Coronal Segment Research Articles

Push-Out Bond Strength of Fiber-Reinforced Post Using Various Post Space Irrigation Treatments.

Objective: This study aims to provide the impact of different endodontic irrigation treatments after post space preparation on the push-out bond strength of fiber posts to dentin using self-adhesive cements. Methods and Materials: A total of 180 extracted premolar teeth were selected. The canals were instrumented by and then were filled. After preparing the post space, teeth were divided into 12 groups according to irrigants (normal saline solution; 17% EDTA [ethylenediaminetetraacetic acid] + 5.25% NaOCl [sodium hypochlorite]; 17% EDTA; 5.25% NaOCl; and 1.2% chlorhexidine [CHX]) and irrigation technique (conventional syringe irrigation [CSI] and passive ultrasonic irrigation [PUI]). After cementation, the samples were sectioned to obtain 1-mm disks from coronal and apical parts, a push-out test was performed using a universal testing machine (Z050, Zwick/Roell, Ulm, Germany) at a speed of 1 mm/min. The data were analyzed using one-way analysis of variance (ANOVA) and Mann-Whitney U tests. Results: The push-out bond strength was higher in coronal segment in comparison to apical segment. The highest push-out bond strength value was related to NaOCl + EDTA using PUI (12.39 ± 1.08). There are significant differences when comparing NaOCl + EDTA group with EDTA group using CSI or PUI technique (p < 0.05) except in coronal region with CSI technique. In both apical and coronal regions, phosphoric acid irrigation was found to be similar to normal saline solution and CHX groups regardless of activation technique. Conclusion: The push-out bond strength values were significantly affected by the irrigation protocol. Using PUI and 17% EDTA + 5.25% NaOCl in apical region could be an effective irrigant for smear layer removal after post space preparation.

The comparative of chitosan and chitosan nanoparticle versus ethylenediaminetetraacetic acid on the smear layer removal: A systematic review and meta-analysis of in vitro study.

The purpose of this systematic review of meta-analysis was to compare the effectiveness of removing the smearing layer using EDTA versus Chitosan (Ch) and Chitosan nanoparticles (Ch-NPs). A search was performed in four electronic databases (Web of Science, PubMed, Scopus, and Cochrane). The included studies were assessed by two reviewers using Joanna Briggs Institute's critical appraisal checklist for the quasi-experimental studies. Outcomes obtained by scanning electron microscopy (SEM) and conventional methods were presented as standardized mean differences alongside 95% confidence intervals. Seven investigations employed 212 single-root teeth. In the apical section (p = .317, 95% CI = -0.820 to 0.266, Tau2 = 0.387), middle segment (p = .914, 95% CI = -1.019 to 0.912, Tau2 = 1.027), and coronal segment (p = .277, 95% CI = -1.008 to 0.289, Tau2 = 0.378). This meta-analysis found no difference between Ch, Ch-NPs, and EDTA in removing the smear layer in the three segments. This systematic review is designed to show evidence related to the PICO question, in which our outcome is smear layer removal and not the clinical success of such a treatment. RESEARCH HIGHLIGHTS: The study aimed to compare the effectiveness of chitosan and chitosan nanoparticles with ethylenediaminetetraacetic acid (EDTA) in removing the smear layer, a layer of debris and organic material on the tooth surface, through a systematic review and meta-analysis. The removal of the smear layer is crucial for successful dental treatments, as it enhances the adhesion of restorative materials and improves the penetration of antimicrobial agents into dentinal tubules. The researchers conducted a systematic review and meta-analysis, searching various databases of electron microscopy results for relevant in vitro studies comparing the effects of chitosan or chitosan nanoparticles with EDTA on smear layer removal. The results encourage further exploration of chitosan and chitosan nanoparticles for clinical use in dentistry, while considering their specific applications and long-term effects.

Bone Shell Technique with Relocated Crestal Ridge Segment for Anterior Horizontal Mandibular Ridge Atrophy: A Case Series.

Horizontal and vertical ridge augmentation via the bone shell technique provides predictable outcomes. The external oblique ridge is the most-used donor site for bone plate harvesting, followed by the mandibular symphysis. The lateral sinus wall and the palate have also been described as alternative donor sites. This preliminary case series reports a bone shell technique that used the coronal segment of the knife-edge ridge as a bone shell in five consecutive edentulous patients (20 sites) with severe mandibular horizontal ridge atrophy and adequate ridge height. The follow-up period was 1 to 4 years. The average horizontal bone gains at 1 mm and 5 mm below the newly formed ridge crest were 3.6 ± 0.76 mm and 3.4 ± 0.92 mm, respectively. Ridge volume was sufficiently restored in all patients to enable implant placement in a staged approach. In 2 of the 20 sites, additional hard tissue grafts were required at implant placement. The advantages of utilizing the relocated crestal ridge segment are as follows: The donor and recipient sites are the same, no major anatomical structures are compromised, periosteal releasing incisions and flap advancement are not required for primary wound closure, and the risk of wound dehiscence is minimized due to reduced muscle tension.

Management of Severe Dento-Alveolar Traumatic Injuries in a 9-Year old Boy: A Case Report

Dentoalveolar traumas can lead to various injuries that may result in tooth loss. A suitable treatment plan and appropriate interventions should be performed to maintain the dental function and aesthetics, especially for the anterior teeth. Objective: To report the interventions performed on dentoalveolar trauma on a 9-years old male patient who presented with gingival immersion of the right maxillary central incisor and missing a tooth due to a falling accident. Case Report: The patient had multiple traumatic injuries. The medical and dental history was taken, and the clinical and radiologic examinations were performed. The patient underwent surgical intervention and splinting to take the intruded tooth back into its normal place. Moreover, the teeth with lateral luxation underwent apexification and composite filling. Also, endodontic treatment was performed on the coronal segment of the tooth with root fractures. The patient underwent clinical and radiographic follow-up for 24 months to assure the treatment efficiency and prevent further complications. Conclusion: It was shown that the interventions performed could preserve the function and aesthetics of the patient’s teeth, which can directly impact his quality of life and emotional state in adolescence

Influence of Blood Contamination on Push-Out Bond Strength of Three Calcium Silicate-Based Materials to Root Dentin

A proper bond between root canal filling materials and dentin surface is essential to resist dislodgement and guarantee long-term success. Blood exposure is likely to occur in various clinical situations in which calcium silicate-based materials are used; therefore, it is fundamental to render data concerning the influence of blood on bond strength. The present study aims to evaluate the effect of blood contamination on the push-out bond strength obtained with three different biomaterials to root canal dentin; Ninety extracted human mono-radicular permanent teeth were selected. The root canals were prepared with Gates Glidden burs until a diameter of 1.10 mm was achieved. Teeth were then randomly divided into six experimental groups (n = 15) according to the presence/absence of blood contamination and biomaterial used for root canal filling (ProRoot® MTA, BiodentineTM, and TotalFill® BC Putty). After one week, each root was sectioned in three segments (coronal, middle, and apical regions). Specimens were then submitted to push-out bond strength tests. Fracture pattern evaluation was performed. The significance level was set at 5%.; Blood contamination did not affect the push-out bond strength of any of the three tested calcium silicate-based cements (p &gt; 0.05). Regardless of blood contamination, TotalFill showed statistically higher push-out bond strength when compared with Biodentine (p = 0.040) and MTA (p = 0.004). Biodentine exhibited higher bond strength than MTA (p = 0.043). Biomaterials’ comparison within each radicular segment revealed statistically superior bond strength of both Biodentine and TotalFill over MTA (p &lt; 0.05) in the coronal segment. TotalFill presented higher push-out bond strength regarding the apical segment compared to Biodentine (p = 0.003). Fractures were mostly adhesive.; Overall results indicate TotalFill presents the highest push-out bond strength values, followed by Biodentine and, lastly, MTA. Blood contamination did not affect the dislodgement resistance. Biomaterials’ comparison within each radicular segment revealed both TotalFill and Biodentine as the preferable alternatives for application in the coronal region. TotalFill might be the biomaterial of choice for placement in the apical region.

مقایسه دقت تشخیصی توموگرافی کامپیوتری با اشعه مخروطی با رادیوگرافی پری اپیکال دیجیتال مستقیم ( CCD) در ارزیابی شکستگی های افقی ریشه دندانهای تک ریشه ای (مطالعه آزمایشگاهی)

Abstract Introduction and aim: Between 0.5 to 7 percent of injuries in permanent teeth include root fractures. If it is left without diagnosis, tooth will become nonvital and subsequent necrotic pulp leads to loss of the tooth. Diagnosis is based on radiography (a radiolucent line /lines) and mobility of coronal segment of tooth. In this study accuracy of cone beam computed tomography(CBCT) was compared with periapical direct digital radiography (CCD) in evaluation of horizontal root fracture in single root teeth. Method and material This in vitro study was performed on 90 recently extracted single root teeth. In study group horizontal fractures(45 teeth) were done by applying mechanical force of hammer and the each two broken segment were stuck together by glue and then imaging performed by CCD and CBCT . The images were evaluated by two radiologists as a single blind study. Results were analyzed by SPSS software ver. 22. To comparing sensitivity, specificity, positive and negative predictive value using Wilcoxon and MC Nemar analysis and Spearman’s correlation coefficient were calculated. Results: Sensitivity, specificity, positive and negative predictive value in CBCT were 97.8%, 95.6%, 93% 92% respectively and CCD were 86.7%, 66.7%, 80% and 85% respectively. Accuracy of CBCT was 93% and that of CCD was 60%. Conclusion: The results for CBCT for both observers and gold standard were not significantly statistically different, but for CCD for one of the observers a significant difference was observed.

A Comparative Study of Surface Hardness between Two Bioceramic Materials in an Experimental Apexification Model under Wet and Dry Conditions

Background:The placement of a wet cotton pellet against Mineral Trioxide Aggregate (MTA) is often recommended to ensure the completion of its setting reaction.Objective:This study aimed to evaluate the setting behaviour of MTA Angelus and NeoMTA by comparing their hardness after placing them in dry and moist conditions.Methodology:A simulated open apex was created on 40 polyvinyl tubes. The apical 4 mm of the tubes was filled with the two materials, NeoMTA Plus (Avalon Biomed Inc. Bradenton, FL, USA) and MTA Angelus (Angelus, Londrina, PR, Brazil) (n=20 per group). Both groups were subdivided into two subgroups based on the dry and wet conditions (n=10 per group). A wet cotton pellet was placed above the two materials in the wet group, and the coronal segment was sealed using Type II Glass ionomer cement (GC corporation Tokyo, Japan). Gutta-percha was placed against the test materials in the dry group with the coronal segment sealed with amalgam. Samples were placed in an oasis soaked in phosphate-buffered saline for seven days in 100% humidity and at 37°C. Microhardness was measured independently at 4 and 2 mm from the apex. Hardness was compared between materials and conditions, applying analysis of variance (a = .05).Results:The presence of dry or wet conditions had no significant effect on material hardness. MTA Angelus showed significantly higher hardness values compared with NeoMTA Plus.Conclusion:The moisture of the periapical environment can compensate for the absence of a wet cotton pellet and is adequate for the setting of the materials.

Reattachment of Fractured Tooth-Series of 2 Case Reports

Most common consequences of trauma is the crown fracture, mainly maxillary anterior tooth due to itsforward positioning in the arch. Understanding the outcome of the planned treatment gives an idea regardingthe prognosis of that particular treatment. Various options are available for the treatment of fractured tooth.Among all reattachment of fractured coronal segment to that tooth provides instant esthetic, as it restoresthe original form, colour, contour, surface texture and also gives a psychological comfort to the patient. Thisclinical case report focuses on the successful reattachment of two fractured coronal crowns using glass-fibrereinforced composite post. Since, both of the fractured teeth were of complex type, endodontic treatmentwas performed for both of the cases. At the end, a natural-looking restoration is achieved.

Management of an Oblique Crown Fracture of an Anterior Tooth with a Missed Coronal Segment: A Case Report

Management of an Oblique Crown Fracture of an Anterior Tooth with a Missed Coronal Segment: A Case Report

Endodontic Treatment of a Tooth with Traumatic Fracture of Root Middle Third.

Root fracture occurs in 0.5 to 7% of all dental injuries. Subsequent to this injury, the coronal segment is displaced, while the apical segment is rarely displaced. Emergency treatment involves repositioning of the coronal segment close to the radicular segment as much as possible to enhance the chance of pulp revascularization. If pulp necrosis occurs, the infective products cause an inflammatory response and radiolucency is seen at the fracture line. In the present case, the patient had two maxillary central incisors with horizontal middle third root fractures due to a traumatic accident four years earlier. The right central incisor showed an endodontic abscess due to pulp infection in the coronal segment. The coronal fragment was treated. In this case study all signs and symptoms resolved after treatment and three year follow-up showed a successful treatment outcome. The left central incisor had a vital pulp according to vitality tests, so "observation only" strategy was considered for this tooth.

A rare case of an immature incisor with horizontal root fracture traumatized at the time of eruption

Dental trauma resulting in root fracture is a rare condition that affects up to 7% of permanent teeth, and injury to immature teeth is even rarer. This case report aimed to show the prognosis of a horizontal root-fractured immature maxillary incisor traumatized at the time of eruption.&#x0D; Because of an accident, a 6-year-old boy was referred to our clinic with horizontal root fracture of the permanent maxillary left central incisor associated with an extrusive luxation. The coronal segment was repositioned, and a dental splint was applied for 7 weeks. After 48 months, clinical examination revealed a positive response to electrical pulp testing and an absence color change of the tooth. Continuation of root development and calcification of the coronal pulp space was observed radiographically. It was concluded that fixation of teeth is a conservative treatment for immature teeth with horizontal root fractures, resulting in the pulp vitality and spontaneous healing with no other treatment.&#x0D; &#x0D; How to cite this article: Erkmen Almaz M, Şaroğlu Sönmez I, Akbay Oba A. A rare case of an immature incisor with horizontal root fracture traumatized at the time of eruption. Int Dent Res 2018;8(2):94-6.&#x0D; &#x0D; Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.

A NEW SPECIES OF CEROPEGIA L. (APOCYNACEAE) FROM SOUTHERN WESTERN GHATS OF INDIA

Ceropegia paulsamii Karuppusamy et Ravichandran sp. nov. (Apocynaceae) is described and illustrated from Megamalai wildlife sanctuary in southern Western Ghats of Tamilnadu state, India. It is similar to Ceropegia decaisneana Wight but differs in sub-succulent fasciculate roots, flowers with short corolla lobes with middle constriction, outer corona trilobed, whitish, and basally caudate each coronal segment.

Influence of Post Angulation between Coronal and Radicular Segment on the Fracture Resistance of Endodontically Treated Teeth.

The objectives of coronal restoration in the Endodontically Treated Teeth (ETT) include rehabilitation of aesthetics, function and prevention of coronal leakage. The long axis of root and the coronal segment in the maxillary anterior teeth varies according to the occlusal scheme. The restorative dentist is required to fabricate the post angulation in compatibility to contour of the adjacent teeth. To evaluate the influence of the angle between the long axes of core facial surface and the radicular segment of the post on fracture resistance of ETT. Total of 30 maxillary intact canines was root canal treated, sectioned 2 mm above the CEJ. The custom made nickel-chromium endodontic posts were fabricated using direct method. The samples were divided among three groups of 10 each. The angle between coronal segment and radicular segment of post in Group-I, Group-II, Group-III were 5°, 10° and 15° respectively. The teeth samples were cemented with full veneer metal crown and tested under universal testing machine. The static load at the angle of 130° was applied until the fracture to record the fracture strength. The obtained data was statistically analysed with ANOVA and Tukey post-hoc test. The Group-III showed the highest fracture strength with 666.15 N. The Group-II and Group-I recorded the mean fracture strength at 443.37 N and 276.74 N respectively. The endodontic post with higher angle between the long axis of facial surface and radicular segment long axis had the positive correlation to the fracture strength in ETT.

Endodontic smear layer removal using conventional and endodontic microbrush device: A scanning electron microscope and profilometer study

Aims: The aim of this study is to compare the effectiveness smear layer removal in root canals between the conventional method and with a new mechanical device. Materials and Methods: Thirty extracted noncarious central incisors were used and divided equally into three groups. Group A (n = 10) was used the control group and was not biomechanically prepared or irrigated. Group B (n = 10) was cleaned and shaped using the conventional method with rotary instruments and by irrigation with 5.25% sodium hypochlorite (NaOCl) and saline. Group C (n = 10) was cleaned and shaped using a new mechanical device, a microendobrush along with the conventional method of irrigation with 5% NaOCl and saline. The teeth were split longitudinally into two halves and each half was divided into three equal parts to obtain a pair of coronal, middle and apical third segment. The specimens were mounted on clear acrylic and were evaluated under a profilometer microscope and scanning electron microscope to view the surface roughness. Statistical Analysis Used: Statistical analysis was done using One-way ANOVA post hoc Tukey test. Data were analyzed using Statistical Package for Social Sciences (SPSS), version 15.0 (SPSS Inc., Chicago, IL, USA) at significance level of P ≤ 0.05. Results: The results reveal that the newer method of irrigation with the microendobrush had better removal of the smear layer and other debris. The conventional method of irrigation shows better results than the control teeth but is not as efficient in removing smear layer compared to the newer method of irrigation. Conclusions: Based on the limitation of the study, the results reveal that the newer method of chemomechanical preparation is more effective at smear layer removal compared to the conventional method of chemomechanical preparation.

Effect of Alveolar Ridge Preservation with PDFDBA on Orthodontic Tooth Movement Rate, Formation of Gingival Invagination and Root Resorption: A Randomized, Controlled Pilot Study

Introduction Tooth extraction is a common method of providing space for orthodontic treatments. Caries, periodontal diseases and traumas may also lead to tooth extraction. Consequences of these extractions areresorptive remodeling of the alveolar bone[1,2], especially in the coronal segment of b

Intentional Replantation of a Root-Fractured Tooth with Pulp Canal Obliteration

Root fracture is defined as a fracture involving the dentin, cementum, and pulp. Most fractures occur in the maxillary anterior teeth between the ages of 11 and 20 years old. The treatment for root fracture in permanent teeth involves the reduction and fixation of the displaced coronal segment. When signs of pulp necrosis or inflammatory root resorption are present, root canal therapy should be performed. Since most apical fragments maintain pulp vitality, root canal therapy is typically limited to coronal fragments. However, it`s too difficult to achieve a proper apical stop on coronal fragment. Intentional replantation involves performing root apex treatment outside the mouth after intentional extraction of the tooth in a controlled environment and then replanting it. The objective is `perfect` root canal therapy. Intentional replantation may be used in cases of failed typical root canal therapy, problematic endodontic retreatment due to the existing restoration or a calcified root canal, and when apical surgery is contraindicated because of a lack of reasonable approaches. In this case, intentional replantation was carried out to treat a horizontal root fracture in a maxillary central incisor with a calcified root canal due to previous trauma. We achieved a clinically and functionally satisfactory result.

The use of MTA/blood mixture to induce hard tissue healing in a root fractured maxillary central incisor. Case report and treatment considerations

To report the use of MTA/blood mixture for the induction of hard tissue healing of multiple horizontal root fractures in a maxillary incisor. An 18-year-old male patient was referred after suffering trauma to the anterior maxilla. Radiographic evaluation revealed multiple horizontal fractures in the middle and cervical third of his maxillary right central incisor. Clinical evaluation revealed third grade mobility of the coronal segment. The patient's accompanying radiographs revealed that root canal treatment of all segments had been previously initiated and both segments had been rendered pulpless. The coronal segment was repositioned and stabilized. A bi-antibiotic mixture, containing equal parts of ciprofloxacin and metronidazole, was used for the disinfection of the root canal segments. A blood clot was induced from the periapical area and MTA powder was mixed with the blood creating a bioceramic mixture covering all the fractures. Thick MTA was placed as a coronal barrier and the tooth was restored. Recall examination after 24months revealed healing of the horizontal fractures. The MTA mixed with the blood lost its radio-opacity over time. Tooth mobility returned to normal limits. A low range of 5-25% of all horizontally root fractured cases develop pulp necrosis, confined in the coronal segment, leaving the apical segment with vital tissue. In the unfortunate situation that the pulp of both segments becomes necrotic or the entire pulp tissue is removed, the use of MTA/blood mixture may be beneficial for the induction of hard tissue healing. MTA when mixed with blood seems to lose its radio-opacity over time.

Comparison of the Surface Hardness among 3 Materials Used in an Experimental Apexification Model under Moist and Dry Environments

IntroductionProcedures used in single-visit or multiple-visit approaches to apical barrier creation were used with an experimental apexification model to test the surface hardness of 3 materials. The purpose of this study was to examine the microhardness of the materials after setting in moist or dry conditions. MethodsA simulated open apex and periapical environment model was created using polyethylene tubes placed into a porous block filled with phosphate-buffered saline. White ProRoot Mineral Trioxide Aggregate (MTA; Dentsply Tulsa Dental, Tulsa, OK), EndoSequence Root Repair Material (ESRRM; Brasseler USA, Savannah, GA), and Biodentine (BD; Septodont, Louisville, CO) were mixed and placed into the apical 4 mm of the tubes (N = 15). The moist group had a damp cotton pellet above the test materials (mineral trioxide aggregate or ESSRM) with Fuji II LC (GC America, Alsip, IL) sealing the coronal segment. The dry group had gutta-percha placed directly against the test materials with amalgam sealing the coronal segment. After 10 days of storage in 100% humidity at 37°C, samples were sectioned, and microhardness was independently measured at 2 mm and 4 mm from the apical end. Differences were assessed using analysis of variance and a Tukey post hoc test (α = .05). ResultsAnalysis of variance analyses showed no significant effect of wet or dry conditions on resultant material hardness. A Tukey post hoc test showed that using ESRRM and BD would not result in a significant difference in hardness, but using MTA would result in statistically significant different hardness values when compared with ESRRM or BD. ConclusionsEither a moist or dry environment could allow hardening of materials; thus, both methods could be acceptable for clinical treatment procedures.

Endodontic management of horizontal root fractures in maxillary central incisors

AbstractRoot fracture implies fracture of cementum, dentin, and pulp. These injuries are relatively infrequent as they constitute &lt;3% of all dental injuries. When a root fracture occurs horizontally, the coronal segment may or may not be displaced. This article illustrates two varied treatment options for horizontal root fractures in maxillary central incisors. In the first case, endodontic treatment was performed using a mineral trioxide aggregate (MTA)-based sealer. In the second case, repositioning and splinting of the teeth allowed revascularization and preservation of teeth vitality. A 12-month follow-up period was reported for the two cases.

Intraradicular splinting of a mid-root fracture with a fiber post

Introduction: Trauma causes fractures of anterior teeth commonly, where extraction is not considered as a part of treatment plan. This case report presents the endodontic management of a horizontally fractured right central incisor involving healing with granulation tissue, using an intraradicular splinting technique. Case Report: A patient complained of pain and mobility of the upper right front teeth since 1 day. The root canal therapy of the upper central incisor was done. The intraradicular stabilization involved placing a fiber post in the canal and luting with resin cement. Discussion: This case demonstrates that intraradicular splinting can be used to manage horizontally fractured teeth with necrotic and mobile coronal segment. The recent improvements in the dental materials resin-based restorative materials with tooth-colored fiber post are of choice because of several advantages such as esthetics, bonding to tooth structure, and low modulus elasticity similar to that of dentin.