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Nielsen BA, Craig Baumgartner J: Comparison of the EndoVac sys-

Clinical Significance.—Irrigation has been tem to needle irrigation of root canals. J Endod 33:611-615, 2007
demonstrated essential to debridement of root
canals. Traditional irrigation methods, using Reprints available from J Craig Baumgartner, Dept of Endodontology,
a needle to deliver the solution, become less ef- 611 Campus Dr, Portland, OR 97239-3097; e-mail: baumgarc@
fective as the critical apical area is approached. ohsu.edu
The device reported here demonstrated more
effective cleaning of the critical last millimeter
of canal length compared with the conventional
needle technique.

Endodontics
Push-out bond strength of obturation system

Background.—The canal space is obturated to prevent material that were created by air trapped in the seal when
leakage from the oral cavity and periradicular tissues into the primer or sealer was placed. Another explanation for
the root canal system and to seal up any microorganisms the lower bond strength in the EP group is polymerization
that were not removed when the canal was cleaned and shrinkage of the sealer. The stress of this shrinkage may
shaped. Ideally endodontic sealers also adhere to dentin, cause the resin-based sealer to separate from the dentinal
increasing the chance of obtaining successful endodontic walls.
treatment. Adhering to dentin and bonding to the tooth
structure contribute to the resistance to tooth fracture, Claims have been made that the Epiphany Soft Resin
helping to ensure greater clinical survival for the treated Endodontic Obturation System performs as well as gutta-
tooth. The effectiveness of an endodontic obturation tech-
nique or material can be assessed using a push-out bond
strength test. The push-out bond strengths to intraradicular
dentin of Epiphany/Resilon, a new thermoplastic synthetic
polymer-based root canal filling material, and gutta-per-
cha/AH26 were evaluated.

Methods.—Thirty roots were divided into 2 groups for


treatment using the 2 endodontic obturation systems.
Epiphany Soft Resin Endodontic Obturation System was
used for 1 group (EP) and gutta-percha points plus AH26
Root Canal Sealing for the other (GP). The roots were sliced
horizontally so a push-out strength test could be performed
from apical to coronal in a universal testing machine (Fig 1).
The values were analyzed statistically and compared
between groups.

Results.—Seventy-eight slices were tested for each


group. The EP group had a mean push-out bond strength
of 0.51 MPa, whereas the GP group had a mean value of
1.70 MPa (Table 1). The groups were also assessed by
location of the bond strength distribution, but there was
no correlation between location and group.
Fig 1.—Diagram for the push-out bond strength test. (This article
Discussion.—Gutta-percha had greater push-out bond was published in J Endod, 33, Sly MM, Moore BK, Platt JA, et al, Push-
strength than the new obturation system. The difference out bond strength of a new endodontic obturation system [Re-
between the 2 groups may be a function of the presence silon/Epiphany], 120-162, Copyright American Association of End-
of voids between the dentinal walls and the obturation odontics (2007).)

40 Dental Abstracts
Table 1.—Push-out Bond Strength
Group N Mean (MPa) SD SE Min. Max. Clinical Significance.—Hermetic sealing and
obturation of the canal space is 1 requirement
EP 78 0.51 0.30 0.08 0.06 1.29
of successful endodontic therapy. Bonding of
GP 78 1.70 0.71 0.18 0.99 3.43
the filling material to the canal walls would
P value obtained from the rank transformation (not shown) (P < .0001). seem to provide a superior seal compared with
(This article was published in J Endod, 33, Sly MM, Moore BK, Platt JA, et al, conventional gutta-percha and sealer. In this
Push-out bond strength of a new endodontic obturation system [Resilon/ study using push-out bond strength as the
Epiphany], 120-162, Copyright American Association of Endodontics benchmark of sealing effectiveness, gutta-per-
(2007).) cha outperformed the bonded material. Further
testing for leakage at the apical foramen is in
percha and offers the advantage of forming a monoblock order.
bonding to the dentinal walls. It looks and handles like
gutta-percha. The monoblock results when the Resilon
core bonds to the resin sealer, which attaches to the
Sly MM, Moore BK, Platt JA, et al: Push-out bond strength of a new
primed root dentin. The core part of the Epiphany sys-
endodontic obturation system (Resilon/Epiphany). J Endod 33:120-
tem may not be optimized for effective chemical coupling 162, 2007
to methacrylate-based sealers. This would include both
the Epiphany and RealSeal sealers. The ability of both Reprints available from MM Sly, Indiana Univ School of Dentistry,
sealer and core material to bond together requires fur- Dental Materials, 1121 W Michigan St, Room 118, Indianapolis, IN
ther study. 46202; e-mail: msly@iupui.edu

Esthetic Dentistry
Cryosurgery for gingival melanin pigmentation

Background.—High levels of oral melanin pigmenta- on development, maturation, or reproduction and show
tion are normal in African, East Asian, Mediterranean, and no genotoxic and oncogenic tendencies. TFE is used in
Hispanic populations but fairly rare in light-skinned individ- dentistry for cold-pulp testing. Cryosurgical procedures
uals. Gingival melanin pigmentation (GMP) results from an have been reported to cause hypopigmentation as an ad-
excessive deposition of melanin and can be produced verse effect. Whether TFE-cooled cotton swab applications
naturally or triggered by smoking tobacco, endocrine could produce depigmentation of GMP-affected tissues was
disturbances, Albright’s syndrome, malignant melanoma, investigated.
antimalarial therapy, Peutz-Jeghers syndrome, trauma, he-
mochromatosis, or chronic pulmonary disease. With the Methods.—The 21 healthy women (age 18 to 53 years)
increasing emphasis on esthetic factors, a need to manage who volunteered complained of dissatisfaction with the es-
GMP has arisen. No medical problem is at issue here; the thetics of GMP. Two were nonsmokers; the others smoked
concern is esthetic. Approaches have included gingivec- over 10 cigarettes daily. The pigmented areas were isolated
tomy, free gingival grafting, acellular dermal matrix, laser and air dried (Fig 1). Topical anesthesia using 4% Xylocaine
surgery, electrosurgery, and gas expansion cryosurgery. spray was used to minimize discomfort. A cotton swab was
The treatment of choice has been laser surgery, although sprayed with TFE and immediately rolled gently over the
cryosurgery offers the advantages of not requiring sutures treatment area. For each area, a freezing zone was main-
and dressings, being free of bleeding, nonscarring, having tained continuously for 30 to 40 seconds. A single treat-
a rare incidence of secondary infection, and producing ment was given, then the patients were reexamined after
minimal disruption of surrounding tissues. Its expense 1, 2, and 4 weeks. Recalls at 6-month intervals were done
and the safety and practical concerns attending the storage for 30 months. Preoperative and postoperative digital pho-
of liquid gases are likely the reasons it is used so infrequen- tographs of the treated areas were obtained and compared.
tly.The nonchlorofluorocarbon, nonflammable gas 1,1,1,2
tetrafluoroethane (TFE) is used as a coolant for refrigera- Results.—The women had slight erythema of the gin-
tion systems and electron circuits. Exposures of healthy giva immediately after cryosurgery. A superficial necrosis
persons to TFE through short-term inhalation or skin con- then became apparent until a whitish slough of tissue could
tact have demonstrated no adverse effect on pulse, blood be removed, revealing a clean pink surface. Gingival appear-
pressure, electrocardiographic status, or lung function. ance returned to normal within a week; the return of kera-
Animal exposures have been linked to no adverse effects tinization required 3 to 4 weeks. Patient acceptance of the

Volume 53  Issue 1  2008 41

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