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BACKGROUND: This study aimed to investigate the penetration depth of two different dyes after root canal preparation using PIPS and SWEEPS methods. MATERIALS AND METHODS: A total of 60 single-rooted human teeth which were extracted for periodontal reasons were collected and stored in the sterile saline until using in the study. The crowns of the teeth were cut such that the remaining piece was 12 mm long. The root canals were prepared. Teeth were divided randomly into two initial groups (n = 30): indocyanine green solution (ICG) and methylene blue solution. Then, these teeth were divided into final subgroups (n = 10): Er:YAG laser irradiation with PIPS(photon-induced photoacoustic streaming) technique, Er:YAG laser irradiation with SWEEPS(shock-wave enhanced emission photoacoustic streaming) technique, and no irradiation. The penetration depth measurements were done by the stereo microscope in three zones of each specimen. RESULTS: The difference between ICG in the control group and PIPS and SWEEPS in the coronal area was not significant. In the middle section the difference between PIPS and the control group was marginally insignificant (P = 0.053). In the methylene blue group, PIPS had significantly higher penetration depth in the apical area compared to the control group (P = 0.004). In the middle section, both PIPS and SWEEPS showed significantly higher penetration than the control group. CONCLUSION: According to the results of this study, the laser has the potential to increase the penetration of methylene blue. Root canal preparation with the PIPS technique can increase the dye penetration. However, the SWEEPS technique and the conventional method have a similar outcome in terms of dye penetration.

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Addition of zinc oxide (ZnO) to Mineral Trioxide Aggregate (MTA) has been shown to rectify tooth discoloration caused by Angelus MTA. This study evaluated the microhardness, compressive strength, calcium ion release and crystalline structures of MTA mixed with ZnO in different environmental conditions. Molds with a diameter of 4 mm and a height of 6 mm were used for compressive strength, calcium ion release and X-ray diffraction (XRD) evaluations. Molds with 6 mm diameter and 4 mm height were used for surface microhardness evaluations. Cements evaluated include Angelus MTA (Angelus, Brail), Angelus MTA + ZnO, ProRoot MTA (Dentsply Tulsa Dental, OK), and ProRoot MTA + ZnO. Each group was divided into 3 subgroups according to exposure conditions: normal saline (NS), phosphate buffered saline (PBS) or blood. After 7 days incubation, surface microhardness, compressive strength and XRD analysis was performed. Calcium ion release was evaluated after 3, 24 and 168h incubation using atomic absorption spectrophotometry. Data were analyzed by One Way Anova followed by the Tukey HSD Post hoc tests and T-Test. The significance level was set at 0.05. Addition of ZnO to Angelus and ProRoot MTA significantly decreased the compressive strength of these cements regardless of the environmental conditions (P < 0.001); however, it had no significant effect on their microhardness or calcium ion release. In conclusion, adding ZnO to Angelus and ProRoot MTA can adversely affect the compressive strength of Angelus and ProRoot MTA.

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OBJECTIVE: The objective of this study was to analyze the microstructure and crystalline structures of ProRoot MTA, Biodentine, CEM Cement, and Retro MTA when exposed to phosphate-buffered saline, butyric acid, and blood. METHODS AND MATERIALS: Mixed samples of ProRoot MTA, Biodentine, CEM Cement, and Retro MTA were exposed to either phosphate-buffered saline, butyric acid, or blood. Scanning electron microscope (SEM) and energy-dispersive X-ray spectroscopic (EDX) evaluations were conducted of specimens. X-ray diffraction (XRD) analysis was also performed for both hydrated and powder forms of evaluated calcium silicate cements. RESULTS: The peak of tricalcium silicate and dicalcium silicate detected in all hydrated cements was smaller than that seen in their unhydrated powders. The peak of calcium hydroxide (Ca(OH)2) in blood- and acid-exposed ProRoot MTA, CEM Cement, and Retro MTA specimens were smaller than that of specimens exposed to PBS. The peak of Ca(OH)2 seen in Biodentine™ specimens exposed to blood was similar to that of PBS-exposed specimens. On the other hand, those exposed to acid exhibited smaller peaks of Ca(OH)2. CONCLUSION: Exposure to blood or acidic pH decreased Ca(OH)2 crystalline formation in ProRoot MTA, CEM Cement and Retro MTA. However, a decrease in Ca(OH)2 was only seen when Biodentine™ exposed to acid. CLINICAL RELEVANCE: The formation of Ca(OH)2 which influences the biological properties of calcium silicate cements was impaired by blood and acid exposures in ProRoot MTA, CEM Cement, and Retro MTA; however, in the case of Biodentine, only exposure to acid had this detrimental effect.

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OBJECTIVE: Calcium hydroxide is the most widely used intracanal medicament in endodontics, which should be removed prior to permanent root canal filling to minimize its intervention with the bonding of endodontic sealers. This ex-vivo study aimed to evaluate the effect of pretreatment with calcium hydroxide on the bond strength of Resilon/Epiphany self etch (SE) to the radicular dentin after removing the calcium hydroxide by hand file or ultrasonic methods. MATERIALS AND METHODS: Thirty-six single-rooted human extracted teeth were used in this study. After root canal preparation, the teeth were divided into three groups. In group 1, as the control, no pretreatment was performed; while in groups 2 and 3, this was carried out using calcium hydroxide paste. After one week, the paste was removed with hand stainless steel K-files in group 2 and ultrasonic instrumentation in group 3. All samples were obturated with Resilon/Epiphany SE. One-millimeter slices of mid-root dentin were prepared for the push-out test (14 slices per group). After the bond strength was assessed, the failure modes were examined. The data were analyzed using one-way ANOVA and Dunnett Post Hoc tests. RESULTS: Group 2 significantly showed the lowest bond strength (0.947 ± 0.47) (P = 0.01). No significant differences were found between the control group (2.32 ± 1.43) and group 3 (1.78 ± 1.04) (P = 0.01). CONCLUSIONS: Under the conditions of this ex vivo study, calcium hydroxide as the intracanal medicament and its removal using hand instrumentation adversely affected the bond strength of Resilon/Epiphany SE.

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AIM: Mineral trioxide aggregate (MTA) is the material of choice for apical barrier techniques during root canal treatment of teeth with open apices. However, the precise control of MTA during the placement of an apical plug is challenging. This article describes the outcomes of unintentional extrusion of MTA into the periradicular tissue during apical barrier treatment in three cases. SUMMARY: Three cases of maxillary central incisors in adult patients with open apices were referred for treatment. After conventional access and canal preparation, MTA was placed into the apical portion of the root canals to act as an apical barrier/plug. A large increment of MTA was extruded in all cases. In Case 1, after a 4-year follow-up, the extruded MTA had resorbed and the periradicular lesion had healed. In Cases 2 and 3, after follow-up, the patients remained symptomatic and were scheduled for periradicular surgery. In Case 2, soft unset particles of MTA were present in the lesion and were curetted. In Case 3, the extruded MTA had set hard but was sandwiched between the oral mucosa and bone; its removal relieved the pain experienced on buccal palpation. KEY LEARNING POINTS: Extruded MTA may not harden and may be associated with ongoing periapical irritation; Extruded set MTA when encapsulated in the mucosa and not surrounded by bony matrix may act as a mechanical irritant on palpation; Mineral trioxide aggregate should be confined to the root canal system; Teeth where MTA has been extruded beyond the foramen should be followed-up to monitor the outcome.

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Leakage of sealer from root canals to periapical tissues during root canal obturation may occur. This study was designed to evaluate the possible effect of three root canal sealers (zinc oxide-eugenol, Grossman, and AH 26) on adherence of mouse macrophages. Macrophages were obtained from the peritoneal cavity of BALB/c mice and suspended in RPMI-1640 medium. Adherence capacity assays were carried out in Eppendorf tubes. Each sealer was tested four times after mixing (immediately, 12 hours, 24 hours, and 48 hours after) and for three period of incubation (10, 20, and 30 minutes) with suspended cells. Cells were counted under the light microscope, and the adherence index was determined. Zinc oxide-eugenol and Grossman sealers killed all macrophages, and the adherence index was considered less than 1 for these sealers. AH 26 reduced the adherence index in all different periods after mixing and incubation times. But in sealer that had mixed 48 hours before the experiment and with 10 minutes of incubation, the adherence index was increased slightly, but the difference was not statistically significant (P < 0.05).

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