Journal of Conservative Dentistry最新文献

Context: Endodontic retreatment is the first line of treatment in cases of failed primary endodontic treatment. Although associated with challenges such as incomplete removal of obturating material, increased clinical time, and extrusion of apical debris, endodontic retreatment still has considerable success rate in the general population.

Aims: The aim of this study was to evaluate and compare the efficacy of TruNatomy, ProTaper retreatment, and RaCe file systems to remove the obturating material, time taken to remove the obturating material, and apical extrusion of debris using cone-beam computed tomography (CBCT).

Settings and design: In vitro study.

Subjects and methods: Forty-five moderately curved mesiobuccal roots of the mandibular molars were instrumented up to #25, 4% taper and obturated with bioceramic sealer and lateral compaction technique. Teeth were divided randomly into three groups (n = 15). Teeth were retreated with TruNatomy, ProTaper retreatment, and RaCe file systems, respectively. Preretreatment and postretreatment CBCT scans were recorded and percentage of obturating material removed was calculated. Time taken to remove the obturating material and apical extrusion of debris was noted.

Statistical analysis used: Descriptive statistics including percentage, mean, standard deviation, Tukey's post hoc test, Kruskal-Wallis test, and Mann-Whitney Post hoc test were used.

Results: The total time needed for the removal of obturating material was comparatively shorter in the RaCe group, followed by the ProTaper retreatment group and TruNatomy group (P < 0.001). TruNatomy files were significantly better in removing the obturating material than the ProTaper retreatment files (P = 0.04). Statically, no difference between RaCe and TruNatomy files was noted. Apically extruded debris was more in the TruNatomy group than in the RaCe and ProTaper retreatment groups (P = 0.01).

Conclusions: All tested endodontic files were effective in removal of obturating material, although none could completely remove the filling material and no system could completely eliminate apical extrusion.

Background: Cavity preparation often causes gingival bleeding which can be controlled by hemostatic agents (HAs). These along with blood act as contaminants and hamper the bonding mechanism. Collagen cross-linkers (CCLs) are agents known to increase the bond strength (BS) to dentin. Hence, the purpose of this in vitro study was to determine the effect of two different CCLs, proanthocyanidin (grape seed extract [GSE]) and hesperidin on the microtensile BS (μTBS) of a self-etch adhesive (SEA) system to dentin which was contaminated with blood and a HA.

Materials and methods: Thirty-six extracted human molars were collected, and their occlusal surfaces were sectioned to expose the dentin. The teeth were randomly divided into four groups: Group I - Control, Group II - Contamination with blood and HA, Group III - Application of GSE after contamination, and Group IV - Application of hesperidin extract after contamination. The SEA was applied, followed by the use of a nanocomposite. Dentin-composite rods were obtained from each group, and μTBS testing was done. The fracture pattern was visually classified as an adhesive failure at the interface, cohesive failure in composite, or dentin. The scanning electron microscope (SEM) analysis was done for two samples from each group. Statistical analysis was done using the Student's unpaired "t" and ANOVA test.

Results: Group II showed a statistically significant reduction in μTBS in comparison to Group I. This was overcome in Groups III and IV. Hesperidin showed marginally better results than GSE.

Conclusions: The use of GSE and hesperidin increases the μTBS of composite resin to dentin postcontamination with blood and ViscoStat Clear with Single Bond Universal Adhesive.

Context: Adjuvant use of platelet-rich fibrin (PRF) in many areas of dentistry is well documented. However, its role in periapical surgery remains contested which requires further clarification by a higher level of evidence.

Aim: The objective of this systematic review was to evaluate the effect of PRF on periapical surgery using meta-analysis.

Materials and methods: A comprehensive literature search was conducted in PUBMED, Cochrane Central Register of Controlled Trials, SCIENCE DIRECT, and GOOGLE SCHOLAR for randomized controlled trials (RCT) published until May 2021. Meta-analysis was performed for comparisons of baseline (pretreatment) versus posttreatment values for different measurement parameters (postoperative pain, peri apical healing both qualitatively and quantitatively). The risk of bias in all the included trials was assessed after the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions.

Results: Among the 356 eligible articles found in the initial search, 10 RCTs from 2011 through 2021 were included. Qualitative analysis of all the included studies showed that PRF may play a positive role in bone healing, reduction in periapical lesions, and enhancing quality of life using different imaging modalities. The results of the meta-analysis indicated a significant reduction in postoperative pain when PRF was used (standard mean difference [SMD] = 0.515; 95% confidence interval [CI] = 0.061- 0.969;P = 0.026; I 2 = 0%). However, there was no statistically significant association observed while evaluating peri apical bone healing both qualitatively (odds ratio [OR] = 1.427; 95% CI = 0.309-6.584; P = 0.648) and quantitatively measured by Cone beam computed tomography (SMD = -0.264; 95% CI = -0.974-0.447;P = 0.454) between PRF and control group.

Conclusions: Considering the notable benefits demonstrated by use of PRF, it may be considered as a valuable adjunct in periapical surgery. However, more high-quality trials are necessary to assess the exact role of PRF.

Introduction: The study evaluates and compare the effect of 3% warm NaOCl with NaOCl at room temperature in root canal irrigation on postoperative pain.

Materials and methods: In this randomized controlled trial, mandibular molars with symptomatic irreversible pulpitis in healthy 18-year-old patients and above were included. The sample consisted of 56 patients evaluating the postoperative pain, allocated randomly into 2 groups of 3% NaOCl at two different temperatures, i.e. at room temperature and at 60°C. Endodontic treatment was initiated for each group and instrumentation was done using MTwo rotary files. The final irrigation was performed according to the groups assigned. For each included tooth, preoperative and postoperative pain scores at 6, 12, 24, 48, and 72 h were collected through the Heft Parker Visual Analog Scale. Statistical analysis was performed using independent t-test, Chi-square test, Mann-Whitney U-test, and Friedman test followed by Wilcoxon test.

Results: The mean percentage reduction in pain scores was significantly higher among the warm NaOCl group as compared to the control group at different time intervals (P < 0.001). The mean number of analgesics taken was significantly lower among the warm NaOCl group as compared to the control group (P < 0.001).

Conclusion: The warm NaOCl group recorded less postoperative pain than the control group during the first 72 h following single-visit endodontic therapy.

[This retracts the article on p. 271 in vol. 26, PMID: 37398852.].

Objective: The objective of the study was to evaluate the effect of access cavity design on fracture resistance of the extracted maxillary first and second molars prepared with three minimally invasive files.

Materials and methods: One hundred and twelve extracted human maxillary molars were selected for the study and divided randomly into three groups according to different minimally invasive files used (self-adjusting files [SAF], XP-endo Shaper [XP], and 4 V-Taper 2H [VT]) and one control group (CG). All experimental groups were subdivided into two subgroups, i.e., conservative access cavity (CAC) and traditional access cavity (TAC). All the canals in different experimental groups were enlarged up to apical size 30. The data were analyzed using the analysis of variance and Post hoc Tukey tests (P < 0.05).

Results: The highest mean fracture resistance of teeth with CAC was of the CG (1399.957), followed by teeth with CAC instrumented by SAF (1378.314) and XP-endo Shaper (1202.929). The least value was of the V-Taper file system (937.157). Furthermore, the highest mean fracture resistance value of teeth with TAC was of the CG (1143.171), followed by teeth with TAC instrumented by SAF (1150.607) and then XP-endo Shaper (998.150). The least value was of the V Taper file system (757.050).

Conclusion: Conservative endodontic access (CAC) in the maxillary molars had shown significantly increased fracture resistance over TAC. SAF showed the maximum fracture resistance, while V-Taper files showed the least fracture resistance among the experimental groups compared.

Aim: The aim of this in vitro study was to measure the quality of marginal adaptation of three root end filling materials by scanning electron microscope (SEM).

Methodology: Thirty extracted human permanent single-rooted single canal maxillary anterior teeth with mature apices were prepared up to 60 K-file and obturated. Teeth were resected 3 mm from the apex using a cross-cut fissure bur at 90° angle to the long axis of the tooth. Root end cavities of 3 mm were prepared in each of the teeth with an ultrasonic tip to receive the root end filling material. Group 1 - mineral trioxide aggregate (MTA), Group 2 - Biodentine, and Group 3 - Geristore. The samples were mounted in resin blocks for sectioning with a hard-tissue microtome and sectioned apically at 1 mm and 2 mm levels from the apex. They were gold sputtered and viewed under SEM for evaluating the adaptation of the material to the canal walls.

Results: The mean value for Group II (Biodentine) was lower than the mean value for Group I (MTA) and Group III (Geristore) at 1 mm and 2 mm.

Conclusion: Biodentine showed significantly better marginal adaptation as compared to MTA and Geristore.

Aims: The aim of this study was to evaluate and compare the pericervical dentin preservation and fracture resistance of root canal-treated teeth with rotary endodontic file systems of different types of taper.

Subjects and methods: Thirty-two single-rooted human-extracted premolars were used. They were mounted in wax, and preoperative cone-beam computed tomography (CBCT) scans were taken with 11 × 8 Field of view (FOV). The evaluation of the pericervical dentin thickness was done at the cementoenamel junction level. After pre-CBCT, the 32 samples were divided into four groups (n = 8) - Group A: fixed tapered hand files, Group B: variable regressive tapered TruNatomy, Group C: progressive tapered ProTaper Gold, and Group D: fixed tapered HyFlex EDM. Following instrumentation, postoperative CBCT scans were taken to evaluate pericervical dentin thickness. Obturation was done and access cavity was restored with composite. Fracture strength was checked for all the samples using "universal testing machine" until fracture, and calculated in newtons (N).

Statistical analysis used: Student's t-test and ANOVA test, along with Tukey's post hoc analysis, were used for comparing mean values between the groups, and P < 0.05 was considered statistically significant.

Results: The results of this study showed that there is no statistically significant difference in preserving pericervical dentin with file system of different types of taper and fracture resistance between the groups.

Conclusions: Within the limitations of the study, it was concluded that different types of file taper systems used for root canal preparation have no significant effect on the preservation of pericervical dentin and fracture resistance of teeth.

Background: Cleaning and shaping represent a vital step in the endodontic procedure. In routine endodontic therapy, the fracture of nickel-titanium (NiTi) instruments is a procedural problem creating a major obstacle to therapy.

Aim: This study examines the life span of one Neoendo Flex and ProTaper Next (PTN) rotary file using reciprocating motion and compares the time required by both file systems for canal preparation.

Materials and methods: One hundred maxillary permanent central incisors were selected. In that, fifty teeth are utilized in a reciprocating motion (RM) with the PTN file (n = 25) and Neoendo Flex file (n = 25). To check fractured resistance and the overall root canal preparation time, fifty more teeth are employed in continuous motion (CM) with canals prepared using PTN (n = 25) and Neoendo Flex (n = 25). All canals are prepared following the sequence of respective files. Later, the fracture mechanism of the files was inspected using a scanning electron microscope.

Results: In an RM motion, both PTN and Neoendo Flex files can be used in a minimum of 25 canals in single-rooted teeth. Statistical analysis using the Mann-Whitney U-test showed no significant difference in total time taken by PTN and Neoendo Flex in both motions.

Conclusion: Within the limitation of this study, the RM was found to be better than CM with less incidence of instrument fracture.