In Vitro Comparison of Cytotoxicity and Genotoxicity of Three Vital Pulp Capping Materials

Introduction: Direct pulp capping (DPC) is a treatment for maintaining pulp vitality and its biological function. Ideally, pulp capping agents are expected to induce pulp cells to form hard tissue. This in vitro study assessed the cytotoxicity and genotoxicity of three vital pulp capping (VPC) agents naming Biodentine (Septodont, Saint-Maur-des-Fosses, France), mineral trioxide aggregate (ProRoot MTA; Dentsply, Tulsa Dental, Tulsa, OK, USA) and TheraCal LC (Bisco Inc, Schamburg, IL, USA) on human dental pulp fibroblasts. Methods and Materials: Human fibroblasts were exposed to 100 µL of ProRoot MTA, TheraCal LC and Biodentine in 0-1000 µg/mL concentrations and incubated at 37°C for 24 h. Their cytotoxicity and genotoxicity were assessed using the methyl thiazol tetrazolium (MTT) and the comet assays, respectively. The data were analyzed by Kruskal-Wallis test at the level of significance set at 0.05. Results: None of the tested materials had cytotoxicity or genotoxicity. Conclusion: TheraCal LC, Biodentine and ProRoot MTA can be alternately used for VPC treatment of teeth.Keywords: Biodentine; Cytotoxicity; Genotoxicity; ProRoot MTA; TheraCal L

Nonsurgical Management of an Extensive Perforative Internal Root Resorption with Calcium-Enriched Mixture Cement

Internal inflammatory root resorption (IIRR) is a rare condition of the root canal and if it is left untreated it may lead to destruction of the surrounding dental hard tissues. Odontoclasts are responsible for this situation which can potentially perforate the root. Many initiating factors have been mentioned for IIRR, almost all causing chronic inflammation in the vital pulp. IIRR is usually symptom free, but in cases of root perforation, a sinus tract usually forms. The prognosis of treatment depends on the size of lesion with small lesions being managed with good prognosis. However, in case of notable destruction of the tooth, the prognosis is poor and tooth extraction may become inevitable. This report represents the management of an extensive perforative IIRR that was successfully sealed with calcium-enriched mixture (CEM) cement. After 12 months the tooth was still symptomless and in function

The Effects of Three Bleaching Agents on Tooth Discoloration Caused by Mineral Trioxide Aggregate

Introduction: Successful outcome of pulp capping treatment using mineral trioxide aggregate (MTA), often leads to tooth discoloration. This study aimed to compare the efficacy of external bleaching technique with three bleaching agents naming hydrogen peroxide, carbamide peroxide and sodium perborate for correction of tooth discoloration caused by MTA. Methods and Materials: This in vitro, experimental study used 36 tooth blocks prepared from 12 bovine central incisors. White ProRoot MTA was applied in cavities; drilled in blocks for 40 days to cause discoloration. Then, the blocks were assigned to three experimental groups (n=12). Following application of hydrogen peroxide, carbamide peroxide and sodium perborate, the color parameters were determined at baseline and at 1, 7 and 14 days, using a spectrophotometer. Data were analyzed using repeated measure ANOVA and Tukey’s test. Results: No significant difference was noted in color change (∆E) immediately after bleaching with hydrogen peroxide and carbamide peroxide (P>0.05). However, these two groups had significant differences in ∆E with the sodium perborate group (P=0.001). Hydrogen peroxide group showed significantly higher ∆E at 1 week compared with other groups (P=0.01). The three groups were significantly different in ∆E at 2 weeks after bleaching (P=0.001). Pairwise comparisons revealed no significant difference between sodium perborate and carbamide peroxide in ∆E but they both had a significant difference with hydrogen peroxide (P=0.01). Conclusion: The three bleaching agents bleached the discoloured teeth effectively. Hydrogen peroxide had the highest efficacy whilst sodium perborate and carbamide peroxide had lower but similar efficacy.Keywords:Bleaching; Carbamide Peroxide; Hydrogen Peroxide; Mineral Trioxide Aggregate; Sodium Perborate

In Vitro Spectrophotometry of Tooth Discoloration Induced by Tooth-Colored Mineral Trioxide Aggregate and Calcium-Enriched Mixture Cement

Introduction: There are numerous factors that can lead to tooth discoloration after endodontic treatment, such as penetration of endodontic materials into the dentinal tubules during root canal treatment. The aim of this in vitro study was to compare discoloration induced by tooth colored mineral trioxide aggregate (MTA) and calcium-enriched mixture (CEM) cement in extracted human teeth. Methods and Materials: Thirty two dentin-enamel cuboid blocks (7×7×2 mm) were prepared from extracted maxillary central incisors. Standardized cavities were prepared in the middle of each cube, leaving 1 mm of enamel and dentin on the labial surface. The specimens were randomly divided into two study groups (n=12) and two positive and negative control groups (n=4). In either study groups the cavities were filled with MTA or CEM cement. The positive and negative control groups were filled with blood or left empty, respectively. The cavities were sealed with composite resin and stored in normal saline. Color measurement was carried out by spectrophotometry at different time intervals including before (T0), and 1 week (T1), 1 month (T2) and 6 months (T3) after placement of materials. Repeated-measures ANOVA was used to compare the discoloration between the groups; the material type was considered as the inter-subject factor. The level of significance was set at 0.05. Results: No significant differences were detected between the groups in all time intervals (P>0.05). Conclusion: Tooth discoloration was similarly detectable with both of the two experimental materials.Keywords: Calcium-Enriched Mixture; CEM Cement; Crown Discoloration; Mineral Trioxide Aggregate; MTA; Spectrophotometer

Effect of Dexamethasone Intraligamentary Injection on Post-Endodontic Pain in Patients with Symptomatic Irreversible Pulpitis: A Randomized Controlled Clinical Trial

Introduction: The aim of this randomized-controlled clinical trial was to assess the effect of intraligamentary (PDL) injection of dexamethasone on onset and severity of post-treatment pain in patients with symptomatic irreversible pulpitis. Methods and Materials: A total number of 60 volunteers were included according to the inclusion criteria and were assigned to three groups (n=20). After administration of local anesthesia and before treatment, group 1 (control) PDL injection was done with syringe containing empty cartridge, while in groups 2 and 3 the PDL injection was done with 0.2 mL of 2% lidocaine or dexamethasone (8 mg/2 mL), respectively. Immediately after endodontic treatment patients were requested to mark their level of pain on a visual analogue scale (VAS) during the next 48 h (on 6, 12, 24 and 48-h intervals). They were also asked to mention whether analgesics were taken and its dosage. Considering the 0-170 markings on the VAS ruler, the level of pain was scored as follows: score 0 (mild pain; 0-56), score 1 (moderate pain; 57-113) and score 3 (severe pain; 114-170). The data were analyzed using the Kruskal-Wallis and the Chi-square tests and the level of significance was set at 0.05. Results: After 6 and 12 h, group 1 and group 3 had the highest and lowest pain values, respectively (P<0.01 and P<0.001 for 6 and 12 h, respectively). However, after 24 and 48 h the difference in the pain was not significant between groups 1 and 2 (P<0.6) but group 3 had lower pain levels (P<0.01 and P<0.8 for 24 and 48 h, respectively). Conclusion: Pretreatment PDL injection of dexamethasone can significantly reduce the post-treatment endodontic pain in patients with symptomatic irreversible pulpitis.Keywords: Dexamethasone; Endodontic Treatment; Intraligamentary Injection; Post endodontic Pain; Symptomatic Irreversible Pulpiti

In Vitro Comparison of Pushout Bond Strength of ProRoot MTA, Biodentine and TheraCal

One problem encountered in vital pulp therapy is the dislodgment of biomaterial as the result of the application of mechanical condensation forces for the final restoration of the cavity or occlusal loads. In this in vitro, experimental study, 90 denti

Craniofacial Pain as the Sole Sign of Prodromal Angina and Acute Coronary Syndrome: A Review and Report of a Rare Case

Orofacial pain can arise from different regions and etiologies. Some of the most debilitating pain conditions arise from the structures innervated by the trigeminal system (head, face, masticatory musculature, temporomandibular joint and associated structures). The problem with referred pain is the misdiagnosis and unnecessary therapy directed to the pain location instead of its origin. When craniofacial pain is the sole sign of myocardial ischemia, failure to recognize its cardiac source can endanger the patient. In particular, apart from unnecessary dental treatments, patients with acute myocardial infarction who do not experience chest pain run a very high risk of misdiagnosis and death. As endodontists, each of us may face many patients complaining of pain sensation in the teeth with the main source being other craniofacial/visceral organs. This review plots a diagnostically challenging case paving the way for further literature presentation in this regard. The aim of this compendious review was to gain knowledge about the prevalence, clinical characteristics and possible mechanisms of craniofacial pain of cardiac origin, in order to improve the clinician’s ability to make a correct diagnosis.Keywords: Craniofacial Pain; Myocardial Infarction; Orofacial Pain; Pre-Infarction Angina; Prodromal Angina; Referred Pai

Onset and duration of 2% lidocaine as inferior alveolar nerve block versus buccal/lingual infiltration of 4% articaine in mandibular second molars: Clinical trial study

BACKGROUND AND AIM: The effectiveness of buccal or lingual (B/L) infiltration of 4% articaine as supplemental injection for pulp anesthesia of mandibular teeth was confirmed in previous studies. However, this study was aimed to compare the effectiveness of 2% lidocaine as inferior alveolar nerve block (IANB) versus B/L infiltration of 4% articaine for pulp anesthesia, as primary injection in mandibular second molars. METHODS: Thirty adult volunteers ranging from 18 to 40 years old with no systemic disease or medicine intake were included in this split-mouth, double-blind, randomized clinical trial study. Each mandibular side of included subjects was allocated randomly to control group (IANB using 2% lidocaine and 1/80000 epinephrine using direct technique) and B/L infiltration group using 4% articaine (Septanest; Septodont, Saint-Maur-des-Fosses, France). After obtaining base line sensitivity, electric pulp testing (EPT) was done at 5, 8, 11, 15, 20, 25, 30, 45, 60, 75, and 90 minutes post injections. The data were analyzed using chi-square test. RESULTS: The success rate of anesthesia for IANB group was 83.3% (25 of 30 subjects) and 30% (9 of 30 subjects) for B/L infiltration group, and the difference between the groups was statistically significant (P = 0.0005). The mean onset time of pulp anesthesia for IANB group was 22.6 ± 30.9 minutes and 65.5 ± 38.0 for B/L infiltration group, and the difference between the groups was statistically significant (P = 0.0001). The mean duration time of pulp anesthesia for IANB group was 53.0 ± 27.4 minutes and 10.6 ± 17.2 for B/L infiltration group, and the difference between the groups was statistically significant (P = 0.0001). CONCLUSION: The results indicated that IANB using 2% lidocaine was more successful than B/L infiltration of 4% articaine in onset and duration of pulp anesthesia of mandibular second molars as primary injections. KEYWORDS: Articaine; Lidocaine; Local Anesthesia; Molar; Inferior Alveolar Nerve; Volunteer

Repair of a furcation perforation with mineral trioxide aggregate: A case report with 6 year follow-ups

Perforations might occur due to carious lesions, tooth resorption or they might be iatrogenic during endodontic treatment or in most cases they might occur during post space preparation. CASE REPORT: A 31-year-old female patient presented with a complaint of chronic pain on tooth #30 during last 6 months and sensitive to bite since a few days ago. There was a mild swelling on the gingival tissue in the furcation area in the intraoral examination, with a narrow strip-shaped pocket measuring 3 mm in depth. Radiographic examination revealed an incomplete root canal treatment of the tooth. A prefabricated post had been placed in the distal root, with an incorrect path toward the furcation area. There was a small radiolucency in the furcation area and a pronounced radiolucency around the mesial root of the tooth. After removal of the post, hemorrhage was observed in the furcation area. The diameter of the perforation was approximately 1 mm. The perforated area was sealed with Pro Root mineral trioxide aggregate (MTA). In the next session when setting of MTA was evaluated and confirmed, retreatment of the tooth was done. After 6 months, no swelling or sensitivity was observed and after 6 year follow-ups radiographic examination revealed that the lesion had almost resolved. CONCLUSION: In the present case, the lesion of furcation perforation was small in size, but the time interval between the occurrence of perforation and the repair procedure was long, success was achieved due to the control of the aseptic conditions, control of hemorrhage and proper placement of the repair material, which was confirmed in the 6 year follow-ups

epair of a furcation perforation with mineral trioxide aggregate: A case report with 6 year follow-ups

BACKGROUND AND AIM: One of the most common reasons for the failure of endodontic treatment is root perforation. Perforations might occur due to carious lesions, tooth resorption or they might be iatrogenic during endodontic treatment or in most cases they might occur during post space preparation. CASE REPORT: A 31-year-old female patient presented with a complaint of chronic pain on tooth #30 during last 6 months and sensitive to bite since a few days ago. There was a mild swelling on the gingival tissue in the furcation area in the intraoral examination, with a narrow strip-shaped pocket measuring 3 mm in depth. Radiographic examination revealed an incomplete root canal treatment of the tooth. A prefabricated post had been placed in the distal root, with an incorrect path toward the furcation area. There was a small radiolucency in the furcation area and a pronounced radiolucency around the mesial root of the tooth. After removal of the post, hemorrhage was observed in the furcation area. The diameter of the perforation was approximately 1 mm. The perforated area was sealed with Pro Root mineral trioxide aggregate (MTA). In the next session when setting of MTA was evaluated and confirmed, retreatment of the tooth was done. After 6 months, no swelling or sensitivity was observed and after 6 year follow-ups radiographic examination revealed that the lesion had almost resolved. CONCLUSION: In the present case, the lesion of furcation perforation was small in size, but the time interval between the occurrence of perforation and the repair procedure was long, success was achieved due to the control of the aseptic conditions, control of hemorrhage and proper placement of the repair material, which was confirmed in the 6 year follow-ups