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International Endodontic Journal Oct 2022Luxation injuries and other stimuli may lead to a pulp canal obliteration (PCO). Even though the apposition of tertiary dentine is a sign of a vital pulp, in some cases... (Review)
Review
Luxation injuries and other stimuli may lead to a pulp canal obliteration (PCO). Even though the apposition of tertiary dentine is a sign of a vital pulp, in some cases root canal treatment is indicated in the long term due to apical periodontitis or pulpitis. Depending on the extent of PCO, root canal treatment may be challenging even for experienced and well-equipped endodontic specialists. The 'guided endodontics' (GE) technique was introduced 6 years ago as an alternative to conventional access cavity preparation for teeth with PCO and apical pathosis or irreversible pulpitis. Using three-dimensional radiological imaging such as cone-beam computed tomography and a digital surface scan, an optimal access to the orifice of the calcified root canal can be planned virtually with appropriate software. GE is implemented either with the help of templates analogous to guided implantology (= static navigation) or by means of dynamic navigation based on a camera-marker system. GE has emerged as a field of research in the last 6 years with very promising laboratory-based results regarding the accuracy of guided endodontic access cavities for both static and dynamic navigation. Clinical implementation seems to provide favourable results, but the evidence is mainly based on numerous case reports and a few case series. This narrative review aims to provide an update on the present status of GE and to identify relevant research areas that could contribute to further improvements of this technique.
Topics: Humans; Pulpitis; Endodontics; Dental Pulp Cavity; Root Canal Therapy; Periapical Periodontitis; Cone-Beam Computed Tomography; Dental Pulp Diseases
PubMed: 35075661
DOI: 10.1111/iej.13687 -
International Endodontic Journal May 2022Irrigation is considered the primary means of cleaning and disinfection of the root canal system. The purpose of this review was to set the framework for the obstacles... (Review)
Review
Irrigation is considered the primary means of cleaning and disinfection of the root canal system. The purpose of this review was to set the framework for the obstacles that irrigation needs to overcome, to critically appraise currently used irrigants and irrigation methods, to highlight knowledge gaps and methodological limitations in the available studies and to provide directions for future developments. Organization of bacteria in biofilms located in anatomic intricacies of the root canal system and the difficulty to eliminate them is the main challenge for irrigants. Sodium hypochlorite remains the primary irrigant of choice, but it needs to be supplemented by a chelator. Delivery of the irrigants using a syringe and needle and activation by an ultrasonic file are the most popular irrigation methods. There is no evidence that any adjunct irrigation method, including ultrasonic activation, can improve the long-term outcome of root canal treatment beyond what can be achieved by instrumentation and syringe irrigation. It is necessary to redefine the research priorities in this field and investigate in greater depth the penetration of the irrigants, their effect on the biofilm and the long-term treatment outcome. New studies must also focus on clinically relevant comparisons, avoid methodological flaws and have sufficiently large sample sizes to reach reliable conclusions. Future multidisciplinary efforts combining the knowledge from basic sciences such as Chemistry, Microbiology and Fluid Dynamics may lead to more effective antimicrobials and improved activation methods to bring them closer to the residual biofilm in the root canal system.
Topics: Dental Pulp Cavity; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite; Therapeutic Irrigation
PubMed: 35338652
DOI: 10.1111/iej.13739 -
International Journal of Environmental... Oct 2022The main objective of this paper is to perform an updated literature review of guided endodontics based on the available up-to-date scientific literature to identify and... (Review)
Review
The main objective of this paper is to perform an updated literature review of guided endodontics based on the available up-to-date scientific literature to identify and describe the technique, its benefits, and its limitations. Four electronic databases (PubMed, Scopus, Science Direct, and Web of Science) were used to perform a literature search from 1 January 2017 to 13 May 2022. After discarding duplicates, out of 1047 results, a total of 29 articles were eligible for review. Guided endodontics is a novel technique that is currently evolving. It is applied in multiple treatments, especially in accessing and locating root canals in teeth with pulp canal obliteration, microsurgical endodontics, and removing glass fiber posts in endodontic retreatments. In addition, it is independent of an operator's experience, requires less treatment time for the patient, and is more accurate and safer than conventional endodontics.
Topics: Humans; Root Canal Therapy; Endodontics; Tooth; Dental Care; Dental Pulp Cavity
PubMed: 36360780
DOI: 10.3390/ijerph192113900 -
International Endodontic Journal May 2022Root canal curvature and calcification introduce factors that increase the risk of procedural accidents during root canal treatment. The inability to achieve patency to... (Review)
Review
Root canal curvature and calcification introduce factors that increase the risk of procedural accidents during root canal treatment. The inability to achieve patency to the apical third, asymmetrical dentine removal leading to transportation, perforation, and instrument fracture inside the curved trajectories are some of the procedural problems that might jeopardize the management of intraradicular infection and result in poor treatment outcomes. In fact, curved and constricted canals introduce such complexity that total instrumentation concepts and specially designed instruments have been developed to deal with the challenge. This narrative review seeks to provide and consolidate the principles necessary for understanding the dynamics of curved and constricted canal management and to improve the understanding for future developments in this field.
Topics: Dental Pulp Cavity; Root Canal Preparation; Root Canal Therapy; Titanium
PubMed: 35106792
DOI: 10.1111/iej.13685 -
Journal of Endodontics Feb 2021Endodontic treatment of teeth with pulp canal obliteration presents a challenge given the high likelihood of procedural errors and complications during treatment. These...
Endodontic treatment of teeth with pulp canal obliteration presents a challenge given the high likelihood of procedural errors and complications during treatment. These drawbacks can be avoided by using a personalized 3-dimensional (3D) guide designed by overlaying a cone-beam computed tomographic scan with an intraoral scan of the patient. This 3D guide enables the clinician to obtain a straight access to the obliterated root canal.This article described guided endodontics in managing 7 severely obliterated teeth using both virtually designed 3D guides and a customized 1-mm-diameter cylindrical bur. This treatment approach was demonstrated to be safe and fast and can be considered as a predictable technique for the location of calcified canals, thus minimizing complications.
Topics: Cone-Beam Computed Tomography; Dental Care; Dental Pulp Cavity; Endodontics; Humans; Root Canal Therapy
PubMed: 33278454
DOI: 10.1016/j.joen.2020.11.026 -
Journal of Oral Science Jan 2022The aim of this study was to use dye penetration to measure apical and coronal leakage simultaneously in single-canal teeth that had been treated endodontically using a... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
The aim of this study was to use dye penetration to measure apical and coronal leakage simultaneously in single-canal teeth that had been treated endodontically using a single-cone obturation technique.
METHODS
One hundred single-canal, extracted human teeth were cleaned and shaped with ProTaper NEXT rotary files to size-X5 (50/.06), then randomly assigned to five sealer groups for single-cone gutta-percha obturation. The teeth were soaked in 0.6% rhodamine B at 37°C for seven days, then the roots were ground mesiodistally and the maximum apical and coronal dye penetration was measured. Differences in leakage among the sealer groups were examined using the Kruskal-Wallis test. Pairwise comparisons were made using the Mann-Whitney test with Bonferroni correction.
RESULTS
The mean values (mm) of dye penetration for AH Plus, Pulp Canal Sealer, NeoSEALER Flo, EndoSequence BC, and Super-Bond RC Sealer were 0.200, 0.300, 0.675, 0.850, and 0.900 apically, whereas 1.675, 2.075, 4.800, 6.500, and 4.125 coronally. Pairwise comparisons showed significant apical differences between AH Plus/Super-Bond RC Sealer (P = 0.047) and significant coronal differences between AH Plus/NeoSEALER Flo (P = 0.001), AH Plus/EndoSequence BC (P < 0.01), AH Plus/Super-Bond RC Sealer (P < 0.01), Pulp Canal Sealer/NeoSEALER Flo (P = 0.010), Pulp Canal Sealer/EndoSequence BC (P < 0.01), and Pulp Canal Sealer/Super-Bond RC Sealer (P < 0.01).
CONCLUSION
Coronal leakage was worse than apical leakage for all sealers. AH Plus exhibited the least leakage apically and coronally; Super-Bond RC Sealer showed the most leakage apically, and EndoSequence BC showed the most leakage coronally.
Topics: Dental Pulp Cavity; Epoxy Resins; Gutta-Percha; Humans; Root Canal Filling Materials; Root Canal Obturation
PubMed: 34980828
DOI: 10.2334/josnusd.21-0433 -
Journal of Endodontics Feb 2022Endodontic treatment in severely calcified canals is always a challenging task because it can result in accidents such as deviations or perforations. Recently, guided...
Endodontic treatment in severely calcified canals is always a challenging task because it can result in accidents such as deviations or perforations. Recently, guided endodontics has become an alternative approach for pulp canal calcification, facilitating the location of root canals more predictably through the combined use of cone-beam computed tomographic imaging, oral scanning, and endodontic access guides. Although several reports have shown that guided endodontics is safer, faster and can be performed without an operating microscope and by less experienced operators, the technique has limitations, and iatrogenesis may occur. This article describes the limitations of static-guided endodontics and possible causes of failures. In the present case, not fixing the guide to the bone and inaccuracies generated by manually performing mesh merger software led to root perforation. Endodontic microsurgery was effective in resolving this case and should be considered the treatment of choice when guided endodontics cannot be used safely or when it fails.
Topics: Cone-Beam Computed Tomography; Dental Pulp Calcification; Dental Pulp Cavity; Endodontics; Humans; Root Canal Therapy
PubMed: 34801590
DOI: 10.1016/j.joen.2021.11.004 -
Brazilian Dental Journal 2021These case reports aimed to describe the management of lateral perforation in the middle cervical third of the root in two maxillary incisors with pulp canal...
These case reports aimed to describe the management of lateral perforation in the middle cervical third of the root in two maxillary incisors with pulp canal calcification using Bio-C Repair, with safe and viable clinical treatment strategies. Digital radiographic exams were obtained with different angles and analyzed using different filters. Cone-beam computed tomography (CBCT) images were requested to show the actual position of the canal, location of the perforation, and guide the strategic planning of the case. Subsequently, cavity access was prepared with the aid of dental operating microscopy. After perforation was identified, granulation tissue was removed and the original canal was identified and then dressed with calcium hydroxide. In the second visit, the perforation was filled with Bio-C Repair and the canal system filled with gutta-percha points and a root canal sealer (Bio-C Sealer). The teeth were restored with glass fiber post, 4 mm beyond the perforation level, and provisory crowns. Both teeth treated as described above were functional and asymptomatic with a 1-year clinical and radiographic assessment. The Bio-C Repair is suggested as a new cement option for the management of lateral canal perforations, with effective results as observed after a one-year follow-up.
Topics: Calcium Hydroxide; Dental Pulp Cavity; Gutta-Percha; Humans; Root Canal Filling Materials; Root Canal Obturation; Root Canal Preparation
PubMed: 33913996
DOI: 10.1590/0103-6440202103568 -
Scanning 2021The aim of this study was to evaluate the quality of four root canal obturation techniques using microcomputed tomography (micro-CT).
PURPOSE
The aim of this study was to evaluate the quality of four root canal obturation techniques using microcomputed tomography (micro-CT).
MATERIALS AND METHODS
A total of 36 mandibular first premolars with mostly round canals were decoronated, then instrumented up to a size F3 rotary file, and dressed with an epoxy resin-based sealer. Subsequently, they were divided into 4 different groups ( = 9) based on the method of obturation: lateral condensation using 0.02 tapered master cone (LC2), lateral condensation using 0.04 tapered master cone (LC4), matched single-cone technique (MS), and matched single cone-mediated ultrasonic activation (MSUA). All the teeth were scanned using micro-CT (resolution of 19 m), and the percentage volume of voids was calculated. One-way analysis of variance and Tukey test were used to analyze the data ( = 0.05).
RESULTS
The total percentage volume of voids was significantly lower in the MSUA group compared to all other groups ( < 0.05). The total percentage volume of voids was significantly lower in the MS group compared to the LC4 ( < 0.001) and LC2 ( < 0.001) groups. However, there was no significant difference between the LC2 and LC4 groups ( < 0.65).
CONCLUSIONS
MSUA, significantly, showed the least root canal filling voids amongst all the obturation techniques studied. MSUA can be considered an effective method for the filling of the round root canals. In general, lateral condensation using either 0.02 or 0.04 tapered master cones had significantly the highest volume percentage of voids amongst the experimental groups.
Topics: Dental Pulp Cavity; Gutta-Percha; Root Canal Filling Materials; Root Canal Obturation; Root Canal Preparation; X-Ray Microtomography
PubMed: 33717394
DOI: 10.1155/2021/6632822 -
Journal of the American Dental... Jan 2021Endodontics is a rewarding and challenging profession. The tasks of negotiating, cleaning, and shaping canals can frustrate even the most talented clinicians,...
BACKGROUND AND OVERVIEW
Endodontics is a rewarding and challenging profession. The tasks of negotiating, cleaning, and shaping canals can frustrate even the most talented clinicians, particularly if the canals are blocked by calcifications. Circumventing these obstructions can be a slow, tedious process, and at times it is not possible. Various techniques have been developed to assist with this problem but have met with limited success. Given that the success of endodontic treatment is dependent on the elimination or reduction of bacterial influences on periapical tissues, this is a critical issue.
CASE DESCRIPTION
A new application of an existing technology is available. This technique uses 3-dimensional (3D) radiography (cone-beam computed tomography) and 3D intraoral imaging. Through the integration of the data sets, pathways are planned to locate blocked canals. Templates can be designed and fabricated on 3D printers that fit intimately on the dentition. Special drills are selected that fit through the sleeves embedded in the template. These pathways align the drill and guide the depth of the access. Once the canals are accessed, conventional root canal treatment is possible.
CONCLUSIONS AND PRACTICAL IMPLICATIONS
This case report reviews a new technique for treating a necrotic calcified root canal. The canal was identified in the apical one-third of the root. A pathway was planned to negotiate the canal using digital technology. The blockage was bypassed, and the root canal was successfully treated using a "template-guided access technique" with minimal tooth loss.
Topics: Cone-Beam Computed Tomography; Dental Pulp Cavity; Endodontics; Humans; Imaging, Three-Dimensional; Root Canal Therapy
PubMed: 33168140
DOI: 10.1016/j.adaj.2020.07.025