Scanning Electron Microscopic Evaluation of the Sealer-Dentine Interface of Three Sealers

Introduction: This study aimed to evaluate the dentin-sealer interface in three different sealers using scanning electron microscopy (SEM). Methods and Materials: Thirty extracted human single-rooted teeth were prepared using ProTaper rotary files and were randomly divided into three groups (n=10) including BC Sealer, AH-Plus and Dorifill. The root canals were filled with cold lateral condensation technique and stored for 7 days in 100% humidity at 37°C. Cross sections were prepared from the coronal, middle, and apical sections of the roots. Then SEM images were taken and the width of gaps was measured by software. Sectional images were evaluated by two endodontists. Data were analyzed using two- and one-way ANOVA and Kruskal-Wallis tests. Results: The mean gap width was significantly lower in coronal area in BC Sealer group compared to Dorifill (P=0.043) and likewise in AH-Plus group compared to Dorifill (P=0.018). There was no significant difference between BC Sealer and AH-Plus group in this area (P=0.923). No significant difference was detected in apical and middle zones among three sealers (P=0.367 and 0.643, respectively). Dentin-sealer interface showed no significant difference in three sealers in the apical area (P=0.051), but dentin-BC Sealer interface was better than AH-Plus in middle and coronal areas, and both outperformed Dorifill (P=0.001). Conclusion: BC Sealer and AH-Plus had less gaps than Dorifill in coronal area. In addition, BC Sealer had better dentin interface in middle and coronal area compared to AH-Plus, and both performed better than Dorifill. Reverse relationship was observed between the mean gap width and dentin-sealer interface quality.Keywords: Endodontic Sealer; Interface; Gap; Root Sealer; Scanning Electron Microscop

Root Canal Morphology of Permanent Mandibular Premolars in Iranian Population: A Systematic Review

Introduction: It is essential for clinicians to have knowledge about root canal configuration, although its morphology varies largely in different ethnicities and even in different individuals within the same ethnic group. The current study reviewed the root canal configuration of root canals in mandibular first and second premolars among Iranian population based on independent epidemiological studies. Methods and Materials: A comprehensive search was conducted on retrieved articles related to root canal configuration and prevalence of each types of root canal in mandibular premolars based on Vertucci’s classification. An electronic search was conducted in Medline, Scopus and Google Scholar from January 1984 to September 2015. Results: In eleven studies conducted in eight provinces, 1644 mandibular first premolars and 1268 second premolars were investigated. Within mandibular first premolars, 70.9% were Vertucci's type I, followed by 10.4% type III, 7.18% type IV, 5.23% type II and 5.16% type V. In addition, among mandibular second premolars, 82.86% were type I, 6.25 type III, 5.32% type II, 4.27% type IV, and 0.69% type V. Conclusion: These results highlight the necessity of searching for additional possible root canals by clinicians. Moreover, these results indicated the ethnical characteristics of Iranian population regarding the morphology of mandibular premolars compared to other populations.Keywords: Anatomy; Iranian; Mandibular Premolar; Review; Root Cana

Fracture Resistance of Roots after Application of Different Sealers

Introduction: Vertical root fracture inevitably leads to tooth extraction. Thus, root filling with obturating materials and sealers that can reinforce the tooth would be an ideal way to reduce fracture in root treated teeth. This study aimed to assess the fracture resistance of roots following the application of different sealers including Epiphany, iRoot sealer and AH-plus. Methods and Materials: Fifty extracted human single-canal premolars without caries, curvature or cracks were used in this study. Tooth crowns were cut to yield 13-mm-long roots. Five roots were put in the negative control group and were left unprepared. Forty-five canals were prepared using ProTaper rotary files up to F3 and were then randomly divided into three groups based on the sealer type (n=15). The root canals were filled using cold lateral condensation technique with gutta-percha and AH-Plus sealer, gutta-percha and iRoot sealer and Resilon and Epiphany sealer, in groups one to three, respectively. The roots were then mounted in acrylic molds for fracture resistance testing and subjected to compressive load at a crosshead speed of 1mm/min until fracture. Data were analyzed using the one-way ANOVA. Results: The mean fracture resistance was 673.38±170.42 N in AH-Plus, 562.00±184.68 N in iRoot, 708.03±228.05 N in Resilon and 592.59±117.29 N in the control group. No statistically significant difference was found between the experimental groups and the negative control group (P=0.26). Conclusion: Application of AH-Plus, bioceramic and Resilon sealers did not change the fracture resistance of roots compared to that of unprepared root canals.Keywords: AH-Plus; Bioceramic; Epiphany; Fracture Resistance; iRoot; Resilon; Seale

Comparison of Charge-Coupled Devices and Photostimulable Phosphor Storage Plates for Detection of Vertical Root Fractures in Endodontically Treated Teeth: An In Vitro Study

Objective: Vertical root fracture (VRF) is among the most common causes of endodontic treatment failures. This study aims to compare charge-coupled devices (CCD) and photostimulable phosphor plates (PSP) for detection of vertical root fractures in endodontically treated teeth.Methods: In this diagnostic in vitro study, 40 maxillary anterior teeth were selected and after preparation and root canal filling, their crowns were cut 2mm above the cementoenamel junction (CEJ). The teeth were embedded in a piece of dried bone and radiographed using CCD and PSP with equal geometry at zero and 15° horizontal angles. VRFs were then induced and the fractured fragments were reattached. The teeth were radiographed again. Three observers evaluated the radiographs for detection of fracture line. Data were analyzed using the Proportion test and Wilcoxon’s Signed Ranks test.Results: No significant difference was found between the two sensors in detection of VRFs [p-value (complete)= 0.592, p-value (absolute)= 1]. The sensitivity of the two sensors for detection of buccolingual and mesiodistal fractures was not significantly different [p-value BL (absolute)= 0.109, p-value BL (complete) 0.180] [p-value MD (complete)=0.593, p-value MD (absolute)= 0.102]. The sensitivity of both sensors for detection of buccolingual fracture was higher than for mesiodistal fractures (p<0.001).Conclusion: CCD and PSP had equal efficacy for detection of VRFs in endodontically treated teeth

In Vitro Comparison of Diagnostic Accuracy of DIAGNOdent and Digital Radiography for Detection of Secondary Proximal Caries Adjacent to Composite Restorations

Introduction: Early detection of secondary proximal caries is critical for the preservation of tooth vitality. This study sought to assess and compare the diagnostic accuracy of DIAGNOdent and digital radiography for detection of secondary proximal caries adjacent to composite restorations.Methods: Sixty extracted molars including 30 teeth with carious lesions and 30 sound teeth were randomly selected. Class II cavities were prepared in all teeth and carious dentin was intentionally left in the gingival floor of cavities in 30 carious teeth. All cavities were restored with composite resin. The teeth were mounted in wax blocks (three teeth per block) and examined for caries using (DIAGNOdent kaVo Dental, Biberach, Germany). Digital radiographs using DIGORA photostimulable phosphor (PSP) plates (Soredex Corporation, Helsinki, Finland) were obtained from all teeth using the parallel technique and were evaluated by 4 observers. Repeated measure analysis of variance (ANOVA) was applied to calculate sensitivity and specificity values of the two diagnostic techniques. Receiver operating characteristic (ROC) curve was plotted for DIAGNOdent results and based on that, the cutoff points were determined.Results: The sensitivity and specificity values at the cut-off point of 10.5 were 0.622 ± 0.038 and 0.822 ± 0.077 for DIAGNOdent and 0.591 ± 0.093 and 0.891 ± 0.083 for digital radiography, respectively. The area under the ROC curve was 0.7 for DIAGNOdent. Weighted kappa revealed moderate to almost perfect intra-observer agreement (0.46-0.99). Intraclass correlation coefficient (ICC) for DIAGNOdent was calculated to be 0.88.Conclusion: No statistically significant difference was noted in diagnostic accuracy of DIAGNOdent and digital radiography for detection of secondary proximal caries adjacent to composite restorations. Thus, DIAGNOdent may be used as an adjunct diagnostic tool for detection of secondary proximal caries beneath composite restorations

In Vitro Microleakage of Mineral Trioxide Aggregate, Calcium-Enriched Mixture Cement and Biodentine Intra-Orifice Barriers

Introduction: This in vitro study compared the coronal microleakage of mineral trioxide aggregate (MTA), calcium-enriched mixture (CEM) cement and Biodentine as intra-orifice barriers. Methods and Materials: The study was conducted on 76 extracted single-canal human teeth. Their root canals were prepared using ProTaper rotary files and filled with gutta percha and AH-26 sealer using lateral condensation technique. Coronal 3 mm of the gutta percha was removed from the root canals and replaced randomly with MTA, CEM cement or Biodentine in the three experimental groups (n=22). A positive and a negative control group were also included (n=5). The entire root surfaces of all teeth were covered with two layers of nail varnish in such a way that only the access openings were not coated. In the negative control group, the access opening was also coated with nail varnish. All teeth were immersed in India ink and after clearing, the samples were evaluated under a stereomicroscope under ×10 magnification to assess the degree of dye penetration. The data were analyzed using the Kruskal-Wallis test. The level of significance was set at 0.05. Results: The negative control group showed no leakage while the positive control group showed significantly higher microleakage than the test groups (P>0.05). CEM cement had the lowest (0.175±0.068 mm) and MTA showed the highest dye penetration (0.238±0.159 mm) among the experimental groups; although these differences were not statistically significant (P=0.313). Conclusion: CEM cement exhibited the least microleakage as an intra-orifice barrier in endodontically treated teeth.Keywords: Biodentine; Calcium-Enriched Mixture; Intra-Orifice Barrier; Microleakage; Mineral Trioxide Aggregat

Cavity Preparation by Laser in Primary Teeth: Effect of 2 Levels of Energy Output on the Shear Bond Strength of Composite Restoration to Dentin

Introduction: One of the main applications of laser in dentistry is the removal of dental caries and preparation of restorative cavities. The morphology and wettability of laser prepared surfaces are different from that of those prepared with conventional method which may affect the quality of the adhesive potential of bonding agents in these surfaces. This study aimed to assess the shear bond strength of a total-etch and self-etch adhesive system to primary tooth dentin prepared by two different energy densities of Er:YAG laser in comparison with surfaces prepared by bur.Methods: A total of 60 human primary second molars extracted for orthodontic purposes were selected and randomly divided into 3 main groups of equal (n = 20). Group A: Preparation of dentin surface by bur; group B: Preparation of dentin surface by laser with 300 mJ energy level; group C: Preparation of dentin surface by laser with 400 mJ energy level. In each of the main groups, the teeth were randomly assigned to 2 subgroups. Composite resin material was bonded with the total-etch adhesive system in subgroups A1, B1, and C1 and with the self-etch adhesive system in subgroups A2, B2, and C2. The samples were thermo-cycled, and composite restorations shear bond strength was measured in MPa. Data were analyzed using two-way analysis of variance (ANOVA), and P values less than 0.05 were considered statistically significant.Results: The highest and the lowest shear bond strength values were observed in group A2 (Preparation by bur- Composite resin material bonded by Clearfil SE Bond) and group C2 (Preparation by laser with 400 mJ energy level - Composite resin material bonded by Clearfil SE Bond), respectively. The results showed no statistically significant differences between the study subgroups (P > 0.05).Conclusion: It is concluded that in terms of shear bond strength to dentin, Single Bond and Clearfil SE Bond adhesive agents adequately perform in primary tooth dentin prepared by Er: YAG laser with energy levels of 300 and 400 mJ and frequency of 10 Hz

Effect of Blood Exposure on Push-Out Bond Strength of Four Calcium Silicate Based Cements

Introduction: The purpose of this study was to compare the push-out bond strength of white ProRoot Mineral Trioxide Aggregate (MTA), Biodentine, calcium-enriched mixture (CEM) cement and Endosequence Root Repair Material (ERRM) putty after exposure to blood. Methods and Materials: A total of 96 root dentin slices with a standardized thickness of 1.00±0.05 mm and standardized canal spaces were randomly divided into 4 main experimental groups (n=24) according to the calcium silicate based cement (CSC) used: white ProRoot MTA, CEM Cement, ERRM Putty and Biodentine. Specimens were exposed to whole fresh human blood and then subdivided into two subgroups depending on the exposure time (24 or 72 h). Push-out bond strength was measured using a universal testing machine. Failure modes were examined under a light microscope under ×10 magnification. Data were analyzed using the two-way ANOVA test. Results: Biodentine exhibited the highest values regardless of the exposure time. The lowest push-out strength values were seen in white ProRoot MTA and CEM cement in both post exposure times. After exposure to blood, the push-out bond strength of all materials increased over time. This increase was only statistically significant in white ProRoot MTA and ERRM specimens. The dominant failure mode in all CSCs was the adhesive mode. Conclusion: Biodentine showed the highest values of push-out bond strength and may be better options for situations encountering higher dislocation forces in a short time after cement application.Keywords: Biodentine; Blood; Calcium-Enriched Mixture Cement; Endosequence Root Repair Material; Mineral Trioxide Aggregat

Functional Outcomes of Temporomandibular Joint Ankylosis Treatments: A 10-year cohort study

Introduction : Ankylosis of the temporomandibular joint (TMJ) is a disabling condition due to the fusion of joint to the base of skull and results in mouth opening limitation. Several surgical techniques have been described for treatment of this condition but no consensus has been reached. This study sought to assess the success of treatment with regard to long-term functional improvement and rate of complications in ankylosis patients during a 10-year period. Materials and Methods: Patients who underwent unilateral or bilateral condylectomy without joint reconstruction during 2001-2011 in the Maxillofacial Surgery Department of Shariati Hospital were evaluated in this historical cohort study. The patients were recalled to ensure the accuracy of information in their medical records and were clinically examined. Improvement in their joint function and rate of complications were evaluated. Data were analyzed using Wilcoxon Signed rank test, multivariate tests, Mauchly's sphericity test and McNemar’s test. Results: A total of 27 subjects (13 males and 14 females) with a mean age of 34.8 years and 6.1 years mean duration of follow-up were evaluated. The results of observation showed that trauma was the most common cause of ankylosis (63%). The most common type of ankyloses was fibrous (55.6%) and 55.6% of the patients had bilateral ankylosis. Maximum mouth opening (MMO), the amount of lateral movement and open bite significantly improved after the operation (P<0.001). Frontal, zygomatic and buccal nerves had been injured in 4, 4 and 3 patients, respectively during the operation. Conclusion: Condylectomy without reconstruction significantly improves the TMJ function in patients with TMJ ankylosis with regard to MMO, the amount of lateral movement, maintenance of occlusion and the skeletal form

Correlation of CA19-9 and P57 (KiP2) Expression with Tumor Grade and Invasive Front in Oral Squamous Cell Carcinoma

Statement of the Problem: Oral squamous cell carcinoma (OSCC) is one of the most widely occurring cancers worldwide. Early diagnosis of primary tumors is the key to improve treatment outcome. Detecting cancer, determining prognosis, and monitoring disease progression or treatment response can be done based on molecular markers. CA19-9 is an isolated form of Lewis antigen. It is widely used for detecting pancreatic cancer in the clinical setting. P57 (KiP2) is a tumor suppressor gene. It is a positive regulator of cell proliferation, regulating proliferation through G1 phase by inhibiting cyclin dependent kinases. Its expression decreases in most malignancies. OSCC has variable differentiation grades and local invasion potential. Purpose: The aim of this study was to evaluate and assess the correlation of CA19-9 and P57 expression with invasive front and grade of OSCC. Materials and Method: This cross-sectional study was performed on forty paraffin blocks in three histologic grades; well, moderate, and poorly differentiated SCC. The two markers were assessed by immunohistochemistry methods (En vision). Proportional and total scores and staining intensity were measured for all samples. Results: CA19-9 staining was low in all three grades. The Kruskal Wallis test showed no significant correlation between tumor grade and CA19-9 expression; however, there was a significant difference between tumor intensity and margin intensity (p= 0.003). P57 staining was high in all three grades. The Kruskal Wallis test showed no significant correlation between tumor grade and P57 expression. There were no significant differences in total intensity of staining in margins of tumor (p= 0.85). Conclusion: Within the limitations of this study, it may be concluded that expression of CA19-9 and P57 cannot be used as determinants of tumor grade. Higher expression of CA19-9 in invasive front of SCC can be representative of local invasion and higher activity of tumor cells in the margins