Diagnostic Value of Cone-Beam Computed Tomography and Digital Periapical Radiography in Detection of Separated Instruments

Introduction: File Fracture is one of the most common problems during root canal treatment which can affect treatment procedure and prognosis, so it is important to diagnose and prevent it. The aim of this study was to evaluate and compare the diagnostic value of cone-beam computed tomography (CBCT) and digital periapical radiography for detection of separated instrument retained inside the canal. Methods and Materials: Ninety single-rooted extracted human teeth were selected and randomly divided into 3 groups (n=30). Group 1, separated file #10 at the 2-mm apical third of the root canal; group 2, separated file #35 at the 2-mm apical third of the root canal; and group 3, without a broken file (control group). The teeth were instrumented to size #30 and were shaped to size #55 and then the canals were obturated up to separated instrument, or the working length for the teeth without a separated instrument, with lateral condensation technique. After that all teeth were placed in dry skull, digital radiography and CBCT was taken. After data collection, data was analyzed using SPSS software by means of sensitivity, specificity, positive and negative predictive values, and frequency tables. Results: Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of digital periapical radiography in detection of a fractured file #10 in the canal was 96.7% and 63.3%, 76.7%, 73.1%, 67.6%, 70%, for CBCT, respectively. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of digital periapical radiography in detection of a fracture file #35 in the canal was 93.3%, 96.7%, 96.6%, 93.5% and 95%, and 36.7%, 76.7%, 61.1%, 54.8%, 56.66%, for CBCT, respectively. Conclusion: Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of digital periapical radiography was better than the CBCT technique in both sizes of broken files.Keywords: Broken File; Cone-Beam Computed Tomography; Digital Radiography; Separated Instrumen

Diagnostic Value of Cone-Beam Computed Tomography and Periapical Radiography In Detection of Vertical Root Fracture

Introduction: Vertical root fracture (VRF) is the longitudinal fracture of the root in endodontically treated teeth. Considering the limitations of two-dimensional radiographic images in detection of VRF and introduction of cone-beam computed tomography (CBCT), this study was designed to find the sensitivity, specificity and accuracy of CBCT and periapical (PA) radiography in detection of VRFs. Methods and Materials: This was a cross-sectional in vitro study on 80 extracted human single canal teeth including 40 maxillary and 40 mandibular teeth. After standardized endodontic treatment of the roots, VRF was induced in half of the teeth in each group, and other half were left without fracture. Teeth were inserted in dry maxillary and mandibular alveoli. PA radiographs and CBCT images were taken from the specimens. Data were analyzed with SPSS software. The McNemar test was used to evaluate the sensitivity, specificity and accuracy of images, and kappa coefficient was used to assess the degree of agreement between the observers. The level of significance was set at 0.05. Results: Sensitivity and specificity values of CBCT were 97.5% and 95%, respectively. However, for PA radiography the sensitivity and specificity were 67.5% and 92.5%, in order of appearance. Accuracy of CBCT (96.25%) and PA radiography (80%) in both jaws were significantly different (P=0.022). Two methods were not significantly different when testing specificity (P=0.298). Conclusion: This study showed that the sensitivity and accuracy of CBCT in detection of vertical root fracture are higher than periapical radiography. CBCT can be recommended to be used in detection of vertical root fractures

Comparison of Microleakage of MTA and CEM Cement Apical Plugs in Three Different Media

Introduction: Microleakage is of the causes of endodontic treatment failure. The aim of this in vitro study, was to compare the microleakage of mineral trioxide aggregate (MTA) and calcium-enriched mixture (CEM) cement apical plugs in three environments. Methods and Materials: A total of 130 human extracted single rooted teeth were collected. After decoronation, preparation of the root canal space and simulation of open apices, 5 teeth were selected as positive and negative control groups and the rest of the samples were randomly divided into two groups (MTA plug and CEM cement plug) and each group was divided into 3 subgroups (dry, contaminated with saliva and contaminated with blood). In each group apical plug was placed into the canal. After full setting of the apical plug, microleakage of the samples were evaluated using fluid filtration method and the data were analyzed using two-way analysis of variance. Results: In dry and saliva contaminated environments, the leakage of MTA samples were 40.906±2.081 and 39.608±2.081, respectively which was significantly more than that of CEM cement samples (26.977±2.081 and 27.000±2.081, respectively). However, in blood-contaminated environments, the amount of leakage in MTA group (21.640±2.081) was significantly lower than CEM cement group (44.358±2.081). Conclusion: According to the results of this study, in dry and saliva-contaminated conditions CEM cement provides significantly better seal in comparison to MTA.Keywords: Calcium-Enriched Mixture Cement; Microleakage; Mineral Trioxide Aggregat

Sealing Ability of Mineral Trioxide Aggregate and Calcium-Enriched Mixture Cement as Apical Barriers with Different Obturation Techniques

Introduction: Endodontic treatment in pulpless immature teeth is challenging due to the lack of an apical stop. Insertion of an apical plug is an alternative to conventional long-term apexification with calcium hydroxide. The aim of this study was to compare the apical microleakage of mineral trioxide aggregate (MTA) and calcium-enriched mixture (CEM) cement as apical plugs with three different obturation techniques. Methods and Materials: This experimental study was conducted on 130 single rooted human teeth with one canal. Samples were randomly divided into 2 experimental groups (n=60) and two negative and positive control groups containing 5 samples each. After cleaning and shaping, an open apex configuration was prepared in all samples. MTA or CEM cement apical plugs with 5 mm thicknesses were placed. Then, each group was divided to 4 subgroups and the remaining space of root canals were filled with either lateral compaction or thermoplasticized injectable gutta-percha or was obturated by filling the entire canal with apical plug material. In one remaining subgroup the canal space was left unfilled. Microleakage was measured by the fluid filtration method and results were analyzed by means of the two-way ANOVA test. Results: There were no significant differences between microleakage of MTA and CEM cement apical plugs (P=0.92). The difference between three obturation methods was not significant, either (P=0.39). Conclusion: MTA and CEM cement have similar sealing ability as apical plugs and no significant difference was found in microleakage of the three groups

Evaluating the Accuracy of Two Microleakage Assessment Methods for Mineral Trioxide Aggregate and Calcium-enriched Mixture Cement

Introduction: Multiple methods for evaluating microleakage have been introduced over the years, but there has been no agreement as to which technique will give more accurate results. The aim of this study was to compare the accuracy and results of fluid filtration and marginal adaptation methods for mineral trioxide aggregate (MTA) and calcium-enriched mixture (CEM) cement apical plugs. Methods and Materials: A total of 250 single-rooted human teeth were collected. The teeth were decoronated, the root canals were prepared and open apex condition was stimulated by passing #1 to 4 Peeso Reamer drills from apical foramen. Five teeth were selected as the positive and negative controls and the rest of the samples were randomly allocated to two groups of MTA and CEM cement plugs. In each group, apical plug was placed into the canal. After the apical plugs were completely set, microleakage and marginal adaptation of the samples were evaluated using fluid filtration method and scanning electron microscopy (SEM), respectively. The obtained results were analyzed by independent-samples t test. Results: Gap between plug and dentin walls and air bubbles displacement was higher in MTA group compared to the CEM cement group, though this difference between MTA group and CEM cement group was not statistically significant. Conclusion: According to the obtained results, it seems that there is a direct relationship between the two methods of microleakage assessment. Keywords: Calcium-enriched Mixture Cement; Marginal Adaptation; Microleakage; Mineral Trioxide Aggregat

Antimicrobial Activity of Calcium Hydroxide and Betamethasone on Enterococcus faecalis; An in vitro Assessment

Introduction: Calcium hydroxide (CH) is one of the most common intracanal medications. Corticosteroids (CS) are used in endodontics because of their anti-inflammatory activity. This study aimed to evaluate the antimicrobial effect of CH+betamethasone and CH+saline against Enterococcus faecalis (E. faecalis) using agar diffusion test and measuring the microbial zone of inhibition (ZOI). Methods and Materials: Four plates containing Mueller-Hinton broth and E. faecalis culture media, were prepared. In each plate, 5 holes (5×3 mm) were created and a creamy mixture of CH+betamethasone was inserted into the holes (10 holes for each material). Two holes with ampicillin disks and two empty holes were used as negative and positive controls, respectively. Plates were incubated for 24 h and then the diameter of microbial ZOI was measured. The pH of each mixture was measured by pH meter. Data were analyzed using the Mann-Whitney U test. Results: The mean diameter of ZOI for CH+betamethasone and CH+saline was 3.4 and 3 mm, respectively. The difference was not significant (P=0.143). The pH was 12.5 for CH+saline and 12.3 CH+betamethasone, respectively. Conclusion: The mixture of CH+betamethasone had good antimicrobial effects against E. faecalis. Further studies are needed to confirm the value of this mixture in clinical settings.Keywords: Antimicrobial Activity; Betamethasone; Calcium Hydroxide; Enterococcus faecalis; Intracanal Medicatio

FREQUENCY AND PREDICTOR FACTORS OF IRREVERSIBLE PULPITIS

Abstract. Objective: Referral pains are one of the most common challenges which dentists are faced with them during diagnosis and before treatment. Pain referral can take place in tooth and other craniofacial structures and influence the diagnostic process. The present study was accomplished to evaluate the prevalence of irreversible pulpitis in patients refferd to Endodontic department of dental school of shahid Sadoughi University in 2017 with chief complaint of pain. Methods: This study is a descriptive and cross-sectional type of study conducted on 100 patients(21 males and 79 females) refferd to Endodontic department of dental school of shahid Sadoughi University in 2017 with chief complaint of pain.Informed consent was taken from patients. Data obtained from medical history, dentistry history, clinical examinations, and radiography were recorded in questionnaire developed for this purpose. Finally, the data were analyzed using SPSS18 software, Chi-square and Fisher exact test. Results: In the present research, the prevalence of irreversible pulpitis was obtained to be 77%. This prevalence in female was significantly more than males (P-value = 0.021). Patients with irreversible pulpit significantly reported more severe pain (p-value=0.000) and pain at the real site (p-value=0.028).The frequency of irreversible pulpitis showed no significant correlation with age and type of pain (P-value<0.05). Conclusion: Considering the findings of this research, the prevalence of irreversible pulpitis in patients refferd to Endodontic department of dental school of shahid Sadoughi University in 2017 with chief complaint of pain was three times more than that of other diseases. This frequency showed significant relationship with factors of gender, pain severity, and the pain feeling site.Keywords: Irreversible pulpitis, pain, root canal treatment

Comparison of Microleakage of CEM Cement Apical Plug in Different Powder/ Liquid Ratio in Immature Teeth Using Fluid Filtration Technique

Statement of the Problem: Sealing ability is one of the most important factors for successful endodontic treatment. Some studies have shown that the powder to liquid ratio can influence the properties of dental materials. Subsequently, this may happen for those used for sealing in endodontics. Purpose: The purpose of this research was to assess the microleakage of calcium-enriched mixture (CEM) cement apical plug in different powder to liquid ratio. Materials and Method: Ninety-six extracted human single root and single canal teeth were decoronated. Working length was determined using ≠15 k-file. Canal preparation was performed using step back method. Samples were divided into 3 groups randomly. CEM cement was placed into the canal with 1.13, 2.27 and 3.40 powder to liquid ratio in the group 1, 2 and 3, respectively. After complete setting of CEM cement, the micro leakage value was evaluated using fluid filtration method. Data were analyzed using ANOVA and Scheffe tests. Results: The bubble movement in three groups showed a statistically significant difference (p< 0.001). Minimum and maximum bubble movements were observed in the group with powder to liquid ratios of 3.40 and 1.13 respectively. Conclusion: Increased CEM Cement powder to liquid ratio will increase the sealing ability of this material as apical plug. Considering the conditions of this study, the powder to liquid ratio of 3:40 provided the best sealing ability

Evaluation of antibacterial effects of different calcium hydroxide compositions on planktonic Enterococcus faecalis

Background and Aims: Calcium hydroxide has a pronounced antimicrobial activity against most of the bacterial species found in infected root canals and endodontic infections. It is one of the most frequently used intracanal medications in endodontic therapy. The objective of this study was to determine the antimicrobial efficacy of six calcium hydroxide formulations (mixed with saline, lidocaine 2%, chlorhexidine 2%, chlorhexidine 0.2%, Iodine Potassium iodide (IKI) 2%, and glycerin) on Enterococcus faecalis using agar diffusion test.Materials and Methods: Twelve culture plates were incubated with Enterococcus faecalis. Five cavities were made in each plate with 5 mm diameter and 4 mm depth. Two plates were randomly considered for each calcium hydroxide formulation and filled completely with creamy mixture of tested materials. The plates were incubated at 37ºC for 48 hours. The diameter of inhibition zone around each well was recorded in millimetres and data were submitted to ANOVA and Tukey tests.Results: The results of this study showed that all tested calcium hydroxide pastes had good antimicrobial activity. The antimicrobial activity of calcium hydroxide mixed with lidocaine, chlorhexidine 2% and IKI 2% were significantly greater than that of calcium hydroxide mixed with saline (P0.01).Conclusion: Considering the results of this study, lidocaine 2%, chlorhexidine 2% and IKI 2% are suggested to be used for preparation of calcium hydroxide paste. Further studies with different methods are needed for confirming these results

Comparison of the diagnostic accuracy of different image processing algorithms in the diagnosis of jawbone defects

Background and Aim:  Intra-bone lesions are common in lesions, among them periapical lesions have a higher incidence. Todays, all direct digital imaging systems provide various types of image processing techniques. The purpose of this study is to investigate the effects of different digital image processing techniques on the diagnosis of bony defects. Materials and Methods:  In this experimental study, 50 sheep inferior half-jawbones were used. Lesions were created by round bars with numbers 1/4, 1/2, 1, 2 and 4. Digital images were obtained by edge enhance, sharpening, invert gray scale processing method and unprocessed investigated by two radiologists and in case of disagreement them observers by third observer. The method of recording the results was definitive diagnosis of lesion number 1, misdiagnosis number 2 and possible diagnosis number 3 .The results were analyzed by chi-square and Fisher's exact tests. Results: Percent of diagnostic sensitivity in unprocessed Images (71.8%) and images processed with Sharpen filter (71.4%) were significantly higher than images processed with invert grayscale (68.5%) and edge Enhancer (53%).(p<0.001) Conclusion: To detect bone lesions, unprocessed and processed digital images with Sharpen filters have higher diagnostic accuracy