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Nonsurgical repair of furcal perforations: a literature review.

The important steps in the management of a furcal perforation are immediate action, adequate isolation, debridement, and sealing of the defect. Studies have shown that repair materials or underlying matrix material such as amalgam, Cavit, calcium hydroxide, glass ionomers, hydroxylapatite, tricalcium phosphate, and demineralized freeze-dried bone have not been able to produce consistent results. However, current research on new materials such as mineral trioxide aggregate may advance treatment modalities significantly for furcation repair.

Aluminum Compounds↗

Influence of substituting B2O3 for CaF2 on the bonding behaviour to bone of glass-ceramics containing apatite and wollastonite.

Glass-ceramics containing crystalline oxy-fluoroapatite (Ca10(PO4)6(O,F2)) and wollastonite (CaSiO3) (designated AWGC) are reported to have a fairly high mechanical strength as well as the capability of forming a chemical bond with bone tissue. The chemical composition is MgO 4.6, CaO 44.9, SiO2 34.2, P2O5 16.3, and CaF2 0.5 in weight ratio. In this study the influence of substituting B2O3 for CaF2 on the bonding behaviour of glass-ceramics containing apatite and wollastonite to bone tissue was investigated. Two kinds of glass-ceramics containing apatite and wollastonite were prepared. CaF2 0.5 was replaced with B2O3 at 0.5 and 2.0 in weight ratio (designated AWGC-0.5B and AWGC-2.0B). Rectangular ceramic plates (15 x 10 x 2 mm, abraded with No. 2000 alumina powder) were implanted into a rabbit tibia. The failure load, when an implant detached from the bone, or the bone itself broke, was measured. The failure load of AWGC-0.5B was 8.00 +/- 1.82 kg at 10 weeks after implantation and 8.16 +/- 1.36 kg at 25 weeks after implantation. The failure load of AWGC-2B was 8.08 +/- 1.70 kg at 10 weeks after implantation and 9.92 +/- 2.46 kg at 25 weeks after implantation. None of the loads for the two kinds of glass-ceramics decreased as time passed. Giemsa surface staining and contact microradiography revealed direct bonding between glass-ceramics and bone. SEM-EPMA showed a calcium-phosphorus rich layer (reaction zone) at the interface of ceramics and bone tissue. The thickness of the reaction zone was 10 to -15 microns and did not increase as time passed.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Potential application of coal-fuel oil ash for the manufacture of building materials.

In this paper coal-fuel oil ash has been characterized in terms of leaching behaviour and reactivity against lime and gypsum in hydratory systems for the manufacture of building materials. Its behaviour was also compared to that of coal ash. Metal release was measured in a dynamic leaching test with duration up to 16 days. The results have shown that coal-fuel oil ash behaves very similarly to coal ash. The reactivity of coal-fuel oil ash against lime and gypsum was measured in mixtures containing only lime and in mixtures containing both lime and gypsum. These systems were hydrated at 25 and 40 degrees C under 100% R.H. The results have shown that the main hydration products are the same as those that are usually formed in similar coal ash-based systems. That is, calcium silicate hydrate in coal-fuel oil ash/lime systems and calcium silicate hydrate plus calcium trisulphoaluminate hydrate in coal-fuel oil ash/lime/gypsum systems. From the quantitative point of view, hydration runs showed that the amounts of both chemically combined water and reacted lime measured in the case under investigation are very similar to those found in similar coal ash-based systems. Finally, the measurement of unconfined compressive strength proved that the systems have potentiality for the manufacture of pre-formed building blocks.

Aluminum Compounds↗

Dens invaginatus in an immature maxillary lateral incisor: a case report of complex endodontic treatment.

This case report presents the surgical endodontic treatment of an Oehlers Class II invaginated immature tooth. In this case, communication between the invagination and the pulp caused pulp necrosis, periapical inflammation, and cessation of root formation. The initial treatment goal was to achieve apexification and then fill both the root canal and the canal of the invagination. After a 6-month treatment with calcium hydroxide dressings, there was no healing radiographically and no sign of a hard tissue barrier in the apex. Periapical surgery with the placement of mineral trioxide aggregate (MTA) root-end filling was deemed successful at the 1-year recall. To treat dens invaginatus, both conventional and surgical endodontic treatment techniques should be considered. In dens invaginatus, conventional endodontic treatment modalities may be unsuccessful because of inadequate debridement and disinfection; however, subsequent periapical surgery and retrofilling with MTA may promote healing.

Adult↗

Decoloration of 1% methylene blue solution in contact with dental filling materials.

OBJECTIVES: Leakage studies have been performed frequently, since a tight seal provided by various dental fillings has been considered clinically important. The dye penetration experiment using a methylene blue solution as a tracer is one of the most common methods applied in these types of studies. The stability of the colour of methylene blue in contact with six dental filling materials was observed. METHODS: Silicon rubber tubes and human tooth roots of 10 mm in length and 1.5 mm inner diameter were filled with amalgam, calcium hydroxide, Cavit, Fuji II, mineral trioxide aggregate, or zinc oxide eugenol, 10 tubes or roots for each material. Groups of five tubes or roots filled with the same material were immersed in 0.8 ml 1% methylene blue dye solution. The optical density of the methylene blue solution before immersion and after 24, 48 and 72 h of immersion was measured in a spectrophotometer at 596 nm. RESULTS: The methylene blue solution was found to be decoloured over time by all the test materials (P < 0.01) except for Fuji II, in both silicone tubes and roots. At 24 h, the optical density value of methylene blue decreased by 73% for the Ca(OH)2/silicone group and 84% for the mineral trioxide aggregate/silicone group. CONCLUSION: Methylene blue is decoloured by some dental filling materials, which may result in unreliable results for these materials in dye leakage studies.

Aluminum Compounds↗

Inflammatory cytokines reaction elicited by root-end filling materials.

Cytokines are inflammation in the list of tissue reactions that cytokines control of cell and tissue growth, development, and differentiation. Root-end filling materials often contact with existing periapical tissue, and they need to be biocompatible with remnant periapical tissue. The aim of this study was to focus the effects of the root end filling materials on bone cell viability and expression of inflammatory cytokines and their role in maintaining health and stability of the restored dental tissues. Calcium hydroxide-based (Life), zinc oxide eugenol-based (Super EBA), and mineral trioxide aggregate-based (MTA) root-end filling materials were used to investigate their effect on a human osteosarcoma cell line (U2OS). The cell attachment assay was observed microscopically, and the expression of interleukin-2, -4, and -10 were quantified by enzyme-linked immunosorbent assay. Any resultant difference between the root-end filling material was analyzed statistically by one-way analysis of variance. The results showed that the best cell attachment to root-end filling material occurred with MTA. The IL-4 (0.824 +/- 0.396) and IL-10 (2.06 +/- 1.24) levels were greater for the MTA group, whereas IL-2 expression for the three kinds of root-end filling materials was similar. All materials were able to induce expression of inflammatory cytokines from cultured bone cells.

Aluminum Compounds↗

[Treatment of teeth with open apices using mineral trioxide aggregate as apical barrier].

PURPOSE: To evaluate the clinical effect of treatment of teeth with open apices using mineral trioxide aggregate (MTA) as apical barrier under surgical operating microscope. METHODS: The root canals of 23 teeth with open apices were cleaned and shaped, and disinfected with calcium hydroxide. The MTA mixture were then carried into the apical part of the root canals to create a 3-5 mm apical barrier. The remainder of the canals were filled with AH plus and Obtura II gutta-percha. The revisit times, the period and result of the treatment were recorded for all cases. RESULTS: The treatment of all cases was accomplished within 2 or 3 weeks. Postoperative X-ray films showed that the canals of 16 teeth were obturated very well. 7 teeth showed 1-2 mm over-filling. All recalled patients declared their teeth to be asymptomatic. The recall radiographs indicated that the apical radiolucent areas of teeth with pre-existing apical lesion decreased apparently or disappeared completely. No new radiolucency was found around the roots. CONCLUSION: MTA is effective and quick in treatment of teeth with open apices, even thought there is slight over-filling of the material.

Aluminum Compounds↗

The use and predictable placement of Mineral Trioxide Aggregate in one-visit apexification cases.

Endodontic treatment of the pulpless tooth with an immature root apex poses a special challenge for the clinician. The main difficulty encountered is the lack of an apical stop against which to compact an interim dressing of calcium hydroxide (Ca(OH)2), or the final obturation material. In these situations the unpredictability of the result, the difficulty in creating a leak-proof temporary restoration for the duration of treatment, and the difficulty in protecting the thin root from fracture may lead to complications when using traditional (Ca(OH)2-based) apexification techniques. Furthermore, given the increased mobility of today's society, lengthy treatment protocols are fraught with problems, and may not be followed through to completion. This may lead to ultimate failure of the case. Mineral Trioxide Aggregate (MTA) has recently been introduced for use in endodontics. Current literature supports its efficacy in a multitude of procedures including apexification. The focus of this paper is to propose a one-visit apexification protocol with MTA as an alternative to the traditional treatment practices with Ca(OH)2. One-visit apexification may shorten the treatment time between the patient's first appointment and the final restoration. The importance of this approach lies in the expedient cleaning and shaping of the root canal system, followed by its apical seal with a material that favours regeneration. Furthermore, the potential for fractures of immature teeth with thin roots is reduced, as a bonded core can be placed immediately within the root canal.

Aluminum Compounds↗

[Clinical management of open apices teeth with mineral trioxide aggregate (MTA) as apical barrier in adults].

OBJECTIVE: To evaluate the clinical effect of treatment of open apices teeth with mineral trioxide aggregate (MTA) compared with apexification using Vitapex in the adult. METHODS: The root canals of 41 anterior teeth and premolars with single canal and open apices in adults were cleaned and shaped, and then disinfected with calcium hydroxide. The apical root canals of 21 teeth in experimental group were filled with MTA to create a 3-5 mm apical barrier. The remainder of the canals was filled with AH plus and Obtura II gutta-percha. The canals of 20 teeth in control were treated with Vitapex. The root canals were then filled with Obtura II gutta-percha when the apical barrier could be detected. The visit times, period and result of the treatment were recorded for all cases. RESULTS: Good result was achieved in the most cases in the experimental group. The postoperative X-ray films showed that the canals of 15 teeth were obturated well. 6 teeth showed over-filling by 0.5-2 mm. The recalled patients declared their teeth to be asymptomatic except one. The recall radiographs indicated that the apical radiolucent areas of the teeth with pre-existing apical lesion decreased apparently or disappeared completely, except one tooth with large apical radiolucency. No new radiolucency was found around the roots. In the control group, the apexification of 11 teeth succeeded, and 9 failed. The average visit times was 3.5 in experimental group and 6.0 in control. The average period of the whole endodontic treatment was 11.8 days in experimental group and 306.8 in control. CONCLUSION: MTA is more effective and quicker than apexification in treatment of teeth with open apices in adults.

Adult↗

Comparative evaluation of endodontic management of teeth with unformed apices with mineral trioxide aggregate and calcium hydroxide.

PURPOSE: The purpose of this study was to compare mineral trioxide aggregate (MTA) and calcium hydroxide (Ca(OH)2) for their efficacies and time taken for formation of apical biological calcific barriers and resolution of periapical radiolucencies, if present at baseline, in teeth with unformed apices. METHODS: Twenty nonvital permanent maxillary incisors with unformed apices, stratified according to the size of periapical radiolucencies and stage of root development, were equally allocated to MTA and Ca(OH)2 groups. In group 1 (MTA group), after 7 days of disinfection with Ca(OH)2, MTA was packed into the apical one third of the root canals and obturation with gutta percha (GP) was performed in 90% (9/10) of cases within 15 to 30 days. In group 2 (Ca(OH)2 group), obturation was performed following clinical and radiographic depiction of the apical stop. RESULTS: The mean time taken for apical biological barrier formation was 3 +/- 2.9 months for group 1 and 7 +/- 2.5 months for group 2 (P=.008). The periapical radiolucencies were resolved in 4.6 +/- 1.5 months for group 1 and 4.4 +/- 1.3 months for group 2 (P=.83). The total treatment was completed in 0.75 +/- 0.4859 months and 7 +/- 2.5 months for groups 1 and 2, respectively. CONCLUSION: The 2 materials were found to be equally efficacious in the management of nonvital teeth with unformed apices. Time taken to complete the treatment and the biological barrier formation in group 1 was significantly less than that for group 2. The healing time for periapical radiolucencies was almost identical.

Adolescent↗

Tissue reactions after subcutaneous and intraosseous implantation of mineral trioxide aggregate and ethoxybenzoic acid cement.

Biocompatibility of mineral trioxide aggregate and ethoxybenzoic acid cement was investigated by subcutaneous and intraosseous implantation of the materials in rats. Tissue reactions were studied at 15, 30, and 60 days after implantation. Subcutaneous implantation of mineral trioxide aggregate initially elicited severe reactions with coagulation necrosis and dystrophic calcification; the reactions, however, subsided to mostly moderate with time. Subcutaneous implantation of ethoxybenzoic acid cement initially elicited mostly moderate reactions that subsided to mild in time. Osteogenesis was not observed with either material upon subcutaneous implantation indicating that neither material is osteoinductive. Reactions to intraosseous implants of both materials were less intense than with subcutaneous implantation. Osteogenesis occurred in association with intraosseous implants indicating that both materials are osteoconductive.

Aluminum Compounds↗

Contamination of tooth-colored mineral trioxide aggregate used as a root-end filling material: a bacterial leakage study.

This experiment investigated the ability of tooth-colored mineral trioxide aggregate (MTA) to maintain an apical seal in the presence of bacteria when contaminated with blood, saline or saliva. Ninety extracted human teeth with single canals were randomly placed into six groups of 15. Canals were prepared to size 50. The apical 3 mm of each root was removed and 3 mm root-end preparations were made with a #329 bur. Root-end preparations in groups 1 through 3 were filled with MTA after contamination with blood, saline, or saliva, respectively. In group 4, uncontaminated root-end preparations were filled with MTA. Groups 5 and 6 served as negative and positive controls. A tube/tooth assembly was utilized to suspend each root end in Trypticase Soy Broth (TSB). The access chambers were filled with Staphylococcus epidermidis. Positive growth over thirty days was demonstrated by turbidity of the TSB. Vitek analysis was used to confirm the presence of S. epidermidis in the positive samples. Data evaluation consisted of a chi(2) analysis (p < 0.05). Although all experimental groups demonstrated leakage, tooth-colored MTA contaminated with saliva (group 3) leaked significantly more than the uncontaminated tooth-colored MTA (group 4) (p = 0.028).

Aluminum Compounds↗

The effects of sodium hypochlorite (5.25%), Chlorhexidine (2%), and Glyde File Prep on the bond strength of MTA-dentin.

The purpose of this study was to evaluate the effects of sodium hypochlorite (5.25%), chlorhexidine (2%), and Glyde File Prep on the bond strengths of MTA-dentin in vitro. Standardized dentin disks were prepared and the central hole in each disk was filled with mineral trioxide aggregate (MTA). The specimens were randomly divided into four groups to be immersed in saline, 5.25% NaOCl, 2% chlorhexidine, and Glyde File Prep for 2 hours. The bond strengths of MTA-dentin were measured with a material testing system (MTS) and the fractured surfaces on the root walls were observed by scanning electron microscopy. Compared with the control group, the bond strengths were significantly lower in Glyde File Prep group (p < 0.05) and there was no significant difference in the chlorhexidine group or in the NaOCl group (p > 0.05). This study suggested that Glyde File Prep could negatively affect the bond strengths of MTA-dentin.

Aluminum Compounds↗

Sealing ability of three materials in the orifice of root canal systems obturated with gutta-percha.

There were 130 single roots randomly assigned to one of 12 experimental or two control groups. Forty specimens each were sealed with 1, 2, 3, or 4 mm of Cavit, ProRoot MTA, or Tetric. After creation of a uniform orifice diameter, the smear layer was removed and the canal systems obturated using warm lateral compaction of gutta-percha (GP). GP was removed to the experimental depth, experimental materials placed in the orifice, and roots submerged in India ink in a vacuum flask. Specimens were demineralized and leakage measured using a 10x stereomicroscope and graded for depth of leakage by one calibrated, blinded rater. There was no significant interaction (p > 0.05) between test materials and orifice depths, nor main effect of orifice depth (p > 0.05). However, there was a statistically significant main effect of test materials with Tetric demonstrating a significantly better seal than Pro Root or Cavit (p < 0.0001) irrespective of orifice depth.

Aluminum Compounds↗

A comparative study of the biocompatibility of three root-end filling materials in rat connective tissue.

The purpose of this study was to compare the biocompatibility of amalgam, gray MTA and white MTA in the connective tissue of rats. We used 45 Sprague-Dawley rats in this study. The rats were divided into three groups. Root end filling materials were placed in polyethylene tubes and inserted into the rats' connective tissue through incisions. The rats were sacrificed after 3 days, 1 wk, and 3 wk, respectively. Histologic samples were sectioned in 5-mum thicknesses and stained with hematoxylin and eosin. Kruskal-Wallis test was used for statistical analysis. The results showed that after 3 days, white MTA was more biocompatible than gray MTA and amalgam. After 1 week, gray MTA was more biocompatible than white MTA and Amalgam. After 3 wk, there were no significant differences between experimental groups and the control group.

Aluminum Compounds↗

Apical leakage of root-end placed SuperEBA, MTA, and Geristore restorations in human teeth previously stored in 10% formalin.

The purpose of this study was to determine if storage of extracted teeth in 10% formalin affects microleakage of MTA, Geristore, or SuperEBA root-end fillings. There were 130 freshly extracted single-rooted teeth collected, immediately placed in phosphate buffered saline (PBS) and stored for less than 24 hours. Teeth were divided and either placed in 10% formalin for a 4-weeks immersion or immediately prepared. Preparation for all teeth consisted of canal instrumentation, obturation, apical resection, retrograde preparation, and placement of a root-end filling material. After 72 hours, the apical portions were immersed in India ink under vacuum pressure for 30 minutes, and then stored in ink for 1 week. Negative controls and positive controls performed as expected. In general, there was significantly less dye leakage of root-end restorations in teeth stored in 10% formalin when compared to the freshly extracted teeth (p < 0.0001). No difference in dye leakage was observed between Geristore restorations placed in teeth stored in formalin as compared to fresh teeth (p = 0.892). Less dye leakage was noted in teeth restored with Geristore as compared to MTA and SuperEBA, regardless of storage medium (p < 0.0001). No difference was observed between MTA and SuperEBA root-end restorations (p = 0.157). The results of this study provide evidence that storage of teeth in 10% formalin over a 4-week period may significantly influence dye leakage as compared to leakage in freshly extracted teeth.

Aluminum Compounds↗

Histologic study of furcation perforations treated with MTA or Super EBA in dogs' teeth.

OBJECTIVE: The aim of this study was to investigate the histologic response to MTA or Super EBA when used for the repair of furcation perforations in dogs' teeth. STUDY DESIGN: Ninety mandibular premolar and molar teeth of 9 mongrel dogs were used in this study. The teeth were divided into 3 groups. Seventy-two teeth were repaired with either MTA or Super EBA (36 each), and 18 teeth were not repaired and used as negative controls. All groups were histologically examined at 1 month, 3 months, and 6 months after treatment. Histologic evaluation was done with regard to inflammation and type of healing. RESULTS: The Super EBA group showed moderate inflammation in 1 month; the inflammation decreased over time, but most of specimens showed inflammatory reaction from mild to severe at the end of 6 months. The perforation area was filled by connective tissue in specimens in which no inflammation was seen. In the MTA group, mild inflammation was seen in 1 month, it decreased in 3 months, and no inflammation was detected in 6 months. New cementum formation was taken in place in 4 specimens in 1 month, in 8 specimens in 3 months, and in all specimens in 6 months. CONCLUSIONS: MTA showed less inflammation than Super EBA. MTA specimens showed healing with new cementum formation in the perforation area, whereas Super EBA specimens in which no inflammation was seen showed connective tissue healing.

Aluminum Compounds↗