The purpose of this clinical study was to compare the marginal fit of dental crowns based on three different intraoral digital and one conventional impression methods.Forty-nine teeth of altogether 24 patients were prepared to be treated with full-coverage restorations. Digital impressions were made using three intraoral scanners: Sirona CEREC AC Omnicam (OCam), Heraeus Cara TRIOS and 3M Lava True Definition (TDef). Furthermore, a gypsum model based on a conventional impression (EXA’lence, GC, Tokyo, Japan) was scanned with a standard laboratory scanner (3Shape D700). Based on the dataset obtained, four zirconia copings per tooth were produced. The marginal fit of the copings in the patient’s mouth was assessed employing a replica technique.Overall, seven measurement copings did not fit and, therefore, could not be assessed. The marginal gap was 88 μm (68–136 μm) [median/interquartile range] for the TDef, 112 μm (94–149 μm) for the Cara TRIOS, 113 μm (81–157 μm) for the laboratory scanner and 149 μm (114–218 μm) for the OCam. There was a statistically significant difference between the OCam and the other groups (p < 0.05).Within the limitations of this study, it can be concluded that zirconia copings based on intraoral scans and a laboratory scans of a conventional model are comparable to one another with regard to their marginal fit.Regarding the results of this study, the digital intraoral impression can be considered as an alternative to a conventional impression with a consecutive digital workflow when the finish line is clearly visible and it is possible to keep it dry.
OBJECTIVE: Due to an increased focus on erosive tooth wear (ETW), the European Federation of Conservative Dentistry (EFCD) considered ETW as a relevant topic for generating this consensus report. MATERIALS AND METHODS: This report is based on a compilation of the scientific literature, an expert conference, and the approval by the General Assembly of EFCD. RESULTS: ETW is a chemical-mechanical process resulting in a cumulative loss of hard dental tissue not caused by bacteria, and it is characterized by loss of the natural surface morphology and contour of the teeth. A suitable index for classification of ETW is the basic erosive wear examination (BEWE). Regarding the etiology, patient-related factors include the pre-disposition to erosion, reflux, vomiting, drinking and eating habits, as well as medications and dietary supplements. Nutritional factors relate to the composition of foods and beverages, e.g., with low pH and high buffer capacity (major risk factors), and calcium concentration (major protective factor). Occupational factors are exposition of workers to acidic liquids or vapors. Preventive management of ETW aims at reducing or stopping the progression of the lesions. Restorative management aims at reducing symptoms of pain and dentine hypersensitivity, or to restore esthetic and function, but it should only be used in conjunction with preventive strategies. CONCLUSIONS: Effective management of ETW includes screening for early signs of ETW and evaluating all etiological factors. CLINICAL RELEVANCE: ETW is a clinical condition, which calls for the increased attention of the dental community and is a challenge for the cooperation with other medical specialities.
To evaluate the influence of irradiation time on degree of conversion (DC) and microhardness of high-viscosity bulk-fill resin composites in depths up to 6 mm.Four bulk-fill materials (Tetric EvoCeram Bulk Fill—TECBF; x-tra fil—XF; QuixFil—QF; SonicFill—SF) and one conventional nano-hybrid resin composite (Tetric EvoCeram—TEC) were irradiated for 10, 20, or 30 s at 1,170 mW/cm2. DC and Knoop microhardness (KHN) were recorded after 24-h dark storage at five depths: 0.1, 2, 4, 5, and 6 mm. Data were statistically analyzed using ANOVA and Bonferroni’s post-hoc test (α = 0.05).With increasing bulk thickness, DC and KHN significantly decreased for TEC. TECBF and SF showed a significant decrease in DC and KHN at 4-mm depth after 10-s irradiation, but no decrease in DC after 30-s irradiation (p > 0.05). XF and QF demonstrated no significant DC decrease at depths up to 6 mm after irradiation of at least 20 s. At 4-mm depth, all materials tested achieved at least 80 % of their maximum DC value, irrespective of irradiation time. However, at the same depth (4 mm), only XF and QF irradiated for 30 s achieved at least 80 % of their maximum KHN value.Regarding DC, the tested bulk-fill resin composites can be safely used up to at least 4-mm incremental thickness. However, with respect to hardness, only XF and QF achieved acceptable results at 4-mm depth with 30 s of irradiation.Minimum irradiation times stated by the manufacturers cannot be recommended for placement of high-viscosity bulk-fill materials in 4-mm increments.
This study aims to evaluate the apical extrusion of debris by the two reciprocating single-file systems: WaveOne and Reciproc. Conventional multi-file rotary system was used as a reference for comparison. The hypotheses tested were (i) the reciprocating single-file systems extrude more than conventional multi-file rotary system and (ii) the reciprocating single-file systems extrude similar amounts of dentin debris.After solid selection criteria, 80 mesial roots of lower molars were included in the present study. The use of four different instrumentation techniques resulted in four groups (n = 20): G1 (hand-file technique), G2 (ProTaper), G3 (WaveOne), and G4 (Reciproc). The apparatus used to evaluate the collection of apically extruded debris was typical double-chamber collector. Statistical analysis was performed for multiple comparisons.No significant difference was found in the amount of the debris extruded between the two reciprocating systems. In contrast, conventional multi-file rotary system group extruded significantly more debris than both reciprocating groups. Hand instrumentation group extruded significantly more debris than all other groups.The present results yielded favorable input for both reciprocation single-file systems, inasmuch as they showed an improved control of apically extruded debris.Apical extrusion of debris has been studied extensively because of its clinical relevance, particularly since it may cause flare-ups, originated by the introduction of bacteria, pulpal tissue, and irrigating solutions into the periapical tissues.
The aim of this research was to analyse the dental discolouration caused by mineral trioxide aggregate (MTA) induced by bismuth oxide and also assess the colour stability of other dental cements.Bismuth oxide, calcium tungstate and zirconium oxide were placed in contact with sodium hypochlorite for 24 h after which they were dried and photographed. Phase analyses were performed by X-ray diffraction (XRD) of radiopacifiers before and after immersion in sodium hypochlorite. Furthermore, teeth previously immersed in water or sodium hypochlorite were filled with MTA Angelus, Portland cement (PC), PC with 20 % zirconium oxide, PC with 20 % calcium tungstate and Biodentine. Teeth were immersed for 28 days in Hank’s balanced salt solution after which they were sectioned and characterized using scanning electron microscopy (SEM) with energy-dispersive mapping and stereomicroscopy.Bismuth oxide in contact with sodium hypochlorite exhibited a change in colour from light yellow to dark brown. XRD analysis demonstrated peaks for radiopacifier and sodium chloride in samples immersed in sodium hypochlorite. The SEM images of the dentine to material interface showed alteration in material microstructure for MTA Angelus and Biodentine with depletion in calcium content in the material. The energy-dispersive maps showed migration of radiopacifier and silicon in dentine.MTA Angelus in contact with a tooth previously immersed in sodium hypochlorite resulted in colour alteration at the cement/dentine interface.MTA Angelus should not be used after irrigation with sodium hypochlorite as this will result in tooth discoloration.
This study was conducted in order to assess the pretreatment method (air abrasion, both wet and dry, and Al2O3 grinder), the conditioning method (comprised of different adhesive systems), the repair resin composite (low and high modulus of elasticity), the contamination of CoJet air-abraded surfaces with water, and the effect phosphoric acid on the macrotensile bond strength (TBS) to aged CAD/CAM resin nanoceramic (RNC).Aged RNC substrates (LAVA Ultimate, 3M ESPE; N = 900; 10,000 cycles, 5 °C/55 °C) were air-abraded (CoJet 3M ESPE) with and without water contamination or treated with an Al2O3 grinder (Cimara, Voco). Immediately after pretreatment, half of the specimens were additionally cleaned with phosphoric acid, while the rest were only rinsed with water. Four intermediate agents (Futurabond U/VOCO, Scotchbond Universal/3M ESPE, One Coat Bond/Coltène Whaledent, visio.link/bredent) were selected for conditioning the surface, while no conditioned specimens acted as control groups. Specimens were thereafter repaired using two direct resin composites (Arabesk Top and GrandioSo, VOCO), stored for 24 h at 37 °C in H2O, and thermally aged for 10,000 cycles (5 °C/55 °C; n = 15/subgroup). TBS and failure types were determined and evaluated with four- and one-way ANOVA and χ 2 test (p < 0.05).The highest influence on TBS was exerted by the conditioning method (partial eta-squared (η P 2) = 0.273, p < 0.05), followed by the resin composite repair (η P 2 = 0.07, p < 0.05) and the surface pretreatment method (η P 2 = 0.032, p < 0.05), while an acid contamination after surface pretreatment was insignificant (p = 0.154).Air abrasion produced superior TBS compared to grinding of the surface with Al2O3 prior to repair. The tested universal adhesives proved to be effective intermediate agents for repairing aged CAD/CAM RNC, while visio.link and Scotchbond Universal performed slightly better than Futurabond U.Phosphoric acid or water contamination of the air-abraded surface does not affect the repair bond strength.
The aim was to test the properties of experimental calcium silicate/calcium phosphate biphasic cements with hydraulic properties designed for vital pulp therapy as direct pulp cap and pulpotomy.CaSi-αTCP and CaSi-DCDP were tested for ion-releasing ability, solubility, water sorption, porosity, ability to nucleate calcium phosphates, and odontoblastic differentiation—alkaline phosphatase (ALP) and osteocalcin (OCN) upregulation—of primary human dental pulp cells (HDPCs).The materials showed high Ca and OH release, high open pore volume and apparent porosity, and a pronounced ability to nucleate calcium phosphates on their surface. HDPCs treated with CaSi-αTCP showed a strong upregulation of ALP and OCN genes, namely a tenfold increase for OCN and a threefold increase for ALP compared to the control cells. Conversely, CaSi-DCDP induced a pronounced OCN gene upregulation but had no effect on ALP gene regulation.Both cements showed high biointeractivity (release of Ca and OH ions) correlated with their marked ability to nucleate calcium phosphates. CaSi-αTCP cement proved to be a potent inducer of ALP and OCN genes as characteristic markers of mineralization processes normally poorly expressed by HDPCs.Calcium silicate/calcium phosphate cements appear to be attractive new materials for vital pulp therapy as they may provide odontogenic/dentinogenic chemical signals for pulp regeneration and healing, and dentin formation in regenerative endodontics.
The aim was to evaluate the effects of orally administered Lactobacillus rhamnosus GG (LGG) and Bifidobacterium animalis subsp. lactis BB-12 (BB-12) on the number of salivary mutans streptococci (MS), amount of plaque, gingival inflammation and the oral microbiota in healthy young adults.The study was a randomised, controlled, double-blind trial. Healthy volunteers used lozenges containing a combination of LGG and BB-12 (test group, n = 29) or lozenges without added probiotics (control group, n = 31) for 4 weeks. At baseline and at the end of the test period, the plaque index (PI) and gingival index (GI) were determined, and stimulated saliva was collected. The microbial composition of saliva was assessed using human oral microbe identification microarray (n = 30). MS and lactobacilli (LB) were plate cultured.The probiotic lozenge decreased both PI and GI (p < 0.05) while no changes were observed in the control group. However, no probiotic-induced changes were found in the microbial compositions of saliva in either group.The probiotic lozenge improved the periodontal status without affecting the oral microbiota.Short-term consumption of LGG and BB-12 decreased the amount of plaque which was associated with a clinical impact: a decrease in gingival inflammation.
The aim of the present study was to assess human and bacterial peptidylarginine deiminase (PAD) activity in the gingival crevicular fluid (GCF) in the context of serum levels of antibodies against citrullinated epitopes in rheumatoid arthritis and periodontitis.Human PAD and Porphyromonas gingivalis-derived enzyme (PPAD) activities were measured in the GCF of 52 rheumatoid arthritis (RA) patients (48 with periodontitis and 4 without) and 44 non-RA controls (28 with periodontitis and 16 without). Serum antibodies against citrullinated epitopes were measured by ELISA. Bacteria being associated with periodontitis were determined by nucleic-acid-based methods.Citrullination was present in 26 (50 %) RA patients and 23 (48 %) controls. PAD and PPAD activities were detected in 36 (69 %) and 30 (58 %) RA patients, respectively, and in 30 (68 %) and 21 (50 %) controls, respectively. PPAD activity was higher in RA and non-RA patients with periodontitis than in those without (p = 0.038; p = 0.004), and was detected in 35 of 59 P. gingivalis-positive samples, and in 16 of 37 P. gingivalis-negative samples in association with high antibody levels against that species.PAD and PPAD activities within the periodontium are elevated in RA and non-RA patients with periodontitis. PPAD secreted by P. gingivalis residing in epithelial cells may exert its citrullinating activity in distant regions of the periodontium or even distant tissues.In periodontitis, the citrullination of proteins/peptides by human and bacterial peptidylarginine deiminases may generate antibodies after breaching immunotolerance in susceptible individuals.
Previous reported results of up to 12 months as well as 24-month follow-ups revealed superior and equivalent treatment outcomes for vital pulp therapy (VPT) using calcium-enriched mixture cement (CEM) in comparison with root canal therapy (RCT) for mature molars with established irreversible pulpitis, respectively. Present non-inferiority multicenter randomized clinical trial assesses the final long-term (5-year) results as well as the effects of patients’ age/gender and the presence of preoperative periapical lesion on the treatment outcomes.A total number of 407 patients were blindly allocated into two treatment groups [group 1 (VPT/CEM, n = 205) and group 2 (RCT, n = 202)] treated in 23 health-care centers by calibrated dentists. The treatment outcomes were assessed after 60 months.The 5-year results revealed no significant differences in the successes of both study arms (P = 0.29); a total number of 271 patients were available (~33 % were lost to follow-up). The patients’ age/gender did not affect the outcomes; the presence of preoperative periapical lesion also did not implement a significant effect in both groups (P > 0.05).As an alternative for RCT, VPT/CEM can be considered as a valid treatment for vital mature permanent molars clinically diagnosed with irreversible pulpitis.Considering the favorable outcomes of 6- to 60-month follow-ups, as an evidence-based/simple/affordable/effective/biologic approach in cases of irreversible pulpitis, VPT/CEM is highly recommended for universal clinical practice.
The aim of this prospective randomized clinical trial was to compare mineral trioxide aggregate (MTA) with calcium hydroxide (CH) as materials for inducing root apex closure in immature necrotic permanent incisors.The design of this study has been extensively described in the authors’ previous report. Children (n = 30), aged from 6 to 18 years and presenting a non-vital permanent incisor, were treated. Half of the group received treatment using MTA, the other half with CH. At recall visits after 6 and 12 months, the presence or absence of a calcified apical barrier was assessed using clinical and radiographic examinations. The anonymised radiographs were evaluated by two independent investigators. Statistical analyses were performed using a Fischer’s test (p < 0.05 was used as the threshold for statistical significance).Presence of a mineralized barrier was observed for 43.8 % of the CH group and 64.7 % of the MTA group at the 6-month examination. After 12 months, these figures were respectively 50 and 82.4 % (p < 0.07). For both groups, pain and tenderness to percussion had disappeared at the 3-month examination.Neither material showed a statistically significant difference at the 6-month examination. At the 12-month examination, the MTA group displayed better results in terms of apical closure. In the CH group, four out of 15 teeth exhibited coronal or radicular fractures after 12 months.Apexification using MTA seems preferable to CH in order to early achieve the coronoradicular filling and to limit the risk of root fracture.
To investigate the effect of various dilutions of antibiotic medicaments used in endodontic regeneration on the survival of human dental pulp stem cells (DPSCs) and to determine their antibacterial effect against established Enterococcus faecalis biofilm.The cytotoxic and antibacterial effects of different triple (TAP) and double antibiotic paste (DAP) dilutions (0.125, 0.25, 0.5, 1, and 10 mg/ml) were tested against Enterococcus faecalis established biofilm and DPSC. Established bacterial biofilm were exposed to antibiotic dilutions for 3 days. Then, biofilms were collected, spiral plated, and the numbers of bacterial colony forming units (CFU/ml) were determined. For the cytotoxic effect, lactate dehydrogenase activity assays (LDH) and cell viability assays (WST-1) were used to measure the percentage of DPSC cytotoxicity after 3-day treatment with the same antibiotic dilutions. A general linear mixed model was used for statistical analyses (α = 0.05).All antibiotic dilutions significantly decreased the bacterial CFU/ml. For WST-1 assays, all antibiotic dilutions except 0.125 mg/ml significantly reduced the viability of DPSC. For LDH assays, the three lowest tested concentrations of DAP (0.5, 0.25, 0.125 mg/ml) and the two lowest concentrations of TAP (0.25 and 0.125 mg/ml) were non-toxic to DPSC.All tested dilutions had an antibacterial effect against E. faecalis. However, 0.125 mg/ml of DAP and TAP showed a significant antibacterial effect with no cytotoxic effects on DPSCs.Using appropriate antibiotic concentrations of intracanal medicament during endodontic regeneration procedures is critical to disinfect root canal and decrease the adverse effects on stem cells.
The study aimed to analyse the shear bond strength of computer-aided design and computer-aided manufacturing (CAD/CAM) polymethyl methacrylate (PMMA)- and composite-based polymer materials repaired with a conventional methacrylate-based composite after different surface pretreatments.Each 48 specimens was prepared from six different CAD/CAM polymer materials (Ambarino high-class, artBloc Temp, CAD-Temp, Lava Ultimate, Telio CAD, Everest C-Temp) and a conventional dimethacrylate-based composite (Filtek Supreme XTE, control) and aged by thermal cycling (5000 cycles, 5–55 °C). The surfaces were left untreated or were pretreated by mechanical roughening, aluminium oxide air abrasion or silica coating/silanization (each subgroup n = 12). The surfaces were further conditioned with an etch&rinse adhesive (OptiBond FL) before the repair composite (Filtek Supreme XTE) was adhered to the surface. After further thermal cycling, shear bond strength was tested, and failure modes were assessed. Shear bond strength was statistically analysed by two- and one-way ANOVAs and Weibull statistics, failure mode by chi2 test (p ≤ 0.05).Shear bond strength was highest for silica coating/silanization > aluminium oxide air abrasion = mechanical roughening > no surface pretreatment. Independently of the repair pretreatment, highest bond strength values were observed in the control group and for the composite-based Everest C-Temp and Ambarino high-class, while PMMA-based materials (artBloc Temp, CAD-Temp and Telio CAD) presented significantly lowest values. For all materials, repair without any surface pretreatment resulted in adhesive failures only, which mostly were reduced when surface pretreatment was performed.Repair of CAD/CAM high-density polymers requires surface pretreatment prior to adhesive and composite application. However, four out of six of the tested CAD/CAM materials did not achieve the repair bond strength of a conventional dimethacrylate-based composite.Repair of PMMA- and composite-based polymers can be achieved by surface pretreatment followed by application of an adhesive and a conventional methacrylate-based composite.
This study investigated the biological activity of the essential oil from Cymbopogon nardus and of the phytoconstituent citronellal on Candida strains as to the inhibition of adherence to dental implants and cover screws.The essential oil was analyzed by gas chromatography coupled to mass spectrometry (GC-MS) and had its MIC and MFC determined against 12 strains of Candida. Then, tests of inhibition of adherence to the dental implants and cover screws were carried out using the MIC of the substances, followed by scanning electron microscopy analysis. Nystatin and chlorhexidine were used as positive controls, and experiments were performed in triplicate.The analysis by GC-MS of the essential oil identified citronellal as the major compound. The MICs of the essential oil, citronellal, chlorhexidine, and nystatin—able to inhibit 100 % of the strains—were found to be 64, 512, 64, and 32 μg/ml, respectively. The essential oil significantly inhibited the adherence of Candida albicans to the dental implants and cover screws (p 0.05) compared to the growth control.The essential oil and citronellal have proven antifungal activity and are able to inhibit the in vitro adherence of C. albicans.Clinical relevance: There has been a search for alternative natural product-containing formulations that should be effective in inhibiting adherence of yeasts to the surfaces of materials and also able to treat oral fungal infections. Further trials could make these products an alternative to chemical removal of peri-implant biofilm.
Zirconia-based prostheses are used for esthetic crown and fixed restorations, but follow-ups are still limited. The authors evaluated the 7-year clinical results of 303 zirconia core restorations, performed in a general dental private practice.Clinical events (fracture and loss of retention, gingivitis, tenderness, excess cement, and temporary pain) were recorded in 303 zirconia core restorations positioned in 88 patients. Kaplan-Meier survival probability estimates were computed for failures (needed the replacement or removal of the prosthesis) and complications (resolved without replacing the prosthesis).One hundred and fifty single crowns (130 tooth-supported, 20 implant-supported) and 153 multiple units up to 6 elements (49 tooth-supported, 104 implant-supported) were followed-up for 7 years in 88 patients (40 men, 48 women), aged 35–89 years (mean 57). During the follow-up period, there were no complications for 287 (95 %) of the restorations. Sixteen restorations/abutment teeth (5 %) had some complication: extraction of abutment tooth (7, 2 %); caries (2, 1 %), porcelain veneer fracture (3, 1 %), loss of retention (4, 1 %). Nine (3 %) restorations were recorded as failures. The overall 7-year survival probability estimate for failures was 0.966 (95 % confidence limits, 0.932 and 0.983), for complications was 0.976 (95 % confidence limits 0.947 and 0.989), with a cumulative survival rate of 94.7 %.Within the analyzed follow-up, zirconia core restorations appear a good clinical solution, with favorable functional properties.All ceramic restorations can be successfully used for both single-and multiple-unit prostheses, either teeth or implants supported.
We speculated that the long-term survival of narrow or conventional diameter (<5 mm) implants is higher than that of wide-diameter implants (≥5 mm) when placed in posterior atrophic maxillae. The aim of this paper was to systematically review indexed literature regarding the influence of implant diameter on long-term survival of dental implants placed in posterior maxilla.The addressed focused question was “Does implant diameter influence long-term survival of dental implants placed in posterior maxilla?” Databases were searched from 1986 till June 2014 using the following MeSH terms: “dental implants,” “dental implant-abutment design,” “maxilla,” and “survival.” Review articles, case reports, letters to the editor, unpublished data, and studies published in languages other than English were excluded. Reference list of potentially relevant original and review studies was hand-searched.The initial search yielded 51 studies. Scrutiny of the titles and abstracts reduced the number of clinical studies included in the present review to 19. Mean age of the patients ranged between 37 and 60 years. Cylindrical and tapered implants were used in 12 and 3 studies, respectively. In all studies, threaded, rough-surfaced dental implants with diameters ranging between 3.0 and 5.5 mm were used. In all studies, follow-up periods and cumulative survival rates ranged between 5 and 15 years and 80.5 and 100 %, respectively.The role of implant diameter on long-term survival of dental implants placed in posterior maxilla is secondary. A well-designed surgical protocol, achievement of sufficient primary stability at the time of implant placement, and pre- and postsurgical oral hygiene maintenance visits are critical factors that influence the long-term survival of dental implants placed in posterior atrophic maxilla.
Platelet-rich plasma has been used in the treatment of extraction socket; however, randomized controlled clinical trial is still lacking to evaluate its effect on extraction socket healing. Single center, assessor-blinded, parallel group, randomized controlled clinical trial was conducted. Sixty patients with indication of a simple one molar extraction in the mandible were randomized to receive plasma rich in growth factors (PRGF) or blood clot. A cross-stitch suture was placed in both groups. Clinical, radiographical, and histological assessments were performed during 10-12 weeks of follow-up. Cone beam CT analysis has shown that the percentage of patients where the sockets are regenerated at a parts per thousand yen75 % of the baseline volume was significantly higher in PRGF group (96.7 %) than the control group (45.5 %). Pain and inflammation (day 3 and day 7) have been significantly lower in PRGF group than the control group but not at day 15. Soft tissue healing scores have been significantly higher in the test group. No serious adverse events have been occurred in both groups. Histological analysis has indicated the presence of significantly thicker keratinized epithelium and significantly higher newly formed bone in the PRGF group. PRGF was associated with enhanced healing of extraction socket of mandibular molars throughout the observation period. Plasma rich in growth factors could be a useful tool to enhance the healing of extraction sockets by minimizing postoperative complications and stimulating the hard and soft tissues regeneration.
Objectives The aim of this prospective randomized clinical trial was to compare mineral trioxide aggregate (MTA) with calcium hydroxide (CH) as materials for inducing root apex closure in immature necrotic permanent incisors. Methods The design of this study has been extensively described in the authors' previous report. Children (n=30), aged from 6 to 18 years and presenting a non-vital permanent incisor, were treated. Half of the group received treatment using MTA, the other half with CH. At recall visits after 6 and 12 months, the presence or absence of a calcified apical barrier was assessed using clinical and radiographic examinations. The anonymised radiographs were evaluated by two independent investigators. Statistical analyses were performed using a Fischer's test (p<0.05 was used as the threshold for statistical significance). Results Presence of a mineralized barrier was observed for 43.8% of the CH group and 64.7% of the MTA group at the 6-month examination. After 12 months, these figures were respectively 50 and 82.4% (p<0.07). For both groups, pain and tenderness to percussion had disappeared at the 3-month examination. Conclusion Neither material showed a statistically significant difference at the 6-month examination. At the 12-month examination, the MTA group displayed better results in terms of apical closure. In the CH group, four out of 15 teeth exhibited coronal or radicular fractures after 12 months. Clinical relevance Apexification using MTA seems preferable to CH in order to early achieve the coronoradicular filling and to limit the risk of root fracture.
The aim of this study is to evaluate the posttreatment pain after instrumentation of root canals with a single-file reciprocating (RECIPROC, VDW, Germany) or rotary (One Shape, MicroMega, France) file system.Six hundred forty patients were assessed for eligibility, and 624 patients were included in this study. The teeth were randomly allocated to one of the instrumentation protocols. The teeth underwent routine root canal treatment after which patients were discharged with a questionnaire to gather data about the incidence (yes/no), nature (mild, moderate, or severe), and duration of pain (days). The data were analyzed using statistical analyses (preoperative pain scores by Mann-Whitney U test, incidence and intensity of pain by chi-squared test, intake of analgesics, and duration of pain by Student’s t test) with P = 0.05.Pain analysis was performed for 605 patients (311 males and 294 females) as 5 patients were excluded due to sealer extrusion and 14 were lost to follow-up. The mean age of the patients was 31 ± 2 years. There was significant difference in the incidence of postoperative pain (P < 0.001). There was significant difference in the number of patients who had mild (P = 0.001), moderate (P = 0.002), and severe (P = 0.001) pain between the two groups. Intensity of pain showed significant difference, with patients in the One Shape group (40.5 %) reporting more values of severe pain (P = 0.002); the percentage of patients who took analgesics was significantly higher in the One Shape group (40.5 %) than in the Reciproc group (19.3 %) (P = 0.002). There was no significant difference in the duration of postoperative pain between the two groups when the pain was mild (P = 0.301), but One shape showed significantly longer duration of moderate (P = 0.001) and severe pain (P = 0.002).Reciproc showed significantly less intensity and duration of posttreatment pain compared to One Shape.Reciprocation movement offers a more predictable and safer approach of root canal preparation, in addition to producing less postoperative pain. The need for patients to take analgesics may reduce following this approach.
Herpesviral–bacterial synergism may play a potential role in periodontitis and peri-implantitis (PI) etiopathogenesis. PI lesions can worsen depending on specific microbial challenge and host susceptibility. This cross-sectional split-mouth study aimed to substantiate herpesviral–bacterial co-infection in PI patients and assess associations with periodontopathogen salivary contamination.PCR-based identification was performed on 23 patients presenting PI and contralateral healthy implants, and compared to unstimulated whole saliva. Clinical evaluation included probing depths, bleeding on probing, and suppuration. Radiographs were assessed for the presence of lamina dura and bone loss. Three sample sites per patient were tested: PI lesions, healthy implant sulci, and saliva. Quantitative PCR evaluated Epstein–Barr virus (EBV) and cytomegalovirus (CMV) copy counts. Significance of group comparisons for binary-dependent variables, within-subjects designs, was determined by McNemar's chi-square test. Risk analysis was evaluated through odds ratios (OR).PI lesions were 14.2 (P = 0.001; 95 % confidence interval [CI], 1.6–124.1) and 3 times (P = 0.03; 95 % CI, 0.7–11.9) more likely to harbor EBV than healthy implants and saliva, respectively. EBV positive predictive value was 90 %. PI was associated with absence of lamina dura and higher periodontopathogen proportions. Saliva sampling showed high agreement with PI bacterial detection (89–100 % rate) but not with EBV (44.4 %). The OR of PI lesions harboring Treponema denticola or Tannerella forsythia was 6.79 (P = 0.007; 95 % CI, 1.8–25.0) and 3.3 (P < 0.0001; 95 % CI, 0.3–34.3) times higher than healthy implants, respectively. Saliva of patients with PI was 5.6 times more likely to be contaminated with Prevotella nigrescens than healthy peri-implant sulci (P = 0.002). PI lesions were 1.92 times more likely to harbor Prevotella nigrescens than healthy implants (P = 0.04).EBV is a potential candidate in peri-implantitis etiopathogenesis. Saliva PCR analysis is useful in predicting peri-implantitis-specific bacterial infection but not EBV or CMV.Herpesviral–bacterial synergism may favor ongoing microbial challenge in peri-implant disease and exacerbate its progression. EBV infection may explain non-responsive to treatment PI. Peri-implantitis individuals may benefit from antiviral therapy.