The purpose of this study was to evaluate the effect of post space preparation on apical sealing according to the methods and time of gutta percha removal. Forty six extracted single rooted teeth were selected for this study. Forty teeth were used as experimental groups and six teeth as control groups. Forty teeth were routinely prepared by step-back method and obturated with gutta percha cones and zinc oxide-eugenol cement using lateral condensation. All obturated teeth were divided into 4 groups of 10 teeth each. In each group of 1, 2, 3, heated plugger, gate glidden drill and chloroform and K-file were used respectively for post space preparation by removing the gutta percha immediately after obturation. In group 4, post space were prepared with gate glidden drill one week after obturation. In all experimental groups, the post space were prepared so that 4mm of apical gutta percha remained. After post space preparation, apical leakage were measured with electrochemical method for 28 days and analyzed statistically. The following results were obtained ; 1. No statistically significant differences in apical leakage were occured among the experimental groups using heated plugger, gate glidden drill and chloroform and K-file to remove the gutta percha immediately after obturation. 2. No significant difference in apical leakage was found between the teeth prepared post space immediately after obturation and those prepared 1 week after obturation. 3. In all experimental groups, the apical leakage was increased with time passage regardless of the post space preparation time and the gutta percha removal techniques.
This study was conducted to evaluate and compare the apical leakage among the retrograde filling materials; retrograde filling with non-zinc amalgam, cavity varnish and non-zinc amalgam, z.o.e cement, Glass Ionomer cement, scotch bond and silux. Sixty single rooted teeth were divided into six groups and each tooth was individually prepared for its particular group. The specimens were incubated at $37^{\circ}C$ for 24 hrs and then were infiltrated by 2% methylene blue for 7 days. Apical leakage was evaluated by measuring the degree of dye penetration between the filling material and the canal wall. The results were as follows: 1. The scotch bond and silux group showed the least amount of apical leakage and the control group showed the greatest amount of apical leakage. 2. The groups retrofilled with cavity varnish and amalgam, glass-Ionomer cement, scotch bond and silux showed significantly good apical seal than control group. 3. The groups retrofilled with glass Ionomer cement, scotchbond and silux showed significantly good apical seal than the groups retrofilled with Amalgam and Zinc oxide eugenol cement.
Numerous studies have been focused on the immunologic aspects of inflamed pulp and periapical tissues. The purpose of this study was to evaluate levels of serum IgG and IgM in patients of acute pulpitis and acute apical abscess using Enzyme-Linked Immunosorbent Assay. Streptococcus mutans, Streptococcus sanguis, Bacteroides intermedius and Bacteroides gingivalis were grown for use as antigen and they were harvested by centrifugation. The patients were divided into 3 groups; patients of acute apical abecess, acute pulpitis and normal control 5 patients of each group were selected and their blood was obtained via intravenous puncture. Sera were prepared by centrifugation of each blood samples. Then serum antibodies were measured by modified ELISA. The following results were obtained; 1. Serum IgM levels of patients with acute pulpitis and acute apical abscess seemed to be slightly higher than those of normal control 2. Serum IgG levels of patients with acute apical abscess were slightly higher than those of normal control 3. Serum IgG and IgM levels of acute apical abscess patients and serum IgM levels of acute pulpitis were highest to Bacteroides gingivalis.
Despite considerable focus on the regenerative endodontic treatment of immature teeth with necrotic infected pulps and apical periodontitis, little data exist with regard to its possible implementation in necrotic permanent teeth with complete apical and radicular development. The present report describes the procedures and outcome of a regenerative endodontic treatment approach in 2 previously-traumatized incisors with closed apex with apical periodontitis. A 2-visit treatment procedure was employed. At initial visit, the root canals were copiously irrigated, followed by placement of a triple antibiotic paste containing ciprofloxacin, metronidazole, and clindamycin into the root canals. After 4 weeks, the antibiotic paste was removed, and apical bleeding was initiated with size 10 hand files beyond the apices. The root canals were coronally sealed with mineral trioxide aggregate, and the access cavities were restored with bonded resin composite. At post-operative 60 months, both teeth were remained asymptomatic, with the recall radiographs showing complete resolution of apical radiolucency and reestablishment of periradicular tissues. In both teeth, the dimensions of root space remained unchanged as verified by image analysis. The revitalization protocol utilizing root canal disinfection and induced apical bleeding in necrotic, closed-apex incisors may offer a clinically acceptable alternative to conventional root canal treatment.
Objective: The purpose of this study was to analyze the Cone-beam computed tomograghy(CBCT) scan of endodontically treated maxillary first molars and investigate how second mesiobuccal (MB2) canal is treated, how the prognosis of mesiobuccal (MB) root is different compared to other roots and the prognosis factor on apical periodontitis. Methods: Subjects were endodontically treated maxillary first molars whose were collected from CBCT scans taken from January 2018 until December 2019. A total of 525 maxillary first molars were analyzed by an endodontist to determine the presence of the MB2 canal, the quality of the root canal filling, and the presence of apical periodontitis. The chi square test and Fisher's exact test was used to examine the relationship between each variable. Results: MB2 canals were found in 46.3%, of which 76.5% were not treated. The more main canal of mesiobuccal root (MB1 canal) was well filled, the more significantly MB2 canal was well filled (p<0.001). The apical periodontitis of MB root was not related to the filling quality of MB1 canal (p=0.370) and was related to the filling quality of MB2 canal (p=0.004). The apical periodontitis of MB root was related to the quality of canal filling of MB2 canal and the apical periodontitis of DB and P root. Conclusions: It was found that the majority of MB2 canals were not treated. The apical periodontitis of MB root was analyzed to be related to the quality of canal filling of MB2 canal. The apical lesion of the MB root was not correlated with the treatment of the MB1 canal, but it was significantly related to the quality of filling of MB2 canal.
The aim of this study was to compare the apical sealing ability of a new thermoplasticized gutta-percha filling technique, the Easy Filling and the Quick Obturation system with lateral condensation technique and Thermafil system to evaluate their clinical acceptabilities. Fifty-two extracted single-rooted teeth were instrumented to #35 using the .04 taper ProFile system. Four groups of 12 teeth were obturated by lateral condensation technique. Thermafil system and two new thermoplasticized gutta-percha techniques, the Easy Filling system and Quick Obturation system (Meta Dental co. Ltd. Korea), respectively. Four teeth served as controls. After the teeth were immersed in 2% methylene blue dye for 48 hours, they were resected horizontally at 1mm to 5mm level from the anatomical apex using a low-speed microtome. Each section was examined under a stereomicroscope at ${\times40}$ magnification and photographed. After each image was scanned, the leakage area was measured at each level using Brain 3 (Nosdia Tech., Korea) software. Leakage ratio was calculated for each group and was analyzed statistically to come up with the following results: 1. At 1mm level, the Quick Obturation system had the largest amount of apical leakage and it was statistically significant when compared with the lateral condensation group and the Thermafil group (p<0.05). 2. At 2mm and 3mm level, there were no significant difference of apical leakage among all four groups (p>0.05), and from 4mm level, no apical dye penetration was observed in all the groups. In conclusion, the apical seal produced by Easy Filling system and the Quick Obturation system was comparable to lateral condensation technique and Thermafil system except for the 1mm level. More improvement of the apical seal can be expected as the operator becomes skillful with the new techniques.
Using several varieties of Cymbidium, investigations were carried out to make clear how the protocormic tissue develops from the cultured explant. Explant to be cultured were prepared in several ways: exclusively apical meristem, apical meristem dissected out with the basal part attached, axillary bud primordia in their initial stage of development, or apical or axillary bud dissected out as a whole etc. It was observed that protocorms or protocormic tissues were developed from the explant's meristematic tissues regardless of where these tissues were located. Apical meristem, leaf primordia, leaf axil, or internodal part of young bud turned easily protocormic, while the scaly leaves of axillary bud or stem tissue of mother shoot turned quickly brwonish and died away. Both in axillary and apical bud explant alike, whether they were cultured whole or divided, some took quickly green color while others were slower, and some developed protocorms easily while others remained unchanged for months. Varietal difference as well as environmental factors seemed to be responsible for it. Further details should be clarified by histogenetical investigations.
Use of an apical plug in management of cases with open apices has gained popularity in recent years. Biodentine, a new calcium silicate-based material has recently been introduced as a dentine substitute, whenever original dentine is damaged. This case report describes single visit apexification in a maxillary central incisor with necrotic pulp and open apex using Biodentine as an apical barrier, and a synthetic collagen material as an internal matrix. Following canal cleaning and shaping, calcium hydroxide was placed as an intracanal medicament for 1 mon. This was followed by placement of small piece of absorbable collagen membrane beyond the root apex to serve as matrix. An apical plug of Biodentine of 5 mm thickness was placed against the matrix using pre-fitted hand pluggers. The remainder of canal was back-filled with thermoplasticized gutta-percha and access cavity was restored with composite resin followed by all-ceramic crown. One year follow-up revealed restored aesthetics and function, absence of clinical signs and symptoms, resolution of periapical rarefaction, and a thin layer of calcific tissue formed apical to the Biodentine barrier. The positive clinical outcome in this case is encouraging for the use of Biodentine as an apical plug in single visit apexification procedures.
Cytokinins are adenine derivatives that regulate numerous plant growth and developmental processes, including apical and floral meristem development, stem growth, leaf senescence, apical dominance, and stress tolerance. However, not much is known about how cytokinin biosynthesis and metabolism is regulated. We identified a novel Arabidopsis gene, ALL, encoding an aldolase-like enzyme that regulates cytokinin signaling. An Arabidopsis mutant, all-1D, in which ALL is activated by the nearby insertion of the 35S enhancer, exhibited extreme dwarfism with rolled, dark-green leaves and reduced apical dominance, symptomatic of cytokinin-overproducing mutants. Consistent with this, ARR4 and ARR5, two representative primary cytokinin-responsive genes, were significantly induced in all-1D. Whereas SHOOT MERISTEMLESS (STM) and KNAT1, which regulate meristem development, were also greatly induced, expression of REV and PHV that regulate lateral organ polarity was inhibited. ALL encodes an aldolase-like enzyme that belongs to the HpcH/HpaI aldolase family in prokaryotes and is down-regulated by exogenous cytokinin, possibly through a negative feedback pathway. We propose that ALL is involved in cytokinin biosynthesis or metabolism and acts as a positive regulator of cytokinin signaling during shoot apical meristem development and determination of lateral organ polarity.
The purpose of this experiment was to determine: (1) the safe automatic apical reverse setting that prevents overinstrumentation of the root canal, using Tri Auto ZX$^{(R)}$ and (2) the effect of various irrigant on such instrumentation. The instrumentation was carried out with the automatic apical reverse setting of 0.5, 1.0, 1.5, and 2.0. The root canal irrigants used in usual manner were normal saline(0.9%), NaOCl(2.5%), and RC Prep$^{(R)}$. For each reverse setting and each irrigant, ten teeth were used with the total of 120 teeth. The distance between the file tip and the apical constriction was determined by stereomicroscope using the point that the file began to rotate in reverse direction. When the reverse setting mode was set to 0.5, 18 of 30 were overinstrumented. If these were discriminated by irrigant, 10 of 6 with 0.9% saline, 10 of 6 with NaOCl, and 10 of 6 with RC Prep$^{(R)}$ has the file tip located 0.57${\pm}$0.30mm, 0.73${\pm}$0.39mm, and 0.26${\pm}$0.25mm beyond the apical constriction respectively. In 1.0 setting 15 of 29 were over the apical constriction, and the distribution was 6 in saline, 5 in NaOCl, and 4 in RC Prep$^{(R)}$. The mean distance over the apical constriction was 0.28${\pm}$0.13mm with saline, 0.75${\pm}$0.61mm with NaOCl, and 0.25${\pm}$0.17mm with RC Prep$^{(R)}$. When the autoatic reverse mode was set to 1.5, and 2.0, 5, and 1 teeth were found to be overinstrumented in respective settings. But there were large variations in overinstrumented distances when an attempt was made to compare the effect of irrigants on this overinstrumentations and they were meaningless for the small sample size. When all of the autoreverse setting were combined to compare the number of overinstrumented teeth with each irrigant, there were no significant differences (14 for normal saline, 12 for NaOCl, 13 for RC Prep$^{(R)}$). When 0.5 or 1.0 automatic apical reverse setting mode was used the Tri Auto ZX$^{(R)}$ in clinical application, the possibility of overinstrumentation beyond the apical constriction exists in 55.9% of cases. Therefore 1.5 or 2.0 setting is safer for the preparation inside the canal but this type setting needs additional apical hand preparation of the root canal because the accuracy is lower than 0.5 or 1.0 setting.
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