The Effect of Bleaching Agents on the Microstructure and Surface Microhardness of Three Calcium Silicate-based Barrier Materials

Introduction: The aim of this study was to evaluate the effects of exposure to sodium perborate and H2O2 on the surface characteristics of MTA Angelus, Biodentine and MTA Repair HP after 1 and 6 month time intervals. Methods and Materials: Three calcium silicate-based cements were evaluated: MTA Angelus, Biodentine, MTA Repair HP. A total of 234 specimens were stored in Hank’s balanced salt solution (HBSS) for 1 month or 6 months in which afterwards were divided into 3 groups according to bleaching agent applied: control, sodium perborate, 35% hydrogen peroxide. The microstructural changes were evaluated by scanning electron microscopy and energy-dispersive X-ray spectroscopy. The surface microhardness was also evaluated. Data were analyzed by one-way analysis of variance and Games-Howell post-hoc tests for the effect bleaching agents and hydraulic calcium silicate-based cements and t-test was for the effect of time. Results: Distinctive alterations with uneven depression areas, woodpecker defects and cracks were seen due to exposure to perborate and H2O2 on all evaluated cements. Exposure to H2O2 caused a decrease in Ca/Si ratio in all experimental cements. Both H2O2 and perborate significantly decreased the microhardness of all cement (P<0.05) with H2O2 having a more profound effect (P<0.01). A 6-month delay in exposure to bleaching agents significantly increased the microhardness of Biodentine compared to 1 month (P<0.001 for both bleaching agents). Conclusion: Based on this in vitro study, H2O2 had more detrimental effects on MTA Angelus, Biodentine and MTA Repair HP. Sodium perborate may be a more conservative selection when considering effects on barrier materials.Keywords: Bleaching Agent; Calcium Silicate Cement; Microhardness; Mineral Trioxide Aggregate; Scanning Electron Microscop

Extensive Idiopathic External Root Resorption in First Maxillary Molar: A Case Report

External root resorption of permanent teeth is a multifactorial process. Several etiologic and predisposing factors have been related to external root resorption. Idiopathic external root resorption is defined as cases of external root resorption without a distinct etiologic factor. This article presents an extensive idiopathic external root resorption of maxillary first molar with irreversible pulpitis in an 18-year-old patient. The resorption was diagnosed in conventional radiographs and confirmed with Cone Beam Computed Tomography (CBCT) images. Unlike other reports in this field, and despite the severe resorption of all roots, there was no abnormal tooth mobility. Cold and electric pulp tests confirmed tooth vitality and revealed irreversible pulpitis. Therefore the exact etiology of the resorption remained unclear. Considering the poor prognosis due to severe root resorption, extraction and implant replacement was indicated

Management of a Large Periapical Lesion Using Decompression: A Case Report with Three-year Follow-up

Large radicular lesions should be treated initially by orthograde root canal therapy. When the signs and symptoms of the infection (e.g. persistent purulent drainage) do not resolve after this treatment, then surgical approaches should be considered. In the cases of large radicular cysts, total enucleation of the cyst can endanger adjacent structures and teeth. Therefore, decompression or marsupialization techniques are recommended in order to decrease the size of the lesion. In this case report, a 55-year-old woman with previously initiated therapy was referred to endodontic department for management of a sinus tract associated with tooth #7. Root canal treatment was performed and intracanal irrigant (5.25% sodium hypochlorite) activated using passive ultrasonic application, various intracanal medicament (calcium hydroxide, double antibiotic paste) was used in multiple sessions, but intracanal purulent drainage was not resolved. After this, decompression was performed using needle cap to maintain the opening of the cyst and remained for three months. During this period the cavity was kept clean and rinsed by the patient with 0.2% chlorhexidine mouthwash. After three-year follow-up, radiographic examination revealed substantial osseous repair of the defect and clinical signs and symptoms were absent

Cyclic Fatigue Resistance of Five Different Glidepath Files in Double Curved Artificial Canals

Introduction: The aim of this study was to examine the cyclic fatigue resistances #16 ProGlider, #15.02 Scout RaCe, #15.03 NeoNiti, One G and Path-File NiTi glide path files in S-shaped artificial canals. Materials and Methods: Twenty files from each group were tested. An artificial groove simulating double (S-shaped) curved canal measuring 1.5 mm in width at the top level decreasing towards the apical reaching 0.3 mm at the tip having a 0.06 taper, 18 mm in length, and 1.5 in depth machined in a stainless steel block was used in this study. Resistance to cyclic fatigue was determined by counting the numbers of cycles to failure (NCF). Furthermore, the fragment length of the fractured tips and angle and radius of curvature formed by each file in each trajectory were evaluated. The data were analyzed using the one-way analysis of variance and Tukey’s HSD test and the level of significance was set at 5%. Results: NeoNiti GPS and Scout RaCe glide path files showed significantly higher NCF values compared to other evaluated glide path files (P<0.001) but no significant difference when compared with each other (P=0.67). Conclusion: Based on this in vitro study NeoNiti GPS and Scout RaCe glide path files had the highest cyclic fatigue resistance in simulated double (S-shaped) curved artificial canals among the evaluated path finding files. Therefore, it seems that they can be used with more confidence in endodontic treatment of S-shaped canals clinically

Effect of Intra-Canal Calcium Hydroxide Remnants on the Push-Out Bond Strength of Two Endodontic Sealers

Introduction: The aim of this study was to evaluate the effect of intra-canal calcium hydroxide (CH) remnants after ultrasonic irrigation and hand file removal on the push out bond strength of AH-26 and EndoSequence Bioceramic sealer (BC Sealer). Methods and Materials: A total of 102 single-rooted extracted human teeth were used in this study. After root canal preparation up to 35/0.04 Mtwo rotary file, all the specimens received CH dressing except for 34 specimens in the control group. After 1 week, the specimens with CH were divided into 2 groups (n=34) based on the CH removal technique; i.e. either with ultrasonic or with #35 hand file. Then specimens were divided into two subgroups according to the sealer used for root canal obturation: AH-26 or BC Sealer. After 7 days, 1 mm-thick disks were prepared from the middle portion of the specimens. The push out bond strength and failure mode were evaluated. Data were analyzed by the two-way ANOVA and Tukey’s post hoc tests. Results: The push out bond strength of both sealers was lower in specimens receiving CH. These values were significantly higher when CH was removed by ultrasonic (P<0.05). The dominant mode of failure in all subgroups was of mixed type except for the BC Sealer specimens undergoing CH removal with hand file which dominantly exhibited adhesive mode of failure. Conclusion: CH remnants had a negative effect on the push out bond strength of AH-26 and BC Sealer. Ultrasonic irrigation was more effective in removing CH.Keywords: AH-26; Calcium Hydroxide; Endosequence BC Sealer; Push-Out Bond Strengt

Incidence of Dentinal Crack Formation Using ProTaper Universal and WaveOne Systems in Straight and Curved Root Canals

Introduction: This study aimed to compare dentinal micro crack formation following root canal instrumentation with ProTaper Universal (PTU) and WaveOne (WO) rotary systems in straight and curved root canals. Methods and Materials: One hundred mesiobuccal (MB) straight and curved canals of mandibular molars meeting inclusion criteria were divided into two control (n=10) and four experimental groups (n=20). After mounting the teeth and simulating the periodontal ligament, all the MB canals were coronally flared using Gates-Glidden drills #3 and 2 respectively. Then, in the experimental groups, the canals were instrumented with either PTU files (Sx, S1, S2, F1, F2), or Primary WO (25/0.08). Afterwards, roots were horizontally sectioned at 2, 4, and 6 mm from the apices, and evaluated under a microscope under 20× magnification. Data were analyzed with the Chi-Square and Kruskal-Wallis tests. The significance level was set at 0.05. Results: The control groups showed no cracks. There was no significant difference between the two systems in the straight root canals (P>0.05). But in the curved root canals, PTU produced significantly more cracks (P<0.05) with the complete crack type which was dominant (P=0.013) compared to WO. Conclusions: This in vitro study showed that in curved root canals, instrumentation with reciprocal WO system may be safer than full rotational PTU instruments regarding crack formation.Keywords: Crack; Dentin; Instrumentation; Reciprocating; Root Canal Preparation

Evaluation of the Fractured Surface of Five Endodontic Rotary Instruments: A Metallurgical Study

Introduction: The aim of this study was to compare several metallurgic properties of Neoniti instrument with four other commonly used endodontic rotary files. Methods and Materials: Neoniti A1 (25/0.08), RaCe (25/0.06), Mtwo (25/0.06), Twisted file (25/0.06) and ProTaper Next X2 (25/0.06) were examined by differential scanning calorimetry (DSC) before and after heat treatment at 500°C. X-ray diffraction (XRD) was also performed on the specimens. Furthermore, scanning electron microscopy (SEM) and x-ray energy-dispersive spectrometric (EDS) analyses were carried out on randomly selected fractured files. Results: In SEM tests, dimpled ruptures, characteristic of ductile fracture, were seen in all evaluated cross sections of all files. The SEM results of all evaluated files were alike. EDS results revealed higher proportions of Nickel (Ni) rich intermetallic compounds in Neoniti; whereas, in all the other files the proportion of Titanium (Ti) rich precipitates was higher. DSC results indicated that the temperature present in the oral environment, the austenite phase existed in all files. Mtwo and RaCe files did not show austenite transformation in the temperature range evaluated in this study. Only Neoniti revealed rhombohedal phase (R-phase) transformation. After heat treatment. No significant difference was seen in the transformation temperatures of all evaluated files. XRD evaluations revealed that Neoniti contained both Ni-rich and Ti-rich precipitates. The amount of the martensite phase was higher in ProTaper Next. Conclusion: The metallurgic properties of Neoniti files were different from other evaluated rotary files. This file contained higher proportions of Ni-rich precipitates.Keywords: Differential Scanning Calorimetry; Instrumentation; Nickel-Titanium; Root Canal Preparation; Scanning Electron Microscopy ; Transition Temperatures; X-ray Diffractio

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

Comparison of the Effect of Root Canal Preparation by Using Wave One and ProTaper on Postoperative Pain: A Randomized Clinical Trial

Introduction: WaveOne is a single-file reciprocating instrumentation system with the benefits of M-Wire alloy that has increased flexibility and improved resistance to cyclic fatigue over the conventional alloy. Root canal preparation techniques may cause postoperative pain. The goal of the present study was to compare the intensity and duration of postoperative pain when using WaveOne or ProTaper Universal systems for instrumentation of root canals. Methods: Forty-two patients who fulfilled specific inclusion criteria were assigned to 2 groups according to the root canal instrumentation technique used, WaveOne or ProTaper Universal. Root canal treatment was carried out in 2 appointments, and the severity of postoperative pain was assessed by numerical rating scale (NRS) score after each session until complete pain relief was achieved. Analgesic consumption, duration of pain, and root canal preparation time were also recorded. Results: The mean NRS score and duration of pain after both appointments were significantly higher in the WaveOne group (P < .05); however, the mean analgesic consumption was only significantly higher in the WaveOne group after the first appointment (P < .05). In all groups the highest mean NRS score was seen 6 hours after each therapeutic appointment. Canal preparation time was significantly shorter in the WaveOne group (P < .001). Conclusions: Postoperative pain was significantly lower in patients undergoing canal instrumentation with ProTaper Universal rotary instruments compared with the WaveOne reciprocating single-file technique