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

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

The Effect of Canal Dryness on Bond Strength of Bioceramic and Epoxy-resin Sealers after Irrigation with Sodium Hypochlorite or Chlorhexidine

Introduction: The aim of this in vitro study was to evaluate the effect of canal dryness on the push-out bond strength of two resin sealers (AH-Plus and Adseal) and a bioceramic sealer (Endosequence BC sealer) after canal irrigation with sodium hypochlorite (NaOCl) and chlorhexidine (CHX). Methods and Materials: A total of 18 extracted human premolars were used. Canals were prepared and were divided to two groups based on irrigation solution (either NaOCl or CHX). The samples were again divided based on pre-obturation canal condition (wet, half-wet and dry). The samples were sub-divided into 3 groups based on the sealer type; the teeth were obturated with gutta-percha and test sealers (Adseal, AH-Plus or BC sealer). A total number of 18 groups were available to be cut into dentine disks (12 disks in each group). The type of bond failure was also assessed in each group. Data were analyzed using the 3-way ANOVA, post hoc Tukey’s tests, t-test and the Fisher’s exact test. The level of significance was set at 0.05. Results: The bond strength of Adseal was not affected by the canal condition or irrigation with either NaOCl or CHX. Although the bond strength of AH-Plus was not affected by the irrigant type, the highest bond strength was seen in dry canals. For Endosequence BC sealer, the canal conditions did not affect the bond strength; however, CHX reduced the bond strength. Conclusion: Bond strength of resin sealers was not affected by irrigation solution; however, canal moisture negatively affected the bond strength of AH-Plus. CHX reduced the bond strength of BC sealer.Keywords: Bioceramic; Chlorhexidine; Epoxy Resin-Based Root Canal Sealer; Root Canal Sealer; Sodium Hypochlorite

Retreatment of a 6-Canalled Mandibular First Molar with Four Mesial Canals: A Case Report

Successful root canal treatment requires adequate knowledge regarding morphologic variations in root canal system of teeth. This report describes a six-canalled mandibular first molar with four mesial root canals requiring endodontic retreatment. The two additional canals in the mesial root were found during retreatment with the aid of illumination and magnification. In conclusion, the possibility of atypical morphology and additional canals should never be over looked

The Effect of Photobiomodulation on the Depth of Anesthesia During Endodontic Treatment of Teeth With Symptomatic Irreversible Pulpitis (Double Blind Randomized Clinical Trial)

Introduction: Achieving appropriate anesthesia in patients with symptomatic irreversible pulpitis in mandibular molars during endodontic treatment is always one of the most challenging aspects. Photobiomodulation (PBM) has been used in dentistry due to its anti-inflammatory properties and regenerative effects. This study evaluates the effects of PBM in the depth of anesthesia in inferior alveolar nerve block.Methods: In this randomized clinical trial, 44 patients requiring endodontic treatment in lower molar, left or right were selected, half of them were randomly treated with PBM therapy. Laser irradiation by 980 nm diode laser with a single dose (15 J/cm2, for 20 seconds) before anesthesia was performed at the buccal aspect. Inferior alveolar nerve block was performed once. Success was defined as no or mild pain (no need for any supplemental injection), based on the visual analogue scale during access cavity preparation. Results were evaluated using SPSS software.Results: The results of this study showed that the necessity for supplemental injection was lower in the group receiving laser than in the group without laser (P = 0.033). The mean pain intensity during dentin cutting was lower in the group receiving laser than in the group without laser (P = 0.031). Also, the mean pain intensity during pulp dropping was lower in the group receiving laser, than the group without laser (P = 0.021).Conclusion: Based on the results of this study, it seems that the application of PBM before anesthesia is effective on increasing depth of anesthesia

Non-Surgical Retreatment of Maxillary Lateral Incisor with Unusual Anatomy: A Case Report and Mini Review

Knowledge about internal anatomy plays a crucial role in the success of the root canal treatment. Many studies on internal anatomy have repeatedly reported that maxillary lateral incisors have only one canal. The primary aim of this article was to describe successful non-surgical retreatment of a permanent maxillary lateral incisor with two root canals and open apices. The treatment was carried out using dental operating microscope and the canals were obturated with mineral trioxide aggregate (MTA) as an apical plug. A review of literature was also conducted to evaluate the anatomical variations of maxillary lateral incisors.Keywords: Maxillary Lateral Incisor; Retreatment; Root Canal Anatom

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

The effect of Carvacrol on Enterococcus faecalis as a final irrigant

INTRODUCTION: Sodium hypochlorite (NaOCl) is an effective antimicrobial irrigant, however its toxic effects and deterrent odor are not ideal. Carvacrol is an edible plant extract with anti-inflammatory and anti-bacterial properties that is effective against Enterococcus (E) faecalis. The aim of this study was to evaluate Carvacrol's antibacterial efficacy against E. faecalis bacteria as a final irrigant. MATERIALS AND METHODS: Forty extracted single-rooted human teeth were utilized. After mechanical preparations, samples were randomly divided into three experimental (A, B and C) and two control groups. E. faecalis was cultured in both experimental and positive control groups. After bacterial counting in all canals, 5.25% NaOCl, 0.6% Carvacrol emulsion and MTAD were used as final irrigants in groups A, B and C respectively. Data were analyzed using Kruskal-Wallis and Mann-Whitney U tests. RESULTS: There was no meaningful difference in bacterial reduction between groups A and B; however, group C showed significantly lower efficacy compared to other groups (P<0.05). CONCLUSION: The 0.6% Carvacrol disinfects root canals effectively. It also has anti-inflammatory qualities and therefore may be an acceptable alternative for NaOCl

Calcium Enriched Mixture and Mineral Trioxide Aggregate Activities against Enterococcus Faecalis in Presence of Dentin

Introduction: The purpose of this in vitro study was to compare the antibacterial activity of Calcium Enriched Mixture (CEM) with ProRoot Mineral Trioxide Aggregate (MTA) against Enterococcus faecalis (E. faecalis) in the presence/absence of dentin powder. Materials and Methods: Two series of freshly mixed (10, 50, and 100 mg), set crushed powder (10, 50, and 100 mg), and pieces of uncrushed set (50, 100 mg) of CEM and MTA were prepared (n=32 groups). All samples were suspended in normal saline for direct exposure test against E. faecalis; in the second series, 50 mg of the dentin powder was also added to the solution. Dentin powder suspension and bacterial suspension served as negative and positive control groups, respectively (n=2). The suspensions were incubated at room temperature for 1, 60, and 240 min; each group was tested five times and survival of the bacteria in test solutions was assessed by 10-fold serial dilutions and cultured on Brain Heart Infusion (BHI) plates. The plates were incubated at 37ºC. The mean values of log10 CFU were calculated and compared in all tested groups. The total number of tests added up to 510 times. Results: In presence of dentin powder, freshly mixed powder from set materials, and pieces of uncrushed set materials of both tested cements killed >95% of the bacterial cell in 1 min. Adding dentin powder caused an increase in antibacterial activity of freshly mixed powder from crushed set CEM and MTA but no acceleration in bacterial killing was observed, when dentin was mixed with set or uncrushed cements. Dentin powder alone reduced the number of viable bacteria in the 4-hour duration. There were no significant differences between different weights of freshly mixed, crushed set powder and uncrushed set of CEM cement and MTA at different times. Conclusion: Under the conditions of this in vitro study, CEM cement as well as MTA have antibacterial effects against E. faecalis. The addition of equal amounts of dentin powder to the suspension of CEM or MTA resulted in swifter elimination of bacteria

A New Nano-Chitosan Irrigant with Superior Smear Layer Removal and Penetration

Our primary objective was to measure root canal penetrations of aqueous antibacterial nano-chitosan (Nano-CS), for the first time. The second objective was to compare and contrast such penetrations to those of chitosan (CS) itself, as well as sodium hypochlorite (NaOCl), chlorhexidine (CHX) and ethylenediamintetraacetic acid (EDTA), at the routinely used concentrations. Molar roots were split longitudinally by a rotary diamond saw. Nano-CS was made by dissolving CS in acetic acid and adding tripolyphosphate (TPP), followed by a freeze-drying process. Dentin penetrations are estimated through measurements of sessile contact angles. Penetrations of the probed irrigants were assessed as inverse functions of their sessile contact angles. Accordingly, all Nano-CS solutions showed smaller sessile angles compared to those of NaOCl, CS, and EDTA samples. Hence, Nano-CS appeared to be a superior irrigant for demonstrating a higher penetration than the latter three. It fell only behind CHX, yet, the superb chelating ability of Nano-CS enabled it to remove smear layer to a larger extend than all of our other irrigants including CHX. Nano-CS could be considered as a new irrigant. Higher penetration was its main advantage over CS, and commercial NaOCl, and EDTA. This was verified by  the smaller sessile contact angle of Nano-CS. Anticipated chelating effect of Nano-CS could anchor more efficient removal of smear layer. This was another advantage of Nano-CS over other irrigants including CHX. Other advantages of Nano-CS included its reported biocompatibility, biodegradability and antibacterial effects. Commercialization of Nano-CS was deemed in the near horizon