Journal of Dental Medicine

The cleaning and shaping of root canals is one of the most important proccesses in endodontics. In many cases, the physiologic or pathologic proccedures can affect the canals. So, using the instruments and materials, which could be applied in cleaning and shaping of narrow canals is necessary. The aim of this study was the evaluation of Iranian and foreign chelating agents on periradicular tissue of cats. After cleaning and shaping of canals in 18 lower canines of cats, the original RC-Prep and an Iranian chelating agents were placed equally in two groups with 9 teeth in each one. The patency of canals preserved for materials leakage. In 3 lower canines of cats, phosphoric acid was placed as positive controls.3 canine teeth as negative controls had nothing in them. The crowns were sealed and the cats were sacrificed in 1/21/42 days periods after conducting vital perfussions. The teeth samples with their surrounding osseous tissues were gathered and placed in three groups each contained 6 samples. Histologic preparations were done and the tissue reactions to these materials were evaluated by counting the proliferative inflammatory cells. Also the morphometric analysis for these samples was done. The inflammatory reactions of these materials (the original RC-Prep. & the Iranian chelating agent) were not statistically different. Both of these materials were different in inducing tissue reactions in comparison with those of positive and negative controls, and these differences were statistically important.

Background and Aim: Achieving appropriate seal in canal obturation is the main goal of endodontic therapy. However, in some cases, it can not be obtained by non-surgical procedures alone. Retrograde surgery is one of the most common procedures in endodontics. Apical seal improvement can be obtained by root end filling and decreasing the root end resection angle (bevel angle). The aim of this study was to investigate the role of bevel angle on apical microleakage following the use of amalgam and MTA as root end filling materials.

Materials and Methods: In this experimental study, 128 extracted human teeth were instrumented and obturated by lateral condensation technique. The teeth were divided into two groups and the apical root resection was performed by high speed fissure bur (one group perpendicular to the long axis of the teeth and the other 45 to the long axis. The 3 mm root end cavity was prepared by ultrasonic device. Each group was divided into two subgroups: One filled with amalgam and the other with MTA. Teeth were incubated for 72 h, covered by two layers of nail polish (except for apical 3mm) and submerged in methylene blue for 48 h. Teeth were washed under tap water and mesiodistally dissected by low speed disc. Dye penetration was evaluated by stereomicroscope. Data were analysed by two way ANOVA and Tukey tests with p<0.05 as the limit of significance.

Results: The results showed that retrofill material type had a significant effect on microleakage and MTA was superior to amalgam in this respect. Bevel angle failed to show any significant effect on apical microleakage.

Conclusion: Based on the results of this study, it seems that the use of MTA instead of amalgam in clinical practice can improve the success rate of endodontic surgery whereas the bevel angle can be determined based on the status of each individual case However, increasing the bevel angle seems to increase microleakage due to exposure of more dentinal tubules.

Background and Aim: Mineral Trioxide Aggregate (MTA) is a material used in many endodontic problems. Recently a number of studies, have reported that Portland Cement (PC) and MTA have similar physical, chemical and biologic properties. In addition, a material known as Root MTA which is produced in Iran has been claimed to have similar properties to Pro Root MTA. If these claims are true, possible use of PC and Root MTA in clinic instead of Pro Root MTA will be quite cost effective. The aim of this study was to investigate the toxicity of Pro Root MTA, Root MTA and Portland Cement on L929 mouse fibroblasts.

Materials and Methods: In this experimental study 0, 4, 24 hours and 7 days' extracts of materials were transferred to cell culture plates containing L929 fibroblasts. After 24 hours incubation, cells were stained by Neutral Red (NR), and optical density (OD) of each cell was read with ELISA reader. Data were analyzed using Tukey HSD and one way analysis of variance. P<0.05 was considered as the level of significance.

Results: In all surveyed groups and negative control group, at all time points separated cells from the base of the well were round. Refraction which is a characteristic of cellular death was not observed, whereas the separated cells from the base of well in positive control group showed refractional characteristic.

Conclusion: Based on the findings of this study Pro Root MTA, PC and Root MTA have the same biocompatibility. PC seems to have the potential to be used in the same clinical situation as MTA. However in order to replace MTA with these less expensive materials more in vitro and in vivo studies are suggested.

Background and Aim: Researches have shown that bacteria play the main role in development of pulpal and periapical diseases. Chemo-mechanical cleaning of infected root-canal system can not remove all of the microorganisms. Thus interappointment medicaments are necessary to aid this goal. Calcium hydroxide is one of the most useful medicaments in root canal therapy, but this medicament can not eliminated all of the bacteria in root canal system. Carvacrol is an edible plant extract that has antimicrobial and anti-inflammatory effects. If this extract is effective against endodontic bacteria, it can be used as an root canal medicament.

Materials and Methods: In this experimental study, Initially, MIC and MBC of carvacrol detected with Macro broth dilution method and determined as 0.3% and 0.6%, respectively. After that, 30 single root and single canal extracted human teeth were used in this study. The number of specimens determined in a pilot study on 4 extracted teeth. After preparation to apical size # 30 with hand and rotary instruments, teeth were randomly divided into two experimental and two control groups. After culturing Enterococcus faecalis in prepared canals, we used emulsion of 0.6% carvacrol and calcium hydroxide in two A and B experimental groups for 7 days as the intracanal medicament. Microbial samples obtained before and after experiment. Then, canals with negative culture selected to obtain dentinal shaving to culture. Data obtained from microbiological samples analyzed with kruskal-wallis and Bonferroni tests.

Results: Results of this study showed that emulsion of 0.6% carvacrol has no significant difference with calcium hydroxide in elimination enterococcus faecalis after 7 days dressing (p>0.05).

Conclusion: Carvacrol can be used as an intrappointment intracanal medicament.

Background and Aim: A considerable percentage of failure in Endodontic treatments in maxillary molars is attributed to undiscovered second mesiobuccal canal (MB₂).There are different methods for discovering and accessing to this canal. The purpose of this ex vivo study was to compare the detection ability of three methods (direct look, fiberoptic loup and surgical microscope) to find MB₂ after troughing with ultrasonic.

Materials and Methods: In this experimental study, we selected 90 extracted maxillary molars (45 first and 45 second molars) in which after access cavity preparation MB₂ canal was not discovered by direct vision and endodontic explorer. They were divided into 3 groups (n=30). The dentinal shelf between mesiobuccal and palatal canals was eliminated by an endodontic ultrasonic tip (troughing). After that, first group was searched by direct vision, second group by a loup and fiberoptic light and third group by dental operating microscope. Data were analyzed, specificity and sensitivity were calculated.

Results: The results showed that 21%, 61%, and 92% of MB₂ canals after troughing was found by direct vision, fiberoptic loup, and surgical microscope, respectively.

Conclusion: Based on the results of this study, surgical microscope and loup with fiberoptic are preferred methods for discovering MB₂ canal. Troughing with ultrasonic can help find MB₂ canal in all methods.

Background and Aims: In the last decade, several studies have reported the isolation of stem cell population from different dental sources, while their mesenchymal nature is still controversial. The aim of this study was to isolate stem cells from mature human dental pulp and follicle and to determine their mesenchymal nature before differentiation based on the ISCT (International Society for Cellular Therapy) criteria.
Materials and Methods: In this experimental study, intact human third molars extracted due to prophylactic or orthodontic reasons were collected from patients aged 18-25. After tooth extraction, dental pulp and follicle were stored at 4°C in RPMI 1640 medium containing antibiotics. Dental pulp and follicle were prepared in a sterile condition and digested using an enzyme solution containing 4mg/ml collagenase I and dispase (ratio: 1:1). The cells were then cultivated in α-MEM medium. Passage-3 cells were analyzed by flow cytometry for the expression of CD34, CD45, CD 73, CD90 and CD105 surface markers.
Results: Dental pulp and follicle were observed to grow in colony forming units, mainly composed of a fibroblast-like cell population. Flow cytometry results showed that dental pulp and follicle are highly positive for CD73, CD90 and CD105 (mesenchymal stem cell markers) and are negative for hematopoietic markers such as CD34 and CD 45.
Conclusion: In this study we were able to successfully confirm that dental pulp and follicle stem cells isolated from permanent third molars have a mesenchymal nature before differentiation. Therefore, these two sources can be considered as an easy accessible source of mesenchymal stem cells for stem cell research and tissue engineering.

Background and Aims: Instrumentation of the root canals results in formation of smear layer which covers the dentinal tubules. In infected teeth, it is ideal to achieve a material that has the ability to remove the smear layer besides antimicrobial activity. Therefore, this study was designed to evaluate the antimicrobial effect of Citrus aurantifolia extracts (lime juice and rind extract) on Enterococcus faecalis within dentinal tubules in the presence of smear layer.
Materials and Methods: One-hundred and forty dentin tubes were prepared from bovine incisors. After removal the smear layer, the specimens were infected with Enterococcus faecalis. Then, the smear layer was reformed. Test solutions were used as the irrigants in study roups as follows: group 1: 5.25% NaOCl group 2: 17% EDTA group 3: NaOCl+EDTA group 4: Lime juice group 5: ethanolic rind extract of C.aurantifolia group 6: 96% ethanol. Dentin chips were collected from inner and outer layers of dentinal walls and optical density was measured. The data were analyzed using one-way ANOVA and Tamhane tests.
Results: In outer layer of dentin, the efficacy of rind extract was less than that of NaOCl+EDTA (P<0.05). Also Lime juice was less effective than EDTA, NaOCl and NaOCl+EDTA (P<0.05). In inner layer of dentin, Lime juice was significantly less effective than NaOCl and NaOCl+EDTA (P<0.05). The efficacy of rind extract was less than that of NaOCl+EDTA (P<0.05).
Conclusion: In the presence of smear layer, the antimicrobial activity of Lime juice was less than that of NaOCl but the efficacy of rind extract was similar to that of NaOCl.

  Background and Aims: Impacted third molar reduces the bone level in the distal aspect of second molar, and sometimes it can lead to root resorption of the adjacent tooth. The purpose of this study was to determine this resorption using panoramic and periapical radiographs.

  Materials and Methods: In this cross-sectional descriptive study 54 patient (28 men, 26 women) above 15 years old with the average of 22 years in Oral and Maxillofacial Department of Tehran University were studied. A periapical radiography from the third molar and a panoramic radiograph were taken from each patient (Because of their routine use and evaluation of accuracy of panoramic compared with periapical), and the magnitude of the root resorption for the second molar was determined by 2 observers and written in a questionnaire. Data were analyzed using Fisher test.

  Results: The prevalence of the root resorption of the second molar adjacent to the impacted third molar in the panoramic and the periapical radiographies, with respect to the limitation of the sample size were 46.3% and 31.5%, respectively, with 95% confidence(P>0.05). Most of these resorptions were in the cervical third of the second molar roots and in cases in which the third molars were mesially oriented or horizontal. There was also no significant difference between panoramic and periapical radiographs.

  Conclusion: Due to the increased risk of the resorption of the second molar adjacent to the third molar, extraction of the impacted third molars, especiall y mesially oriented or horizontal ones are recommended.

Background and Aims: Management of pain and inflammation after third molar surgery is an important challenge of this treatment. Various medications have been proposed for pain control after surgery. Comparing the effectiveness of various drugs used in this field can improve dentists' clinical decisions. The aim of this study was to compare the effect of Ketorolac and Gelofen on pain relief in patients undergoing third molar surgery.
Materials and Methods: This randomized single-blinded clinical trial was performed on 140 patients who were divided into two groups of 70 after receiving the ethical code. The first group was prescribed 400 mg Gelofen capsule for 1 week, while the second group was prescribed 30 mg ketorolac ampule for 1 week. Then, using the visual analog scale (VAS), the patient’s pain was recorded 48 hours, 1 week, and 2 weeks after surgery. Data analysis was carried out using SPSS20 software by descriptive analysis of the results. Ki-square, T-test, and variance analysis were also used for analysis of variables.
Results: The pain level in the ketorolac group after 48 hours, 1 week, and 2 weeks following surgery was significantly less than Gelofen group (P<0.01). Ketorolac effect on pain was irrelevant to the gender, age, and type of tooth variables.
Conclusion: From the results, it was concluded that Ketorolac had greater effect on pain relief after third molar surgery than Gelofen.