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This study assessed the effect of Biodentine coated with Emdogain (Biodentine/Emdogain) on proliferation and differentiation of human stem cells from the apical papilla (SCAPs). METHODS AND RESULTS: In this in vitro, experimental study, SCAPs were isolated from two immature impacted third molars and cultured. After ensuring the stemness of the cells by assessing the cell surface markers, they were exposed to Biodentine, Emdogain, and Biodentine/Emdogain for 24 and 72 h. The control cells did not receive any intervention. Cell viability was evaluated by the methyl thiazolyl tetrazolium assay. Expression of odontogenic differentiation genes was analyzed by the quantitative reverse transcription polymerase chain reaction. Alkaline phosphatase (ALP) activity was quantified by the respective kit. Data were analyzed by one-way ANOVA, t-test, and Mann-Whitney test (α = 0.05). Cell viability did not change after 24 h of exposure to biomaterials. At 72 h, the viability of the cells exposed to Biodentine and Biodentine/Emdogain decreased compared with the control group. The expression of dentin sialophosphoprotein, dentin matrix protein 1, and bone sialoprotein genes, and ALP activity significantly increased in all three experimental groups, compared with the control group at both 24 and 72 h; this increase was significantly greater in Biodentine/Emdogain group. The number of mineralized nodules significantly increased in all groups after 72 h with a greater rate in Biodentine/Emdogain group.All biomaterials increased the differentiation of SCAPs, expression of odontogenic genes, and ALP activity, but Biodentine/Emdogain was significantly more effective for this purpose.

Background: Knowing the shape of the root and the root canal system is essential for the success of the surgical and non-surgical treatment of the root canal, however; it is difficult to judge root and root canal anatomy from two-dimensional radiographs . The aim of this study is to investigate correlation between root morphology of the mandibular second molars in panoramic view and the root type of these teeth based on Cone Beam Computed Tomography (CBCT) images. Methods: In this study, 1231 CBCT scans of the second mandible molars were selected from archives of a private radiology clinic from October 2018 to March 2021, and panoramic images reconstructed from CBCT images. The root morphology of the second mandible molar was classified on panoramic image in type 1,2,3,4,5. Root pattern in cross-section of CBCT image was classified into three types of single, double and c-shape.Correlation between root morphology in panoramic image and CBCT was analyzed with Chi-Square test and significance level was 0.05. Results: 62.7% of the second mandibular molars were type1, 97.3% of them had double pattern in cross-section of CBCT.28.6% of the samples were type2, which showed 92.6% double pattern. 3.9% of them were type3, 47.9% had c-shape pattern.0.9% of them were type4, 45.5% of them showed single pattern.3.8% of teeth were type5, 76.6% had single pattern. The prevalence of c-shape canals was higher in women and most c-shape canals showed C3 pattern. Conclusion: There was a strong correlation between the root morphology in panoramic image and root canal pattern in the axial section of the CBCT images. According to this study, if the second mandibular molar has a type3 morphology in the panoramic image, it may have a c-shape canal with a high probability.

This study evaluated the effect of different amperage values and voxel sizes of two CBCT scanners on VRF detection in the presence of different intracanal posts. After post-space preparation, VRFs were induced in half of the samples of 20 maxillary premolars. Five different intracanal posts were passively placed in each root canal. Samples were scanned using CS 9300 and Cranex3D with two different voxel sizes and amperage setting in each unit. The diagnostic sensitivity, specificity and accuracy were compared using the Mann-Whitney and Kruskal-Wallis tests (α = 0.05). Changes in amperage and voxel size did not affect the detection of VRFs (p ⟩ 0.05). The VRF detection accuracy was the highest in fibreglass and the lowest in nickel-chromium group. Changes in amperage and voxel size within assessed values do not seem to influence the detection of VRF whereas different intracanal post-materials have significant effect on VRF detection.

Background This study aimed to assess the effect of irradiation of light-emitting diode (LED) and low-level diode laser on osteogenic/odontogenic differentiation of stem cells from the apical papilla (SCAPs). Materials and Methods SCAPs were isolated from the human tooth root. The experimental groups were subjected to 2–4 J/cm2 diode laser and LED irradiation in osteogenic medium. The control group did not receive any irradiation. Cell proliferation was assessed by the methyl thiazolyl tetrazolium (MTT) assay. Osteogenic differentiation was evaluated by alizarin red staining (ARS), and expression of osteogenic genes by real-time polymerase chain reaction (RT-PCR). Results The MTT assay showed no significant difference in cell viability/proliferation of SCAPs in the laser, LED, and control groups at 24 or 48 hours (P 2 energy density and LED can cause osteogenic differentiation and proliferation of SCAPs. Further studies are required to assess the mechanism of effect of diode laser and LED.

Introduction: In Cone-beam Computed Tomography (CBCT) images, metallic artifacts by root filling materials reduce the quality of images. It seems that bioceramic sealers produce fewer artifacts than gutta-percha. In this situation, the possibility of VRF detection could increase, and therefore, flap and exploratory surgery would not be needed. The purpose of this study was to evaluate the performance of a bioceramic-based root filling material in the detection of Vertical Root Fractures (VRF) in CBCT imaging. Materials and Methods: This study was conducted at the dental school from March to August 2019, and 100 healthy human mandibular premolar teeth were obtained and randomly divided into two equal groups. The teeth were filled with either AH26 and gutta-percha or bioceramic root filling materials. VRF was induced on half of the decoronated teeth in each group using a Global Testing Machine, and the others were considered control. CBCT imaging was performed by the Cranex 3D machine. Comparisons of the 2 groups were made using the Mann-Whitney test. Results: There was a significant difference between the two groups of bioceramic and gutta-percha in the measured indices, including sensitivity (P=0.017), specificity (P=0.018), positive predictive value (P=0.018), negative predictive value (P=0.018), and accuracy (P=0.011). The Area Under Curve (AUC) also showed a significant difference between the two groups (P=0.011). According to Kappa test results, no significant difference was obtained between the findings of the two observers. Conclusion: Different root filling materials showed a different extent of artifact in CBCT images. Bioceramic root filling material induces fewer artifacts in CBCT images, and the diagnostic value of VRF in CBCT images in the root canals filled with it is greater than those filled with AH26 and gutta-percha.

Background: This study aimed to assess the effects of calcium hydroxide, Biodentine, calcium-enriched mixture (CEM) cement, and mineral trioxide aggregate (MTA) on root dentin flexural strength after a 30-day exposure period. Methods: This in vitro experimental study evaluated 25 freshly extracted sound human incisors with no caries or restorations. The apical 5 mm and the coronal two-thirds of the crowns were cut such that all samples had 10 mm length. Dentin samples (n=20 in each group) were then exposed to 2 mm thickness of calcium hydroxide, Biodentine, CEM cement, MTA, or saline (control) in petri dishes for 30 days. Finally, dentin samples were subjected to a three-point bending test after the intervention, and the flexural strength data were analyzed using one-way ANOVA, Tukey’s test, and t test. Results: Thirty-day exposure to all four biomaterials decreased the flexural strength of root dentin (P0.05). Conclusions: In general, all four tested biomaterials decrease the dentin strength although this reduction is more prominent by calcium hydroxide.

Objectives: This study compared the effects of calcium-enriched mixture (CEM) cement, Emdogain, and their combination (CEM/Emdogain) on differentiation and proliferation of stem cells from the apical papilla (SCAPs). Methods: In this in vitro, experimental study, SCAPs were isolated from two sound immature impacted third molars and cultured. After ensuring their stemness by detecting cell surface markers they were exposed to CEM cement, Emdogain, and CEM cement coated with Emdogain for 24 and 72 hours. The control cells did not undergo any intervention. Cell viability [by methyl thiazolyl tetrazolium (MTT) assay], expression of odontogenic differentiation genes [by quantitative reverse-transcription polymerase chain reaction (qRT-PCR)] and alkaline phosphatase (ALP) activity (by ALP staining kit) were evaluated. Data were analyzed by one-way ANOVA, t-test, and Mann-Whitney test (α=0.05). Results: Cell viability in the CEM cement and CEM/Emdogain groups decreased compared with the control group at 72 hours (P0.05). The number of mineralized nodules significantly increased in all groups at 72 hours, with a higher rate in the CEM/Emdogain group. Conclusion: All biomaterials increased the differentiation of SCAPs, expression of odontogenic differentiation genes, and ALP activity, but CEM/Emdogain was considerably more effective for this purpose.

Background: This study assessed the effect of Biodentine coated with Emdogain (Biodentine/Emdogain) on proliferation and differentiation of stem cells from the apical papilla (SCAP). Methods and Results: In this in vitro, experimental study, SCAP were isolated from two immature impacted third molars and cultured. After ensuring the stemness of the cells by assessing their cell surface markers, they were exposed to Biodentine, Emdogain, and Biodentine/Emdogain for 24 and 72 hours. The control cells did not receive any intervention. Cell viability was evaluated by the methyl thiazolyl tetrazolium (MTT) assay. Expression of odontogenic differentiation genes was analyzed by the quantitative reverse transcription polymerase chain reaction (qRT-PCR). Alkaline phosphatase (ALP) activity was quantified by the respective kit. Data were analyzed by one-way ANOVA, t-test, and Mann-Whitney test (α=0.05). Cell viability did not change after 24 hours of exposure to biomaterials. At 72 hours, the viability of the cells exposed to Biodentine and Biodentine/Emdogain decreased compared with the control group. The expression of dentin sialophosphoprotein (DSPP), dentin matrix protein 1 (DMP1), and bone sialoprotein (BSP) genes, and ALP activity significantly increased in all three experimental groups, compared with the control group at both 24 and 72 hours; this increase was significantly greater in Biodentine/Emdogain group. The number of mineralized nodules significantly increased in all groups after 72 hours with a greater rate in Biodentine/Emdogain group.Conclusions: All biomaterials increased the differentiation of SCAP, expression of odontogenic genes, and ALP activity, but Biodentine/Emdogain was significantly more effective for this purpose.

Objective: To provide a review of the literature about the photobiomodulation therapy (PBMT) dental treatment protocols in endodontic, restorative, and prosthetic dentistry based on validated clinical studies published so far. More specifically, this study was carried out to carefully review therapeutic protocol of PBMT in clinical studies and their conclusions. Background data: The importance of using low-power lasers and photobiomodulation (PBM) is increasing in dentistry mainly due to their painless and noninvasive function. However, lack of sufficient clinical studies has led to unclear results regarding PBMT in dentistry, and also lack of an available precise protocol for clinicians. Moreover, scarcity of clinical studies in this area has made conduction of a precise systematic review study difficult. Methods: In our study, published clinical studies up to April 2019 were reviewed from library sources, Google Scholar, PubMed and Medline, Elsevier, Embase, Cochrane, Scopus, and Web of science (ISI). Inclusion criteria included those presented in clinical trials and case report/case series, language (English), and studies available in full text. Exclusion criterion was in vitro studies. Results: In general, findings of clinical studies have shown that PBMT can have a significant role in reducing postoperative dental pain, increasing depth of anesthesia, improving tooth hypersensitivity, reducing inflammation of the tissue, and helping wound healing. Conclusions: A review of clinical studies showed that the use of alternative or adjunctive PBMT is of great importance in controlling postoperative pain after endodontic treatments. In addition, evidence suggests that different parameters of light can be efficient in the treatment of tooth hypersensitivity. Nevertheless, lack of sufficient clinical studies and reliable results do not allow introducing a precise treatment protocol.

Objective: This study sought to assess the effect of cryogenic treatment on cyclic fatigue of Neoniti and Reciproc nickel-titanium (NiTi) rotary files. This in vitro, experimental study was performed on 48 Neoniti and Reciproc NiTi rotary files (#25, 6% taper) in two subgroups with and without cryogenic treatment. The files in cryogenic subgroups were stored in liquid nitrogen chamber at -196°C for 24 h. Next, they were placed at room temperature (25°C) to gradually warm up. Stainless steel (SS) blocks were used to standardize the degree of rotation of the files. The SS blocks simulated a root canal with the negative pattern of gutta-percha with 0.08 taper, #25 tip size, and 45° canal curvature. Each endodontic file was rotated in this canal until fracture. The time until fracture was recorded by a digital chronometer. Time to fracture was used to calculate the number of rotations before file fracture as the cyclic fatigue scale. Results: The mean cyclic fatigue resistance of both Neoniti and Reciproc rotary files in cryogenic subgroups was significantly higher than that in non-cryogenic control subgroups (P

Background Cleaning and shaping of the root canal system is an important step of endodontic treatment. Canal transportation is a common procedural error in preparation of curved canals. This study aimed to compare the canal transportation and centering ratio of two rotary files in curved canals using cone-beam computed tomography (CBCT). Methods Forty-four extracted human mandibular first molars with mature apices and 10° to 30° apical curvature were selected. The samples were randomly divided into two groups (n = 22) with similar curvature. The canals were prepared with ProTaper and XP-endo Shaper file systems according to the manufacturers’ instructions. The CBCT images were obtained using Cranex 3D CBCT scanner before and after root canal preparation, and canal transportation and centering ratio of the files at 3, 4 and 5 mm levels from the apex were calculated. Data were compared between the two groups using independent t-test at 0.05 level of significance. Results The ProTaper Universal caused greater canal transportation and had lower centering ratio than XP-endo Shaper in both mesiodistal and buccolingual directions at all levels from the apex. The difference between the two groups regarding canal transportation was significant at all levels from the apex in buccolingual direction (P P > 0.05). The difference between the two groups regarding centering ratio was not significant (P > 0.05) in mesiodistal direction at all levels except for 4 mm from the apex (P Conclusion The ProTaper Universal causes greater canal transportation in both buccolingual and mesiodistal directions than XP-endo Shaper.

Introduction: An important issue in treatment planning and endodontic treatment is to deal with sophisticated internal dental morphology. Deviations from normal anatomy in maxillary molars are usually related to the number of canals in mesiobuccal root. Although unusual anatomy is not uncommon in maxillary molars, the occurrence of 3 separate canals with distinct orifices and apical foramina (as we see in this case) is extremely rare. Getting familiar with this unusual anatomy helps clinicians to treat patients more efficiently with less chance of failure. Case Presentation: This case report describes a successful endodontic management of an uncommon variation of the maxillary first molar with a third mesiobuccal canal. The tooth had a deep carious lesion and the pulp was irreversibly damaged causing pain on the left side of the face. The periodontium was normal. The tooth received root canal treatment and 400 mg ibuprofen was prescribed every 6 hours for 2 to 3 days. The patient remained asymptomatic and the 3-month follow-up radiograph revealed normal periodontium. Conclusions: Inability to identify and treat additional canals that are very common in the MB root of maxillary first molar could lead to treatment failure.

Background: Complete debridement is the major key to successful non-surgical endodontic treatment in teeth with periapical lesions. The missed canals serve as a harbor for bacteria and the irritant factors that lead to treatment failure. Most anatomical studies found that the maxillary lateral incisor is a singlerooted tooth. Most cases reported about the maxillary lateral incisors with two roots are the result of fusion or gemination and are usually accompanied by an enlarged crown. However, a few studies reported that the crown dimensions were normal. Knowing this unusual anatomy helps clinicians to treat patients more efficiently with less chance of failure. Case Presentation: This case report describes successful endodontic management of an uncommon variation of the maxillary lateral incisor with two root canals. Based on the clinical and radiographic findings, pulp necrosis and symptomatic apical periodontitis were diagnosed. The tooth received root canal treatment. The patient was followed up for 6 months and clinical and radiographic examinations in the follow-up sessions showed improvement in the periapical condition and the tooth became asymptomatic. Conclusions: Due to the wide morphological variations in the root and the root canal system of the teeth, clinicians should have knowledge of any anatomical variation to minimize the risk of endodontic treatment failure following inadequate debridement of indistinguishable or inaccessible portions of the root canal system.

Introduction: The present study was set to investigate the training quality and its association with the quality of root canal therapy performed by fifth year dentistry students. Methods and Materials: A total number of 432 records of endodontic treatment performed by fifth year dentistry students were qualified to be further investigated. Radiographs were assessed by two independent endodontists. Apical transportation, apical perforation, gouging, ledge formation, and the quality of temporary restoration were error types investigated in the present study. Results: the prevalence of apical transportation, ledge formation, and apical perforation errors were significantly higher in molars in comparison with other types of teeth. The most prevalent type of error was the apical transportation, which was significantly higher in mandibular teeth. There was no significant differences among teeth in terms of other types of errors. Conclusion: The quality of training provided for dentistry students should be improved and endodontic curriculum should be modified.

Introduction: The aim of this study was to assess the radiographic technical quality of root canal therapy performed by fifth year students of Dental School of Hamadan University of Medical Sciences from 2015 to 2016. Methods and Materials: Four hundred and seventy records of root canal therapies were evaluated. Records with graphies taken as initial, master apical file (MAF), master apical cone (MAC) and final radiographs were included in the study and records of patient younger than 16 years and older than 68 years were excluded from further investigations. Lastly, 432 teeth were selected. Obturation length, canal tapering, quality and density of filling material were the variables investigated in the present study. Two independent investigators examined the radiographies using a magnifying lens (×2) and x-ray viewer. Data were analyzed using chi-square test. Results: The technical quality of root filling performed by undergraduate dental students was classified as acceptable in 10.4% of cases. Moreover, 70.8% of teeth had adequate filling, 17.1% were underfilled and 12% were overfilled. The three groups were significantly different in terms of working length and taper quality. One hundred ninety four (44.9%) records had adequate taper and 109 (25%) records had adequate density. There was a significant association between teeth location and the length of obturation so that the probability of a successful treatment was higher in maxillary teeth. Furthermore, the rate of a proper length of obturation was higher among incisors than that of premolars and molars. Conclusion: The technical quality of root canal therapy performed by dental students in Hamadan University of medical sciences is not as acceptable as it should be. One of the most important factors in this regard is a high student/professor ratio.

The possibility of extra canals in mandibular premolars is quite low; however, it must be taken into account in clinical and radiographic evaluations during root canal treatment. This case series describes the presence of one root and three canals in mandibular premolars in three patients. The case series underlines the importance of complete knowledge about root canal morphology and possible variations to increase the ability of clinicians to treat difficult cases.How to cite this articleDaneshvar F, Baziar H, Karkehabadi H, Jafarzadeh H, Bhandi S, Patil S. Mandibular First Premolars with One Root and Three Canals: A Case Series. J Contemp Dent Pract 2015;16(6):519-522.