Iranian Endodontic Journal

Introduction: Osteopontin (OPN), plays an important role in immune system modulation. OPN can activate osteoclasts, thus causing resorption of bone. In addition, it might have a protective function against polymicrobial endodontic infections. Since different isoforms of OPN might have diverse roles, the aim of the present study was to compare gene expression of different isoforms of osteopontin in symptomatic irreversible pulpitis and normal pulps of the human dental pulp. Materials and Methods: Pulps were taken from 20 teeth with symptomatic irreversible pulpitis as the case group and from 20 intact premolars scheduled for extraction as the control group. After RNA extraction and synthesis of complementary DNA (cDNA), quantitative real-time polymerase chain reaction (PCR) was used for the evaluation of gene expression of OPN, OPN2 and OPN3. The Mann-Whitney U, t and Chi-square tests were used to analyze differences between the groups. Results: Mean values of OPN, OPN2 and OPN3 in normal pulps were 0.695±0.295, 0.656±0.298 and 0.816±0.422, respectively. Mean values of OPN, OPN2 and OPN3 in symptomatic irreversible pulpitis were 2.52±1.82, 1.99±0.899 and 1.816±0.954, respectively. Unlike OPN and OPN2, OPN3 exhibited significantly higher expression in normal pulps (P<0.05). Conclusion: The results of the present case- control study showed that some variants of OPN are upregulated during pulpitis and it might be due to their prominent modulatory roles in dental pulps.

Introduction: The aim of this study was to evaluate the location of the apices of the maxillary posterior teeth to the maxillary sinus floor (MSF), the symmetry between both sides and the possible variations between males and females using cone-beam computed tomography (CBCT) in an Egyptian subpopulation. Materials and Methods: CBCT images were collected from 120 patients (240 second premolars, 480 1^st and 2^nd molars, 1680 roots). The proximity of roots of maxillary second premolar and 1^st and 2^nd molars to the floor of the sinus was categorized into three categories: inside the sinus floor (IS), touching the sinus floor (TS) or outside the sinus floor (OS). The correlation of the distance with gender was analyzed as well as for symmetry. Friedman’s test was used to compare between different roots and the Dunn’s test was used for pair-wise comparisons when Friedman’s test was significant. The Mann-Whitney U test was used to compare males and females. The significance level was set at P≤0.05. Results: The highest prevalence of roots outside the sinus was found with second premolar (right and left) followed by palatal roots of right and left second molar. In addition, the highest prevalence of roots inside the sinus was found with mesiobuccal roots of maxillary second molar followed by the palatal root of maxillary first molar. There was no statistically significant difference between males and females or between both sides. Conclusion: Neither gender nor side variations regarding the proximity to the maxillary sinus floor were observed.

Introduction: The goal of this paper was to determine the impact of calcium hydroxide (CH) and nano-calcium hydroxide (NCH) on the push-out bond strength of an epoxy resin-based sealer. Materials and Methods: A total of 48 mandibular premolars were decoronated in vitro and instrumented by a ProTaper rotary system up to F4. The specimens then were randomly allocated into 3 groups (n=16). The two intervention groups were treated with either CH or NCH and one control group which did not receive any intracanal medicament. After one week of medicament placement, the specimens were irrigated by 10 mL 17% EDTA, followed by 10 mL 2.5% NaOCl and an ultimate flushing by 5 mL sterile saline. The samples were obturated using AH-Plus Jet sealer and gutta-percha by lateral condensation technique. Push-out test was done by a universal test machine to evaluate the bond strength among the sealer and the root canal dentin. Repeated measurement analysis followed by Tukey’s HSD and Bonferroni post-hoc tests were used for data analysis. Results: The control group showed a higher push-out bond strength in comparison to the specimens in the CH and NCH groups (P<0.05). In spite of the greater push-out bond strength of the samples treated with NCH in comparison to those in CH group, no statistically notable difference was found among them (P>0.05). Additionally, irrespective of the kind of medicament, the bonding at the apical level of the root canal was stronger compared to the coronal third (P<0.001). Conclusion: According to the present in vitro study, application of CH and NCH resulted in a significant reduction of the bond strength between the epoxy resin-based sealer and dentinal walls. Although, application of these medicaments resulted in reduction of bonding of epoxy resin-based sealers root canal dentin significantly.

Introduction: The aim of the present in vitro study was to compare the accuracy of the working length measurements of four foramen locators: Root ZX mini, Raypex 6, Woodpex III and Propex Pixi in uniradicular premolars with simulated root resorption. Materials and Methods: For this study, 30 single-rooted permanent premolars were selected. The samples were divided into two groups: 15 teeth with simulated external root resorption and 15 teeth with internal resorption. Each sample was immersed in containers with alginate covering only the root part. Measurements were acquired from the four foramen locators and compared with the working length measurements that have been previously obtained with the direct visual technique and the use of a Digital USB Microscope under 5×. Next, the Shapiro-Wilk normality test was applied. The ANOVA test and t-test for related samples were performed, in order to analyze the measurements obtained. Results: In the teeth with external resorption, no statistically significant differences in the measurements were obtained with Raypex 6 and Propex Pixi foramen locators, but there were statistically significant differences with Root ZX mini and Woodpex III Root Zx mini [Root Zx mini (P=0.040) and Woodpex III (P=0.000)]. On the other hand, in the samples with internal root resorption, there were no statistically significant differences in measurements with the Root ZX mini, Propex Pixi and Raypex 6 foramen locators. However, there were significant differences with Woodpex III. Conclusions: Based on this in vitro study, Raypex 6 had the highest accuracy in premolars with simulated external resorption and Root ZX mini was the most accurate in teeth with simulated internal resorption. Furthermore, external root resorption affects the accuracy of foramen locators more than internal resorption.

Introduction: This ex vivo study aimed to compare the adaptation of single gutta-percha cone in teeth prepared with the Wave One Gold and Reciproc Blue reciprocating systems through cone-beam computed tomography. Materials and Methods: A total of 40 recently extracted mono radicular premolars were randomly assigned into two groups (n=20) corresponding to Reciproc Blue and Wave One Gold reciprocating systems and adapted to a single cone system. Each group was evaluated by cone-beam computed tomography at 1 mm, 2 mm and 4 mm from the apical foramen. We evaluated the number of walls adapted by the cone, quality of filling and the number of spaces between the filling and the walls of the root canal. The Mann-Whitney U and T-tests were employed to associate and compare both groups (P<0.05). Results: At 1 mm in the lingual wall the Wave One Gold system did not adapt by 45% compared to 15% with Reciproc Blue (P<0.05). Likewise, the single-cone filling technique of the Reciproc Blue system showed better sealing quality obtaining an ideal category (75%) compared to Wave One Gold (40%) (P<0.05). The amount of space (mm) found between the cone and the filling walls was greater with Wave One Gold. However, these values were not statistically significant. Conclusions: Based on this ex vivo study the better adaptation of root canals and ideal filling condition was more frequent with Reciproc Blue than Wave One Gold system, mainly at 1 mm from the radicular apex.

Paresthesia can result from some post-endodontic problems, including bacterial infections or mishaps which occur during the cleaning, shaping, and filling of the root canal. There are pharmacological and instrumental methods for the treatment of paresthesia; however, if presenting symptoms are suggestive of nerve injury, surgical approaches, such as intentional replantation, could be considered. In this case report study, we treated paresthesia that had occurred after endodontic treatment using intentional replantation. This case report describes the use of intentional replantation of a mandibular premolar as a successful technique to treat paresthesia involving the lower lip.

The aim of this study was to describe a new strategy, consisting of the use of cone-beam computed tomography (CBCT) in the planning and intraoperative stages of root canal treatment (RCT), associated with the use of radiopaque gutta-percha markers, as an auxiliary tool in the location of severely calcified root canals. Three cases involving anterior and posterior teeth with severe calcification of the root canal were submitted to initial periapical radiographic and CBCT evaluations for diagnosis and planning of the operative steps. In a first intervention, when the location of the canal orifice was not successful, radiopaque markers were inserted in the suggested position of canal orifice with the aid of magnification and the use of ultrasonic devices, in order to perform an intraoperative CBCT analysis that allowed dynamic navigation through the static position of markers. The association of intraoperative CBCT with radiopaque markers allowed the location of the canal orifice and the following RCT execution. The use of CBCT in two different moments of RCT allowed the diagnosis of three-dimensional anatomical variations of root canal. Add, when associated with the use of radiopaque gutta-percha markers, acted as an auxiliary tool in the location of the canal orifice of calcified canals. Therefore, the presented strategy provides the clinician the precision that cases with calcification require and give an important contribution to treatment predictability.

External cervical resorption is a type of pathological root resorption that is often asymptomatic. It leads to progressive loss of dental hard tissues while the pulp usually remains vital. The first symptom reported by a patient may be a pink shadow at an esthetic zone. This case report describes the treatment of external cervical resorption of a first upper incisor according to the new classification, treatment and management methods introduced in 2018. After 30 months the endodontic treatment was performed due to pulp necrosis and symptomatic apical periodontitis.