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Background: To overcome some of the disadvantages of the current primary root canal obturating materials, there is a continued interest in search for chemical compounds with broader and more effective antibacterial action and less cytotoxicity. Aim: This study aimed to evaluate and compare in vivo the clinical and radiographic success of mixtures of zinc oxide-Ocimum sanctum extract, zinc oxide-ozonated oil, and zinc oxide-eugenol (ZOE) as obturating materials in pulpectomy of primary molars. Settings and Design: This was an in vivo randomized controlled clinical trial. Materials and Methods: Ninety primary molars selected were randomly divided into three groups. Group A was obturated with zinc oxide-O. sanctum extract, Group B with zinc oxide-ozonated oil, and Group C with ZOE. All the groups were evaluated for success or failure based on clinical and radiographic criteria at the end of 1, 6, and 12 months. Statistical Analysis Used: The intra- and inter-examiner reliability of the first and the second co-investigators was calculated by Cohen's kappa statistic. The data were analyzed using Chi-square test, P ≤ 0.05 (indicates statistical significance). Results: By the end of 12 months, the overall clinical success rate was 88%, 95.7%, and 90.9% in Groups A, B, and C, respectively; whereas the radiographic success rate was found to be 80%, 91.3%, and 86.4% in Groups A, B, and C, respectively. Conclusion: On the basis of the overall success rates of all the three obturating materials, the following order of performance can be concluded: zinc oxide-ozonated oil > ZOE > zinc oxide-O. sanctum extract.

Background Primary teeth are necessary for mastication, speech, and guiding the eruption of permanent teeth. Dental caries often requires pulpectomy treatment to preserve these teeth. The success of pulpectomy depends on root canal obturation quality. This study aimed to compare the filling quality of zinc oxide-eugenol (ZOE) and Endoflas using lentulo and reverse rotary techniques, assessed by micro-computed tomography. Methods An in vitro study was conducted on 32 extracted human primary mandibular second molars. Teeth were randomly divided into four groups ( n  = 8) based on obturation material (ZOE or Endoflas) and technique (lentulo spiral or reverse rotary file). After standard canal preparation, obturation was performed. Micro-computed tomography assessed the quality of obturation by measuring the percentage of void and filling volume. Statistical analysis was performed using analysis of variance (ANOVA) test ( p  < 0.05). Results The lowest total void percentage was observed in the (ZOE + Lentulo) group (22.61 ± 9.00), and the highest in the (Endoflas|+Lentulo) group (35.97 ± 5.90). ZOE obturation resulted in lower voids (24.09 ± 8.50) compared to Endoflas (30.70 ± 8.50). The reverse rotary technique showed non significant lower voids (25.50 ± 7.60) than Lentulo (29.29 ± 10.10) ( p  = 0.181). A significant interaction effect was observed between material and technique in term of total voids ( p  = 0.021). (ZOE + Lentulo) group showed the highest filling volume (76.50 ± 9.10), while (Endoflas + Lentulo) had the lowest (64.02 ± 5.90). ZOE yielded higher filling volume (75.47 ± 8.50) compared to Endoflas (69.22 ± 8.50), with a significant material effect ( p  = 0.034), but no significant effect of technique ( p  = 0.138). Conclusion ZOE + Lentulo technique provided the most root canal obturation quality, while Endoflas + Lentulo showed the least quality. The root canal filling quality was more influenced by the obturation material than the technique used.

Background Zinc-oxide eugenol (ZOE) cements are among the most used temporary materials in dentistry. Although ZOE has advantages over other temporary fillers, its mechanical strength is weaker, so researchers are working to improve it. E-glass fibers have emerged as promising reinforcing fibers in recent years due to their strong mechanical behavior, adequate bonding, and acceptable aesthetics. Objectives To evaluate and compare the compressive strength, surface microhardness, and solubility of the ZOE and those reinforced with 10 wt.% E-glass fibers. Methods A total of 60 ZEO specimens were prepared; 30 specimens were reinforced with 10 wt.% E-glass fibers, considered modified ZOE. The characterization of the E-glass fibers was performed by XRF, SEM, and PSD. The compressive strength, surface microhardness, and solubility were evaluated. Independent sample t-tests were used to statistically assess the data and compare mean values ( P  ≤  0.05 ). Results The results revealed that the modified ZOE showed a significantly higher mean value of compressive strength and surface microhardness while having a significantly lower mean value of solubility compared to unmodified ZOE ( P  ≤ 0.05). Conclusion The modified ZOE with 10 wt.% E-glass fibers had the opportunity to be used as permanent filling materials.

Objectives: Retained cement is an idiopathic factor contributing to early implant loss, making the selection of cement with minimal toxicity to peri-implant hard and soft tissues crucial. This study aimed to evaluate the cytotoxicity of three types of temporary cements and titanium specimens cemented with each, following direct exposure to human gingival fibroblasts (HGF) and MG-63 osteoblast-like cells. Materials and Methods: In this in vitro study, zinc oxide-eugenol (ZOE), eugenol-free zinc oxide (ZONE), and resin (R) cements were prepared in cylindrical forms of similar dimensions. Each cement was applied to titanium disks to create cemented titanium samples. Cytotoxicity was evaluated using the MTT assay at 24 hours, 72 hours, and 7 days. Cytotoxicity was assessed on HGF and MG-63 osteoblast-like cells using the MTT assay at 24, 72 hours, and 7 days. Data analysis involved two-way and one-way ANOVA, with Tukey's post-hoc tests, and statistical significance was defined as P<0.05. Results: All cements significantly reduced cell viability in both cell lines. None of the cements demonstrated cellular viability percentages above the minimum threshold (70%) required for biocompatibility. The cytotoxicity of the cemented titanium disks was not significantly different from that of the cement-only samples (P>0.05). Additionally, there were no significant differences in the sensitivity of MG-63 osteoblast-like cells and HGF cells to the evaluated cements. Conclusion: The composition of the cement played a significant role in the host cell response. This study demonstrated that dental cements could induce tissue toxicity in the gingiva and bones, ultimately affecting implant survival.

IntroductionEndodontic treatment success is achieved not only when the cement provides a hermetic seal but also when the injured periapical tissue is regenerated. However, an exaggerated inflammatory reaction hinders tissue regeneration and it has been shown that dental materials affect the inflammatory response through modulation of cytokine secretion. This work was set to investigate the effects of the presence of hydrocortisone in zinc oxide eugenol sealers (Endomethasone N) on modulating the initial steps of inflammation in vitro.Material and methodsHydrocortisone and eugenol leaching from Endomethasone N and Pulp Canal Sealer (PCS) were quantified by ELISA and spectrofluorometry, respectively. The effects of Endomethasone N and Pulp Canal Sealer were studied on lipopolysaccharides (LPS)-stimulated human periodontal ligament (hPDL) cells. Cytokine (IL-6, TNF-α) secretion from cells was quantified by ELISA. Inflammatory cell (THP-1) adhesion to activated endothelial cells, their migration and activation were studied in vitro.ResultsEndomethasone N decreased secretion of IL-6 and TNF-α from hPDL cells. THP-1 adhesion to activated endothelial cells (HUVECs) and migration significantly decreased with Endomethasone N while no effect was observed with PCS. Activation of THP-1 decreased with both materials’ extracts but was significantly lower with Endomethasone N than with PCS.ConclusionThese results performed in vitro show that Endomethasone N anti-inflammatory effects are due to the presence of hydrocortisone.Clinical relevanceEndomethasone N has potential local anti-inflammatory effects which appear to be due to its hydrocortisone rather than eugenol content. Decreasing the inflammatory response is a pre-requisite to initiate the periapical healing.

Background: Pulpectomy is a routine practice in children with pulpal and periapical infections, the success of which depends on the elimination of bacteria from the root canals. Propolis, a natural product with proven antibacterial and anti-inflammatory properties when mixed with zinc oxide powder as root canal filling material, it could provide good success in endodontic therapy of primary teeth. Aim: The aim was to evaluate and compare the clinical effectiveness of zinc oxide-propolis mixture with zinc oxide eugenol (ZOE) as root canal filling material in nonvital primary molars. Settings and Design: This was a 2-arm, parallel group randomized controlled trial with blinded outcome assessment. Materials and Methods: Forty primary molars from children aged 4-8 years requiring pulpectomy treatment were randomly allocated into two groups according to the obturating material used: zinc oxide-propolis mixture (test group) and ZOE (control group). All the pulpectomy treated teeth were finally restored with stainless steel crowns, and the children were recalled at 6, 12, and 24 months for postoperative clinical and radiographic evaluation. Statistical Analysis: Chi-square test was used to analyze the data. Results: The overall success rate of pulpectomy with zinc oxide-propolis mixture and ZOE was found to be 95% and 70%, respectively, and the difference was statistically significant (P = 0.037). Zinc oxide-propolis mixture has shown a success rate of 100% at 6 months and 95% at 12 and 24 months follow-up, whereas ZOE has shown 80% success rate at 6 and 12 months, and it declined to 70% at 24-month follow-up. Conclusion: Zinc oxide-propolis mixture demonstrated good clinical and radiographic success at the end of 24 months, and hence, it can be considered as an alternate root canal filling material in the primary teeth.

Aim: The present study was aimed to investigate the functional relationship between the mixing temperature and properties of a commercially available zinc oxide eugenol impression paste (ZnOE paste). Settings and Design: In-vitro study. Materials and Methods: A custom-made simulated mixing device was indigenously designed to maintain different mixing temperatures, simulating cold, ambient, and hot weather. A commercially available ZnOE paste was mixed according to the manufacturer's instructions in the simulated mixing device at the temperatures ranging from 10°C to 50°C. Initial setting time and consistency were measured according to A. D. A. Specification No. 16 (n = 8). A stainless-steel die having 25, 50, and 75 μm lines was used for surface detail reproduction. Detail reproduction of the stone casts of the impressions was evaluated with a stereomicroscope at 30 magnification (n = 8). The shear bond strength of ZnOE paste to self-cure acrylic tray resin was measured by using the UTM at a crosshead speed of 0.5 mm/min (n = 8). Statistical Analysis Used: Data were analyzed by using one-way analysis of variance (ANOVA) and Tukey's post hoc tests at a confidence interval of 95% (alpha =0.05) Results: Initial setting time, consistency, and detail reproduction of the ZnOE paste were affected by the mixing temperature (P < 0.001). Mixing ZnOE paste at a lower temperature of 10°C and higher temperatures of 40°C and 50°C resulted in shorter initial setting time, thicker consistency, and poor detail reproduction. However, no significant difference was obtained in the shear bond strength among the different mixing temperatures evaluated (P > 0.05). Conclusion: Based on this in vitro study, it is advisable to perform the manipulation of ZnOE paste at a clinical/laboratory temperature of 30°C for optimum performance. The simulated mixing device used in this study can be an alternative for extreme climatic conditions.

Context: Despite modern advancement in material and technical aspect, management of infected primary molars is of prime concern in pediatric endodontics. An effective root canal material plays the major role in achieving the fluid impervious seal by defending against variant microflora and maintaining the tooth in function for longer duration. Aims: This study aims to evaluate and compare the success of endoflas as root canal filling material in infected primary molars with zinc oxide eugenol (ZOE). Materials and Methods: Primary molars with necrotic pulp in healthy, cooperative children were selected. Ethical clearance and informed consent was obtained. Standardized pulpectomy procedure was done and root canals were filled with either ZOE or endoflas. Further follow-up with clinical and radiographic evaluation was carried at 0, 3, 6, 12, and 24 months. The findings obtained were statistically analyzed using Chi-square test. Results: Endoflas showed acceptable results as root canal filling material in primary molars even at 2-year follow-up, though overfilling of root canals led to low success rate compared to teeth with combined optimal and under fillings. There was no significant difference between the two materials (P > 0.05). Conclusions: Endoflas could be a potential alternative to ZOE for preserving infected primary molars.

The aim of this study was to determine whether the residual presence of eugenol in coronal dentin may compromise the bond strength of resin-based restorative materials. A search was performed on MEDLINE/Pubmed, Scopus, and by hand search for relevant papers. No restriction was applied for language and publication date. The studies selected for analysis tested specimens with reduced size (micro-shear bond strength (µSBS) and micro-tensile bond strength (µTBS)) of adhesive systems and resin-based restorative materials applied to coronary dentin “contaminated” with eugenol-based materials. The search provided 335 articles, but only 10 studies met the inclusion criteria. The pooled global analysis showed a significant influence of eugenol, as it negatively influenced the bond strength of resin-based restorations (5.79 (3.31–8.28) MPa, p < 0.00001). The subgroup analyses for conventional etch-and-rinse (p = 0.003) and self-etch (p < 0.0004) adhesive systems, as well as for µSBS (p = 0.01) and µTBS (p < 0.0001), showed a negative influence of eugenol on the bond strength. Data were statistically heterogeneous. However, it was possible to observe that eugenol could negatively affect the bonding of resin-based restorative materials to dentin. Further evidence is necessary in order to acquire more accurate information about this issue and confirm that the residual presence of eugenol in dentin compromises the bond strength of resin-based materials.

Root canal sealers with antimicrobial activity are highly beneficial; therefore, their antimicrobial properties could be improved by incorporation of antimicrobial agents. In the present study, the release of the quaternary ammonium compounds from endodontic sealers admixed with either benzalkonium chloride (BC) or cetylpyridinium chloride (CPC) at loadings of 2% wt was monitored. The effect of these additives on the compressive strengths and their release from the sealers was determined after 1 and 4 weeks. All of the materials studied were found to be capable of releasing antimicrobial additive in useful quantities. The release of CPC occurred to a statistically significant greater extent than BC for all materials. The addition of both BC and CPC generally decreased the compressive strength of all the endodontic sealers, with the exception of CPC in AH Plus, where the compressive strength was significantly increased. This suggests that, for these endodontic sealers, the antimicrobial additives alter the setting chemistry. AH Plus is an epoxy-based material cured with an amine, and in this case the increase in compressive strength with CPC is attributed to an enhanced cure reaction with this system. In all other cases, the additive inhibited the cure reaction to a greater or lesser extent.