OBJECTIVE To evaluate the antimicrobial effect by measuring the minimum inhibitory concentration MIC and minimum bactericidal concentration MBC of propolis, BioPure MTAD, 5% sodium hypochlorite (NaOCl), and 2% chlorhexidine CHX on Enterococcus faecalis (E. faecalis) and Candida albicans (C. albicans) in vitro. METHODS This study was performed in the Faculty of Dentistry and Pharmacy at Erciyes University, Kayseri, Turkey from February to April 2010. Ethanol extract of propolis (EEP) was prepared from propolis collected from Kayseri, Turkey, and proper media for microorganisms were prepared using sterile broth medium to give final concentrations between 0.002-2.4 mg/ml for propolis, 0.000125-0.512 mg/ml for CHX, and 1:2-1:4096 dilutions for NaOCl and BioPure MTAD. Using the macrobroth dilution method, MIC, and MBC values of irrigants on the growth of E. faecalis and C. albicans were determined. RESULTS Propolis and other irrigants were found to be effective on C. albicans and E. faecalis. Propolis and NaOCl were more effective in lower concentrations on C. albicans than on E. faecalis. In contrast, CHX and MTAD were more effective in lower concentrations on E. faecalis than on C. albicans. CONCLUSION Propolis showed antimicrobial activity against E. faecalis and C. albicans. It appears that propolis is an effective intracanal irrigant in eradicating E. faecalis and C. albicans.

HASH(0x21996240)

AIM Dental caries with its bacterial agent is an infectious disease, and shows a vertical transmission. The control of bacterial transmission of Mutans streptococci (MS) from mother to child has been studied, and its results on their children's caries development, and on their siblings' bacterial levels, have been analysed in a field-trial (for 4 years) in rural area. MATERIAL AND METHODS In the same tribe, 8 mothers and their 11 children (test children [TC]), and then (following years) their 9 siblings (test sibling [TSb]), were followed for 4 years. The study started when the TC group had just started to erupt. Test mothers were subjected to a preventive regime. Examination of caries development as well as determination of plaque levels of MS in TC and TSb were carried out annually and at 6-month intervals. At the end of 4 years, two control groups (control children [CC] and control siblings [CSb]) resembling TC and TSb were selected from the other tribe living in the same village, and bacterial data and caries status were compared to both test groups. RESULTS Microbial data demonstrated that the test children (p<0.01) and test siblings (p<0.05) had significantly low bacterial level in plaque samples. Accordingly, TC had significantly low dmf-t and -s number compared to corresponding control group (p<0.001 for dmf-t, p<0.0001 for dmf-s). CONCLUSION The preventive regimen was applicable in rural southeastern Anatolia, where an introverted life style with a great tribal system is prevailing, any other preventive measures may have been practical or available, and babies are basically cared by mothers.

OBJECTIVE The purpose of this study was to compare the effectiveness of various medicaments, including Ca(OH)2/2% chlorhexidine, 2% chlorhexidine gel, and Ca(OH)2 alone, against Enterococcus faecalis and Candid albicans in vitro. STUDY DESIGN Eighty extracted single-rooted human maxillary teeth were used. After removing the crown, each root was instrumented up to size 50 by using a conventional technique. The root canal was irrigated with ethylenediamine tetra-acetic acid (EDTA) solution to remove smear layer. Then, roots were infected with E faecalis and C albicans. Subsequently, the roots were divided into 4 treatment groups: group 1 was treated with calcium powder hydroxide in distilled water, group 2 was treated with calcium hydroxide powder in 2% chlorhexidine, group 3 was treated with 2% chlorhexidine gel, and group 4 was treated with 0.9% sterile saline serving as negative control. Microbial samples were taken after 7, 15, and 30 days. After incubation, dentine chips were obtained form each root canal and examined microbiologically. The microbiological samples were plated to count colony-forming units in per milligram of dentin. RESULTS The results showed that the 2% chlorhexidine gel was significantly more effective than calcium hydroxide with 2% chlorhexidine, calcium hydroxide, and control saline solution (P <.05). CONCLUSION Under the conditions of this study, 2% chlorhexidine gel is effective in the elimination of E faecalis and C albicans from the root canal system. However, to support this in vitro observation, further in vivo studies are needed.

Objectives: We analyzed pentraxin 3 (PTX3) levels and the relation of PTX3 levels with GRACE risk scores in 39 patients with non-ST elevation acute coronary syndrome (ACS) and stabile angina after stenting. Study design: Seventeen patients with ACS and 22 patients with stabile angina who underwent coronary stenting were included in the study. PTX3 levels were measured serially at admission, at the 8th hour and at the 24th hour after stenting. Results: While diabetes and hypertension were more frequent in the stabile angina group, leukocyte counts were significantly higher in the ACS group. PTX3 levels measured at the 8th hour were significantly higher in the ACS group compared to the stabile angina group (p=0.003). Strong correlations were observed between 24th hour PTX3 levels and GRACE scores calculated for risk of death and death/MI at admission (in-hospital/to 6 months), and for risk of death/MI at discharge to 6 months (R=0.571, p=0.01, R=0.564, p=0.01; R=0.558, p=0.02, R=0.512, p=0.03; R=0.653, p=0.004, respectively). Conclusion: The serum PTX3 levels may provide important information for the early risk stratification of patients with ACS who underwent coronary stenting.

OBJECTIVE The purpose of this clinical study was to compare the retention rates of two flowable restorative systems (Admira Flow and Grandio Flow) with that of a conventional resin-based sealant (Fissurit F). MATERIALS AND METHODS The study was planned as a clinical trial with a split-mouth design. A total of 122 sealants (38 Admira Flow, 41 Grandio Flow, 43 Fissurit F) were randomly applied to completely erupted permanent molars in 35 patients aged 9-20 years and followed up for 24 months. Data were analyzed using Pearson's χ(2) and multiple comparison tests. RESULTS At the end of the follow-up period, Fissurit F had higher retention rates (81.0%) than both Admira Flow (60.5%) and Grandio Flow (57.1%), with p < 0.05. However, there was no significant difference in caries development among groups (p > 0.05). CONCLUSION The two flowable composite resin materials used as fissure sealant were less retentive than the conventional resin sealant.

OBJECTIVE: The purpose of this study was to review and compare the differences between mandibular fractures in young and adult patients. MATERIAL AND METHODS: Patients treated at the Oral and Maxillofacial Department of Dicle University during a five-year period between 2000 and 2005 were retrospectively evaluated with respect to age groups, gender, etiology, localization and type of fractures, treatment methods and complications. RESULTS: 532 patients were included in the study, 370 (70%) males and 162 (30%) females, with a total of 744 mandibular fractures. The mean age of young patients was 10, with a male-female ratio of 2:1. The mean age of adult patients was 28, with a male-female ratio of 3:1. The most common causes of injury were falls (65%) in young patients and traffic accidents (38%) in adults. The most common fracture sites were the symphysis (35%) and condyle (36%) in young patients, and the symphysis in adults (36%). Mandibular fractures were generally treated by arch bar and maxillomandibular fixation in both young (67%) and adult (39%) patients, and 43% of the adult patients were treated by open reduction and internal fixation. CONCLUSION: There was a similar gender, monthly and type of treatment distribution in both young and adult patients in the southeast region of Turkey. However, there were differences regarding age, etiology and fracture site. These findings between young and adult patients are broadly similar to those from other studies. Analysis of small differences may be an important factor in assessing educational and socioeconomic environments.

PURPOSE The aim of this study was to evaluate the effect of different cavity disinfectants on dentin bond strengths of composite resin applied with two different adhesive systems. MATERIALS AND METHODS One hundred mandibular third molars were sectioned parallel to the occlusal surface to expose midcoronal dentin. The dentin surfaces were polished with waterproof-polishing papers. The specimens were randomly divided into 5 groups of 20 each. In group 1, the specimens were not treated with any cavity disinfectants and served as control. From groups 2 to 5, dentin surfaces were treated with the following cavity disinfectants, respectively; 2% chlorhexidine solution, 2.5% NaOCl, 1% chlorhexidine gel, 3% H2O2. The specimens were then randomly divided into 2 subgroups including ten teeth each to evaluate the effect of different bonding systems. Dentin bonding systems were applied to the dentin surfaces and the composite buildups were created. After the specimens were stored in an incubator for 24 h, the shear bond strength was measured at a crosshead speed of 1 mm/min. The bond strength data were analyzed with one way analysis of variance and Tukey-HSD tests. RESULTS There was no significant difference between chlorhexidine gel and control groups regardless of the type of the bonding agent (p > 0.05). On the other hand, pretreatment with NaOCl, H2O2 or chlorhexidine solutions had a negative effect on the shear bond strength of self-etching bonding systems. CONCLUSION The findings of this study suggest that when NaOCl, H2O2 or chlorhexidine solution are used as a cavity disinfectant, an etch-and-rinse bonding system should be preferred.

OBJECTIVES To assess the incidence of postoperative pain after single- and multi-visit endodontic treatment of teeth with vital and non-vital pulp. METHODS In total, 306 patients with teeth requiring endodontic treatment were identified and were included in this study. Two experienced clinicians treated the patients, who were randomly assigned to two groups. While the teeth of patients in group 1 were obturated, group 2 were temporarily sealed and obturated after one week. Three days after the root canal instrumentation of each tooth, the patients were asked whether they experienced any postoperative pain and to rate the level of discomfort as no, mild, moderate, or severe pain. Data were analyzed statistically using the chi-square test. RESULTS No significant difference in postoperative pain was found between vital and non-vital teeth (P>.01). Mild, moderate, and severe pain occurred in 31.4, 13.7, and 4.6% of vital teeth, respectively. Postoperative pain occurred in 107 (69.9%) and 106 (69.3%) teeth in the single- and multi-visit treatment groups, respectively. There was no significant difference in postoperative pain between the two groups (P>.01). CONCLUSIONS The prevalence of postoperative pain did not differ between vital and non-vital teeth. The majority of patients in either groups reported no or only mild pain.

OBJECTIVE: The purpose of this study was to investigate the clinical performance of high-strength glass ionomer cement (HSGIC) and resin-modified glass ionomer (RMGIC) in single and multiple surface carious cavities in the field conditions. MATERIAL AND METHODS: A split-mouth design, including ninety-one fillings placed on contra lateral molar pairs of 37 children, was used in permanent dentition. As filling materials, a HSGIC (Ketac Molar/3M ESPE) and a RMGIC (Vitremer/ 3M ESPE) were used with the Atraumatic Restorative Treatment (ART). Baseline and 6, 12 and 24-month evaluations of the fillings were made with standard-ART and USPHS criteria by two examiners with kappa values of 0.92 and 0.87 for both criteria. RESULTS: According to the USPHS criteria, the retention rates of RMGIC and HSGIC restorations were 100% and 80.9% for single surface, and 100% and 41.2% for multiple surface restorations after 24 months, respectively. Irrespective of surface number, RMGIC was significantly superior to HSGIC (p= 0.004), according to both standard-ART and USPHS criteria. CONCLUSION: The results indicate that RMGIC may be an alternative restorative technique in comparison to high-strength GIC applications in ART-field-trials. However, further clinical and field trials are needed to support this conclusion.

Dens invaginatus is a critical condition for endodontic treatment. It frequently presents a complex internal anatomy and might be associated with incomplete root and apical development. This article presents one of the few reported cases of endodontic retreatment of Type III dens invaginatus. First, the internal anatomy was modified using burs under an operating microscope. Next, conventional chemical and mechanical preparation with hand files and 2.5% sodium hypochlorite was performed. Finally, an intracanal dressing with calcium hydroxide was used for nine months, at which point the anatomical features in the root canal system could be accessed. Adequate periradicular healing was observed and regression of the lesion was noted at the two-year follow-up. This case reinforces the idea that knowledge about the biologic aspects of endodontics, combined with adherence to technical standards, is helpful in resolving complex cases.

Objective-To document the short- and long-term outcomes of surgical endodontic treatment in dogs in a clinical setting. Design-Retrospective case series. Animals-15 dogs that underwent surgical endodontic treatment. Procedures-Medical records of dogs that underwent surgical endodontic treatment at 3 institutions from January 1995 to December 2011 were reviewed. Information extracted included signalment, history, initial clinical signs, physical and radiographic examination findings, treatment, and outcome. Outcome was determined through evaluation of the pre- and postoperative radiographs as well as clinical and radiographic findings at follow-up evaluations. On the basis of radiographic findings, treatment was considered successful if the periapical lesion and bone defect created by surgery had completely healed and no new root resorption was detected; a treatment was considered to have no evidence of failure if the periapical lesion remained the same or had not completely resolved and root resorption was static. Results-15 dogs were treated by means of apicoectomy and retrograde filling following a failed or complicated orthograde root canal treatment. The mean long-term follow-up time was 15.2 months (range, 3 to 50 months). On radiographic evaluation, 10 of 15 dogs had successful resolution of the periapical disease; 5 dogs had no radiographic evidence of failure of endodontic treatment. All dogs were considered to have a successful clinical outcome. Conclusions and Clinical Relevance-Surgical endodontic treatment was an effective option for salvaging endodontically diseased but periodontally healthy teeth of dogs in which orthograde treatment was unsuccessful and nonsurgical retreatment was unlikely to succeed.

AIM The objective of the study was to determine the neutralizing effect of proanthocyanidin (grape seed extract) and lycopene (tomato extract) on reactive oxygen species (ROS) generated by the mixture when used as an intracanal medicament. The study also evaluated the effect of proanthocyanidin and lycopene on the antibacterial efficacy of a mixture of chlorhexidine (CHX) and calcium hydroxide [Ca(OH)(2)] against Enterococcus feacalis. MATERIALS AND METHODS Four sample groups were prepared as follows. Group I: 2% CHX gluconate (control group) and group II: a mixture of 125 mg of Ca(OH)(2) with 2% CHX gluconate solution. Group III was a mixture of 125 mg of Ca(OH)(2) with 1 mL of 2% CHX gluconate solution and 1 mL of 5% proanthocyanidin solution and group IV, a mixture of 125 mg of Ca(OH)(2) with 1 mL of 2% CHX gluconate solution and 1 mL of 5% lycopene solution. The groups were analyzed for ROS formation using the mass spectrometer (JEOL GC MATE II) immediately after preparation. The antibacterial property was evaluated by using agar diffusion method and the results were statistically analyzed using one-way analysis of variance (ANOVA) and Tukey-Kramer multiple comparison tests. RESULTS The peak value of 196.96 denotes ROS formation. Group II shows a higher peak value than other groups. Group IV shows a drastic reduction in the peak value. Group IV shows a drastic reduction in ROS formation when compared with group II, group III, and the control group. Antibacterial efficacy was higher in group IV, followed by group III, group II, and group I. CONCLUSION Lycopene and proanthocyanidin reduce the ROS significantly by virtue of their antioxidant property. Lycopene shows more antioxidant property when compared with proanthocyanidin.

INTRODUCTION This study evaluated and compared colony forming units (CFUs) and minimum inhibitory concentrations (MICs) of calcium hydroxide and propolis as intracanal medicaments. MATERIALS AND METHODS Eighty human single-root and caries-free teeth were selected and divided into five groups. Crowns were removed. Root canals were then prepared in a step-back manner. The samples were then inoculated by Enterococcus (E.) faecalis and incubated for 21 days. Intracanal medications were applied including, calcium hydroxide (n=20), propolis (n=20), and ethanol (n=20). Two groups of 10 teeth were also used as the positive and negative controls. Microbiological sampling was performed utilizing a piezo-reamer drill after one week of incubation. The samples were plated and CFUs were counted after 48 hours. MICs of calcium hydroxide and propolis were measured by serial dilution and agar dilution methods, respectively. The statistical tests of ANOVA and Duncan post-hoc were used to compare different medications. RESULTS MICs and CFUs of propolis were dramatically less than calcium hydroxide. The difference between the groups was statistically significant (P<0.001). CONCLUSION Our results reveal that propolis is an effective antimicrobial intracanal agent.

Microorganisms play a major role in the initiation and perpetuation of pulpal and periapical disease. In order to predictably achieve a bacteria-free root canal system, it is necessary to use intracanal medicaments. Calcium hydroxide [Ca(OH)(2)] is the most common intracanal medicaments. It is effective against primary infections. However, its effectiveness against Enterococcus (E.) faecalis and Candida (C.) albicans is controversial. On the other hand, chlorhexidine (CHX) is a potent agent against E. faecalis and C. albicans. For this reason, the combination of Ca(OH)(2) and CHX has been suggested as an intracanal medicament. The purpose of this article was to review antimicrobial efficacy of Ca(OH)(2), CHX as well as their combination.

INTRODUCTION Antimicrobial activity of interappointment intracanal medications is an important consideration in endodontics. Considering the fact that calcium hydroxide (CH) cannot sterilize the root canal system, completing its antimicrobial spectrum seems necessary. The aim of this study was to compare the antibacterial activity of CH combined with three different vehicles in root canal system. MATERIALS AND METHODS In this in vitro experimental study, 61 freshly extracted human single rooted teeth were used. After chemo-mechanical preparation, the teeth were dressed with CH in combination with: G1: Distilled water (DW); G2: 5.25% sodium hypochlorite; G3: 0.2% chlorhexidine solution. All teeth were mounted in a 2-chamber apparatus. After sterilization, the coronal chamber was exposed to bacteria and the apical chamber was filled with broth for 90 days. Leakage was recorded when turbidity was observed in broth. Mean times of leakage and turbidity percentage were recorded for each group. Data were analyzed by One Way ANOVA test (α=0.005). RESULTS The highest mean time of contamination was for chorhexidine/CH combination (M=66.76 days), and the lowest was for DW/CH combination (M=40.29 days). Statistically significant difference was observed between G3 and G1 (P=0.042), but the difference between G2 and G3 (P=0.76) or G1 and G2 (P=0.18) were not significant. 88.23% of the samples of G1, 70.58% of G2, and 64.70% of G3 were contaminated after 3 months. CONCLUSION As an intracanal medication, the chlorhexidine/CH combination had significantly more antibacterial activity than DW/CH combination.

INTRODUCTION The aim of this study was to evaluate the enamel matrix derivative (EMD) biomaterial in nonvital immature teeth. METHODS To arrest root development, pulpectomies were performed in the lower first molars of 36 4-week-old rats; the cavities were left exposed to the oral environment for 3 weeks. Then, chemical disinfection was performed, and triple antibiotic paste (TAP) or EMD was applied in the root canals. A control group did not receive any treatment. Radiographic and histological data were evaluated after 3 and 6 weeks. RESULTS At 3 weeks, TAP promoted a milder inflammatory response and increased root lengths compared with the control group. At 6 weeks, root development and reduced periapical lesions could be observed in both test groups, mainly because of the deposition of a cementum-like tissue. EMD promoted narrower canals compared with TAP (P <.05). CONCLUSIONS EMD deserves attention as a potential tool in the treatment of nonvital immature teeth. The ingrowth of cementum-like tissues into canal spaces favored dental wall thickness and may contribute to tooth resistance and support.

In a 2008 article on cone beam volumetric tomography (CBVT) and dentoalveolar applications, Tyndall and Rathore wrote:'It is in the area of endodontic applications that the literature has proved most fruitful to date.' This statement is even truer today than in 2008. A review of the literature has demonstrated that, in many cases, CBVT is more efficacious than traditional forms of 2-D imaging. Endodontic applications of CBVT include the diagnosis of periapical lesions due to pulpal inflammation, identification and localization of internal and external resorption, the detection of vertical root fractures, the visualization of accessory canals, and elucidation of the causes of non-healing endodontically treated teeth. Prior to 2008, most published articles on CBVT applications in endodontics were either case reports or in vitro studies. Since that time more well designed clinically related scholarly activity has been published. This article attempts to survey the field of CBVT applications in endodontics and provide the readers with an overview of what has been found. The authors hope that this knowledge will form a foundation for appropriate clinical decision making with specific reference to selection criteria for the endodontic applications of CBVT.

Microorganisms are the possible source of endodontic lesions. The polymicrobial infection makes the sterilization of the root canal difficult. The following case report describes the non-surgical endodontic treatment of teeth with a large periradicular lesion. First, an intracanal dressing of calcium hydroxide was given. Since the symptoms did not subside, the treatment protocol was changed. A triple antibiotic paste was used instead for 3 months. On follow up, teeth were clinically asymptomatic and radiographically showed healing of the periradicular lesion. The result of the case show that when most commonly-used medicaments fail in eliminating the symptoms, then a triple antibiotic paste (metronidazole, ciprofloxacin, and minocycline) can be used clinically in the treatment of teeth with large periradicular lesions.

Abstract -  The release and diffusion of hydroxyl ions (OH(-)) of calcium hydroxide (Ca(OH)(2))-based intracanal medications may be affected by the association with other substances. The aim of this study was to evaluate the diffusion of OH- ions through root dentin by the medications: G1, Ca(OH)(2)/saline; G2, Calen; G3, Calen/camphorated p-monochlorophenol (CMCP); and G4, Calen/0.4% chlorhexidine (CHX). Root canals from bovine teeth were prepared in a standardized manner. A cavity until dentin was prepared in the middle third of the root surface of each specimen. The external surface of the root was made impermeable using a layer of adhesive, except the prepared cavity. The root canals were filled with different medications, and teeth were individually stored in flasks containing 10 ml distilled water at 37°C. The water pH was measured at 1, 3, 7, 14, 21, 30, and 60 days. Data obtained were subjected to anova and Tukey's tests. Increase in pH was observed at 3 days for Calen/CHX and from 7 to 14 days for the other mixtures. Calen paste promoted pH increase up to 21 days. Calen/CMCP had the highest pH up to 21 days, and all groups had similar results at 30 days. At 60 days, the greatest pH values were observed for Calen/CMCP and Calen alone. All different formulations of Ca(OH)(2)-based medications tested release hydroxyl ion that can diffuse through the dentin.