms. RESULTS: With identical median NRS-11 scores of 8, the teeth diagnosed with acute SAP and SIP were severely painful. The decision tree analysis resulted in a tree with splits according to pain on cold, perceived tooth extrusion, and pain duration. The overall sensitivity of the tree to detect SAP based on key symptoms was 95 %, its specificity was 31 %. CONCLUSIONS: The best indicator for SAP was a reported absence of pain to cold stimuli. In teeth that did have a history of pain triggered by cold stimuli, the decision tree correctly identified SAP in 72 % of the teeth that felt too high and had hurt for less than one week

Biological Markers for Pulpal Inflammation: A Systematic Review

<div><p>Background and Objective</p><p>Pulpitis is mainly caused by an opportunistic infection of the pulp space with commensal oral microorganisms. Depending on the state of inflammation, different treatment regimes are currently advocated. Predictable vital pulp therapy depends on accurate determination of the pulpal status that will allow repair to occur. The role of several players of the host response in pulpitis is well documented: cytokines, proteases, inflammatory mediators, growth factors, antimicrobial peptides and others contribute to pulpal defense mechanisms; these factors may serve as biomarkers that indicate the status of the pulp. Therefore, the aim of this systematic review was to evaluate the presence of biomarkers in pulpitis.</p><p>Methods</p><p>The electronic databases of MEDLINE, EMBASE, Scopus and other sources were searched for English and non-English articles published through February 2015. Two independent reviewers extracted information regarding study design, tissue or analyte used, outcome measures, results and conclusions for each article. The quality of the included studies was assessed using a modification of the Newcastle-Ottawa-Scale.</p><p>Results and Conclusions</p><p>From the initial 847 publications evaluated, a total of 57 articles were included in this review. In general, irreversible pulpitis was associated with different expression of various biomarkers compared to normal controls. These biomarkers were significantly expressed not only in pulp tissue, but also in gingival crevicular fluid that can be collected non-invasively, and in dentin fluid that can be analyzed without extirpating the entire pulpal tissue. Such data may then be used to accurately differentiate diseased from healthy pulp tissue. The interplay of pulpal biomarkers and their potential use for a more accurate and biologically based diagnostic tool in endodontics is envisaged.</p></div