E-ISSN 2548-0839
: 4 (2)

Volume: 4  Issue: 2 - 2019

ORIGINAL ARTICLES
1.Effects of Dimensions of Root-End Fillings and Peripheral Root Dentine on the Healing Outcome of Apical Surgery
Thomas von Arx, Evodie Marwik, Michael M. Bornstein
doi: 10.14744/eej.2019.76376  Pages 49 - 56
Objective: The objective of this study was to assess dimensions of root-end fillings (REFs), as well as peripheral root dentine (PRD) and their effects on the healing outcome of apical surgery.
Methods: Cone beam computed tomography (CBCT) scans were utilized to measure the REF length and width and the PRD thickness in 61 roots of 53 teeth 1 year after apical surgery. Measurements were taken in the mesio-distal as well as bucco-lingual directions. The REF alignment with respect to the root axis was also evaluated. In addition, the dimensions of REF and PRD were assessed for possible correlations with the healing outcome. Criteria for determining the healing outcome included clinical and radiographic parameters.
Results: The mean REF length was 2.02±0.52 mm. No significant differences were observed with regard to tooth groups, but one-canal roots had a significantly longer mean REF than two-canal roots (P=0.006). The mean REF widths were 1.14±0.24 mm mesio-distally and 2.61±1.24 mm bucco-lingually. Roots with two canals presented a significantly wider REF (P<0.001) in the bucco-lingual dimension but had a significantly narrower REF in the mesio-distal direction (P<0.001) compared to roots with single canals. PRD measured on average 1.19±0.23 mm at the resection level and 1.44±0.27 mm at the coronal end of the REF. Almost all REFs were perfectly aligned with the longitudinal axis of the roots. With regard to healing outcomes, no correlations were found with REF and PRD values, respectively.
Conclusion: The mean REF length was 2.02 mm. On average, a thickness >1 mm of peripheral root dentine was maintained. The REF or PRD dimensions had no statistical effect on the healing outcome.

2.Effect of CPoint, EndoSequence BC, and Gutta-percha Points on Viability and Gene Expression of Periodontal Ligament Fibroblasts
Claudia Meneses, Alessandra Gambini, Lucas Olivi, Marcelo dos Santos, Carla Renata Sipert
doi: 10.14744/eej.2019.74046  Pages 57 - 61
Objective: This study aimed to investigate the cytotoxic and biomodulatory potential of conventional gutta-percha (CGP) points, gutta-percha points containing bioceramics (BC), and CPoint polymer (CP) points on periodontal ligament (PDL) cells in vitro.
Methods: PDL fibroblasts were cultured and stimulated with extracts of CGP, BC, and CP in serial dilutions to evaluate cell viability using MTT assay. Next, the 1: 5 dilution was used to stimulate the cells for 72 h to assess the gene expression of type I collagen (COL-1) and cement protein 1 (CEMP-1), by reverse transcription followed by quantitative PCR. Data were statistically analyzed using one-way analysis of variance (ANOVA) (P<0.05).
Results: Pure extracts of CGP and CP were found to be cytotoxic for PDL (P<0.01). Once diluted to 1: 5, only CP showed cytotoxicity. BC did not affect cell viability in any extract sample. No extract significantly altered the gene expression of COL-1. For CEMP-1, a significant increase in gene expression was observed only for CGP (P<0.05).
Conclusion: CP was found to be more cytotoxic than CGP, while BC demonstrated no cytotoxicity. The tested cones did not affect COL-1 gene expression, while CGP upregulated CEMP-1. Our results suggest that obturation point components may affect the biological responses of PDL fibroblasts.

3.Evaluation of Root and Root Canal Morphology of Mandibular First and Second Molars in a Greek Population: A CBCT Study
Eleni Kantilieraki, Antigone Delantoni, Christos Angelopoulos, Panagiotis Beltes
doi: 10.14744/eej.2019.19480  Pages 62 - 68
Objective: Τo study the number of roots, canal configurations, and frequency of morphological variations in mandibular first and second molars in a Greek population.
Methods: This study examined 478 mandibular first molars and 524 mandibular second molars using a high-resolution cone-beam computed tomography (CBCT). The number of roots was recorded and the root canal configuration was categorized based on the classification by Vertucci. The presence and configuration of C-shaped root canals were recorded and they were classified according to the Fan classification. The symmetry between the right and the left side was also evaluated.
Results: Among the mandibular first molars, 0.2% teeth were single-rooted, 96.4% were two-rooted, and 3.3% were three-rooted. In the mandibular second molars, 12.2%, 82.8%, and 4.9% were single-rooted, two-rooted, and three-rooted, respectively. In two-rooted mandibular first and second molars, the most frequent root canal pattern observed was Vertucci’s type II in the mesial root (69.8% and 64.1%, respectively) and Vertucci’s type I in the distal root (81.7% and 97.7%, respectively). Three-rooted molars showed one oval-shaped mesial root and two distal roots (56.2% in first molars, 65.4% in second molars), where each distal root contained a single root canal (type I), and the mesial root presented either type II (53.3%), IV (26.6%), I (13.3%), or V (6.6%) canal configurations. C-shaped canals were only detected in mandibular second molars (5.3% of teeth, 10.8% of individuals), and bilateral occurrence was observed in 24.5% patients. The most frequent root canal pattern was Fan’s C1 type at the orifice, followed by C3a and C3b in the coronal and middle third, which joined into a single canal (C4) apically.
Conclusion: The characteristics of the root and root canal anatomy of the mandibular first and second molars of Greek individuals were similar to those observed in Caucasians. However, the higher incidence of third roots in mandibular molars in Greek individuals compared to Caucasians requires absolute clinical awareness.

4.Effect of Pulpotomy Procedures With Mineral Trioxide Aggregate and Dexamethasone on Post-endodontic Pain in Patients with Irreversible Pulpitis: A Randomized Clinical Trial
Mona Bagheri, Hussein Khimani, Lida Pishbin, Hassan Shahabinejad
doi: 10.14744/eej.2019.91885  Pages 69 - 74
Objective: Endodontic post-treatment pain continues to be one of the main problems encountered by dental professionals. Therefore, pain control during and after endodontic treatment is one of the most important issues in endodontics. The purpose of this clinical trial was to compare postoperative pain relief achieved with dexamethasone (DEX) and mineral trioxide aggregate (MTA) used as pulp coverage after pulpotomy in human molars with irreversible pulpitis.
Methods: This prospective double-blind study was conducted on 54 patients complaining of dental pain due to irreversible pulpitis. The standard pulpotomy procedure was performed by the same dentist in all patients. At the time of the cotton pellet placement, patients were randomly divided into three groups: those in whom a sterile dry cotton (DC) pellet was used, patients treated with a cotton pellet soaked in MTA, and those who were treated with a cotton pellet soaked in DEX. After completion of the treatment, patients received rescue medication every 6 hours for the first day. Postoperative pain was assessed at 6-hour intervals for 24 hours, and then every day until day 7 using a visual analog scale.
Results: In general, patients treated with MTA suffered the lowest levels of pain at all time intervals. Post-pulpotomy pain was significantly reduced at 18 and 24 hours and from days 2 to 7 post-treatment in the MTA group. DEX lowered the pain level more than the DC pellet. However, the differences observed in the mean pain scores of the DEX and DC pellet groups at all-time intervals were not statistically significant.
Conclusion: Pulpotomy procedures can reduce pain related irreversible pulpitis. Pulpotomy with MTA-soaked cotton pellet significantly reduces pain intensity in patients with irreversible pulpitis.

5.The Precision of Propex Pixi with Different Instruments and Coronal Preflaring Procedures
Inês Ferreira, Ana Cristina Braga, Irene Pina-vaz
doi: 10.14744/eej.2019.52724  Pages 75 - 79
Objective: This study aimed to evaluate the influence of the instrument regarding the apical fit and type of the alloy and coronal preflaring procedures in the accuracy of Propex Pixi.
Methods: A total of 40 extracted human single-rooted permanent teeth with apical diameters of 200 µm were selected. A #10 K-file was inserted in the root canal until its end could be observed by a dental microscope to obtain the actual working length (WL). Electronic measurements were performed using Propex Pixi to the root apex (“0.0”). Different file alloys (stainless steel [SS] and nickel titanium [NiTi]) and sizes (#10, #15, and #20) were used before and after coronal flaring. Statistical analysis was performed by a factorial analysis of variance (P≤0.05).
Results: Results showed that the measurements of electronic length (EL) were closer to the actual working length (WL) after coronal flaring (P<0.05). A significant intraclass correlation was observed between EL and WL. In addition, results showed no significant differences between files with different sizes or alloys.
Conclusion: Under the conditions of this study, Propex Pixi demonstrated adequate precision. Its accuracy was enhanced by coronal preflaring procedures regardless of the instrument type used (SS or NiTi) and the apical fit.

6.Vascularity and Angiogenic Signaling in the Dentine-Pulp Complex of Immature and Mature Permanent Teeth
Lara Friedlander, Trudy Milne, Haizal Mohd Hussaini, Benedict Seo, Alison Rich, Ahmad Al-Hassiny
doi: 10.14744/eej.2019.26349  Pages 80 - 85
Objective: This study aimed to examine the protein and gene expression of vascular endothelial growth factor (VEGF) and angiopoietins-1 and 2 in tissue from healthy and inflamed dental pulps.
Methods: Permanent teeth with pulps diagnosed as healthy or reversible pulpitis were used for immunohistochemistry (IHC) and gene expression experiments. For IHC, a whole pulp tissue was excavated from the pulp chamber, and it was formalin-fixed and processed for routine IHC with angiogenic markers anti-VEGF, anti-Ang1, and anti-Ang2. Staining was visualized with diaminobenzidine (DAB), and examined using light microscopy. The distribution of markers in healthy and inflamed pulps was qualitatively and quantitatively analyzed. Real-time quantitative polymerase chain reaction (RT qPCR) was used to ascertain the gene expression levels of ANGPT1, ANGPT2, and TEK in the presence of inflammation. Statistical analysis was performed using the Mann–Whitney test with the statistical significance level set at 0.05.
Results: There was increased protein and mRNA expression of VEGF and Ang-1 markers in inflamed pulp samples as compared with that in the healthy pulp tissue. IHC demonstrated intense expression of the VEGF protein on endothelial cells (EC) and some non-ECs, and there was significantly more staining on ECs associated with inflamed tissue (P<0.001). Ang-1 and Ang-2 were significantly expressed on ECs and non-ECs (P<0.05). RT qPCR did not show significant differences in gene expression between healthy and inflamed samples although similar trends were observed to IHC.
Conclusion: The presence of Ang-1, Ang-2, VEGF, and TEK gene in healthy and mildly inflamed pulp tissue associated with reversible pulpitis indicates that these angiogenic factors may participate in physiological and pathological angiogenesis and healing. The inflammatory process may regulate Ang-1/Ang2/Tie2 signaling; and together with VEGF, these growth factors have an important role in modulating pulp angiogenesis.

REVIEW ARTICLES
7.Latest Concepts in the Endodontic Management of Patients with Cardiovascular Disorders
Maryam Kuzekanani, James Leo Gutmann
doi: 10.14744/eej.2019.70288  Pages 86 - 89
There are several cardiovascular interventions that need special considerations in the provision of treatments within the scope of endodontics. If these interventions are not carefully identified, diagnosed, and considered in the overall treatment plan for the patient, they may result in fatal conditions. These include hypertension that causes fatal cardiac disorders, such as angina pectoris, ischemic heart diseases, and myocardial infarction, and also cerebrovascular diseases; congestive heart failure; infective endocarditis, valvular diseases, and carrying pacemakers; and the use of antiplatelet and anticoagulant drugs that are commonly prescribed for patients who have experienced heart stroke. The aim of this article is to review the newest recommendations for patients with these disorders who require endodontic treatments.

CASE REPORT
8.Cemental Tear on Maxillary Anterior Incisors: A Description of Clinical, Radiographic, and Histopathological Features of Two Clinical Cases
Teng Kai Ong, Nurharnani Harun, Tong Wah Lim
doi: 10.14744/eej.2019.13007  Pages 90 - 95
In this case report, three teeth with complete or incomplete cemental tear in two patients were presented. Even though periapical radiograph could detect cemental tear in these three teeth, the cone-beam computed tomography scanning clearly revealed the pattern of the cemental tear, which was later confirmed by histopathological examination. Therefore, this case report shows the benefits of incorporating both cone-beam computed tomography and histopathological examination to diagnose cemental tear.

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