


Citations

This study evaluated the effect of ProTaper Next (PTN), ProTaper Universal Retreatment (PTR) and hybrid instrumentation (HI) for canal filling removal on the fracture resistance (FR), mode of failure (MoF), and filling removal time.
Ninety-six, mandibular premolars were decoronated and randomly divided into 6 groups (
There was a significant difference in FR among all groups (
The effect of filling removal on FR may depend on the filling removal technique/system used. PTR could be faster and protect against fracture followed by PTN; HI could adversely affect FR. FR may be associated with filling removal time.

This study aimed to relate the file fragment length and location in the root canal to the retrieval chances, the clinical time required and the occurrence of secondary fractures.
Sixty clinical cases of fractured instruments were included in this study. They were classified according to the instrument length and the location of the root canal. In each group, the success rate in the instrument retrieval, the clinical time required and the occurrence of secondary fractures were evaluated. The collected data were analyzed using the Kruskal-Wallis test on the basis of a 0.05 significance level.
The fragment length showed no significant influence on the assessed variables (
In accordance with the findings of this study, the fractured fragment length did not influence any of the variables assessed, but it is suggested to focus on the fragment location inside the root canal to decide the retrieval of a fractured instrument.
Citations

The aim of this study was to examine the use of hand or rotary files by pre-graduation (fourth- and fifth-year) and postgraduate students in endodontic treatments and to determine the incidence of file fracture and the management of cases with broken instruments.
A total of 2,168 teeth undergoing primary endodontic treatment were included in this study. It was determined that 79 of these teeth resulted in broken tools. In the case of broken tools, the education level of the treating clinician, the tooth that was being treated, the canal and fracture level, the curvature of the tooth and the management of the broken instrument were recorded. Periapical radiographs of the patients were used to calculate curvature following the Schneider method.
There was no significant difference in the incidence of broken tools according to education level (
There was no statistically significant difference between fourth-year students, fifth-year students and postgraduate students in terms of instrument fracture.
Citations

This systematic review aimed to investigate whether minimally invasive root canal preparation ensures higher fracture resistance compared to conventional root canal preparation in endodontically treated teeth (ETT). A comprehensive search strategy was conducted on the “PubMed, Web of Science, and Scopus” databases, alongside reference and hand searches, with language restrictions applied. Two independent reviews selected pertinent laboratory studies that explored the effect of minimally invasive root canal preparation on fracture resistance, in comparison to larger preparation counterparts. The quality of the studies was assessed, and the risk of bias was categorized as low, moderate, or high. The electronic search yielded a total of 1,767 articles. After applying eligibility criteria, 8 studies were included. Given the low methodological quality of these studies and the large variability of fracture resistance values, the impact of reduced apical size and/or taper on the fracture resistance of the ETT can be considered uncertain. This systematic review could not reveal sufficient evidence regarding the effect of minimally invasive preparation on increasing fracture resistance of ETT, primarily due to the inherent limitations of the studies and the moderate risk of bias.
Citations

This study evaluated the effects of Biodentine (BD), Bio-C Repair (BCR), and mineral trioxide aggregate (MTA) plug on the fracture resistance of simulated immature teeth with replacement root resorption (RRR) and
Sixty bovine incisors simulating immature teeth and RRR were divided into 5 groups: BD and BCR groups, with samples completely filled with the respective materials; MTA group, which utilized a 3-mm apical MTA plug; RRR group, which received no root canal filling; and normal periodontal ligament (PL) group, which had no RRR and no root canal filling. All the teeth underwent cycling loading, and compression strength testing was performed using a universal testing machine. RAW 264.7 macrophages were treated with 1:16 extracts of BD, BCR, and MTA containing receptor activator of nuclear factor-kappa B ligand (RANKL) for 5 days. RANKL-induced osteoclast differentiation was assessed by staining with tartrate-resistant acid phosphatase. The fracture load and osteoclast number were analyzed using 1-way ANOVA and Tukey’s test (α = 0.05).
No significant difference in fracture resistance was observed among the groups (
The treatment options for non-vital immature teeth with RRR did not strengthen the teeth and promoted a similar resistance to fractures in all cases. BD, MTA, and BCR showed inhibitory effects on osteoclast differentiation, with BCR yielding improved results compared to the other materials.
Citations

The aim of this study was to evaluate the influence of peak kilovoltage (kVp) and a metal artifact reduction (MAR) tool on image quality and the diagnosis of vertical root fracture (VRF) in cone-beam computed tomography (CBCT).
Twenty single-rooted human teeth filled with an intracanal metal post were divided into 2 groups: control (
The kVp and MAR did not influence the diagnosis of VRF (
Protocols with higher kVp combined with MAR improved the image quality of CBCT examinations. However, those factors did not lead to an improvement in the diagnosis of VRF.
Citations

To evaluate the fracture incidence of Reciproc R25 instruments (VDW) used during non-surgical root canal retreatments performed by students in a postgraduate endodontic program.
From the analysis of clinical record cards and periapical radiographs of root canal retreatments performed by postgraduate students using the Reciproc R25, a total of 1,016 teeth (2,544 root canals) were selected. The instruments were discarded after a single use. The general incidence of instrument fractures and its frequency was analyzed considering the group of teeth and the root thirds where the fractures occurred. Statistical analysis was performed using the χ2 test (
Seven instruments were separated during the procedures. The percentage of fracture in relation to the number of instrumented canals was 0.27% and 0.68% in relation to the number of instrumented teeth. Four fractures occurred in maxillary molars, 1 in a mandibular molar, 1 in a mandibular premolar and 1 in a maxillary incisor. A greater number of fractures was observed in molars when compared with the number of fractures observed in the other dental groups (
The use of Reciproc R25 instruments in root canal retreatments carried out by postgraduate students was associated with a low incidence of fractures.
Citations

The aim of this review was to evaluate the effects of different access cavity designs on endodontic treatment and tooth prognosis. Two independent reviewers conducted an unrestricted search of the relevant literature contained in the following electronic databases: PubMed, Science Direct, Scopus, Web of Science, and OpenGrey. The electronic search was supplemented by a manual search during the same time period. The reference lists of the articles that advanced to second-round screening were hand-searched to identify additional potential articles. Experts were also contacted in an effort to learn about possible unpublished or ongoing studies. The benefits of minimally invasive access (MIA) cavities are not yet fully supported by research data. There is no evidence that this approach can replace the traditional approach of straight-line access cavities. Guided endodontics is a new method for teeth with pulp canal calcification and apical infection, but there have been no cost-benefit investigations or time studies to verify these personal opinions. Although the purpose of MIA cavities is to reflect clinicians' interest in retaining a greater amount of the dental substance, traditional cavities are the safer method for effective instrument operation and the prevention of iatrogenic complications.
Citations

This study was conducted to compare the post-fracture survival rate of endodontically treated molar endodontically treated teeth (molar ETT) restored with resin composites or crowns and to identify potential risk factors, using a retrospective cohort design.
Dental records of molar ETT with crowns or composite restorations (recall period, 2015–2019) were collected based on inclusion and exclusion criteria. The incidence of unrestorable fractures was identified, and molar ETT were classified according to survival. Information on potential risk factors was collected. Survival rates and potential risk factors were analyzed using the Kaplan-Meier log-rank test and Cox regression model.
The overall survival rate of molar ETT was 87% (mean recall period, 31.73 ± 17.56 months). The survival rates of molar ETT restored with composites and crowns were 81.6% and 92.7%, reflecting a significant difference (
The survival rate from fracture was higher for molar ETT restored with crowns was higher than for ETT restored with composites, especially in the first 2 years after restoration. Molar ETT with limited tooth structure loss only on the occlusal surface could be successfully restored with composite restorations.
Citations

This study evaluated the effect of repeated uses and autoclaving in the instrumented area, fracture resistance, and time of instrumentation of thermally treated nickel-titanium reciprocating systems.
Two hundred simulated canals were instrumented using Reciproc Blue and WaveOne Gold. Each file was used up to 10 times or until fracture. The instrumented area was measured in pre- and post-operative images, using ImageJ software. Kaplan-Meier survival analysis evaluated the number of uses of instruments before fracture. Instrumented area and time of instrumentation were analyzed by Mann-Whitney U test and Kruskal-Wallis. Correlations among the number of uses and instrumented area were measured. The level of statistical significance was set at
Reciproc Blue presented a higher estimated number of uses in comparison with WaveOne Gold (
Reciproc Blue was more resistant than WaveOne Gold, suffering later fracture. Additionally, the sterilization cycles did not influence the estimated number of uses of thermally treated reciprocating instruments, but the instrumented area of root canals was reduced along with the repeated uses of both instruments.
Citations

This study investigated the incidence of root dentin defects after the use of different post space preparation (PSP) drills.
Seventy-two bovine incisors were selected and obtained 14-mm-long root sections. Twelve roots served as controls with no intervention (G1). The 60 root canals remaining were instrumented using the crown-down technique with the ProTaper Next system and obturated using the lateral condensation technique. Specimens were randomly distributed into 5 groups (
Root dentin defects were observed in 39.6% of the root sections. No defects were observed in G1. G5 had significantly more cracks and craze lines than G1, G2, and G3 (
PSP drills caused defects in the root dentin. Gates-Glidden drills caused fewer root defects than Largo-Peeso reamers and Exacto drills.
Citations

The replacement of missing teeth, especially in the anterior region, is an essential part of dental practice. Fiber-reinforced composite resin bridges are a conservative alternative to conventional fixed dental prostheses or implants. It is a minimally invasive, reversible technique that can be completed in a single visit. The two cases presented herein exemplify the treatment of root-fractured anterior teeth with a natural pontic immediately after extraction.
Citations

To compare the flexural cyclic fatigue resistance and the length of the fractured segments (FLs) of recently introduced M-Pro rotary files with that of RaCe rotary files in curved canals and to evaluate the fracture surface by scanning electron microscopy (SEM).
Thirty-six endodontic files with the same tip size and taper (size 25, 0.06 taper) were used. The samples were classified into 2 groups (n = 18): the M-Pro group (M-Pro IMD) and the RaCe group (FKG). A custom-made simulated canal model was fabricated to evaluate the total number of cycles to failure and the FL. SEM was used to examine the fracture surfaces of the fragmented segments. The data were statistically analyzed and comparisons between the 2 groups for normally distributed numerical variables were carried out using the independent Student's
The M-Pro group showed significantly higher resistance to flexural cyclic fatigue than the RaCe group (
Thermal treatment of nickel-titanium instruments can improve the flexural cyclic fatigue resistance of rotary endodontic files, and the M-Pro rotary system seems to be a promising rotary endodontic file.
Citations

Pulp revascularization is an alternative treatment in immature traumatized teeth with necrotic pulp. However, this procedure has not been reported in horizontal root fractures. This is a case report of a 9-year-old patient with multiple horizontal root fractures in 2 upper central incisors that were successfully treated with pulp revascularization. The patient presented for treatment 2 years after the initial trauma, and revascularization was attempted after the initial treatment with calcium hydroxide had failed. Prior to pulp revascularization, cone-beam computed tomography and autoradiograms demonstrated multiple horizontal fractures in the middle and apical thirds of the roots of the 2 affected teeth. Revascularization was performed in both teeth; platelet-rich plasma (PRP) was used in one tooth (#11) and the conventional method (blood clot) was used in the other tooth (#21). Clinical and radiographic follow-up over 4 years demonstrated pulp calcification in the PRP-treated tooth. Neither of the 2 teeth were lost, and the root canal calcification of tooth #11 was greater than that of tooth #21. This case suggests that PRP-based pulp revascularization may be an alternative for horizontal root fractures.
Citations

The aim of this study was to investigate the effect of glide path preparation with PathFile and ProGlider nickel-titanium (NiTi) files on the cyclic fatigue resistance of WaveOne NiTi files.
Forty-four WaveOne Primary files were used and divided into four groups (
The highest number of cycles to failure was found in the control group, and the lowest numbers were found in the 1 WaveOne group and the PF+WaveOne group. Significant differences were found among the 1 WaveOne, PF+WaveOne, and control groups (
Glide path preparation with NiTi rotary files did not affect the cyclic fatigue resistance of WaveOne Primary files used on acrylic blocks.
Citations

The aim of this study was to investigate whether the diameter and direction of the plunger and simulation of the periodontal ligament (PDL) affected the stress distribution in endodontically treated premolars.
A fracture strength test was simulated via finite element analysis. A base model was set up, and the following parameters were modified: plunger diameter (3 mm vs. 6 mm), plunger direction (vertical vs. 135° angular to the central fossa), and PDL simulation. The analysis was conducted using the CosmosWorks structural analysis program, and the results are presented in terms of von Mises stresses.
The smaller plunger increased the stresses at the contact area of the crown, but the plunger diameter had no effect on the stress distribution within the root. An angular plunger direction increased stresses within the root, as well as at the buccal cusp of the crown, compared with the vertical direction. Simulation of the PDL caused higher stress accumulation, especially in the cervical region of the root.
The plunger diameter had no effect on the stress distribution in the roots, whereas the plunger direction and PDL simulation did affect the stress distribution. More stringent standards can be established by taking such parameters into account when performing fracture testing in future studies.
Citations

The purpose of this research was to identify the top 10 most-cited articles on the management of fractured or broken instruments and to perform a bibliometric analysis thereof.
Published articles related to fractured instruments were screened from online databases, such as Web of Science, Scopus, PubMed, and ScienceDirect, and highly cited papers, with at least 50 citations since publication, were identified. The most-cited articles were selected and analysed with regard to publication title, authorship, the journal of publication, year, institution, country of origin, article type, and number of citations.
The top 10 most-cited articles were from various journals. Most were published in the
This bibliometric analysis revealed interesting information about scientific progress in endodontics regarding fractured instruments. Overall, clinical research studies and basic research articles published in high-impact endodontic journals had the highest citation rates.
Citations

This systematic review aims to summarize the current clinical studies that investigated survival rates against fracture of endodontically treated posterior teeth restored with crowns or resin composite restorations. Literature search were performed using keywords. Publications from 1980 to 2016 were searched in PubMed, ScienceDirect, Web of Science, MEDLINE, and SCOPUS. Included studies were selected based on inclusion and exclusion criteria. Three clinical studies were included: 1 randomized controlled trial and 1 prospective and 1 retrospective cohort studies. Pooled survival rates ranged from 94%–100% and 91.9%–100% for crowns and resin composite, respectively. The majority of teeth had no more than 3 surface loss of tooth structure. The studies included were heterogeneous, and were not appropriate for further meta-analysis. Current evidence suggested that the survival rates against the fracture of endodontically treated posterior teeth restored with crowns or resin composites were not significantly different in the teeth with minimum to moderate loss of tooth structure.
Citations

The purpose of this study was to evaluate the effect of adhesive luting on the fracture resistance of zirconia compared to that of a composite resin and a lithium disilicate glass ceramic.
The specimens (dimension: 2 mm × 2 mm × 25 mm) of the composite resin, lithium disilicate glass ceramic, and yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) were prepared. These were then divided into nine groups: three non-luting groups, three non-adhesive luting groups, and three adhesive luting groups, for each restorative material. In the non-luting groups, specimens were placed on the bovine tooth without any luting agents. In the non-adhesive luting groups, only zinc phosphate cement was used for luting the specimen to the bovine tooth. In the adhesive luting groups, specimens were pretreated, and the adhesive luting procedure was performed using a self-adhesive resin cement. For all the groups, a flexural test was performed using universal testing machine, in which the fracture resistance was measured by recording the force at which the specimen was fractured.
The fracture resistance after adhesive luting increased by approximately 29% in the case of the composite resin, 26% in the case of the lithium disilicate glass ceramic, and only 2% in the case of Y-TZP as compared to non-adhesive luting.
The fracture resistance of Y-TZP did not increased significantly after adhesive luting as compared to that of the composite resin and the lithium disilicate glass ceramic.
Citations

Although it is challenging, the early diagnosis of a vertical root fracture (VRF) is crucial in order to ensure tooth preservation. The purpose of this clinical case report was to describe reparative surgery performed to treat a tooth affected by an incomplete VRF. A 26 year old male patient was suspected to have a VRF in a maxillary left central incisor, and an exploratory flap was performed in order to confirm the diagnosis. After detecting the fracture, the lesion was surgically treated, the fracture and the infected root-end were removed, and a platelet-rich plasma membrane was used to cover the defect in order to prevent bacterial migration. A 24 month clinical and radiological follow-up examination showed that the tooth was asymptomatic and that the healing process was in progress. The surgical approach described here may be considered an effective treatment for a combined endodontic-periodontal lesion originating from an incomplete VRF and a recurrent periapical lesion.
Citations

Exposing sound structure of a subgingivally fractured tooth using orthodontic extrusion is considered to be a conservative way to re-establish biologic width without sacrificing esthetics or jeopardizing periodontal support of neighboring teeth. When a misaligned tooth is traumatically involved, a more comprehensive approach combining tooth extrusion and re-alignment may be necessary for a successful restorative outcome. This case report describes a successful esthetic management of a patient with complicated crown-root fracture on the maxillary right central incisor and pre-existing malocclusion in the maxillary anterior region. Forced eruption along with re-alignment of teeth by orthodontic movement seems to allow re-positioning of the fracture line to a favorable position and correction of crowding, providing a better esthetic result.
Citations

To determine and compare the fracture resistance of endodontically treated maxillary central incisors restored with different posts and cores.
Forty-eight upper central incisors were randomly divided into four groups: cast post and core (group 1), fiber-reinforced composite (FRC) post and composite core (group 2), composite post and core (group 3), and controls (group 4). Mesio-distal and bucco-lingual dimensions at 7 and 14 mm from the apex were compared to ensure standardization among the groups. Twelve teeth were prepared for crown restoration (group 4). Teeth in other groups were endodontically treated, decoronated at 14 mm from the apex, and prepared for posts and cores. Resin-based materials were used for cementation in groups 1 and 2. In group 3, composite was used directly to fill the post space and for core build-up. All samples were restored by standard metal crowns using glass ionomer cement, mounted at 135° vertical angle, subjected to thermomechanical aging, and then fractured using a universal testing machine. Kruskal-Wallis and Mann-Whitney
Fracture resistance of the groups was as follows: Control (group 4) > cast post and core (group 1) > fiber post and composite core (group 2) > composite post and core (group 3). All samples in groups 2 and 3 fractured in restorable patterns, whereas most (58%) in group 1 were non-restorable.
Within the limitations of this study, FRC posts showed acceptable fracture resistance with favorable fracture patterns for reconstruction of upper central incisors.
Citations

Among dental traumas, horizontal root fractures are relatively uncommon injuries. Proper initial management and periodical evaluation is essential for the successful treatment of a root-fractured tooth. If pulpal necrosis develops, endodontic treatment is indicated, exclusively for the coronal fragment. Fragment diastases exert a great influence on healing at the fracture line and on pulpal necrosis. An adequately treated root-fractured tooth has a good prognosis. This case report describes the treatment and 2-yr follow up of 3 maxillary central incisors, first with horizontal root fracture, second with horizontal root fracture and avulsion, and third with horizontal root fracture and lateral luxation. All three cases were treated with mineral trioxide aggregate (ProRoot, Dentsply). During 2 yr of follow-up evaluation, the root-fractured teeth of the present patients were well retained in the arch, showing periodontal healing, even after endodontic treatment.
Citations

This study compared the cyclic fatigue resistance of nickel-titanium (NiTi) files obtained in a conventional test using a simulated canal with a newly developed method that allows the application of constant fatigue load conditions.
ProFile and K3 files of #25/.06, #30/.06, and #40/.04 were selected. Two types of testing devices were built to test their fatigue performance. The first (conventional) device prescribed curvature inside a simulated canal (C-test), the second new device exerted a constant load (L-test) whilst allowing any resulting curvature. Ten new instruments of each size and brand were tested with each device. The files were rotated until fracture and the number of cycles to failure (NCF) was determined. The NCF were subjected to one-way ANOVA and Duncan's
Spearman's rank correlation coefficient (ρ = -0.905) showed a significant negative correlation between methods. Groups with significant difference after the L-test divided into 4 clusters, whilst the C-test gave just 2 clusters. From the L-test, considering the negative correlation of NCF, K3 gave a significantly lower fatigue resistance than ProFile as in the C-test. K3 #30/.06 showed a lower fatigue resistance than K3 #25/.06, which was not found by the C-test. Variation in fatigue test methodology resulted in different cyclic fatigue resistance rankings for various NiTi files.
The new methodology standardized the load during fatigue testing, allowing determination fatigue behavior under constant load conditions.
Citations

The purpose was to investigate the preference and usage technique of NiTi rotary instruments and to retrieve data on the frequency of re-use and the estimated incidence of file separation in the clinical practice among general dentists.
A survey was disseminated via e-mail and on-site to 673 general dentists. The correlation between the operator's experience or preferred technique and frequency of re-use or incidence of file fracture was assessed.
A total of 348 dentists (51.7%) responded. The most frequently used NiTi instruments was ProFile (39.8%) followed by ProTaper. The most preferred preparation technique was crown-down (44.6%). 54.3% of the respondents re-used NiTi files more than 10 times. There was a significant correlation between experience with NiTi files and the number of reuses (
A large number of general dentists in Korea prefer to re-use NiTi rotary files. As their experience with NiTi files increased, the number of re-uses increased, while the frequency of breakage decreased. Operators who adopt the hybrid technique showed less tendency of separation even with the increased number of re-use.
Citations

Traumatic injuries of the face often involve root fractures especially in anterior teeth. The prognosis and the treatment of the root fracture depend on the extent of the fracture line, general health and patient compliance. This case report outlines a new conservative trial treatment modality to stabilize the maxillary central incisors with horizontal root fracture on the cervical to middle third by fabricating canine guidance to remove loading on the traumatized maxillary central incisors during eccentric movements and thus inducing spontaneous healing of the fractured line between the fragments. Radiographs after thirty months showed adequate healing with no signs of pathological changes including root resorption, ankylosis or displacement. Long term follow-up revealed that vitality, stability and aesthetics were maintained and the patient was satisfied with the outcome.
Citations

Complications resulting from condylar fracture include occlusal disturbance due to loss of leverage from temporomandibular joint (TMJ). In general, closed reduction with active physical training has been performed, and under favorable circumstances, adaptation occurs in attempt to restore the articulation. The patient in this case report had unilateral condylar fracture accompanied with multiple teeth injuries, but he was left without any dental treatment for 1 mon which led to unrestorable occlusal collapse. Fortunately, delayed surgical repositioning of dislocated maxillary anterior teeth followed by consistent long-term physical training has been proved successful. Normal occlusion and satisfactory remodeling of condyle were obtained on 10 mon follow-up.

This
Thirty two mature human single rooted mandibular premolars in similar size and dentin thickness without decay or restorations were hand and rotary instrumented and 16 teeth vertically packed with calcium hydroxide paste and sealed coronally with caviton to imitate the endodontic procedure and the other 16 teeth was left empty as a control group. The apicies of all the samples were sealed with resin, submerged in normal saline and put in a storage box at 37℃ to mimic the oral environment. After 1 and 4 wk, 8 samples out of 16 samples from each group were removed from the storage box and fracture strength test was performed. The maximum load required to fracture the samples was recorded and data were analysed statistically by the two way ANOVA test at 5% significance level.
The mean fracture strengths of two groups after 1 wk and 4 wk were similar. The intracanal placement of calcium hydroxide weakened the fracture strength of teeth by 8.2% after 4 wk: an average of 39.23 MPa for no treatment group and 36.01 MPa for CH group. However there was no statistically significant difference between experimental groups and between time intervals.
These results suggest that short term calcium hydroxide application is available during endodontic treatment.
Citations

The aim of this paper is to discuss the mechanical and geometric features of Nickel-titanium (NiTi) rotary files and its clinical effects. NiTi rotary files have been introduced to the markets with their own geometries and claims that they have better ability for the root canal shaping than their competitors. The contents of this paper include the (possible) interrelationship between the geometries of NiTi file (eg. tip, taper, helical angle, etc) and clinical performance of the files as follows;
- Fracture modes of NiTi rotary files - Non-cutting guiding tip and glide path - Taper and clinical effects - Cross-sectional area and clinical effects - Heat treatments and surface characteristics - Screw-in effect and preservation of root dentin integrity - Designs for reducing screw-in effect
Based on the reviewed contents, clinicians may have an advice to use various brands of NiTi rotary instruments regarding their advantages which would fit for clinical situation.
Citations

This study evaluated microtensile bond strength (µTBS) and short-rod fracture toughness to explain fractural behavior of repaired composite restorations according to different surface treatments.
Thirty composite blocks for µTBS test and sixty short-rod specimens for fracture toughness test were fabricated and were allocated to 3 groups according to the combination of surface treatment (none-treated, sand blasting, bur roughening). Each group was repaired immediately and 2 weeks later. Twenty-four hours later from repair, µTBS and fracture toughness test were conducted. Mean values analyzed with two-way ANOVA / Tukey's B test (α = 0.05) and correlation analysis was done between µTBS and fracture toughness. FE-SEM was employed on fractured surface to examine the crack propagation.
The fresh composite resin showed higher µTBS than the aged composite resin (
Surface treatment by mechanical interlock is more important for effective composite repair, and the fracture toughness test could be used as an appropriate tool to examine the fractural behavior of the repaired composite with microtensile bond strength.

The development of adhesive dentistry has allowed that the crown fragment reattachment can be another option in the treatment of crown fracture. However, additional crown lengthening procedure or extrusion of the tooth may be necessary in the treatment of crown root fracture because subgingival fracture line in close proximity to the alveolar bone leads to challenges for restorative procedure and the violation of the biologic width. This case report presents a modified crown fragment reattachment technique of crown root fracture with pulp exposure, which was done without additional crown lengthening procedures. After the endodontic treatment, the patient was treated using a post insertion and the fragment reattachment technique, which made it possible to preserve the space for the biologic width and maintain a dry surgical field for adequate adhesion through the modification of the fractured coronal fragment. Since a coronal fracture was occurred and reattached afterward, it was observed that the coronal fragment was well maintained without the additional loss of periodontal attachment through 2-year follow up.

The purpose of this study was to determine the effect of post types and sizes on fracture resistance in immature tooth model with various restorative techniques. Bovine incisors were sectioned 8 mm above and 12 mm below the cementoenamel junction to simulate immature tooth model. To compare various post-and-core restorations, canals were restored with gutta-percha and resin core, or reinforced dentin wall with dual-cured resin composite, followed by placement of D.T. LIGHT-POST, ParaPost XT, and various sizes of EverStick Post individually. All of specimens were stored in the distilled water for 72 hours and underwent 6,000 thermal cycles. After simulation of periodontal ligament structure with polyether impression material, compressive load was applied at 45 degrees to the long axis of the specimen until fracture was occurred.
Experimental groups reinforced with post and composite resin were shown significantly higher fracture strength than gutta-percha group without post placement (p < 0.05). Most specimens fractured limited to cervical third of roots. Post types did not influence on fracture resistance and fracture level significantly when cement space was filled with dual-cured resin composite. In addition, no statistically significant differences were seen between customized and standardized glass fiber posts, which cement spaces were filled with resin cement or composite resin individually. Therefore, root reinforcement procedures as above in immature teeth improved fracture resistance regardless of post types and sizes.
Citations

The purpose of this study was to investigate the fracture resistance of crown-root fractured teeth repaired with dual-cured composite resin and horizontal posts. 48 extracted human premolars were assigned to control group and three experimental groups. Complete crown-root fractures were experimentally induced in all control and experimental teeth. In the control group, the teeth (n=12) were bonded with resin cement and endodontically treated. Thereafter, the access cavities were sealed with dual-cured composite resin. In composite resin core - post group (n=12), the teeth were endodontically treated and access cavities were sealed with dual-cured composite resin. In addition, the fractured segments in this group were fixed using horizontal posts. In composite resin core group (n=12), the teeth were endodontically treated and the access cavities were filled with dual-cured composite resin without horizontal posts. In bonded amalgam group (n=12), the teeth were endodontically treated and the access cavities were sealed with bonded amalgam. Experimental complete crown-root fractures were induced again on repaired control and experimental teeth. The ratio of fracture resistance to original fracture resistance was analyzed with Kruskal-Wallis test. The results showed that teeth in control and composite resin core - post group showed significantly higher resistance to re-fracture than those in amalgam core group (

It was reported that esthetic composite resin restoration reinforces the strength of remaining tooth structure with preserving the natural tooth structure. However, it is unknown how much the strength would be recovered. The purpose of this study was to compare the fracture resistance of three types of undermined cavity filled with composite resin with that of non-cavitated natural tooth.
Forty sound upper molars were allocated randomly into four groups of 10 teeth. After flattening occlusal enamel, undermined cavities were prepared in thirty teeth to make three types of specimens with various thickness of occlusal structure (Group 1 ~ 3). All the cavity have the 5 mm width mesiodistally and 7 mm depth bucco-lingually. Another natural 10 teeth (Group 4) were used as a control group. Teeth in group 1 have remaining occlusal structure about 1 mm thickness, which was composed of mainly enamel and small amount of dentin. In Group 2, remained thickness was about 1.5 mm, including 0.5 mm thickness dentin. In Group 3, thickness was about 2.0 mm, including 1 mm thickness dentin. Every effort was made to keep the remaining dentin thickness about 0.5 mm from the pulp space in cavitated groups. All the thickness was evaluated with radiographic Length Analyzer program.
After acid etching with 37% phosphoric acid, one-bottle adhesive (Single Bond™, 3M/ESPE, USA) was applied following the manufacturer's recommendation and cavities were incrementally filled with hybrid composite resin (Filtek Z-250™, 3M/ESPE, USA). Teeth were stored in distilled water for one day at room temperature, after then, they were finished and polished with Sof-Lex system.
All specimens were embedded in acrylic resin and static load was applied to the specimens with a 3 mm diameter stainless steel rod in an Universal testing machine and cross-head speed was 1 mm/min. Maximum load in case of fracture was recorded for each specimen.
The data were statistically analyzed using one-way analysis of variance (ANOVA) and a Tukey test at the 95% confidence level.
The results were as follows:
Fracture resistance of the undermined cavity filled with composite resin was about 75% of the natural tooth. No significant difference in fracture loads of composite resin restoration was found among the three types of cavitated groups.
Within the limits of this study, it can be concluded the fracture resistance of the undermined cavity filled with composite resin was lower than that of natural teeth, however remaining tooth structure may be supported and saved by the reinforcement with adhesive restoration, even if that portion consists of mainly enamel and a little dentin structure.
Citations

The treatment of esthetic areas with single-tooth implants represents a new challenge for the clinician. In 1993, a modification of the forced eruption technique, called "orthodontic extrusive remodelling," was proposed as a way to augment both soft- and hard-tissue profiles at potential implant sites. This case report describes augmentation of the coronal soft and hard tissues around a fractured maxillary lateral incisor associated with alveolar bone loss, which was achieved by forced orthodontic extrusion before implant placement. Through these procedures we could reconstruct esthetics and function in a hopeless tooth diagnosed with subgingival root fracture by trauma.

The purpose of this study was to determine the effect of sodium hypochlorite and steam autoclaving on the cyclic fatigue of nickel-titanium endodontic files.
Two types of files with a .06 taper and #30 were used, K3® (SybronEndo, Glendora, California, USA) and Hero642®(Micro-Mega, Besançon, France).
The files were divided into 6 experimental groups containing 10 files each group depending the soaking time in 6% sodium hypochlorite solution and number of cycles of steam autoclave. After sterilization, a cyclic fatigue test was performed on each file, and the fracture time was recorded in seconds. The control group underwent the cyclic fatigue test only. After the test, the surface characteristics of the files were observed using scanning electron microscopy (SEM).
All groups containing the Hero 642® files showed a similar cyclic fatigue fracture time. However, the cyclic fatigue fracture time with the K3® files was significantly shorter in groups which were treated with sodium hypochlorite than in the control group (P < 0.05). SEM revealed both Hero642® and K3® files to have significant corrosion on the file surface in groups treated with sodium hypochlorite, compared with the sharp and regular blades of the control group. K3® files showed more corrosion than the Hero642® files. Bluntness of the blades of the K3® file was observed in groups treated with steam autoclave. Although there was no obvious destruction on the surface of steam autoclaved Hero642® files, slight bluntness was observed.
Sterilizing with a steam autoclave is much less destructive to K3® files than sodium hypochlorite. The longer time exposed to sodium hypochlorite, the more destructive pattern was shown on the blades of the files. Therefore, when using sodium hypochlorite solution, the exposure time should be as short as possible in order to prevent corrosion and increase the cyclic fatigue fracture time.

The fracture toughness test is believed as a clinically relevant method for assessing the fracture resistance of the dentinal restoratives. The objectives of this study were to measure the fracture toughness (K1C) and microtensile bond strength of dentin-resin composite interface and compare their relationship for their use in evaluation of the integrity of the dentin-resin bond.
A minimum of six short-rod specimens for fracture toughness test and fifteen specimens for microtensile bond strength test was fabricated for each group of materials used. After all specimens storing for 24 hours in distilled water at 37℃, they were tensile-loaded with an EZ tester universal testing machin. Statistical analysis was performed using ANOVA and Tukey's test at the 95% confidence level, Pearson's coefficient was used to verify the correlation between the mean of fracture toughness and microtensile bond strength. FE-SEM was employed on fractured surface to describe the crack propagation.
Fracture toughness value of Clearfil SE Bond (SE) was the highest, followed by Adper Single Bond 2 (SB), OptiBond Solo (OB), ONE-STEP PLUS (OS), ScotchBond Multi-purpose (SM) and there was significant difference between SE and other 4 groups (p < 0.05). There were, however, no significant difference among SB, OB, OS, SM (p > 0.05). Microtensile bond strength of SE was the highest, followed by SB, OB, SM, OS and OS only showed significant lower value (p < 0.05). There was no correlation between fracture toughness and microtensile bond strength values. FE-SEM examination revealed that dentin bonding agent showed different film thickness and different failure pattern according to the film thickness.
From the limited results of this study, it was noted that there was statistically no correlation between K1C and µTBS. We can conclude that for obtaining the reliability of bond strength test of dentin bonding agent, we must pay more attention to the test procedure and its profound scrutiny.
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This
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The purpose of this study is to evaluate the effects of surface treatment and composition of reinforcement material on fracture strength of fiber reinforced composite inlay bridges.
The materials used for this study were I-beam, U-beam TESCERA ATL system and ONE STEP(Bisco, IL, USA). Two kinds of surface treatments were used; the silane and the sandblast. The specimens were divided into 11 groups through the composition of reinforcing materials and the surface treatments.
On the dentiform, supposing the missing of Maxillary second pre-molar and indirect composite inlay bridge cavities on adjacent first pre-molar disto-occlusal cavity, first molar mesio-occlusal cavity was prepared with conventional high-speed inlay bur.The reinforcing materials were placed on the proximal box space and build up the composite inlay bridge consequently. After the curing, specimen was set on the testing die with ZPC. Flexural force was applied with universal testing machine (EZ-tester; Shimadzu, Japan). at a cross-head speed of 1 mm/min until initial crack occurred. The data wasanalyzed using one-way ANOVA/Scheffes' post-hoc test at 95% significance level.
Groups using I-beam showed the highest fracture strengths (p < 0.05) and there were no significant differences between each surface treatment (p > 0.05). Most of the specimens in groups that used reinforcing material showed delamination.
The use of I-beam represented highest fracture strengths (p < 0.05). In groups only using silane as a surface treatment showed highest fracture strength, but there were no significant differences between other surface treatments (p > 0.05). The reinforcing materials affect the fracture strength and pattern of composites inlay bridge. The holes at the U-beam did not increase the fracture strength of composites inlay bridge.
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In this study, the changes in the degree of conversion (DC) and the microtensile bond strength (MTBS) of self-etching adhesives to dentin was investigated according to the time after curing. The MTBS of Single Bond (SB, 3M ESPE, USA), Clearfil SE Bond (SE, Kuraray, Japan), Xeno-III (XIII, Dentsply, Germany), and Adper Prompt (AP, 3M ESPE, USA) were measured at 48h, at 1 week and after thermocycling for 5,000 cycles between 5℃ and 55℃. The DC of the adhesives were measured immediately, at 48h and at 7 days after curing using a Fourier Transform Infra-red Spectrometer. The fractured surfaces were also evaluated with scanning electron microscope. The MTBS and DC were significantly increased with time and there was an interaction between the variables of time and material (MTBS, 2-way ANOVA, p = 0.018; DC, Repeated Measures ANOVA, p < 0.001). The low DC was suggested as a cause of the low MTBS of self-etching adhesives, XIII and AP, but the increase in the MTBS of SE and AP after 48h could not be related with the changes in the DC. The microscopic maturation of the adhesive layer might be considered as the cause of increasing bond strength.
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There are various factors affecting the fracture of NiTi rotary files. This study was performed to evaluate the effect of cross sectional area, pecking motion and pecking distance on the cyclic fatigue fracture of different NiTi files. Five different NiTi files-Profile®(Maillefer, Ballaigue, Switzerland), ProTaper™ (Maillefer, Ballaigue, Switzerland), K3® (SybronEndo, Orange, CA), Hero 642® (Micro-mega, Besancon, France), Hero Shaper®(Micro-mega, Besancon, France)-were used. Each file was embedded in temporary resin, sectioned horizontally and observed with scanning electron microscope. The ratio of cross-sectional area to the circumscribed circle was calculated. Special device was fabricated to simulate the cyclic fatigue fracture of NiTi file in the curved canal,. On this device, NiTi files were rotated (300rpm) with different pecking distances (3 mm or 6 mm) and with different motions (static motion or dynamic pecking motion). Time until fracture occurs was measured. The results demonstrated that cross-sectional area didn't have any effect on the time of file fracture. Among the files, Profile® took the longest time to be fractured. Between the pecking motions, dynamic motion took the longer time to be fractured than static motion. There was no significant difference between the pecking distances with dynamic motion, however with static motion, the longer time was taken at 3mm distance. In this study, we could suggest that dynamic pecking motion would lengthen the time for NiTi file to be fractured from cyclic fatigue.
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This study investigated the hypothesis that the dentin bond strength of self-etching adhesive (SEA) might be improved by applying additional layer of bonding resin that might alleviate the pH difference between the SEA and the restorative composite resin. Two SEAs were used in this study; Experimental SEA (Exp, pH: 1.96) and Adper Prompt (AP, 3M ESPE, USA, pH: 1.0). In the control groups, they were applied with two sequential coats. In the experimental groups, after applying the first coat of assigned SEAs, the D/E bonding resin of All-Bond 2 (Bisco Inc., USA, pH: 6.9) was applied as the intermediate adhesive. Z-250 (3M ESPE, USA) composite resin was built-up in order to prepare hourglass-shaped specimens. The microtensile bond strength (MTBS) was measured and the effect of the intermediate layer on the bond strength was analyzed for each SEA using t-test. The fracture mode of each specimen was inspected using stereomicroscope and Field Emission Scanning Electron Microscope (FE-SEM). When D/E bonding resin was applied as the second coat, MTBS was significantly higher than that of the control groups. The incidence of the failure between the adhesive and the composite or between the adhesive and dentin decreased and that of the failure within the adhesive layer increased. According to the results, applying the bonding resin of neutral pH can increase the bond strength of SEAs by alleviating the difference in acidity between the SEA and restorative composite resin.
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Straight access cavity design allows the operator to locate all canals, helps in proper cleaning and shaping, ultimately facilitates the obturation of the canal system. However, change in the fracture strength according to the access cavity designs was not clearly demonstrated yet. The purpose of this study was to determine the influence of different access cavity designs on the fracture strength in endodontically treated mandibular anterior teeth.
Recently extracted mandibular anterior teeth that have no caries, cervical abrasion, and fracture were divided into three groups (Group 1 : conventional lingual access cavity, Group 2 : straight access cavity, Group 3 : extended straight access cavity) according to the cavity designs. After conventional endodontic treatment, cavities were filled with resin core material. Compressive loads parallel to the long axis of the teeth were applied at a crosshead speed of 2mm/min until the fracture occurred. The fracture strength analyzed with ANOVA and the Scheffe test at the 95% confidence level.
The results of this study were as follows :
1. The mean fracture strength decrease in following sequence Group 1 (558.90 ± 77.40 N), Group 2 (494.07 ± 123.98 N) and Group 3 (267.33 ± 27.02 N). 2. There was significant difference between Group 3 and other groups (P = 0.00).
Considering advantage of direct access to apical third and results of this study, straight access cavity is recommended for access cavity form of the mandibular anterior teeth.
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The purpose of this in vitro study was to evaluate the effect of surface defects and cross-sectional configuration of NiTi rotary files on the fatigue life under cyclic loading. Three NiTi rotary files (K3™, ProFile®, and HERO 642®) with #30/.04 taper were evaluated. Each rotary file was divided into 2 subgroups: control (no surface defects) and experimental group (artificial surface defects). A total of six groups of each 10 were tested. The NiTi rotary files were rotated at 300rpm using the apparatus which simulated curved canal (40 degree of curvature) until they fracture. The number of cycles to fracture was calculated and the fractured surfaces were observed with a scanning electron microscope. The data were analyzed statistically. The results showed that experimental groups with surface defects had lower number of cycles to fracture than control group but there was only a statistical significance between control and experimental group in the K3™ (p<0.05). There was no strong correlation between the cross-sectional configuration area and fracture resistance under experimental conditions. Several of fractured files demonstrated characteristic patterns of brittle fracture consistent with the propagation of pre-existing cracks.
This data indicate that surface defects of NiTi rotary files may significantly decrease fatigue life and it may be one possible factor for early fracture of NiTi rotary files in clinical practice.
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In the unique metal iris method, the developing interfacial gap at the cavity floor resulting from the cavity wall property during polymerizing composite resin might affect the nominal shear bond strength values. The aim of this study is to evaluate that the iris method reduces the cohesive failure in the substrates and the cavity wall property effects on the shear bond strength tests using iris method.
The occlusal dentin of 64 extracted human molars were randomly divided into 4 groups to simulate two different levels of cavity wall property (metal and dentin iris) and two different materials (ONE-STEP® and ALL-BOND® 2) for each wall property. After positioning the iris on the dentin surface, composite resin was packed and light-cured. After 24 hours the shear bond strength was measured at a crosshead speed of 0.5 mm/min. Fracture analysis was performed using a microscope and SEM. The data was analyzed statistically by a two-way ANOVA and t-test.
The shear bond strength with metal iris was significant higher than those with dentin iris (p = 0.034). Using ONE-STEP®, the shear bond strength with metal iris was significant higher than those with dentin iris (p = 0.005), but not in ALL-BOND® 2 (p = 0.774). The incidence of cohesive failure was very lower than other shear bond strength tests that did not use iris method.
The iris method may significantly reduce the cohesive failures in the substrates. According to the bonding agent systems, the shear bond strength was affected by the cavity wall property.
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