Systematic Review

Comparison of Pulpotomy with for Mocresol and MTA in Primary Molars: a Systematic Review and Meta - Analysis

Masoud Fallahinejad Ghajari, Mahkameh Mirkarimi, Mehdi Vatanpour, Mohammad Javad Kharrazi Fard

Iranian Endodontic Journal, Vol. 3 No. 3 (2008), 10 July 2008, Page 45-49

Introduction: There are various studies looking at the effects of formocresol (FC) and mineral trioxide aggregate (MTA) on pulpotomy of primary molars. This is a systematic review of literature comparing the success rates of MTA and FC in pulpotomy of primary molars. Materials and Methods: The study list was obtained using PubMed, EMBASE, Scopus, Science Citation Index, Iran Medex, Google Scholar, the Cochrane Library, and also some hand searches contains through dental journals approved by the Iranian Ministry of Health. Papers which met the inclusion were accepted. The quality of studies for the meta-analysis was assessed by a series of validity criteria according to Jadad's scale. Eight qualified studies met the criteria. Terms of clinical outcomes and radiographic findings were evaluated in all studies to assess clinical success and root resorption. Fixed model was applied to aggregate the data of homogenous studies. A random effect model was carried out for measuring the effect size of heterogeneous studies. Results: The overall clinical and radiographic success rates based on the data suggested that MTA was superior to FC (P=0.004) with the Odds Ratio=3.535 and 95% confidence interval (1.494-8.369). Conclusion: Primary molars pulpotomy with MTA have better clinical and radiographic success rates than FC.

Original Article

In Vitro Comparison of the Effectiveness of Chlorhexidine and Two Calcium Hydroxide Formulations on Enterococcus Faecalis

Mohammad Reza Sharifian, Noushin Shokouhinejad, Marzieh Aligholi Aligholi, Mohammad Emaneini, Arash Katebi, Hadi Assadian

Iranian Endodontic Journal, Vol. 3 No. 3 (2008), 10 July 2008, Page 50-56

INTRODUCTION: The aim of this in vitro study was to compare the effectiveness of three intracanal medicaments in disinfecting the root canal and dentin of experimentally infected human teeth with Enterococcus faecalis (EF). MATERIALS AND METHODS: One hundred extracted human single-rooted teeth were used. After root canal preparation, teeth were mounted in epoxy resin. Following sterilization, the teeth were infected for 28 days with EF. Then root canals were filled with one of three different disinfectants: viscous 2% Chlorhexidine (CHX), calcium hydroxide paste (CH) or a mixture of CH and CHX (n=30 in each group). Antimicrobial assessments were performed at 1, 3 and 7 days (n=10 in each time period). Microbial samples were obtained from root canals before and after the experiment. Also dentin samples were examined. The data was analyzed using Two- Way ANOVA test. RESULTS: The findings showed that there was no difference between experimental groups at different time periods. The mixture of CH/CHX in 7 days was able to eliminate EF completely from root canal system. The most elimination of EF was from dentinal tubules. CONCLUSION: According to the results of this in vitro study, viscous 2% CHX, mixture of CH with distilled water and 2% CHX are all effective disinfectants.

INTRODUCTION: The purpose of this in vitro study was to compare working length (WL) changes after straight-line access (SLA) and different coronal flaring (CF) methods. MATERIALS AND METHODS: Coronal access preparations were made (without SLA) in molar teeth to allow access to 120 canal orifices with a hand file. The suitable cusp and root tips were then flattened to facilitate reproducible and accurate measurements. WL was determined before and after SLA and after different methods of CF. These methods consisted of: stainless-steel (SS) hand files + NiTi hand files, SS hand files + Gates Glidden burs (GG) (#1 to #3), (#3 to #1), GG in step-back manner and crown-down manner without using SS hand files and NiTi rotary orifice shapers. Data was analyzed by paired T-test and coefficient of variance. RESULTS: The mean difference in WL changes after SLA was statistically greater than other methods of CF (P<0.001). The mean difference of WL after CF, in SS hand files + GG (#3 to #1) group was significantly different with SS hand files + NiTi hand files group (P<0.004) and NiTi rotary group (P<0.04). Also the mean changes of WL in SS hand files + NiTi hand files group was significantly different with GG (#1 to #3) group (P<0.01). CONCLUSION: It is better to established working length after SLA. Least changes in WL was occurred with NiTi rotary orifice shapers after coronal flaring.

The Effect of Three Different Root Canal Irrigant Protocols for Removing Smear Layer on the Apical Microleakage of AH26 Sealer

Ali Reza Farhad, Behnaz Barekatain, Ali Reza Koushki

Iranian Endodontic Journal, Vol. 3 No. 3 (2008), 10 July 2008, Page 62-67

INTRODUCTION: The purpose of this in vitro study was to assess the apical microleakage of AH26 sealer when three different root canal irrigant regimens were used. MATERIALS AND METHODS: Eighty single-rooted human teeth were randomly divided into three experimental (n=20) and two control groups (n=10). NaOCl was used as irrigant during instrumentation, and apical patency was ensured in all teeth. Final irrigation was implemented as follow: group A- 17% EDTA + 5.25% NaOCl, Group B- 7% citric acid + 5.25% NaOCl, and group C- 20% citric acid + 5.25% NaOCl. The experimental and negative control groups were obturated by laterally condensed gutta-percha with AH26 sealer. The positive control group was obturated without sealer. The teeth were stored in 100% humidity and 37ºC for 48 hours. In the experimental groups and positive control group, the root surfaces except for the apical 2 mm were covered with nail polish and sticky wax. In the negative control group, the roots were completely covered. The samples were then immersed in 2% methylene blue dye for 72 hours at 37ºC. After that the roots were sectioned longitudinally and the dye penetration was measured. The results were statistically analyzed by One-way Variance and Post Hoc Tukey tests. RESULTS: Statistically significant difference was found between groups (P<0.05). Group C showed the least (1.072 mm) and group A showed the most (2.072 mm) amount of dye penetration. CONCLUSION: When a resin-based sealer is used for the obturation of the root canal system, it is better to use a citric acid irrigant instead of EDTA to remove the smear layer and to improve the apical seal.

Assembling of Fluid Filtration System for Quantitative Evaluation of Microleakage in Dental Materials

Maryam Javidi, Neda Naghavi, Ehsan Roohani

Iranian Endodontic Journal, Vol. 3 No. 3 (2008), 10 July 2008, Page 68-72

INTRODUCTION: There are several methods for evaluating microleakage in dentistry, for example dye or bacterial leakage, electro-chemical methods, radioisotope labeling and fluid filtration. The purpose of this study was to assemble the fluid filtration system for quantitative evaluation of microleakage in dental materials. MATERIALS AND METHODS: The roots were connected to a tube filled with an underwater pressure supply. A bubble was introduced into the water to measure endodontic leakage. A digital camera and professional software were utilized to record and measure the bubble displacement. RESULTS: Our system was constructed successfully and functioned correctly. CONCLUSION: In this pilot study we found this system efficient for the evaluation of microleakage of dental materials.

Technical Quality of Root Canal Treatment Performed By Undergraduate Dental Students

Bahareh Dadresanfar, Nahid Mohammadzadeh Akhlaghi, Mehdi Vatanpour, Hojat Atef Yekta, Ladan Baradaran Mohajeri

Iranian Endodontic Journal, Vol. 3 No. 3 (2008), 10 July 2008, Page 73-78

INTRODUCTION: This study was carried out to evaluate the technical quality of root canal treatment (RCT) performed by undergraduate dental students at the Islamic Azad University in Tehran, Iran. MATERIALS AND METHODS: Four-hundred records of patients who had received RCT at faculty of dentistry, between the years 2004-2006 were evaluated. For each treated tooth at least three periapical x-rays were assessed: preoperative, working length measurement, and postoperative. Evaluation of root canal filling was based on two variables: length and density. The filling length was recorded as adequate, under- or overfilled. Density of filling was recorded as poor or adequate. Fillings with adequate length and density were recorded as acceptable. Detected iatrogenic errors were: ledge formations, root perforations, furcation perforations, strip perforations and presence of fractured instruments. Results were evaluated statistically using one-way ANOVA and Chi-square analysis. RESULTS: Out of the 400 teeth, 50.5% had at least one of the mentioned errors. Acceptable filling was observed in 32.5% of all studied teeth. Ledge was found in 17.5% of the teeth. Canal curvature was the most important factor associated with ledge formation (P<0.05). CONCLUSION: The technical quality of RCT performed by undergraduate dental students using step-back preparation and cold lateral condensation was classified as acceptable in 32.5% of the cases.

A Comparative Study of Apical Microleakage Using the Conventional Lateral Condensation and Mechanical Lateral Condensation Techniques

Shahriar Shahriari, Seyed Mohsen Jalalzadeh, Hasan Abedi, Hasan Abedi

Iranian Endodontic Journal, Vol. 3 No. 3 (2008), 10 July 2008, Page 79-82

INTRODUCTION: This study compared apical dye penetration using lateral condensation technique (LC) and LC technique with a reciprocal handpiece (mechanical lateral condensation or MLC) as a new method. MATERIALS AND METHODS: Forty-eight human extracted straight canine teeth were used. After crown amputation, the teeth were randomly divided into four experimental groups of 10 teeth each and two negative and positive control groups of 4 teeth each. The groups were as follows: IA, 10 obturations completed by operator A using the LC technique; Group IB, 10 obturations completed by operator B using the LC technique; Group IIA, 10 obturations completed by operator A using the MLC technique; and Group IIB, 10 obturations completed by operator B using the MLC technique. All roots were placed in 2% methylene blue dye and centrifuged at 3000 rpm for 3 minutes. Following centrifugation, the roots were cut along their long axis and evaluated under a stereomicroscope to measure the depth of dye penetration. RESULTS: A t-test showed that the teeth which were filled by the MLC technique had less dye penetration in comparison with LC technique (P<0.05). CONCLUSION: This in vitro study illustrates that canals obturated with the MLC technique had superior apical seal than canals filled with the LC technique.

Case Report

Endodontic Re-Treatment of Maxillary Second Molar with Two Separate Palatal Roots: A Case Report

Jamileh Ghoddusi, Abbas Mesgarani, Salman Gharagozloo

Iranian Endodontic Journal, Vol. 3 No. 3 (2008), 10 July 2008, Page 83-85

Maxillary second molar with two palatal roots is a rare dental anatomy. The diagnosis and treatment of exceeded root may create challenge for clinicians. The authors discuss the retreatment of a maxillary second molar in which exceeded root was undiagnosed in previous treatment. The case report underlines the importance of complete knowledge about root canal morphology which achieved by careful clinical and radiographic examination. In retreatment procedures clinicians should consider missed canals.

Delayed Tooth Replantation after Traumatic Avulsion: A Case Report

Zohreh Khalilak, Mahshid Shikholislami, Ladan Mohajeri

Iranian Endodontic Journal, Vol. 3 No. 3 (2008), 10 July 2008, Page 86-89

Avulsion is a serious injury which causes damage to dental and supportive tissues, ranging from 1-16 % among dental injuries and it mostly occurs in maxillary incisors. This report presents a case of replantation of a traumatically avulsed central incisor. The left central incisor of an 8 year-old boy with open apex was avulsed and was left in unclean and dry conditions. Tooth was replaced after 270 min and splinted. After 24 hours, tooth was treated endodontically. The calcium hydroxide paste was applied as intracanal medicament. After one year the calcium hydroxide was not replaced and was maintained in the canal, permanently. The tooth followed for 5 years. During follow up, the tooth kept stable. However, the resulted dent alveolar ankylosis prevented growth of the alveolar process. Spite of the fact that in children, replacement resorption leads to the loss of ankylosed teeth within 1-5 years; this tooth has remained in a stable, infra-position for 5 year and in functional position after coronal restoration. However, in such cases other treatments such as decoronation should be considered.

The Importance of Long Time Follow-Up after Vital Pulp Therapy: A Case Report

Parviz Amini, Masoud Parirokh

Iranian Endodontic Journal, Vol. 3 No. 3 (2008), 10 July 2008, Page 90-92

This report describes a case of an eight years old girl who was treated for complicated crown fracture of right maxillary central incisor because of a sport accident. For the tooth total pulpotomy was performed in order to achieve apexogenesis and the tooth was restored with a composite resin. The patient was reviewed over 10 years. At first the tooth showed continued root development and complete apex formation following vital pulp therapy, however, after 10 years the tooth developed pulp necrosis and periapical radiolucency. Following root canal therapy, periapical radiolucency has been healed.


External root resorption: Arrested or progressing?

Mehdi Vatanpour, Maryam Javidi, Mina Zarei, Shiva Shirazian

Iranian Endodontic Journal, Vol. 3 No. 3 (2008), 10 July 2008, Page 93-94

External root resorption may be an uncontrolled phenomenon, and the most known interventions have no effect. Even progressive external root resorption may not be controlled by long term Ca(OH)2 therapy. Currently, there are no treatment options for vital tooth that suffer from root resorption. This invasive resorption can lead to extraction of the tooth. The use of new technologies such as low power laser may control this type of resorption.