Can Type of Instrumentation and Activation of the Final Irrigant Improve the Obturation Quality in Oval Root Canals? A Push-Out Bond Strength Study

To appraise the outcome of file systems and activation of the final irrigant on the push-out bond strength of root fillings in oval canals. Single-rooted mandibular premolars (n = 180) with oval canals were divided into three groups (n = 60) for instrumentation: ProTaper Next (PTN), WaveOne (WO), and Self-adjusting File (SAF). The specimens were further divided into subgroups (n = 20) and subjected to final irrigation with activation by EndoActivator or passive ultrasonic irrigation or without activation. Then, the specimens were again subdivided (n = 10) and obturated with gutta-percha and AH Plus (GP-AH) or C-Point with EndoSequence bioceramic sealer (C-EBC). One-millimeter-thick horizontal slices were cut from the apical third of the root, 5 mm from the apex, and subjected to push-out bond strength (BS) testing. Specimens for which SAF was used exhibited higher BS values than those for which PTN or WO was used (p < 0.05). Activation of the final irrigation did not affect the BS of the root fillings. Root fillings made of C-EBC presented a higher BS than those made of GP-AH (p < 0.05). Adhesive failure was more common with specimens instrumented using PTN and WO. Root canals instrumented with SAF, showed the highest bond strength values for both root filling materials. The C-EBC produced significantly higher bond strength values than those of the GP-AH.

Determination of the Accuracy of Linear Height Bone for Implant Placement in Panoramic Radiography Relative to CBCT in the Posterior Areas of the Jaws

Purpose: In the levels of implant treatment in the posterior region, determining the height of the bone has particular importance. The aim of the study was to compare the accuracy of linear bone height measurement for implant placement on panoramic view compared to CBCT in posterior jaw area. Materials and Methods: The study was performed on 20 patients. In each of the posterior edentulous areas, a surgical guide for each patient was marked with gutta-percha (a total of 70 points). Panoramic radiographs and CBCTs were obtained from the patients and then the distance between the marked points in the maxilla to the maxillary sinus and in the mandible to the upper border of the alveolar canal was measured by Romaxis software and analyzed by Statistical software Stata 14. The obtained measurements of panoramic view were compared to CBCTs using t-test. P≤0.05 was considered significant. Results: The mean difference between the sizes obtained from panoramic radiography and CBCT radiography in the maxilla was 0.34 mm (P = 0.57) and the mean difference between the sizes obtained from panoramic radiography and CBCT radiography in the mandible was 0.86 mm (P = 0.004). Conclusion: According to the results of study, it is logical panoramic radiography just used to pre-assessment of implant procedures in posterior area of mandible were as it could be more reliable in maxilla.

Mineral trioxide aggregate for apexification in non-vital teeth with open apices: A case report

Management of immature non-vital teeth poses challenge for the clinician owing to the thin root canal walls and open apices which may show apical divergence. Apexification is the technique of inducing the apical closure with a root end filling material for non-vital immature young permanent teeth. Traditionally, Calcium hydroxide was the material of choice for apexification of immature permanent teeth but introduction of MTA has shown remarkable promise as an alternative to calcium hydroxide. This report presents a case of apexification of anterior two young permanent teeth with open apices using MTA and Gutta percha followed by esthetic build up using cast metal posts and full coverage restorations.

Endodontic Management of a Maxillary Lateral Incisor with Dens Invagination and Periapical Lesion: A Case Report and Mini Review of the Literature

Dens invagination (DI) is a dental anomaly that can cause pulpal and periapical pathoses of the affected tooth. We describe the treatment of a healthy 18-year-old female with a chief complaint of recurrent facial swelling pertaining to a peg-shaped maxillary lateral incisor with DI. Examinations showed necrosis of the involved tooth with symptomatic apical periodontitis. Cone-beam computed tomography corresponded to Oehlers type II DI. Orthograde endodontic treatment was performed. To completely debride the canal and resolve the persistent purulent discharge, various methods and medicaments were used in separate sessions including passive ultrasonic activation of 5.25% sodium hypochlorite solution, calcium hydroxide mixed with 2% chlorhexidine, and double antibiotic paste as intracanal medicament. After resolution of the symptoms, the root canal and the invaginated space were filled by a mineral trioxide aggregate plug and backfilled with thermoplasticized gutta-percha. At the one-year follow-up, complete bone healing was noted in the affected periradicular area.

Microhardness evaluation of root dentin after using resin sealer solvents

Background. This study aimed to assess the effects of methyl ethyl ketone (MEK) and ethyl acetate (EA) on dentin microhardness, used as resin sealer solvents. Methods. Eighty halves of single-rooted teeth were randomly divided into four groups to apply MEK, EA, chloroform, or saline solution. Vickers hardness values were measured for three root levels before and after the direct application of solvents for 5 and 15 minutes or a 1-minute application with ultrasonic agitation. The results were analyzed using repeated-measures ANOVA, and adjustments were made for comparisons with Bonferroni tests. Results. The dentin microhardness decreased in all the solvent groups (P<0.05). The changes in microhardness increased with prolonged exposure times, except for the saline solution group. Chloroform exhibited the most significant decrease in value. Furthermore, ultrasonic agitation elicited a more substantial decline in values. Conclusion. MEK and EA might be preferred over chloroform as a solvent for resin sealers because they offer an attenuated decrease in dentin microhardness and do not have gutta-percha-dissolving properties.

Endodontic Irrigants and Their Activation Efficacy on Cleansing Post-Space Root Canal Walls

The aim of this study was to evaluate the efficacy of activated irrigants (EDTA e NaOCL) during the cleansing of root walls, of the smear layer, of the debris, and gutta-percha after the preparation of the restorative space. Twenty single and multi-rooted (n = 20) have been collected. All samples were prepared by the same operator, using Nickel-titanium rotating instruments (Mtwo) through the Simultaneous Shaping Technique. The continuous-wave of condensation technique of obturation was used. To all specimens, the restorative space has been made, leaving 5 mm of apical gutta-percha, and postoperative periapical X-rays were performed. The samples were randomly divided into two groups: Group (A): cleansing of the root walls with ultrasonic activation of the irrigants (NEWTRON P5 XS; Satelec Acteon); Group (B): radicular walls wash without ultrasonic activation of endodontic irrigants (NaOCl 5.25% and EDTA 17%). Both dental sample groups were cut longitudinally with a low-speed saw (Isomet); the samples were observed by using a scanning electron microscope (Jeol, Jsm-6060LV) in order to evaluate: (1) the amount of debris/smear layer; (2) the mount of obstruction of dentinal tubules found in the two groups; and (3) evaluation of the presence of gutta-percha. Then, the other five samples each group (with and without ultrasonic activation) were prepared following the same protocol. Then, a universal bonding system (G-Praemio Bond, GC) and a layer of a flowable resin composite (Gaenial Flow, GC) were light-cured and used on top of the prepared root canal walls. The samples were cut in two pieces along the long axis of the root. Then, half sample teeth were kept in an acidic solution (37% HCl) for 48 h in order to completely dissolve dental structures and to have a direct view of resin tags formation under SEM. The other half was prepared to observe the adhesive interface under SEM. The amount of debris was not satisfactory in 9 out of 10 cases in Group B, while in Group A, which has been treated with ultrasounds, the result was either good or great in most of the samples. For the sample group treated with ultrasound, the tubules were evaluated as perfectly clean in 9 out of 10 cases, instead, the results are unsatisfactory for 9 out of 10 cases of group B not treated with ultrasound. Differences between Group A and B were statistically significant. With respect to the presence of debris and tubules obstruction treatment with ultrasonic activation, it offers with no doubt better results. When ultrasonic activation is used in combination with endodontic irrigants, a clean dentin substrate is be obtained for the adhesion of restorative materials, but in order to confirm the findings of this study, further in vivo trials are needed.

Obturation of Root Canals By Vertical Condensation of Gutta-Percha – Benefits and Pitfalls

Vertical condensation of gutta-percha is one of the frequently used techniques of hermetic and three-dimensional obturation of root canal system which is one of the primary goals of endodontic tooth treatment. Techniques for filling root canals have been described since ancient Egypt and have undergone dynamic development in recent decades. The aim of the article is to analyze the technique of obturation of root canals using vertical condensation of guttapercha and to point out its benefits and pitfalls. The poor-quality treatment of the tooth deteriorates its prognosis, function, and long-term survival in the oral cavity; thus, the hermetic obturation of the root canals is one of the most important pillars of the complex tooth treatment. Obturation of the root canals by vertical condensation of warm gutta-percha is nowadays considered in the correct indications as one of the most commonly used techniques in the excellent dental practices. Even though it is quite technologically challenging and time-consuming it enables to reach high level of predictability and clinical success. Currently, the obturation technique based on master gutta-percha cone combined with the calcium-silicate based sealer is emerging. However, long term results of clinical studies and follow-up are needed to make a significant improvement in the area of endodontics.

An in vitro study on the effects of serum proteins on Enterococcus faecalis adhesion to three types of root sealers and gutta-percha

Background The extrusion of overfilled materials that extend beyond the apical foramina into the periradicular tissue may serve as a reservoir for bacterial adhesion and further affect recovery from periapical diseases. The aim of this study was to evaluate the effects of serum proteins on Enterococcus faecalis adhesion and survival on the surface of a calcium hydroxide-based root canal sealer (Apexit Plus), an epoxy resin sealer (AH-Plus) and a bioceramic sealer (iRoot SP). Methods Apexit Plus, AH-Plus and iRoot SP were evenly coated on gutta-percha, using gutta-percha alone as the control. After root canal sealer setting, the number of E. faecalis adhering to the root canal sealers and gutta-percha was counted in fetal bovine serum (FBS) or tryptic soy broth supplemented with 1% glucose (TSBG) by viable cell plate counts. The morphology of 7-day-old E. faecalis biofilms in FSB and TSBG was observed by scanning electron microscopy (SEM). Furthermore, E. faecalis biofilms on the three root canal sealers were labeled with a LIVE/DEAD BacLight™ Bacterial Viability Kit, and the ratios of viable to dead cells were analyzed using laser scanning microscopy operative software (Zen software). Results In the assays, after 1 and 7 days, the number of E. faecalis adhering to the root canal sealers or gutta-percha in FBS were significantly lower than those in TSBG (P < 0.05). In FBS, E. faecalis adhesion to iRoot SP and gutta-percha was reduced to a greater extent than that adhered to Apexit Plus and AH-Plus. Few E. faecalis accumulated on iRoot SP in FBS, whereas many bacteria assembled on iRoot SP and formed biofilms in TSBG. The ratio of viable cells in the E. faecalis biofilm on iRoot SP was the lowest. Conclusions Calcium hydroxide-based root canal sealers, epoxy resin sealers and bioceramic sealers may provide a substrate for E. faecalis adhesion, and the bioceramic sealer in this study showed the least E. faecalis adhesion in the presence of serum proteins compared to the other two sealers.

Adaptation of the single-cone in prepared long oval-shaped canals: a micro-computed tomography study

The present study aimed to evaluate adaptation of the single gutta-percha cone on root canal walls prepared with the two systems, the XP-endo Shaper (XPS; FKG Dentaire, La Chaux-de-Fonds, Switzerland) and ProTaper Next systems (PTN; Dentsply Sirona, Ballaigues, Switzerland) by using micro-computed tomography (micro-CT) technology. Twenty long oval-shaped canals in mandibular incisors were scanned by micro-CT (Skyscan 1172; Bruker microCT, Kontich, Belgium). Two groups were divided into (n = 10) according to the canal preparation protocol: XPS group with an extra 45 s of instrumentation and PTN group. A gutta percha cone, with respect to the protocol used for each group (size 40, .04 taper, XPS and size 40, .06 taper, PTN) was adapted to the canal at the working length of all the samples, and all root canals were filled, using the single-cone technique. The mean values for volume of voids and percentage relative to the mentioned space were correspondingly higher in XPS group than they were PTN group, mean values for volume of voids (3.61 mm3 - 1.92 mm3) and for percentage of voids (39.25% - 23.28%), respectively, significant differences were recorded (p < 0.05) between the two groups (XPS and PTN, Student’s-t test for homogenous variances and Mann–Whitney test). The canals prepared with XPS, in the procedure performed with an extra 45 s of instrumentation, showed a higher volume of voids than those prepared with the PTN system, in obturation of the root canal with the single cone technique.

Endodontic Management of Endo-Perio Lesions

An endo-perio lesion is one of the more common tooth-related problems. An association between the presence of apical and marginal periodontitis is known in the literature and has been observed in 5.7% of individuals aged 40–45 years old. The purpose of the present article is to present three case reports describing the successful retreatment of endo-perio lesions. In each of these cases, we used a biologically active bioceramic root canal sealer, GuttaFlow Bioseal, which is a bioactive root canal filling material composed of gutta percha, polydimethylsiloxane, platinum catalyzer, zirconium dioxide, and bioglass. All cases were followed up clinically and radiographically for a period of at least 11 months.