Evaluation of the physical and chemical properties of two commercial and three experimental root-end filling materials

Objective. The aim of this study was to evaluate the pH, calcium release, setting time, and solubility of two commercially available mineral trioxide aggregate (MTA) cements (white MTA Angelus and MTA Bio), and of three experimental cements (light-cured MTA, Portland cement with 20% bismuth oxide and 5% calcium sulfate, and an epoxy resin-based cement). Study design. For evaluation of pH and calcium ion release, polyethylene tubes with 1.0 mm internal diameter and 10.0 mm length were filled with the cements and immediately immersed in flasks containing 10 mL deionized water. After 3, 24, 72, and 168 hours, the tubes were removed and the water from the previous container was measured for its pH and calcium content with a pH meter and an atomic absorption spectrophotometer. For analysis of the setting time, Gilmore needles weighing 100 g and 456.5 g were used, in accordance with the American Society for Testing and Materials specification no. C266-03. Solubility of each cement was also tested. Results. All the cements were alkaline and released calcium ions, with a declining trend over time. After 3 hours, Portland cement + bismuth oxide and MTA Bio had the highest pH and light-cured MTA the lowest. After 1 week, MTA Bio had the highest pH and light-cured MTA and epoxy resin-based cement the lowest. Regarding calcium ion release, after 3 hours, Portland cement + bismuth oxide showed the highest release. After 1 week, MTA Bio had the highest. Epoxy resin-based cement and light-cured MTA had the lowest calcium release in all evaluation periods. Regarding setting times, white MTA Angelus and MTA Bio had the shortest, Portland cement + bismuth oxide had an intermediate setting time, and the epoxy resin-based cement had the longest. The materials that showed the lowest solubility values were the epoxy resin-based cement, Portland cement + bismuth oxide, and light-cured MTA. The highest solubility values were presented in white MTA Angelus and MTA Bio. Conclusions. The white MTA Angelus and MTA Bio had the shortest setting times, higher pH and calcium ion release, and the highest solubility. In contrast, the epoxy resin-based cement and light-cured MTA showed lower values of solubility, pH, and calcium ion release. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 110: 250-256)

An ex vivo comparison of root canal length determination by three electronic apex locators at positions short of the apical foramen

Objective. The aim of this study was to evaluate the precision of working length determination of 3 electronic apex locators (EALs): Root ZX, RomiApex D-30, and Ipex at 0.0 mm, at the apical foramen (AF), and at 1.0 mm short of the AF. Methodology. Thirty-eight mandibular premolars had their real lengths previously determined. Electronic measurements were determined at 1.0 mm, followed by measurements at 0.0 mm, performed in triplicate. Results. Precision of devices at 1.0 mm and 0.0 mm were: 94.7% and 97.4%, respectively (Root ZX); 78.9% and 97.4% (RomiApex D-30); and 76.3% and 97.4% (Ipex). Although no statistical differences were observed between the EALs at 0.0, at 1.0 mm Root ZX performed significantly better than the others. Conclusion. The EALs had acceptable precision when measuring the working length at the AF. However, when used at levels short of the AF, only Root ZX did not suffer a significant negative effect on precision. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;110:e57-e61)

Root Canal Area Increase Promoted by the EndoSequence and ProTaper Systems: Comparison by Computed Tomography

Introduction: The aim of this study was to compare the increase of the root canal area after instrumentation with EndoSequence or ProTaper rotary systems. Methods: Twenty-two mesial root canals from mandibular molars were instrumented. Teeth were mounted on a base, numbered, and divided into 2 groups; teeth from 1-11 (PT group) were instrumented by using the ProTaper system, and teeth from 12-22 (ES group) were instrumented by using the EndoSequence system. Cone beam computed tomography was performed on all teeth before and after instrumentation. Measurements at 3,5, and 7 mm as well as differences in instrument performance were statistically compared by the Student t test at 5% significance level. Results: Both systems increased significantly the root canal area (P < .05) at all levels. Comparison between the rotary systems showed significantly greater increase (P < .05) for EndoSequence at 3 mm, with no statistically significant difference (P < .05) at the other levels. Conclusions: Both rotary systems increased significantly the root canal area. (J Endod 2010;36:1179-1182)

Depth and percentage of penetration of endodontic sealers into dentinal tubules after root canal obturation using a lateral compaction technique: A confocal laser scanning microscopy study

Objective. The aim was to compare the percentage and depth of sealer penetration into dentinal tubules during obturation using Sealer 26, GuttaFlow, or Sealapex in root canals filled with the lateral compaction technique. Study design. Thirty root canals filled with the lateral compaction technique using GuttaFlow (n = 10), Sealapex (n = 10), or Sealer 26 (n = 10) were analyzed using confocal microscopy. The teeth were sectioned at 3 and 5 mm from the apex, and statistical analyses was performed using analysis of variance-Tukey test (P < .05). Results. Sealapex showed the deepest sealer penetration at both levels evaluated (P < .05). No statistically significance was found between Sealer 26 and GuttaFlow at the 3 mm and 5 mm levels. No statistical significance was found in the percentage of penetration around the root canal wall among the 3 sealers evaluated at both levels. Conclusions. Although Sealapex displayed deeper penetration into the dentinal tubules there was no difference in the percentage of adaptation to the root canal walls among the 3 sealers evaluated. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 108: 450-457)

Evaluation of pH and calcium ion release of new root-end filling materials

Objective. The purpose of this study was to evaluate the pH and calcium ion release of 6 materials used for root-end filling and perforation repair. Study design. Gray ProRoot MTA, gray MTA-Angelus, white MTA-Angelus, and CPM were compared to 2 experimental ones: MTA-exp, also based in Portland cement with a modified mixing liquid, and MBPc, an epoxy-resin based cement containing calcium hydroxide. After 3, 24, 72, and 168 hours the water in which each sample had been immersed was tested to determine the ph and calcium ion release. Results. All the analyzed materials showed alkaline pH and capacity to release calcium ions; however, a tendency of reduction of these characteristics was noted for all the analyzed materials, except for the MBPc, which showed a slight increase of pH among the 3 initial periods. Conclusion. The results suggest that all materials investigated presented alkaline pH and ability of release of calcium ions. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 108: 135-139)

Flat-Oval Root Canal Preparation with Self-Adjusting File Instrument: A Micro-Computed Tomography Study

Introduction: The aim of this study was to evaluate the root canal preparation in flat-oval canals treated with either rotary or self-adjusting file (SAF) by using micro-tomography analysis. Methods: Forty mandibular incisors were scanned before and after root canal instrumentation with rotary instruments (n = 20) or SAF (n = 20). Changes in canal volume, surface area, and cross-sectional geometry were compared with preoperative values. Data were compared by independent sample t test and chi(2) test between groups and paired sample t test within the group (alpha = 0.05). Results: Overall, area, perimeter, roundness, and major and minor diameters revealed no statistical difference between groups (P > .05). In the coronal third, percentage of prepared root canal walls and mean increases of volume and area were significantly higher with SAF (92.0%, 1.44 +/- 0.49 mm(3), 0.40 +/- 0.14 mm(2), respectively) than rotary instrumentation (62.0%, 0.81 +/- 0.45 mm(3), 0.23 +/- 0.15 mm2, respectively) (P < .05). SAF removed dentin layer from all around the canal, whereas rotary instrumentation showed substantial untouched areas. Conclusions: In the coronal third, mean increases of area and volume of the canal as well as the percentage of prepared walls were significantly higher with SAF than with rotary instrumentation. By using SAF instruments, flat-oval canals were homogenously and circumferentially prepared. The size of the SAF preparation in the apical third of the canal was equivalent to those prepared with #40 rotary file with a 0.02 taper. (J Endod 2011;37:1002-1007)

Bond strength of Epiphany (TM) Sealer combined with different adhesive systems photo-activated with LED and QTH

The Epiphany (TM) Sealer is a new dual-curing resin-based sealer and has been introduced as an alternative to gutta-percha and traditional root canal sealers. The canal filling is claimed to create a seal with the dentinal tubules within the root canal system producing a `monoblock` effect between the sealer and dentinal tubules. Therefore, considering the possibility to incorporate the others adhesive systems, it is important to study the bond strength of the resulting cement. Forty-eight root mandibular canines were sectioned 8-mm below CEJ. The dentine discs were prepared using a tapered diamond bur and irrigated with 1% NaOCl and 17% EDTA. Previous the application Epiphany (TM) Sealer, the Epiphany (TM) Primer, AdheSE, and One Up Bond F were applied to the root canal walls. The LED and QTH (Quartz Tungsten Halogen) were used to photo-activation during 45 s with power density of 400 and 720 mW/cm(2), respectively. The specimens were performed on a universal testing machine at a cross-head speed of 1 mm/min until bond failure occurred. The force was recorded and the debonding values were used to calculate Push-out bond strength. The analysis of variance (ANOVA) and Tukey`s post-hoc tests showed significant statistical differences (P < 0.05) to Epiphany (TM) Sealer/Epiphany (TM) Primer/QTH and EpiphanyTM Sealer/AdheSE/QTH, which had the highest mean values of bond strength. The efficiency of resin-based filling materials are dependent the type of light curing unit used including the power density, the polymerization characteristics of these resin-based filling materials, depending on the primer/adhesive used.

Atomic Absorption Spectrometry and Scanning Electron Microscopy Evaluation of Concentration of Calcium Ions and Smear Layer Removal With Root Canal Chelators

Aim. The aim of this study was to evaluate the concentration of calcium ions and smear layer removal by using root canal chelators according to flame atomic absorption spectrophotometry and scanning electron microscopy. Forty-two human maxillary central incisors were irrigated with 15% ethylenediaminetetraacetic acid (EDTA), 10% citric acid, 10% sodium citrate, apple vinegar, 5% acetic acid, 5% malic acid, and sodium hypochlorite. The concentration of calcium ions was measured by using flame atomic absorption spectrometry, and smear layer removal was determined by scanning electron microscopy. Mean +/- standard deviation, one-way analysis of variance, Tukey-Kramer, Kruskal-Wallis, Dunn, and kappa tests were used for statistical analysis. The use of 15% EDTA resulted in the greatest concentration of calcium ions followed by 10% citric acid; 15% EDTA and 10% citric acid were the most efficient solutions for removal of smear layer. (J Endod 2009;35:727-730)

Quantitative 3D profilometry and SEM analysis of the adaptation of root-end filling materials placed under an optical microscope

P>Aim To evaluate by 3D profilometry and scanning electron microscopy (SEM), the marginal adaptation of mineral trioxide aggregate (MTA) and Sealer 26 placed in root-end cavities with direct vision or under an optical microscope. Methodology The root ends of 52 root filled canine teeth were filled with MTA or Sealer 26 under direct vision or optical microscope (n = 13). In each group, eight specimens were analysed by profilometry for measurement of the area and depth of gaps. In the other five specimens, gap area was measured using SEM to verify marginal adaptation and surface characteristic. Data were analysed by parametric (anova and Tukey) and non-parametric (Kruskal-Wallis and Dunn) tests. Results The assessment of the adaptation of both materials to dentine was not influenced by the mode of visualization, which was confirmed by both profilometry and SEM observations. The voids measured with profilometry for Sealer 26 under direct vision were significantly wider and deeper than those for MTA under direct vision (P < 0.05). In SEM, significantly larger gap areas were observed with Sealer 26 (P < 0.05). Conclusion Root-end cavities filled with MTA had smaller gaps and better marginal adaptation than Sealer 26.

Temperature variation at the external root surface during 980-nm diode laser irradiation in the root canal

Objective: To assess the temperature variation in the cervical, middle and apical thirds of root external wall, caused by 980-nm diode laser irradiation with different parameters. Methods: The roots of 90 canines, had their canals instrumented and were randomly distributed into 3 groups (n = 30) according to the laser potency (1.5 W, 3.0 W and 5.0 W). Each group was subdivided into 3 (n = 10) according to the frequency (CM, 100 Hz and 1000 Hz), and each subgroup divided into 2 (n = S): dried canal or filled with distilled water. The maximum temperature values were collected by 3 thermocouples located at each third of the root external wall and recorded by digital thermometers. Results: The groups irradiated in the continuous mode (CM) presented the highest values (11.82 +/- 5.78), regardless of the canals were dry or not, which were statistically different (p < 0.01) from those obtained with 100 Hz (6.22 +/- 3.64) and 1000 Hz (6.00 +/- 3.36), which presented no statistical difference between them (p > 0.01). The groups irradiated with 5.0 W presented the greatest temperature variation (12.15 +/- 5.14), followed by 3.0 W (7.88 +/- 3.92) and 1.5 W (4.02 +/- 2.16), differing between them (p < 0.01). The cervical third of the root presented the highest temperature rises (9.68 +/- 5.80), followed by the middle (7.66 +/- 4.87) and apical (6.70 +/- 4.23), with statistical difference among them (p < 0.01). After 30 s from the end of irradiation, all the specimens presented temperature variation lower than 10 degrees C. Conclusions: Application of 980-nm diode laser in the root, at 1.5 W in all operating modes, and 3.0 W, in the pulsed mode, for 20 s, can safely be used in endodontic treatment, irrespective of the presence of humidity. (C) 2008 Elsevier Ltd. All rights reserved.

Effect of 980-nanometer diode laser on root canal permeability after dentin treatment with different chemical solutions

This study evaluated the effect of 980-nm diode laser at different parameters on root canal dentin permeability associated with different irrigants. Seventy-five canines were sectioned at 15 mm from the apex, prepared mechanically up to #40 .02 instrument, and irrigated with 2 mL distilled water. Final irrigation (10 mL) was used as follows: (1) distilled water; (2) 1% NaOCl; (3) 17% ethylenediaminetetraacetic acid + a cationic surfactant cetyltrimethylammonium bromide (EDTAC). Laser was applied at 1.5 or 3.0 W as either continuous wave or pulsed wave (100 Hz). The teeth were then processed histochemically, the percentage of copper ion penetration into the dentin of the canal walls was counted, and the data were analyzed statistically with the Tukey-Kramer test (alpha < .01). When laser was associated with water, an increase in permeability was found, whereas permeability decreased when associated with EDTAC. Dentin permeability after laser irradiation was directly dependent on the solution used for final irrigation.

Effect of Chelating Solutions on the Microhardness of Root Canal Lumen Dentin

Introduction: The greatest reduction in microhardness of the most superficial layer of dentin of the root canal lumen is desired. The use of chelating agents during biomechanical preparation of root canals removes smear layer, increasing the access of the irrigant into the dentin tubules to allow adequate disinfection, and also reduces dentin microhardness, facilitating the action of endodontic instruments. This study evaluated the effect of different chelating solutions on the microhardness of the most superficial dentin layer from the root canal lumen. Methods: Thirty-five recently extracted single-rooted maxillary central incisors were instrumented, and the roots were longitudinally sectioned in a mesiodistal direction to expose the entire canal extension. The specimens were distributed in seven groups according to the final irrigation: 15% EDTA, 10% citric acid, 5% malic acid, 5% acetic acid, apple vinegar, 10% sodium citrate, and control (no irrigation). A standardized volume of 50 mu L of each chelating solution was used for 5 minutes. Dentin microhardness was measured with a Knoop indenter under a 10-g load and a 15-second dwell time. Data were analyzed statistically by one-way analysis of variance and Tukey-Kramer multiple-comparison test at 5% significance level. Results: EDTA and citric acid had the greatest overall effect, causing a sharp decrease in dentin microhardness without a significant difference (p > .05) from each other. However, both chelators differed significantly from the other solutions (p < .001). Sodium citrate and deionized water were similar to each other (p > .05) and did not affect dentin microhardness. Apple vinegar, acetic acid, and malic acid were similar to each other (p > .05) and presented intermediate results. Conclusion: Except for sodium citrate, all tested chelating solutions reduced microhardness of the most superficial root canal dentin layer. EDTA and citric acid were the most efficient. (J Endod 2011;37:358-362)

In vitro evaluation of the temperature increment at the external root surface after Er,Cr: YSGG laser irradiation of the root canal

Objectives: A study was made to determine the temperature increment at the dental root surface following Er,Cr:YSGG laser irradiation of the root canal. Design. Human canines and incisors previously instrumented to K file number ISO 30 were used. Irradiation was carried out with glass fiber endodontic tips measuring 200 μm in diameter and especially designed for insertion in the root canal. The teeth were irradiated at 1 and 2 W for 30 seconds, without water spraying or air, and applying a continuous circular movement (approximately 2 mm/sec.) in the apico-coronal direction. Results: At the 1 W power setting, the mean temperature increment was 3.84ºC versus 5.01ºC at 2 W. In all cases the difference in mean value obtained after irradiation versus the mean baseline temperature proved statistically significant (p< 0.05). Conclusions: Application of the Er,Cr:YSGG laser gives rise to a statistically significant temperature increment at the external root surface, though this increment is probably clinically irrelevant, since it would appear to damage the tissues (periodontal ligament and alveolar bone) in proximity to the treated tooth

Microbial culture and checkerboard DNA-DNA hybridization assessment of bacteria in root canals of primary teeth pre- and post-endodontic therapy with a calcium hydroxide/chlorhexidine paste

Aim. To investigate the root canal microbiota of primary teeth with apical periodontitis and the in vivo antimicrobial effects of a calcium hydroxide/chlorhexidine paste used as root canal dressing. Design. Baseline samples were collected from 30 root canals of primary teeth with apical periodontitis. Then, the root canals were filled with a calcium hydroxide paste containing 1% chlorhexidine for 14 days and the second bacteriologic samples were taken prior to root canal filling. Samples were submitted to microbiologic culture procedure to detect root canal bacteria and processed for checkerboard DNA-DNA hybridization. Results. Baseline microbial culture revealed high prevalence and cfu number of anaerobic, black-pigmented bacteroides, Streptococcus, and aerobic microorganisms. Following root canal dressing, the overall number of cfu was dramatically diminished compared to initial contamination (P < 0.05), although prevalence did not change (P > 0.05). Of 35 probes used for checkerboard DNA-DNA hybridization, 31 (88.57%) were present at baseline, and following root canal dressing, the number of positive probes reduced to 13 (37.14%). Similarly, the number of bacterial cells diminished folowing application of calcium hydroxide/chlorhexidine root canal dressing (P = 0.006). Conclusion. Apical periodontitis is caused by a polymicrobial infection, and a calcium hydroxide/chlorhexidine paste is effective in reducing the number of bacteria inside root canals when applied as a root canal dressing.

Matrix Metalloproteinase Expression in Teeth with Apical Periodontitis Is Differentially Modulated by the Modality of Root Canal Treatment

Introduction: The objective of this study was to investigate the expression of matrix metalloproteinases (MM Ps) in apical periodontitis and during the periapical healing phase after root canal treatment. Methods: Apical periodontitis was induced in dog teeth, and root canal treatment was performed in a single visit or by using an additional calcium hydroxide root canal dressing. One hundred eighty days after treatment the presence of inflammation was examined, and tissues were stained to detect bacteria. Bacterial status was correlated to the degree of tissue organization, and to further investigate molecules involved in this process, tissues were stained for MMP-1, MMP-2, MMP-8, and MMP-9. Data were analyzed by using one-way analysis of variance followed by Tukey test or Kruskal-Wallis followed by Dunn test. Results: Teeth with apical periodontitis that had root canal therapy performed in a single visit presented an intense inflammatory cell infiltrate. Periapical tissue was extremely disorganized, and this was correlated with the presence of bacteria. Higher MMP expression was evident, similar to teeth with untreated apical periodontitis. In contrast, teeth with apical periodontitis submitted to root canal treatment with calcium hydroxide presented a lower inflammatory cell infiltrate. This group had moderately organized connective tissue, lower prevalence of bacteria, and lower number of MMP-positive cells, similar to healthy teeth submitted to treatment. Conclusions: Teeth treated with calcium hydroxide root canal dressing exhibited a lower percentage of bacterial contamination, a lower MMP expression, and a more organized extracellular matrix, unlike those treated in a single visit. This suggests that calcium hydroxide might be beneficial in tissue repair processes. (J Endod 2010;36:231-237)