Chronic maxillary sinusitis caused by root canal overfilling of Calcipex II

Synergistic effects of reduced graphene oxide on the antibacterial activity of calcium hydroxide-based intracanal medicaments containing different vehicles

PURPOSE

This study investigated the synergistic effects of reduced graphene oxide (RGO) on the antibacterial activity of three calcium hydroxide-based intracanal medicaments with different vehicles.

METHODS

Multispecies biofilms were cultured in a bovine root canal model. Intracanal medicaments containing nonaqueous vehicles, including N-methyl-2-pyrrolidone (NMP; CleaniCal), propylene glycol (PG; UltraCal XS), and polyethylene glycol (PEG; Calcipex II), were placed in the model. The synergistic effects of RGO were evaluated by analyzing colony-forming units, extracellular deoxyribonucleic acid (eDNA) levels, and findings from confocal laser-scanning microscopy (CLSM) and scanning electron microscopy. To evaluate the cytotoxicity of each vehicle, a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay was performed. To determine whether RGO altered the physicochemical properties of the medicaments, flowability and pH were measured. A P-value of <0.05 was considered to indicate statistical significance.

RESULTS

In the CleaniCal group, bacterial viability, eDNA levels, and extracellular polymeric substrate (EPS) were significantly lower in the presence of RGO. However, only bacterial viability significantly differed in the other groups. PEG resulted in the highest cell viability among the vehicles. Furthermore, there was no significant difference in flowability or pH in relation to the inclusion of RGO.

CONCLUSION

The results suggest that RGO enhances the antibacterial effect of intracanal medicaments containing NMP.

Rheological properties and handling characteristics of four injectable calcium hydroxide pastes

The aim of this study was to investigate the rheological properties and handling characteristics of four brands of injectable calcium hydroxide pastes (Calcipex II, CleaniCal, DiaPaste, Well-Paste). Shear viscosity was measured with a rotational rheometer. A universal mechanics analyzer assembled in the laboratory was used to quantify the force for extrusion and extruded weight of the materials. The apical pressure during injection into an artificial root canal was measured using a pressure sensor. All materials exhibited pseudoplastic behavior. The force for extrusion was highest for DiaPaste, and lowest for CleaniCal, while the extruded weight was lowest for DiaPaste and highest for CleaniCal (p<0.05), indicating a need for caution when using CleaniCal. However, the pressure generated at the apex may vary depending on the shape, and taper of the needle tip, as well as the viscosity of the materials.

Assessing the efficacy of jet dispenser versus direct syringe injection for calcium hydroxide paste placement in artificial root canals

This study aimed to evaluate the efficacy of a novel jet dispenser (JD) for filling simulated straight and curved canals with calcium hydroxide (Ca(OH)2) paste by comparing the level of intracanal medicament with traditional direct syringe delivery. The Ca(OH)2 paste was delivered into the canals using either a direct syringe with binding tip and unbinding tip or a JD. The analysis of the ratio of the canal filled area (RCFA) in the coronal, middle, and apical thirds was conducted using the Kruskal-Wallis and Mann-Whitney U tests (α = 0.05). The JD resulted in a significantly higher RCFA of 1.00 in the middle and apical thirds in both the straight and curved canals than the direct syringe method (p < 0.001). Voids were frequently observed in the direct syringe group, whereas JD showed no voids within the filled area. In the direct syringe groups, the apical area was more readily filled in both canal types when the tip was bound (p < 0.001). The JD was found to be more effective in filling the entire canal space than the binding and unbinding conditions of the direct injection method, particularly in the apical area.

Removal of Calcium Hydroxide Paste Leaked Into the Maxillary Sinus

Calcium hydroxide is a widely used endodontic medicament with antibacterial activity. When excessive pressure is applied during injection of calcium hydroxide paste or apical perforation occurs, calcium hydroxide can leak into the maxillary sinus and is adsorbed onto the sinus membrane. Although a leakage of calcium hydroxide may not usually cause clinical symptoms, when a large amount of leakage occurs, it can cause degeneration of adjacent tissue and functional disorder, requiring immediate surgical removal. However, due to adsorption to the sinus membrane, calcium hydroxide leaked into the maxillary sinus is difficult to remove completely. Here, we describe the case of a 47-year-old patient in whom a large amount of calcium hydroxide leaked into the maxillary sinus and was successfully removed using modified endoscopic-assisted sinus surgery, and favorable bone regeneration and sinus membrane regeneration were achieved. In addition, histological and ultrastructural changes of the membrane resulted from the calcium hydroxide were presented.

Maxillary antroliths detected by cone-beam computed tomography in an adult dental population

PURPOSE

This study evaluated the prevalence and characteristics of maxillary antroliths using cone-beam computed tomography (CBCT) scans performed for maxillofacial diagnostic purposes.

MATERIALS AND METHODS

CBCT scans of 13,946 patients over the age of 20 were reviewed for maxillary antroliths, and prevalence according to sex, age, and the side of the jaw was calculated. The relationships of single or multiple antroliths with sex, side, and the degree of sinus inflammation were evaluated. The shape and dimension of antroliths were also assessed. The data were analyzed using descriptive statistics, the chi-square or Fisher exact tests, and Kendall's tau-b.

RESULTS

A total of 138 (0.99%) of the 13,946 patients showed an antrolith in at least 1 sinus. Only 18 patients presented a bilateral manifestation, which brought the total number of sinuses containing an antrolith to 156 (0.56%). Multiple antroliths were observed in 36 sinuses, and the total number of antroliths was 207: 110 punctate, 65 linear, and 32 amorphous. The antrolith dimensions varied from 1 mm2 to 91 mm2 (average, 10.2±15.5 mm2). No statistically significant differences were found according to sex, side, and age group (P>0.05). However, there was a statistically significant difference between the multiplicity of antrolith and the degree of sinus inflammation (P<0.05).

CONCLUSION

Cone-beam computed tomography is an effective modality for the detection of incidental antroliths. Maxillary antroliths were found to be very rare and were usually asymptomatic. Dentists should have a comprehensive understanding of their diagnosis and treatment in light of possible associated dental problems.

Influence of the Maxillary Sinus on the Accuracy of the Root ZX Apex Locator: An Ex Vivo Study

This study evaluated the accuracy of the Root ZX (J. Morita, Tokyo, Japan) electronic apex locator in determining the working length when palatal maxillary molar roots are in a relationship with the sinus. Seventeen human maxillary molars with vital pulp were scheduled for an extraction and implant placement as part of a periodontal treatment plan. The access cavity was prepared, and a #10 K file (Dentsply Maillefer, Ballaigues, Switzerland) was inserted into the palatal root using the Root ZX apex locator in order to determine the electronic working length (EWL); then, the teeth were extracted. To determine the real working length (RWL), a #10 K file was introduced into the root canal until its tip touched a glass plate. EWL and RWL were compared. Images reconstructed with CBCT (cone beam computerized tomography) revealed that eight palatal roots were related to the maxillary sinus, whereas nine were not. The results showed a significant difference between the EWL and the RWL of the palatal roots related to the sinus (p < 0.001). No significant difference was observed in measurements of roots not in contact with the sinus (p > 0.05). Within the study limitations, the reliability of Root ZX was influenced by the relationship of the roots with the maxillary sinus.

Removal efficacy and cytotoxicity of a calcium hydroxide paste using N-2-methyl-pyrrolidone as a vehicle

Objectives

This study investigated the removal efficacy and cytotoxicity of a newly developed calcium hydroxide paste (cleaniCal, Maruchi) using N-2-methyl-pyrrolidone (NMP) as a vehicle in comparison with ApexCal (Ivoclar Vivadent) and Calcipex II (Nishika), which use different vehicles such as polyethylene glycol and propylene glycol, respectively.

Materials and Methods

Thirty maxillary premolars with oval-shaped canals were divided into 3 groups and the teeth were filled with one of the pastes. After removal of the paste, micro-computed tomographic (μ-CT) imaging was obtained to assess the volume of residual paste in the root canal of each tooth. The teeth were then split longitudinally and the area of the paste-coated surface was evaluated by stereomicroscopy. The cytotoxicity of each product was assessed using an agar overlay assay. The effect of each vehicle on cell viability was evaluated using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. The data were analyzed using one-way analysis of variance and Tukey's tests to detect any significance (p < 0.05).

Results

In the μ-CT and stereomicroscopic analysis, cleaniCal exhibited less remnants of medicament than ApexCal and Calcipex. cleaniCal showed a higher cytotoxicity than the other pastes in the agar overlay assay. Furthermore, NMP exhibited lower cell viability compared to the other vehicles.

Conclusions

cleaniCal showed better removal efficacy compared to the other products. However, clinicians should be aware of the higher cytotoxicity of the NMP-based material and consider its possible adverse effects on periradicular tissue when it is overfilled.

Maxillary Sinus Impaction of a Core Carrier Causing Sustained Apical Periodontitis, Sinusitis, and Nasal Stenosis: A 3-year Follow-up

INTRODUCTION

The aim was to present a case report of a full-length extrusion of an obturator's core carrier into the maxillary sinus, causing clinical symptoms from the nose region with differential diagnostics aspects, which, in turn, led to several surgical treatments of the nostrils before diagnosis and correct endodontic retreatment of a maxillary right first molar. A 36-year-old man presented in 2012 with complaints from the right nostril region. Medical treatment with antibiotics and surgical procedures because of nasal stenosis resulted only in partial improvement. Five years earlier, a root canal treatment was performed on the maxillary right first molar. Intraoral radiographs revealed 10-mm overfilling of root filling material into the maxillary sinus from the palatal root of tooth #3.

METHODS

Before surgical removal of the excess root filling material, orthograde revision was performed. Cone-beam computed tomographic imaging was used to localize the position of the root filling material, which protruded through the maxillary sinus and reached the inferior nasal wall.

RESULTS

Surgical removal from the palatal aspect revealed that the root filling material was a core carrier of an obturator. Scanning electron microscopy and transmission electron microscopy showed evidence of microbial biofilm on the core carrier as well as remnants of sinus mucosa. At the long-term follow-ups, the tooth had healed apically, and symptoms of nasal stenosis were markedly reduced.

CONCLUSIONS

This case report represents a challenging differential diagnostic topic urging the importance of a medical and dental interdisciplinary dialogue. The use of cone-beam computed tomographic imaging was crucial for the surgical retreatment.

Proximity of Posterior Teeth to the Maxillary Sinus and Buccal Bone Thickness: A Biometric Assessment Using Cone-beam Computed Tomography

INTRODUCTION

The aims of this study were to evaluate the vertical and horizontal relationships between the maxillary sinus floor (MSF) and the root apices of maxillary posterior teeth with various root configurations and the distance from the root apex to the MSF and the buccal cortical plate.

METHODS

Serial axial, coronal, sagittal, and paraxial cone-beam computed tomographic images of 132 Korean patients with fully erupted bilateral maxillary posterior teeth were analyzed. The vertical and horizontal relationships between the roots of maxillary posterior teeth and the MSF were determined. Distances from the apex to the MSF and the buccal bone plate were measured. The data were correlated with age, sex, side, and tooth type.

RESULTS

In total, 2159 apices in 1056 teeth were evaluated. For the vertical relationships, the frequency in group 1, in which a root apex protruded into the MSF, significantly increased toward the posterior (first premolars: 1.5%, second premolars: 14.8%, first molars: 40.5%, second molars: 44.7%, P < .001). The apices of the mesiobuccal roots of the second molars were found frequently in group 1 (35.8%) and had the shortest mean vertical distance to the MSF (0.18 mm) and the thickest mean horizontal distance to the buccal cortical plate (4.99 mm) among buccal roots of 3-rooted molars (P < .001). The frequency of group 1 differed significantly by age (P < .05). No statistically significant difference was found in sex or side analysis. For the horizontal relationship between the molar roots and the MSF, most teeth were in group BP, in which the lowest point of the MSF was located centrally, relative to the roots (94.3% for first molars, 81.0% for second molars). For the first molars, no significant difference according to sex or side was found. However, the right side (P = .003) and males (P = .005) showed higher incidences for second molars.

CONCLUSIONS

The data in this study highlight the close proximity between the root apex of maxillary posterior teeth and the MSF and provide estimated distances from the root apex to the buccal cortical plate. Special care must be taken in treatment planning in the maxillary posterior region.