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Morphologic effects on L929 fibroblasts of titanium tetrafluoride application.

OBJECTIVE: The aim of this study was to investigate the effect of titanium tetrafluoride solution on L929 fibroblasts by scanning electron microscopy. Titanium tetrafluoride was then compared with sodium fluoride and acidulated phosphate fluoride. STUDY DESIGN: Cells were treated with fluoride solutions for 1 minute either directly, through a filter membrane with a pore size of 0.4-micron, or indirectly, through dentin disks; they were then investigated at an electron microscopic level. RESULTS: Fluoride application on smeared dentin disks showed fewer cytotoxic effects on fibroblasts than application on nonsmeared dentin disks. Acidulated phosphate fluoride and titanium tetrafluoride appeared to be more cytotoxic than sodium fluoride. Because all fluoride solutions used in this study contained the same fluoride concentration, pH was considered to be the main factor causing the higher toxicity. CONCLUSION: Because these solutions demonstrated toxicity in vitro, they must be further evaluated under in vivo conditions to ascertain their clinical safety.

Acidulated Phosphate Fluoride↗

Dentin penetration of 2 calcium hydroxide combinations.

OBJECTIVE: Calcium hydroxide is a common intracanal medicament. The powder can be mixed with different vehicles for placement in canals. This study examines pH changes in dentin with 2 different calcium hydroxide preparations. STUDY DESIGN: The combinations used were calcium hydroxide + distilled water and calcium hydroxide + glycerin (1/7 distilled water). One hundred forty extracted teeth with single canals were used. pH changes in dentin after the intracanal placement of these combinations were evaluated at different dentin thicknesses by measuring the pH of the external environment. RESULTS: For all dentin thicknesses and at all time periods, the calcium hydroxide + glycerin combination showed significantly higher pH values than the calcium hydroxide + distilled water combination. CONCLUSIONS: Considering pH elevations, we propose the use of a calcium hydroxide + glycerin combination.

Calcium Hydroxide↗

Influence on pH of vehicle containing glycerin used with calcium hydroxide.

- The pH values of the external aqueous medium, relative to the roots of 41 human premolar teeth filled with Ca(OH)2 in to several vehicles, were evaluated in the present study. After root canal biomechanical preparation and smear-layer removal, the teeth were stored individually, immersed in flasks containing 800 ml of ultra-pure deionized water for a period of 118 days. A pH meter was used to analyse the pH values as a function of time. The measurements were divided into phase 1: dissolution, in which all canals remained empty and open in the absence of medicament for 48 days, and phase 2: diffusion, in which the specimens were divided into 10 groups which consisted of three control groups: group 1, water control; group 2, sealing control; and group 3, opened canal dissolution control, and seven experimental groups, with five teeth each, whose canals were filled with Ca(OH)2 paste associated with the following vehicles: group 4, saline solution; group 5, polyethylene glycol (Calen); group 6, glycerin and parachlorophenol (PMCC); group 7, PMCC; group 8, glycerin; group 9, glycerin and formo cresol (FC); and group 10, anesthetic solution. This phase lasted for 70 days. A total of 1058 measurements of the pH values were made. Regression analysis was used for statistical evaluation. The results show that all groups containing polyol in the composition of the paste had a trend to acidification in the interval between filling and 14 days later (therapeutic period) and, at the end of the experiment (1687 h to 70 days after canal filling), the pH was slightly alkaline. We conclude that polyhydroxy alcohol (glycerin and polyethylene glycol, Calen) diffusion enhances acidification of the aqueous medium.

Calcium Hydroxide↗

Fissures at risk.

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Bicuspid↗

In vitro dentinal penetration by tracers used in microleakage studies.

Many microleakage studies, in their methodology, employ different tracers which may penetrate around restorative materials to varying extents due to their physical or chemical characteristics. The present series of in vitro studies were designed to compare the ability of freshly obtained microleakage tracers to enter cut dentinal tubules. Tracers selected were 5% eosin, 2% methylene blue, 50% silver nitrate and Indian ink all buffered, where necessary, to a range of pH 6.9-7.2. The solution of Indian ink was further investigated by particle size analysis to determine the range of particle sizes within the solution. Particles ranged from < 1 micron to 600 microns. Buffered and unbuffered solutions of the tracers were applied for 1 h to open cavities, devoid of a smear layer, prepared in 42 premolars. Specimens were sectioned longitudinally through the cavities either with or without water coolant. Penetration into dentinal tubules by the tracer resulted in an area of stained dentine and this area was subsequently measured using image analysis. The results demonstrated that there were few statistically significant differences between the areas of dentinal penetration associated with each tracer. Neither the tracer used, its pH nor sectioning technique had a predictably significant effect on dentinal penetration. Indian ink was observed to be capable of entering dentinal tubules.

Analysis of Variance↗

Clinical and SEM evaluations of three compomer systems in Class V carious lesions.

The aim of this study was to evaluate the clinical performance of three compomer systems: Compoglass F, Dyract AP and F2000 in Class V carious lesions. In addition, some restorations were placed in teeth scheduled for extractions in order to evaluate the compomer/dentin interface with the scanning electron microscope (SEM). A total of 175 Class V carious lesions having the gingival margins extending into cementum were restored with the tested materials. Each restoration was clinically evaluated immediately after placement, after 1 year and after 2 years using the USPHS criteria. After 1 year no loss of restoration was recorded. No significant difference between the materials was observed for any evaluation category. After 2 years, one Compoglass and two Dyract restorations were lost. No loss of F2000 was reported. No significant difference was reported between the tested materials and between the 2-year data and baseline ones. A well-defined hybrid layer as well as resin tags was seen at the interface between the tested materials and vital dentin.

Adult↗

In vitro diffusion of hydroxyl ions through root dentine from various calcium hydroxide medicaments.

The purpose of this study was to determine diffusion of hydroxyl ions through dentine from different calcium hydroxide [Ca(OH)2] medicaments. Forty-five single-rooted teeth were instrumented and cavities (3 mm in diameter and 1 mm in depth) were prepared on the facial surface of each root. After smear layer was removed with 17% EDTA all surfaces of roots, except cavities, were coated with nail polish. Teeth were randomly divided into four experimental groups (each 10 samples) and a control group (five samples). They were filled with: group 1, Ca(OH)2 and distilled water mixture; group 2, TempCanal; group 3, Calasept; and group 4, Ca(OH)2 plus point. Control group, in which nothing was applied to the canals. All samples were immersed in distilled water maintained at 37 degrees C. pH values were measured at 1 h, 2 h, 3 h, 24 h, 48 h, 72 h, 4 days, 5 days, 6 days, 7 days and 14 days. Ca(OH)2-distilled water mixture and TempCanal showed highest pH values at 24 h. Calasept, Ca(OH)2 plus point and control showed highest pH values at 3 h. Time intervals after 24 h, Ca(OH)2-distilled water mixture, TempCanal and Calasept showed higher pH values than Ca(OH)2 plus point, with a statistically significant difference (P<0.05). The pH value of Ca(OH)2 plus point was lower than the values of other materials after 3 h. This study indicates that non-setting Ca(OH)2 based materials have an effective release of hydroxyl ions compared with Ca(OH)2 plus point.

Calcium Chloride↗

Sealing evaluation of the cervical base in intracoronal bleaching.

Discoloration of non-vital teeth is an esthetic deficiency frequently requiring bleaching treatment. The purpose of this study was to evaluate in vitro the cervical base efficacy in order to prevent or to minimize the leakage along the root canal filling and into the dentinal tubules. Thirty-eight extracted single-root human teeth were used, which were biomechanically prepared, filled, and divided into three experimental groups: G1, a cervical base was applied (3 mm of thickness) below the cemento-enamel junction, with resin-modified glass-ionomer cement (Vitremer); G2, the base was done with glass-ionomer cement (Vidrion R); and G3 (Control), did not receive any material as base. A mixture of sodium perborate and hydrogen peroxide 30% was placed inside the pulp chamber for 3 days, and the access opening was sealed with Cimpat. This procedure was repeated thrice. Soon after this, a paste of calcium hydroxide was inserted into the pulp chamber for 14 days. All teeth were covered with two layers of sticky wax, except the access opening, and immersed in blue India Ink for 5 days. The results did not show statistically significant differences between the three groups concerning the leakage inside the dentinal tubules. Regarding the apical direction, a statistical difference (ANOVA P < 0.05) was observed among the experimental group G1 and control group G3. No statistically significant difference was observed between G2 and G3 groups. Therefore, the placement of a cervical base before internal bleaching procedures is still recommended.

Analysis of Variance↗

Clinical implications of the smear layer in endodontics: a review.

It has been recognized for many years that root canal instrumentation produces a smear layer that covers the surfaces of prepared canal walls. This layer contains inorganic and organic substances such as fragments of odontoblastic processes and necrotic debris. There is a lack of agreement regarding the effect of the smear layer on the quality of instrumentation and obturation, but the smear layer itself may be infected and may protect the bacteria within the dentinal tubules. Various methods have been used to remove the smear layer. Conflicting results have been obtained from numerous in vitro studies regarding the significance of the presence or the removal of the smear layer.

Dental Leakage↗

Effects of rotary instrumentation and different etchants on removal of smear layer on human dentin.

STATEMENT OF PROBLEM: Various methods of rotary preparation and conditioning of teeth affect surface topography and may affect the retention of dental restorations. PURPOSE: This study microscopically evaluated dentin surfaces prepared by different rotary instruments and etched using several types of acid etchants that have been deemed suitable dentin conditioners. MATERIAL AND METHODS: Occlusal surfaces of 35 extracted human molars were ground wet with 320-grit silicon carbide paper to the depth of the central groove and then prepared with diamond (n = 5) and finishing burs (n = 30). Five specimens from each group were used for SEM evaluation of mechanical preparation effects. Dentin specimens (n = 5) prepared with finishing burs were then etched with 1 of 5 etchants (25% polyacrylic acid, 10% phosphoric acid, 10% citric acid, 20% lactic acid, or 32% phosphoric acid) for 10 seconds. Specimens were critical-point dried and freeze fractured for SEM analysis. RESULTS: Diamond rotary instruments created more undulating surfaces than finishing burs. Fine grooves were observed running perpendicular to undulations and parallel to the direction of instrument rotation. Specimens prepared with finishing burs exhibited a smooth surface interrupted by only a slight granularity. The amorphous smear layer was partially removed after the application of 25% polyacrylic acid (pH 1.53), but all dentinal tubules contained plugs. The number of dentin tubules containing plug material and the amount of material in the tubules decreased noticeably with 10% phosphoric acid (pH 0.86), and the dentin surface had an appearance similar to the specimen etched with 10% citric acid (pH 1.70). The surfaces treated with 20% lactic acid (pH 1.40) produced a clearly etched surface with minimal demineralization. Etching of dentin with 32% phosphoric acid (pH 0.16) revealed significant changes in dentin with the evidence of increased tubule diameter. CONCLUSION: Differences related to the method of instrumentation were found in the surface characteristics of dentin. The degree of smear layer removal was related to the pH of the acid etchant.

Acid Etching, Dental↗

The carbon dioxide laser as an aid in apicoectomy: an in vitro study.

OBJECTIVE: To achieve the required goal of optimally sealing the apical section and the root-canal when performing an apicoectomy, the authors decided to use the CO2 laser as an additional aid. SUMMARY BACKGROUND DATA: The CO2 laser has previously shown to have an excellent sealing effect on dentin surfaces. METHODS: In this in vitro study, the authors examined the effects of CO2 laser application in apicoectomies with the help of color penetration tests and scanning electron microscopic (SEM) examinations. Sections and root canals were irradiated with low power (0.5 W) in continuous wave mode for totally 20 sec. The thermal stress for the adjacent tissues attaching thereto is moderate as shown by infrared-spectroscopy. RESULTS: A comparison with nonirradiated samples revealed that CO2 laser irradiation reduced color penetration at the section to a minimum. Also, irradiation of the root-canal wall resulted in satisfactory sealing of the surface. These findings were supported by the results of the SEM examinations. CONCLUSIONS: CO2 laser treatment optimally prepares the tooth for final intraoperative filling because of sealing of the dentinal tubules, the resultant elimination of niches for bacteria and the sterilizing effect of the laser.

Apicoectomy↗

Cementoenamel junction: microscopic analysis and external cervical resorption.

There is a lack of data regarding the shapes and distribution of the mineralized tissue that composes the cementoenamel junction. A sample of 198 permanent human teeth was analyzed by optical microscopy and scanning electron microscopy. Scanning electron microscopy showed three types of tissue interrelations: enamel overlapped by cementum; enamel and cementum edge-to-edge; and a gap, revealing a strip of exposed dentin. Using optical microscopy, a fourth type of cementoenamel junction was observed: cementum overlapped by enamel. The distribution of the hard tissues found at the cementoenamel junction is unpredictable and irregular both for any tooth type (e.g. on cuspids) and on any one individual tooth. Based on these results and on analysis of the mechanisms involved in cervical root resorption, it is possible to consider the cervical region as prone to external resorption.

Dental Cementum↗

Tetracycline HCl solution as a root canal irrigant.

The effect of tetracycline hydrochloride as an endodontic irrigant on smear layer removal was examined by scanning electron microscopy and compared with bidistilled water, 2.5% sodium hypochlorite (NaOCl), and 50% citric acid in 20 extracted teeth. Five teeth, as a control, were irrigated with bidistilled water only in group 1. All the other groups were irrigated with NaOCI during instrumentation. The final rinses were NaOCl in group 2, citric acid in group 3, and 1% tetracycline hydrochloride in group 4. Scanning electron microscopic results and statistical analysis revealed that bidistilled water and NaOCl were ineffective in removing the smear layer, whereas citric acid and tetracycline hydrochloride were significantly more effective (p < 0.001). No statistically significant difference was detected between tetracycline hydrochloride and citric acid (p > 0.05). However tetracycline hydrochloride demineralized less peritubular dentin.

Anti-Bacterial Agents↗

Immunohistochemical evaluation of the effects of sodium hypochlorite on dentin collagen and glycosaminoglycans.

To test the hypothesis that a commercial solution of 5% NaOCl produces structural and molecular alterations in the collagen and glycosaminoglycans of mineralized and demineralized dentin, radicular segments from human teeth were treated with 5% NaOCl or 2 min at room temperature. As a control, distilled water replaced NaOCl. The experimental and control specimens were processed for indirect immunofluorescence by using antitype I collagen and antichondroitin sulfate antibodies. Tissue sections were morphometrically analyzed. A single exposure for 2 min to a 5% NaOCl solution produced a drastic loss of immunoreactivity in the dentin surface for both antibodies that were used in demineralized specimens. A narrow and irregular band of fluorescence loss was detected in mineralized-dentin segments when anticollagen antibodies were used. The results of this study suggest that 5% NaOCl induces alterations in dentin collagen and glycosaminoglycans and show the protective role of hydroxyapatite on organic matrix stability.

Adult↗

Sealer distribution in coronal dentin.

A major cause of tooth discoloration is sealer remnants in the pulp chamber after root canal treatment. The purpose of this study was to assess coronal distribution and color changes of four commonly used sealers placed in the pulp chamber after 2 yr. Fifty extracted premolars were cross-sectioned in the coronal third of the root. The chamber contents were removed, and instrumentation was via the canal; then freshly mixed sealer was placed in each chamber. Sealers evaluated were: AH 26, Kerr Pulp Canal Sealer, Roth 801, and Sealapex. The apical access was sealed with white sticky wax, and the tooth was maintained in a moist environment at 37 degrees C for 2 yr. Teeth were split longitudinally, and digital images of the exposed dentin were made, scrambled, and evaluated blindly by trained evaluators for color changes and for presence of sealer in dentin. There was no measurable penetration of sealer into dentin for all groups and no dentin discoloration occurred. The sealers displayed marked discoloration. At 2 yr, the sealers discolored and remained confined primarily to the pulp chamber.

Bismuth↗

Ca2+ diffusion through dentin of Ca(OH)2 associated with seven different vehicles.

This investigation measured the diffusion of Ca2+ through dentin by using Ca(OH)2 associated with various vehicles. After mechanical preparation and removal of smear layer, 41 human premolar teeth were stored individually in flasks containing 800 ml of ultra-pure deionized water for 2855 h. The Ca2+ concentration was measured by atomic absorption spectrophotometry as a function of time. These measurements were divided into two phases: dissolution, to check the loss of Ca2+ from the tooth structure itself, for which all canals were kept empty and open in the absence of medication for 1168 h, and diffusion, in which the specimens were divided into 10 groups (3 control groups: group 1 = water control, group 2 = sealing control, and group 3 = open canal dissolution control; 7 experimental groups in which the whose canals were filled with Ca(OH)2 paste associated with the following vehicles: group 4 = saline; group 5 = polyethylene glycol (Calen); group 6 = glycerin and camphorated parachlorophenol group 7 = camphorated paramonochlorophenol; group 8 = glycerin; group 9 = glycerin and tricresol formaldehyde (TCF); and group 10 = anesthetic solution. This phase lasted 1687 h. A total of 1058 measurements of Ca2+ were made. Regression analysis was used for statistical evaluation. We concluded that diffusion occurred differently for each group: the medications used in the root canals interacted with the dentinal structure or among themselves; the medication coated the dentinal tubule, facilitating the diffusion of Ca2+ into the external part of the root.

Anesthetics, Local↗

Diffusion of Ca(OH)2 associated with different vehicles: chromatographic study (high-performance liquid chromatography).

Using high-performance liquid chromatography (HPLC), small amounts of liquid samples in which 25 premolar human teeth were immersed were evaluated. Each tooth was immersed separately in 800-ml flasks with distilled ultra-pure deionized water and remained there for 1678 h after the filling of their canals with Ca(OH)2 associated with different vehicles: group 1: polyethylene glycol and colophon (Calen); group 2: glycerin and camphorated paramonochlorophenol; group 3: camphorated paramonochlorophenol; group 4: glycerin and tricresol formol; and group 5: anesthetic solution (Citanest). Five polyethylene tubes were filled with each of these pastes and placed unsealed in similar flasks. At the end of this period, HPLC analyses of the aqueous medium related to each group were performed to detect other substances that had diffused from the pastes used in the canals of the teeth other than calcium and hydroxyl ions. Although the groups presented different maximum peaks when there was no barrier, they all showed higher values than when the tooth was present. At least 15 substances other than Ca2+ and OH- were detected in the aqueous medium of group 4. Analyzing the HPLC graphs, we concluded that not only Ca2+ and OH-, but also a considerable quantity of other components of the pastes diffused through the dentine and reached the external root surface.

Anesthetics, Local↗

Peroxide penetration into the pulp from whitening strips.

It was observed that externally applied bleaching gels may penetrate into the pulp chamber. This study was conducted to evaluate the peroxide diffusion from two whitening strips into the pulp chamber. Twenty-four, human, extracted, maxillary central teeth were separated into three groups (n = 8). All teeth were sectioned 3-mm apical to CEJ, the intracoronal pulp tissue was removed, and the pulp chamber was filled with acetate buffer. Vestibuler crown surfaces of teeth in the experimental groups were subjected to whitening strips; the teeth in the control group were exposed only to distilled water. The acetate buffer solution in each tooth was transferred to the tube. Leuco-crystal violet and enzyme horseradish peroxidase also were added to the tube. The pulpal peroxide was determined spectrophotometrically. The results indicated that the whitening strip containing 14% hydrogen peroxide presented a higher pulpal peroxide penetration than 6.5 % hydrogen peroxide (p < 0.001).

Dental Devices, Home Care↗