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PubMed2004

Electronic apex locator.

Locating the appropriate apical position always has been a challenge in clinical endodontics. The electronic apex locator (EAL) is used for working length determination as an important adjunct to radiography. The EAL helps to reduce the treatment time and the radiation dose, which may be higher with conventional radiographic measurements. According to recent publications, the accuracy of frequency-dependent EALs appears to be much higher compared with traditional-type EALs (simple resistance type or impedance type). This article reviews the history and the working mechanism of the currently available EALs, and suggests the correct usage of the apex locator for a better canal length measurement.

Dental Pulp Cavity↗
PubMed2004

Endodontic working width: current concepts and techniques.

Root canal morphology is a critically important part of conventional and surgical endodontics (root canal therapy). Many in vitro studies have recorded the scales and average sizes of root canals, but there have been few clinical attempts to determine the working width. In the absence of a study that defines what the original width and optimally prepared horizontal dimensions of canals are, clinicians are making treatment decision without any support of scientific evidence. This article provides definitions and perspectives on the current concepts and techniques to handle working width-the horizontal dimension of the root canal system-and its clinical implications.

Dental Pulp↗
PubMed2004

Interim restorations.

Interim restorations are a critical component of fixed prosthodontic treatment, biologically and biomechanically. Interim restoration serves an important diagnostic role as a functional and esthetic try-in and as a blueprint for the design of the definitive prosthesis. When selecting materials for any interim restoration, clinicians must consider physical properties, handling properties, patient acceptance, and material cost. Although no single material meets all the requirements and material classification alone of a given product is not a predictor of clinical performance, bis-acryl materials are typically best suited to single-unit restorations, and poly(methylmethacrylate) interim materials are generally ideal for multi-unit, complex, long-term, interim fixed prostheses. As with most dental procedures, the technique used for fabrication has a greater effect on the final result than the specific material chosen.

Biomechanical Phenomena↗
PubMed2004

Fiber-reinforced composite prostheses.

Metal-free prosthetic dentistry continues to gain interest. Although the metal alloys contribute great strength and stiffness to restorations and prostheses, they do so at a considerable esthetic liability. Two somewhat divergent metal-free approaches to fixed tooth replacement continue to be developed for a variety of clinical applications. These are all-ceramic and all-polymeric systems. The polymeric prostheses are the subject of this article.

Composite Resins↗
PubMed2005

Influence of specimen size and regional variation on long-term resin-dentin bond strength.

OBJECTIVES: Verify whether the dimension of a bonded specimen stored prior microtensile testing and its regional variation may affect the resin-dentin bond strength (BS) over time. METHODS: Thirty human third molars had a flat dentin surface exposed and all peripheral enamel removed. Two adhesive systems (Single-Bond and One-Step) were applied and composite resin crowns (Z250) were constructed. Teeth were divided into three groups (n = 5). Group A specimens were sectioned to obtain sticks to be tested in tension (0.5 mm/min) immediately. Group B specimens were stored in water for 6 months, before sectioning and testing. Group C specimens were sectioned; the sticks were stored for 6 months and tested. In groups A and B, the origin of the sticks, periphery and inner regions was controlled. Bond strength (BS) was expressed as an index that considers cohesive failures and estimated values of premature debonded specimens. One-way ANOVA and Tukey's test (alpha = 0.05) were used to compare groups A, B and C, and a second analytical approach (A and B) employed a two-way ANOVA (time versus regional differences) for each adhesive system. RESULTS: For Single-Bond (SB), the BS for specimens in group A was higher than for groups B and C. For One-Step (OS), the BS in group A was higher than for B, which was in turn higher than for C. In the second group approach, no difference was found when the test was performed immediately; however, after 6 months, the inner sticks from group B showed significantly higher BS. SIGNIFICANCE: (1) The amount of decrease in BS is dependent on the specimen size; (2) the decrease in BS was greater for peripheral specimens than more centrally located specimens.

Analysis of Variance↗
PubMed2005

Factorial analysis of variables influencing stress in all-ceramic crowns.

OBJECTIVE: The objective of this investigation was to evaluate the relative contribution of variables in the crown-cement-tooth system that can influence magnitude of maximum principal stress in all-ceramic crowns. METHODS.: Factorial analysis was performed to calculate the coefficients of main and interactive effects of seven variables on maximum stress distribution in a series of finite element models of an axisymmetric stylized ceramic crown-cement-tooth system. Variables investigated at two levels were selected for their clinical relevance and included those relating to crown material and geometry (thickness and cuspal incline), cement modulus and thickness, supporting tooth core, and position at which the occlusal load was applied. RESULTS: The average principal stress for all combinations of all variables was 135.1 MPa but stress magnitude ranged from 73.7 to 214.0 MPa. Crown material and thickness are of primary importance in stress magnitude but other variables (cement modulus, load position, and supporting tooth core) also contribute to the stress magnitude. Interactions between these variables can have an important influence, particularly since the stress in the crown is not necessarily sensitive to the same factors for all crown material systems. SIGNIFICANCE: Comprehensive evaluation of stress in a crown of a crown-cement-tooth system must integrate the influence of single variables and their interactions.

Aluminum Silicates↗
PubMed2005

Clinical evaluation of 546 tetracycline-stained teeth treated with porcelain laminate veneers.

OBJECTIVE: The purpose of this study was to evaluate the clinical result of 546 tetracycline-stained teeth restored with a porcelain laminate veneer system (Cerinate, Den-Mat, USA) for aesthetic reasons. METHODS: Tetracycline-stained teeth (546) were restored with a porcelain veneer system, and bonded with Ultra Bond resin cement. The restorations were recalled after 0.5, 1.5 and 2.5 years, respectively. Modified Ryge criteria were used to evaluate the veneers marginal adaptation, interfacial staining, secondary caries, postoperative sensitivity and the patients' satisfaction of the colour of the restorations. RESULTS: This study found that 99% veneers had excellent marginal adaptations; and less than 1% veneers required rebonding in the first 6 months; the colour of the veneers was stable and no evident staining was found. Almost all patients were satisfied with the colour match of their restorations 1 year after placement. CONCLUSIONS: The research indicated that the porcelain veneer restoration system under investigation provided a reliable and highly satisfactory choice for the aesthetic restoration of tetracycline-stained teeth.

Anti-Bacterial Agents↗
PubMed2004

The use of a 3D laser scanner using superimpositional software to assess the accuracy of impression techniques.

OBJECTIVE: Several studies have made comparisons in the dimensional accuracy of different elastomeric impression materials. Most have used two-dimensional measuring devices, which neglect to account for the dimensional changes that exist along a three-dimensional surface. PURPOSE: The aim of this study was to compare the dimensional accuracy of an impression technique using a polyether material (Impregum) and a vinyl poly siloxane material (President) using a laser scanner with three-dimensional superimpositional software. MATERIALS AND METHODS: Twenty impressions, 10 with a polyether and 10 with addition silicone, of a stone master model that resembled a dental arch containing three acrylic posterior teeth were cast in orthodontic stone. One plastic tooth was prepared for a metal crown. The master model and the casts were digitised with the non-contacting laser scanner to produce a 3D image. 3D surface viewer software superimposed the master model to the stone replica and the difference between the images analysed. RESULTS: The mean difference between the model and the stone replica made from Impregum was 0.072mm (SD 0.006) and that for the silicone 0.097mm (SD 0.005) and this difference was statistically significantly, p=0.001. CONCLUSIONS: Both impression materials provided an accurate replica of the prepared teeth supporting the view that these materials are highly accurate.

Dental Impression Materials↗
PubMed2006

Residual dentin thickness in bifurcated maxillary premolars after root canal and dowel space preparation.

Residual dentin thickness in 25 extracted bifurcated maxillary premolars after canal and Parapost preparation was assessed using acrylic muffle, after embedding in polyester resin and sectioned horizontally. After each procedure, the residual dentin thickness was compared to the original dentin thickness at eight aspects in three root levels. Residual dentin thickness measurements were calculated using photographs and a Digitizer. In the lingual aspect, the original dentin thickness averaged 0.99 mm (coronal slice) and 0.78 mm (middle slice). Dentin removal after dowel preparation was 31%. Three-way ANOVA with repeated measures was used. The difference in residual dentin thickness was highly significant regarding procedure (canal and dowel preparation, p < 0.0001), slice (middle, coronal, p < 0.0001), and the eight aspects (p < 0.0001). This in vitro study emphasizes the minimal dentin width of the buccal root, especially towards the bifurcation. Thus, dowels should be avoided in this root.

Analysis of Variance↗
PubMed2006

An in vitro evaluation of the apical sealing ability of a new resin-based root canal obturation system.

The purpose of this study was to assess the apical sealing ability of the new resin-based Epiphany-Resilon root canal filling system, and to compare this with the sealing abilities of different pairings of AH plus, gutta-percha, Epiphany, and Resilon. Seventy extracted human single-rooted teeth were used. All teeth were instrumented using a set of ProTaper rotary instruments. The canal spaces were filled with different combinations of core and sealer using lateral condensation, as follows: group 1, AH Plus + gutta-percha; group 2, AH Plus + Resilon; group 3, Epiphany + Resilon; group 4, Epiphany + gutta-percha. Apical leakage quantity was measured with the computerized fluid filtration meter. Statistical analysis indicated that Epiphany gutta-percha combination had the least amount of microleakage than all the other groups; AH Plus gutta-percha combination proved to have second least amount of microleakage among the groups. AH Plus-Resilon combination demonstrated the greatest amount of microleakage. There were a significant difference between Epiphany gutta-percha and AH Plus-Resilon combinations (p < 0.05). It was found that there were no significant differences between Epiphany-Resilon combination and all the other groups (p > 0.05).

Dental Bonding↗
PubMed2006

The role of apical size determination and enlargement in the reduction of intracanal bacteria.

The master apical preparation size in root canal therapy is debatable despite considerable research. The present study compared file sizes that bind at the apex before and during crown-down preparation and assessed the relation between apical size and extent of intracanal bacterial load. There were 100 single-rooted teeth biomechanically prepared after inoculation with Enterococcus faecalis. Canals were preflared, and apical size was ascertained by the first file to bind (FAB) at the working length (WL). During crown-down preparation, the first crown-down file to reach the apex during instrumentation was noted (CDF). Teeth were then divided into three master apical file size groups of CDF + 1, CDF + 2, and CDF + 3. Positive controls were inoculated postinstrumentation, whereas negative controls were instrumented without inoculation (n = 5). The samples were then cultured for intracanal bacterial counts. Fifteen samples and four controls were analyzed under SEM. The data were analyzed using ANOVA, Student's t-test, and chi(2) tests. The CDF was demonstrated to be an average of four file sizes larger than the FAB (p < 0.05). There was a significant increase in the number of samples with negative cultures from CDF + 1 to CDF + 3. SEM observation revealed bacteria on dentinal walls and in tubules even in most negative canal cultures.

Analysis of Variance↗
PubMed2005

The use of a resin-bonded prosthesis while maintaining the diastemata: a clinical report.

A dental arch with diastemata and missing lateral incisors represents a challenge because of discrepancies in tooth size. If an implant-supported prosthesis is not possible or not selected as a treatment option, a modified resin-bonded fixed partial denture may be a treatment option to eliminate the esthetic problems of conventional fixed partial dentures. This clinical report describes the procedures to replace congenitally missing lateral incisors with a resin-bonded prosthesis, while maintaining diastemata.

Adult↗
PubMed2006

Comparison of temperature increase in the pulp chamber during the polymerization of materials used for the direct fabrication of provisional restorations.

STATEMENT OF PROBLEM: Polymerization of resin materials used for the fabrication of provisional restorations is associated with an exothermic reaction. This temperature rise may present a serious biological problem, since it can cause iatrogenic thermal trauma to the pulp. PURPOSE: This in vitro study compared the temperature increase in the pulp chamber of a molar placed in contact with different resins used for the direct fabrication of provisional restorations. MATERIAL AND METHODS: Polymethyl methacrylate (Jet), polyethyl methacrylate (Snap), polyvinylethyl methacrylate (Trim), Bis-acrylic composite (Protemp II), and a VLP urethane dimethacrylate (Revotec LC) were compared with respect to their exothermic reaction properties during polymerization. A mandibular molar prepared for a complete coverage restoration was placed in an acrylic resin block. A thermal probe connected to a digital thermometer was placed into the pulp chamber. Specimens were submerged in a water bath to simulate intraoral conditions. The provisional resin materials tested were measured and mixed according to manufacturer's instructions. The resin mixture was placed into a vacuum-formed acetate template and was then positioned on the prepared molar tooth. The temperature was recorded during polymerization at 30-second intervals until it was evident that the peak temperature had been reached. Temperature increase was measured ( degrees C) for both the initial crown fabrication and the reline procedures. Data were analyzed with descriptive statistics, 1-way analysis of variance, and Tukey Honestly Significant Difference tests (alpha=.05). RESULTS: One-way ANOVA revealed significant differences (F=57.010, P<.0001) in temperature rise for different provisional resin materials. Mean temperature increase for the provisional crown fabrication ranged from 37.76 degrees C for the polyvinylethyl methacrylate to 39.40 degrees C for the polymethyl methacrylate. Mean temperature rise for the reline procedures ranged from 36.80 degrees C for the polyvinylethyl methacrylate to 37.69 degrees C for the polymethyl methacrylate. All of the tested materials produced an exothermic chemical reaction. CONCLUSIONS: Polymethyl methacrylate produced the higher exothermic reaction in both initial crown fabrication and reline procedures. Polyethyl methacrylate, polyvinylethyl methacrylate, and Bis-acrylic resins tested were not significantly different from each other.

Acrylic Resins↗
PubMed2004

A comparison of Profile, Hero 642, and K3 instrumentation systems in teeth using digital imaging analysis.

OBJECTIVE: To evaluate the changes in cross-sectional area morphology of curved canals after instrumentation with Profile((R)), Hero 642((R)), and K3((R)) using digital imaging analysis. Study design Thirty mesial mandibular curved canals were used (25-40 degrees ). The molars were embedded in resin and the roots were sectioned transversely at three levels: apical, middle, and coronal. The canals were randomly distributed into 3 groups for instrumentation using Profile.04 and.06, Hero 642, and K3. The pre- and postinstrumentation sections were digitized and areas corresponding to the canals were measured with image-processing software. RESULTS: Hero eliminated significantly more dentine than K3 and Profile in all 3 sections (P <.01, ANOVA test), with no differences observed between the latter 2 systems (P >.05, Student-Newman-Keuls test). All 3 systems yielded a rounded canal morphology in the coronal, middle, and apical thirds. CONCLUSION: Hero rotary instruments produced more changes in cross-sectional area of the root canal.

Analysis of Variance↗
PubMed2005

The risk of furcal perforation in mandibular molars using Gates-Glidden drills with anticurvature pressure.

OBJECTIVE: The aim of this study was to determine whether using Gates-Glidden (GG) drills and anticurvature pressure in curved mesial root canals of mandibular molars could remove more dentin from the mesial canal wall and remove less dentin from the distal canal wall at a level 2 mm below the furcation. STUDY DESIGN: In 5 groups of mesial roots with an average curvature of 32-34 degrees, 103 canals were prepared using a size #2 or #3 GG drill in the coronal third (straight portion of the canal only) or coronal half (straight portion and part of the curved portion), with or without applying anticurvature pressure. Using a modification of the Bramante muffle mold the cross-section of the mesial root at 2 mm below bifurcation was photographed twice, before and after the use of GG; the photos were then scanned as tagged image files. The thickness of the mesial and distal canal walls wer measured using an image analysis program. The reduction of the wall thickness after the use of GG was calculated. RESULTS: Before enlargement, the average and minimal thickness of the distal wall was 0.92 and 0.43 mm respectively, thinner than that of the mesial wall (1.50 and 0.87 mm, correspondingly). After the use of GG, the reduction of the mesial wall was similar to the reduction of the distal wall (P > .05 for all groups). In 4 groups the maximal reduction of the distal wall was > or =0.72 mm. CONCLUSIONS: After using GG drills and anticurvature pressure, dentin was uniformly removed regardless of the size of the GG and the depth of placement of GG. Flaring with GG drills in mandibular molars may result in perforations; application of anticurvature pressure did not reduce the risk.

Dental Instruments↗
PubMed2006

A clinical method to determine the optimal apical preparation size. Part I.

OBJECTIVE: To establish a new approach for determination of the optimal apical preparation size (APS). STUDY DESIGN: After preflaring 212 root canals from 80 extracted molars, electronic working length (WL) was measured to establish where the apical preparation size (APS) should be determined. Subsequently, nontapered, noncutting special instruments were used to reach WL. The diameter of the largest special instrument (SI) width that had to overcome some resistance to advance to WL was defined as d(SI). After sectioning the roots apically, the diameter of a potential rotary instrument was determined for each section, allowing a complete cutting of the root canal wall. The estimation of APS was related to d(SI). RESULTS: Theoretically, individual APS of d(SI) + 0.60 mm yielded circumferential apical preparations in 98% of the cases. When shaping palatal/distal root canals of molars to d(SI) + 0.40 mm, and mesiobuccal/mesiolingual/distobuccal root canals of molars to d(SI) + 0.30 mm, complete preparations of root canal walls resulted in 78% (95% CI, 69%-87%) and 72% (95% CI, 65%-80%) of canals, respectively. CONCLUSION: The described approach allowed evaluation of the APS for most root canals. Root canals should be shaped to larger sizes than normally recommended.

Algorithms↗
PubMed2006

Comparison in vivo of the first tapered and nontapered instruments that bind at the apical constriction.

OBJECTIVE: To compare sizes of the first instrument with or without taper that binds to the narrow apical diameter of the root canal after coronal flaring. STUDY DESIGN: For the study, 388 canals were examined in patients with intact apices. A standard endodontic access cavity was prepared and the coronal third flared using standardized K-files, Gates Glidden reamers, or Profile rotary instruments. Apical patency was established using K-file size 10 and working length determined using an apex locator and radiographs. Standardized K-file hand instruments were gently introduced to working length beginning with size 15. The first K-file to bind to the canal walls and reach the working length was recorded as FKFB. Nontapered instruments (Lightspeed) were then gently introduced by hand to each canal in ascending order beginning with size 20 to working length. The first instrument to bind to the canal walls and reach the working length was recorded as FLSB. Statistical analysis was carried out using univariate analysis of variance. RESULTS: The average size of FLSB was approximately 2 ISO sizes larger than FKFB (P < .001). Minimal differences were found in the maxillary central incisors (6.7 +/- 3.0) and maximal differences in canals from maxillary lateral incisors (15.4 +/- 3.5). CONCLUSIONS: The first nontapered instruments to bind at the apical constriction were larger and reflected the actual narrow apical diameter of the canal better than the tapered instruments.

Dental Instruments↗
PubMed2006

Accuracy of the apex locating function of TCM Endo V in simulated conditions: a comparison study.

OBJECTIVE: The aim of this study was to evaluate the accuracy of the apex-locating function of the TCM Endo V and to compare the results to these of the Root ZX. STUDY DESIGN: Forty-seven extracted maxillary incisor teeth with mature apices and patent single root canals were used for the study. After the root surfaces were cleaned and access cavities were prepared, the true working lengths (TL) were determined with a #10 stainless steel file. All samples were mounted in an alginate model especially developed to test the apex locators. Both electronic apex locators were used according to the manufacturer's recommendations and adjusted to 0.5-mm accuracy to the apical foramen. EL(1) was designates as the working length measured with Root ZX and EL(2) was designated as the working length measured with TCM Endo V. A paired t test was used to statistically analyze the significance of the mean differences at the 95% confidence interval of the differences (P = .001) among TL, EL(1), and EL(2). RESULTS: There were no statistically significant differences between TL and EL(1), TL and EL(2), and EL(1) and EL(2) (P = .001). Both Root ZX and TCM Endo V gave similar results. CONCLUSIONS: TCM Endo V proved to be as reliable as Root ZX but the use of the device to determine the working length was not easy as Root ZX. Further studies are needed to compare TCM Endo V in clinical conditions with similar electric motor and apex locator combined devices.

Dental Instruments↗