• Restorative Dentistry and Endodontics
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• v.39 no.4
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• pp.265-269
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• 2014

Objectives: To evaluate the effect of different ultrasonic tip designs on intraradicular post removal. Materials and Methods: The crowns of forty human canine teeth were removed, and after biomechanical preparation and filling, the roots were embedded in acrylic resin blocks. The post spaces were made, and root canal molding was performed with self-cured acrylic resin. After casting (Cu-Al), the posts were cemented with zinc phosphate cement. The specimens were randomly separated into 4 groups (n = 10), as follows: G1 - no ultrasonic vibration (control); G2 - ultrasonic vibration using an elongated cylindrical-shaped and active rounded tip; G3 - ultrasonic vibration with a flattened convex and linear active tip; G4 - ultrasonic vibration with active semicircular tapered tip. Ultrasonic vibration was applied for 15 seconds on each post surface and tensile test was performed in a Universal Testing Machine (Instron 4444 - 1 mm/min). Results: G4 presented the highest mean values, however, with no statistically significant difference in comparison to G3 (p > 0.05). G2 presented the lowest mean values with statistically significant difference to G3 and G4 (p < 0.05). Conclusions: Ultrasonic vibration with elongated cylindrical-shaped and active rounded tip was most effective in reducing force required for intraradicular post removal.

• Journal of Dental Anesthesia and Pain Medicine
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• v.21 no.5
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• pp.441-449
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• 2021

Background: The efficacy of local anesthesia decreases in patients with symptomatic irreversible pulpitis. Therefore, it was proposed that the use of premedication with an anti-inflammatory drug might increase the success rate of pulpal anesthesia in mandibular posterior teeth with vital inflamed pulp. Methods: One hundred thirty-four patients who were actively experiencing pain willingly participated in this study. The Heft Parker (HP) visual analog scale (VAS) was used to record the initial pain intensity. Patients were randomly allocated to receive a placebo, 10 mg of ketorolac, and 650 mg of paracetamol. The standard inferior alveolar nerve block (IANB) was administered to all patients using 2% lidocaine with 1:200,000 adrenaline after one hour of medication. After 15 min, the patient was instructed to rate the discomfort during each step of the treatment procedure, such as access to remaining dentin, access to the pulp chamber, and during canal instrumentation on the HP VAS. IANB was considered successful if the patient reported no or mild pain during access preparation and instrumentation. Moderate or severe pain was classified as a failure of IANB and another method of anesthesia was used before continuing the treatment. Results: The rate of successful anesthesia in the placebo, paracetamol, and ketorolac groups was 29%, 33%, and 43%, respectively, and no statistically significant difference was found between the groups. Conclusion: Preoperative administration of paracetamol or ketorolac did not significantly affect the success rate of IANB in patients with irreversible pulpitis. No significant difference was observed between the paracetamol and ketorolac groups.

• Restorative Dentistry and Endodontics
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• v.44 no.3
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• pp.27.1-27.12
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• 2019

This case report describes a technique in which endodontic treatment and permanent indirect restoration were completed in the same clinical appointment with the aid of a computer-aided design/computer-aided manufacturing (CAD/CAM) system. Two patients were diagnosed with irreversible pulpitis of the mandibular first molar. After access preparation, root canals were located, irrigation was performed until bleeding ceased, and the coronal tooth structure was prepared for indirect restoration. Then, utilizing an interim 3-mm build-up of the endodontic access cavity, a hemi-arch digital scan was performed with an intraoral scanner. Subsequent to digital scanning, restoration design was performed simultaneously with the endodontic procedure. The root canals were shaped using the Race system under irrigation with 2.5% sodium hypochlorite followed by root canal filling. The pulp chamber was subsequently filled with a 3-mm-thick composite resin restoration mimicking the interim build-up previously utilized to facilitate block milling in the CAD/CAM system. Clinical try-in of the permanent onlay restoration was followed by acid etching, application of a 5th generation adhesive, and cementation of the indirect restoration. Once the restoration was cemented, rubber dam isolation was removed, followed by occlusal adjustment and polishing. After 2 years of follow-up, the restorations were esthetically and functionally satisfactory, without complications.

• Restorative Dentistry and Endodontics
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• v.48 no.1
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• pp.4.1-4.10
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• 2023

Objectives: This study aimed to compare the torsional and cyclic fatigue resistance of ProGlider (PG), WaveOne Gold Glider (WGG), and TruNatomy Glider (TNG). Materials and Methods: A total of 15 instruments of each glide path system (n = 15) were used for each test. A custom-made device simulating an angle of 90° and a radius of 5 millimeters was used to assess cyclic fatigue resistance, with calculation of number of cycles to failure. Torsional fatigue resistance was assessed by maximum torque and angle of rotation. Fractured instruments were examined by scanning electron microscopy (SEM). Data were analyzed with Shapiro-Wilk and Kruskal-Wallis tests, and the significance level was set at 5%. Results: The WGG group showed greater cyclic fatigue resistance than the PG and TNG groups (p < 0.05). In the torsional fatigue test, the TNG group showed a higher angle of rotation, followed by the PG and WGG groups (p < 0.05). The TNG group was superior to the PG group in torsional resistance (p < 0.05). SEM analysis revealed ductile morphology, typical of the 2 fracture modes: cyclic fatigue and torsional fatigue. Conclusions: Reciprocating WGG instruments showed greater cyclic fatigue resistance, while TNG instruments were better in torsional fatigue resistance. The significance of these findings lies in the identification of the instruments' clinical applicability to guide the choice of the most appropriate instrument and enable the clinician to provide a more predictable glide path preparation.

• Restorative Dentistry and Endodontics
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• v.36 no.6
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• pp.465-476
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• 2011

In current endodontic practice, introduction of operating microscope, ultrasonic instruments, and microinstruments has induced a big change in the field of surgical retreatment. In this study, we aimed to offer key steps of endodontic microsurgery procedure compared with traditional root-end surgery, and to evaluate factors influencing success and failure based on published articles. Endodontic microsurgery is a surgical procedure performed with the aid of a microscope, ultrasonic instruments and modern microsurgical instruments. The microscope provides magnification and illumination - essential for identifying minute details of the apical anatomy. Ultrasonic instruments facilitate the precise root-end preparation that is within the anatomical space of the canal. Modern endodontics can therefore be performed with precision and predictability, thus eliminating the disadvantages inherent in traditional periapical surgery such as large osteotomy, beveled apicoectomy, inaccurate root-end preparation and the inability to observe isthmus. Factors influencing the outcomes of endodontic microsurgery may be diverse, but standardization of procedures can minimize its range. Among patient and tooth-related factors, periodontal status and tooth position are known to be prognostic, but there are only few articles concerning this matter. High-evidence randomized clinical trials or prospective cohort studies are needed to confirm these findings.

• Restorative Dentistry and Endodontics
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• v.19 no.2
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• pp.585-601
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• 1994

The purpose of this study was to evaluate the ability of several intracoronal base materials to prevent cervical leakage of a bleaching agent into the dentinal tubules and along the root canal. In this study, thirty-two anterior teeth were used. After lingual access was prepared in each tooth, tooth was instrumented with a step-back technique to a Nos. 40-50 using K-type files. All teeth were obturated with a lateral condensation technique. Excess gutta percha was removed with a warm instrument to the facial level of the CEJ. Teeth were divided into four groups : Teeth in control group were not filled with base material. Teeth in groups 1, 2, and 3 had 2mm of gutta percha removed with a warm instrument, then Dycal, Fuki II LC and Z-100 were filled with palstic instruments on the top of the gutta percha respectively. All teeth were bleached for 7 days, fresh bleach was added for another 7 days, then a 10 % methylene blue dye was placed inside the access preparation. They were stored at $37^{\circ}C$ and $100^{\circ}C$ humidity for 5 days. Each tooth was sectioned perpendicular to the long axis using a diamond disk. Initial cuts were made at the most coronal level of facial and lingual CEJ's, then another cuts continued appically in the levels of 0.5mm, 1.5mm, and 2.0mm respectively. The amount of dye leakage through the dentinal tubules was determined at each cut section. In addition, when the cut specimen was determined to be last penetration of any dye, this level was recorded as depth of apical leakage from the coronal terminus of the gutta percha, Dycal, Fuji II LC and Z-100. The acquired data were analyzed by Tukey's Multiple Range Test adn Cochran-Mantel-Haenszel Test to see if there was any statistically significant difference in dye penetration and linear apical leakage among the groups. The results were as follows : 1. Control group at levels of CEJ and 0.5mm, group 3 at level of 1.5mm, and group 2 AND 3 at level of 2.0mm showed the least dye penetration through the facial or lingual dentinal tubules, but there were no significant difference among three groups. 2. Group 2 at levels of CEJ and 0.5mm, group 3 at level of 1.5mm, and group 2 and 3 at level of 2.0mm showed the least dye penetration through the proximal dentinal tubules, but there were no significant difference among control group, group 2, and group 3. 3. Group 1 showed the greatest dye penetration through the facial or lingual and proximal dentinal tubules at all levels, and there were significant difference with other three groups. 4. Control group and group 1 showed 2mm apical dye leakage at facial or lingual and proximal aspects, group 2 showed 1.5mm, and group 3 showed 0.5mm.

• The Journal of Advanced Prosthodontics
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• v.6 no.3
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• pp.200-206
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• 2014

PURPOSE. This in vitro study investigated the fracture resistance of endodontically treated premolars restored using silorane-or methacrylate-based composite along with or without fiber or nano-ionomer base. MATERIALS AND METHODS. Ninety-six intact maxillary premolars were randomly divided into eight groups (n = 12). G1 (negative control) was the intact teeth. In Groups 2-8, root canal treatment with mesio-occlusodistal preparation was performed. G2 (positive control) was kept unrestored. The other groups were restored using composite resin as follows: G3, methacrylate-based composite (Z250); G4, methacrylate composite (Z250) with polyethylene fiber; G5 and G6, silorane-based composite (Filtek P90) without and with the fiber, respectively; G7 and G8, methacrylate-and silorane-based composite with nano-ionomer base, respectively. After aging period and thermocycling for 1000 cycles, fracture strength was tested and fracture patterns were inspected. The results were analyzed using ANOVA and Tukey HSD tests (${\alpha}$=0.05). RESULTS. Mean fracture resistance for the eight groups (in Newton) were G1: $1200{\pm}169^a$, G2: $360{\pm}93^b$, G3: $632{\pm}196^c$, G4: $692{\pm}195^c$, G5: $917{\pm}159^d$, G6: $1013{\pm}125^{ad}$, G7: $959{\pm}148^d$, G8: $947{\pm}105^d$ (different superscript letters revealed significant difference among groups). Most of the fractures in all the groups were restorable, except Group 3. CONCLUSION. Silorane-based composite revealed significantly higher strength of the restored premolars compared to that of methacrylate one. Fiber insertion demonstrated no additional effect on the strength of both composite restorations; however, it increased the prevalence of restorable fracture of methacrylate-based composite restored teeth. Using nano-ionomer base under methacrylate-based composite had a positive effect on fracture resistance and pattern. Only fiber-reinforced silorane composite restoration resulted in a strength similar to that of the intact teeth.

• Restorative Dentistry and Endodontics
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• v.25 no.1
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• pp.1-16
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• 2000

It is difficult to treat the endodontic apical perforation successfully. In this study, we hypothesized that the application of PDGF-BB and IGF-I into periapical perforation site may accelerate periapical healing and lead to bone deposition. And the specificity of osteonectin in periapical healing was investigated. The experiments were performed on the upper and lower 51 premolar teeth of 4 beagle dogs. The pulp chamber of each tooth was opened and the dental plaque was inserted into the canal for developing the periapical lesion for 5 weeks. Then, the roots were artificially perforated at the apex with the number 4 profile of .06 taper. In each step, standard periapical radiographs were taken to compare the size of lesion each other. The radiographs were scanned and analyzed by image analysis system. The mean and standard deviation of periradicular radiolucency ratios were calculated in each group. ANOVA was used for comparison. 51 premolars were grouped into 3 groups; control group, calcium hydroxide-treated group and calcium hydroxide plus growth factors-treated group. In the control group, the apical perforations were not sealed and obturated with gutta-percha and ZOE sealer by lateral condensation technique. In the experimental groups, the apical perforation were sealed with calcium hydroxide and with/without $4{\mu}g$ of PDGF-BB & IGF-I in cellulose gel and obturated by lateral condensation technique. Fluorescent bone markers were used to measure new bone formation. Following 2, 4, 12 weeks after experiment the dogs were sacrificed and histologic sections were prepared. Each tooth block including periapical lesion was sectioned mesiodistally. One half of the sections were decalcified with 6% nitric acid and processed by standard paraffin embedding technique. The sections were stained by hematoxylin and eosin, and immunostained for osteonectin. Histomorphometrical measurement of neoformed bone was performed using a light microscope. And the other half of the sections were prepared by undecalcified preparation, and confocal laser scanning microscopic investigations were done.

• Restorative Dentistry and Endodontics
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• v.25 no.1
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• pp.144-152
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• 2000

Intracoronal bleaching is currently disregarded by many clinicians because of the potential consequence of cervical resorption. To prevent this complication it is recommended that intra coronal barrier materials be placed over the root canal obturation and sodium perborate be used with water rather than with hydrogen peroxide. The purpose of this study was to evaluate the amount of the hydrogen peroxide penetration according to the difference in intracanal base materials and sodium perborate preparation. Fifty extracted intact premolars were instrumented, and filled with gutta-percha. And then the outer surface of the teeth was sealed with wax exposing the CEJ. The prepared teeth were placed in plastic tubes containing 1.5ml distilled water with their entire root submerged into the solution, The teeth were divided into the following five groups. In the first two groups gutta-percha was removed without placement of barrier, and then water or superoxole(30% $H_2O_2$) with sodium perborate were used respectively for bleaching. In the other three groups, after removal of gutta-percha, an intracanal isolating barrier(ZPC, IRM, Fuji II LC) was placed and then bleached with sodium perborate and superoxole. The bleaching procedure was performed 4 times with 1 week interval. The results were as follows : 1. All the groups showed a tendency of increasing penetration amount with increasing treatment times(P<0.05). 2. After the 1st and 2nd treatments, there was no significant difference in microleakage among the groups. 3. After the 3rd bleaching with superoxole and sodium perborate, there was no significant difference in microleakage between gutta-percha alone group and gutta-percha with ZPC, Fuji II LC barrier group. But significant difference was found between IRM barrier group and other groups(P<0.01). 4. After the 4th bleaching with superoxole and sodium perborate, there was no significant difference between gutta-percha alone group and gutta-percha with barrier groups. 5. After the 4th treatment, the group bleached with sodium perborate and water without barrier showed lower hydrogen peroxide penetration than that of other groups(P<0.01).

• Restorative Dentistry and Endodontics
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• v.33 no.1
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• pp.20-27
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• 2008

The purpose of this study was to evaluate the consistency of two electronic apex locators in vitro model. Materials consisted of fifty two extracted premolars and two electronic apex locators; Root ZX (J. Morita, Osaka, Japan) and E-Magic Finder Deluxe (S-Denti. Cheonan, Korea). After access preparation, the teeth were embedded in a saline-mixed alginate model. Canal lengths of each tooth were measured at "0.5" and "Apex" mark of the apex locators, respectively so that each tooth had two measurements from 0.5 and Apex points. The file was fixed at final measurement using a glass ionomer cement. The apical 4 mm from the apex was exposed to measure the distance from the file tip to the major apical foramen of each tooth. Average distances and standard deviations were used to evaluate the consistency. Results showed that all measurements of both Root ZX and E-Magic Finder located the major foramen the range of ${\pm}0.5\;mm$ level. Both apex locators showed better consistency at Apex mark than at 0.5 mark. The average distance of file tip-major foramen was - 0.18 mm at 0.5 mark and - 0.07 mm at Apex mark in Root ZX, - 0.25 mm at 0.5 mark and - 0.02 mm at Apex mark in E-Magic Finder. Standard deviation was 0.21 at 0.5 mark and 0.12 at Apex mark in Root ZX, 0.12 at 0.5 mark and 0.09 at Apex mark in E-Magic Finder.