Search Results (49)

The proper selection of bioactive root-end material is one of the main prognostic factors for the successful healing outcome of apical microsurgery (AMS). The aim of the present in vitro study was to evaluate and compare the marginal adaptability of a novel calcium silicate cement (CSC), Harvard MTA Universal, and Biodentine used as root-end filling materials. The endodontic treatment of 20 extracted human maxillary central incisors was performed. The apicoectomy was simulated, and root-end cavities were prepared ultrasonically using universal retrotips. Teeth were randomly assigned into two equal groups (n = 10) according to the retrofilling cement used: Group 1—Harvard MTA Universal and Group 2—Biodentine. The specimens were stored in relative humidity for 48 h and sectioned longitudinally. The data were processed and analyzed statistically. Harvard MTA exhibited a significantly lower mean gap width (1.16 ± 0.37 µm) than Biodentine (2.48 ± 0.38 µm) (p < 0.05), indicating a more intimate interfacial adaptation. Additionally, the phenomenon of material penetration into the dentinal tubules was observed only in the Harvard MTA group. Within the limitations of this in vitro study, Harvard MTA Universal demonstrated better interfacial properties than Biodentine when applied as a root-end filling material. This novel biomaterial could be regarded as a promising alternative for earlier calcium silicate cements in the context of AMS goals. Clinical relevance: The quality of marginal adaptation is a determinative feature for the clinical performance of CSCs and the long-term prognosis of AMS. Full article

Background: Dental anxiety often poses a significant barrier to effective dental care in pediatric patients. This study evaluated the efficacy and safety of oral midazolam at two different doses for sedation and amnesia in preschool children undergoing dental procedures under 30 min, including primary teeth extraction, root canal treatment, dental filling, and stainless-steel crown. Methods: This prospective, double-blind, randomized controlled trial included 80 children aged 3–6 years with dental anxiety (Types 1 and 2 of the Frankl Behavior Rating Scale) at the National Hospital of Odonto-Stomatology, Hanoi. following the CONSORT guidelines. Participants were randomly assigned to receive oral midazolam at 0.3 mg/kg or 0.6 mg/kg. Sedation efficacy, onset time, procedure duration, cooperation level (Houpt Behavior Rating Scale), recovery time, and amnesia at 12 h, 24 h, and 1 week, as well as adverse events, were recorded and analyzed. Results: Both midazolam doses were effective for sedation (0.3 mg/kg: 95% vs. 0.6 mg/kg: 100%, p = 0.49). The higher dose (0.6 mg/kg) provided significantly longer effective procedural time (27.3 ± 4.1 min vs. 20.3 ± 4.0 min, p < 0.001) and better patient cooperation (95% vs. 78.9%, p = 0.045), but slightly prolonged recovery time (34.6 ± 4.6 min vs. 31.8 ± 4.4 min, p = 0.008). Both doses produced similar amnesic effects, with approximately 90% anterograde amnesia at 12 h post-procedure. Adverse events were minimal and mild. Conclusions: Both 0.3 mg/kg and 0.6 mg/kg doses of oral midazolam are safe and effective for sedation and amnesia in preschool children undergoing dental procedures. While the 0.6 mg/kg dose provides better procedural cooperation and prolonged sedation, it also requires a slightly longer recovery time. Full article

The aim of this study is to evaluate the apical sealing ability of novel bioceramic-based (BCB) and widely used resin-based (RB) root canal sealers in combination with traditional or bioceramic-coated gutta-percha points. A total of 92 human single-root extracted teeth were endodontically treated and divided into three groups (A, B, and C) of 30 samples based on the endodontic sealer/type of gutta-percha points/obturation method used. One tooth sample was used for the negative and positive controls (each). Group A: BCB sealer BioRoot RCS (Septodont, Saint-Maur-des-Fossés, France)/bioceramic-impregnated gutta-percha TotalFill BC points (FKG Dentaire, La Chaux-de-Fonds, Switzerland)/cold hydraulic single-cone. Group B: BioRoot RCS (Septodont, France)/traditional Protaper Gold Gutta-Percha Points (Dentsply Sirona, Charlotte, NC, USA)/cold hydraulic single-cone. Group C: RB sealer AdSeal (Meta Biomed, Cheongju, Republic of Korea)/traditional Protaper Gold Gutta-Percha Points (Dentsply Sirona, USA)/warm vertical condensation. A dye penetration method was applied, and the length of apicocoronal penetration was measured using a surgical microscope. The data were statistically analyzed to evaluate differences at the 0.05 significance level. A significant difference was found between groups A and C, p = 0.0003, and groups B and C, p = 0.003. The data analysis proved that the BCB sealer using the cold hydraulic single-cone method ensured a substantially better seal than the RB sealer using the warm vertical condensation method. The choice of the type of gutta-percha points (bioceramic-coated or regular) appeared to be unimportant. No statistical significance was found between groups A and B, which indicates that using bioceramic-coated gutta-percha points does not bring any considerable benefit in view of a no-gap root canal obturation. Full article

The aim of this study was to compare the efficacy of the guided tissue regeneration (GTR) of periodontal infrabony defects using the frozen radiation-sterilized allogenic bone graft (FRSABG) versus deproteinized bovine bone mineral (DBBM) 5 years after treatment. The association between patients’ compliance and periodontitis recurrence with 5-year outcomes was also evaluated. Thirty infrabony defects in 15 stage III/IV periodontitis patients were randomly allocated to the FRSBAG group (tests) or the DBBM group (controls). Between 1 and 5 years, one patient was lost to follow-up and one tooth was extracted due to root fracture. No tooth was extracted for periodontal reasons. Consequently, 13 teeth in test sites and 14 teeth in control sites were available for the 5-year analysis. The clinical attachment level gain (CAL-G, primary outcome), probing pocket depth (PPD), radiographic defect depth (DD), and linear defect fill (LDF) were examined at baseline and 5 years post-surgically. Both groups showed statistically significant improvements in all evaluated clinical and radiographic parameters at 5 years, with insignificant intergroup differences. CAL-Gs were 4.46 ± 2.07 mm in the FRSBAG group, and 3.86 ± 1.88 mm in the DBBM group (p = 0.5442). In six (43%) patients, we observed periodontitis recurrence, among whom two (33.33%) participated regularly in supportive periodontal care (SPC) and the other four (66.7%) did not take part in SPC. A regression analysis revealed that periodontitis recurrence was a significant predictor of CAL loss and DD increase. FRSBAG and DBBM were both equally effective 5 years after the GTR of infrabony defects. Within the limitations of the present study, its outcomes advocate that both grafts may be considered as a viable option based on patient preferences and clinical considerations. Full article

The impact of adding silver nanoparticles (AgNPs) to bioceramic (BC) sealer on their ability to penetrate dentinal tubules is still unknown. Thus, this confocal laser scanning microscopic (CLSM) study aimed to assess the extent of dentinal tubule penetration of BC sealer (TotalFill^® Hiflow BC Sealer™, FKG, Switzerland) with and without AgNPs using the single-cone (SC) technique and the continuous-wave condensation (CWC) technique. AgNPs alone as well as in a mixture with the BC sealer were characterized using scanning electron microscopy and transmission electron microscopy. Single-rooted extracted human teeth (N = 100) were selected and prepared, and then divided into four groups (n = 25). Group 1 (BC/SC): BC sealer obturated with the SC technique. Group 2 (BC+AgNPs/SC): BC sealer with AgNPs obturated with the SC technique. Group 3 (BC/CWC): BC Sealer obturated with the CWC technique. Group 4 (BC+AgNPs/CWC): BC Sealer with AgNPs obturated with the CWC technique. After 2 weeks, roots were horizontally sectioned to obtain 1 mm thick dentin slices that were evaluated with CLSM. Sealer dentinal tubule penetration area and the maximum depth of penetration were measured. Data were analyzed with one-way ANOVA and the Tukey multiple comparison tests (p ≤ 0.05). The characterization process demonstrated a spherical-shaped nanoparticles without obvious agglomeration. The results showed that Group 2 (BC+AgNPs/SC) significantly demonstrated the highest mean tubular penetration depth, while group 3 (BC/CWC) had the lowest mean depth. Group 2 (BC+AgNPs/SC) exhibited the significantly highest mean value for the total area of penetration. However, groups 1 (BC/SC) and 3 (BC/CWC) exhibited the lowest mean value of total penetration area, with no statistically significant difference. The integration of AgNPs with BC sealer markedly enhanced penetration into dentinal tubules. The SC technique demonstrated superior penetration relative to the CWC technique. Full article

Filling post-extraction alveoli with hydroxyapatite-based materials is becoming an increasingly common procedure in veterinary dentistry. In dogs, tooth roots vary in structure depending on the weight of the dog, but data on tooth length and volume have not yet been described. This study aimed to establish reference data on tooth root length and post-extraction alveolar volume for mature maxillary and mandibular incisors and canines in dogs. We determined the mean length and volume of these teeth in dogs in the weight ranges of 1–5 kg, 5–10 kg, 10–20 kg, and over 20 kg. The obtained values given showed a correlation between tooth length and alveolar volume in a specific weight range. A review of the commercially available hydroxyapatite-based bone substitute materials was then conducted. A table is presented which shows how to calculate the volume of bone substitute material required to fill a post-extraction alveolus with a given material. Statistics were used to assess significant differences between the mass of the bone substitute product used (μL) for specific weight ranges and to demonstrate the correlation between tooth length and alveolar volume for a specific weight range. The data obtained in this study can serve as reference values for tooth crown length and alveolar volume, allowing operators to plan a specific volume of bone substitute material for filling post-extraction alveoli. This research is interesting because it shows that the weight of an animal is an important aspect in planning the amount of bone substitute material for tooth extraction. In clinical work, it is much easier to weigh an animal than it is to make calculations based on the length of the tooth root. Full article

Background: Adhesion within endodontic obturation material and root canal walls improves the efficacy of the endodontic treatment by establishing a barrier that inhibits reinfection and entombs residual bacteria. This study evaluates the push-out bond strength (POBS) of calcium silicate sealers compared to an epoxy-resin-based sealer. Methods: A total of 36 extracted mono-radicular teeth were prepared with Pro Taper Ultimate and irrigated with 5.25% sodium hypochlorite and 17% EDTA. The specimens were randomly split into three groups (n = 12) according to the endodontic sealer and filling technique used as follows: Ah Plus with the continuous wave condensation technique (CWC), Ah Bioceramic (Ah Bio) with the single-cone technique, and Total Fill Hi-Flow (FKG Hi-Flow) with the CWC technique. The material was allowed to set for 4 weeks, and afterwards, the roots were placed in acrylic resin and sectioned into 1 mm transverse slices. A POBS test was conducted using a universal testing machine, and the mode of bond failure was assessed at 4× magnification using a stereomicroscope. Six specimens from each group were selected for SEM-EDX examination to evaluate dentinal tubule penetration. The data were analysed using analysis of variance and Tukey and Bonferroni post hoc tests. Results: The POBS tests revealed higher values for Ah Plus in comparison to both calcium silicate sealers (p < 0.001), while FKG Hi-Flow showed superior results to Ah Bio (p < 0.001). The cohesive mode of failure was prevalent in all three groups. Conclusions: In conclusion, the resin-based sealer showed higher bond strength and better dentinal tubule penetration than the two calcium silicate sealers tested, while FKG Hi-Flow outperformed AH Bio. Full article

Resin core build-ups following root canal treatment still have many issues. This study evaluated whether a new low-polymerization-shrinkage resin core system (LC2) could address these issues by assessing its bonding performance to root canal dentin using microtensile bond strength tests and gap formation using swept-source optical coherence tomography (SS-OCT). Twenty-four extracted human lower premolars were used for bonding performance tests, while forty-eight sound extracted human wisdom teeth were used for gap observation. Four systems were compared: Luminous Core LC flow (LC1), LC2, MI Core LC flow (MIC), and Filtek Fill & Core (FFC). Cylindrical cavities were prepared, bonded, and filled with resin cores, and gap formation was evaluated. The results showed significant differences in bond strength between the coronal and apical sides: LC1 (coronal: 29.9 ± 3.8 MPa; apical: 12.4 ± 2.0 MPa), LC2 (coronal: 31.2 ± 3.6 MPa; apical: 17.8 ± 3.6 MPa), MIC (coronal: 28.7 ± 3.8 MPa; apical: 8.8 ± 2.1 MPa), and FFC (coronal: 29.0 ± 4.2 MPa; apical: 9.5 ± 1.9 MPa). LC2 exhibited significantly higher bond strength at the apical side compared to the other systems (p < 0.05). Gap formation was significantly reduced in LC2 (10.9 ± 5.0%) and FFC (11.9 ± 5.0%) compared to LC1 (31.8 ± 10.5%) and MIC (32.0 ± 5.6%) (p < 0.05). These findings suggest that LC2 is advantageous for resin core build-ups, particularly in improving adhesion to root canal dentin and reducing gap formation. Full article

Depending on the obturation technique, the tooth and surrounding tissues may heat up during root canal filling, particularly with warm methods. This study aimed to analyze the temperature increase in the periradicular and -apical region during various warm obturation techniques with a present simulated periodontal blood flow. Seventy-five extracted human teeth were shortened to 11 mm (cut-grinder Primus diamond cutting device; Walter Messner GmbH, Oststeinbek, Germany) and prepared using the ProTaper Gold system (Dentsply Sirona Inc., Charlotte, NC, USA) ISO size 40/.06. Specimens were prepared to ensure stable fluid circulation in an artificially created periodontal space, and the procedure was recorded with a thermal infrared camera (VarioCAM HD; InfraTec GmbH Infrarotsensorik und Messtechnik, Dresden, Germany). The following obturation methods were applied: I, cold single-cone obturation (control group); II, gutta-percha-coated rigid carrier technique (GuttaFusion); III, squirting technique (injection technique); IV, continuous wave technique; and V, Schilder technique. Statistical analysis was performed using the Kruskal–Wallis test, followed by the Mann–Whitney pairwise test using the sequential Bonferroni procedure for significant differences (p < 0.05). The Schilder technique with 0 mL/min showed the lowest temperature change, with a median of 0.00 °C (max. 0.00 °C, min. 0.00 °C, IQR 0.00 °C). In contrast, the continuous wave technique at a circulation rate of 2.6 mL/min exhibited the highest temperature change, with a median of 3.76 °C (max. 5.33 °C, min. 2.42 °C, IQR 1.46 °C). Although warm obturation techniques can increase surface temperature, none of the methods produced changes that were potentially damaging to the periodontium or surrounding bone. Full article

The aim of this study was to evaluate the bond strength of the calcium silicate-based sealer (CSS) modified with the silver nanoparticles (AgNPs) using the single-cone technique (SC) and the continuous wave condensation (CWC) technique, measured by a universal testing machine. The AgNPs and the modified sealers were characterized by scanning electron microscopy and transmission electron microscopy. One hundred single-rooted extracted human permanent teeth with a single root canal were cleaned and shaped with a Protaper Next system. The teeth were randomly divided into four groups (n = 25) as follows: Group 1, canals were obturated using the SC technique with TotalFill^® BC Sealer. Group 2, canals were obturated using the SC technique with TotalFill^® BC Sealer mixed with AgNPs. Group 3, canals were obturated using the CWC technique with TotalFill^® HiFlow BC Sealer. Group 4, canals were obturated using the CWC technique with TotalFill^® HiFlow BC Sealer mixed with AgNPs. After two weeks, 1 mm-thick dentin slices were cut and exposed to a push-out bond strength test using a universal testing machine. Specimens were examined under a digital microscope to determine the mode of failure. Statistical analysis was performed using ANOVA and Tukey multiple comparison tests (p < 0.05). The nanoparticle characterization revealed a spherical morphology with no obvious aggregations. The results showed that group 4 had the highest dislodgement resistance compared to all groups (p < 0.05). Group 4 was significantly higher in push-out bond strength value than group 1 (p < 0.001) and group 3 (p < 0.003), but not significantly higher than group 2. Cohesive failure was the most prevalent failure mode among all groups. It can be concluded that the incorporation of silver nanoparticles into the calcium silicate-based sealer significantly increased the bond strength. The warm obturation approach demonstrated significantly higher resistance to dislodgment as compared to the single-cone technique. Full article

Aim: The aim of this study was to compare the fitting accuracy of custom-made metal posts and cores fabricated by half-digital and milling technique to that of conventional cast posts fabricated by direct technique. Methods: Sixteen extracted single-rooted teeth were endodontically treated followed by post space preparation. A direct resin post and core pattern was made for each tooth and used for the fabrication of two posts (n = 16). Each post resin pattern was digitized with a laboratory scanner and used for the fabrication of a milled cobalt–chrome (Co–Cr) alloy post, while the direct resin pattern, after scanning, was cast in a Co–Cr alloy to produce a cast post. Each post was seated on its respective tooth and evaluated using microcomputed tomography. The following variables were evaluated: total space volume between the post and root canal, the volume and distance of the apical gap between each post and the remaining apical root canal filling, as well as the distance and surface area of the space between the post and lateral root canal wall at four determined points along the length of each post. Results: The results revealed that half-digital and milled posts had a statistically significantly higher total space volume (p < 0.05), apical gap volume (p < 0.02) and distance (p < 0.02), as well as a higher surface area of space between the post and root canal wall at the cervical area as compared to the cast post (p < 0.05). Conclusions: This study demonstrated that the fitting accuracy of cast posts was more accurate than posts fabricated with half-digital and milling technique. Full article

This study aimed to evaluate and compare the quality of matching single-cone obturation using three different single-file systems—WaveOne^® Gold (Dentsply Sirona, Bensheim, Germany), Reciproc^® blue (VDW GmbH, Munich, Germany), and Procodile^® (Komet Medical, Gebr. Brasseler GmbH & Co. KG, Lemgo, Germany). The evaluation focused on the percentage of gutta-percha-filled areas (PGFAs), sealer-filled areas (PSFAs), and unfilled areas (PUAs) across three different sections of curved and straight root canals. Sixty extracted human teeth were categorized into six groups. Based on radiographically determined root canal curvature, thirty curved and thirty straight root canals were prepared using the single-file systems according to the manufacturers’ instructions and obturated with matching gutta-percha cones using AH-Plus sealer. A total of 180 sections were evaluated digitally under the microscope and the results were statistically analyzed. The mean gutta-percha percentages for Reciproc^® blue, Procodile^®, and WaveOne^® Gold were 83%, 82%, and 80%, respectively. No significant (p > 0.05) and relevant (η_p² < 0.10) differences were found in the proportion of form-fitting gutta-percha cones between the systems in all sections. Similarly, canal anatomy showed no significant influence (p > 0.05). Ex vivo, all three systems showed comparable filling quality in all sections of curved and straight canals. Therefore, it can be concluded that all three file systems, in combination with their corresponding gutta-percha points, might be reliable methods for root canal obturation. Reciproc^® Blue, Procodile^®, and WaveOne^® Gold consistently achieved comparable obturation results across various root configurations and levels of the root canal. Full article

Tooth decay, also known as caries, is a significant medical problem that harms teeth. Treatment is based on the removal of the carious material and then filling the cavity left in the tooth, most commonly with amalgam or composite resin. The consequences of filling failure include repeating the filling or performing another treatment such as a root canal or extraction. Dental amalgam contains mercury, and there is a global effort to reduce its use. However, no consensus has been reached regarding whether amalgam or composite resin materials are more durable, and which is the best restorative material, when using randomized clinical trials. To determine which material is superior, we performed a retrospective cohort study using a large database where the members of 58 dental clinics with 440 dental units were treated. The number of failures of the amalgam compared to composite resin restorations between 2014 and 2021 were compared. Our data included information from over 650,000 patients. Between 2014–2021, 260,905 patients were treated. In total, 19,692 out of the first 113,281 amalgam restorations failed (17.49%), whereas significantly fewer composite restorations failed (11.98%) with 65,943 out of 555,671. This study indicates that composite is superior to amalgam and therefore it is reasonable to cease using mercury-containing amalgam. Full article

This study aimed to compare the nanoleakage of retrograde fillings with premixed calcium silicate-based putty and mineral trioxide aggregate (MTA), using two different techniques (traditional and Lid). Sixty-four extracted human teeth were decoronated, then root canals and ends were instrumented for retrograde filling and divided into four groups according to the retrograde filling technique: the traditional and the Lid technique. Each group (n = 15) was filled with Ceraseal + Well-Root putty, Well-Root putty, Ceraseal + ProRoot MTA, and ProRoot MTA. The nanoleakage was evaluated using the Nanoflow device (IB Systems) on days 1, 3, 7, 15 and 30. Data were collected twice per second at the nanoscale (nL/s) and calculated after archiving the stabilization of fluid flow. The Kruskal–Wallis and Mann–Whitney U-tests were used for statistical analysis. All groups showed enhanced sealing ability over time. Regardless of filling materials, the Well-Root putty, Ceraseal+Well-Root putty, and Ceraseal+ProRoot MTA groups indicated less nanoleakage than the ProRoot MTA group in the first week of evaluation (p < 0.05). Although all groups did not show significant differences after 2 weeks, the Ceraseal+ProRoot MTA group leaked less than ProRoot MTA on Days 3 and 7 (p < 0.05). The scanning electron microscopic examined good adaptation to the cavity wall, which was similar to nanoleakage results. Premixed calcium silicate-based putty retrograde filling material alone and using the “lid technique” were shown to be faster and less prone to nanoleakage when compared to MTA. Full article

The aim of this in vitro study was to evaluate the effect of the pre-application of a dentin-bonding agent and the application of different lasers on the prevention of tooth discoloration caused by mineral trioxide aggregate (MTA) in the presence of blood. Sixty extracted human anterior teeth were selected, with root lengths standardized to 10 mm and root canals shaped using Gates-Glidden drills #3 to #5. The samples were divided into six groups (n = 10): Group 1 with no surface treatment and Groups 2 to 6 with Optibond universal adhesive and Neodymium yttrium aluminum garnet (Nd:YAG), Erbium yttrium aluminum garnet (Er:YAG), Erbium-chromium-yttrium-scandium-gallium-garnet (Er:Cr:YSGG), and diode laser applications, respectively. Root canals were filled with fresh human blood, and ProRoot MTA and a collagen barrier were then placed. Color changes were measured with a spectrophotometer at 0, 7, 30, 90, and 180 days post MTA placement. Color differences (∆E) were analyzed using a two-factor mixed-design ANOVA with the Sidak method (p = 0.05). All treatment groups exhibited discoloration above the acceptability threshold. Although all treatment approaches exhibited less color change compared to the control group (p < 0.05), there was no significant difference among them in terms of preventing color change (p > 0.05). It was determined that none of the methods could guarantee 100% prevention of discoloration caused by MTA–blood contact. Full article