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The Journal of Contemporary Dental... Oct 2023To evaluate and compare canal-centering ability (CCA), canal transportation (CT), and dentinal crack formation by using Hyflex-electrical discharge machining (EDM),...
AIM
To evaluate and compare canal-centering ability (CCA), canal transportation (CT), and dentinal crack formation by using Hyflex-electrical discharge machining (EDM), OneShape, WaveOne Gold, and Reciproc single file system in the mesiobuccal root of maxillary first molar at coronal, middle, and apical third using cone-beam computed tomography (CBCT) and scanning electron microscopy (SEM).
MATERIALS AND METHODS
Mesiobuccal roots of 120 freshly extracted maxillary molar teeth were divided into four experimental groups; Hyflex-EDM, OneShape, WaveOne Gold, and Reciproc ( = 30/group). Preinstrumentation scanning was done using CBCT for all samples at coronal one-third (4 mm), middle one-third (8 mm), and apical one-third (12 mm). After cleaning and shaping with standard irrigation protocol, the specimens were again scanned. Canal-centering ability and CT were calculated using pre- and postinstrumentation CBCT values. A scanning electron microscope was used to identify dentinal crack formation.
RESULTS
No significant difference was found for CCA by any of the systems at coronal, middle, and apical third, respectively. However, OneShape was found to have better CCA at the coronal third and WaveOne Gold at the middle and apical third. There was a significant difference in canal transportation at the apical third ( = 0.004) with WaveOne Gold having the least CT followed by Reciproc at the apical third. OneShape resulted in more dentinal cracks in the coronal and middle thirds. Also, Hyflex-EDM was better in the apical third.
CONCLUSION
No difference in CCA was observed between the groups. The lowest values for CT were obtained for WaveOne Gold (similar to Reciproc) whereas both rotary files showed higher values for CT. Also, OneShape showed the most dentinal at all levels. Furthermore, Hyflex-EDM and WaveOne Gold produced the least dentinal cracks at all levels.
CLINICAL SIGNIFICANCE
Given that the Reciprocating file system had the least CT and least dentinal cracks, the clinical success rate of root canal treatment (RCT) with the Reciprocating file system can be a better choice to improve the longevity of root canal-treated teeth.
Topics: Dental Pulp Cavity; Molar; Root Canal Preparation; Root Canal Therapy
PubMed: 38152914
DOI: 10.5005/jp-journals-10024-3571 -
Journal of Endodontics Aug 2023Laser ablation (LA) therapy is used as an adjunct to endodontic treatment to improve microbial reduction. However, studies evaluating the impact of LA with indocyanine... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Laser ablation (LA) therapy is used as an adjunct to endodontic treatment to improve microbial reduction. However, studies evaluating the impact of LA with indocyanine green (ICG) are scarce. This study aimed to evaluate the antimicrobial efficacy of LA therapy with ICG in root canal treatment.
METHODS
Sixty patients with periapical lesions in teeth with a single canal and absence of pain, edema, and previous treatment were selected. Patients were randomly allocated into 3 groups according to the apical sizes used (n = 20); 25/04, 30/04, and 35/04 were the final sizes used. In half the patients of each group, 2.5% sodium hypochlorite was used as an irrigating solution, and in the other half, saline solution was used. After instrumentation, all patients received LA therapy with ICG. Root canal sampling was performed before (S1) and after (S2) root canal instrumentation and immediately after LA therapy with ICG (S3). Colony-forming units were counted, and statistical tests were applied (P < .05).
RESULTS
There was a significant reduction in colony-forming units from S1 to S2 in all treatment protocols (P < .05); 2.5% sodium hypochlorite as an irrigating solution showed a greater microbial reduction compared with saline solution (P < .05). LA therapy with ICG further reduced the microbial counts significantly (S2 to S3 and S1 to S3) whether sodium hypochlorite or saline was used (P < .05).
CONCLUSIONS
LA therapy with ICG significantly increased microbial reduction in root canals regardless of instrumentation sizes or the irrigation solution used.
Topics: Humans; Dental Pulp Cavity; Sodium Hypochlorite; Indocyanine Green; Saline Solution; Root Canal Preparation; Root Canal Therapy; Anti-Infective Agents; Laser Therapy; Root Canal Irrigants
PubMed: 37355163
DOI: 10.1016/j.joen.2023.06.009 -
European Endodontic Journal Jan 2024With the ever-increasing understanding of tooth anatomy, there is a renewed focus on the pulp chamber as an important component of the root canal system. For example,... (Review)
Review
With the ever-increasing understanding of tooth anatomy, there is a renewed focus on the pulp chamber as an important component of the root canal system. For example, the pulp chamber is of critical relevance during diagnostic procedures such as pulp sensibility tests, deep caries removal, vital pulp treatments, access cavity preparation, tooth whitening, tooth restoration as well as methods for examining the floor of the pulp chamber to aid the detection of root canal orifices or the presence of perforations and cracks. The more recent concept of minimal invasive endodontics has also created a need to understand better the anatomy of the pulp chamber. The purpose of this article is to discuss the research methods used to study pulp chamber anatomy and the significance of the pulp chamber in endodontic research and clinical practice. In addition, directions for future research are emphasised.
Topics: Dental Pulp Cavity; Root Canal Preparation; Endodontics; Root Canal Therapy; Tooth
PubMed: 37990569
DOI: 10.14744/eej.2023.76598 -
Odontology Oct 2023The aim of this systematic review and meta-analysis (SRM) was to assess postoperative pain (PP) after endodontic treatment with bioceramic root canal sealer compared to... (Meta-Analysis)
Meta-Analysis Review
The aim of this systematic review and meta-analysis (SRM) was to assess postoperative pain (PP) after endodontic treatment with bioceramic root canal sealer compared to AH Plus® sealer. This SRM was carried out in accordance with the items on the PRISMA 2020 checklist and Cochrane guidelines and registered in PROSPERO (CRD42021259283). Only randomized clinical trials (RCTs) were included. Meta-analysis was conducted using R software, the standardized means difference (SMD) measure of effect was calculated for quantitative variables, and the odds ratio (OR) for binary variables. The Cochrane tool (RoB 2.0) was used to assess the risk of bias, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of evidence. Qualitative and quantitative analysis included 18 and 17 studies, respectively. For quantitative variables, the bioceramic root canal sealer presented less occurrence of postoperative pain than the AH Plus® sealer in 24 h (SMD - 0.17 [- 0.34; - 0.01], p = 0.0340). For binary variables, there was no difference observed between the sealers evaluated, except for sealer extrusion where the bioceramic group had lower post-filling material extrusion (OR 0.52 [0.32; 0.84], p = 0.007). Regarding the risk of bias analysis, low risk was observed for most domains, except allocation that was considered unclear, while the certainty of evidence ranged from moderate to low. The results showed that bioceramics sealers reduced postoperative endodontic pain only after 24 h and showed less sealer extrusion compared to the AH Plus® sealer. However, more robust and standardized clinical trials are needed to confirm the results with less heterogeneity and higher quality of evidence.
Topics: Humans; Root Canal Filling Materials; Epoxy Resins; Dental Pulp Cavity; Randomized Controlled Trials as Topic; Root Canal Obturation; Pain, Postoperative
PubMed: 37378833
DOI: 10.1007/s10266-023-00830-z -
Journal of Endodontics Dec 2023This study aimed to compare the postoperative pain level changes resulting from using calcium silicate- (EndoSeal MTA) and calcium hydroxide-based (Sealapex) root canal... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
This study aimed to compare the postoperative pain level changes resulting from using calcium silicate- (EndoSeal MTA) and calcium hydroxide-based (Sealapex) root canal sealers in mandibular first and second molar teeth with symptomatic apical periodontitis.
METHODS
A total of 60 patients with symptomatic apical periodontitis in their lower molar teeth were randomly allocated into 2 groups according to sealer type (n = 30). Demographic data, including gender, age, and smoking habit, and preoperative pain measures were recorded. Root canal treatments were performed in a single visit. Postoperative pain measurements and analgesic intake were measured at 6, 12, 24, and 48 hours and after 3, 5, and 7 days using the visual analog scale. The data were statistically analyzed using a chi-squared test (to compare gender, age, smoking habit, analgesic intake, and sealer extrusion), the Mann-Whitney U test (to compare pain levels), Friedman tests (for the evaluations of the reduction in pain levels over time), and Spearman's correlation test (to analyze the relationships of age, gender, smoking habit factors with postoperative pain) (P = .05).
RESULTS
The statistical analysis showed no significant differences between the groups in postoperative pain and analgesic intake at any of the time intervals evaluated (P > .05).
CONCLUSIONS
Patients treated with calcium silicate- and calcium hydroxide-based root canal sealers experienced similar postoperative pain and no statistically significant differences were observed in analgesic intake.
Topics: Humans; Calcium Hydroxide; Root Canal Filling Materials; Dental Pulp Cavity; Epoxy Resins; Calcium Compounds; Silicates; Periapical Periodontitis; Pain, Postoperative; Analgesics
PubMed: 37683888
DOI: 10.1016/j.joen.2023.08.023 -
Journal of Endodontics Oct 2023This laboratory study aimed to evaluate the accumulated hard tissue debris (AHTD) and shaping performance following root canal instrumentation with a novel stainless...
INTRODUCTION
This laboratory study aimed to evaluate the accumulated hard tissue debris (AHTD) and shaping performance following root canal instrumentation with a novel stainless steel rotary system (Gentlefile; MedicNRG, Kibbutz Afikim, Israel) compared with two single-file nickel-titanium instruments of different kinematics through micro-computed tomography (micro-CT) analysis.
METHODS
Thirty isthmus-containing mesial roots of human mandibular molars with a curvature of 15°-35° were scanned with micro-CT at an isotropic resolution of 12 μm and randomly assigned to three groups (n = 10) according to the instruments used for canal preparation: Gentlefile (GF; #23/.04), One Curve (OC; #25/.06; Micro-Mega, Besancon, France), and Reciproc Blue R25 (RB; #25/.08; VDW, Munich, Germany). The AHTD, unprepared canal surface area, volume changes, surface area changes, and transportation were evaluated by comparing preoperative and postoperative micro-CT images. In addition, the time required for canal preparation was recorded. Data were statistically analyzed using the one-way analysis of variance (ANOVA) test or the Kruskal-Wallis test at a significance level of 5%.
RESULTS
No significant differences were observed in the percentage of AHTD or in the unprepared canal surface area between the three groups (P > .05). The RB group demonstrated a significantly greater percentage increase in volume and surface area than the GF group (P < .05). The GF and OC groups showed significantly less transportation at 3 mm from the apex than the RB group (P < .001). The OC group required significantly less time for instrumentation than the RB and GF groups (P < .05).
CONCLUSIONS
Instrumentation with GF (#23/.04), OC, and RB yielded similar levels of AHTD and unprepared surface area in isthmus-containing curved canals. GF achieved this with less dentin removal and apical transportation, at the expense of a longer preparation time.
Topics: Humans; Dental Pulp Cavity; X-Ray Microtomography; Root Canal Preparation; Tooth Root; Molar; Equipment Design
PubMed: 37516238
DOI: 10.1016/j.joen.2023.07.019 -
Journal of Endodontics Sep 2023This study aimed to compare the effectiveness of a dynamic navigation system and a three-dimensional microscope in retrieving broken rotary Nickel-Titanium files when...
INTRODUCTION
This study aimed to compare the effectiveness of a dynamic navigation system and a three-dimensional microscope in retrieving broken rotary Nickel-Titanium files when using trepan burs and the extractor system.
MATERIALS AND METHODS
Thirty maxillary first bicuspids with 60 separate roots were split into 2 comparable groups based on a comprehensive cone beam computed tomography analysis of the root length and curvature. After standardized access opening, glide paths, and patency attainment with the K file (sizes 10 and 15), the teeth were arranged on 3D models (three per quadrant, six per model). Subsequently, controlled-memory heat-treated Nickel-Titanium rotary files (#25/0.04) were notched 4 mm from the tips and fractured at the apical third of the roots. The C-FR1 Endo file removal system was employed under both guidance to retrieve the fragments, and the success rate, canal aberration, treatment time, and volumetric changes were measured. The statistical analysis was performed using IBM SPSS software at a significance level of 0.05.
RESULTS
The microscope-guided group had a higher success rate than the dynamic navigation system guidance, but the difference was insignificant (P > .05). In addition, the microscope-guided drills resulted in a substantially lower proportion of canal aberration, shorter time to retrieve the fragments and less change in the root canal volume (P < .05).
CONCLUSION
Although dynamically guided trephining with the extractor can retrieve separated instruments, it is inferior to three-dimensional microscope guidance regarding treatment time, procedural errors, and volume change.
Topics: Titanium; Nickel; Dental Pulp Cavity; Root Canal Preparation
PubMed: 37393950
DOI: 10.1016/j.joen.2023.06.014 -
Australian Endodontic Journal : the... Aug 2023This study aimed to determine the prevalence of pulp canal obliteration (PCO) and its association with periapical pathology (Hypodense areas) in cone-beam computed...
This study aimed to determine the prevalence of pulp canal obliteration (PCO) and its association with periapical pathology (Hypodense areas) in cone-beam computed tomography (CBCT) scans of anterior teeth. A total of 2161 CBCT scans from patients 18 years or older taken between 2000 and 2020 were selected. Patient-, tooth- and scan-related data were registered. Two calibrated evaluators recorded the number of teeth with PCO ≥4 mm in the cervical third of the roots and the presence or absence of periapical hypodensities (PH). The length of the root canal that was calcified was also determined. Logistic regression analysis was used to determine whether any of the recorded factors influenced the presence of PCO and the presence of periapical pathology in teeth presenting with PCO. The only factor significantly related to the presence of PCO was patient age. The prevalence of PH in teeth exhibiting PCO was 10%.
Topics: Humans; Dental Pulp Cavity; Prevalence; Spiral Cone-Beam Computed Tomography; Root Canal Therapy; Dental Pulp Diseases; Cone-Beam Computed Tomography
PubMed: 35877115
DOI: 10.1111/aej.12669 -
Journal of Dentistry Sep 2023For successful root canal treatment (RCT), it is essential to objectively assess the presence and activity of bacteria in the root canal system. However, current methods...
OBJECTIVES
For successful root canal treatment (RCT), it is essential to objectively assess the presence and activity of bacteria in the root canal system. However, current methods rely on subjective observations of root canal exudates. This study aimed to confirm whether real-time optical detection using bacterial autofluorescence can evaluate endodontic infection status by assessing the red fluorescence (RF) detected from root canal exudates.
METHODS
During RCT, endodontic paper points were used to collect root canal exudates scored using conventional organoleptic tests to assess the severity of root canal infections. RF on the paper points was assessed using quantitative light-induced fluorescence (QLF) technology. RF intensity and area from the paper points were quantified, and their correlations with infection severity were assessed using their organoleptic scores. The oral microbiome composition of RF samples was compared with non-red fluorescent (non-RF) samples.
RESULTS
The RF detection rate was nil and >98% in the non-infectious and severe groups. The RF intensity and area significantly increased with infection severity (p<0.001) and showed strong correlations with organoleptic scores (r=0.72, 0.82, respectively). The diagnostic accuracy for detecting root canal infection using RF intensity was good to excellent (AUC = 0.81-0.95) and increased with infection severity. The microbial diversity of the RF samples was significantly lower than that of the non-RF samples. Gram-negative anaerobic bacteria such as Prevotella and Porphyromonas were more predominant in RF samples.
CONCLUSIONS
Optical detection using bacterial autofluorescence can objectively evaluate endodontic infection status in real-time by assessing the RF of endodontic root canal exudates.
CLINICAL SIGNIFICANCE
This real-time optical technology can be utilised to detect endodontic bacterial infection without conventional incubation, allowing clinicians to determine the endpoint of chemomechanical debridement and increase the positive outcomes of RCTs.
Topics: Bacteria; Root Canal Therapy; Dental Pulp Cavity
PubMed: 37392816
DOI: 10.1016/j.jdent.2023.104600 -
Australian Endodontic Journal : the... Sep 2023To study the anatomical characteristics of the root and root canal system of the mandibular second molars in the population of Gansu province, and to provide theoretical...
To study the anatomical characteristics of the root and root canal system of the mandibular second molars in the population of Gansu province, and to provide theoretical and clinical references for improving the success rate of root canal therapy (RCT) of mandibular second molars. The number of roots and root canals, root canal type and pulp chamber height of mandibular second molars were determined by observing cone-beam computed tomography (CBCT) images of people living in Gansu. The most common type of mandibular second molars in the Gansu province population was a double root with three root canals (47.55%), followed by a C-shaped root (35.56%). There were more females than males with a C-shaped root (p < 0.05). The most common root canal subtype of the C-type root was C3 (13.91%). Most of the population (77.11%) had bilateral mandibular second molars with symmetrical root canal morphology. With an increase in age, the height of the pulp chamber decreased significantly. The incidence of root canal variation of the mandibular second molars is relatively high in the population of Gansu province. Preoperative examination with CBCT is essential for mandibular second molars that need RCT to avoid root canal treatment failure and decrease the occurrence of postoperative pain as much as possible.
Topics: Male; Female; Humans; Dental Pulp Cavity; Spiral Cone-Beam Computed Tomography; Tooth Root; Mandible; Molar; Root Canal Therapy; Cone-Beam Computed Tomography
PubMed: 36125937
DOI: 10.1111/aej.12692