Treatment of Furcal Perforation of Primary Molars with ProRoot MTA versus Root MTA: A Laboratory Study

Introduction: Furcal perforations are one of the most challenging causes of endodontic failures. Several materials including MTA have been used for non surgical repair of these perforations. The aim of this study was to compare treatment outcome of furcal perforation treatment in primary molars using Root MTA and ProRoot MTA. Materials and Methods: This in vitro study was conducted on 54 primary first molars that were randomly divided into the two experimental groups of 24 teeth each and two control groups (n=6). After preparation of access cavities, perforations were made and the perforation areas were repaired using either Root or ProRoot MTAs. After staining and preparation of mesiodistal longitudinal sections, dye leakage was measured using a stereomicroscope. The data was analyzed by the Mann Whitney statistical test. Significant level was set at 0.05. Results: The data indicated that the dye leakage of ProRoot MTA is significantly lesser than Root MTA (P=0.001). Conclusion: ProRoot MTA showed good sealing ability in repairing furcal perforations of primary molars

A Histopathological Comparison of Pulpotomy with Sodium Hypochlorite and Formocresol

Introduction: Formocresol is widely used in primary teeth pulpotomies; however it is known to have several side effects. The purpose of this study was to assess pulpal changes of primary teeth pulps after pulpotomy with sodium hypochlorite and formocresol.Materials and Methods: In this randomized clinical trial, 22 teeth were selected. These teeth were randomly divided into 2 groups (formocresol; n=11 and sodium hypochlorite n=11). Two months post-operatively teeth were extracted and pulpal responses were evaluated by recording the degree of inflammation and extent of pulpal involvement. Dentinal bridge formation was also evaluated. Finally the data was analyzed with McNemartest. Results: The formocresol group demonstrated mild inflammation in 4 cases whereas sodium hypochlorite had mild inflammation in six cases. Severe inflammation was only found in 1 case in the sodium hypochlorite group, but it was present in 4 cases in the formocresol group. In sodium hypochlorite group there were no cases of necrosis, and dentinal bridge was found in 3 cases, unlike, the formocresol group which had necrosis but no dentinal bridge formation.  Conclusion: Based on the results of this study sodium hypochlorite may be a suitable solution for conducting pulpotomy in primary teeth.

Histopathological Evaluation of Primary Teeth after Pulp Capping with Calcium-Enriched Mixture and Bioactive Glass

Introduction: Direct pulp capping (DPC) is a conservative vital pulp therapy, which has some limitations in primary dentition. The aim of this study was to evaluate pulpal response of primary teeth after DPC with two biocompatible materials naming calcium-enriched mixture (CEM) and bioactive glass (BAG). Methods and Materials: This study was designed as a randomized clinical trial. After obtaining informed consent, 20 sound primary canines scheduled for orthodontic extraction, were selected. Following mechanical pulp exposure, the exposed site was capped with either CEM cement or BAG and then restored with amalgam. Teeth were extracted after two months and examined histopathologically. Parameters of hard tissue bridge (HTB) formation, its type and pulpal inflammation scores, were compared between the two groups. Data were analysed using the Fisher’s exact test. Results: All CEM specimens showed inflammation scores of 0 (less than 10%). In the BAG group, inflammation scores of 0, 1 and 2 were observed in 7, 2 and 1 specimens, respectively. Fisher’s exact test showed no significant differences (P>0.05). All CEM specimens (100%) formed HTB, which was irregular in all cases. In 7 of 10 teeth in BAG, HTB formed and was irregular. Fisher’s exact test revealed no significant differences between the two groups in this regard (P<0.001). Conclusion: Both CEM and BAG are suitable DPC agents in terms of HTB formation and pulp inflammation scores.Keywords: Bioactive Glass; Calcium-Enriched Mixture; Direct Pulp Capping; Primary Teet

Microleakage of CEM Cement and ProRoot MTA as Furcal Perforation Repair Materials in Primary Teeth

Introduction: Iatrogenic furcal perforation is a procedural accident in endodontic treatments of primary/permanent teeth; prognosis may be favorable if a complete seal with biomaterial is immediately established. The purpose of this in vitro study was to evaluate microleakage of calcium enriched mixture (CEM) cement and ProRoot mineral trioxide aggregate (MTA) for sealing primary molar furcal perforations. Materials and Methods: This study was conducted on 38 extracted human primary molars. Furcation perforations were created in the pulp chamber floor. The teeth were divided randomly in two experimental groups (n=17) and two positive and negative controls (n=2). Perforations were then repaired with biomaterials. After 72 h, the teeth were submerged in 2% fuchsin dye solution for 24h. The samples were sectioned longitudinally and evaluated for dye leakage. Data analyzed statistically using ANOVA test. Results: The negative and positive controls behaved as expected. Dye microleakage was observed in all experimental samples; however, there was no statistically significant difference between the microleakage of MTA (4.411±2.042 mm) and CEM (3.647±1.040 mm) groups (P>0.05). Conclusion: Based on the findings of this in vitro study, CEM and tooth-colored ProRoot MTA have similar sealing ability for furcal perforation repair of primary molar teeth

Comparative Evaluation of Clinical and Radiographic Success of MTA and Propolis in Pulpotomy of Primary Molars

Introduction: In this study, the results of using MTA and propolis in the pulpotomy of primary molar teeth are evaluated clinically and radiographically. Methods and Methods: A total of 25 healthy 4 to 8 year old children each having two carious primary molar teeth in one arch, based on inclusion criteria were selected. In each child, random assignment of the pulpotomy medicaments was done as follows: Group I, MTA in one side; Group II, Propolis in another side. All the pulpotomized teeth were evaluated at 3, 6, and 9 month clinically and radiographically, based on the scoring criteria system. Finally data was analyzed using GEE analysis. Results: Results showed that the effects of treatment and time on two scores were tested. Based on the results of this model, the chances of having clinical score 2, versus score 1 are about 2.7 times higher in MTA treatment than in propolis (P=0.001). Similarly, the chance of having a clinical score 2 relative to its one, at 9th month is approximately 6.8 times higher than the 3th month (P=0.000) and at 6th month is approximately 2.8 times higher than the 3th month (P=0.005). The chance of having higher scores of radiographies in treatment of propolis is approximately 6.5 times than that of MTA (P=0.000). Also, the chance of having higher scores of radiographic index at 6th month is approximately 5 times and at 9th month is approximately 27 times more than the 3th month (P=0.00). Conclusions: Based on the results of this experimental study, teeth treated with MTA showed more suitable clinical and radiographic results as compared to propolis at 9 months follow-up.Keywords: Mineral Trioxide Aggregate; Primary Teeth; Propolis; Pulpotom

Comparing the Fracture Rate of Hero 642, FlexMaster and Mtwo in the Simulated Canals

Introduction: File fracture is one of the main procedural mishaps in endodontic treatment. The aim of this in vitro study was to compare the fracture rate of three NiTi rotary systems; Hero 642, Mtwo and FlexMaster in artificial canals. Methods and Materials: In this study, bovine long bone was used. After primary preparation of bones, longitudinal sections with 4-cm diameter were cut and encoded. Subsequently, semicircular sections were prepared. A total number of 500 canals were created in the same way; the upper 3 mm of the canals were initially prepared with orifice shapers and then canals were filed with FlexMaster files sizes 25/0.02 and 25/0.04 to 13 mm of canal length. The prepared canals were assigned into 3 groups of the following systems: Hero 642, Mtwo and FlexMaster. Six selected instruments were used from each system; the files were applied 13 mm along the canals for 10 sec with manufacturer’s suggested speed and torque. The number of the canals prepared by each file before its separation was recorded; finally the data was analyzed with ANOVA test. Results: Mean number of prepared canals in Mtwo, FlexMaster and Hero groups before file separation was 15, 25 and 32, respectively. Conclusion: Results of this study showed that the number of prepared canals by Hero 642 was more than FlexMaster and Mtwo systems

Cytotoxicity of Silver Nanoparticles on Human Gingival Epithelial Cells: An In Vitro Study

Objective: Nanosilver has numerous applications in medicine due to its potent antibacterial activity. However, data regarding the bio-safety of its effective concentrations is scarce. This study aims to assess the toxicity of silver nanoparticles on human gingival epithelial cells under in-vitro  conditions.Methods: This in vitro study evaluated the toxic effects of filtered and unfiltered nanosilver solution on human gingival epithelial cells obtained from the Pasteur Institute of Iran using the methylthiazol tetrazolium bromide (MTT) assay (mitochondrial function)and membrane leakage of lactate dehydrogenase (LDH) at 24, 48 and 72h time points. The concentrations of silver nanoparticle solution used were 0.05, 0.1, 0.2, 0.5, 1, 2, 5, 10, 20 and 50µg/ml.Results: The MTT assay showed that nanosilver solution at high concentrations (20 and 50µg/ml) significantly decreased the viability of cells at all time points. The lower non-fatal concentrations at 24 and 48h were capable of causing cell death or significantly inhibit cell growth at 72h. The LDH assay demonstrated that death of epithelial cells only occurs at high concentrations of nanosilver (20 and 50µg) and no significant toxicity was seen at lower concentrations.Conclusion: Based on the results, silver nanoparticles have toxic effects on human gingival epithelial cells and this effect is time and dose-dependent

A Histopathological Comparison of Pulpotomy with Sodium Hypochlorite and Formocresol

Introduction: Formocresol is widely used in primary teeth pulpotomies; however it is known to have several side effects. The purpose of this study was to assess pulpal changes of primary teeth pulps after pulpotomy with sodium hypochlorite and formocresol. Materials and Methods: In this randomized clinical trial, 22 teeth were selected. These teeth were randomly divided into 2 groups (formocresol; n=11 and sodium hypochlorite n=11). Two months post-operatively teeth were extracted and pulpal responses were evaluated by recording the degree of inflammation and extent of pulpal involvement. Dentinal bridge formation was also evaluated. Finally the data was analyzed with McNemartest. Results: The formocresol group demonstrated mild inflammation in 4 cases whereas sodium hypochlorite had mild inflammation in six cases. Severe inflammation was only found in 1 case in the sodium hypochlorite group, but it was present in 4 cases in the formocresol group. In sodium hypochlorite group there were no cases of necrosis, and dentinal bridge was found in 3 cases, unlike, the formocresol group which had necrosis but no dentinal bridge formation. Conclusion: Based on the results of this study sodium hypochlorite may be a suitable solution for conducting pulpotomy in primary teeth

Evaluation of dental complaints in Tehran Medical Council between 2005-2012

Background and Aims: One of the major challenges in dental practice is dental complaints that majority of complaints resulted in criminal prosecution and the legal practitioners. The aim of this study was to investigate the patients’ complaints on the diagnosis and treatment plan, dentist’s behavior, treatment charge, and management unlike the behavior of medical affairs, lack of enforcement in Tehran Medical Council between 2005-2011. Materials and Methods: We referred to the Medical Council in order to obtain permission for evaluating complaints of dentists in Tehran. All files in units of prosecutors, magistrates and judicial committee were evaluated. Data were analyzed using spss version16 software. Results: The results showed that the highest percentage of complaints was related to the how treatment was managed (41.7%) and the lowest percentage of complaints were about the dentist's diagnosis and treatment plan (2.9%). Conclusion: Based on the results of this study, with dentists’ awareness of the existing rules and strict supervision, occurrence of complaints on the dental treatment can be prevented

Evaluation of antimicrobial efficacy of nanosilver solution, sodium hypochlorite and normal saline in root canal irrigation of primary teeth

Background: Bacteria are the main etiological factors in the development of dentinal caries and its progression to pulpal and periapical disease. Enterococcus faecalis is the bacterial species most frequently recovered from the root-filled teeth. Aim: This study aimed to evaluate the antimicrobial effectiveness of nanosilver (NS) solution as an endodontic irrigation solution of primary teeth against E. faecalis. Settings and Design: Thirty-six canals of primary teeth were selected for this ex vivo study. Methods and Materials: Thirty-six canals of primary teeth were prepared up to the file #35 and all of the specimens were sterilized. Then, root canals were inoculated with a suspension containing E. faecalis bacteria. The teeth were then randomly divided into three groups. Antimicrobial effectiveness was evaluated immediately after dividing into groups by counting colony-forming units on brain heart infusion broth plates. Statistical Analysis: Data were analyzed using Kolmogorov–Smirnov, Welch, and Dunnett's T3 tests. Results: Sodium hypochlorite showed the highest antimicrobial effectiveness against E. faecalis and showed significant differences compared with normal saline and NS solution (P < 0.001). Conclusion: Based on the results of this study, solution of NS particles can be used as an alternative to other root canal irrigating solutions