Original Article

Effect of Different Luting Cements on Fracture Resistance in Endodontically Treated Teeth

Narmin Mohammadi, Amir Ahmad Ajami, Soodabeh Kimyai, Mojdeh Rezaei Aval

Iranian Endodontic Journal, Vol. 3 No. 4 (2008), 1 October 2008 , Page 97-102

INTRODUCTION: The aim of the present study was to evaluate the effect of three types of luting cements used for post cementation on the fracture resistance of endodontically treated maxillary premolars, restored with resin composite. MATERIALS AND METHODS: One hundred intact single-rooted human maxillary premolars were randomly divided into 5 groups of 20 each. In groups 2-5, post spaces were prepared after root canal treatment and clinical crown reduction up to 1.5 mm above the CEJ. Teeth were divided in groups as follows: Group 1: intact teeth, Group 2: active prefabricated metallic posts (PMP), Group 3: PMP cemented with zinc phosphate luting cement, Group 4: PMP cemented with glass ionomer luting cement and Group 5: PMP cemented with resin luting cement. In groups 2-5 the teeth were restored with resin composite. Following thermocycling, the palatal cusp of each specimen was loaded to compression at an angle of 150˚ to its longitudinal axis at a strain rate of 2 mm/min until fracture occurred. Data were analyzed using one-way ANOVA and a post hoc Tukey test. Chi-square test was used for comparison of failure mode. RESULTS: There were significant differences in fracture resistance between the test groups (P<0.001). The differences between group 2 with groups 1, 4 and 5 were statistically significant (P<0.05); whereas there were no significant differences in fracture resistance between the two other groups (P>0.05). Furthermore, there were no significant differences in the mode of failure between the 5 groups (P>0.05).  CONCLUSION: Zinc phosphate, glass ionomer and resin luting cements showed similar behaviors and achieved fracture resistance comparable to intact teeth. However, the use of active post (without cement) adversely affected the fracture resistance of root canal treated teeth.

Antimicrobial Effects of AH26 Sealer/Antibiotic Combinations Against Enterococcus Faecalis

Hasan Razmi, Kazem Ashofteh Yazdi, Fereshteh Jabalameli, Shaghayegh Parvizi

Iranian Endodontic Journal, Vol. 3 No. 4 (2008), 1 October 2008 , Page 103-108

INTRODUCTION: The purpose of this in vitro study was to evaluate the antimicrobial effects of two antibiotics added to AH26 sealer against Enterococcus faecalis (EF). MATERIALS AND METHODS: The antimicrobial effects of two antibiotic (amoxicillin and doxycycline) that were added separately to AH26 sealer was evaluated by using the agar diffusion test and in vitro human root inoculation method. The freshly mixed sealers were placed in prepared wells inside agar plates inoculated with EF, and were incubated at 37°C. The zones of inhibition were measured at 24, 48, 72 hours and 7 days. Root specimens were prepared and obturated with lateral condensation technique. Samples were collected from infected root canals after 2 and 7 days of incubation and the number of colony-forming units (CFU) was determined. The data were analyzed using one-way and two-way ANOVA. RESULTS: The findings of this study revealed that sealer-antibiotic combination containing amoxicillin and doxycycline had a significant difference in the mean zones of inhibition when compared to AH26 sealer alone in all of the time periods (P<0.05). The minimum effective concentration against EF was one percent of sealer powder weight for both of amoxicillin and doxycyline. The mean log10 CFU in AH26-doxycyline combination group was significantly lower than other groups at 48 h incubation period (P<0.05). AH26-doxycycline combination group and AH26-Amoxicillin combination group killed bacteria (mean CFU=0) in the dentinal tubules at 7 days incubation period. CONCLUSION: In vitro root fillings carried out with gutta-percha and AH26-antibiotic combination were effective in killing EF in dentinal tubules.

Comparison of Extracted Teeth and Simulated Resin Blocks on Apical Canal Transportation

Zohreh Khalilak, Arjang Fallahdoost, Bahareh Dadresanfar, Gholamreza Rezvani

Iranian Endodontic Journal, Vol. 3 No. 4 (2008), 1 October 2008 , Page 109-112

INTRODUCTION: We aimed to compare apical canal transportation of extracted teeth and two types of simulated resin blocks. MATERIALS AND METHODS: Mesiobuccal root of extracted maxillary molars, high hardness simulated resin blocks (Knoop hardness=40) and low hardness simulated resin blocks (Knoop hardness=22) were prepared with K-files using step-back technique (n=15 canals in each group). Double exposure radiographic technique was used for extracted teeth. Simulated resin blocks were stabilized and scanned before and after preparation. Pre and post-preparation pictures were superimposed and apical transportation was measured. The data were analyzed statistically using ANOVA and Tukey HSD tests. RESULTS: There was no significant difference in apical canal transportation between extracted teeth and high hardness resin blocks (P>0.05). Low hardness resin blocks showed more apical transportation than the other groups (P<0.05). CONCLUSION: Under the conditions of this study, apical canal transportation for extracted teeth and high hardness simulated resin blocks were similar.

Stress Distribution Changes after Root Canal Therapy in Canine Model: A Finite Element Study

Allahyar Geramy, Mohammad Jafar Eghbal, Sara Ehsani

Iranian Endodontic Journal, Vol. 3 No. 4 (2008), 1 October 2008 , Page 113-118

INTRODUCTION: The fracture strength of endodontically treated teeth compared to vital ones has long been a source of controversy. It is not clear how root canal therapy affects the stress distribution in teeth. The purpose of this study was to evaluate the changes in stress distribution after root canal therapy in a human maxillary canine by finite element analysis (FEM). MATERIALS AND METHODS: Two 3D FEM models of a maxillary canine were created; one represented a virgin tooth and the other represented the same tooth after root canal therapy. A single force of 14.1 N was applied 45 degrees to horizontal plane to the center of the palatal surface; stress distribution was then analyzed in both models. RESULTS: SEQV (VonMises stress) analysis demonstrated an obvious decrease after root canal therapy and the regions near cementoenamel junction (CEJ) showed the highest displacement. The endodontically treated tooth demonstrated higher deflection than the vital one. CONCLUSION: Maximum stress and displacement was repeatedly found in the cervical area, hence more emphasis should be placed on the reinforcement of this region.

The Effect of Different Irrigation Regimens on the Apical Seal of Two Endodontic Sealers

Shiva Sadeghi, Tania Safari

Iranian Endodontic Journal, Vol. 3 No. 4 (2008), 1 October 2008 , Page 119-122

INTRODUCTION: The purpose of this in vitro study was to investigate the influence of 5.25% sodium hypochlorite (NaOCl) and 0.12% chlorhexidine gluconate (CHX) use separately and combined as endodontic irrigants on the apical sealing ability of two endodontic sealers. MATERIALS AND METHODS: Eighty-six extracted maxillary central incisor teeth were used. The teeth were decoronated at the CEJ, access cavities were prepared, root canals were instrumented up to a master apical file size #40, irrigated with either 0.12% CHX alone, 5.25% NaOCl alone, 5.25% NaOCl and 0.12% CHX combined, or saline and dried using paper points. Obturation was accomplished by lateral condensation technique using one of two endodontic sealers AH26 or Apexit. Apical leakage was measured using dye penetration method and data were analyzed by one way ANOVA and Tukey's HSD test. RESULTS: The results showed significant differences between NaOCl+CHX/AH26 group and both CHX/AH26 and saline/AH26 groups (P<0.05). There was also a significant difference between saline/AH26 and other irrigant/AH26 groups (P<0.001) also there was statistically significant differences between saline/Apexit group and other irrigant/Apexit groups (P<0.001). The mean leakage of CHX/AH26 and CHX/Apexit was statistically different as well as for NaOCl/AH26 and NaOCl/Apexit (P<0.05). CONCLUSION: Under the conditions of this in vitro study, combination of NaOCl/CHX can significantly increase apical sealing ability of AH26 sealer.

A Comparative Scanning Electron Microscope Investigation of Cleanliness of Root Canals Using Hand K-Flexofiles, Rotary Race and K3 Instruments

Saeed Rahimi, Vahid Zand, Shahriar Shahi, Sahar Shakouie, Mohammad Forough Reyhani, Mohammad Mohammadi Khoshro, Pardis Tehranchi

Iranian Endodontic Journal, Vol. 3 No. 4 (2008), 1 October 2008 , Page 123-128

INTRODUCTION: The most important aims of root canal preparation are the removal of vital pulp tissue, remaining necrotic debris and infected dentin, eliminating the bulk of bacteria present in the root canal system. The aim of this study was to compare the cleaning efficacy of hand K-Flexofiles and rotary RaCe and K3 instruments in root canal preparation. MATERIALS AND METHODS: A total of 60 single rooted teeth with maximum curvature of <20º were selected and divided into three groups of 20 teeth each. Canals were prepared with K-Flexofiles, K3 and RaCe instruments using crown down preparation technique, up to size #30. After instrumentation, the root canals were flushed with 5 mL of 2.5 % NaOCl solution. The amount of debris and smear layer was quantified on the basis of Hulsmann method using a scanning electron microscope. The data were statistically analyzed with one-way ANOVA test at a significance level of P<0.05. RESULTS: None of the three groups achieved completely debrided root canals.. In general, K-Flexofiles were able to achieve cleaner canals compared to K3 and RaCe instruments (P<0.05). There were no significant differences between three groups in smear layer removal throughout the root canal walls (P<0.05). CONCLUSION: K-Flexofiles group had less remained debris when compared to K3 and RaCe instruments.

A Comparative Study of Antimicrobial Activity of Proroot MTA, Root MTA, and Portland Cement on Actinobacillus Actinomycetemcomitans

Mohammad Saeed Sheykhrezai, Marzieh Aligholi, Roghayeh Ghorbanzadeh, Abbas Bahador

Iranian Endodontic Journal, Vol. 3 No. 4 (2008), 1 October 2008 , Page 129-133

INTRODUCTION: The purpose of our study was to evaluate the antibacterial effect of ProRoot MTA (PRMTA), Root MTA (RMTA) and Portland cement (PC) at their clinical concentration (70 mg/25 µL) against Actinobacillus actinomycetemcomitans (Aa) one of the prominent periodontal (pocket) microorganisms. MATERIALS AND METHODS: Agar diffusion test on Blood Agar with Hemin and Vitamin K (BAHV) was employed in this study. The microorganisms were seeded on the BAHV by spreaders. Small holes, 6 mm in diameter, were made in the BAHV by removing agar. PRMTA, RMTA and PC were placed into the wells immediately after manipulation. The plates were incubated in anaerobic atmosphere at 37°C for 72 h and the zones of inhibition were measured. RESULTS: In the agar diffusion test PRMTA, RMTA and PC against Aa showed zones of inhibition. Analyzing the antimicrobial activity of PRMTA, RMTA and PC according to paired one-way ANOVA and Post Hoc Test (Turkey's test) analysis showed a statistically significant difference (P<0.05) between PRMTA, RMTA and PC. RMTA showed the largest zone of inhibition (29 mm) against Aa. There was no difference in the zones of inhibition between the 48 and 72 h time periods. CONCLUSION: In this in vitro study PRMTA and RMTA presented similar antimicrobial activity against Aa.

Case Report

Endodontic Treatment of a Large Periradicular Lesion: A Case Report

Saeed Asgary, Sara Ehsani

Iranian Endodontic Journal, Vol. 3 No. 4 (2008), 1 October 2008 , Page 134-136

This case report describes the endodontic treatment of a large cyst-like periradicular lesion a 29-year-old female with a large chronic periapical abscess in the region of right maxillary sinus presented into private practice, accompanied with non-vital first upper molar and poorly root treated second upper molar. Conservative root canal treatment was carried out for both of the involved teeth in a single appointment. Post operative examination after two weeks revealed complete resolution of the sinus tract. The clinical and radiographic examination after 9 months revealed complete periapical healing. The appropriate diagnosis of periradicular lesion and the treatment of the infected root canal system allowed complete healing of these large lesions without endodontic surgery.

Endodontic Treatment of a Mandibular Second Molar with Two Mesial Roots: Report of a Case

Shohreh Ravanshad, Mohammad Reza Nabavizade

Iranian Endodontic Journal, Vol. 3 No. 4 (2008), 1 October 2008 , Page 137-140

A case of unusual root morphology is presented to demonstrate anatomic variations in mandibular second molars. The most common configuration of mandibular second molar is to have two roots with three root canals; however mandibular molars may have many different combinations. Endodontic therapy was performed in a mandibular second molar with 3 separate roots 2 located mesially and one distally. Radiographically all 3 root canals terminated with individual foramina. Three orifices or 3 independent canals were found in the 3 separate roots, indicating a rare anatomic configuration. Looking for additional roots, canals and unusual morphology is an important part of successful endodontics as the knowledge of their existence occasionally enable clinicians to treat a case that otherwise might have ended in failure.


Comparison of cytotoxicity of three dentin bonding systems with two thicknesses of dentin barrier on L929 cell line

Farshid MirMotalebi, Fatemeh Malekzadeh, Jalil Tavakol Afshari, Shahrzad Nazari

Iranian Endodontic Journal, Vol. 3 No. 4 (2008), 1 October 2008 , Page 118

Introduction: Along with introduction of dentin bonding agents (DBA), their clinical use as lining materials is increasing rapidly. Since remaining dentinal thickness (RDT) has always been a concern for cytopathic effect of restorative materials, its effect on reduction of cytotoxicity of these materials especially DBAs is critical. The purpose of this study was to evaluate and compare the cytotoxicity of three dentin bonding systems, belonged to the 4th, 5th and 6th generation of DBAs on L929 cell line.

Materials and Methods: Thirty human premolar teeth were included. Class I cavity preparations were prepared on occlusal surfaces. After crown separation, a flat dentinal surface was provided and RDT (remaining dentinal thickness) was adjusted at 0.5 and 1.5 mm. Then, cavities were treated in three groups with experimental DBAs: Group 1: Scotchbond multipurpose, Group 2: Excite, Group 3: AdheSE. Blue inlay wax sealed the cavities. Crowns were immersed in culture medium for 24 hours and the cytotoxicity of the resultant toxic medium was measured quantitatively with MTT assay in 4 serial dilutions. Data were analyzed with ANOVA and Tukey`s test at 95% significance level.

Results: MTT assay determined that only in neat dilution of 0.5 mm RDT, cell changes were significantly different from control. Besides, no significant differences were found between the three experimental DBAs regarding cytotoxic effect on L929 cell line.

Conclusion: Considering the limitations of an in vitro study, if the RDT is less than 0.5 mm in vivo, regardless of the type of DBA, destructive cellular changes in pulp tissue can be expected.


Keywords: Cytotoxicity, Dentin barrier, Dentin bonding agent.