Effect of different mixing and placement methods on the quality of MTA apical plug in simulated apexification model

It is necessary apical plug material to exhibit proper adaptation with the root canal walls. Presence of voids at the interface between the root canal wall and this material result in micro leakage, which might have a relationship with post treatment disease. The aim of the present study was to evaluate the effect of different mixing (manual and ultrasonic) and placement (manual and manual in association with indirect ultrasonic) method of Mineral Trioxide Aggregate (MTA) on the void count and dimension in the apical plug in natural teeth with simulated open apices. Eighty human maxillary central incisors were selected. After simulation of the open apex model, the teeth were assigned to 4 groups based on the mixing and placement techniques of MTA: group 1, manual mixing and manual placement; group 2, manual mixing and manual placement in association with indirect ultrasonic; group 3, ultrasonic mixing and and manual placement; and group 4, ultrasonic mixing and manual placement in association with indirect ultrasonic. The prepared samples were placed within gypsum sockets in which the periodontal ligament was reconstructed with polyether impression material. In group 1, after mixing, the material was condensed with a hand plugger. In group 2, after mixing, the ultrasonic tip was contacted with the hand plugger for 2 seconds. In groups 3 and 4, mixing was carried out with the ultrasonic tip for 5 seconds and in groups 3 and 4, similar to groups 1 and 2, respectively, the materials were placed as apical plugs, measuring 3 mm in length. A wet cotton pellet was placed at canal orifices and dressed with Cavit. After one week, the cone beam computed tomography (CBCT) technique was used to count the number of voids between the material and root canal walls. The void dimensions were determined using the following scoring system: score 1, absence of voids; score 2, the void size less than half of the dimensions of the evaluated cross-section; score 3, the void size larger than half of the dimensions of the evaluated cross-section. Chi-squared and Fisher?s exact tests were used for statistical analyses. Statistical significance was set at P0.05). Evaluation of void dimensions showed no score 3 in any of the study groups and the dimensions of all the voids conformed to score 2. Under the limitations of the present study, use of ultrasonic mixing and manual placement techniques resulted in a decrease in the number of voids in the apical plug

Scanning Electron Microscopy and Energy-Dispersive X-Ray Microanalysis of Set CEM Cement after Application of Different Bleaching Agents

Introduction: The present study evaluated the element distribution in completely set calcium-enriched mixture (CEM) cement after application of 35% carbamide peroxide, 40% hydrogen peroxide and sodium perborate as commercial bleaching agents using an energy-dispersive x-ray microanalysis (EDX) system. The surface structure was also observed using the scanning electron microscope (SEM). Methods and Materials: Twenty completely set CEM cement samples, measuring 4×4 mm2, were prepared in the present in vitro study and randomly divided into 4 groups based on the preparation technique as follows: the control group; 35% carbamide peroxide group in contact for 30-60 min for 4 times; 40% hydrogen peroxide group with contact time of 15-20 min for 3 times; and sodium perborate group, where the powder and liquid were mixed and placed on CEM cement surface 4 times. Data were analyzed at a significance level of 0.05 through the one Way ANOVA and Tukey’s post hoc tests. Results: EDX showed similar element distribution of oxygen, sodium, calcium and carbon in CEM cement with the use of carbamide peroxide and hydroxide peroxide; however, the distribution of silicon was different (P<0.05). In addition, these bleaching agents resulted in significantly higher levels of oxygen and carbon (P<0.05) and a lower level of calcium (P<0.05) compared to the control group. SEM of the control group showed plate-like and globular structure. Sodium perborate was similar to control group due to its weak oxidizing properties. Globular structures and numerous woodpecker holes were observed on the even surface on the carbamide peroxide group. Conclusion: The mean elemental distribution of completely set CEM cement was different when exposed to sodium perborate, carbamide peroxide and hydrogen peroxide.Keywords: Bleaching Agents; Calcium-Enriched Mixture; Energy-Dispersive X-Ray Microanalysis; Scanning Electron Microscop

Anatomic Features of C-shaped Mandibular Second Molars in a Selected Iranian Population Using CBCT

Introduction: The aim of this retrospective study was to analyze the frequency of C-shaped root canal configuration and characterize mandibular root canal morphology using cone-beam computed tomography (CBCT) with 3D images in an Iranian population. Methods and Materials: This study consisted of retrospective evaluation of CBCT images from 231 adult patients (153 with bilateral second mandibular molars). Two endodontists examined 384 mandibular second molars of a population in Tabriz, Iran to determine the presence of C-shaped canals and their anatomical characteristics. Root canal configurations were categorized at three different levels. Bilateral or unilateral occurrence of C-shaped canals and their relationship to gender, age and tooth position were examined and statistically analyzed using chi squared test and Fisher’s exact test in SPSS 17. The significance level was set at 0.05. Results: Of 384 mandibular second molars examined, 82 (21.4%) molars from 58 patients had a C-shaped root canal configuration. The prevalence of bilateral C-shaped canals was 15.6% amongst 153 patients with bilateral mandibular second molars. There were no significant differences in the distribution of C-shaped canals with respect to gender or age (P=0.06 and P=0.86, respectively). Only 4 teeth (4.9%) had the same root canal configuration from the orifice to the apex. In the remainder of the teeth, the cross-sectional root canal configuration changed at different levels of the root. Conclusion: There were significant variations in the number of roots and canal morphology in mandibular second molars, which should be considered during debridement and obturation of the root canal system.Keywords: C-shaped Canal; Canal Configuration; Cone-beam Computed Tomography; Mandibular Second Mola

Evaluation of Antibacterial Efficacy of Photodynamic Therapy vs. 2.5% NaOCl against E. faecalis-infected Root Canals Using Real-time PCR Technique

Bacteria like E. faecalis can produce intra- and extra-radicular biofilms. Theoretically, the adjustable penetration ability of lasers enables better access to root canal system. Therefore the aim of the present study was to compare the ability of photoactivated laser and 2.5% NaOCl irrigation solution to eliminate E. faecalis from the root canals by real-time PCR technique. Sixty extracted human upper central incisors were selected and sterilized in an autoclave. The root canals were infected with E. faecalis (PTCC 1237, Persian Type Culture Collection, Iran) and then incubated for 24 hours. The samples were randomly divided into 3 groups. No intervention was made in the control group (group 1). In group 2, laser therapy was performed with a power of 100 mW by diode laser for 120 seconds. In group 3, the canals were irrigated with 5 mL of 2.5% NaOCl; then all the samples were sonicated in 15 mL of normal saline in test tubes in order to isolate the bacteria. DNA extraction was performed followed by real-time PCR technique for all the samples. Inhibition of bacterial growth in all the experimental samples was significantly more than that in the control group. There was a significant difference between photodynamic therapy and 2.5% NaOCl. The effect of NaOCl in all the samples was better than photodynamic therapy. The results of the mean CT (cyclic threshold) were 40, 30.2 and 15.35 for 2.5% NaOCl, photodynamic therapy and control group, respectively. Based on the results of this experimental study, 2.5% NaOCl eliminated E. faecalis from infected root canals more effectively compared to photodynamic therapy

Effect of the TiO2 nanoparticles on the selected physical properties of mineral trioxide aggregate

Some of the efforts to improve the properties of Mineral Trioxide Aggregate (MTA) include incorporation of some nanoparticles such as Titanium dioxide (TiO2). The aim of this study was to evaluate the effect of TiO2 nanoparticles on the setting time, working time, push-out bond strength and compressive strength of MTA. The physical properties to be evaluated were determined using the ISO 6786:2001 and 9917 specifications. Fifteen samples of each material (MTA or MTA with 1% weight ratio of TiO2 Nanoparticles) were prepared for any evaluated physical property. Data were analyzed using descriptive statistics and T-test. Statistical significance was set at P<0.05. There was the significant effect of the material type (presence and absence of TiO2 nanoparticles) on the push-out bond strength, compressive strength, working time and setting time, with significantly higher values achieved in the group with TiO2 nanoparticles than the group without these particles (P=0.01 for the setting time and compressive strength, P=0.03 for the working time and P=0.001 for the bond strength). Based on the findings of this in vitro study, incorporation of the TiO2 nanoparticles with weight ratio of 1% increased the setting time, working time, compressive strength and push out bond strength of MTA

The Effect of Different Mixing Methods on the pH and Solubility of Mineral Trioxide Aggregate and Calcium-Enriched Mixture

Introduction: The aim of this study was to evaluate the effect of different mixing techniques on the pH and solubility of mineral trioxide aggregate (MTA) and calcium-enriched mixture (CEM). Methods and Materials: Five samples were prepared from each biomaterial with different mixing techniques including hand-, amalgamator- or ultrasonic-mixing and were then placed in pre-weighted plastic tubes to determine their pH values. Each tube was then incubated in 10 mL deionized distilled water for 1 h at 37ºC. An electrode was placed in the fluid in each flask at 24ºC and the pH was recorded. In the next stage, six samples from each mixing technique/material were separately placed in glass bottles containing 50 mL of distilled water at 37ºC for 1 h and were let dry for 1 h at 37ºC. The samples’ weights were measured and recorded twice. The procedure was repeated at 1-, 7- and 21-day intervals. Data were analyzed with the repeated measures ANOVA (for solubility) and two-way ANOVA (for pH) and then the post-hoc Tukey’s test was done. Results: The pH of the materials was not significantly affected by mixing methods (P=0.8 for CEM and P=0.1 for MTA). The solubility of all test groups was within the acceptable range (≤3%). However, the solubility of CEM at 1- and 21-day intervals was significantly different (P=0.03 for 1 day and P=0.001 for 21 days). Different mixing techniques had significant effects on the solubility of MTA at the three time points (P=0.004, 0.003 and 0.002 for 1-, 7- and 21-day intervals, respectively). Conclusion: The pH of biomaterials was not influenced by the mixing technique and their solubility was within the acceptable range

The Effect of Different Mixing Methods on Working Time, Setting Time, Dimensional Changes and Film Thickness of Mineral Trioxide Aggregate and Calcium-Enriched Mixture

Introduction: The aim of the present study was to evaluate the effect of different mixing techniques (conventional, amalgamator and ultrasonic mixing) on the physical properties the working time (WT), setting time (ST), dimensional changes (DC) and film thickness (FT)] of calcium-enriched mixture (CEM) cement and mineral trioxide aggregate (MTA). Methods and Materials: The mentioned physical properties were determined using the ISO 6786:2001 specification. Six samples of each material were prepared for three mixing techniques (totally 36 samples). Data were analyzed using descriptive statistics, two-way ANOVA and Post Hoc Tukey’s tests. The level of significance was defined at 0.05. Results: Irrespective of mixing technique, there was no significant difference between the WT and FT of the tested materials. Except for the DC of MTA and the FT of the all materials, other properties were significantly affected with mixing techniques (P&lt;0.05). The ultrasonic technique decreased the ST of MTA and CEM cement and increased the WT of CEM cement (P&lt;0.05). Conclusion: The mixing technique of the materials had no significant effect on the dimensional changes of MTA and the film thickness of both materials.Keywords: Calcium-Enriched Mixture; Dimensional Changes; Film Thickness; Mineral Trioxide Aggregate; Setting Time; Working Tim

The Effect of Different Mixing Methods on the Flow Rate and Compressive Strength of Mineral Trioxide Aggregate and Calcium-Enriched Mixture

Introduction: Flow rate (FR) and compressive strength (CS) are important properties of endodontic biomaterials that may be affected by various mixing methods. The aim of this experimental study was to evaluate the effect of different mixing methods on these properties of mineral trioxide aggregate (MTA) and calcium-enriched mixture (CEM) cement. Materials and methods: Hand, amalgamator and ultrasonic techniques were used to mix both biomaterials. Then 0.5 mL of each mixture was placed on a glass slab to measure FR. The second glass slab (100 g) was placed on the samples and 180 sec after the initiation of mixing a 100-g force was applied on it for 10 min. After 10 min, the load was removed, and the minimum and maximum diameters of the sample disks were measured. To measure the CS, 6 sample of each group were placed in steel molds and were then stored in distilled water for 21 h and 21 days. Afterwards, the CS test was performed. Data were analyzed with multi-variant ANOVA and post hoc Tukey tests. The level of significance was set at 0.05. Results: There were significant differences in FR of MTA and CEM cement with different mixing techniques (P&lt;0.05). In the MTA group, none of the mixing techniques exhibited a significant effect on CS (P&gt;0.05); however, in CEM group the CS at 21-h and 21-day intervals was higher with the hand technique (P&lt;0.05). Conclusion: Mixing methods affected the flowability of both biomaterials and compressive strength of CEM cement

A Review of Antibacterial Agents in Endodontic Treatment

Microorganisms play a major role in initiation and perpetuation of pulpal and periapical diseases. Therefore, elimination of the microorganisms present in the root canal system is the fundamental objective of endodontic treatment. The use of mechanical debridement, chemical irrigation or other antimicrobial protocols and intra-canal medicaments are critical to attain this goal. The aim of this article was to review the antimicrobial agents and their properties in endodontics

Tissue Reaction and Biocompatibility of Implanted Mineral Trioxide Aggregate with Silver Nanoparticles in a Rat Model

Introduction: Biocompatibility and antimicrobial activity of endodontic materials are of utmost importance. Considering the extensive applications of mineral trioxide aggregate (MTA) in dentistry and antimicrobial properties of silver nanoparticles, this study aimed to evaluate the subcutaneous inflammatory reaction of rat connective tissues to white MTA with and without nanosilver (NS) particles. Methods and Materials: Polyethylene tubes (1.1×8 mm) containing experimental materials (MTA and MTA+NS and empty control tubes) were implanted in subcutaneous tissues of seventy-five male rats. Animals were divided into five groups (n=15) according to the time of evaluation: group 1; after 7 days, group 2; after 15 days, group 3; after 30 days, group 4; after 60 days and group 5; after 90 days. The inflammatory reaction was graded and data was analyzed using the Kruskal-Wallis and Mann-Whitney U tests. Statistical significance was defined at 0.05. Results: Comparison of cumulative inflammatory reaction at all intervals revealed that the mean grade of inflammatory reaction to MTA, MTA+NS and control samples were 3, 2 and 2, respectively. According to the Mann-Whitney analysis there were no significant differences between MTA+NS and MTA (P=0.42). Conclusion: Incorporation of 1% nanosilver to MTA does not affect the inflammatory reaction of subcutaneous tissue in rat models.Keywords: Biocompatibility; Mineral Trioxide Aggregate; Nanosilver; Silver Nanoparticl