Radiation-induced root surface caries restored with glass-ionomer cement placed in conventional and ART cavity preparations: Results at two years

The document attached has been archived with permission from the Australian Dental Association (8th Jan 2008). An external link to the publisher’s copy is included.Background: There are no published studies comparing the clinical performances of more-viscous glass-ionomer cement (GIC) restorations when placed using conventional and atraumatic restorative treatment (ART) cavity preparation methods to restore root surface caries. Methods: One dentist used encapsulated Fuji IX GP and Ketac-Molar to restore 72 conventional and 74 ART cavity preparations for 15 patients who had received cervicofacial radiation therapy. Two assessors evaluated the restorations at six, 12, and 24 months for retention, marginal defects and surface wear, and recurrent caries. Results: After two years, the cumulative restoration successes were 65.2 per cent for the conventional and 66.2 per cent for the ART cavity preparations, without statistical or clinical significance (P>0.50). Restoration dislodgement accounted for 82.8 per cent and marginal defects for 17.2 per cent of all failures. There were no instances of unsatisfactory restoration wear or recurrent caries observed. Teeth with three or more restored cervical surfaces accounted for 79.3 per cent of all failures (P<0.0001). Conclusions: For root surface caries restored with GIC, the use of hand instruments only with the ART method was an equally effective alternative to conventional rotary instrumentation for cavity preparation. Larger restorations had higher failures, usually from dislodgement.JY Hu, XC Chen, YQ Li, RJ Smales and KH Yi

In vitro evaluation of surface roughness, adhesion of periodontal ligament fibroblasts, and Streptococcus gordonii following root instrumentation with Gracey curettes and subsequent polishing with diamond-coated curettes

Objectives: The objective of the study was to evaluate the efficacy of an additional usage of a diamond-coated curette on surface roughness, adhesion of periodontal ligament (PDL) fibroblasts, and of Streptococcus gordonii in vitro. Materials and methods: Test specimens were prepared from extracted teeth and exposed to instrumentation with conventional Gracey curettes with or without additional use of diamond-coated curettes. Surface roughness (Ra and Rz) was measured before and following treatment. In addition, the adhesion of PDL fibroblasts for 72h and adhesion of S. gordonii ATCC 10558 for 2h have been determined. Results: Instrumentation with conventional Gracey curettes reduced surface roughness (median Ra before: 0.36μm/after: 0.25μm; p < 0.001; median Rz before: 2.34μm/after: 1.61μm; p < 0.001). The subsequent instrumentation with the diamond-coated curettes resulted in a median Ra of 0.31μm/Rz of 2.06μm (no significance in comparison to controls). The number of attached PDL fibroblasts did not change following scaling with Gracey curettes. The additional instrumentation with the diamond-coated curettes resulted in a two-fold increase in the number of attached PDL fibroblasts but not in the numbers of adhered bacteria. Conclusions: Treatment of root surfaces with conventional Gracey curettes followed by subsequent polishing with diamond-coated curettes may result in a root surface which provides favorable conditions for the attachment of PDL fibroblasts without enhancing microbial adhesion. Clinical relevance: The improved attachment of PDL fibroblasts and the limited microbial adhesion on root surfaces treated with scaling with conventional Gracey curettes followed by subsequent polishing with diamond-coated curettes may favor periodontal wound healin

New technologies to improve root canal disinfection

Effective irrigant delivery and agitation are prerequisites to promote root canal disinfection and debris removal and improve successful endodontic treatment. This paper presents an overview of the currently available technologies to improve the cleaning of the endodontic space and their debridement efficacy. A PubMed electronic search was conducted with appropriate key words to identify the relevant literature on this topic. After retrieving the full-text articles, all the articles were reviewed and the most appropriate were included in this review. Several different systems of mechanical activation of irrigants to improve endodontic disinfection were analysed: manual agitation with gutta-percha cones, endodontic instruments or special brushes, vibrating systems activated by low-speed hand-pieces or by sonic or subsonic energy, use of ultrasonic or laser energy to mechanically activate the irrigants and apical negative pressure irrigation systems. Furthermore, this review aims to describe systems designed to improve the intracanal bacterial decontamination by a specific chemical action, such as ozone, direct laser action or light-activated disinfection. The ultrasonic activation of root canal irrigants and of sodium hypochlorite in particular still remains the gold standard to which all other systems of mechanical agitation analyzed in this article were compared. From this overview, it is evident that the use of different irrigation systems can provide several advantages in the clinical endodontic outcome and that integration of new technologies, coupled with enhanced techniques and materials, may help everyday clinical practice

Flexibility of Various Nickel-Titanium Rotary Endodontic Files

Introduction: Nickel-titanium rotary files were originally developed to allow for greater flexibility when instrumenting root canals. The increased flexibility of nickel-titanium instruments allowed operators to negotiate canal curvatures with greater ease. File design is continually changing. Manufacturers are trying to produce files that will work more efficiently and safely. Knowing the properties of files marketed is especially important in helping to choose an appropriate file system. Current ISO standards require force measurements at a static point along the file. The purpose of this study was to evaluate the flexibility of four different nickel-titanium files at three different points along the file. Materials and Methods: Flexibility of four different nickel-titanium rotary files (EndoSequence, ProFile, Vortex, and Vortex Blue) was measured. Each file was clamped at 3mm, 5mm, or 7mm (n = 10/length/file) and a universal testing machine was used to bend the files to a maximum deflection of 4.5mm. All data were statistically analyzed by two-way analysis of variance and post-hoc Tukey test (P = 0.05) to determine any significant differences. Results: Statistically significant (P \u3c 0.05) differences were present. In general, ProFile was the stiffest, displaying the greatest force and bending moment values. Vortex Blue was significantly more flexible, with lower force needed for deflection and bending moments. Conclusion: Vortex Blue files showed greater flexibility compared with the other nickel-titanium rotary files studied

Differential Scanning Calorimetric (DSC) Study of New and Sterilized Nickel-Titanium Rotary Endodontic Instruments

Introduction: Nickel-Titanium (NiTi) files have become popular in endodontic procedures compared to traditional stainless steel hand files owing to their increased flexibility which is especially advantageous in curved canals. Due to the associated costs, endodontic instruments are frequently re-used, which requires sterilization between uses. With the application of temperature NiTi has the ability to undergo phase transformations, altering the properties of the instruments. The purpose of this study was to investigate phase transformations of four brands of NiTi rotary endodontic instruments in the as-received condition and after multiple sterilization cycles under steam sterilization, using differential scanning calorimetry. Materials and Methods: Four brands of nickel-titanium endodontic rotary files size 35, .04 taper were evaluated in this study: ProFile (Dentsply Tulsa Dental Specialties, Tulsa, OK), ProFile Vortex (Dentsply), Vortex Blue (Dentsply), and HyFlex CM (Coltène/Whaledent, Cuyahoga Falls, OH). The transformation temperatures and phase transformations of these files were determined in the as-received condition and after 1, 3, and 5 cycles of steam sterilization by differential scanning calorimetry. Measurements were analyzed using a two-way ANOVA. Results: There were significant differences between file brands in austenite finish temperature (p \u3c 0.05) but the only statistical significant differences in thermal properties when comparing files before and after 1, 3, and 5 cycles of steam sterilization were found with onset heating (p \u3c 0.05). Conclusion: Repeated cycles of steam sterilization do not appear to influence the phase transformations of NiTi endodontic instruments

The Effect of EDTA in Attachment Gain and Root Coverage

Root surface biomodification using low pH agents such as citric acid and tetracycline has been proposed to enhance root coverage following connective tissue grafting. The authors hypothesized that root conditioning with neutral pH edetic acid would improve vertical recession depth, root surface coverage, pocket depth, and clinical attachment levels. Twenty teeth in 10 patients with Miller class I and II recession were treated with connective tissue grafting. The experimental sites received 24% edetic acid in sterile distilled water applied to the root surface for 2 minutes before grafting. Controls were pretreated with only sterile distilled water. Measurements were evaluated before surgery and 6 months after surgery. Analysis of variance was used to determine differences between experimental and control groups. We found significant postoperative improvements in vertical recession depth, root surface coverage, and clinical attachment levels in test and control groups, compared to postoperative data. Pocket depth differences were not significant (P\u3c.01)

Nanodiamond-Gutta Percha Composite Biomaterials for Root Canal Therapy.

Root canal therapy (RCT) represents a standard of treatment that addresses infected pulp tissue in teeth and protects against future infection. RCT involves removing dental pulp comprising blood vessels and nerve tissue, decontaminating residually infected tissue through biomechanical instrumentation, and root canal obturation using a filler material to replace the space that was previously composed of dental pulp. Gutta percha (GP) is typically used as the filler material, as it is malleable, inert, and biocompatible. While filling the root canal space with GP is the standard of care for endodontic therapies, it has exhibited limitations including leakage, root canal reinfection, and poor mechanical properties. To address these challenges, clinicians have explored the use of alternative root filling materials other than GP. Among the classes of materials that are being explored as novel endodontic therapy platforms, nanodiamonds (NDs) may offer unique advantages due to their favorable properties, particularly for dental applications. These include versatile faceted surface chemistry, biocompatibility, and their role in improving mechanical properties, among others. This study developed a ND-embedded GP (NDGP) that was functionalized with amoxicillin, a broad-spectrum antibiotic commonly used for endodontic infection. Comprehensive materials characterization confirmed improved mechanical properties of NDGP over unmodified GP. In addition, digital radiography and microcomputed tomography imaging demonstrated that obturation of root canals with NDGP could be achieved using clinically relevant techniques. Furthermore, bacterial growth inhibition assays confirmed drug functionality of NDGP functionalized with amoxicillin. This study demonstrates a promising path toward NDGP implementation in future endodontic therapy for improved treatment outcomes

Aerodynamic design and performance testing of an advanced 30 deg swept, eight bladed propeller at Mach numbers from 0.2 to 0.85

The increased emphasis on fuel conservation in the world has stimulated a series of studies of both conventional and unconventional propulsion systems for commercial aircraft. Preliminary results from these studies indicate that a fuel saving of from 15 to 28 percent may be realized by the use of an advanced high speed turboprop. The turboprop must be capable of high efficiency at Mach 0.8 above 10.68 km (35,000 ft) altitude if it is to compete with turbofan powered commercial aircraft. An advanced turboprop concept was wind tunnel tested. The model included such concepts as an aerodynamically integrated propeller/nacelle, blade sweep and power (disk) loadings approximately three times higher than conventional propeller designs. The aerodynamic design for the model is discussed. Test results are presented which indicate propeller net efficiencies near 80 percent were obtained at high disk loadings at Mach 0.8

Influence of Taper on the Flexibility of Nickel-Titanium Rotary Files

Introduction: Modern nickel-titanium instruments have various tapers and have been marketed to have superior flexibility from previous generations. Current ISO standards require force measurements at a static point along the file. Unfortunately, root canal anatomy varies and produces multiple forces along the length of the file. The purpose of this study was to determine the influence of taper on the flexibility of various nickel-titanium files. Materials and Methods: The flexibility of stainless steel hand files and nickel-titanium rotary files of various tapers was measured. The sample size was 10 for each type, taper and size. The files were measured at 3, 5 and 7 mm from the tip using a digital caliper and marked with a rubber stopper and a distance of 20mm from the tip was used as the deflection point. Each file was securely fastened on a load-sensing cell and bending was accomplished using a universal testing machine to a maximum deflection of 4.5 mm at a rate of 2 mm/minute under room temperature conditions (22OC ±1OC). Data was collected electronically via Merlin Software and transferred to Microsoft Excel. Statistical analysis was completed with IBM SPSS Statistics software and a two-way analysis of variance (ANOVA) was used as well as a Post-hoc Tukey test. Results: The force and bending moments of EndoSequence .06 taper files was significantly greater (p\u3c0.05) than EndoSequence .04 and stainless steel hand files at all lengths. No significant difference was noted between EndoSequence .04 and stainless steel hand files from 0.25 mm to 3.0 mm. From 3.5 mm to 4.5 mm, the force and bending moments for stainless steel hand files was significantly greater (p\u3c 0.05) than EndoSequence .04 files. Within each file group, the force and bending moments were significantly greater (p\u3c0.05) as the grasp length increased (7 mm\u3e5 mm\u3e3 mm). Conclusions: With a vast array of root canal instruments currently available clinicians should consider the properties of instruments before cleaning and shaping. Nickel-titanium files with tapers greater than 0.04 should not be used for apical enlargement of curved canals because these files are significantly stiffer resulting in an increased chance of canal transportation