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Indian Journal of Dental Research :... 2021A successful root canal treatment involves the elimination of microorganisms, and prevents them from reinfecting the root and/or peri-radicular tissues. This can be...
BACKGROUND
A successful root canal treatment involves the elimination of microorganisms, and prevents them from reinfecting the root and/or peri-radicular tissues. This can be mainly achieved by efficient cleaning and shaping of the root canal system. Due to the complexity of the root canal morphology, hand and rotary files cannot clean areas such as the isthmuses and lateral canals. In such cases, effective irrigation and the use of intracanal medicaments are essential. Medicaments that are applied should be removed before obturation.
AIM
To evaluate the efficacy of passive ultrasonic irrigation in the removal of three different intracanal medicaments - Triple antibiotic paste (TAP), Odontopaste, and Metapex using a stereomicroscope.
METHODOLOGY
A total of 45 single-rooted human teeth were selected and decoronated. The root canals were shaped with ProTaper rotary files. The specimens were fixed in modified Eppendorf vials with silicone material. The roots were split longitudinally, and a standardized groove was prepared in the apical part. The teeth were randomly divided into three groups each containing 15 samples based on the intracanal medicament used: TAP, Odontopaste, and Metapex.
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The root halves were reassembled with sticky wax and remounted in the Eppendorf vial. Each specimen was irrigated with 3% NaOCl and agitated using a passive ultrasonic device. The root segments were disassembled. Digital images were obtained using a stereomicroscope.
RESULTS
The data were evaluated statistically using Kruskal-Wallis and Mann-Whitney U tests. There was a statistically significant difference in the remaining intracanal medicament score (P < 0.05).
CONCLUSION
Odontopaste showed the least remaining amount score, whereas TAP and Metapex showed greater retention within the dentin.
Topics: Calcium Hydroxide; Dental Pulp Cavity; Humans; Root Canal Irrigants; Root Canal Preparation; Therapeutic Irrigation; Ultrasonics
PubMed: 35229781
DOI: 10.4103/ijdr.IJDR_915_19 -
Journal of Dentistry Aug 2023To (1) validate the use of a post-operative intraoral scan (IOS) versus Cone Beam Computed Tomography (CBCT), gold standard, on its ability to measure the accuracy of...
OBJECTIVES
To (1) validate the use of a post-operative intraoral scan (IOS) versus Cone Beam Computed Tomography (CBCT), gold standard, on its ability to measure the accuracy of guided endodontics, and (2) present clinical data on the accuracy of guided endodontics.
METHODS
Four models, including 10 extracted teeth each, were created. Forty guided access cavities were planned on dentin to simulate pulp canal obliteration (PCO). Two operators performed guided access cavities. A post-operative CBCT and IOS were acquired. The coronal, apical, and angular deviations were measured with CBCT and IOS. Clinical accuracy was measured using an IOS acquired immediately after drilling the access cavity with the aid of a guide. Data analysis was performed using multiway Anova and corrected for simultaneous hypothesis testing according to Tukey. P ≤ 0.05 was considered statistically significant. Descriptive statistics on the clinical accuracy of guided endodontics were performed.
RESULTS
Thirty-eight cavities were assessed with a mean length of 13.8 mm. No statistical difference between operators and methods was found for all parameters (P > 0.05). Thirty-three patients were treated with guided endodontics and measured using an IOS. Results show an average coronal, apical, and angular deviation of 0.2 mm, 0.45 mm, and 1.91 respectively. The average length of the access cavities was 12.5 mm.
CONCLUSIONS
An IOS can be used to measure the accuracy of guided endodontics. Clinical data showed high accuracy of guided endodontics with a mean apical deviation smaller than 0.5 mm and a mean angular deviation of less than 2.
CLINICAL SIGNIFICANCE
The use of an IOS does not involve additional radiation exposure. A safety margin of at least 1 mm around the planned trajectory should be respected when planning the case to minimize the possibility of root perforation.
Topics: Humans; Dental Pulp Cavity; Endodontics; Dental Caries; Dental Pulp Diseases; Cone-Beam Computed Tomography
PubMed: 37263407
DOI: 10.1016/j.jdent.2023.104566 -
Journal of Applied Oral Science :... 2020This study assessed the incidence and variability features of root canals system (RCS) and their ramifications according to Pucci & Reig (PR) (1944) and the American...
OBJECTIVES
This study assessed the incidence and variability features of root canals system (RCS) and their ramifications according to Pucci & Reig (PR) (1944) and the American Association of Endodontists (AAE) (2017) by micro-computed tomography (μCT).
METHODOLOGY
500 representative extracted human teeth of each tooth group (n=50) (maxillary/mandibular central and lateral incisors, canines, first and second premolars and molars) were scanned by μCT with a resolution of 26.70 μm. The reconstructed cross-sections images and the visualization of the continuous slices in the transversal axis were performed using DataViewer software. RCS were classified according to Pucci & Reig (main canal, collateral canal, lateral canal, secondary canal, accessory canal, intercanal, recurrent canal) and AAE (main canal, accessory canal, lateral canal). The apical deltas were assessed for both classifications. The prevalence of apical deltas was evaluated using the Chi-squared test (p<0.05).
RESULTS
According to PR, a higher incidence of lateral canals was observed in maxillary canines (10%), central incisors (8%) and first premolars (6%). Using AAE, the highest incidence of lateral canals was observed in the mandibular first premolars (85%), first and second molars (84%), lateral incisors (67%), canines (59%), and in maxillary first premolars (52%). Regarding accessory canals, the PR showed a frequency in 2% of the maxillary lateral incisors and maxillary and mandibular first premolars and 3% of mandibular first and second molars. On the other hand, the AAE showed the highest incidence of accessory canals in 86% of the maxillary first premolars, 71% in mandibular lateral incisors, 69% in mandibular first premolars, 65% in mandibular canines, and 56% in maxillary canines. The PR showed the lowest incidence of apical deltas for all dental groups when compared with AAE (p=0.004). Interestingly, distal canals in maxillary molars showed a significant discrepancy between classifications (p=0.027).
CONCLUSIONS
μCT enabled accurately describing the RC system and related ramifications, adding to the PR and AAE classifications, with some discrepancies reported for maxillary molars. Clinical Relevance This μCT study enabled a thorough description of the variability among root canals and their ramifications, including clinically relevant details on the presence and location of lateral canals and accessories in all human tooth groups, beyond the currently existing classification systems.
Topics: Dental Pulp Cavity; Humans; Imaging, Three-Dimensional; Mandible; Maxilla; Reference Values; Statistics, Nonparametric; Tooth Apex; X-Ray Microtomography
PubMed: 32049137
DOI: 10.1590/1678-7757-2019-0393 -
BMC Oral Health Jan 2023To compare the retreatment efficiency of XP-endo Shaper and R-Endo files in curved root canals using ImageJ software.
OBJECTIVES
To compare the retreatment efficiency of XP-endo Shaper and R-Endo files in curved root canals using ImageJ software.
METHODS
Forty extracted mandibular first molars with curved mesial canals (25°-35°) were chosen. Access cavities, preparation and obturation of root canals were performed. Roots were randomly distributed into two groups corresponding to the retreatment files used. Group 1 retreated with XP-endo Shaper file, and group 2 retreated with R-Endo files. Each root was sectioned and photographed. ImageJ software was used to estimate the percentage of residual filling material that existed on the three root canal segments. Mann-Whitney U and the Kruskal-Wallis tests were used to compare the percentages of residual filling material between the teeth segments (P < .05).
RESULTS
The R-Endo group showed a significantly higher median percentage of residual filling material than the XP-endo Shaper group. In both groups, the coronal segments had the highest median of the residual filling material, followed by the middle and apical segments.
CONCLUSION
XP-endo Shaper is significantly more effective than R-Endo in removing root canal filling materials in the coronal, middle, and apical segments.
Topics: Humans; Dental Pulp Cavity; Root Canal Obturation; Root Canal Preparation; X-Ray Microtomography; Root Canal Filling Materials; Retreatment
PubMed: 36694152
DOI: 10.1186/s12903-023-02735-3 -
Surgical and Radiologic Anatomy : SRA Jul 2019To investigate the prevalence of isthmi and middle mesial (MM) canals in the mesial roots of mandibular first molars (MFM) in a Mongoloid subpopulation and to evaluate...
PURPOSE
To investigate the prevalence of isthmi and middle mesial (MM) canals in the mesial roots of mandibular first molars (MFM) in a Mongoloid subpopulation and to evaluate their association with demographic and anatomic characteristics.
METHODS
Cone-beam computed tomography (CBCT) images of 496 patients with 823 MFMs were selected and analyzed. The following data were collected: patient age and gender, side, presence and distribution of MM canal and isthmus, distance between mesiobuccal (MB) and mesiolingual (ML) orifices, and MB-ML root canal system (RCS) morphology. Logistic regression was used to determine the association between demographic and anatomic characteristics and the presence of isthmi in the apical third.
RESULTS
The overall prevalence of isthmus and an MM canal in MFM was 64.6% and 10.8%, respectively. The highest prevalence of isthmi and MM canals was found in patients of ≤ 20 and of 41-60 years, respectively (p < 0.05). The prevalence of isthmi declines with age. A total of 41.3% of the MFMs had isthmi in the apical third of the mesial roots. Younger age, shorter MB-ML orifice distance, and Weine type II RCS increased the probability of the presence of an isthmus in the apical third (p < 0.05).
CONCLUSION
The prevalence of isthmus in MFM is high in the subject population, but the prevalence of MM canals is not as high as previously reported. Demographic and anatomic characteristics could aid clinicians to better predict the presence of MM canal and an isthmus.
Topics: Adolescent; Adult; Age Factors; Aged; Anatomic Variation; Asian People; Child; Cone-Beam Computed Tomography; Dental Pulp Cavity; Female; Humans; Male; Mandible; Middle Aged; Molar; Prevalence; Sex Factors; Tooth Root; Young Adult
PubMed: 30937566
DOI: 10.1007/s00276-019-02231-w -
BMC Oral Health Mar 2024Root canal treatment procedures require a thorough understanding of root and canal anatomy. The purpose of this systematic review was to examine the morphological...
Assessment of the root and canal morphology in the permanent dentition of Saudi Arabian population using cone beam computed and micro-computed tomography - a systematic review.
INTRODUCTION
Root canal treatment procedures require a thorough understanding of root and canal anatomy. The purpose of this systematic review was to examine the morphological differences of teeth root and their canals assessed using cone-beam computed and micro-computed tomography in Saudi Arabian population.
METHODOLOGY
An electronic search was conducted in PubMed / Medline, Scopus, Google Scholar, and Web of Science databases until January 2023 to retrieve related studies. "Root canal morphology," "Saudi Arabia," "Micro-CT," and "cone-beam computed tomography" were used as keywords. A modified version of previously published risk of bias assessment tool was used to determine the quality assessment of included studies.
RESULTS
The literature search revealed 47 studies that matched the criteria for inclusion, out of which 44 studies used cone beam computed tomography (CBCT) and three were micro-computed tomography (micro-CT) studies. According to the modified version of risk of bias assessment tool, the studies were categorized as low, moderate, and high risk of bias. A total of 47,612 samples were included which comprised of either maxillary teeth (5,412), or mandibular teeth (20,572), and mixed teeth (21,327). 265 samples were used in micro-CT studies while 47,347 teeth samples were used in CBCT studies. Among the CBCT studies, except for three, all the studies were retrospective studies. Frequently used imaging machine and software were 3D Accuitomo 170 and Morita's i-Dixel 3D imaging software respectively. Minimum and maximum voxel sizes were 75 and 300 μm, Vertucci's classification was mostly used to classify the root canal morphology of the teeth. The included micro-CT studies were in-vitro studies where SkyScan 1172 X-ray scanner was the imaging machine with pixel size ranging between 13.4 and 27.4 μm. Vertucci, Ahmed et al. and Pomeranz et al. classifications were applied to classify the root canal morphology.
CONCLUSION
This systematic review revealed wide variations in root and canal morphology of Saudi population using high resolution imaging techniques. Clinicians should be aware of the common and unusual root and canal anatomy before commencing root canal treatment. Future micro-CT studies are needed to provide additional qualitative and quantitative data presentations.
Topics: Humans; Dentition, Permanent; Saudi Arabia; X-Ray Microtomography; Retrospective Studies; Dental Pulp Cavity; Tooth Root
PubMed: 38493123
DOI: 10.1186/s12903-024-04101-3 -
Journal of Endodontics Feb 2011The objective of this study was to evaluate the antimicrobial effects of photodynamic therapy (PDT) on infected human teeth ex vivo. (Comparative Study)
Comparative Study
INTRODUCTION
The objective of this study was to evaluate the antimicrobial effects of photodynamic therapy (PDT) on infected human teeth ex vivo.
METHODS
Fifty-two freshly extracted teeth with pulpal necrosis and associated periradicular radiolucencies were obtained from 34 subjects. Twenty-six teeth with 49 canals received chemomechanical debridement (CMD) with 6% NaOCl, and 26 teeth with 52 canals received CMD plus PDT. For PDT, root canal systems were incubated with methylene blue (MB) at concentration of 50 μg/mL for 5 minutes, followed by exposure to red light at 665 nm with an energy fluence of 30 J/cm(2). The contents of root canals were sampled by flushing the canals at baseline and after CMD alone or CMD+PDT and were serially diluted and cultured on blood agar. Survival fractions were calculated by counting colony-forming units (CFUs). Partial characterization of root canal species at baseline and after CMD alone or CMD+PDT was performed by using DNA probes to a panel of 39 endodontic species in the checkerboard assay.
RESULTS
The Mantel-Haenszel χ(2) test for treatment effects demonstrated the better performance of CMD+PDT over CMD (P = .026). CMD+PDT significantly reduced the frequency of positive canals relative to CMD alone (P = .0003). After CMD+PDT, 45 of 52 canals (86.5%) had no CFUs as compared with 24 of 49 canals (49%) treated with CMD (canal flush samples). The CFU reductions were similar when teeth or canals were treated as independent entities. Post-treatment detection levels for all species were markedly lower for canals treated by CMD+PDT than they were for those treated by CMD alone. Bacterial species within dentinal tubules were detected in 17 of 22 (77.3%) and 15 of 29 (51.7%) canals in the CMD and CMD+PDT groups, respectively (P = .034).
CONCLUSIONS
Data indicate that PDT significantly reduces residual bacteria within the root canal system, and that PDT, if further enhanced by technical improvements, holds substantial promise as an adjunct to CMD.
Topics: Bacteria; Chi-Square Distribution; Combined Modality Therapy; Debridement; Dental Pulp Cavity; Dental Pulp Necrosis; Disinfection; Humans; Methylene Blue; Periapical Periodontitis; Photochemotherapy; Radiation-Sensitizing Agents; Root Canal Therapy; Treatment Outcome
PubMed: 21238805
DOI: 10.1016/j.joen.2010.10.008 -
Journal of Applied Oral Science :... 2016To determine the prevalence of three-rooted mandibular molars in a Brazilian population using cone beam computed tomography (CBCT) and to analyze the anatomy of...
OBJECTIVES:
To determine the prevalence of three-rooted mandibular molars in a Brazilian population using cone beam computed tomography (CBCT) and to analyze the anatomy of mandibular first molars with three roots through micro-CT.
MATERIAL AND METHODS:
CBCT images of 116 patients were reviewed to determine the prevalence of three-rooted first mandibular molars in a Brazilian subpopulation. Furthermore, with the use of micro-CT, 55 extracted three-rooted mandibular first molars were scanned and reconstructed to assess root length, distance between canal orifices, apical diameter, Vertucci's classification, presence of apical delta, number of foramina and furcations, lateral and accessory canals. The distance between the orifice on the pulp chamber floor and the beginning of the curvature and the angle of canal curvature were analyzed in the distolingual root. Data were compared using the Kruskal-Wallis test (α=0.05).
RESULTS:
The prevalence of three-rooted mandibular first molars was of 2.58%. Mesial roots showed complex distribution of the root canal system in comparison to the distal roots. The median of major diameters of mesiobuccal, mesiolingual and single mesial canals were: 0.34, 0.41 and 0.60 mm, respectively. The higher values of major diameters were found in the distobuccal canals (0.56 mm) and the lower diameters in the distolingual canals (0.29 mm). The lowest orifice distance was found between the mesial canals (MB-ML) and the highest distance between the distal root canals (DB-DL). Almost all distal roots had one root canal and one apical foramen with few accessory canals.
CONCLUSIONS:
Distolingual root generally has short length, severe curvature and a single root canal with low apical diameter.
Topics: Anatomic Variation; Anatomy, Cross-Sectional; Brazil; Cone-Beam Computed Tomography; Dental Pulp; Dental Pulp Cavity; Female; Humans; Imaging, Three-Dimensional; Male; Mandible; Molar; Odontometry; Reference Values; Statistics, Nonparametric; Tooth Root
PubMed: 27812625
DOI: 10.1590/1678-775720150511 -
Indian Journal of Dental Research :... 2023The success of pulpectomy depends on complete eradication of microbial load by cleaning and shaping the primary root canals that is difficult to achieve because of...
BACKGROUND
The success of pulpectomy depends on complete eradication of microbial load by cleaning and shaping the primary root canals that is difficult to achieve because of anatomical intricacy of primary pulp dentin complex. Numerous instruments were tried, however, they proved to be inadequate. Selfadjusting file (SAF) is a newer file system that facilitates less dentin removal with maximal cleansing of root canals.
AIM
To evaluate and compare the in vitro root canal cleaning efficacy with SAF, Protaper Universal, and Hand K-files in primary teeth.
MATERIALS AND METHODS
Sixty extracted primary anterior teeth were randomly divided into three groups by lottery method. Access cavity was prepared, the canals were enlarged up to 20 K file, and an Indian ink was injected into each canal. Then the Group I (n = 20) was treated with SAF, Group II (n = 20) with Rotary Protaper Universal and Group III (n = 20) with Hand K-files and the root canal cleaning efficacy was evaluated based on the amount of Indian ink remaining in the canal walls under stereomicroscopy. Data were analyzed using Kruskal-Wallis one way ANOVA test and post hoc Tuckey test for intragroup and intergroup comparison, respectively.
RESULTS
A statistically highly significant difference was observed with SAF (mean = 1.5), Protaper (mean = 2.5), and Hand K-files (mean = 2.9). However, there was no significant difference in root canal cleaning efficacy with Protaper Universal and Hand K-files.
CONCLUSION
The SAFs had shown superior cleaning efficacy compared with rotary Protaper Universal and manual K files.
Topics: Dental Pulp Cavity; Equipment Design; Root Canal Preparation; Root Canal Therapy; Tooth, Deciduous; Humans
PubMed: 37417060
DOI: 10.4103/ijdr.ijdr_66_22 -
The Bulletin of Tokyo Dental College 2012The aim of this study was to evaluate the performance of undergraduates in their first contact with manual and rotary root canal instrumentation. Forty-two students who...
The aim of this study was to evaluate the performance of undergraduates in their first contact with manual and rotary root canal instrumentation. Forty-two students who had never worked on a root canal before instrumented 42 extracted lower-incisors. Participants were assigned to one of two groups: Rotary instrumentation or manual instrumentation. Pre- and post-operative computed tomography scans were obtained with a 3-dimensional dental imaging system. Starting and finishing times of preparation were recorded. The cross-sectional area of the root canal was analyzed with 2-mm-below-the-apex initial and final transverse images recorded through a digital imaging system and analyzed with software to measure the initial and final area of the root canal in mm(2). Data from the cross-sectional area of the root canal and time spent were subjected to the Mann-Whitney's U-test (p<0.05). The rotary instrumentation group showed smaller time for preparation (p=0.0204). No differences between rotary and manual instrumentation regarding the cross-sectional area of the root canal were observed (p=0.25). No accidents occurred. Undergraduate students showed good performance in their first contact with the manual and rotary instrumentation with regard to time spent and cross-sectional area of the root canal, with no operative accidents.
Topics: Anatomy, Cross-Sectional; Cone-Beam Computed Tomography; Dental Alloys; Dental Pulp Cavity; Edetic Acid; Education, Dental; Endodontics; Equipment Design; Humans; Imaging, Three-Dimensional; Incisor; Nickel; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite; Stainless Steel; Students, Dental; Time Factors; Titanium; Tooth Apex
PubMed: 23124306
DOI: 10.2209/tdcpublication.53.155