Search

Dental caries is one of the most common diseases in the world, and global incidence rates are increasing. The early detection of dental lesions enables a conservative approach to be employed and represents a priority in modern dentistry. Recent studies have suggested that conventional diagnostic methods, such as visual tactile inspection and X-ray examination, exhibit low sensitivity and are not very effective in early diagnoses. Consequently, late detection of decay is associated with an increased loss of tooth structure. New diagnostic systems based on optical properties have been developed to facilitate early detection. Several studies have evaluated the performance of near-infrared imaging (NIRI) as an early diagnostic tool. NIRI using light ranging from 700 to 1700 nm has demonstrated better optical properties compared to conventional optical systems using light in the visible spectra. NIRI enables deeper penetration of the light in the tooth tissue, weak scattering with lower background noise and strong photon absorption with detailed images. Several in-vivo studies have demonstrated that NIRI technology has the potential to improve performance compared with current diagnostic methods. NIRI exhibits increased sensitivity compared to radiographs and is more suitable to identify approximal enamel lesions. This paper aimed to review these recent advances and their potential applications in daily clinical practice.

Aim: This ex vivo study aims to compare the accuracy of two electronic apex locators, Wirele-X (Forum Engineering Technologies Ltd., Israel), tested in two modalities, alone and connected to the display screen and Dentaport ZX (J. Morita, Tokyo, Japan) in determining the working length. Methodology: 15 single-rooted teeth were selected for this study. The actual microscopic working length was measured using a size 10 K-file that was advanced until the tip of the file could be visualized just within the apical foramen under a stereomicroscope. Then each tooth was placed into the alginate to simulate the clinical conditions. Wirele-X and Dentaport ZX were used according manufacturer's instructions. Three measurements were performed for each tooth and each apex locator and modality and differences between the electronic and actual working lengths were calculated. Positive values indicated measurements that extruded beyond the apical foramen, while negative values indicated measurements that were short of the apical foramen. Means and standard deviation were calculated and the statistical analysis was performed using One-way ANOVA and Tukey tests (P<0.05). Results: The difference between electronic and actual working length was 0.05±0.34 mm for Wirele-X alone, 0.003±0.37 mm for Wirele-X connected to the display screen and 0.08±0.35 mm for Dentaport ZX. No statistical differences were found among Wirele-X alone, Wirele-X connected to the display screen and Dentaport ZX (p>0.05). Conclusions: Wirele-X in both modalities and Dentaport ZX showed a high accuracy in determining working length and were accurate to within ±0.5 mm, without any statistical differences among them.

Objectives: To evaluate the efficacy of a stepwise intraoperative activation (SIA) of irrigants during and after the instrumentation compared with that of a conventional activation (CA) performed only after the instrumentation to remove smear layer and debris using different activation devices. Materials and methods: A total of 70 single-rooted teeth were divided into a control group (no activation, n = 10) and two different experimental groups according to the irrigant activation protocol used: group 1 (CA), in which sodium hypochlorite was activated only after the use of the last mechanical file, and group 2 (SIA), in which activation was performed during and after the instrumentation. The two groups were divided into 3 subgroups according to the activation device used (n = 10): passive ultrasonic irrigation (PUI, subgroup a), EndoActivator (EA, subgroup b), and EDDY (subgroup c). The roots were split longitudinally and observed using scanning electron microscopy (SEM) to evaluate the presence of debris and smear layer, and the results were statistically analyzed. Results: All activation protocols and devices were more effective than control group in removing smear layer and debris from all root canal thirds (P < 0.05), except for CA-EA (group 1b) in the apical third. In the apical third, SIA was found to be more effective than CA (P < 0.05) to remove smear layer and residual debris when PUI was used, to remove the smear layer when EA was used (P < 0.05), and to remove residual debris when EDDY was used (P < 0.05). PUI and EDDY removed statistically more smear layer and debris than EA in the apical third (P < 0.05). Conclusions: The SIA technique improved the smear layer and debris removal from the apical third and debris removal from the coronal third, and PUI and EDDY were more effective than EA in the apical third. Clinical relevance: The stepwise intraoperative activation (SIA) technique may increase smear layer and debris removal.

Calcium hydroxide apexification and Mineral Trioxide Aggregate (MTA) apexification are classical treatments for necrotic immature permanent teeth. The first tend to fail for lack of compliance given the high number of sessions needed; the second has technical difficulties such as material manipulation and overfilling. With both techniques, the root development is interrupted leaving the tooth with a fragile root structure, a poor crown-to-root ratio, periodontal breakdown, and high risk of fracture, compromising long-term prognosis of the tooth. New scientific literature has described a procedure that allows complete root development of these specific teeth. This regenerative endodontic procedure (REP) proposes the use of a combination of antimicrobials and irrigants, no canal walls instrumentation, induced apical bleeding to form a blood clot and a tight seal into the root canal to promote healing. MTA is the most used material to perform this seal, but updated guidelines advise the use of other bioactive endodontic cements that incorporate calcium and silicate in their compositions. They share most of their characteristics with MTA but claim to have fewer drawbacks with regards to manipulation and aesthetics. The purpose of the present article is to review pertinent literature and to describe the clinical procedures protocol with its variations, and their clinical application.

Photodynamic therapy (PDT) is a treatment modality that was initiated in 1900; however, it was not until the last decade that PDT regained attention for its several favourable features during the treatment of microbial infections in endodontics. Recently, several papers advocated its use for root canal treatment. The concept of photodynamic inactivation requires microbial exposure to either exogenous or endogenous photosensitizer molecules, followed by visible light energy, typically wavelengths in the red/near-infrared region that cause the excitation of the photosensitizers resulting in the production of singlet oxygen and other reactive oxygen species that react with intracellular components and consequently produce cell inactivation and death. Recently, PDT has been suggested as a promising effective adjunct to standard antimicrobial intracanal cleaning and shaping for the treatment of periapical lesions. Current publications tested PDT in terms of bacterial load reduction in vivo, in vitro and ex vivo, showing promising results. The purpose of this article was to review the existing literature on PDT in the endodontic field regarding its mechanism of action, photosensitizers and light sources, limitations and clinical procedures. Although positive results have been demonstrated in vitro, there are considerably fewer in vivo investigations. In conclusion, more in vivo studies are needed on the use of antimicrobial PDT in root canal treatment.

Introduction: The purpose of this study was to evaluate the effect of autoclave sterilization on cyclic fatigue resistance of rotary endodontic instruments made of traditional and new nickel-titanium (NiTi) alloys. Methods: Four NiTi rotary endodontic instruments of the same size (tip diameter 0.40 mm and constant .04 taper) were selected: K3, Mtwo, Vortex, and K3 XF prototypes. Each group was then divided into 2 subgroups, unsterilized instruments and sterilized instruments. The sterilized instruments were subjected to 10 cycles of autoclave sterilization. Twelve files from each different subgroup were tested for cyclic fatigue resistance. Means and standard deviations of number of cycles to failure (NCF) and fragment length of the fractured tip were calculated for each group, and data were statistically analyzed (P lt .05). Results: Comparing the results between unsterilized and sterilized instruments for each type of file, differences were statistically significant (P lt .05) only between sterilized and unsterilized K3XF files (762 versus 651 NCF). The other instruments did not show significant differences (P > .05) in the mean NCF as a result of sterilization cycles (K3, 424 versus 439 NCF; Mtwo, 409 versus 419 NCF; Vortex, 454 versus 480 NCF). Comparing the results among the different groups, K3 XF (either sterilized or not) showed a mean NCF significantly higher than all other files(P lt .05). Conclusions: Repeated cycles of autoclave sterilization do not seem to influence the mechanical properties of NiTi endodontic instruments except for the K3 XF prototypes of rotary instruments that demonstrated a significant increase of cyclic fatigue resistance. (J Endod 2012;38:222-225)

Introduction: The purpose of this study was to evaluate the effect of autoclave sterilization on cyclic fatigue resistance of rotary endodontic instruments made of traditional and new nickel-titanium (NiTi) alloys. Methods: Four NiTi rotary endodontic instruments of the same size (tip diameter 0.40 mm and constant .04 taper) were selected: K3, Mtwo, Vortex, and K3 XF prototypes. Each group was then divided into 2 subgroups, unsterilized instruments and sterilized instruments. The sterilized instruments were subjected to 10 cycles of autoclave sterilization. Twelve files from each different subgroup were tested for cyclic fatigue resistance. Means and standard deviations of number of cycles to failure (NCF) and fragment length of the fractured tip were calculated for each group, and data were statistically analyzed (P lt .05). Results: Comparing the results between unsterilized and sterilized instruments for each type of file, differences were statistically significant (P lt .05) only between sterilized and unsterilized K3XF files (762 versus 651 NCF). The other instruments did not show significant differences (P > .05) in the mean NCF as a result of sterilization cycles (K3, 424 versus 439 NCF; Mtwo, 409 versus 419 NCF; Vortex, 454 versus 480 NCF). Comparing the results among the different groups, K3 XF (either sterilized or not) showed a mean NCF significantly higher than all other files(P lt .05). Conclusions: Repeated cycles of autoclave sterilization do not seem to influence the mechanical properties of NiTi endodontic instruments except for the K3 XF prototypes of rotary instruments that demonstrated a significant increase of cyclic fatigue resistance. (J Endod 2012;38:222-225)

Objective. The aim of this study was to investigate the influence of the shape of 3 different artificial canals on the trajectory followed by different nickel-titanium rotary instruments. Study design. Ten ProFile and Mtwo instruments, tip sizes 20 and 25, taper .06, were tested in 3 simulated root canals with an angle of curvature of 60 and radius of curvature of 5 mm but with different shapes. Geometric analysis of the trajectory that each instrument followed inside the 3 different artificial canals was performed on digital images, determining 3 parameters: angle and radius of the curvature and the position of the center of the curvature. Mean values were then calculated for each instrument size in all of the artificial canals. Data were analysed using 1-way analysis of variance, Holm t test, and Student t test to determine any statistical difference (P lt .05). Results. In all instrument sizes, a statistically significant difference was noted among the artificial canals for the radius and angle of curvature. No statistically significant difference was noted between instruments of the same size for the radius and angle of curvature and the position of the center of the curve when measured in the canal constructed on the dimension of the instruments. Conclusions. Different instruments follow different trajectories in artificial canals constructed with the same parameters of curvature but different shapes, depending on their different bending properties. All of the instruments respected the established parameters of curvature only when the artificial canal is designed on the dimension of the instruments. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:e60-e66)

Non disponibile

Objective: Aim of the present study was to evaluate the cytotoxicity of Real Seal 1 compared to other commercially available endodontic filling materials: Real Seal (SybronEndo, Orange, CA, USA) and Thermafil (Tulsa Dental, Tulsa, OK, USA). Material and Methods: Periodontal ligament cells from healthy patients were cultured. The eluate of Real Seal 1TM (RS1), Real Seal (RS) and Thermafil (TF) samples was used for the cells viability tests, both diluted (50%) or undiluted (100%). Incubation of the specimens was performed in culture medium for 24 h, 48 h and 72 h at 37 °C under sterile conditions. The cellular mortality was evaluated by MTT test. Results were statistically analysed and the statistical significance was set at p< 0.05. Results: None of the studied materials showed toxic effects during the period of observation (0 -72 h) when compared to the control group. Only RS induced a very modest increase in cell mortality (about 3% at both concentrations used, during the first 24 hours), when increasing the incubation time, however, only the lower concentration continued to show modest toxicity. Conclusions: Results of the present study showed that all tested materials did not exhibit cytotoxic effects when compared to the control group.

Background: Root canal disinfection needs to be improved because actual techniques are not able to eliminate all microorganisms present in the root canal system. The aim of the present study was to investigate the in vitro cytotoxicity of FotoSan (CMS Dental APS, Copenhagen Denmark), 17\% EDTA and 2\% chlorhexidine. Material/Methods: Fibroblasts of periodontal ligament from healthy patients were cultured. FotoSan (with and without light activation for 30 sec.), 17\% EDTA and 2\% chlorexidine were used for the cell viability tests. Untreated cells were used as control. The cellular vitality was evaluated by MTT test. The production of reactive oxygen species (ROS) was measured using an oxidation-sensitive fluorescent probe. Results were statistically analyzed by ANOVA, followed by a multiple comparison of means by Student-Newman-Keuls, and the statistical significance was set at p < 0.05. Results: MTT tests showed that cytotoxic effects of FotoSan (both photocured and uncured) were statistically lower (p < 0.05) than that observed using 2\% Chlorhexidine, while no significant differences were found in comparison with 17\% EDTA. No alterations in ROS production were detectable in any of the tested materials. Conclusions: Since the toxicity of the FotoSan photosensitizer, both light-activated and not light-activated, is similar to common endodontic irrigants, it can be clinically used with precautions of use similar to those usually recommended for the above-mentioned irrigating solutions.