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During root canal treatment, intra-canal content as well as irrigants and root filling materials may be extruded into the periapical tissues, leading to undesirable consequences such as delay of healing and flare-ups. Although apical extrusion of debris is an inherent occurrence of root canal treatment and no instrument or technique has totally solved this problem, attempts are underway to minimize the harm exerted to periapical tissues with the development of new techniques. This has led researchers to continuously evaluate new instruments and methodologies in terms of apical extrusion. New research on extrusion is frequently published some of which utilize traditional experimental designs and others assessing extrusion using modified or innovative methodologies. This review focuses on the research methods and experimental models to study apical extrusion of debris and irrigants by making a critical analysis of each technique. A PubMed and Scopus search was conducted and 144 articles relevant to apical extrusion were retrieved from 1968 until 2021. The methodologies used in every research article were evaluated and a classification was created. Each methodology is described with the general outlines and advantages and drawbacks of each technique summarized with a critical approach. It appears that the collection of debris in a vial still serves as a method chosen by authors even in most recent studies. On the other hand, development of experimental models that include multiple factors considering the drawbacks of the existing study designs is essential to draw more reliable conclusions on the apical extrusion phenomenon.

OZDEMIR-OZENEN, Didem/0000-0002-2607-7634; Ozcakir-Tomruk, Ceyda/0000-0003-1545-5588; Ozdemir-Karatas, Meltem/0000-0001-7132-9936 The aim of the present study is to evaluate the knowledge, attitudes, and behaviors of dental students on oral cancer in Istanbul, Turkey. A self-administered questionnaire adapted from Tanriover et al. consisting of 48 questions was distributed to 311 students enrolled in the fourth and fifth grades of a dental faculty in Istanbul, Turkey. Questions were grouped under 5 main headings: socio-demographic features, knowledge on risk factors and diagnostic procedures, history taking regarding to alcohol and smoking status, opinions and behaviors of oral cancer, and distribution of dental students according to diagnostic practice of oral cancer. The frequencies and percentages were calculated with descriptive analysis. The differences in distributions were analyzed using the chi-squared test. The p value was set at 0.05 for statistical significance. The overall response rate was 98% (305/311). The majority of the students identified tobacco and alcohol as risk factors (82% and 75.1%, respectively), while older age and inadequate consumption of fruits and vegetables were less likely to be known (60.2% and 52.8%, respectively). Almost one-fifth of the students stated that they have never performed oral cancer examinations during their first or subsequent dental examinations of their patients. Female students thought that dentists were authorized to make oral cancer examinations with a higher frequency compared to males (65.8% and 34.2%, respectively; p = 0.006). On the other hand, female students reported that they did not receive adequate education regarding cessation of smoking with a higher frequency compared with males (69.2% female and 30.8% male respectively; p = 0.0001). As this present study revealed that future dentists had insufficient knowledge in some of the main concepts on oral cancer risk factors, and they lacked the confidence in performing oral examinations in their patients, it is concluded that there is a need for a more structured teaching program with greater emphasis on the early signs and risk factors of OC. Reorganization of the dental curriculum, and courses which further draw attention on the responsibility of the dental practitioner in the detection of oral cancers will be beneficial for the creation of awareness on this significant topic among future dental workforce. Understanding the knowledge and perception of dental students on oral cancers is not only limited to a specific country but it is a worldwide critical issue in which information should be exchanged.

Ozenen, Gurkan/0000-0001-7996-8097; Sungurtekin-Ekci, Elif/0000-0001-8465-8309; OZDEMIR-OZENEN, Didem/0000-0002-2607-7634; Tanriover, Ozlem/0000-0003-0251-3451 This study was performed to determine how senior students rate the importance of each competency of their performance and collect information on the self-perceived confidence levels pertaining to each competency. An anonymous survey was conducted on senior students of 6 consecutive years between 2012 and 2017. Students were asked to rate the importance of each competency and their self-confidences using a 5-point scale. Application of appropriate interpersonal and communication skills was ranked as the most important competency whereas developing a catastrophe preparedness plan for dental practice was ranked as having the lowest importance. Areas reported as weaker should be a warning sign for educators to develop strategies for better delivery and implementation of competencies and students' performance.

Background. Failure in the provision of inferior alveolar nerve block anesthesia (IANB) is a significant problem during endodontic treatment of irreversible pulpitis. Various methodologies have been advocated one of which is administration of premedication prior to anesthesia. Despite the considerable number of reports, the topic yet deserves more clarification. This systematic review was conducted to provide an oversight on the effectiveness of premedication prior to IANB in mandibular teeth. Methods. A PubMed and Cochrane Database search was conducted by using MeSH terms inferior alveolar nerve block + pulpitis and mandibular anesthesia+pulpitis. Two reviewers independently performed the screening, selection of papers, and data extraction. Papers in English language that included randomized clinical studies on the impact of different medications on the success of inferior alveolar block anesthesia in irreversible pulpitis were included. Additionally, relevant supporting literature was also used where necessary. Results. Initially, 118 papers were selected from PubMed and 68 were selected from Cochrane. Five additional articles were retrieved from Google Search. Following the elimination of duplicates and irrelevant articles, 35 studies were selected meeting the criteria. It was observed that there was moderate evidence to suggest that some premedications were partially effective for the enhancement of mandibular anesthetic effect in irreversible pulpitis. Conclusion. Though some medications appear to be promising, further supporting research will help highlight this significant topic which requires further clarification.

Aim: The aim of this study was to assess senior dental students’ acquisition of knowledge after 3 months following a reminder lecture. Materials and Methods: A 1 h lecture including a slide presentation was prepared according to the Guidelines of International Association of Dental Traumatology (IADT). The participants were asked to fill-out a questionnaire of 31 questions before (T0), after (T1) and 3 months (T2) after the lecture and were given 15 min for the completion of each questionnaire. Statistical significance level was set at P

Aim: The aim of this study was to assess senior dental students’ acquisition of knowledge after 3 months following a reminder lecture. Materials and methods: A 1 h lecture including a slide presentation was prepared according to the Guidelines of International Association of Dental Traumatology (IADT). The participants were asked to fill-out a questionnaire of 31 questions before (T0), after (T1) and 3 months (T2) after the lecture and were given 15 min for the completion of each questionnaire. Statistical significance level was set at P

Objective: The purpose of this study was to compare the apically extruded debris during endodontic retreatment of teeth with open apices using hand instruments and rotary instruments with continuous rotation and reciprocation. Methodology: Forty-five single-rooted maxillary incisors and canines were used. The root tips were dissected and #1 Gates Glidden burs were allowed to protrude 1 mm beyond the apex. After root canal shaping and filling using AH Plus and gutta-percha, the teeth were randomly divided into 3 groups (n=15). Removal of filling was performed as follows: Group 1: ProTaper Universal-Retreatment files using continuous rotation + ProTaper Universal files Group 2: K-type hand files Group 3: Reciproc files using the reciprocating motion. The extruded debris was collected in glass vials. The weight of the collecting vials was measured before and after instrumentation using a microbalance and the difference was recorded as the amount of extruded debris. The data were statistically analysed using Kruskall Wallis and Bonferroni corrected Mann Whitney U test. Results: Statistical analysis showed that the amount of extrusion was significantly less in rotary systems compared to hand instruments and reciprocating systems (p

Amaç: Bu çalışmanın amacı, Protaper Gold (PTG; Dentsply Maillefer, Ballaigues, Switzerland), WaveOne Gold (WOG; Dentsply Maillefer), One Shape New Generation (OSNG; MicroMega, Besancon, France), Twisted File Adaptive (TFA; SybronEndo, Orange, CA, USA), and K3XF (SybronEndo) nikel-titanyum enstrümantasyon sistemleri ile preparasyon boyunca apikalden taşan debris miktarını araştırmaktır.Gereç ve Yöntem: Yetmiş beş insan tek köklü mandibular premolar diş rastgele olarak 5 gruba ayrılmıştır (n=15). Kök kanalları PTG, WOG, OSNG, TFA, ve K3XF eğeleri kullanılarak üreticinin talimatlarına göre prepare edilmiştir. Enstrümantasyon boyunca apikalden taşan debris önceden tartılmış ependorf tüplerin içinde toplanmıştır. Ependorf tüpler daha sonra 5 gün boyunca 70°C'de bir inkübatör içerisinde muhafaza edilmiştir. Tüpler yeniden tartıldı ve ilk ve son ağırlıkları arasındaki fark hesaplanmıştır. Veriler istatistiksel olarak tek yönlü ANOVA ve Tukey post-hoc testleri kullanılarak analiz edilmiştir.Bulgular: TFA grubu diğer tüm gruplar ile karşılaştırıldığında önemli ölçüde daha fazla debris taşırmıştır (P0,05). Buna ek olarak, WOG ve FTG grupları arasında apikalden taşan debris miktarında istatistiksel olarak anlamlı bir farklılık bulunmamıştır (P>0,05).Sonuç: Bu çalışmanın koşulları altında, tüm enstrümantasyon sistemleri debrisin apikal ekstrüzyonu ile sonuçlandı. WOG ve PTG enstrümantasyon sistemleri diğer gruplar ile karşılaştırıldığında en az miktarda debris ekstrüzyonuna neden olmuştur. Apikalden taşan debris miktarı, kullanılan enstrümanın metalürjisine, kinematiğine ve tasarımına göre değişebilir., Aim: The aim of present study was to investigate the amount of debris extruded apically during preparation with ProTaper Gold (PTG; Dentsply Maillefer, Ballaigues, Switzerland), WaveOne Gold (WOG; Dentsply Maillefer), One Shape New Generation (OSNG; MicroMega, Besancon, France), Twisted File Adaptive (TFA; SybronEndo, Orange, CA, USA), and K3XF (SybronEndo) nickel-titanium instrumentation systems.Materials and Method: Seventy-five extracted human single-rooted mandibular premolar teeth were randomly assigned to 5 groups (n = 15). The root canals were prepared according to the manufacturers' instructions using the PTG, WOG, OSNG, TFA, and K3XF instruments. Debris apically extruded during instrumentation was collected in pre-weighed eppendorf tubes. The eppendorf tubes were then stored in an incubator at 70°C for 5 days. The tubes were weighed again, and the difference between the initial and final weights was calculated. The data were statistically analyzed using oneway ANOVA and Tukey's post-hoc tests.Results: The TFA group extruded significantly more debris compared with all other groups (P0.05). Additionally, there was no statistical difference between the WOG and PTG groups in the amount of extruded debris (P>0.05).Conclusions: Under the conditions of this study, all instrumentation systems resulted in apical extrusion of debris. The WOG and PTG instrumentation systems caused the least amount of extruded debris compared with the other groups. The amount of apically extruded debris may vary according to metallurgy, kinematics and design of the instrument used.

The objective of this report is to describe the multidisciplinary management of a cervical resorptive defect using periodontal surgery, endodontic treatment, mineral trioxide aggregate (MTA) and composite resin filling. The resorptive defect was obturated using MTA following the reflection of a mucoperiosteal flap and conventional root canal treatment was completed. The cervical extension of the MTA-filled cavity, which was evident following the suturing of the flap, was reduced and filled with a composite filling material. No complaints were noted by the patient and at the 18-month follow-up the prognosis was favorable. By appropriate multidisciplinary management, root resorptions may be treated successfully. MTA may serve as a good option in such situations owing to its multi-beneficial properties.

Objectives: The aim of this study was to obtain information about senior dental students′ perceptions and self-confidence levels regarding endodontic practice. Materials and Methods: Anonymous survey forms were handed out to senior students at Yeditepe University, Faculty of Dentistry. The students were asked to score their level of confidence using a 5-point scale and comment about future practices. Results: The response rate of the survey was 88%. 11.9% expressed endodontics as the first branch in terms of difficulty. The majority (90.5%) indicated they would perform root canal treatments within their expertise limit in the future but refer difficult cases to an endodontist. Bleaching of endodontically treated teeth, managing flare-ups, placement of a rubber dam were procedures in which students reported the lowest confidence (2.55 ± 1.17, 3.24 ± 0.96, 3.24 ± 1.19, respectively). On the other hand, students felt the lowest confidence in the treatment of maxillary molars followed by mandibular molars (3.43 ± 1.02 and 3.93 ± 0.97, respectively). Students also reported the lowest confidence in root resorptions, endo-perio lesions, traumas, retreatments and apexifications (2.93 ± 1.16, 3.07 ± 0.89, 3.24 ± 0.85, 3.33 ± 1.7 and 3.36 ± 1.1, respectively). Conclusions: The results showing students′ lower confidence in more challenging aspects of dentistry may be related with the attitude of dental schools to refer these cases to post graduate students and instilling information about these cases on a theoretical basis only. Though there seems to be a tendency for students to refer challenging cases to a specialist in future, authorities should give priority to enhance the way information and experience is conveyed regarding various aspects of endodontic treatment.

WOS: 000317398200002, PubMed ID: 23484588, Objective: The purpose of this study was to investigate the antibacterial effects of two different types of laser and aqueous ozone in human root canals infected by Enterococcus faecalis. Background data: Many techniques have been developed to find an alternative to sodium hypochlorite as a disinfection agent for infected root canals. However, no study has evaluated the exactly the same antimicrobial agent with sodium hypochlorite (NaOCl). Methods: Eighty mandibular premolar teeth with single roots and canals were selected. Following root canal preparation and irrigation, sterilization was performed in an autoclave. E. faecalis was incubated in the root canals and kept at 37 degrees C for 24 h. The teeth contaminated with E. faecalis were divided into one negative control group (NaOCl) and three experimental groups; (Er: YAG laser, KTP laser, and aqueous ozone groups)(n = 20). A disinfection procedure was performed for 3 min in order to standardize all groups. After this procedure, the microbial colonies were counted. Results: The results indicated that whereas the NaOCl group exhibited the highest antibacterial effect among all groups, the aqueous ozone showed the highest antibacterial effect among the experimental groups. Whereas a statistically significant difference was noted between the aqueous ozone and laser groups (p < 0.05), the difference between the Er: YAG and KTP lasers was not statistically significant (p > 0.05). Conclusions: The results showed that when aqueous ozone was applied with the aim of disinfecting the root canals, it exhibited a higher antibacterial effect than the KTP and Er: YAG lasers. However, the antibacterial effect of the aqueous ozone was insufficient when compared with NaOCl., Scientific Research Unit of Cumhuriyet University (CUBAP) in Sivas, Turkey, The study was financed by the Scientific Research Unit of Cumhuriyet University (CUBAP) in Sivas, Turkey.

The aim of this study was to assess the current status of mineral trioxide aggregate (MTA) as an educational material in dental schools in Turkey. A survey was sent to senior members of the endodontic departments of seventeen dental schools; fourteen responded. All respondents reported that they used MTA in their clinical practice, with apexification, perforations, retrograde fillings, and root resorptions being the most frequently occurring treatment procedures. All reported that information was given to students regarding MTA mainly as part of the curriculum. The third and fourth years were the periods when MTA was introduced to students in most of the schools. Twelve schools reported that students had the opportunity to observe procedures in which MTA was used, but students had the chance to use the material in a very minor proportion of the schools, mainly under the supervision of clinical instructors. Ten schools agreed that MTA should be included in the regular endodontic curriculum. Financial constraints seemed to be the predominant reason for those who answered this question negatively, followed by difficult handling properties and low radiopacity of the material. Within the limitations of this study, it can be concluded that ways should be sought to prevent financial difficulties from depriving dental students of the opportunity to receive information about contemporary methodologies such as MTA utilization.

– Background: The purpose of this study was to compare the fracture resistances of immature teeth treated with MTA along with root canal obturation methods using AH Plus, MetaSEAL, MTA Fillapex sealers + lateral compaction technique, and Unicore quartz fiber posts. Materials and methods: Fifty single-rooted maxillary anterior teeth were divided into five groups. The crowns were dissected and root canals were enlarged. #6 Peeso reamers were allowed to protrude 1 mm. beyond the apex to simulate immature teeth. The apical 4–5 mm of each tooth was filled using Angelus white MTA. The remaining portions of canals were obturated as follows: Group 1: No backfilling (control), Group 2: AH Plus + gutta-percha, lateral compaction, Group 3: MetaSEAL + gutta-percha, lateral compaction, Group 4: MTA Fillapex + gutta-percha, lateral compaction, Group 5: UniCore Fiber posts luted using PermaFlo DC. The specimens were embedded into self-curing acrylic poured into identical cylinders which were mounted on a jig providing a 45° angle. A compressive load increasing at 1 mm min−1 was applied and the maximum load at which fracture occurred was recorded. Statistical analysis was performed using Kruskal–Wallis and Dunn’s multiple tests. Results: The highest fracture resistance was obtained with Group 5 (Fiber posts) whereas Group 4 (MTA Fillapex) yielded the lowest values. The mean fracture resistance value of Group 2 (AH Plus) was significantly higher than Group 4 (MTA Fillapex) (P = 0.001). The mean fracture value of Group 5 (Fiber posts) was significantly higher than Group 2 (AH Plus), Group 3 (MetaSEAL), and Group 4 (MTA Fillapex) (P = 0.02, 0.004, and 0.0001, respectively). Conclusion: Within the limitations of this study, UniCore quartz fiber posts provided the highest resistance. This methodology may specifically be advantageous for teeth with arrest of development at early stages, as these teeth are more susceptible to fracture owing to their excessively weak dentinal walls.

Karapinar-Kazandag M, Bayrak OF, Yalvac ME, Ersev H, Tanalp J, Sahin F, Bayirli G. Cytotoxicity of 5 endodontic sealers on L929 cell line and human dental pulp cells. International Endodontic Journal, 44, 626–634, 2011. Abstract Aim To investigate the cytotoxicity of five root canal sealers on L929 mouse fibroblasts and primary human dental pulp cells. Methodology Cylindrical specimens of AH Plus (Dentsply De Trey GmbH, Konstanz, Germany), RoekoSeal (Coltene Whaledent, Langenau, Germany), EndoREZ (Ultradent Products Inc., South Jordan, UT, USA), Epiphany (Pentron Clinical Technologies, LLCC, Wallingford, CT, USA) and Activ GP (Brasseller Inc., USA, Savannah, GA, USA) were kept at 37 °C in a humidified atmosphere of 5% CO2 for thrice the length of the setting time given by the manufacturer. Extraction of specimens was performed after setting in cell growth medium for 1, 4 and 7 days. Undiluted, 50% and 25% diluted eluates were incubated with cultured cells for 24 and 72 h. Cytotoxicity was assessed using MTS colorimetric bioassay. Kruskal–Wallis test and post hoc Dunn’s multiple comparison test were used to compare the sealers and diluted/undiluted eluates in terms of cell viability (% of control). Friedman test and post hoc Dunn’s multiple comparison test were performed to compare extraction periods. Wilcoxon test was utilized in comparing 24- and 72-h readings. Results Undiluted 1-day eluate of Activ GP was significantly more cytotoxic than all other sealers (P

Introduction The purpose of this study was to evaluate the microtensile bond strength of a total etch (XP-Bond) and a self-etch (Clearfil SE Bond) adhesive system to dentine surfaces treated using endodontic irrigants. Methods Twenty-four freshly extracted third molars were used. After creating a smear layer on the coronal midthird portion of the crowns, the teeth were divided into three groups and surfaces were irrigated with distilled water, 5.25% NaOCl + 17% EDTA, and 1.3% NaOCl + BioPure MTAD, respectively. Each group was divided into two subgroups, and a self-etching adhesive and an etch-and-rinse adhesive were applied respectively. The teeth were restored with a composite material and sectioned to produce sticks for microtensile bond testing. Results The microtensile bond strength of the MTAD + Clearfil SE group was found to be significantly lower than the microtensile bond strength of the distilled water + Clearfil SE Bond group and the NaOCl, EDTA, + Clearfil SE Bond group (p = 0.0001, p = 0.009). Conclusions Because of the significant reduction of Clearfil SE Bond to coronal dentine after MTAD application, an etch-and rinse adhesive such as XP-Bond may be preferred if this irrigant has been chosen during endodontic treatment.

Karapinar Kazandag M, Sunay H, Tanalp J, Bayirli G. Fracture resistance of roots using different canal filling systems. International Endodontic Journal, 42, 705-710, 2009.AbstractAim To evaluate the fracture resistance of teeth filled with various canal filling materials. Methodology The crowns of 100 single-rooted teeth were removed leaving 12 mm of the roots. The canals were shaped using Endo-Sequence files. Following instrumentation, 80 teeth were divided into four groups. The remaining 20 teeth were divided into two groups. The teeth in each group were filled as follows: Group 1: AH-Plus + Gutta-percha (Cold lateral compaction), Group 2: Resilon + Epiphany (Cold lateral compaction), Group 3: ActiV GP cone + ActiV GP sealer, Group 4: ActiV GP sealer + Gutta-percha (Cold lateral compaction), Group 5: No instrumentation or filling, Group 6: Instrumentation but no filling. After the sealers had set, the roots were embedded in acrylic moulds and subjected to a compressive loading at a rate of 1 mm min-1. The load at which fracture occurred was recorded and statistically analysed using Kruskal-Wallis one-way analysis of variance and Z-tests. Results The fracture values of the experimental teeth were significantly higher than those of the instrumented but unfilled group (P < 0.05). Teeth in the AH-Plus + lateral compaction group had higher fracture resistance compared with the ActiV GP sealer + Gutta-percha group (P < 0.05). Conclusions Systems aiming to obtain a monoblock system were not superior to the conventional AH-Plus + Gutta-percha technique in terms of fracture resistance. The fracture resistance of roots using ActiV GP + lateral compaction Gutta-percha was significantly reduced compared with the AH-Plus + Gutta-percha group. © 2009 International Endodontic Journal.

Objective. To comparatively evaluate the amount of apically extruded debris when ProTaper, ProFile, and HERO Shaper were used for the instrumentation of root canals. Study design. Sixty human mandibular central incisor teeth were randomly assigned to 3 groups, 20 teeth in each. The teeth in the 3 groups were instrumented according to the manufacturers' instructions until the working length, with ProTaper, ProFile, and HERO Shaper rotary instruments respectively. The debris produced was collected in polyethylene tubes. The liquid inside the tubes was removed by lyophilization and the remaining debris was calculated for each group and compared. Results. All instruments tested produced a measurable amount of debris. No statistically significant difference was observed between ProTaper and HERO Shaper in terms of debris extrusion (P > .05). Similarly, no statistically significant difference was observed between ProFile and HERO Shaper even though HERO Shaper extruded a relatively higher amount of debris (P > .05). On the other hand, ProTaper extruded significantly more amount of debris compared to ProFile (P < .001). Conclusions. ProTaper caused a significantly higher amount of debris extrusion compared to ProFile. No statistically significant difference was observed among the other groups tested. As the quantity of debris extrusion is not the only factor responsible for acute exacerbations, future studies can be planned that focus on the types of bacteria causing flare-ups and methods for their elimination. © 2006 Mosby, Inc. All rights reserved.

– Aim: The aim of this study was to assess fracture resistances ofsimulated immature single-rooted teeth whose roots have been backfilledusing 3 different post systems after a 4 mm apical mineral trioxide aggre-gate (MTA) placement. Materials and methods: Forty-eight maxillaryanterior teeth were assigned into four groups. The lengths of each rootwere standardized by cutting off the coronal and apical portions to obtain13 1 mm samples and root canals were enlarged. The #6 Peeso reamerswere allowed to protrude 1 mm beyond apex to simulate immature teeth.Apical 4 mm of each tooth was filled using MTA. The remaining portionswere treated as follows: Group 1 (Control): AH Plus + Gutta-percha coldlateral compaction. Group 2: Glass fiber posts (FRC Postec Plus post)cemented using self-adhesive resin cement. Group 3: Quartz fiber posts (D.T. Light post) cemented using self-adhesive resin cement. Group 4:Zirconia posts (Cosmopost) were placed using self-adhesive resin cement.Specimens were embedded in self-curing acrylic. A compressive load wasapplied lingually at a crosshead speed of 1 mm/min at an angle of 45o untilfracture in a universal testing machine. Results: The mean fractureresistances were 823.17 188.80, 1155.50 190.37, 1208.00 254.32, and1153.25 195.71 Newtons for Groups 1, 2, 3, and 4, respectively. Allexperimental groups had significantly higher fracture resistance comparedwith the control group (P 0.05). Conclusions: Allpost systems exerted a similar reinforcing effect to a simulated immaturetooth and may be preferred specifically in situations which requireadditional reinforcement.The management of immature teeth with arrest of rootdevelopment has always been a challenge for the prac-ticing dentist due to a variety of factors. The incom-plete root formation of these teeth renders a sound andreliable root canal treatment extremely difficult and athorough and efficient debridement and disinfection ofthe wide root canal space cannot be ascertained. Incase, traditional intermittent calcium hydroxide medica-tion is selected as the means of inducing apex forma-tion in teeth with halted root development, multiplepatient recalls are necessary and provision of regularpatient attendance for such a prolonged period maysometimes be difficult. Risk of fractures betweenappointments and possibility of recontamination by thedislocation of temporary filling are additional short-comings apexification treatment by calcium hydroxidemay pose (1, 2).To overcome these difficulties, the usage of mineraltrioxide aggregate (MTA) and single-visit apexificationhave recently been advocated and resulted in favorableoutcomes (3–5). MTA is a promising materialdeveloped in the early 1990s consisting of tricalciumoxide and other mineral oxides such as tricalcium sili-cate, silicate oxide, and tricalcium oxide. The low pHof the material, biocompatibility, low cytotoxicity, anti-microbial action, good sealing ability allowing minimalleakage as well as ability to set in the presence of bloodand moisture are all advantages offered by MTA (6–8).With all these advantages and the collection offavorable clinical outcomes, MTA has taken its placein dental literature as an evidence-based and reputablematerial with over 800 articles in the literature assess-ing its properties as well as clinical behavior.The combination of favorable characteristicsoffered by mineral trioxide aggregate and the shortduration and practicality of single-visit apexificationhave rendered apexification with MTA to be a pref-erable treatment option among dental practitioners.Based upon positive reports on the usage of thistechnique, it can be speculated that more widespreadusage of this innovative methodology is anticipatedin the near future.

The purpose of this study was to evaluate the general attitude of senior dental students towards rubber dam use, specifically focusing on endodontic practices prior to starting to serve community. Questionnaires were distributed to senior year students of a private school and a state school in Istanbul. Questions were asked about areas where the students used rubber dam, its advantages and difficulties, and whether they agreed or disagreed with some aspects of the rubber dam. The private school students rated isolation whereas those of the state school selected prevention of aspiration which the top advantage rubber dam provides. Students of the state school agreed with the opinion that isolation cannot be achieved without rubber dam and it extended the procedure with a significantly higher ratio compared to the private school. Within the limitations of the present study, it can be concluded that the perceptions of dental students on rubber dam needs to be improved and strategies should be developed so that this valuable adjunct will comprise one of the indispensable elements of dental care. © 2014 Jale Tanalp et al.

This study evaluated the radiopacity of 3 repair materials, Biodentine, MM-MTA, and MTA Angelus. Standardized cylindrical rings were prepared. Samples of Biodentine MM-MTA and MTA Angelus were prepared (n = 10 in each group), filled into the rings, and preserved at 37°C until setting. A 1 mm thick dentin slice was used as control. All set specimens were removed and radiographed along with the dentine slice and a graduated aluminium step wedge. Digital images were transferred to the computer using a software. The radiographic densities of the specimens were determined, and the values were converted into millimetres of aluminium (mm Al). One-way ANOVA was used for intergroup comparison, whereas Tukey HSD test was used for detecting the group with the difference. The mean radiopacities of Biodentine, MTA Angelus, and MM-MTA were 2.8 ± 0.48, 4.72 ± 0.45, and 5.18 ± 0.51 mm Al, respectively. The radiopacity of Biodentine was significantly lower compared to other materials (P = 0.001), whereas no significant difference was noted between MTA Angelus and MM-MTA (P = 0.109). All materials had significantly higher radiopacities compared to dentine. The relatively lower radiopacity of Biodentine can be improved to achieve more reliable results in procedures such as retrograde fillings. © 2013 Jale Tanalp et al.

Aim. The purpose of this clinical study was to evaluate the general incidence of post-operative pain and flare-ups in patients who were endodontically treated by two endodontics specialists using rotary instruments (Hero 642, Micro Mega, France) with the same treatment protocol. Methods. Records of 382 teeth belonging to 268 patients treated by two endodontics specialists during a 6-month period were kept and evaluated. Post-operative pain between treatment visits was categorized using a pre-established scoring system. Ninety-five patients were males, whereas 173 were females. Results. Pulpal necrosis without periapicalpathosiswas determined as the most common indication for endodontic treatment (21.7%) followed by irreversible pulpitis and re-Treatment without periapical lesions (18.3%, 18.3%, respectively). The general prevalence of post-operative pain and flare-ups was determined as 8.1%, whereas cases that could be classified as real flare-ups which were severe and required an unscheduled visit (scores 2 and 3) comprised 3.4% of the cases. No statistically significant correlation was determined between gender and post-operative pain and flare-up (p = 0.05). There was a significant correlation between number of appointments and the presence of pain and flare-ups. Teeth undergoing multiple visits had a higher risk of developing post-operative pain and flare-ups compared to those with single appointments with a statistical significance (p = 0.03). Conclusions. Teeth with pre-operative pain were more prone to developingpost-operative pain and discomfort with a statistically significant difference (p = 0.02). While no significant correlation was determined between tooth vitality and pain and flare-ups (p = 0.5), a statistically significant relationship existed between the presence of a periapicalpathosisand post-operative pain and flare-ups. Cases with a periapical lesion had a higher risk of developingpain and flare-upscompared to those with no periapical involvement (p = 0.0001). Future studies may focus on the influence of rotary instrumentation systems in more specific groups of cases. Meanwhile; microbiological as well as psychological aspects of flare-ups are topics that warrant further investigation. © 2013 Informa Healthcare.

Intraradicular posts are useful adjuncts in the restoration of endodontically treated teeth. These systems have undergone a significant evolution in recent years, and fiber-reinforced systems have started to be incorporated into routine clinical care more frequently. Despite the high number of laboratory studies pertaining to the characteristics of fiber posts, clinical studies evaluating their general success rates are rather limited. Since clinical investigations are reliable means to achieve information about the general behavior pattern of materials or techniques, assessment of this data will be beneficial to have a better understanding of fiber-reinforced intraradicular post systems. The purpose of this paper was to make a summary of clinical studies regarding various fiber posts. A PubMed search was conducted and articles dating back to 1990 were retrieved. The paper provides an overview of clinical studies on fiber posts specifically in the last decade as well as commentary analysis.

Extrusion of intracanal debris as well as irrigants is a common occurrence during root canal treatment, and no instrument or technique has thoroughly solved this problem. Because flare-ups may arise with any irritation directed towards periapical tissues, a shaping or irrigation technique should minimize the risk of apical extrusion, even though it may not be prevented. There has been a rapid evolution of root canal instruments and irrigation systems through the last decade, and many have been assessed for their debris extrusion potential. The purpose of this review was to identify publications regarding the evaluation of debris, bacteria and irrigant extrusion during root canal treatment. A PubMed, Ovid and MEDLINE search was conducted using the keywords “apical extrusion”, “debris extrusion” and “endodontic treatment”. The literature search extended over a period of more than 30 years up to 2012. Content of the review was limited to apical extrusion of debris and irrigants, extrusion of liquid by irrigation methods and bacterial extrusion. Issues relevant to apical extrusion were obtained by further search in the reference sections of the retrieved articles. The review provides an update on the current status of apical extrusion.

The purpose of this review was to summarize recent developments regarding photodynamic therapy (PDT) in the field of dentistry.A review of pertinent literature was carried out in PubMED to determine the current position of PDT applications in dentistry. One hundred thirteen relevant articles were retrieved from PubMED by inserting the keywords "photodynamic therapy", "dentistry", "periodontology", "oral surgery", and "endodontics". It is anticipated that this overview will create a specific picture in the practitioner's mind regarding the current status and use of PDT.In spite of different results and suggestions brought about by different researchers, PDT can be considered as a promising and less invasive technique in dentistry.PDT seems to be an effective tool in the treatment of localized and superficial infections. Within the limitations of the present review, it can be concluded that although PDT cannot replace antimicrobial therapy at its current stage, it may be used as an adjunctive tool for facilitating the treatment of oral infections.Oral infections (such as mucosal and endodontic infections, periodontal diseases, caries, and peri-implantitis) are among the specific targets where PDT can be applied. Further long-term clinical studies are necessary in establishing a more specific place of the technique in the field of dentistry.

The purpose of this study was to compare the fracture resistances of immature teeth treated with MTA along with root canal obturation methods using AH Plus, MetaSEAL, MTA Fillapex sealers + lateral compaction technique, and Unicore quartz fiber posts. Fifty single-rooted maxillary anterior teeth were divided into five groups. The crowns were dissected and root canals were enlarged. #6 Peeso reamers were allowed to protrude 1 mm. beyond the apex to simulate immature teeth. The apical 4-5 mm of each tooth was filled using Angelus white MTA. The remaining portions of canals were obturated as follows: Group 1: No backfilling (control), Group 2: AH Plus + gutta-percha, lateral compaction, Group 3: MetaSEAL + gutta-percha, lateral compaction, Group 4: MTA Fillapex + gutta-percha, lateral compaction, Group 5: UniCore Fiber posts luted using PermaFlo DC. The specimens were embedded into self-curing acrylic poured into identical cylinders which were mounted on a jig providing a 45° angle. A compressive load increasing at 1 mm min(-1) was applied and the maximum load at which fracture occurred was recorded. Statistical analysis was performed using Kruskal-Wallis and Dunn's multiple tests. The highest fracture resistance was obtained with Group 5 (Fiber posts) whereas Group 4 (MTA Fillapex) yielded the lowest values. The mean fracture resistance value of Group 2 (AH Plus) was significantly higher than Group 4 (MTA Fillapex) (P = 0.001). The mean fracture value of Group 5 (Fiber posts) was significantly higher than Group 2 (AH Plus), Group 3 (MetaSEAL), and Group 4 (MTA Fillapex) (P = 0.02, 0.004, and 0.0001, respectively). Within the limitations of this study, UniCore quartz fiber posts provided the highest resistance. This methodology may specifically be advantageous for teeth with arrest of development at early stages, as these teeth are more susceptible to fracture owing to their excessively weak dentinal walls.

Objective: The aim of this study was to evaluate the microleakage of Resilon + Epiphany, EndoRez, Activ GP, and conventional AH Plus + gutta-percha technique using the glucose filtration model. Study design: One hundred twenty maxillary incisors were divided into 5 experimental and 2 control groups. After root canal shaping, the experimental groups were filled with AH Plus + gutta-percha (lateral compaction), Resilon + Epiphany (lateral compaction), AH Plus + Protaper's proprietory cone, EndoRez + sealer, or Activ GP + sealer). The specimens were mounted on a glucose model and samples were taken for 3 weeks for leakage measurement. Results: No statistically significant difference was observed between the leakage of all groups at the 3 testing periods (P >.05). Conclusion: The filling materials with the monoblock concept do not seem to be superior to the conventional AH Plus + gutta-percha system regarding microleakage. © 2010 Mosby, Inc. All rights reserved.

This article reports the endodontic and surgical management and 12-month follow-up of a maxillary lateral incisor diagnosed as type III dens invaginatus. A 21-year-old male patient presented to our clinics with complaints of pain and swelling in the right maxillary region. Intraoral and radiographical examination disclosed the presence of a peg-shaped maxillary right lateral incisor diagnosed as type III dens invaginatus. Root canal treatment combined with periapical surgery was initiated. After the completion of root canal treatment for both maxillary right central and lateral incisors, periapical surgery was scheduled. During the surgery, periapical granulation tissue was curreted and bovine-derived hydroxil apatite (Unilab-Surgibone, Mississauga, Ontario, Canada) covered with collagen membrane (Unilab-Surgibone) was placed in the resorptive areas. ProRoot MTA (Dentsply, Tulsa, OK) was placed as a root end filling material. Postoperative 12-month follow-up revaled a satisfactory healing process. © 2008 Mosby, Inc. All rights reserved.

Toothpastes are definitely one of the indispensable elements of oral health care. They are produced to serve multiple purposes and possess complex chemical structures. Slight abrasion, froth, sweetening, bleaching, prevention of plaque, calculus and decay are properties expected from an ideal toothpaste. In recent years, allergic reactions have started to appear more frequently in dental practice. The present case describes the progression of an allergic response to toothpastes, one of the basic agents of oral hygiene.

Aim: To investigate the prevalence of apical periodontitis and the quality of root canal treatment in an adult Turkish population who visited a university dental clinic. Summary: The periapical status of 8863 teeth belonging to 375 patients was evaluated by two pre-calibrated observers from panoramic radiographs. The presence of apical periodontitis, and the prevalence and quality of root fillings were recorded. The relationship between the radiographic quality of root fillings and apical periodontitis was examined by chi-squared statisticl-analysis. Of 8863 teeth, 470 (5.3%) had undergone root canal treatment. Forty-seven per cent of all the subjects had at least one root-filled tooth. Periapical radiolucencies were visible on 4.2% of teeth examined, with 53.5% of root-filled teeth presenting apical periodontitis. Ninety-one per cent of root-filled teeth with periapical pathosis were determined to have inadequate root fillings. A statistically significant correlation was found between the quality of root fillings and the presence of apical periodontitis (P < 0.05). Key learning points: • The radiographic quality of root fillings correlated with periapical radiographic signs of pathosis in a selected population of Turkish adults. • There is a need to improve the standards of root canal treatment in the study population. © 2007 International Endodontic Journal.

Sinus tracts are paths of drainage for abscesses and can occur both intraorally and extraorally. It is a fact that sinus tracts can heal with proper endodontic therapy. However, there are those types that are persistent and will not respond to any treatment. In these perplexing cases, it may be necessary to elevate a surgical flap to unveil the real etiologic factor. In this article, a case is presented in which 2 persistent and nonhealing sinus tracts were observed around the maxillary left incisor area of a 53-year-old female patient. A difficult cast post-and-core removal had been accomplished to the compromised tooth 1 year previously. A surgical flap had to be reflected, and the cause of the persistent inflammation was determined to be 2 separate root perforations. The granulation tissue was removed, the perforations were sealed with mineral trioxide aggregate, and bone graft was packed in the resorptive bone areas. The symptoms subsided by the time of the 2-week recall. No complaints were noted from the patient during the 4-month follow-up period. This case is a good example that demonstrates the possible complications of post preparation and the necessity of explorative surgery for unveiling the etiologic factor of persistent sinus tract formation.

Aim: To describe the development of a delayed type allergic reaction 24 h following the use of nonlatex rubber dam during endodontic treatment. The symptoms were alleviated with adequate medication; however, the patient rejected any further analysis. Summary: In recent years, allergic reactions because of latex rubber dam and gloves have received more attention. Nonlatex products are advocated in clinical use in cases where the patient presents an allergic background. Although rare, adverse reactions may be encountered even with these products. In this article, a very rare case is presented in which a patient developed signs of allergy 24 h after the utilization of nonlatex rubber dam and gloves during endodontic treatment. Signs including visible redness on the mucosa, submucosal oedema and desquamation in the vestibular mucosa were observed. With proper medication, the signs and symptoms were alleviated. Although the patient was referred to an allergy specialist for patch testing, she did not accept any further analysis. Key learning points: This case emphasizes the necessity of precautions during the management of latex-allergic patients in clinical practice. The unusual response encountered in this patient does not undermine the usefulness of nonlatex rubber dam and gloves in sensitive individuals. © 2006 International Endodontic Journal.

Objectives. To comparatively evaluate the shaping efficacies of HERO Shaper rotary instruments and Nitiflex hand files. Study design. The mesial roots of 40 mandibular molars were used. In 20 teeth, the mesiobuccal canals were instrumented with HERO Shaper and the mesiolingual canals with Nitiflex. In the remaining 20 teeth, the mesiobuccal canals were instrumented with Nitiflex and the mesiolingual canals with HERO Shaper. Pre- and postoperative sections were obtained from the coronal, middle, and apical portions and analyzed. Statistical analysis was performed using the Student t test. Results. More dentin was removed from the middle portion with HERO Shaper (P < .05). No statistically significant difference was observed in terms of transportation (P > .05). No instrument fracture or deformation was noted. Conclusions. Both HERO Shaper and Nitiflex can be recommended for clinical practice. Further studies can focus on the comparison of HERO Shaper with other rotary instruments as there is an increasing trend for the utilization of these systems. © 2005 Elsevier Inc. All rights reserved.

Aim To investigate the root and canal morphology of mandibular permanent teeth collected from an indigenous Turkish population. Methodology A total of 1400 extracted mandibular permanent teeth were evaluated. The teeth were divided into seven groups as central incisors, lateral incisors, canines, first premolars, second premolars, first molars and second molars in order to evaluate their root canal configurations. Access cavities were prepared and pulp tissue removed using 5.25% sodium hypochlorite solution. The teeth were stored in 5% nitric acid solution for 5 days, then rinsed under running water for 4 h and placed in increasing concentrations of ethyl alcohol. The teeth were rendered transparent by immersion in xylene solution for 3 days until complete transparency was achieved. Following this procedure, India ink was injected in the root canal systems and their configurations were examined and compared with the classification of Vertucci. The following observations were made: (i) root canal classification of mandibular teeth; (ii) morphology of the mandibular permanent teeth. The classification of Vertucci was taken as a reference during the evaluation; however additional canal morphological types were evaluated as separate groups. Results The presence of a second canal was detected in 68% of mandibular central incisors and 63% of lateral incisors. Lateral canals were found in 6.5% of mandibular central incisors and in 13% of lateral incisors. Overall, 62% of mandibular first premolar teeth had a single canal whereas 71% of second premolars had a single canal. The mandibular first and second molar teeth exhibited similar root canal configurations except for a group of second molar teeth that had a single root and canal. Conclusions The morphological characteristics of teeth in this Turkish population were consistent with those of other studies performed on different populations using similar methodology.

Aim The purpose of this study was to evaluate the fracture resistance of endodontically treated maxillary central incisors restored with quartz fiber posts, composite cores, and crowns when different types of ferrule designs were incorporated. Methods and Materials Sixty maxillary incisors were divided into six groups: Group 1 (control): teeth with root canal treatments having a full crown prosthesis; Group 2: teeth with a 2 mm circumferential ferrule; Group 3: teeth with a 2 mm ferrule only in the vestibular region; Group 4: teeth with a 2 mm ferrule only in the palatal region; Group 5: teeth with a 2 mm ferrule in the vestibular and palatal region, having cavities in both proximal areas; and Group 6: teeth with no ferrule. The teeth in the experimental groups were restored with quartz fiber posts-composite cores and full metallic crowns. All experimental teeth were subjected to an increasing compressive force with a crosshead speed of 1 mm/min, until fracture occurred. Results The median fracture values of groups were as follows: Group 1: 574.4 N, Group 2: 472.4 N, Group 3: 474.3 N, Group 4: 480.7 N, Group 5: 463.1 N, and Group 6: 297.9 N. A statistically significant difference was found between Group 1 and Group 6 (p< 0.01). Conclusion It was concluded different ferrule designs did not have any influence on the fracture resistance of teeth with fiber posts. The results of this study indicate fiber posts can safely be used for their reinforcing properties. Furthermore, there is no significant change in the resistance of teeth with fiber posts regardless of which ferrule design is incorporated. The property of these types of posts is an additional advantage in clinical practice. Citation Dikbas I, Tanalp J, Ozel E, Koksal T, Ersoy M. Evaluation of the Effect of Different Ferrule Designs on the Fracture Resistance of Endodontically Treated Maxillary Central Incisors Incorporating Fiber Posts, Composite Cores and Crown Restorations. J Contemp Dent Pract 2007 November; (8)7:062-069.

The aim of this study was to evaluate radiographically the periapical status and technical standard of root canal therapies performed by a group of undergraduate dental students in Turkey two years following completion of the treatments. A random sample of 264 patients who received root canal treatment from undergraduate students at the Yeditepe University Faculty of Dentistry in 2009 were recalled after two years. The study sample consisted of 319 root-filled teeth in 158 dental patients (females=97, males=61) who presented to the student clinics during that time frame. For each root-filled tooth, two periapical radiographs were examined to identify the periapical status, one showing pre-treatment and the other showing post-treatment status. The quality of endodontic treatment was examined according to the distance between the end of root filling and radiographic apex and the density of the obturation according to presence of voids within the root filling material. This examination found that 54.2 percent of roots had fillings of acceptable length, while 37.3 percent were short, 7.8 percent were overfilled, and 0.6 percent was unfilled; 2.5 percent of the teeth were observed with broken root canal instruments. After two years, PAI scores of teeth with acceptable length of root canal filling (0-2 mm from the radiographic apex) were found to be lower than those of the overfilling and short filling cases (>2mm) (p

Sinus tracts are paths of drainage for abscesses and can occur both intraorally and extraorally. It is a fact that sinus tracts can heal with proper endodontic therapy. However, there are those types that are persistent and will not respond to any treatment. In these perplexing cases, it may be necessary to elevate a surgical flap to unveil the real etiologic factor. In this article, a case is presented in which 2 persistent and nonhealing sinus tracts were observed around the maxillary left incisor area of a 53-year-old female patient. A difficult cast post-and-core removal had been accomplished to the compromised tooth 1 year previously. A surgical flap had to be reflected, and the cause of the persistent inflammation was determined to be 2 separate root perforations. The granulation tissue was removed, the perforations were sealed with mineral trioxide aggregate, and bone graft was packed in the resorptive bone areas. The symptoms subsided by the time of the 2-week recall. No complaints were noted from the patient during the 4-month follow-up period. This case is a good example that demonstrates the possible complications of post preparation and the necessity of explorative surgery for unveiling the etiologic factor of persistent sinus tract formation.

The purposes of this study were to obtain information about the social and demographic profile of students enrolled in the first private Turkish dental school, to gather information regarding the reasons for their preferences, and to obtain data about their career expectations. Questionnaires were distributed to 278 students; 229 returned the survey for an overall response rate of 82 percent. Of the respondents, 145 (65.5 percent) were females and seventy-five (34.5 percent) were males; they had an average age of 21.62±1.58. First degree relative (mother, father, sibling) had the greatest influence on the students in choosing dentistry as a career. Fathers and mothers had similar impact on the students' choice of dental profession (45.9 percent and 46.6 percent, respectively). Humanistic feelings, desire to serve others, and reasonable working hours were the predominant reasons that motivated females to become a dentist (p