Clinical Trial

The The Effect of Adding Clonidine to Articaine and Epinephrine on Post-treatment Pain: A Randomized Clinical Trial Study

Elham Shadmehr, Sara Hashemi, Seyed Saman Hashemi, Yoo jung chung, Arman Goudarzi, Abbasali Khademi

Iranian Endodontic Journal, Vol. 16 No. 4 (2021), 13 October 2021 , Page 210-216

Introduction: Articaine is reported to have a fast onset and a short-acting pulpal anesthesia in inferior alveolar nerve blocks. Clonidine is an α2-adrenoceptor agonist and is used as an adjunct to enhance the anesthetic efficacy and induce greater analgesia. In an attempt to search for more effective ways to achieve profound analgesia after root canal treatment, this randomized clinical trial assessed the efficacy of clonidine added to articaine/epinephrine solution on post-operative pain relief after root canal treatment in mandibular molars with irreversible pulpitis. Materials and Methods: Our randomized clinical trial study enrolled one hundred patients with symptomatic irreversible pulpitis in mandibular molars. They were divided into two groups, each group received either 0.2 mL 150 µg/mL clonidine or distilled water added to 1.8 mL of 4% articaine with 1:100,000 epinephrine cartridge. The alveolar nerve block in the two groups was administered by the same clinician and the subject’s pain scores were recorded at 6, 12, 24, 48 and 72 h post-operatively using a Heft-Parker visual analog scale. Data were analyzed using t, chi-square and repeated-measures ANOVA statistical tests. Results: The mean pain scores for clonidine group were significantly lower than control at all the time intervals after treatment (P<0.05). We did not notice any clinical and there were no complaints from the patients either. Conclusion: Based on this randomized clinical trial study the addition of clonidine to the articaine/epinephrine solution using an inferior alveolar nerve block during root canal treatment in mandibular molars with irreversible pulpitis may be effective in reducing post-operative pain.

Original Article

Comparative Analysis of Continuous versus Reciprocating Instruments in Retreatment of Flat-oval Root Canals

Mônica C Matta, Roberto Paulo C de Araújo , Eugênia Livia A Dantas, Fabio Luiz Cunha D’Assunção, Frederico Barbosa de Sousa

Iranian Endodontic Journal, Vol. 16 No. 4 (2021), 13 October 2021 , Page 217-224

Introduction: Flat-oval root canals of incisors can be problematic in retreatments. This study assessed the efficacy of continuous and reciprocating rotation instruments in retreatment of flat-oval root canals in lower incisors via micro-computed tomography (micro-CT). File systems studied were ProTaper universal retreatment rotary system associated with ProTaper Next (PTUR+PTN), D-RaCe associated with iRaCe (DR+iR), Reciproc (REC), and WaveOne (WO). Materials and Methods: Thirty-two mandibular incisors with flat root canal were divided into 4 groups (n=8). The groups were initially prepared with PTN, iRaCe, REC, and WO, then instrumented, filled, and subjected to micro-CT analyses. All the canals were then retreated with the PTUR+PTN, DR+iR, REC, and WO, and then subjected to new micro-CT analysis  which allowed quantification of residual filling material volume and change in the diameter of the root canal apical third. Endodontic retreatment time was also quantified. Data were analyzed with One-Way ANOVA and post hoc t tests. Results: None of the systems completely removed the filling material. The groups differed in terms of remnant filling material volume (PTUR+PTN=2.9±1.1 mm3; DR+iR=3.6±3.1 mm3; REC=4.9±1.9 mm3; WO=3.1±1.9 mm3) and retreatment time (PTUR+PTN=1:36±0:12 sec; DR+iR=0:57±0:13 sec; REC=2:10±0:44 sec; WO=2:03±0:31 sec), but had similar values in terms of change in apical root canal diameter (P>0.05). Conclusions: Based on this in vitro study, the type of endodontic instrument did not affect the diameter of the root canal apical third. However, PTUR with ProTaper Next had the lowest residual filling material volume and second lowest retreatment time, in flat-oval root canals in mandibular incisors.

Cytotoxicity and Bioactivity of Calcium Silicate-based Cements in a Culture of Stem Cells from the Apical Papilla

Adriana Knorr, Leticia Boldrin Mestieri, Lucas Siqueira Pinheiro , Roberta Almeida Mendes , Pedro Antonio Gonzalez Hernandez, Fernando Branco Barletta , Fabiana Soares Grecca

Iranian Endodontic Journal, Vol. 16 No. 4 (2021), 13 October 2021 , Page 225-231

Introduction: The present in vitro study evaluated the cytotoxicity and bioactivity of commonly-used calcium silicate-based cements in a culture of stem cells from the apical papilla (SCAPs). Materials and Methods: NeoMTA Plus (Avalon Biomed), BiodentineTM (Septodont) and MTA HP Repair (Angelus) cements were evaluated using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) and sulphorhodamine-B (SRB) viability assays. Cells were seeded (1*104 cells mL-1) in 96-well plates and exposed to 1:4 diluted extract in 24 h and 72 h. For the analysis of bioactivity, alkaline phosphatase (ALP) enzyme activity and Alizarin Red S (AZR) were assessed after 24 h of cell culture in 12-well plates (1*104 cells mL-1), where cells were exposed to 1:4 diluted extract on days 1 and 7. Minimum Essential Eagle’s Medium alpha modification was used as control. ANOVA and Tukey’s post hoc test were used to compare the different cements at each experimental time point. Results: No significant differences were found between the cements and the control specimens on MTT at 24h and 72 h (P>0.05); however, the calcium silicate-based cement materials showed higher cell viability compared to the control group (P<0.05). In the 24-h SRB, NeoMTA Plus showed lower cell viability than BiodentineTM and MTA HP Repair (P<0.05), with all groups similar to the control group (P>0.05). Compared to 24-h results, only NeoMTA Plus presented increased cell viability at 72h (P<0.05). ALP activity was similar across the materials at 1day (P>0.05). ALP activity was higher for BiodentineTM when compared to NeoMTA Plus (P<0.05), nevertheless, it was similar to MTA HP Repair and control groups (P>0.05) at 7days. At 1- and 7-day periods ofAZR assay, BiodentineTM presented higher levels of mineralized nodule formation (P<0.05). Conclusion: All evaluated calcium silicate-based cements demonstrated cell viability and bioactivity, suggesting that these (bio)materials may be indicated for use in regenerative dentine-pulp complex procedures.

Simulated Evaluation of Tooth Fracture Resistance during Instrumentation with Single-and Multi-file Rotary Systems

Mostafa Godiny, Seyed Kamal Jalali, Atefeh Khavid, Ali Fatahy

Iranian Endodontic Journal, Vol. 16 No. 4 (2021), 13 October 2021 , Page 232-237

Introduction: Use of rotary files in root canal preparation is inevitable due to their high speed and reduced duration of treatment. However, microcracks and even root fracture may sometimes occur in teeth where canal(s) is/are prepared using these devices. The purpose of the current study was to compare NeoNiti single-file with RaCe multi-file rotary systems. Materials and Methods: An accurate scanner designed detailed three-dimensional file models, and a simulated model was developed using canal-specific features; including dentin thickness, root canal length, taper rate and root canal curvature. Cleaning and shaping conditions were simulated with appropriate speed and crack conditions for both types of files on the computer. Strain accumulation sites in the root dentin wall where microcracks was likely to occur were simulated and investigated. Abaqus and ANSYS software were used to perform finite element simulations. Results: RaCe files with 0.04 taper caused the lowest level of stress (34.33 MPa) to the simulated canal. Conversely, the highest level of stress (62.35 MPa) was applied by 8% NeoNiti file to the simulated canal. Conclusions: Based on the present experimental study, it can be concluded that RaCe multi-file rotary system may better be used in endodontic therapy, and the risk of microcracks in the tooth wall is less than that of NeoNiti single-file rotary system.

Smear Layer Removal from the Apical Third Using the Er,Cr:YSGG Photon-induced Photoacoustic Streaming

Sabreen Sabah Rasheed , Hussien Ali Jawad

Iranian Endodontic Journal, Vol. 16 No. 4 (2021), 13 October 2021 , Page 238-243

Introduction: The purpose was to study the influence of Erbium,Chromium:Yttrium Scandium Gallium Garnet (Er,Cr:YSGG) laser at short pulse duration on smear layer removal from apical root third. Materials and Methods: Twenty-four single-rooted mandibular premolars were used. The roots length was cut to 14 mm and instrumented using the Protaper Gold system to size 40/0.06. The samples were divided into four groups (n=6) as follows: (A) conventional irrigation with 5 mL of 17% Ethylenediaminetetraacetic acid ( EDTA), (B) passive ultrasonic irrigation with 5mL of 17% EDTA, (C) Er,Cr:YSGG induced photoacoustic streaming (PIPS) with 5 mL of 17% EDTA and (D)Er,Cr: YSGG induced PIPS with 5 mL of 5.25% sodium hypochlorite (NaOCl). After final irrigation with normal saline and drying, the roots were painted with nail varnish externally, and 2%methylene blue dye was injected into the canal. The tooth split horizontally at the fourth millimetres. The picture was taken by a professional Digital SLR camera. The dye penetration was measured using analytical software (measure picture CAD-KAS Kessler Germany). Dunnett's test was used to compare control group against experimental groups. Results: After the statistical test, the highest mean percentage was presented in the laser group with 17% EDTA (Group C=85.9804) followed by the laser group with 5.25% NaOCl (Group D=69.7817) and ultrasonic group (Group B=34.5453) respectively and the lowest mean percentage was in the control group (Group A=20.7969). Conclusion: Based on this in vitro study, PIPS technique using Er,Cr:YSGG pulse laser (0.5 W,5 Hz, air and water off) at short pulse duration and 17% EDTA proved effectively in smear layer removal, while the PIPS proved an acceptable result when the laser is used alone assisted by NaOCl.

Case Report

Endodontic Treatment of C-shaped Mandibular Premolars: A Case Report and Review of Literature

Monire Khorasani, Saideh Nabavi, Ali Hamedi, Hamid Jafarzadeh

Iranian Endodontic Journal, Vol. 16 No. 4 (2021), 13 October 2021 , Page 244-253

Our article aimed to present a curious case of a mandibular premolar with a C-shaped root canal and to review the available literature on this anatomical variation. Mandibular premolar teeth account for the greatest endodontic challenges in the course of treatment on account of the morphological variations in their root canal systems, including extra root(s)/canal(s) or a C-shaped configuration. A 20-year-old female patient was referred to the Department of Endodontics of Mashhad Faculty of Dentistry, suffering from abscess, and pain while chewing. On examination the culprit was found to be the left mandibular first premolar. Following special tests and periapical radiography, we found an amalgam restoration proximate to the non-vital pulp chamber, as well as an unusually complex root canal anatomy with periapical radiolucency. A non-surgical root canal treatment with the aid of a dental operating microscope was considered as the treatment plan. Clinicians should always anticipate the presence of a C-shaped configuration in mandibular premolars, and make use of all the available tools to locate and treat such cases. A substantial knowledge of root canal anatomy would be prudent to ensure a successful outcome ensuing surgical and non-surgical root canal treatments.

Periodontal Regeneration of Teeth with Radicular Developmental Groove after Intentional Replantation: Two Case Reports

Ling Qing, Zhiwei Hong, Shuaimei Xu, Yingyuan Ning, Xindi Ma, Maobin Yang, Lei Chen

Iranian Endodontic Journal, Vol. 16 No. 4 (2021), 13 October 2021 , Page 254-260

Our case reports probe whether intentional replantation is a feasible and successful treatment for teeth with radicular developmental groove. Radicular developmental groove is an anatomical malformation that often leads to combined periodontal-endodontic lesion. Treatment of complex radicular groove presents a great challenge to the operator. Two cases of periodontal compromised teeth with this developmental anomaly were treated with intentional replantation and followed up for 2 years. The teeth were asymptomatic and functional. The periodontal probing depths decreased from original 10 mm to 2-3 mm. The receded gingival papillae associated with the teeth was regenerated two years after intentional replantation. With careful case selection and treatment planning, intentional replantation may be a predictable alternative treatment modality for the combined endodontic‐periodontal lesion accompanied with radicular developmental groove.

Endodontic Treatment of Bilateral Mandibular First Premolars with Three Root Canals: A Report of Two Cases

Maryam Dalaei Moghadam, Forough Farahi

Iranian Endodontic Journal, Vol. 16 No. 4 (2021), 13 October 2021 , Page 261-264

Correct diagnosis of root canal anatomy is very important to ensure successful root canal treatment. Man­dibular first premolars with three separate root ca­nals are very rare. Consequently, they often require specific shaping and obturating techniques. This report describes the diagnosis and non-surgical treatment(s) of bilateral mandibular first premolars with three separate root canals.

Orthodontic Movement of Central Incisor with Previously-healed Root Fracture associated with Unerupted Canines

Célia Regina Maio Pinzan-Vercelino, Alex Luiz Pozzobon Pereira, Karina Maria Salvatore Freitas, Marília Matos Nogueira, Cássio Bernard Alves Campos, Júlio Araújo Gurgel, Clóvis Monteiro Bramante

Iranian Endodontic Journal, Vol. 16 No. 4 (2021), 13 October 2021 , Page 265-269

Teeth with root fracture may need orthodontic treatment. This case report presents the management of unerupted canines in a patient with previously-healed/untreated horizontal root fracture in the maxillary left central incisor. The malocclusion was treated maintaining pulp vitality considering the principles to improve the eruption path of maxillary canines and move short-rooted teeth. The root-fractured tooth remained symptomless after orthodontic treatment without significant adverse effects, and stayed stable following 2-year follow-up.