Successful Non-Surgical Root Canal Treatment on Auto-Transplanted Maxillary Premolar with Apical Periodontitis

Auto-transplantation is a procedure that replaces traumatized or congenitally missing teeth. While most auto-transplanted teeth are successfully integrated into recipient sites, the donor tooth may develop apical periodontitis, causing early failure. In the present case report, the periodontic resident performed the procedure on a 15-year-old male by selecting donor teeth #4 and #13 and transplanting them at recipient sites #29 and #20, respectively. After 6 weeks, the patient was referred to the endodontic resident for evaluation of tooth #20 due to symptom development. While one auto-transplanted tooth (donor tooth #4, recipient site #29) was successfully integrated, the other (donor tooth #13, recipient site #20) was unsuccessful: the patient was diagnosed with pulp necrosis and a chronic apical abscess. Because of the patient's age, collaboration among periodontic, endodontic, and orthodontic residents/specialists informed the clinical decision to pursue non-surgical root canal treatment (NSRCT) rather than extraction. The canal was cleaned and shaped to a size #80 using copious irrigation of 2.5% sodium hypochlorite (NaOCl), followed by 17% ethylenediaminetetraacetic acid (EDTA) via the EndoVac Negative Pressure Irrigation system. The tooth was dried with paper points, and then calcium hydroxide was mixed with 2.5% NaOCl and placed with an amalgam carrier 2 mm from the radiographic apex. The tooth was next temporized with Teflon tape and Fuji TRIAGE. Four weeks later, after confirming the patient was asymptomatic and tooth mobility had decreased, the canal was obturated using EndoSequence Bioceramic Root Repair Material Fast Set Putty in 2 mm incremental layers to achieve a three-dimensional fill and create an apical plug to prevent gutta-percha extrusion, then backfilled in incremental layers of gutta-percha to the cementoenamel junction (CEJ). At the 8-month follow-up, the patient was asymptomatic, and the periodontal ligament (PDL) had no signs of periapical pathology. When teeth undergoing auto-transplantation procedures develop apical periodontitis, NSRCT can be implemented.

Use of micro-CT to examine effects of heat on coronal obturation

PURPOSE

The aim of this study was to categorize the effects of heat on coronal obturation with gutta-percha and sealer using X-ray micro-computed tomography (micro-CT).

METHODS

Ten single-rooted, extracted human teeth were shaped using ProTaper NEXT files to size X5 (#50/Taper 6%) with 2.5% NaOCl irrigation. A single ProTaper NEXT X5 gutta-percha point was then inserted with epoxy resin (AH Plus) or tricalcium silicate (EndoSequence BC) sealer (n = 5/group), and cut at the cemento-enamel junction. The teeth were scanned using micro-CT (SkyScan1272) to obtain 11 sagittal 2-D images. Three calibrated raters categorized the coronal 0.5 mm of the images into four categories: "swirled sealer and/or gutta-percha without voids" (I), "uniform voids and sealer/gutta-percha" (II), "non-uniform voids and sealer/gutta-percha" (III), and "swirled sealer and/or gutta-percha with voids" (IV). Intra-rater and inter-rater reliability were then calculated. Chi-square tests were conducted to determine the significance of differences in each category between sealers.

RESULTS

The intra-class correlation coefficient was 0.55 (same rater/two different times) and Fleiss' kappa (different raters/same image) was 0.34. Categories I, II, III, and IV accounted for 16.4%, 4.2%, 30.3%, and 49.1% for AH Plus, and 6.7%, 4.2%, 27.3%, and 61.8% for EndoSequence BC, respectively.

CONCLUSION

Category IV was most common and Category II the least common. Significant differences were evident between sealers for Category I (P < 0.01).

Coronal and apical leakage among five endodontic sealers

PURPOSE

The aim of this study was to use dye penetration to measure apical and coronal leakage simultaneously in single-canal teeth that had been treated endodontically using a single-cone obturation technique.

METHODS

One hundred single-canal, extracted human teeth were cleaned and shaped with ProTaper NEXT rotary files to size-X5 (50/.06), then randomly assigned to five sealer groups for single-cone gutta-percha obturation. The teeth were soaked in 0.6% rhodamine B at 37°C for seven days, then the roots were ground mesiodistally and the maximum apical and coronal dye penetration was measured. Differences in leakage among the sealer groups were examined using the Kruskal-Wallis test. Pairwise comparisons were made using the Mann-Whitney test with Bonferroni correction.

RESULTS

The mean values (mm) of dye penetration for AH Plus, Pulp Canal Sealer, NeoSEALER Flo, EndoSequence BC, and Super-Bond RC Sealer were 0.200, 0.300, 0.675, 0.850, and 0.900 apically, whereas 1.675, 2.075, 4.800, 6.500, and 4.125 coronally. Pairwise comparisons showed significant apical differences between AH Plus/Super-Bond RC Sealer (P = 0.047) and significant coronal differences between AH Plus/NeoSEALER Flo (P = 0.001), AH Plus/EndoSequence BC (P < 0.01), AH Plus/Super-Bond RC Sealer (P < 0.01), Pulp Canal Sealer/NeoSEALER Flo (P = 0.010), Pulp Canal Sealer/EndoSequence BC (P < 0.01), and Pulp Canal Sealer/Super-Bond RC Sealer (P < 0.01).

CONCLUSION

Coronal leakage was worse than apical leakage for all sealers. AH Plus exhibited the least leakage apically and coronally; Super-Bond RC Sealer showed the most leakage apically, and EndoSequence BC showed the most leakage coronally.

Effects of heat on seven endodontic sealers

PURPOSE

To examine the microscopic surface features, chemical composition, and thermodynamic profile of seven endodontic sealers (AH Plus, Adseal, MTA-Fillapex, RoekoSeal, GuttaFlow 2, GuttaFlow BioSeal, and EndoRez) exposed to high-temperature changes using an endodontic obturation device.

METHODS

The thermal properties were examined using scanning calorimetry (DSC) and thermogravimetric analysis (TGA). Then, six disc-shaped specimens of each sealer were prepared and divided into two groups - a room temperature group and a heat exposure group - for analysis of surface and chemical changes using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS).

RESULTS

DSC analysis showed that AH Plus had the highest exothermal signal (122.9°C), while TGA analysis showed that MTA-Fillapex was most affected by increased temperature (32.4% mass loss at 230ºC). SEM analysis showed that while AH Plus and GuttaFlow BioSeal maintained their surface integrity after heat exposure, the EDS profiles demonstrated changes in the chemical composition of the sealers after heat exposure for 5 s. High-temperature exposure had a negative impact on the properties of five of the sealers (Adseal, MTA-Fillapex, RoekoSeal, GuttaFlow 2, and EndoRez).

CONCLUSION

AH Plus and GuttaFlow BioSeal showed minimal changes upon high-temperature exposure, suggesting their suitability for thermal endodontic obturation techniques.

Micro CT pilot evaluation of removability of two endodontic sealers

PURPOSE

This study compared the removability of AH Plus and EndoSequence BC sealers using in vitro micro-computed tomography.

METHODS

Ten single-canal, extracted human teeth were cleaned and shaped with ProTaper NEXT rotary files to size X5 (50/0.06) (Dentsply-Sirona). Canals were obturated with a single cone gutta-percha and either AH Plus (Dentsply-Sirona) (Group A) or EndoSequence BC (Brasseler) (Group B). ProTaper Universal Retreatment files (Dentsply-Sirona) were used to remove obturation materials after 90 days at 37^oC/100% humidity. Each tooth was scanned using micro-computed tomography (SkyScan 1272; Bruker) at an isotropic resolution of 6 μm from which the percent of material removed was calculated. Two-sample t-tests and one-way ANOVA were used for analysis.

RESULTS

The percent removal of materials in the coronal third was 92.9% ± 7.3% (Group A) and 93.2% ± 6.1% (Group B). Removal in the middle third was 94.9% ± 8.5% (Group A) and 96.5% ± 6.1% (Group B). Apical third removal was 76.2% ± 27.9% (Group A) and 70.1% ± 30.8% (Group B). No statistically significant differences were determined between the two sealers or among the sectional thirds within each group (P > 0.05).

CONCLUSION

AH Plus and EndoSequence BC sealers exhibit the same removability at all canal levels of 70% to 96%, with better removal coronally.

Micro-computed tomographic evaluation of single-cone obturation with three sealers

Objectives

This study used micro-computed tomography (µCT) to compare voids and interfaces in single-cone obturation among AH Plus, EndoSequence BC, and prototype surface pre-reacted glass ionomer (S-PRG) sealers and to determine the percentage of sealer contact at the dentin and gutta-percha (GP) interfaces.

Materials and Methods

Fifteen single-rooted human teeth were shaped using ProTaper NEXT size X5 rotary files using 2.5% NaOCl irrigation. Roots were obturated with a single-cone ProTaper NEXT GP point X5 with AH Plus, EndoSequence BC, or prototype S-PRG sealer (n = 5/group).

Results

The volumes of GP, sealer, and voids were measured in the region of 0–2, 2–4, 4–6, and 6–8 mm from the apex, using image analysis of sagittal µCT scans. GP volume percentages were: AH Plus (75.5%), EndoSequence BC (87.3%), and prototype S-PRG (94.4%). Sealer volume percentages were less: AH Plus (14.3%), EndoSequence BC (6.8%), and prototype S-PRG (4.6%). Void percentages were AH Plus (10.1%), EndoSequence BC (5.9%), and prototype S-PRG (1.0%). Dentin-sealer contact ratios of AH Plus, EndoSequence BC, and prototype S-PRG groups were 82.4% ± 6.8%, 71.6% ± 25.3%, and 70.2% ± 9.4%, respectively. GP-sealer contact ratios of AH Plus, EndoSequence BC, and prototype S-PRG groups were 65.6% ± 29.1%, 80.7% ± 25.8%, and 87.0% ± 8.6%, respectively.

Conclusions

Prototype S-PRG sealer created a low-void obturation, similar to EndoSequence BC sealer with similar dentin-sealer contact (> 70%) and GP-sealer contact (> 80%). Prototype S-PRG sealer presented comparable filling quality to EndoSequence BC sealer.

Ion Release From Prototype Surface Pre-Reacted Glass Ionomer (S-PRG) Sealer and EndoSequence BC Sealer

OBJECTIVE

Bioactive ions, when incorporated in an endodontic sealer, can contribute to the long-term success of endodontic therapy by combating the re-infection of a tooth and promoting the healing of the periapical bone. The objective of this study was to measure the release of boron, strontium, and silicon ions from surface pre-reacted glass ionomer (S-PRG) filler containing prototype endodontic sealer over a sustained period in comparison to EndoSequence BC sealer in a simulated clinical model using extracted human teeth in vitro.

METHODS

Twelve extracted human anterior teeth were instrumented using ProTaper Next (Dentsply Sirona, Johnson City, TN, USA) files up to size X3 (#30/variable taper) with copious 2.5% NaOCl irrigation. Teeth were obturated using a single-cone technique with a matching size tapered gutta-percha point and one of two endodontic sealers: prototype S-PRG (Shofu Inc., Kyoto, Japan) or EndoSequence BC (Brasseler, Savannah, GA, USA). The teeth were soaked in phosphate-buffered saline (PBS) solution for 336 hours. Periodically, 1-mL samples of the PBS were analyzed via an inductively coupled plasma mass spectrometer to determine the concentrations of ions released by the sealers.

RESULTS

The average (S.D.) cumulative release (ng/ml) of boron, silicon, and strontium ions over 2 weeks for the prototype S-PRG sealer was 8614.9 (1264.3), 35758.9 (5986.5), and 3965.2 (145.6), and for EndoSequence BC sealer was 1860.5 (82.7), 164648.7 (16468.1), and 227.7 (4.7). Generalized linear mixed model analysis showed significant differences in ion concentration among boron, silicon, and strontium over time between the two sealer groups (Boron: P<0.0001, Silicon: P=0.010, Strontium: P=0.028). Of the three ions, strontium had the lowest amount of release for both sealers. The prototype S-PRG sealer showed a rapid initial burst followed by a slow, continuous release of strontium ions.

CONCLUSION

The prototype S-PRG sealer released boron and strontium ions in higher cumulative concentrations over 2 weeks compared to the EndoSequence BC sealer. Both the prototype S-PRG and EndoSequence BC sealers released silicon ions, although significantly more were eluted from the EndoSequence BC sealer. Antimicrobial and osteogenic ion release from sealers is expected to positively influence the post-treatment control of microbial infections to improve periapical healing.

Positive influence of a dental anaesthesia simulation model on the perception of learning by Mexican dental students

INTRODUCTION

This study evaluated the influence of three-repetition training with a dental anaesthesia simulation model (DASM) on the perception of learning by dental students.

MATERIALS AND METHODS

Dental students who had never used a dental anaesthesia technique were randomly divided into two groups that were taught the anterior superior alveolar nerve infiltrative anaesthesia technique. Group 1 (G1; N = 10) followed a three-stage learning method: (i) theoretical lecture, (ii) clinical demonstration and (iii) DASM training, including three repetitions of the anaesthesia technique. Group 2 (G2; N = 10) followed only the 1st and 2nd stages. The students in both groups then performed the anaesthesia technique. The perception of the students was evaluated by four learning concepts. Each was evaluated with a 5-point Likert scale questionnaire. The average score of each item of the questionnaire for G1 was compared with that of G2. Statistically significant differences were identified with the Mann-Whitney test. The average working time of each group was timed and compared by Student's t-test to identify possible statistically significant differences.

RESULTS

Students in G1 showed higher average scores of perception in controlling the handling of the dental syringe and confidence in performing the injection (P < 0.05) and showed an average working time shorter than that of the students in G2 (P < 0.05).

CONCLUSION

The DASM positively influenced the perception learning of the dental students; it increased their confidence and syringe handling ability, as well as skills to perform the injection of anaesthesia more quickly.

Current status of direct pulp-capping materials for permanent teeth

Direct pulp-capping is a method for treating exposed vital pulp with dental material to facilitate the formation of reparative dentin and to maintain vital pulp. Two types of pulp-capping materials, calcium hydroxide and mineral trioxide aggregate, have been most commonly used in clinics, and an adhesive resin has been considered a promising capping material. However, until now, there has been no comprehensive review of these materials. Therefore, in this paper, the composition, working mechanisms and clinical outcome of these types of pulp-capping materials are reviewed.

Comparison of apical centring ability between incisal-shifted access and traditional lingual access for maxillary anterior teeth

The aim of this study was to compare the apical centring ability of incisal-shifted access (ISA) with that of traditional lingual access (TLA). Fifteen three-dimensional printed resin models were prepared from the computed tomography data for a human maxillary central incisor and divided into ISA (n = 7), TLA (n = 7) and control (n = 1) groups. After access preparation, these models were shaped to the working length using K-files up to #40, followed by step-back procedures. An apical portion of the model was removed at 0.5 mm coronal to the working length. Microscopic images of each cutting surface were taken to measure the preparation area and the distance of transportation. TLA created a larger preparation area than ISA (P < 0.05). The distance of transportation (mean ± standard deviation) was 0.4 ± 0.1 mm for ISA and 0.7 ± 0.1 mm for TLA (P < 0.05). Access cavity preparation has a significant effect on apical centring ability. ISA is beneficial to maintaining apical configuration.

The effect of education on oral health students' attitudes in Australia and New Zealand

Objective:

The aim of this study was to evaluate the oral health attitudes and behavior of students in the oral health curriculum in Australia and New Zealand.

Materials and Methods:

The Hiroshima University - Dental Behavioral Inventory was administered to students in the first (year 1) and final years (year 3) of the oral health curriculum at Charles Sturt University in Australia and the University of Otago in New Zealand. A total of fifty-two year 1 students and forty-five year 3 students completed English version of the questionnaire in 2013. The responses were statistically analyzed by Fisher's exact tests and exact logistic regression models.

Results:

The responses of students in years 1 and 3 differed significantly for “I worry about the color of my teeth” at Charles Sturt University and at the University Otago, for “I think my teeth are getting worse despite my daily brushing,” “I put off going to the dentist until I have a toothache,” and “I don't feel I've brushed well unless I brush with strong strokes.” The estimated odds ratios from the exact logistic regression models showed that year 1 students were more likely to agree with above-mentioned four questions.

Conclusions:

Oral Health students who had been educated in a 3-year oral health curriculum in Australia and New Zealand had more positive attitudes and behaviors related oral health than did students at the beginning of their curriculum.

Influence of powder composition and morphology on penetration of Gray and White ProRoot mineral trioxide aggregate and calcium hydroxide into dentin tubules

This study examined the influence of powder composition and morphology on the penetration of Gray and White ProRoot mineral trioxide aggregate (GMTA, WMTA) and calcium hydroxide (CH) into open dentin tubules. GMTA, WMTA, and CH particle dimensions were analyzed by flow particle image analysis (FPIA). Penetration of open dentin tubules into dentin discs was studied by scanning electron microscopy. Five samples of each material were randomly selected and prepared for this study. The GMTA averages for length (μm), width (μm), perimeter (μm), and aspect ratio were 1.94 ± 1.65, 1.43 ± 1.19, 5.61 ± 4.27, and 0.76 ± 0.14, respectively. Corresponding averages for WMTA were 2.04 ± 1.87, 1.49 ± 1.33, 5.88 ± 4.81, and 0.76 ± 0.14, and for CH were 2.26 ± 1.99, 1.62 ± 1.46, 6.70 ± 5.60, and 0.74 ± 0.15, respectively. The rank order of the averages for particle length, width and perimeter from the largest to the smallest material was CH > WMTA > GMTA. The rank order of the averaged aspect ratios was GMTA > WMTA > CH. SEM showed that all three materials, when deposited and agitated on dentin discs, penetrated the open dentin tubules. Tubule occlusion occurred as particle surface concentrations increased. Significant differences in particle length, width, perimeter, and aspect ratio were observed for GMTA, WMTA, and CH (P < 0.0001 in all cases). All particle types penetrated into open tubules when agitated on dentin discs; all tubules were eventually occluded as particle concentrations grew. (J Oral Sci 56, 287-293, 2014).

The use of lasers for direct pulp capping

Direct pulp capping helps extend the life of a diseased tooth by maintaining tooth vitality. Nowadays, lasers are more frequently used during direct pulp capping in the clinic, but their use has not been previously reviewed. This review presents the basic properties of currently available lasers, scientific evidence on the effects of laser application on direct pulp capping, and future directions for this technology. An extensive literature search was conducted in various databases for articles published up to January 2015. Original in vitro, in vivo, and clinical studies, reviews, and book chapters published in English were included. Various laser systems have been increasingly and successfully applied in direct pulp capping. Lasers offer excellent characteristics in terms of hemostasis and decontamination for field preparation during direct pulp capping treatment; however, the sealing of exposed pulp with one of the dental materials, such as calcium hydroxide, mineral trioxide aggregates, and bonded composite resins, is still required after laser treatment. Clinicians should consider the characteristics of each wavelength, the emission mode, irradiation exposure time, power, type of laser tip, and the distance between the laser tip and the surface being irradiated.

Sustained release of calcium hydroxide from poly(DL-lactide-co-glycolide) acid microspheres for apexification

Calcium hydroxide (CH) loaded poly(DL-lactide-co-glycolide) acid (PLGA) microspheres (MS) might be used for apexification requiring a sustained release of Ca(2+). The aim of this study was to formulate and characterize CH-PLGA-MS. The CH-loaded MS were prepared by either oil-in-water (O/W) or water-in-oil/in-water (W/O/W) emulsion solvent evaporation technique. MS produced by the O/W technique exhibited a larger diameter (18.63 ± 7.23 μm) than the MS produced by the W/O/W technique (15.25 ± 7.37 μm) (Mann-Whitney U test P < 0.001). The CH encapsulation efficiency (E e) and Ca(2+) release were calculated from data obtained by absorption techniques. Ca(2+) release profile was evaluated for 30 days. To know the E e, the CH-loaded MS were dissolved in 1 M NaOH to release all its content and a Ca(2+) colorimetric marker was added to this solution. The reagent marked the Ca(2+) in blue color, which was then measured by a UV-Vis system (650 nm). The percentage of E e was calculated on the basis of the theoretical loading. The E e of the O/W-produced MS was higher (24 %) than the corresponding percentage of the W/O/W-produced MS (11 %). O/W- and W/O/W-produced MS released slower and lower Ca(2+) than a control CH paste with polyethylene glycol 400 (Kruskal-Wallis test). O/W-produced MS released higher Ca(2+) than W/O/W-produced MS (statistically significant differences; P < 0.05). In conclusion, the CH-PLGA-MS were successfully formulated; the technique of formulation influenced the size, encapsulation efficiency and release profile. The MS were better sustained release system than the CH paste.

Comparison of particle morphology between commercial- and research-grade calcium hydroxide in endodontics

Ca(OH)2 aqueous slurry is widely used as an inter-appointment antimicrobial dressing in root canal treatment. The aim of this study was to quantify the particle size and shape of commercial-grade UltraCal XS (UC) and to compare it with that of research-grade Ca(OH)2 (RG) using a flow particle image analyzer (FPIA). The morphology and penetration inside the dentin tubules of the UC and RG particles were examined using a scanning electron microscope (SEM). UC and RG (10 mg) were mixed with 15 mL of alcohol, and were sonicated. Five milliliters of the dispersion was subjected to FPIA, and particle length, width, perimeter and aspect ratio were analyzed. In addition, UC paste and RG aqueous slurry were agitated on dentin discs and were prepared for SEM examination. There were significant differences between UC and RG with regard to the frequency of different length groups (P < 0.0001). UC contained smaller particles than RG (P < 0.0001). Under SEM, the agitated UC and RG particles occluded the opening of dentin tubules and penetrated inside the dentin tubules. The size of UC particles is smaller than those of RG. Both UC and RG particles were able to penetrate into open dentin tubules.

Preliminary study of light-cured hydrogel for endodontic drug delivery vehicle

AIM

Direct pulp capping is the treatment of an exposed vital pulp with a dental material to facilitate the formation of reparative dentin and maintenance of vital pulp. A bioengineered drug delivery vehicle has the potential to increase the success rate of pulp capping. The aim of this study was to develop an injectable and light-curing drug delivery vehicle for endodontic treatment including direct pulp capping.

METHODS

Polyethylene glycol-maleate-citrate (PEGMC) hydrogel was synthesized as a drug delivery vehicle that is composed of PEGMC (45% w/v), acrylic acid (AA) (5% w/v), 2,2'-azobis(2-methylpropionamidine) dihydrochloride (AAPH) (0.1% w/v), and deionized water. The association between prehydrogel-solution volume and visible light-curing was examined. The cytotoxicity of the hydrogel was tested using L929 cells in a cell culture system. Ca(2+) release from the hydrogel was determined using calcium hydroxide as the incorporated medicine.

RESULTS

The results showed that the light-curing time for hydrogel is comparable to composite resin. The hydrogel had cell toxicity similar to adhesive systems. Moreover, controlled Ca(2+) release was obtained from the calcium hydroxide incorporated hydrogel.

CONCLUSIONS

The data suggest that hydrogel should be explored further as a promising drug delivery vehicle for vital pulp therapy and regenerative endodontics.

Dental education in Mexico

The aim of this article is to provide information about dental education in Mexico, including its history, the dental school system, curriculum and dental licensure. In 1977, there were only 59 Mexican dental schools; however, there were 83 schools registered in the last official national count in 2007. Forty-one dental schools are public, and the other 42 are private. Every year the number of private dental schools increases. Admission to dental schools in Mexico requires a high school diploma. All classes are conducted in Spanish. To obtain licensure in Mexico, dental students must complete a 3 to 5-year program plus a year of community service. No formal nationwide standard clinical/didactic curriculum exists in Mexico. There are approximately 153,000 dentists in Mexico, a number that increases each year. The dentist-patient ratio is approximately 1:700. However, the high percentage of inactive licensed dentists in Mexico points to a serious problem.

A comparative study of oral health attitudes and behavior using the Hiroshima University-Dental Behavioral Inventory (HU-DBI) between dental and civil engineering students in Colombia

The aim of this study was to use the Hiroshima University - Dental Behavioral Inventory (HU-DBI) to compare oral health attitudes and behavior of dental and civil engineering students in Colombia. The HU-DBI's survey consisting of twenty dichotomous responses (agree-disagree) regarding tooth brushing, was completed at University Antonio Narino for the dental students and the University of Cauca for the civil engineering students. The Spanish version of the HU-DBI questionnaire was taken by 182 of 247 dental students and 411 of 762 engineering students. The data was-statistically analyzed by the chi-square test and backward logistic regression. Compared to the engineering students, the dental students were more likely to agree with questions such as "I am bothered by the color of my gums"(OR = 2.2, 95% CI: 1.3-3.7),"I think I can clean my teeth well without using toothpaste" (OR = 3.0, 95% CI: 1.5-5.9), "I have used a dye to see how clean my teeth are" (OR = 2.9, 95% CI: 1.9-4.3), and "I have had my dentist tell me that I brush very well" (OR = 2.0, 95% CI: 1.3-3.1). The dental education curriculum in a dental school compared to a civil engineering school in Colombia indicated that a three-phase curriculum in didactics and clinics increased oral health attitudes and behavior from entry to graduation.

Effect of dental education on Peruvian dental students' oral health-related attitudes and behavior

This study evaluated the effect of dental education on oral health-related attitudes and behavior of students in a five-year dental program in Peru. A survey using the Hiroshima University-Dental Behavioral Inventory (HU-DBI), which consists of twenty dichotomous responses (agree-disagree) regarding oral health behavior and attitudes, was completed by Year 1 and Year 5 dental students at the Universidad Inca Garcilaso de la Vega in Lima, Peru. A total of 153 Year 1 students and 120 Year 5 students responded to the Spanish version of the HU-DBI questionnaire. The data were analyzed using chi-square tests and logistic regression analyses. Compared to the Year 1 students, the Year 5 dental students were more likely to agree with questions such as "I think I can clean my teeth well without using toothpaste" (OR=0.24, 95% CI: 0.10-0.58); "I have used a dye to see how clean my teeth are" (OR=0.19, 95% CI: 0.10-0.36); and "I have had my dentist tell me that I brush very well" (OR=0.34, 95% CI: 0.17-0.69). Overall, the data showed that the curriculum in this dental school in Peru resulted in more positive oral health-related attitudes and behavior among Year 5 dental students compared to those of Year 1 dental students.

Endodontic release system for apexification with calcium hydroxide microspheres

The use of calcium hydroxide (CH) as an intracanal medicament for apexification is widespread. However, because of a short residence time in the root canal, the CH must be refreshed frequently, increasing the number of appointments required and leading to patient non-compliance. We hypothesized that a core-/shell-structured CH microsphere system would lead to sustained slow release of calcium and hydroxide ions of CH for long periods of time, eliminating the need for multiple visits for apexification. In this study, calcium hydroxide microspheres (CHMSs) with a core/shell structure were prepared by an emulsion method. The CHMS shell was composed of alginate, which was crosslinked by the Ca(2+) released from the CH in the CHMSs. Therefore, this system provides a unique feedback loop that controls the release of ions from the CHMSs. The in vitro experiments from the root canals of extracted human teeth showed that the CHMSs had a sustained, slow release of Ca(2+), at a constant rate of approximately 2 to 3% per month from day one to the six-month endpoint of the experiment. After 6 months, 72.1 ± 5.8% of the total CH from the CHMSs remained in the root canals of the teeth, while only 46.9 ± 10.9% and 36.8 ± 7.5% remained from a commercial product (UltraCal(®)XS) and CH powder alone, respectively (p < 0.01). The pH of all of the formulations (CHMS, UltraCal(®) XS, and CH powder) in the extracted teeth never rose above 9 during the release period, indicating a buffering effect of the teeth. The core-/shell-structured CHMSs are, therefore, a promising delivery vehicle for the sustained slow release of Ca(2+) and OH(-) in the root canal.

Internal and external resorption in a lower molar with an associated endodontic-periodontic lesion: a case report

This article describes a unique case in which both internal and external inflammatory resorption and endodontic-periodontic lesions were present at the same time in the patient's left mandibular first molar. Based on clinical and radiographic findings, it was determined that the nature of this case was a pulpal infection-induced inflammatory resorption and furcation lesion. After root canal therapy, the furcation lesion and external inflammatory resorption were completely resolved. This case indicates that the correct diagnosis of the stimulating factor for tooth resorption and determination of the primary origin of endodontic-periodontic lesions are critical for clinical management and success.

Comparison of traditional six-year and new four-year dental curricula in South Korea

This study aimed to compare the dental curriculum of the traditional six-year system with that of the new four-year (graduate-entry) system in South Korea. There are 11 dental schools in South Korea: six are public and five are private. Eight offer the new four-year program and the other three offer the traditional six-year program. Descriptive analyses were conducted using bibliographic data and local information along with statistical analyses such as chi-square tests. In the six-year programs, clinical dentistry subjects were taught almost equally in practical and didactic courses, while the basic science courses were taught more often as practical courses (P < 0.0001). In the four-year programs, both the basic science and clinical dentistry subjects were taught didactically more often; while more dentistry subjects were taught than basic sciences (P = 0.004). The four-year program model in South Korea is more focused on dentistry than on basic science, while both basic and clinical dentistry subjects were equally taught in the six-year program.

Characterization of the mineral trioxide aggregate-resin modified glass ionomer cement interface in different setting conditions

INTRODUCTION

Mineral trioxide aggregate (MTA) has been used successfully for perforation repair, vital pulpotomies, and direct pulp capping. However, little is known about the interactions between MTA and glass ionomer cement (GIC) in final restorations. In this study, 2 null hypotheses were tested: (1) GIC placement time does not affect the MTA-GIC structural interface and hardness and (2) moisture does not affect the MTA-GIC structural interface and hardness.

METHODS

Fifty cylinders were half filled with MTA and divided into 5 groups. The other half was filled with resin-modified GIC either immediately after MTA placement or after 1 or 7 days of temporization in the presence or absence of a wet cotton pellet. The specimens were then sectioned, carbon coated, and examined using a scanning electron microscope and an electron probe microanalyzer (SEM-EPMA) for interfacial adaptation, gap formation, and elemental analysis. The Vickers hardness numbers of the interfacial MTA were recorded 24 hours after GIC placement and 8 days after MTA placement and analyzed using the analysis of variance test.

RESULTS

Hardness testing 24 hours after GIC placement revealed a significant increase in hardness with an increase of temporization time but not with a change of moisture conditions (P < .05). Hardness testing 8 days after MTA placement indicated no significant differences among groups. SEM-EPMA showed interfacial adaptation to improve with temporization time and moisture. Observed changes were limited to the outermost layer of MTA. The 2 null hypotheses were not rejected.

CONCLUSIONS

GIC can be applied over freshly mixed MTA with minimal effects on the MTA, which seemed to decrease with time.

In vitro evaluation of dentinal tubule penetration and biomineralization ability of a new root-end filling material

INTRODUCTION

Capasio is being developed as a new generation of endodontic material with potential use as a root-end filling material. The aim of this study was to compare the ability of Capasio and mineral trioxide aggregate (MTA) to penetrate human dentinal tubules and examine the interaction of Capasio and MTA with a synthetic tissue fluid (STF) and root canal walls in extracted human teeth.

METHODS

Root-end preparations were filled with Capasio or MTA, allowed to set for 4 weeks in STF, and then sectioned at 1, 2, and 3 mm from resected surface. Depth of penetration was evaluated by using scanning electron microscopy (SEM). Next, Capasio and MTA samples were prepared both in 1-g pellets and in root-end preparations. Samples were placed in STF, allowed to set, and then characterized by using SEM, energy dispersive x-ray analysis (EDXA), and x-ray diffraction (XRD) techniques.

RESULTS

Penetration of Capasio into dentinal tubules was observed at all levels. No penetration of MTA into dentinal tubules was observed at any level. Both Capasio and MTA formed apatite crystals in the supernatant, on their exposed surfaces, and in the interfacial layers that were similar in structure and elemental composition when evaluated by using SEM and EDXA. XRD analysis of these crystals corresponds with those reported for hydroxyapatite.

CONCLUSIONS

When used as a root-end filling material, Capasio is more likely to penetrate dentinal tubules. Both Capasio and MTA promote apatite deposition when exposed to STF.

Concrescence of permanent maxillary second and third molars: case report of non-surgical root canal treatment

Concrescence is a rare developmental anomaly with an overall incidence of 0.8% in the permanent dentition. While many case reports describe the treatment of concrescence with extraction, there are few reports of non-surgical root canal treatment (NSRCT), due to the atypical root form, canal morphology, and technical difficulties involved in concrescence. This unique case report describes a technical modification of NSRCT that can retain joined posterior maxillary teeth to maintain natural posterior occlusion without surgical intervention or dental implants, thereby avoiding the risk of damage to a large portion of the alveolar bone near the maxillary sinus.

Graduate and undergraduate geriatric dentistry education in a selected dental school in Japan

Geriatric dentistry and its instruction are critical in a rapidly ageing population. Japan is the world's fastest-ageing society, and thus, geriatric dentistry education in Japan can serve as a global model for other countries that will soon encounter the issues that Japan has already confronted. This study aimed at evaluating geriatric dental education with respect to the overall dental education system, undergraduate geriatric dentistry curricula, mandatory internships, and graduate geriatric education of a selected dental school in Japan. Bibliographical data and local information were collected. Descriptive and statistical analyses (Fisher and chi-squared test) were conducted. Japanese dental schools teach geriatric dentistry in 10 geriatric dentistry departments as well as in prosthodontic departments. There were no significant differences found between the number of public and private dental schools with geriatric dentistry departments (P = 0.615). At Showa University School of Dentistry, there are more didactic hours than practical training hours; however, there is no significant didactic/practical hour distribution difference between the overall dental curriculum and fourth-year dental students' geriatric dental education curriculum (P = 0.077). Graduate geriatric education is unique because it is a 4-year PhD course of study; there is neither a master's degree programme nor a certificate programme in geriatric dentistry. Overall, both undergraduate and graduate geriatric dentistry curricula are multidisciplinary. This study contributes to a better understanding of geriatric dental education in Japan; the implications of this study include developing a clinical/didactic curriculum, designing new national/international dental public health policies, and calibrating the competency of dentists in geriatric dentistry.

Cemento-osseous dysplasia in an elderly Asian male: a case report

Cemento-osseous dysplasia is a disorder typically found in middle-aged black women. However, the present report describes a case in a 61-year-old Vietnamese male. Without proper pulp testing and diagnosis, the radiographic presentation can easily be misdiagnosed as periapical periodontitis. On the basis of pulp vitality, lack of clinical symptoms and radiographic features, the diagnosis in this case was periapical cemento-osseous dysplasia at the mixed stage, which generally requires no treatment. At the 18-month follow-up, the patient was still asymptomatic and none of the clinical signs had changed. This case highlights the importance of careful clinical examination, including a pulp vitality test, and of having an unbiased view of age, gender, and ethnicity when diagnosing this condition.

Cytotoxicity evaluation of Gutta Flow and Endo Sequence BC sealers

OBJECTIVE

This study evaluated the cytotoxicity of GuttaFlow and EndoSequence BC sealers and compared them with AH Plus and Tubli-Seal sealers.

STUDY DESIGN

Samples (0.5 mg) of freshly mixed or set BC, GuttaFlow, AH Plus, and Tubli-Seal sealers were eluted with 300, 600, and 1,000 μL cell culture medium for 24 and 72 hours. L929 cells were seeded into 96-well plates at 3 × 10(4) cells/well and cultured with 100 μL eluate from each eluate group. Cells cultured only with culture medium served as control. After 24 hours' incubation, the cytotoxicity was evaluated by MTT assay. Cell viability was calculated as the percentage of the control group, and the results were analyzed with a one-way analysis of variance.

RESULTS

For the freshly mixed sealer, cell viability in the AH Plus group was less than in all of the other 3 sealer groups. The Tubli-Seal sealer group had less cell viability than the EndoSequence BC and GuttaFlow sealer groups. For the set sealer, the Tubli-Seal and AH Plus groups had less cell viability than the EndoSequence BC and GuttaFlow sealer groups. There was no cell viability difference between the EndoSequence BC and GuttaFlow sealer groups in the either freshly mixed or set sealer group.

CONCLUSIONS

The GuttaFlow and EndoSequence BC sealers have lower cytotoxicity than the AH Plus and Tubli-Seal sealers.

Effect of exercise training on the density of endothelial cells in the white adipose tissue of rats

We examined the effects of a 9-week exercise training (TR) in Wistar male rats, beginning at 4 weeks of age, on the density of endothelial cells (ECs) in epididymal white adipose tissue (WAT) and the mRNA expression of angiogenic factors in adipose tissue stromal vascular fraction (SVF) cells. The number of ECs and mRNA expressions were assessed by lectin staining and real-time reverse transcriptase-polymerase chain reaction, respectively. Compared with control (CR) rats, TR rats gained weight more slowly and had significantly lower final weight of WAT due to the reduction in the size and the number of adipocytes. TR significantly increased the number of ECs per square millimeter and per adipocyte (1.37- and 1.23-fold, respectively) in WAT. This is probably because the number of adipocytes is fewer while the number of ECs is constant in the WAT of TR rats, because the regression line of TR rats for adipocyte number-dependent EC number was shifted toward the left without significant differences in the slopes between groups. TR also induced the upregulation of mRNA expression of vascular endothelial growth factor (Vegf)-A and Vegf-receptor-2 in SVF cells, thereby retaining a constant number of ECs in the WAT.

Innovative endodontic therapy for anti-inflammatory direct pulp capping of permanent teeth with a mature apex

Direct pulp capping is treatment of an exposed vital pulp with a dental material to facilitate the formation of reparative dentin and maintenance of vital pulp. It has been studied as an alternate way to avoid vital pulp extirpation. However, the success rate of pulp capping is much lower than that of vital pulp extirpation. Therefore, direct pulp capping is currently considered controversial by many clinicians. To increase the success rate, a critical need exists to develop new biologically based therapeutics that reduce pulp inflammation, promote the continued formation of new dentin-pulp complex, and restore vitality by stimulating the regrowth of pulpal tissue. Bioengineered anti-inflammatory direct pulp-capping materials, together with adhesive materials for leakage prevention, have great potential to improve the condition of the existing pulp from an inflamed to a noninflamed status and lead to a high rate of long-term success.

Dentin permeability reduction by a sequential application of calcium and fluoride-phosphate solutions

OBJECTIVE

A sequential topical application of calcium and fluoride-phosphate solutions was reported to occlude open dentin tubules, mainly with fluoroapatite precipitates by a rapid ionic reaction, and to be effective at treating dentin hypersensitivity. However, its ability to reduce dentin permeability (Lp) is unknown. The aim of this in vitro study was to evaluate the effect of this treatment on Lp.

METHODS

Nine extracted human third molars were sectioned transversely to obtain 0.5 mm-thick discs, which were then etched and rinsed. Aqueous solutions of 5% (w/w) disodium phosphate containing 0.3% (w/w) sodium fluoride (A) and 10% (w/w) calcium chloride (B) were prepared. The sequential application of the A&B solutions was repeated three times on each disc, which was then rinsed with distilled water. The Lp of the discs was measured before and after the application using a modified Pashley's fluid flow measuring system. The differences in the Lp values between the conditions before and after the solution applications were analysed using a generalized estimating equation method and paired t-test. Scanning Electron Microscopy (SEM) was used to observe the dentin surfaces.

RESULTS

All nine discs consistently indicated reduced Lp following the application of the A&B solutions. There was a significant decrease in the mean Lp [microL/(cm(2) s cm H(2)O)] from baseline (-0.27+/-0.25, p=0.011). Overall, an average decrease of 34% Lp occurred after the application of the A&B solutions. SEM observation indicated that the reaction products covered the entire dentin disc surface.

CONCLUSION

The application of the A&B solutions was effective at reducing the Lp of the dentin discs.

PRECEDE-PROCEED model modification in community-based oral health promotion by using the linear structural relations programme

PURPOSE

The PRECEDE-PROCEED (P-P) model is a framework for designing health education/promotion programmes. While the P-P model has been used to design community-based oral health programmes, outcome assessments of the model are seldom reported. The aim of the present study was to explore whether pathways in the P-P model accurately reflect the current status of environmental/behavioural assessment in a Japanese community and to examine whether using the linear structural relations (LISREL) programme would improve the model.

MATERIALS AND METHODS

In a community health centre in Japan, a questionnaire with 29 items regarding oral health was distributed to 824 mothers with 3-year-old children. The items were compiled into eight variables that were tested using the LISREL programme. Goodness-of-fit index (GFI), adjusted goodness-of-fit index (AGFI) and root mean square error of approximation (RMSEA) were statistically analysed before and after P-P model modification.

RESULTS

The GFI, AGFI and RMSEA were 0.913, 0.776 and 0.161 before, and 0.975, 0.939 and 0.075 after P-P model modification, respectively. Indirect effects on the quality of life from the predisposing, reinforcing and enabling factors became stronger than those in the initial P-P model. The overall fit of the modified P-P model was significantly better than that of the P-P model without modification, which did not accurately reflect the status of environmental/behavioural assessment in the community.

CONCLUSIONS

The modified P-P model reflected the current status of environmental/behavioural assessment in the community. Health education models should be tested rigorously to ensure that they fit the reality of people's behaviour.

Chronologic comparison of root dentin moisture in extracted human teeth stored in formalin, sodium azide, and distilled water

This study quantified in vitro the root dentin moisture when 10% formalin (group A), 3% sodium azide (group B), and distilled water (group C) were used as teeth storage media. The root dentin moisture of 66 extracted human mandibular single-rooted teeth was measured at baseline (day 0) and at 1, 3, 7, and 14 days using a digital grain moisture meter. The baseline dentin moisture value was used as covariate in the generalized estimating equation (GEE) analysis. The mean dentin moisture values (%) +/- SD on days 0, 1, 3, 7, and 14 were, respectively: 10.6 +/- 0.64, 14.3 +/- 0.71, 14.6 +/- 0.84, 14.4 +/- 0.64, and 14.7 +/- 0.75 in group A; 11.4 +/- 0.94, 14.6 +/- 0.95, 14.6 +/- 0.76, 14.6 +/- 0.93, and 14.8 +/- 0.81 in group B; and 10.2 +/- 0.95, 12.8 +/- 0.90, 13.3 +/- 0.95, 13.0 +/- 0.91, and 13.2 +/- 0.89 in group C. The dentin moisture increased in all 3 groups; however, there was no overall significant difference in moisture between the formalin and sodium azide groups.

Polypeptide-catalyzed Biosilicification of Dentin Surfaces

In situ formation of mineral particles by biocatalysis would be advantageous for occluding dentin tubules to reduce permeability or for sealing of material-tooth interfaces. One approach would require that the peptide-catalyst remain functional on the dentin surface. Based on recent observations of retained activity on other surfaces, we hypothesized that poly(L-lysine) (PLL), an analog of the protein catalyst responsible for silica formation in primitive marine species, would remain functional on dentin. PLL was applied to dentin discs along with a pre-hydrolyzed silica precursor, tetramethyl orthosilicate (TMOS). Discs were analyzed microscopically (scanning electron microscopy, SEM) and chemically (x-ray photoelectron spectroscopy, XPS). The treated discs, but not the negative controls, exhibited partial distinct coating whose XPS survey was consistent with that of silica, demonstrating that the polypeptide was required and retained its mediating activity. Peptide-catalysts that mediate mineral formation can retain functionality on dentin, suggesting a wide range of preventive and treatment strategies.

Root dentin body moisture changes caused by ascorbic acid

OBJECTIVES

To quantify in vitro the root dentin moisture (DM) when soaked in 10% ascorbic acid solution (Group A) and distilled water (Group B) for up to 14 days.

METHODS

Forty-four extracted human mandibular single-rooted teeth were sectioned perpendicular to the long axis at the CEJ to access the root dentin. The samples were divided into Groups A and B. Baseline (day 0) DM was measured using a digital grain moisture meter. One sample was placed in each tube, which was then filled with solution. All tubes were kept at 37 degrees C and 100% humidity. DM was measured after 1, 3, 7, and 14 days. The baseline DM value was used as a covariate in the generalized estimating equation (GEE) analysis to account for the difference in the baseline DM between the two groups.

RESULTS

The mean DM (%) values+/-standard deviation on days 0, 1, 3, 7, and 14 were 11.4+/-1.08, 17.1+/-0.87, 18.2+/-0.76, 18.4+/-0.77, and 17.9+/-0.90 in Group A, and 10.2+/-0.95, 12.8+/-0.90, 13.3+/-0.95, 13.0+/-0.91, and 13.2+/-0.89 in Group B, respectively. Group A had significantly higher baseline DM than Group B (p=0.006). After adjusting for differences in the baseline, the GEE analysis indicated that, on average, Group A had a significantly higher increase in DM than Group B, with means+/-standard deviation of 4.35+/-0.26.

CONCLUSIONS

The moisture increase in the ascorbic acid group was greater than that in the distilled water group. Soaking root dentin in the unreplenished ascorbic acid solution or distilled water beyond 3 days did not further increase DM.

A rapid nondestructive method for root dentin moisture measurements: in vitro pilot study

Dentin moisture content is important in adhesive bonding and structural strength research; however, there is no rapid method available to assess dentin moisture without sample destruction. This study examined the use of a digital grain moisture meter to measure root dentin moisture in vitro. Extracted mandibular single-rooted teeth were sectioned at the CEJ. The moisture of the root dentin was measured at 6 measuring modes for different grains and repeated 5 times. Dentin weight changes before and after drying were measured to obtain control values. The control values were compared with machine readings. In conclusion, (1) each nondestructive measurement took less than 30 seconds, (2) 24 hours of storage at 37 degrees C and 100% humidity did not restore dentin moisture, and (3) 5 grain modes had a high validity and could be used for dentin moisture measurements.

Dental education in Peru

This paper provides information about Peru's dental history and dental school system, including the curriculum and dental licensure. With the increase in the number of dental schools in Peru, the number of dentists is also increasing. Until 1965, Peru had only three dental schools; currently, there are 14. Four of these dental schools are public, and ten are private. A five- or six-year dental program leads to the B.D.S. degree. After successful completion of a thesis defense or competency examination, the D.D.S. degree is awarded. The D.D.S. is mandatory for practicing dentistry in Peru. Currently, there are approximately 14,000 active dentists, with a dentist-patient ratio of approximately 1:2,000.

Dentin tubule numerical density variations below the CEJ

AIM

To evaluate dentin tubule numerical density variations below the CEJ.

METHODOLOGY

Three human non-carious permanent canines were sectioned parallel to the CEJ to obtain dentin disks 1mm thick whose surfaces were 1mm and 2mm below the CEJ. Each disk was sectioned into quarters resulting in four segment locations: facial, lingual, mesial, and distal. The outer (PDL side) and inner (pulp side) surfaces of the specimens were shaped to expose dentin with SiC papers and polished. Numerical tubule density was determined from SEM images. All data were statistically analyzed using a three-way ANOVA.

RESULTS

The dentin tubule density (number/mm(2)) ranged from 13,700 to 32,300. Dentin tubule density was relatively uniform at 1mm and 2mm below the CEJ and increased by a factor of about two from the outer to the inner surface, which was significantly different (P<0.0001).

CONCLUSIONS

The tubule density variations at the cervical root did not present marked.

Dental education in Malaysia

There was only one dental school in Malaysia until 1997 but five new schools have been established since 1998. This review provides information about dental education in Malaysia including; the history of dental education, the current dental school system and curriculum, and dental licensure. There are four public and two private dental schools in Malaysia. High school graduates are required to take the nationwide matriculation entrance examination or the Higher School Certificate (HSC) to apply for a dental degree programme. A five-year dental programme leads to the BDS or the DDS degree. National or state examinations are not required to practise dentistry. Currently, there are approximately 2,500 dentists, with a ratio of 1 dentist for every 10,000 people.

Comparative analysis of the particle size and shape of commercially available mineral trioxide aggregates and Portland cement: a study with a flow particle image analyzer

The aim of this study is to characterize the particle size distribution and circularity of various Mineral Trioxide Aggregates (MTA) (ProRoot MTA/ MTA Angelus/Gray and White) and Portland cements with effective size ranges of 1.5-160 microm using a flow particle analyzer (Sysmex FPIA-3000, Kobe, Japan). Cumulative percentage of particles between 6 and 10 microm were, 65, 73, 48, 53, and 70 %, for Gray ProRoot MTA, White ProRoot MTA, Gray MTA Angelus, White MTA Angelus, and Portland cement, respectively. ProRoot MTA contains fewer large particles than MTA Angelus. MTA Angelus contains a higher number of small particles than ProRoot MTA. White MTA contains smaller particles with a narrower range of size distribution than Gray MTA. MTA Angelus particles have relatively low circularity and wide size distribution and are less homogeneous than ProRoot MTA.

Dental education in Norway

Our review of dental education in Norway will address the following topics: the history of dental education, the dental school admission process, dental school curriculum, student evaluation, post-graduation and the number of dentists in Norway relative to dental education.

Education of dentists in Thailand

Thailand is geographically located in southeast Asia and its population is 63 million. Little has been published on dental education in Thailand. This paper provides information about Thailand regarding its dental history, dental school system including curriculum and dental licensure. There are eight public and one private dental school in Thailand. A six-year dental education leads to the DDS degree. On graduation from the public dental schools, dentists are required to work in the public system for three years. Currently, there are approximately 8000 active dentists, with a dentist: population ratio of approximately 1:7000.