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Sriprasart K, Wimonchit S. Fracture Resistance of Simulated Immature Teeth Filled with Three Types of Calcium Silicate Cement after Intracanal Medication with Ca(OH) 2: An Ex Vivo Study. Int J Dent 2024; 2024:8386533. [PMID: 38707786 PMCID: PMC11068449 DOI: 10.1155/2024/8386533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/21/2024] [Accepted: 04/15/2024] [Indexed: 05/07/2024] Open
Abstract
Objectives The aim of this study was to evaluate the 1-day fracture resistance of simulated immature teeth with an apical plug with ProRoot MTA, MTA Angelus, and RetroMTA after calcium hydroxide intracanal medication. Materials and Methods Sixty extracted, single-rooted human mandibular premolars were randomly divided into six groups of 10 teeth each. Firstly, to standardize the 9 mm root length, the crowns were cut off at and 9 mm below the cementoenamel junction transversely. Simulations for immature apices were carried out by using No. 1-6 Peeso reamers to pass through the apex to obtain a diameter of 1.7 mm at the apical opening. One group served as a negative control without any treatment, while the other groups received 30 days of calcium hydroxide intracanal medication. Four groups were plugs with 4 mm of ProRoot MTA, MTA Angelus, RetroMTA, and gutta-percha, respectively. The last one was served as a positive control group without filling inside. After 1 day of incubation, specimens were vertically loaded in a universal testing machine at a crosshead speed of 1 mm/min until fracture occurred. The peak load to fracture (Newton) and fracture pattern were recorded. A one-way analysis of variance (ANOVA) followed by Tukey's HSD test was used for data analysis. Results The highest mean load to fracture was shown in the negative control group (543.33 ± 37.17 N), followed by ProRoot MTA (432.82 ± 68.06 N), MTA Angelus (396.92 ± 59.93 N), RetroMTA (389.08 ± 56.25 N), and gutta-percha (283.28 ± 43.40 N), and the lowest belonged to the positive control group (239.98 ± 27.19 N). The significant differences were found between both the control and experimental groups with an apical plug with calcium silicate cement (p < 0.05). There were no significant differences among those three apical plugs (p > 0.05). Conclusion Apical plugs with ProRoot MTA, MTA Angelus, and RetroMTA had an immediate strengthening effect on simulated immature teeth after calcium hydroxide intracanal medication had been used.
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Affiliation(s)
| | - Suwit Wimonchit
- Department of Conservative Dentistry and Prosthodontics, Faculty of Dentistry, Srinakharinwirot University, Bangkok, Thailand
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2
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Chotvorrarak K, Danwittayakorn S, Banomyong D, Suksaphar W. Intraradicular reinforcement of traumatized immature anterior teeth after MTA apexification. Dent Traumatol 2024. [PMID: 38459664 DOI: 10.1111/edt.12947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 02/26/2024] [Accepted: 02/26/2024] [Indexed: 03/10/2024]
Abstract
This review article describes the methods and clinical recommendations for reinforcing traumatized anterior immature teeth with pulp necrosis treated with mineral trioxide aggregate (MTA) apexification. Traumatic injury can cause pulp necrosis and incomplete root formation in immature teeth. MTA apexification is the treatment of choice for necrotic immature teeth, particularly during the middle or late stages of root development. MTA apexification has a high success rate; however, failures due to cervical or root fractures occasionally occur. The risk of fracture is higher in immature teeth with thin root dentin, particularly those with external root resorption. Furthermore, the loading force from any parafunctional habit also increases fracture risk. Therefore, intra-radicular reinforcement may be necessary after MTA apexification. In vitro, intraradicular restoration with a resin composite/core build-up material or a prefabricated fiber post demonstrated better root reinforcement than root canal obturation materials (i.e., gutta-percha and sealer). However, the root-reinforcement effect of MTA orthograde filling in the entire root canal remains unclear. In vivo, the survival of fractured teeth with intraradicular restorations (resin composite/core build-up material or prefabricated fiber posts) is extremely high. Moreover, the survival of teeth with gutta-percha/sealer obturation or MTA orthograde filling and restoration with resin composite extending into the cervical third of the root canal approximately 1-2 mm below the cemento-enamel junction is acceptably high. Based on this evidence, the remaining tooth/root structure and loading force should be carefully examined when considering intra-radicular reinforcement of immature anterior teeth treated with MTA apexification.
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Affiliation(s)
- Kanet Chotvorrarak
- Department of Operative Dentistry and Endodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | | | - Danuchit Banomyong
- Department of Operative Dentistry and Endodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
- Private practice, Bangkok, Thailand
| | - Warattama Suksaphar
- Department of Endodontics, College of Dental Medicine, Rangsit University, Pathum Thani, Thailand
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Coelho SM, Pandolfo MT, Bortoluzzi EA, Rossetto HL, Pereira RP, Minamisako MC, Rodrigues PM, Netto VR, Ramos TDS, Teixeira CDS, Garcia LDFR. Effect of radiation therapy on fracture resistance of simulated immature teeth submitted to root reinforcement. Int J Paediatr Dent 2024; 34:3-10. [PMID: 37038703 DOI: 10.1111/ipd.13073] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 03/27/2023] [Accepted: 04/04/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND The literature is scanty regarding the effect of radiation therapy (RT) on the mechanical properties of immature permanent teeth. AIM To evaluate the effect of RT on the fracture resistance of simulated immature teeth submitted to different types of root reinforcement. DESIGN Sixty-four human teeth simulating the Cvek stage 3 of root development were distributed into eight groups (n = 8), according to exposure or not to RT (70 Gy) and the root reinforcement method: Group NR (control)-no reinforcement/no RT; Group NR + RT (control)-no reinforcement/RT; Group PO-tricalcium silicate-based cement (TS) apical plug/canal obturation/no RT; Group PO + RT-TS apical plug/canal obturation/RT; Group TS-canal filling with TS/no RT; Group TS + RT-canal filling with TS/RT; Group FP-TS apical plug/fibreglass post/no RT; and Group FP + RT-TS apical plug/fibreglass post/RT. Fracture resistance was determined using a universal testing machine (0.5 mm/min). RESULTS In the intergroup comparison, nonirradiated teeth had higher fracture resistance (p < .05). Groups FP and FP + RT had higher fracture resistance (p < .001). CONCLUSION Radiotherapy affected the fracture resistance of simulated immature teeth. Reinforcement with fibreglass posts increased the fracture resistance, regardless of the radiation.
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Affiliation(s)
- Sérgio Murilo Coelho
- Department of Dentistry - Endodontics Division, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Mariana Travi Pandolfo
- Department of Dentistry - Endodontics Division, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Eduardo Antunes Bortoluzzi
- Department of Diagnosis & Oral Health - Endodontics Division, University of Louisville, Louisville, Kentucky, USA
| | | | - Roberta Pinto Pereira
- Department of Restorative Dentistry, Piracicaba School of Dentistry, State University of Campinas, Piracicaba, SP, Brazil
| | | | | | - Vicente Ribeiro Netto
- Department of Radiotherapy, Oncology Research Center (CEPON), Florianópolis, SC, Brazil
| | | | - Cleonice da Silveira Teixeira
- Department of Dentistry - Endodontics Division, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Lucas da Fonseca Roberti Garcia
- Department of Dentistry - Endodontics Division, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, SC, Brazil
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4
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de Souza GL, Freitas GAN, Ribeiro MTH, Lemus NXA, Soares CJ, Moura CCG. Effects of different calcium-silicate based materials on fracture resistance of immature permanent teeth with replacement root resorption and osteoclastogenesis. Restor Dent Endod 2023; 48:e21. [PMID: 37284344 PMCID: PMC10240096 DOI: 10.5395/rde.2023.48.e21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/26/2023] [Accepted: 03/26/2023] [Indexed: 06/08/2023] Open
Abstract
Objectives This study evaluated the effects of Biodentine (BD), Bio-C Repair (BCR), and mineral trioxide aggregate (MTA) plug on the fracture resistance of simulated immature teeth with replacement root resorption (RRR) and in vitro-induced osteoclastogenesis. Materials and Methods Sixty bovine incisors simulating immature teeth and RRR were divided into 5 groups: BD and BCR groups, with samples completely filled with the respective materials; MTA group, which utilized a 3-mm apical MTA plug; RRR group, which received no root canal filling; and normal periodontal ligament (PL) group, which had no RRR and no root canal filling. All the teeth underwent cycling loading, and compression strength testing was performed using a universal testing machine. RAW 264.7 macrophages were treated with 1:16 extracts of BD, BCR, and MTA containing receptor activator of nuclear factor-kappa B ligand (RANKL) for 5 days. RANKL-induced osteoclast differentiation was assessed by staining with tartrate-resistant acid phosphatase. The fracture load and osteoclast number were analyzed using 1-way ANOVA and Tukey's test (α = 0.05). Results No significant difference in fracture resistance was observed among the groups (p > 0.05). All materials similarly inhibited osteoclastogenesis (p > 0.05), except for BCR, which led to a lower percentage of osteoclasts than did MTA (p < 0.0001). Conclusions The treatment options for non-vital immature teeth with RRR did not strengthen the teeth and promoted a similar resistance to fractures in all cases. BD, MTA, and BCR showed inhibitory effects on osteoclast differentiation, with BCR yielding improved results compared to the other materials.
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Affiliation(s)
- Gabriela Leite de Souza
- Department of Endodontics, School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil
| | | | - Maria Tereza Hordones Ribeiro
- Department of Operative Dentistry and Dental Materials, School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil
| | | | - Carlos José Soares
- Department of Operative Dentistry and Dental Materials, School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil
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5
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Implications of Post-Traumatic Treatment of Immature Maxillary Incisors. Int Dent J 2023; 73:337-345. [PMID: 36804746 DOI: 10.1016/j.identj.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/15/2023] [Accepted: 01/17/2023] [Indexed: 02/20/2023] Open
Abstract
The aim of this review was to discuss traumatic dental injuries in view of their treatment implications to provide an evidence-based resource for clinicians when planning treatment for traumatised immature maxillary incisors. Dental trauma to immature maxillary incisors can result in various complications, such as critical fractures, resorptions, or ankylosis, and might lead to tooth loss. Traumatised teeth may exhibit various unaesthetic discolourations as a result of different dental trauma sequelae or materials used for treatment. All of the above can influence patients' social experience, including self-esteem, confidence, eating and speaking abilities, as well as proper development and growth of the jaw bones. Treatment of traumatised immature incisors should focus not only on the acute phase but on the long-term consequences. Any time gained with the tooth in the jaw bone, free of infection, is an achievement, as it allows normal growth and development. All these aspects are discussed in this narrative review, and an evidence-based summary resource is suggested for clinicians to use when planning treatment for traumatised immature maxillary incisors.
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Abu Hasna A, de Paula Ramos L, Campos TMB, de Castro Lopes SLP, Rachi MA, de Oliveira LD, Carvalho CAT. Biological and chemical properties of five mineral oxides and of mineral trioxide aggregate repair high plasticity: an in vitro study. Sci Rep 2022; 12:14123. [PMID: 35986029 PMCID: PMC9391469 DOI: 10.1038/s41598-022-17854-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/02/2022] [Indexed: 12/31/2022] Open
Abstract
Calcium silicate-based cements have diverse applications in endodontics. This study aimed to evaluate the antibiofilm action, biocompatibility, morphological structure, chemical composition and radiopacity of Five Mineral Oxides (5MO), Mineral Trioxide Aggregate Repair High Plasticity (MTA Repair HP), and Mineral Trioxide Aggregate (MTA) cements. MTT analysis was used to test the antibiofilm action of these cements against five anaerobic microorganisms, and test their biocompatibility with mouse macrophage (RAW 264.7) and osteoblasts (MG-63) cultures. Their morphological structure and chemical composition were evaluated by scanning electron microscopy (SEM) coupled to energy dispersion X-ray spectroscopy (EDX), and the phase analysis was performed by X-ray diffraction (XRD). Conventional radiography was used to assess the radiopacity of the cements. 5MO, MTA Repair HP and MTA were effective against Porphyromonas gingivalis, Parvimonas micra, Fusobacterium nucleatum and Prevotella intermedia, they were biocompatible with macrophages and osteoblasts after 5 min of contact, and they had adequate radiopacity to be used clinically. Bismuth oxide (Bi2O3) is used as a radiopacifier in MTA and 5MO, and calcium tungstate, in MTA Repair HP. Titanium dioxide (TiO2) (ANATASE) is responsible for the antimicrobial action and biocompatibility of 5MO.
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Affiliation(s)
- Amjad Abu Hasna
- grid.410543.70000 0001 2188 478XDepartment of Restorative Dentistry, Endodontics Division, Institute of Science and Technology, São Paulo State University – UNESP, Av. Eng. Francisco José Longo Avenue 777, São José dos Campos, São Paulo CEP 12245-000 Brazil
| | - Lucas de Paula Ramos
- grid.410543.70000 0001 2188 478XDepartment of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University – UNESP, São José dos Campos, São Paulo Brazil
| | - Tiago Moreira Bastos Campos
- grid.419270.90000 0004 0643 8732Physics Department, Aeronautics Technological Institute (ITA), São José dos Campos, São Paulo Brazil
| | - Sergio Lucio Pereira de Castro Lopes
- grid.410543.70000 0001 2188 478XDepartment of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University – UNESP, São José dos Campos, São Paulo Brazil
| | - Maisour Ala Rachi
- grid.449576.d0000 0004 5895 8692Department of Operative Dentistry, Syrian Private University (S.P.U), Damascus, Syria
| | - Luciane Dias de Oliveira
- grid.410543.70000 0001 2188 478XDepartment of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University – UNESP, São José dos Campos, São Paulo Brazil
| | - Cláudio Antonio Talge Carvalho
- grid.410543.70000 0001 2188 478XDepartment of Restorative Dentistry, Endodontics Division, Institute of Science and Technology, São Paulo State University – UNESP, Av. Eng. Francisco José Longo Avenue 777, São José dos Campos, São Paulo CEP 12245-000 Brazil
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7
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Multifactorial Analysis of Endodontic Microsurgery Using Finite Element Models. J Pers Med 2022; 12:jpm12061012. [PMID: 35743798 PMCID: PMC9224708 DOI: 10.3390/jpm12061012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/17/2022] [Accepted: 06/18/2022] [Indexed: 12/02/2022] Open
Abstract
Background: The present study aimed to classify the relative contributions of four biomechanical factors—the root-end filling material, the apical preparation, the root resection length, and the bone height—on the root stresses of the resected premolar. Methods: A design of experiments approach based on a defined subset of factor combinations was conducted to calculate the influence of each factor and their interactions. Sixteen finite element models were created and analyzed using the von Mises stress criterion. The robustness of the design of experiments was evaluated with nine supplementary models. Results: The current study showed that the factors preparation and bone height had a high influence on root stresses. However, it also revealed that nearly half of the biomechanical impact was missed without considering interactions between factors, particularly between resection and preparation. Conclusions: Design of experiments appears to be a valuable strategy to classify the contributions of biomechanical factors related to endodontics. Imagining all possible interactions and their clinical impact is difficult and can require relying on one’s own experience. This study proposed a statistical method to quantify the mechanical risk when planning apicoectomy. A perspective could be to integrate the equation defined herein in future software to support decision-making.
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8
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Pandolfo MT, Rover G, Bortoluzzi EA, Teixeira CDS, Rossetto HL, Fernades PCDSV, Côrte-Real ISG, Carvalho SMF, Garcia LDFR. Fracture Resistance of Simulated Immature Teeth Reinforced with Different Mineral Aggregate-Based Materials. Braz Dent J 2021; 32:21-31. [PMID: 34755787 DOI: 10.1590/0103-6440202104236] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 07/08/2021] [Indexed: 11/22/2022] Open
Abstract
This study assessed the fracture resistance of simulated immature teeth reinforced with calcium aluminate cement (CAC) or mineral trioxide aggregate (MTA) containing calcium carbonate nanoparticles (nano-CaCO3). The microstructural arrangement of the cements and their chemical constitution were also evaluated. Forty-eight canines simulating immature teeth were distributed into 6 groups (n=8): Negative control - no apical plug or root canal filling; CAC - apical plug with CAC; CAC/nano-CaCO3 - apical plug with CAC+5% nano-CaCO3; MTA - apical plug with MTA; MTA/nano-CaCO3 - apical plug with MTA+5% nano-CaCO3; and Positive control - root canal filling with MTA. The fracture resistance was evaluated in a universal testing machine. Samples of the cements were analyzed under Scanning Electron Microscope (SEM) to determine their microstructural arrangement. Chemical analysis of the cements was performed by Energy Dispersive X-ray Spectroscopy (EDS). The fracture resistance of CAC/nano-CaCO3 was significantly higher than the negative control (p<0.05). There was no significant difference among the other groups (p>0.05). Both cements had a more regular microstructure with the addition of nano-CaCO3. MTA samples had more calcium available in soluble forms than CAC. The addition of nano-CaCO3 to CAC increased the fracture resistance of teeth in comparison with the non-reinforced teeth. The microstructure of both cements containing nano-CaCO3 was similar, with a more homogeneous distribution of lamellar- and prismatic-shaped crystals. MTA had more calcium available in soluble forms than CAC.
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Affiliation(s)
- Mariana Travi Pandolfo
- Department of Dentistry - Endodontics Division, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Gabriela Rover
- Department of Dentistry - Endodontics Division, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Eduardo Antunes Bortoluzzi
- Department of Dentistry - Endodontics Division, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Cleonice da Silveira Teixeira
- Department of Dentistry - Endodontics Division, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | | | | | | | - Sandra Maria Fernandes Carvalho
- CEMMPRE - Centre for Mechanical Engineering, Materials and Processes, University of Coimbra, Coimbra, Portugal.,CF-UM-UP - Centre of Physics of the Universities of Minho and Porto, Guimarães, Portugal
| | - Lucas da Fonseca Roberti Garcia
- Department of Dentistry - Endodontics Division, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, SC, Brazil
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9
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Balkaya H, Topçuoğlu HS, Demirbuga S, Kafdağ Ö, Topçuoğlu G. Effect of different coronal restorations on the fracture resistance of teeth with simulated regenerative endodontic treatment: An in vitro study. AUST ENDOD J 2021; 48:331-337. [PMID: 34596303 DOI: 10.1111/aej.12573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 08/30/2021] [Accepted: 09/23/2021] [Indexed: 11/29/2022]
Abstract
This study investigated the effect of different coronal restorations on the fracture resistance (FR) of immature teeth with simulated regenerative endodontic treatment. A total of 120 lower premolars were divided into eight groups. Except for negative control, the root canals were instrumented with rotary files and Peeso reamers. Fifteen instrumented teeth were acted as positive control (unrestorated). In the remaining 90 teeth, regenerative endodontic treatment procedures were performed. Ninety teeth were randomly divided into 6 groups according to coronal restoration type; Filtek Z550, Filtek Bulk fill Restorative (FBR), SDR+Filtek Z550, EverX+Filtek Z550, Ribbond+FBR and Ribbond+SDR+Filtek Z550. After thermal ageing, the restorated teeth were subjected to vertical loading force. FR values was obtained as follows: Negative control > Ribbond+FBR = Ribbond+SDR+Filtek Z550 > Filtek Z550 = FBR =SDR+Filtek Z550 = EverX+Filtek Z550 > Positive control, (P < 0.05). The use of Ribbond in combination with composite resin enhanced the FR of teeth.
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Affiliation(s)
- Hacer Balkaya
- Department of Restorative Dentistry, Faculty of Dentistry, Erciyes University, Kayseri, Turkey
| | | | - Sezer Demirbuga
- Department of Restorative Dentistry, Faculty of Dentistry, Erciyes University, Kayseri, Turkey
| | - Özgür Kafdağ
- Private Practice in Endodontics, Antalya, Turkey
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10
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Al-Nahlawi T, Ala Rachi M, Abu Hasna A. Endodontic Perforation Closure by Five Mineral Oxides Silicate-Based Cement with/without Collagen Sponge Matrix. Int J Dent 2021; 2021:4683689. [PMID: 34539787 PMCID: PMC8443381 DOI: 10.1155/2021/4683689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 08/26/2021] [Indexed: 02/07/2023] Open
Abstract
Endodontic perforations are common accidents that occasionally happen as a result of misuse or difficult anatomy of some teeth; it may lead to teeth loss unless a good management is provided. Bioceramic (silicate-based) cements like mineral trioxide aggregate have a big role in management of such accidents. This case report aimed to evaluate the ability of five mineral oxides cement "5MO" in sealing two root canal perforations (furcation and postdrill perforations) and inducing clinical and radiographic healing in the periodontal tissues with/without the use of collagen sponge matrix. A 58-year-old healthy female was referred to our dental office complaining of severe pain in the upper left premolars' region. Periapical radiographic examination revealed unsatisfactory root canal treatment of the teeth #24 and #25 with a furcation perforation and a postdrill perforation, respectively. Cone-beam computed tomography "CBCT" scans confirmed the findings of the periapical radiography and revealed the presence of radiolucent lesions surrounding the apex of both teeth #24 and #25. The treatment plan was a nonsurgical root canal retreatment by endodontic access through the full-ceramic crowns. After three years of follow-up, CBCT scans revealed a complete healing and bone formation on both premolars. This case report indicates the use of 5MO cement for endodontic perforations management.
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Affiliation(s)
- Talal Al-Nahlawi
- Operative Dentistry and Endodontics Department, Syrian Private University (S.P.U), Damascus, Syria
| | - Maisour Ala Rachi
- Operative Dentistry and Endodontics Department, Syrian Private University (S.P.U), Damascus, Syria
| | - Amjad Abu Hasna
- Department of Restorative Dentistry, Endodontics Division, Institute of Science and Technology, Sa˜o Paulo State University – UNESP, Sa˜o José Dos Campos, São Paulo, Brazil
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11
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Elnaghy AM, Mandorah A, Hassan AH, Elshazli A, Elsaka S. Effect of surface treatments on push-out bond strength of calcium silicate-based cements to fiber posts. BMC Oral Health 2021; 21:131. [PMID: 33740953 PMCID: PMC7977572 DOI: 10.1186/s12903-021-01518-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the effect of surface treatments on the push-out bond strength of Biodentine (BD) and white mineral trioxide aggregate (WMTA) to fiber posts. METHODS Two brands of fiber posts were used: Reblida post; RP and RelyX post; RX. Each type of post (n = 80/group) was divided into four groups (n = 20/group) and exposed to surface treatment as follows: Control (no treatment), sandblasting (SB), hydrofluoric acid (HF), and TiF4 4 wt/v%. Each group was further subdivided into two subgroups (n = 10/subgroup) based on the type of CSCs used as follows: Subgroup A: BD and Subgroup B: WMTA. Push-out bond strength of BD and WMTA to glass fiber posts was assessed. Data were statistically analyzed using three-way ANOVA and Tukey's test. A Weibull analysis was performed on the push-out bond strength data. RESULTS BD showed higher bond strength than WMTA (P < 0.001). The push-out bond strength for posts treated with TiF4 4 wt/v% showed greater bond strength than the other surface treatments (P < 0.05). The BD/RP-TiF4 4 wt/v% showed the greater characteristic bond strength (σ0) (15.93) compared with the other groups. Surface treatments modified the surface topography of glass fiber posts. CONCLUSIONS The BD/RP-TiF4 4 wt/v% showed greater bond strength compared with the other groups. The TiF4 4 wt/v% surface treatment enhanced the bond strength of BD and WMTA to glass fiber posts than the other treatments. Surface treatment of fiber post with TiF4 4 wt/v% could be used to improve the bond strength with calcium silicate-based cements.
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Affiliation(s)
- Amr M Elnaghy
- Department of Endodontics, Faculty of Dentistry, Mansoura University, Mansoura, 35516, Egypt.
| | - Ayman Mandorah
- Department of Restorative and Dental Materials, Faculty of Dentistry, Taif University P.O Box 11099, Taif, 21944, Saudi Arabia
| | - Ali H Hassan
- Department of Orthodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Restorative Dental Sciences, Vision Colleges, Jeddah, Saudi Arabia
| | - Alaa Elshazli
- Department of Endodontics, Faculty of Dentistry, Mansoura University, Mansoura, 35516, Egypt
| | - Shaymaa Elsaka
- Department of Restorative Dental Sciences, Vision Colleges, Jeddah, Saudi Arabia.,Department of Dental Biomaterials, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
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12
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Gonzalez CS, Estevez R, Loroño G, García VDF, Caballero Montes JA, Rossi-Fedele G, Cisneros R. Etidronic acid and ethylenediaminetetraacetic acid associated with sodium hypochlorite have limited effect on the compressive fracture resistance of roots ex vivo. J Conserv Dent 2021; 23:484-488. [PMID: 33911358 PMCID: PMC8066680 DOI: 10.4103/jcd.jcd_527_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/20/2020] [Accepted: 12/06/2020] [Indexed: 12/04/2022] Open
Abstract
Aims: To assess the effect of etidronic acid (EA) mixed with sodium hypochlorite (NaOCl) and two ethylenediaminetetraacetic acid-containing preparations (EDTA and SmearClear) alternated with NaOCl, as a final rinse, on root fracture resistance to a compressive force. Materials and Methods: Seventy-two premolar roots were randomly allocated to the following groups according to the irrigant solutions. For the EA group, 9% EA + 2.5% NaOCl were used throughout the assays (n = 21). The remaining groups received 2.5% NaOCl during and immediately after chemo-mechanical instrumentation. Intermediately, the roots received 17% EDTA (n = 19), or SmearClear (n = 16), or no irrigation (control) (n = 16) plus a final rinse with 2.5% NaOCl. The specimens were subjected to a vertical compressive force loaded at a crosshead speed of 0.02 mm/s parallel to the long axis of the root until fracture occurred. The results were compared statistically using the one-way analysis of variance for intergroup comparisons. Results: The negative control presented with the highest values, whereas the SmearClear presented with the lowest values, though no significant differences were found when comparing the different groups (P = 0.82). Conclusions: The use of EA + NaOCl or two EDTA formulations in association with NaOCl does not affect the fracture resistance of previously chemo-mechanically prepared roots.
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Affiliation(s)
| | - Roberto Estevez
- Endodontic Unit, Engineering and Design, European University of Madrid, Madrid, Spain
| | - Gaizka Loroño
- Endodontic Unit, Engineering and Design, European University of Madrid, Madrid, Spain
| | | | | | - Giampiero Rossi-Fedele
- Endodontic Unit, Adelaide Dental School, The University of Adelaide, Adelaide, Australia
| | - Rafael Cisneros
- Endodontic Unit, Engineering and Design, European University of Madrid, Madrid, Spain
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Mello I, Michaud PL, Butt Z. Fracture Resistance of Immature Teeth Submitted to Different Endodontic Procedures and Restorative Protocols. J Endod 2020; 46:1465-1469. [PMID: 32615172 DOI: 10.1016/j.joen.2020.06.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/10/2020] [Accepted: 06/19/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The purpose of this in vitro study was to determine whether the methods used to treat endodontically and restore anterior immature teeth with a necrotic pulp influence their resistance to fracture. METHODS After access opening and cleaning and shaping, 80 specimen teeth were assigned into 5 groups according to the endodontic obturation method and coronal restoration as follows: A1, apexification with a composite restoration in the crown area; A2, apexification with a composite restoration in the crown and 3 mm into the root; IR, immediate revascularization with a composite restoration in the crown area; SR, successful revascularization with a composite in the crown area; and the control group, a mature tooth treated with gutta-percha and sealer with a composite restoration in the crown area. The teeth were mounted in acrylic blocks and brought to fracture under compressive forces in a universal testing machine. Both the fracture strength and the location where the fracture occurred were recorded. RESULTS There were no statistically significant differences in the fracture resistance among the 5 groups (1-way analysis of variance, F4 = .545, P = .703). No statistically significant differences were found in the location where the fracture occurred either (χ24 = 4.1, P = .391). CONCLUSIONS Within the limitations of this in vitro study, it can be concluded that the treatment options used to treat nonvital immature teeth provided the same resistance to fracture.
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Affiliation(s)
- Isabel Mello
- Department of Dental Clinical Sciences, Faculty of Dentistry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Pierre-Luc Michaud
- Department of Dental Clinical Sciences, Faculty of Dentistry, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Zahndra Butt
- Department of Dental Clinical Sciences, Faculty of Dentistry, Dalhousie University, Halifax, Nova Scotia, Canada
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Fráter M, Sáry T, Garoushi S. Bioblock technique to treat severe internal resorption with subsequent periapical pathology: a case report. Restor Dent Endod 2020; 45:e43. [PMID: 33294408 PMCID: PMC7691266 DOI: 10.5395/rde.2020.45.e43] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/27/2020] [Accepted: 05/27/2020] [Indexed: 11/25/2022] Open
Abstract
A variety of therapeutic modalities can be used for the endodontic treatment of a traumatized tooth with internal root resorption (IRR). The authors present a case report of the successful restoration of a traumatized upper central incisor that was weakened due to severe IRR and subsequent periapical lesion formation. A 20-year-old female patient was referred to our clinic with severe internal resorption and subsequent periapical pathosis destroying the buccal bone wall. Root canal treatment had been initiated previously at another dental practice, but at that time, the patient's condition could not be managed even with several treatments. After cone-beam computed tomography imaging and proper chemomechanical cleaning, the tooth was managed with a mineral trioxide aggregate plug followed by root canal filling using short fiber-reinforced composite, known as the Bioblock technique. This report is the first documentation of the use of the Bioblock technique in the restoration of a traumatized tooth. The Bioblock technique appears to be ideal for restoring wide irregular root canals, as in cases of severe internal resorption, because it can uniquely fill out the hollow irregularities of the canal. However, further long-term clinical investigations are required to provide additional information about this new technique.
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Affiliation(s)
- Márk Fráter
- Department of Operative and Esthetic Dentistry, University of Szeged Faculty of Dentistry, Szeged, Hungary
| | - Tekla Sáry
- Department of Operative and Esthetic Dentistry, University of Szeged Faculty of Dentistry, Szeged, Hungary
| | - Sufyan Garoushi
- Department of Biomaterials Science and Turku Clinical Biomaterials Center, Institute of Dentistry, University of Turku, Turku, Finland
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15
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Fatigue failure load of immature anterior teeth: influence of different fiber post-core systems. Odontology 2020; 109:222-230. [PMID: 32361786 DOI: 10.1007/s10266-020-00522-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/17/2020] [Indexed: 12/18/2022]
Abstract
The aim was to explore the fracture-behavior, survival and marginal-microgaps within the root-canal of immature anterior teeth restored with different fiber-reinforced post-core composites (FRCs). 180 bovine-incisors were randomly divided into 6 groups (n = 30). One group served as control (group 6). The rest of the teeth were prepared to an internal diameter of 1.6 mm and the apex was sectioned. After application of an MTA-plug, teeth were restored with FRC materials: Group 1: Bioblock technique with short fiber-reinforced composite (SFRC); Group 2: Bioblock technique with flowable SFRC; Group 3: Individually-made FRC post; Group 4: Conventional FRC post; Group 5: dual-cure core build-up composite. After restorations were completed, teeth (n = 5/group) were sectioned and then stained. Specimens were viewed under a stereo microscope and the percentage of microgaps within the root-canal was calculated. Fatigue-survival was measured using a cyclic-loading testing machine in the rest of the specimens. Flowable SFRC application in the root-canal (Group 2) did not differ from intact-teeth regarding fatigue-survival (p > 0.05). The rest of the groups produced significantly lower survival (p < 0.05) compared to intact-teeth. Post/core restorations made from conventional FRC post (Group 4) exhibited a high number of microgaps (38.3%) at the examined interphase in the root-canal. The restoration of immature incisors with the use of flowable SFRC as post-core material displayed promising performance in a matter of fatigue-resistance and survival.
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16
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Songtrakul K, Azarpajouh T, Malek M, Sigurdsson A, Kahler B, Lin LM. Modified Apexification Procedure for Immature Permanent Teeth with a Necrotic Pulp/Apical Periodontitis: A Case Series. J Endod 2019; 46:116-123. [PMID: 31761331 DOI: 10.1016/j.joen.2019.10.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 09/28/2019] [Accepted: 10/09/2019] [Indexed: 12/13/2022]
Abstract
The current American Association of Endodontists clinical considerations for a regenerative endodontic procedure state that a regenerative procedure is suitable for immature permanent teeth with necrotic pulp when the pulp space is not needed for a post/core in the final restoration. Therefore, many immature permanent teeth with necrotic pulp that have sustained a substantial loss of coronal tooth structure either from caries or trauma are treated by apexification or mineral trioxide aggregate/Biodentine (Septodent, Lancaster, PA) apical barrier techniques in which no further root maturation would occur. This case series presents 10 immature permanent teeth with necrotic pulp in which a post/core was likely required in the future for adequate coronal restoration because of loss of substantial coronal tooth structure and a modified apexification procedure was used. All 10 cases after the modified apexification procedure showed no clinical symptoms/signs and showed radiographic evidence of healed/healing of periapical lesion after a 2-year review. Eight cases showed increased thickness of the apical root canal walls, increased apical root length, and apical closure. The overall percentage change in root length was 7.52%, in root width at the apical one third it was 18.89%, and in radiographic root area it was 15.04% at the 24- to 72-month follow-up period. This modified apexification procedure allows for the tooth to be restored with a post/core if required for the final restoration in the future as well as continued root development.
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Affiliation(s)
- Kamolthip Songtrakul
- Department of Endodontics, New York University College of Dentistry, New York, New York
| | - Talayeh Azarpajouh
- Department of Endodontics, New York University College of Dentistry, New York, New York
| | - Matthew Malek
- Department of Endodontics, New York University College of Dentistry, New York, New York
| | - Asgeir Sigurdsson
- Department of Endodontics, New York University College of Dentistry, New York, New York
| | - Bill Kahler
- School of Dentistry, The University of Queensland, Brisbane, Australia
| | - Louis M Lin
- Department of Endodontics, New York University College of Dentistry, New York, New York.
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17
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Danwittayakorn S, Banomyong D, Ongchavalit L, Ngoenwiwatkul Y, Porkaew P. Comparison of the Effects of Intraradicular Materials on the Incidence of Fatal Root Fracture in Immature Teeth Treated with Mineral Trioxide Aggregate Apexification: A Retrospective Study. J Endod 2019; 45:977-984.e1. [PMID: 31248698 DOI: 10.1016/j.joen.2019.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/08/2019] [Accepted: 05/14/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This study aimed to compare the incidence of root fractures that led to extraction in immature teeth endodontically treated by mineral trioxide aggregate (MTA) apexification and were restored with either reinforced (resin composite or fiber post) or nonreinforced (gutta percha or MTA) intraradicular materials. METHODS Necrotic immature teeth treated with MTA apexification from 1996 to 2017 were selected according to the inclusion and exclusion criteria. Intraradicular materials and preoperative and treatment factors were obtained from dental charts and radiographs. The incidence of fatal root facture was identified. Kaplan-Meier survival analysis and the Cox proportional hazard model were used to show the survival rate and predisposing factors at a significance level of .05. RESULTS The average recall period was 30 months. The incidence of root fracture in the teeth restored with the reinforced materials was 5.5%, which was not significantly different from the nonreinforced materials (8.3%). Furthermore, the fracture rates between the fiber post and resin composite groups were not significantly different. Two significant predisposing factors influencing the incidence of root fracture were detected: preoperative external inflammatory root resorption (hazard ratio = 26.86; P < .05) and patient age > 15 years (hazard ratio = 8.60, P < .05). CONCLUSIONS Immature teeth treated with MTA apexification and restored with the reinforced or nonreinforced intraradicular materials exhibited a similar rate of root fracture. Preoperative external inflammatory root resorption and patient age > 15 years were found to be the predisposing factors that significantly increased the incidence of root fracture.
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Affiliation(s)
- Supatra Danwittayakorn
- Department of Operative Dentistry and Endodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Danuchit Banomyong
- Department of Operative Dentistry and Endodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand.
| | - Lalida Ongchavalit
- Department of Operative Dentistry and Endodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Yaowaluk Ngoenwiwatkul
- Department of Community Dentistry, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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18
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Fracture resistance of simulated immature roots using Biodentine and fiber post compared with different canal-filling materials under aging conditions. Clin Oral Investig 2019; 24:1333-1338. [DOI: 10.1007/s00784-019-03014-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/08/2019] [Indexed: 12/27/2022]
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19
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Jamshidi D, Homayouni H, Moradi Majd N, Shahabi S, Arvin A, Ranjbar Omidi B. Impact and Fracture Strength of Simulated Immature Teeth Treated with Mineral Trioxide Aggregate Apical Plug and Fiber Post Versus Revascularization. J Endod 2018; 44:1878-1882. [PMID: 30390973 DOI: 10.1016/j.joen.2018.09.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/08/2018] [Accepted: 09/11/2018] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Immature necrotic teeth are at a high risk of fracture, especially at the cervical region, after treatment. This study aimed to compare the impact and fracture strength of immature permanent teeth treated with revascularization versus a mineral trioxide aggregate (MTA) plug and fiber post. METHODS This in vitro, experimental study was conducted on 160 maxillary central incisors, which were randomly divided into 10 groups. The groups included a fracture (F) and impact (I) negative control group, F and I positive control groups, F and I MTA groups, F and I revascularizing group, and F and I revascularized groups. Fracture strength was measured using a universal testing machine with a crosshead speed of 1 mm/min. Other tooth samples were then subjected to the Charpy impact test for impact strength measurements, and the amount of energy absorbed by the teeth was determined. Data were analyzed using the Kolmogorov-Smirnov test, analysis of variance, and the Tukey test. RESULTS The mean load to fracture of the negative, positive, MTA, revacularizing, and revascularized groups was 1931.8, 1350.1, 1003.8, 1262.5, and 1100.2 N, respectively, and the mean impact strength was 5.04, 3.6, 3.68, 3.16, and 3.65 J, respectively. The fracture and impact strength of the negative control group was significantly higher than that of the other groups (P < .05), but the other groups were not significantly different in this respect (P > .05). CONCLUSIONS Despite the limitations of this study, the results showed that none of the tested modalities could significantly increase the impact and fracture strength of simulated immature teeth.
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Affiliation(s)
- Davoud Jamshidi
- Department of Endodontics, Dental Caries Prevention Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Hamed Homayouni
- Department of Endodontics, Faculty of Dentistry, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Nima Moradi Majd
- Dental Research Laboratory, Howard University College of Dentistry, Washington, DC
| | - Samaneh Shahabi
- Department of Endodontics, Faculty of Dentistry, Qazvin University of Medical Sciences, Qazvin, Iran.
| | - Armita Arvin
- Department of Endodontics, Faculty of Dentistry, Alborz University of Medical Sciences, Alborz, Iran.
| | - Baharan Ranjbar Omidi
- Department of Operative Dentistry, Faculty of Dentistry, Qazvin University of Medical Sciences, Qazvin, Iran
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20
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Ayrancı F, Ayrancı LB, Özdoğan A, Özkan S, Peker MÖ, Aras MH. Resistance to vertical root fracture of apicoected teeth using different devices during two root canal irrigation procedures. Lasers Med Sci 2018; 33:1685-1691. [DOI: 10.1007/s10103-018-2517-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 04/18/2018] [Indexed: 11/25/2022]
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21
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Aktemur Türker S, Uzunoğlu E, Deniz Sungur D, Tek V. Fracture Resistance of Teeth with Simulated Perforating Internal Resorption Cavities Repaired with Different Calcium Silicate-based Cements and Backfilling Materials. J Endod 2018; 44:860-863. [PMID: 29550008 DOI: 10.1016/j.joen.2018.01.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 01/11/2018] [Accepted: 01/31/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION This study assessed the fracture resistance (FR) of teeth with simulated perforating internal resorption cavities repaired with different calcium silicate-based cements (CSCs) and backfilling materials. METHODS Ninety-six mandibular premolar teeth were used. Twelve of the teeth were assigned as negative control group. Remaining roots were instrumented with rotary files, and standardized internal resorption cavities were prepared on the middle half of roots with burs. Twelve of the samples were not further interfered and were assigned as a positive control group. The apical 4 mm of the remaining 72 root canals was obturated with single-cone technique and divided into 6 groups according to CSCs used for repairing of cavities and backfilling materials as follows: MTA + MTA, MTA + gutta-percha/sealer, Biodentine + Biodentine, Biodentine + gutta-percha/sealer, MTA Plus + MTA Plus, and MTA Plus + gutta-percha/sealer. Specimens were embedded in acrylic resin and then subjected to fracture testing. The forces when the fracture occurred were analyzed with analysis of variance and Bonferroni tests at P = .05. RESULTS No significant difference was found among CSCs irrespective of backfilling materials (P > .05). Groups MTA + gutta-percha/sealer, Biodentine + gutta-percha/sealer, and MTA Plus + gutta-percha/sealer showed significantly lower FR compared with groups MTA + MTA, Biodentine + Biodentine, and MTA Plus + MTA Plus, respectively (P < .05). The highest FR was observed in group Biodentine + Biodentine, and the lowest was in group MTA Plus + gutta-percha/sealer. FR of positive control group was statistically lower than groups completely filled with CSCs (P < .05), whereas FR of negative control group was statistically higher than the groups combined with gutta-percha and sealer (P < .05). CONCLUSIONS The backfilling with CSCs may be a preferable material rather than gutta-percha/sealer combination for the roots with perforated internal resorptions.
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Affiliation(s)
- Sevinç Aktemur Türker
- Bülent Ecevit University, Faculty of Dentistry, Department of Endodontics, Zonguldak, Turkey.
| | - Emel Uzunoğlu
- Hacettepe University, Faculty of Dentistry, Department of Endodontics, Ankara, Turkey
| | - Derya Deniz Sungur
- Hacettepe University, Faculty of Dentistry, Department of Endodontics, Ankara, Turkey
| | - Vildan Tek
- Bülent Ecevit University, Faculty of Dentistry, Department of Endodontics, Zonguldak, Turkey
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