Original Article

In Vitro Evaluation of the Antibacterial Activity of Three Root Canal Sealers

Yazdan Shantiaee, Omid Dianat, Anoosheh Janani, Golbarg Kolahi Ahari

Iranian Endodontic Journal, Vol. 5 No. 1 (2010), 1 January 2010, Page 1-5

INTRODUCTION: Antibacterial activity is one of the desirable properties of an ideal sealer. This study aimed to compare the antimicrobial effect of three different sealers, i.e. resin (AH26), calcium hydroxide (Apexit) and zinc oxide eugenol (ZOE) based sealers.  MATERIALS AND METHODS: Direct contact test with agar diffusion was used in this in vitro study. The freshly mixed sealers were AH26, Apexit and pure ZOE. They were prepared according to manufacturer’s instruction and placed in prepared wells of 30 agar plates inoculated with Streptococcus (S) mutans and Prevotella (P) melaninogenicus (15 samples for each microorganism). All plates were incubated for 7 days (196 hours) at 37˚C under anaerobic conditions, and zones of inhibition were measured after 3 days, 5 days and 7 days. The data were analyzed using Kruskal-Wallis and Friedman tests. RESULTS: In all determined intervals, the antibacterial activity of AH26 was significantly greater than other test materials (P<0.001). ZOE sealer had moderate effect on test microorganisms, whilst Apexit showed the lowest antibacterial activity on S. Mutans and no antibacterial activity on P. melaninogenicus. CONCLUSION: The ascending sequence of bacterial growth inhibition zones was as AH26>Pure ZOE>Apexit.

Comparison of AH26 Physicochemical Properties with Two AH26/Antibiotic Combinations

Hasan Razmi, Shaghayegh Parvizi, Azam Khorshidian

Iranian Endodontic Journal, Vol. 5 No. 1 (2010), 1 January 2010, Page 6-10

INTRODUCTION: The purpose of this study was to compare the setting time and post-setting solubility, flow, film thickness and dimensional changes of AH26 root canal sealer with AH26-Antibiotic combination. MATERIALS AND METHODS: This study was performed according to British standard BS 6876 (2001) which tests the physicochemical properties of endodontic sealers. Three samples of each of tested materials including AH26 alone, AH26/amoxicillin and AH26/doxycycline were used to test each of the properties. They were prepared according to ISO protocols. RESULTS: The setting time of studied materials was 46 hours for AH26, 29 hours for AH26/amoxicillin, 49 hours for AH26/doxycycline. Flow test results were as follows, for AH 26, 15.6 mm; AH26/amoxicillin, 14.9 mm; AH26/doxycycline, 14.2 mm. Film thickness was 0.024 mm in AH26, 0.0283 mm in AH26/amoxicillin, 0.0276 mm AH26/doxycycline. The solubility of AH26 was 0.0076%, AH26/amoxicillin, 0.0113%, and for AH26/doxycycline, 0.013 %. Dimensional changes following setting was 0.07 mm, 2.6 mm, and 1.1 mm for AH 26, AH26/amoxicillin, and AH26/doxycycline, respectively. CONCLUSION: The physico-mechanical properties of AH26 antibiotic combinations were superior compared with AH26, with the exception of flow. Also, AH26/amoxicillin had a lower setting time than AH26. However, all values were within an acceptable range which conformed to ISO.

Comparison of Stresses Induced by Fiber Post, Parapost and Casting Post in Root Canals by Photoelasticity Method

Aliakbar Rezaei, Fereidoon Soltani, Fariborz Vafaei, Masoumeh Khoshhal, Majid Reza Ayatollahi, Naser Soltani, Morteza Nejati

Iranian Endodontic Journal, Vol. 5 No. 1 (2010), 1 January 2010, Page 11-16

INTRODUCTION: Many studies have been performed to evaluate the stress distribution around endodontic posts; those which compared posts composed of different materials are rare. The aim of this study was to compare stresses induced in dentin by three structurally different posts using photoelasticity method. MATERIALS AND METHODS: Nine blocks of PSM-5 Photoelastic material with 45×45×10 mm dimension were prepared. In each block, a canal 9 mm in length and 0.8 mm in width was drilled. Blocks were divided into 3 groups of three each. In the first group, the canals were prepared for insertion of Fiber Post with 1.25 mm width. In the second group, the canals were prepared for insertion of ParaPost with 1.25 mm width and the canals in the third group were prepared for casting post similar to the above samples. Casting Post pattern was made by Duralay resin and casted by Ni-Cr alloy. All posts were cemented in canals with Panavia cement. The stresses were evaluated in the polariscope under three different conditions: 1) without load, 2) with 135 N vertical load, and 3) with 90 N oblique load (26° inclination to post long axis). The fringe orders in the cervical, middle and apical regions of the posts were evaluated and compared with each other.RESULTS: Application of the vertical load induced a high stress concentration (FO=4) in the apical region of the ParaPost, while lower stress was observed in the middle (FO=2) and cervical region (FO=2+). Fiber Post and Casting Post showed even stress distribution (FO=2+). High stress concentration was detected with the application of oblique force in the cervical region of ParaPost (FO=5) and Casting Post (FO=3+). Fiber Posts fractured before reaching 90-N loading force. CONCLUSION: The stress distribution around Fiber Post and Casting Post were constant in comparison with ParaPost. Fiber Post with 1.25 mm width was not recommended in situations with high oblique stresses.

Comparison of Bacterial and Dye Microleakage of Different Root-End Filling Materials

Majid Kazem, Mohammad Jafar Eghbal, Saeed Asgary

Iranian Endodontic Journal, Vol. 5 No. 1 (2010), 1 January 2010, Page 17-22

INTRODUCTION: The provision of an effective apical seal is an essential factor when choosing an appropriate material for success of root-end surgeries. Root-end resection, preparation and obturation should provide an adequate apical seal. The aim of this in vitro study was to investigate bacterial and dye microleakage of four different root-end filling materials and compare the efficacy of these two methods. MATERIALS AND METHODS: Fifty-six single-rooted teeth with intact and straight roots were randomly assigned into four study groups of 12 each and two control groups of three each. After decoronation, root canals were prepared up to file size #40 using step back technique; then, they were filled with gutta-percha and AH26 sealer. Root-ends were resected 3 mm above the root-end and 3 mm deep cavities were prepared. Root-end cavities were filled with amalgam, Root Mineral Trioxide Aggregate (Root MTA), White ProRoot MTA (WMTA), and calcium enriched mixture (CEM) cement. Bacterial leakage was investigated in Trypticase Soy Broth (containing Enterococcus faecalis) after 70 days and 1% methylene blue dye leakage was assessed after 72 hours. Complete dye leakage was checked using stereomicroscope (×40). Data were statistically analyzed using Fisher Exact test. For pair comparison between the two methods Kapa agreement was utilized. RESULTS: After 70 days there was 100% bacterial leakage in amalgam, and CEM cement, 91.7% in WMTA, and 75% in Root MTA. This difference was not significantly different. The difference in complete dye leakage was also not significant (WMTA and CEM cement 16.7%, Amalgam and Root MTA 33.3%). CONCLUSION: There was no significant measure of agreement between dye and bacterial penetration along root-end fillings. CEM cement was not significantly different from currently used retrofilling materials e.g. WMTA.

In Vitro Detection of Simulated Apical Root Perforation with Two Electronic Apex Locators

Kiumars Nazari Moghaddam, Shahrzad Nazari, Leila Shakeri, Kiamars Honardar, Farshid Mirmotalebi

Iranian Endodontic Journal, Vol. 5 No. 1 (2010), 1 January 2010, Page 23-26

INTRODUCTION: The aim of this study was to evaluate the accuracy of two electronic apex locators (Smarpex and NovApex) in detecting apical perforation. MATERIALS AND METHODS: After access cavity preparations, the working length was determined by the first examiner before and after perforation with a stereomicroscope by introducing a K-file size 10 into the canal and size 25 K-file up to the perforation site, respectively. The specimens were embedded in a 17-well plastic box containing alginate. The root canals were irrigated with chlorhexidine 0.2% (CHX) through a 27-gauge needle. Two examiners measured the root canal length twice and the mean value was calculated. The data were analyzed using Kolmogorov-Smirnov and ANOVA tests. RESULTS: The results obtained with each Electronic Apex Locator were compared with the corresponding control length. The statistical analysis showed reliable accuracies in detecting the perforation site for the two experimental electronic apex locators (60% and 80% for NovApex and Smarpex, respectively). CONCLUSION: Although no significant difference was shown between Smarpex and NovApex, these results suggest that electronic apex locators can effectively and reproducibly detect root canal perforations.

Direct Pulp-Capping with Calcium Enriched Mixture in Primary Molar Teeth: A Randomized Clinical Trial

Masoud Fallahinejad Ghajari, Tahereh Asgharian Jeddi, Sonay Iri, Saeed Asgary

Iranian Endodontic Journal, Vol. 5 No. 1 (2010), 1 January 2010, Page 27-30

INTRODUCTION: The aim of this trial was to compare clinical and radiographic success rates of direct pulp capping (DPC) using a novel biomaterial called Calcium Enriched Mixture (CEM) cement versus Mineral Trioxide Aggregate (MTA) in primary molar teeth. MATERIALS AND METHODS: In this randomized clinical trial 42 deciduous molars in 21 patients who had at least two teeth requiring DPC, were treated. The enrolled patients were between 5-8 years. The molar teeth were randomly divided into two experimental groups. Patients and operators were blinded. The teeth were anaesthetized, caries were removed and after pinpoint exposure of dental pulp, haemostasis was achieved. The exposure points were capped with MTA or CEM cement. All teeth were restored with amalgam. Patients were recalled for the 6-month follow up. Statistical analysis was carried out using McNemar test. RESULTS: Thirty-eight teeth were available for follow up (19 in each group). The radiographic evaluations did not show failure in experimental groups; however, in clinical examinations one sinus tract was found in CEM cement group. Clinical success rates in CEM cement and MTA groups were 94.8% and 100%, respectively. Dentinal bridge formation was not observed in the two experimental groups. CONCLUSION: There is no significant difference between treatment outcomes of direct pulp capping with either CEM cement or MTA; therefore, both biomaterials can be used successfully for DPC in primary molar teeth.

Comparison of Bupivacaine and Lidocaine Use for Postoperative Pain Control in Endodontics

Saeed Moradi, Neda Naghavi

Iranian Endodontic Journal, Vol. 5 No. 1 (2010), 1 January 2010, Page 31-35

INTRODUCTION: Many patients suffer from mild, moderate or severe pain during or after root canal therapy. Theoretically, post-operative pain control can be achieved by using long-acting local anesthetics. The aim of this study was to evaluate the efficacy of a long acting anesthesia, bupivacaine, on preventing post-operative pain associated with endodontic treatment, and to compare it with lidocaine. MATERIALS AND METHODS: This study was a double blind and randomized clinical trial on 30 patients' anterior maxillary teeth. The patients were divided into two groups of fifteen. One group was administered lidocanine (2% with 1:100000epinephrine) local anesthesia and the other group was given bupivacaine (0.5% without epinephrine). The pain in patients were compared using the visual analogue scale (VAS) at definite times i.e. before treatment, during treatment and 2,4,6,8,10,12,24,36 and 48 hours after operation. Data were analyzed using One-way ANOVA tests. RESULTS: Bupivacaine significantly decreased postoperative pain compared to lidocaine. Postoperative pain was directly related to preoperative pain. Women reported more pain, though significant difference in postoperative pain report was not found between different ages. CONCLUSION: In conclusion, a single dose of bupivacaine 0.5% used in infiltration anesthesia could be more effective in reduction or prevention of post-operative endodontic pain compared with lidocaine.

Case Report

Mandibular First and Second Molars with Three Mesial Canals: A Case Series

Mohsen Aminsobhani, Behnam Bolhari, Noushin Shokouhinejad, Abdollah Ghorbanzadeh, Sholeh Ghabraei, Mohamad Bagher Rahmani

Iranian Endodontic Journal, Vol. 5 No. 1 (2010), 1 January 2010, Page 36-39

Adequate cleaning, shaping and filling of the root canal system are mandatory for successful root canal treatment. Thorough knowledge of root canal morphology and unusual anatomy of the tooth is critical for the practitioner. The occurrence and location of the third mesial canal (Middle Mesial Canal) in mandibular first and second molars in relation to other two mesial canals that were treated in private practice were studied. In 27 clinical cases, the presence of a middle mesial canal was demonstrated. The third canal was located in the middle of the distance between the mesiobuccal and mesiolingual canals. This canal configuration was found in six second lower molars and twenty one first molars. Middle mesial canal in all of our cases joined to mesiobuccal or mesiolingual canals. None of the teeth consisted of three independent canals with three apical foramina. In conclusion, every attempt should be made to find and treat all root canals of a tooth.