Introduction: The purpose of this ex vivo study was to assess the effect of two root-end filling materials against Candida (C) Albicans.Materials and Methods: ProRoot MTA and CEM Cement were compared immediately and 24 h after mixing, in two different concentrations (50 and 100 mg/mL). A total of 50 culture wells were used and divided into experimental (n=10) and control groups (n=5). Those with no medication served as positive and without C. Albicans served as negative controls. All plates were incubated at 37oC after 1, 24, and 48hours. At each interval, the presence of C. Albicans was assessed and recorded by an independent observer. In addition to observing turbidity, 0.02 mL of samples from each cell was re-cultured on sabouraud dextrose agar plates to confirm change in fungal growth. The data were evaluated and analyzed using Kruskal-Wallis test.Results: Although all fresh and set samples with experimental concentrations showed fungal growth after 1 h; they demonstrated complete fungicidal activity at 24 and 48-h time intervals.Conclusion: Under the conditions of this ex vivo study, CEM cement as well as ProRoot MTA has fungicidal effects against C. Albicans even in concentration of 50 mg/mL and after 24 hours.

Introduction: Root-end preparation and restoration with an endodontic material are required when nonsurgical endodontic retreatment has failed or is impossible. The present clinical study reports the treatment outcomes of periradicular surgery using CALCIUMENRICHED MIXTURE (CEM) cement.Materials and Methods: A prospective outcome study of periradicular surgery using CEM was conducted on 14 permanent teeth with persistent apical periodontitis. Using a standardized surgical protocol, 2-3 mm of the root apex was resected; approximately 3 mm deep root-end cavities were ultrasonically prepared and filled with CEM cement. All patients were available for recall.Results: Clinical and radiographic examination revealed complete healing of periradicular lesions, i.e.regeneration of periodontal ligament and lamina dura in 13 teeth (93% success) during a mean time of 18 months; moreover, the teeth were functional and asymptomatic.Conclusion: Favorable treatment outcomes in this prospective clinical study suggested that CEM cement may be a suitable root-end filling biomaterial.

Statement of Problem: CALCIUM hydroxide which is commonly used as an intracanal medicament, changes the pH of dentin and periradicular tissues to an alkaline pH. In some clinical situations, endodontic reparative cements like CALCIUM ENRICHED MIXTURE cement are used after CALCIUM hydroxide therapy. However, the alkaline pH may affect the physical properties of this cement.Objectives: This study was designed to evaluate the effect of alkaline pH on the push-out bond strength of CALCIUM ENRICHED MIXTURE.Materials and Methods: 80 root slices were prepared from single-rooted human teeth and their lumens were instrumented to achieve a diameter of 1.3mm. CALCIUM ENRICHED MIXTURE (CEM) was mixed according to the manufacturer’s instruction and introduced into the lumens of root slices. The specimens were then randomly divided into 4 groups (n=20) and wrapped in pieces of gauze soaked in synthetic tissue fluid (STF) buffered in potassium hydroxide at pH values of 7.4, 8.4, 9.4, or 10.4. The samples were incubated for 4 days at 37oC. The push-out bond strengths were then measured using a universal testing machine. Failure modes were examined under a light microscope at×20 magnification. The data were analyzed using one-way analysis of variance and Tukey’s post hoc tests.Results: The greatest (1.41±0.193 MPa) and lowest (0.8±0.06 MPa) mean push-out bond strengths were observed after exposure to pH values of 7.4 and 8.4, respectively. There were significant differences between the neutral group and the groups with pH of 8.4 (p=0.008) and 10.4 (p=0.022). The bond failure was predominantly of cohesive type for all experimental groups.Conclusions: Under the condition of this study, alkaline pH adversely affected the Push-out bond strength of CEM cement.

This case report describes the 10-year follow-up of a root-end re-surgery in a 38-year-old woman patient who had symptomatic apical periodontitis and failed endodontic surgery in the upper left central incisor. Past dental history revealed root-end surgery with amalgam in that tooth, which continued to swell and discomfort after the surgery. Upon clinical/radiographic examination, she revealed a grossly compromised crown-to-root ratio of 3:1 with severe mobility of the tooth and apical radiolucency. After thorough treatment planning and patient consent, re-surgery was carried out with CALCIUM-ENRICHED MIXTURE cement as a biocompatible root-end filling material. Postoperative care included strict occlusal management and instructions to the patient to avoid hard foods. At the 10-year follow-up, the tooth was functional, and complete periapical healing was evident with no recurrence of symptoms. This case illustrates the role of modern endodontic microsurgery, appropriate biomaterial selection, and meticulous surgical technique in the long-term success of even challenging cases.