Siqueira, José F; Rôças, Isabela N; Lopes, Hélio P
The purpose of this study was to investigate the patterns of microbial infection of root canals in untreated teeth associated with chronic periradicular lesions by use of scanning electron microscopy. Fifteen extracted teeth with extensive carious lesions, radiolucent lesions of varying sizes, and attached periradicular lesions after extraction were selected for study. After fixation, lesions were removed and the teeth were split into 2 halves. The teeth were then dehydrated, sputter-coated with gold, and then examined for the patterns of microbial colonization of the root canal system by using a scanning electron microscope. All examined root canals were infected, and bacterial cells were seen in practically all areas of the root canal system. The pattern of colonization was not uniform between specimens and even within the same specimen. Most of the root canal walls of all specimens were heavily colonized by a root canal microbiota consisting of cocci and/or rods, often forming mixed communities. Spirilla were occasionally observed as single cells or as small clusters between other bacterial forms. Bacteria were often observed penetrating the dentinal tubules. Although a shallow penetration was the most common finding, bacterial cells could be observed reaching approximately 300 microm in some specimens. Yeastlike cells were observed in 1 specimen together with bacteria. The root canals of teeth associated with periradicular lesions were heavily infected by bacteria and occasionally by fungi. The pattern of colonization of the root canal microbiota often showed the characteristic of a climax community, which may require special considerations regarding its elimination and prevention of clinical problems. In addition, the observed propagation of the infection to the entire root canal system in teeth associated with periradicular lesions suggests that proper therapeutic measures may be necessary to eliminate the root canal infection completely.
Fifty-seven adults with apical periodontitis were examined for the presence of nonpigmented Bacteroides species in 62 infected root canals. Nonpigmented Bacteroides species were found in 35 canals. In four cases two nonpigmented Bacteroides species and in one case three nonpigmented Bacteroides species were found. Species belonging to the B. fragilis group were not isolated. The most frequently isolated species were B. buccae (15 strains), B. oris (12 strains), and B. oralis (7 strains). alpha-Fucosidase, beta-N-acetylglucosaminidase, and beta-xylosidase appeared to be useful in the identification of B. buccae and B. oris. Corroding Bacteroides species were not found; all corroding strains were identified as Wolinella recta. The occurrence of nonpigmented Bacteroides species was compared with the severity of the periapical infection. A total of 13 B. buccae strains were found in acute infections and only 2 strains were found in asymptomatic infections, whereas other nonpigmented Bacteroides species were present in acutely infected and asymptomatic teeth with nearly equal frequency. Ultrastructural study of 13 B. buccae strains showed that 8 strains had a crystalline proteinaceous surface layer (S-layer) outside the outer membrane, but all 13 strains had areas of crystalline protein throughout in the outer membrane. The results suggest that B. buccae may have a specific role in the development of an acute opportunistic infection. Images PMID:3782459
Schäfer, E; Bössmann, K
During and after chemomechanical preparation, particularly before the definitive filling of an infected root canal, a temporary intracanal dressing with an antimicrobial activity is generally indicated. Therefore, the aim of this study was to investigate the antimicrobial effect of ED 84, a liquid root canal disinfectant containing chloroxylenol (10%) and camphor (15%), against selected test organisms (Staphylococcus aureus, Streptococcus faecalis, Escherichia coli, and Candida albicans) both in vitro and under clinical conditions, using extracted teeth. With a contact time of 180 min between undiluted ED 84 and the four bacterial suspensions in the canal, there was a 2 to 3 log reduction in the number of organisms. Under in vitro conditions, the reduction was even greater than 3 logs. When using a liquid medication as a temporary root canal dressing for a duration of approximately 2 days, ED 84 can definitely be used.
... an infection that affects the pulp of a tooth. Generally, there is pain and swelling in the area. The infection can ... their normal routine the next day. Until the tooth is permanently filled or covered with a crown, you should avoid rough chewing in the area.
Gajan, Esrafil Balaei; Aghazadeh, Mohammad; Abashov, Rahib; Salem Milani, Amin; Moosavi, Zohreh
Background and aims The aim of this study was to determine the microorganisms prevalent in the necrotic dental pulp and root canals of unsuccessfully treated teeth. Materials and methods The present study was conducted on 150 single-rooted teeth of patients referring to a dental clinic. Sampling was performed by placing a sterile paper point in the canal for 60 s. Bacterial samples were evaluated by a microbiological technique specific for anaerobic species, used for isolation and identification of sampled strains. Results From the 150 samples taken, 101 were from necrotic pulps (primary infection) and 49 were from the teeth with an unsuccessful endodontic treatment (secondary infection). Conclusion Enterococcus faecalis was a prevalent species in the failed root canals evaluated. PMID:23230477
Dubey, Sandeep; Saha, Suparna Ganguly; Rajkumar, Balakrishnan; Dhole, Tapan Kumar
This study aims to evaluate and compare the antimicrobial efficacy of three selected root canal irrigants (BioPure MTAD, metronidazole, aztreonam) against microbes commonly isolated from polymicrobial microbiota of root canal infection. This study was designed with four experimental groups (Group I - Bacteroides fragilis, Group II - Propionibacterium acnes, Group III - Enterococcus faecalis, Group IV - Candida albicans) based on the microbes selected for the study. Group I and Group II bacteria were used to compare and evaluate antimicrobial effect of BioPure MTAD, metronidazole, aztreonam, and normal saline. Group III and Group IV bacteria were used to compare and evaluate antimicrobial efficacy of BioPure MTAD, aztreonam, and normal saline. Normal saline was used as a control irrigant in this study. Agar disc diffusion method was applied to assess and compare the antimicrobial action of selected irrigants. Metronidazole was found to be the most effective root canal irrigant against B. fragilis and P. acnes among the tested irrigants. Mean zone of inhibition against E. faecalis has been shown to be maximum by BioPure MTAD, followed by aztreonam. Antifungal effect against C. albicans was only shown by BioPure MTAD. Overall, BioPure MTAD is the most effective root canal irrigant as it has shown an antibacterial effect against all the tested microorganisms. However, metronidazole showed maximum antibacterial effect against obligate anaerobes. Aztreonam also showed an antibacterial effect in the present study, raising its possibility to be used as a root canal irrigant in the future.
Kandaswamy, Deivanayagam; Venkateshbabu, Nagendrababu
Successful root canal therapy relies on the combination of proper instrumentation, irrigation, and obturation of the root canal. Of these three essential steps of root canal therapy, irrigation of the root canal is the most important determinant in the healing of the periapical tissues. The primary endodontic treatment goal must thus be to optimize root canal disinfection and to prevent reinfection. In this review of the literature, various irrigants and the interactions between irrigants are discussed. We performed a Medline search for English-language papers published untill July 2010. The keywords used were 'root canal irrigants' and 'endodontic irrigants.' The reference lists of each article were manually checked for additional articles of relevance.
Kandaswamy, Deivanayagam; Venkateshbabu, Nagendrababu
Successful root canal therapy relies on the combination of proper instrumentation, irrigation, and obturation of the root canal. Of these three essential steps of root canal therapy, irrigation of the root canal is the most important determinant in the healing of the periapical tissues. The primary endodontic treatment goal must thus be to optimize root canal disinfection and to prevent reinfection. In this review of the literature, various irrigants and the interactions between irrigants are discussed. We performed a Medline search for English-language papers published untill July 2010. The keywords used were ‘root canal irrigants’ and ‘endodontic irrigants.’ The reference lists of each article were manually checked for additional articles of relevance. PMID:21217955
Berditsch, Marina; Lux, Hannah; Babii, Oleg; Afonin, Sergii; Ulrich, Anne S.
An intrinsic clindamycin-resistant Enterococcus faecalis, the most common single species present in teeth after failed root canal therapy, often possesses acquired tetracycline resistance. In these cases, root canal infections are commonly treated with Ledermix® paste, which contains demeclocycline, or the new alternative endodontic paste Odontopaste, which contains clindamycin; however, these treatments are often ineffective. We studied the killing activity of the cyclic antimicrobial peptide gramicidin S (GS) against planktonic and biofilm cells of tetracycline-resistant clinical isolates of E. faecalis. The high therapeutic potential of GS for the topical treatment of problematic teeth is based on the rapid bactericidal effect toward the biofilm-forming, tetracycline-resistant E. faecalis. GS reduces the cell number of planktonic cells within 20–40 min at a concentration of 40–80 μg/mL. It kills the cells of pre-grown biofilms at concentrations of 100–200 μg/mL, such that no re-growth is possible. The translocation of the peptide into the cell interior and its complexation with intracellular nucleotides, including the alarmon ppGpp, can explain its anti-biofilm effect. The successful treatment of persistently infected root canals of two volunteers confirms the high effectiveness of GS. The broad GS activity towards resistant, biofilm-forming E. faecalis suggests its applications for approval in root canal medication. PMID:27618065
Rôças, Isabela N; Siqueira, José F
Fourty-one bacterial strains isolated from infected dental root canals and identified by 16S rRNA gene sequence were screened for the presence of 14 genes encoding resistance to beta-lactams, tetracycline and macrolides. Thirteen isolates (32%) were positive for at least one of the target antibiotic resistance genes. These strains carrying at least one antibiotic resistance gene belonged to 11 of the 26 (42%) infected root canals sampled. Two of these positive cases had two strains carrying resistance genes. Six out of 7 Fusobacterium strains harbored at least one of the target resistance genes. One Dialister invisus strain was positive for 3 resistance genes, and 4 other strains carried two of the target genes. Of the 6 antibiotic resistance genes detected in root canal strains, the most prevalent were blaTEM (17% of the strains), tetW (10%), and ermC (10%). Some as-yet-uncharacterized Fusobacterium and Prevotella isolates were positive for blaTEM, cfxA and tetM. Findings demonstrated that an unexpectedly large proportion of dental root canal isolates, including as-yet-uncharacterized strains previously regarded as uncultivated phylotypes, can carry antibiotic resistance genes. Copyright © 2012 Elsevier Ltd. All rights reserved.
Chavez de Paz, Luis E; Chávez de Paz, Luis
Current concepts suggest that persisting infections subsequent to endodontic therapy are caused by one or two bacterial species that are "too robust" to be eliminated by conventional treatment measures. As a consequence, numerous studies are exploring the characteristics of these "most" resistant organisms to define an effective treatment strategy to eradicate them from root canals. By taking an ecological perspective, the main objective of this review is to present evidence that the nature of persisting endodontic infections depends not on the robustness of the organisms in the infected site, but on their capability of adapting their physiology to the new environmental conditions set by the treatment. Changes in the environment, such as an increase in pH by calcium hydroxide or the effect of antimicrobials, are capable of triggering genetic cascades that modify the physiological characteristics of bacterial cells. Surface adherence by bacteria to form biofilms is a good example of bacterial adaptation and one that is pertinent to endodontic infections. Increasing information is now available on the existence of polymicrobial biofilm communities on root canal walls, coupled with new data showing that the adaptive mechanisms of bacteria in these biofilms are significantly augmented for increased survival. This ecological view on the persisting infection problem in endodontics suggests that the action of individual species in persisting endodontic infections is secondary when compared to the adaptive changes of a polymicrobial biofilm community undergoing physiological and genetic changes in response to changes in the root canal environment.
Herrera, D R; Silva, E J N L; Santos, C C; Zaia, A A; Ferraz, C C R; Almeida, J F A; Gomes, B P F A
To investigate endotoxin levels from primary endodontic infections before and after chemomechanical preparation (CMP) and to determine their antigenicity against 3T3 fibroblasts through gelatinolytic activity of matrix metalloproteinases (MMPs). Twenty-four root canals with primary endodontic infection and apical periodontitis were selected. Samples were collected using paper points before (S1) and after chemomechanical preparation (CMP) (S2). The limulus amebocyte lysate assay was used for endotoxin measurement. Fibroblasts were stimulated with root canal contents for 24 h. Supernatants of cell cultures stimulated with root canal contents were collected after 24 h to determine the levels of MMP-2 and MMP-9 gelatinolytic activity using the zymography technique. Friedman and Wilcoxon tests were used to compare the amount of endotoxin before (S1) and after CMP (S2) (P < 0.05). Data obtained from gelatinolytic activity were analysed using anova and Tukey's tests (P < 0.05). Endotoxin was recovered in 100% of the samples. There was a significant reduction in endotoxin levels after CMP (P < 0.05). A correlation was found between the levels of endotoxins and MMP-2 expression (P < 0.05). Root canal contents of initial samples (S1) induced significantly greater MMP-2 expression by fibroblasts when compared to S2 and the nonstimulated group (P < 0.05). No gelatinolytic activity of MMP-9 was observed in S1, S2 and control group. Root canal contents from primary endodontic infections had gelatinolytic activity for MMP-2. Moreover, CMP was effective in reducing endotoxin levels and their antigenicity against fibroblasts on gelatinolytic activity. © 2014 International Endodontic Journal. Published by John Wiley & Sons Ltd.
Nóbrega, Letícia M M; Montagner, Francisco; Ribeiro, Adriana C; Mayer, Márcia A P; Gomes, Brenda P F A
The objective of this study was to investigate the bacterial composition present in root canals of teeth associated with acute apical abscess by molecular identification (16S rRNA) of cultivable bacteria. Two hundred and twenty strains isolated by culture from 20 root canals were subjected to DNA extraction and amplification of the 16S rRNA gene (PCR), followed by sequencing. The resulting nucleotide sequences were compared to the GenBank database from the National Center of Biotechnology Information through BLAST. Strains not identified by sequencing were submitted to clonal analysis. The association of microbiological findings with clinical features and the association between microbial species were also investigated. Fifty-nine different cultivable bacteria were identified by 16S rRNA gene sequencing, belonging to 6 phyla, with an average number of 6 species per root canal. Molecular approaches allowed identification of 99% of isolates. The most frequently identified bacteria were Prevotella spp., Pseudoramibacter alactolyticus, Parvimonas micra, Dialister invisus, Filifactor alocis, and Peptostreptococcus stomatis. Positive association was found between Prevotella buccae and Pseudoramibacter alactolyticus and between Parvimonas micra and Prevotella nigrescens (both p<0.05). It was concluded that the microbiota of infected root canals associated with acute apical abscess is diverse and heterogeneous, composed mainly of anaerobic Gram-negative bacteria, with the great majority belonging to the phyla Firmicutes and Bacteroidetes.
Dubey, Sandeep; Saha, Suparna Ganguly; Rajkumar, Balakrishnan; Dhole, Tapan Kumar
Objective: This study aims to evaluate and compare the antimicrobial efficacy of three selected root canal irrigants (BioPure MTAD, metronidazole, aztreonam) against microbes commonly isolated from polymicrobial microbiota of root canal infection. Materials and Methods: This study was designed with four experimental groups (Group I – Bacteroides fragilis, Group II – Propionibacterium acnes, Group III – Enterococcus faecalis, Group IV – Candida albicans) based on the microbes selected for the study. Group I and Group II bacteria were used to compare and evaluate antimicrobial effect of BioPure MTAD, metronidazole, aztreonam, and normal saline. Group III and Group IV bacteria were used to compare and evaluate antimicrobial efficacy of BioPure MTAD, aztreonam, and normal saline. Normal saline was used as a control irrigant in this study. Agar disc diffusion method was applied to assess and compare the antimicrobial action of selected irrigants. Results: Metronidazole was found to be the most effective root canal irrigant against B. fragilis and P. acnes among the tested irrigants. Mean zone of inhibition against E. faecalis has been shown to be maximum by BioPure MTAD, followed by aztreonam. Antifungal effect against C. albicans was only shown by BioPure MTAD. Conclusions: Overall, BioPure MTAD is the most effective root canal irrigant as it has shown an antibacterial effect against all the tested microorganisms. However, metronidazole showed maximum antibacterial effect against obligate anaerobes. Aztreonam also showed an antibacterial effect in the present study, raising its possibility to be used as a root canal irrigant in the future. PMID:28435359
Herbst, Sascha R.; Hertel, Moritz; Ballout, Husam; Pierdzioch, Philipp; Weltmann, Klaus-Dieter; Wirtz, Henrik C.; Abu-Sirhan, Shady; Kostka, Eckehard; Paris, Sebastian; Preissner, Saskia
Objectives: Cold plasma (CP) has been shown to be effective even against multiresistant microorganisms. As previous investigations on the effect of CP in root canals showed promising results, the aim of the present study was to analyze the bactericidal efficacy of CP in different depths of infected dentin. Methods: 32 standardized root canals of human mandibular premolars were infected with Enterococcus faecalis and incubated for one week. Specimens were randomly selected for one of four disinfection methods: control (5mL NaCl), 5mL chlorhexidine (CHX), CP alone (CP), and a combination of 5mL CHX and cold plasma (CHX+CP). CHX was ultrasonically activated for 30s, while cold plasma was used for 60s in the root canals. Dentin samples at depths of 300, 500 and 800 µm were obtained and diluted serially. Colony forming units (CFUs) were counted on agar plates after 24h of incubation. Results: The highest overall logarithmic reduction factors (RF) were obtained from CHX+CP (log RF 3.56 p<0.01; Mann-Whitney U test), followed by CP (log RF 3.27 p<0.01) and CHX alone (log RF 2.65 p<0.01) related to the control. All disinfection methods showed significantly lower CFU counts compared to the control group in 300 µm and 800 µm (both p<0.01, Kruskal-Wallis test). Discussion: The adjuvant use of CP might be beneficial in highly infected root canals to improved disinfection. However, the disinfection effect against Enterococcus faecalis of CP is comparable to ultrasonically activated CHX. PMID:26962378
Schiffner, Ulrich; Cachovan, Georg; Bastian, Jochen; Sculean, Anton; Eick, Sigrun
To investigate the lethal activity of photoactivated disinfection (PAD) on Enterococcus faecalis (ATCC 29212) and mixed populations of aerobic or anaerobic bacteria in infected root canals using a diode laser after the application of a photosensitizer (PS). First, the bactericidal activity of a low power diode laser (200 mW) against E. faecalis ATCC 29212 pre-treated with a PS (toluidine blue) for 2 min were examined after different irradiation times (30 s, 60 s and 90 s). The bactericidal activity in the presence of human serum or human serum albumin (HSA) was also examined. Second, root canals were infected with E. faecalis or with mixed aerobic or anaerobic microbial populations for 3 days and then irrigated with 1.5% sodium hypochlorite and exposed to PAD for 60 s. Photosensitization followed by laser irradiation for 60 s was sufficient to kill E. faecalis. Bacteria suspended in human serum (25% v/v) were totally eradicated after 30 s of irradiation. The addition of HSA (25 mg/ml or 50 mg/ml) to bacterial suspensions increased the antimicrobial efficacy of PAD after an irradiation time of 30 s, but no longer. The bactericidal effect of sodium hypochlorite was only enhanced by PAD during the early stages of treatment. PAD did not enhance the activity of sodium hypochlorite against a mixture of anaerobic bacteria. The bactericidal activity of PAD appears to be enhanced by serum proteins in vitro, but is limited to bacteria present within the root canal.
Santos, Adriana L; Siqueira, José F; Rôças, Isabela N; Jesus, Ederson C; Rosado, Alexandre S; Tiedje, James M
This study performed barcoded multiplex pyrosequencing with a 454 FLX instrument to compare the microbiota of dental root canal infections associated with acute (symptomatic) or chronic (asymptomatic) apical periodontitis. Analysis of samples from 9 acute abscesses and 8 chronic infections yielded partial 16S rRNA gene sequences that were taxonomically classified into 916 bacterial species-level operational taxonomic units (OTUs) (at 3% divergence) belonging to 67 genera and 13 phyla. The most abundant phyla in acute infections were Firmicutes (52%), Fusobacteria (17%) and Bacteroidetes (13%), while in chronic infections the dominant were Firmicutes (59%), Bacteroidetes (14%) and Actinobacteria (10%). Members of Fusobacteria were much more prevalent in acute (89%) than in chronic cases (50%). The most abundant/prevalent genera in acute infections were Fusobacterium and Parvimonas. Twenty genera were exclusively detected in acute infections and 18 in chronic infections. Only 18% (n = 165) of the OTUs at 3% divergence were shared by acute and chronic infections. Diversity and richness estimators revealed that acute infections were significantly more diverse than chronic infections. Although a high interindividual variation in bacterial communities was observed, many samples tended to group together according to the type of infection (acute or chronic). This study is one of the most comprehensive in-deep comparisons of the microbiota associated with acute and chronic dental root canal infections and highlights the role of diverse polymicrobial communities as the unit of pathogenicity in acute infections. The overall diversity of endodontic infections as revealed by the pyrosequencing technique was much higher than previously reported for endodontic infections.
Santos, Adriana L.; Siqueira, José F.; Rôças, Isabela N.; Jesus, Ederson C.; Rosado, Alexandre S.; Tiedje, James M.
This study performed barcoded multiplex pyrosequencing with a 454 FLX instrument to compare the microbiota of dental root canal infections associated with acute (symptomatic) or chronic (asymptomatic) apical periodontitis. Analysis of samples from 9 acute abscesses and 8 chronic infections yielded partial 16S rRNA gene sequences that were taxonomically classified into 916 bacterial species-level operational taxonomic units (OTUs) (at 3% divergence) belonging to 67 genera and 13 phyla. The most abundant phyla in acute infections were Firmicutes (52%), Fusobacteria (17%) and Bacteroidetes (13%), while in chronic infections the dominant were Firmicutes (59%), Bacteroidetes (14%) and Actinobacteria (10%). Members of Fusobacteria were much more prevalent in acute (89%) than in chronic cases (50%). The most abundant/prevalent genera in acute infections were Fusobacterium and Parvimonas. Twenty genera were exclusively detected in acute infections and 18 in chronic infections. Only 18% (n = 165) of the OTUs at 3% divergence were shared by acute and chronic infections. Diversity and richness estimators revealed that acute infections were significantly more diverse than chronic infections. Although a high interindividual variation in bacterial communities was observed, many samples tended to group together according to the type of infection (acute or chronic). This study is one of the most comprehensive in-deep comparisons of the microbiota associated with acute and chronic dental root canal infections and highlights the role of diverse polymicrobial communities as the unit of pathogenicity in acute infections. The overall diversity of endodontic infections as revealed by the pyrosequencing technique was much higher than previously reported for endodontic infections. PMID:22132218
Ma, Rui; Huang, Li-li; Xia, Wen-wei; Zhu, Cai-lian; Ye, Dong-xia
To assess the efficacy of compound Chinese traditional medicine(CTM), which composed of gallic acid, magnolol and polysaccharide of Blettila striata, against the infected root canal bacterial biofilm. Actinomyces viscosus (Av), Enterococcus faecalis (Ef), Fusobacterium nucleatum (Fn) were composed to form biofilm, then confocal laser scan microscope (CLSM) was used to observe and study the bacterial activity. SAS6.12 software package was used for statistical analysis. The biofilm thickness reduced after treatment by both CTM and ZnO (P>0.05),while there was a significant decrease of the percentage of vital bacterias after treatment by CTM (P<0.01). The compound Chinese traditional medicine is effective on biofilm control, so that it would be an effective disinfecting drug for root canal sealers. Supported by Research Fund of Bureau of Traditional Chinese Medicine of Shanghai Municipality (Grant No.2008L008A).
Zehnder, Matthias; Belibasakis, Georgios N
Infections of the root canal space and their sequelae can be extremely painful and potentially dangerous, yet they do not necessarily have to be. Chronic, asymptomatic inflammatory lesions around the apex of a tooth with a necrotic dental pulp or an insufficient root canal treatment can develop unnoticed by the patient, and remain so for years. The course of disease is modulated by both the virulence of the microbiota established in the root canal space and the capacity of the immune system to curb the infection. To both ends, highly convincing investigations to help us understand when and why the tissues around an endodontically involved tooth become acutely inflamed are missing. We will discuss how recent advances in molecular identification of microorganisms have altered our understanding of root canal infections, and which information is currently missing to link clinical experience with observations from experimental research.
Rôças, Isabela N; Siqueira, José F
Members of the Dialister genus are asaccharolytic obligately anaerobic gram-negative coccobacilli that are culture-difficult or remain uncultivated. Their participation in endodontic infections has been only consistently demonstrated after advent of molecular biology approaches. This study was undertaken to characterize Dialister species in samples from primary endodontic infections using a devised 16S rRNA gene-based group-specific heminested PCR assay followed by sequencing of PCR products. Genomic DNA was isolated directly from clinical samples and used as template for PCR. Amplicons from positive specimens were sequenced and phylogenetically analyzed to determine species identity. Ten of 21 clinical samples yielded sequences with the highest percent similarities to oral Dialister species/phylotypes. Seven sequences were from Dialister invisus, and the other three sequences belonged to Dialister pneumosintes, Dialister oral clone BS095 and Dialister sp. clone IS013B24. Findings demonstrated that different Dialister species can take part in the microbiota associated with apical periodontitis lesions.
Harini Priya, M; Bhat, Sham S; Sundeep Hegde, K
Since complete debridement of the root canals of the primary teeth is not practically possible due to the highly variable root canal anatomy, success of the endodontic therapy depends partly on the use ofantibacterial irrigating agents and root canal filling materials. Recent literature indicates that anaerobes comprise a majority of the bacteria in necrotic root canals ofprimary teeth. The study determined the antibacterial effectiveness of four root canal filling materials namely Calcium hydroxide, Zinc oxide eugenol, Vitapex and Metapex against microbial specimens obtained directly from necrotic root canals of primary teeth. Microbial specimens were collected using sterile paper points, from 15 primary maxillary and mandibular posterior teeth of randomly selected children in the age group of 4-10 years with infected non vital primary teeth, requiring pulpectomy procedure. The microbial specimens collected were subjected to microbiological analysis and the antimicrobial potential of root canal filling materials were tested using Agar diffusion technique. were statistically analyzed using one-way ANOVA. Facultative/Aerobic organisms were isolated in all the cases, anaerobic organisms were isolated in 80% of the cases, and Candida albicans was isolated in 1 case. ZOE showed superior inhibitory activity against most of the organisms isolated followed by Vitapex, Calcium hydroxide and Metapex in descending order. Our data may be useful as a guide for relative antimicrobial effectiveness or non-effectiveness of the materials employed. In vivo studies are required to state the specific antimicrobial activity and merits and demerits of any of the test filling material.
Estrela, Carlos; Porto, Olavo César Lyra; Costa, Nádia Lago; Garrote, Marcel da Silva; Decurcio, Daniel Almeida; Bueno, Mike R; Silva, Brunno Santos de Freitas
Inflammatory injuries in the maxillary sinus may originate from root canal infections and lead to bone resorption or regeneration. This report describes the radiographic findings of 4 asymptomatic clinical cases of large reactional osteogenesis in the maxillary sinus (MS) associated with secondary root canal infection detected using cone-beam computed tomographic (CBCT) imaging. Apical periodontitis, a consequence of root canal infection, may lead to a periosteal reaction in the MS and osteogenesis seen as a radiopaque structure on imaging scans. The use of a map-reading strategy for the longitudinal and sequential slices of CBCT images may contribute to the definition of diagnoses and treatment plans. Root canal infections may lead to reactional osteogenesis in the MS. High-resolution CBCT images may reveal changes that go unnoticed when using conventional imaging. Findings may help define initial diagnoses and therapeutic plans, but only histopathology provides a definitive diagnosis. Surgical enucleation of the periapical lesion is recommended if nonsurgical root canal treatment fails to control apical periodontitis.
Morphological and physiological characteristics of 103 streptococcal isolates obtained from positive routine cultures of material from dental root canals at filling, were studied. The majority of the isolates were those which at a primary identification not fullfilled the criteria of enterococci, Strep. sanguis, Strep. mutans or Strep. salivarius. Only a few representative strains of the latter types were included in the study as a control of the method. The resemblance of the 103 isolates to 38 reference strains were assessed with numerical methods. The isolates formed 9 clusters with reference strains occurring in all but one. Of the isolates which it was intended to identify and characterize with numerical taxonomic analysis, all but one joined one of 3 clusters and were identified as Strep. milleri or Strep. mitior (mitis). The most useful cultural characteristics to dfferentiate the two species were growth on the sulphonamide containing MC-agar and 7.5% bile blood agar by Strep. milleri and production of hydrogen peroxide by Strep. mitior. The characteristics of the strains in the nine 80-phenons are given in Table 2. Other characteristics that appeared to be of interest for differentiating Strep. milleri from Strep. mitior and these two species from other viridans streptococci are underlined in Table 2. Strep. milleri seems not earlier to have been reported to occur in infected root canals. The occurrence of Strep. milleri is in agreement with the data given on serological groups found among streptococcal isolates from routine root canal cultures. Little is known about the occurrence and distribution of Strep. milleri in the human oral cavity, which therefore warrant further investigations.
Zandi, Homan; Rodrigues, Renata C V; Kristoffersen, Anne K; Enersen, Morten; Mdala, Ibrahimu; Ørstavik, Dag; Rôças, Isabela N; Siqueira, José F
This study compared the antibacterial effects of 1% sodium hypochlorite (NaOCl) and 2% chlorhexidine digluconate (CHX) during retreatment of teeth with apical periodontitis. Root canal-treated teeth with apical periodontitis were randomly distributed into 2 groups. Bacteriological samples were taken from the canals before (S1) and after (S2) preparation using either NaOCl or CHX irrigation and after calcium hydroxide medication (S3); 16S ribosomal RNA gene-based real-time quantitative polymerase chain reaction was performed to quantify total bacteria, streptococci, and Enterococcus faecalis. Forty-nine teeth were available for analysis (NaOCl, n = 20; CHX, n = 29). Bacterial DNA occurred in all S1 samples, streptococci in 57% and E. faecalis in 6%. The total bacterial counts decreased from S1 to S2 in both groups (P < .01) but were higher in S3 than S2 (P < .01). Thirty-five percent of the teeth in the NaOCl group were positive in S2, decreasing to 20% in S3. In the CHX group, 41% were positive in S2, decreasing to 31% in S3. The bacterial load in S1 influenced the incidence of bacteria in S2 (P < .01). Streptococci were significantly reduced in both groups, and E. faecalis was found in only 1 S2 sample and not in S3. No significant difference between NaOCl and CHX was found. NaOCl and CHX both reduced bacterial counts and the number of infected canals. Intracanal medication with calcium hydroxide reduced the number of canals with persistent infection but resulted in overall larger bacterial counts in the cases positive for bacteria. The effectiveness of antimicrobial treatment can be influenced by the initial bacterial load. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
Sampaio Moura, Marcelo; Zanin, Fatima A. A.; Brugnera, Aldo, Jr.; Rodrigues de Araujo Estrela, Cyntia; Estrela, Carlos; Djalma Pecora, Jesus
This study evaluated in vitro the antimicrobial action of Er:YAG laser in infected root canals. A total of 36 human anterior teeth were prepared, sterilized and inoculated with suspensions of S. aureus, E. faecalis, P aeruginosa, B. subtilis and C. albicans. After the contamination period (28 days), the teeth were irrigated with sterile distilled water or 1% sodium hypochlorite and, then, irradiated with an Er:YAG laser (wavelength 2094 nm) with two different evaluation parameters: 52 mJ and 110 mJ laser output at the fiber tip. After the irradiation, the teeth were irrigated with sterile distilled water and the solutions were collected with sterile paper points and incubated in Letheen Broth for 48 hours. After this period 0,1 ml of this solution was transferred to 10 ml of Brain Heart Infusion and incubated for 48 hours. After 72 hours a new collect ion was done and incubated again. Based on the data, it was concluded that the distilled water or 1% sodium hypochlorite irradiated or not with an Er:YAG laser with two different parameters: 10 Hz, 110 mJ input and 52 mJ output, and 10 Hz, 250 mJ input and 110 mJ output had no antimicrobial activity in the root canals contaminated with the following microorganisms: Enterococcus faecalis, Staphylococcus aureus, Pseudomonas aeruginosa, Bacillus subtilis and Candida albicans.
Valera, Marcia Carneiro; Cardoso, Flávia Goulart da Rosa; Chung, Adriana; Xavier, Ana Cláudia Carvalho; Figueiredo, Mariana Diehl; Martinho, Frederico Canato; Palo, Renato Miotto
This study was conducted to compare the effectiveness of different irrigants used to remove endotoxins and cultivable microorganisms during endodontic therapy. Forty root canals were contaminated and divided into groups according to the irrigant: 2% NaOCl + surfactant, 2% CHX, 2.5% NaOCl, and pyrogen-free saline solution (control). Samples were collected after root canal contamination (S1), after instrumentation (S2), and 7 days after instrumentation (S3). Microorganisms and endotoxins were recovered from 100% of the contaminated root canals (S1). At S2, 2% NaOCl + surfactant, 2% CHX, and 2.5% NaOCl were able to completely eliminate cultivable microorganisms. At S3, both 2% CHX and 2.5% NaOCl were effective in preventing C. albicans and E. coli regrowth, but E. faecalis was still detected. No microorganism species was recovered from root canals instrumented with 2% NaOCl + surfactant. At S2, a higher percentage value of endotoxin reduction was found for 2% NaOCl + surfactant (99.3%) compared to 2% CHX (98.9%) and 2.5% NaOCl (97.18%) (p < 0.05). Moreover, at S3, 2% NaOCl + surfactant (100%) was the most effective irrigant against endotoxins. All irrigants tested were effective in reducing microorganisms and endotoxins from root canals. Moreover, 2% NaOCl + surfactant was the most effective irrigant against endotoxins and regrowth of microorganisms.
Valera, Marcia Carneiro; Cardoso, Flávia Goulart da Rosa; Chung, Adriana; Xavier, Ana Cláudia Carvalho; Figueiredo, Mariana Diehl; Martinho, Frederico Canato; Palo, Renato Miotto
This study was conducted to compare the effectiveness of different irrigants used to remove endotoxins and cultivable microorganisms during endodontic therapy. Forty root canals were contaminated and divided into groups according to the irrigant: 2% NaOCl + surfactant, 2% CHX, 2.5% NaOCl, and pyrogen-free saline solution (control). Samples were collected after root canal contamination (S1), after instrumentation (S2), and 7 days after instrumentation (S3). Microorganisms and endotoxins were recovered from 100% of the contaminated root canals (S1). At S2, 2% NaOCl + surfactant, 2% CHX, and 2.5% NaOCl were able to completely eliminate cultivable microorganisms. At S3, both 2% CHX and 2.5% NaOCl were effective in preventing C. albicans and E. coli regrowth, but E. faecalis was still detected. No microorganism species was recovered from root canals instrumented with 2% NaOCl + surfactant. At S2, a higher percentage value of endotoxin reduction was found for 2% NaOCl + surfactant (99.3%) compared to 2% CHX (98.9%) and 2.5% NaOCl (97.18%) (p < 0.05). Moreover, at S3, 2% NaOCl + surfactant (100%) was the most effective irrigant against endotoxins. All irrigants tested were effective in reducing microorganisms and endotoxins from root canals. Moreover, 2% NaOCl + surfactant was the most effective irrigant against endotoxins and regrowth of microorganisms. PMID:26346574
Hubbezoglu, Ihsan; Zan, Recai; Tunc, Tutku; Sumer, Zeynep
Background: In endodontics, the elimination of resistant bacteria such as Enterococcus faecalis plays an important role for treatment success in root canals. Therefore, new alternative irrigants (instead of sodium hypochlorite) have been researched to achieve ideal endodontic treatment. Objectives: The aim of the present study was to evaluate and to compare the antibacterial effect of aqueous ozone with different concentrations and techniques of application (manual and ultrasonic) against E. faecalis in human root canals. Patients and Methods: Eighty single-root mandibular premolar teeth were selected, prepared and sterilized. E. faecalis was incubated in the root canals and kept at 37°C for 24 h. The teeth were divided into four main groups each has 20 members: NaOCl (positive control) group; 8 ppm aqueous ozone group; 12 ppm aqueous ozone group; and 16 ppm aqueous ozone group. While half of the specimens were disinfected with aqueous ozone by manual technique, the other half was disinfected with the aqueous ozone by ultrasonic technique. Conventional irrigation technique was simultaneously applied with ultrasonic vibration that was produced by VDW.ULTRA device. The disinfection procedures were performed for 180 s to ensure standardization of all the working groups. Paper points (placed in the root canals before and after the disinfection procedures) were transferred to Eppendorf tubes containing 0.5 mL of brain heart infusion broth. Then, 50 μL of the suspension was inoculated onto broth agar media. Microbial colonies were counted, and the data were evaluated statistically using 2-way analysis of variance (ANOVA) and Tukey tests. Results: Although the antibacterial effect of 16 ppm aqueous ozone using a manual technique had an insufficient effect, its ultrasonic application technique resulted in complete disinfection in the root canals. Conclusions: The bactericidal activity of high concentration of aqueous ozone combined with ultrasonic application technique
Hubbezoglu, Ihsan; Zan, Recai; Tunc, Tutku; Sumer, Zeynep
In endodontics, the elimination of resistant bacteria such as Enterococcus faecalis plays an important role for treatment success in root canals. Therefore, new alternative irrigants (instead of sodium hypochlorite) have been researched to achieve ideal endodontic treatment. The aim of the present study was to evaluate and to compare the antibacterial effect of aqueous ozone with different concentrations and techniques of application (manual and ultrasonic) against E. faecalis in human root canals. Eighty single-root mandibular premolar teeth were selected, prepared and sterilized. E. faecalis was incubated in the root canals and kept at 37°C for 24 h. The teeth were divided into four main groups each has 20 members: NaOCl (positive control) group; 8 ppm aqueous ozone group; 12 ppm aqueous ozone group; and 16 ppm aqueous ozone group. While half of the specimens were disinfected with aqueous ozone by manual technique, the other half was disinfected with the aqueous ozone by ultrasonic technique. Conventional irrigation technique was simultaneously applied with ultrasonic vibration that was produced by VDW.ULTRA device. The disinfection procedures were performed for 180 s to ensure standardization of all the working groups. Paper points (placed in the root canals before and after the disinfection procedures) were transferred to Eppendorf tubes containing 0.5 mL of brain heart infusion broth. Then, 50 μL of the suspension was inoculated onto broth agar media. Microbial colonies were counted, and the data were evaluated statistically using 2-way analysis of variance (ANOVA) and Tukey tests. Although the antibacterial effect of 16 ppm aqueous ozone using a manual technique had an insufficient effect, its ultrasonic application technique resulted in complete disinfection in the root canals. The bactericidal activity of high concentration of aqueous ozone combined with ultrasonic application technique showed efficacy similar to that of 5.25% NaOCl in root canals.
Rôças, Isabela N; Siqueira, José F; Debelian, Gilberto J
This molecular study analyzed the microbiota of primary root canal infections from adult Norwegian patients. Samples were taken from the necrotic root canals of teeth with symptomatic (n = 13) or asymptomatic (n = 21) apical periodontitis and chronic apical abscesses (n = 9). DNA was extracted from samples, and bacterial identifications were performed by a closed-ended reverse-capture checkerboard approach targeting 50 candidate endodontic pathogens. Bacterial DNA was detected in all cases. In teeth with asymptomatic apical periodontitis, the most frequent taxa were Dialister invisus (71%), Fusobacterium nucleatum (62%), and Porphyromonas endodontalis (62%). In chronic apical abscesses, the most prevalent taxa were P. endodontalis (100%), D. invisus (89%), Parvimonas micra (78%), and Solobacterium moorei (78%). In teeth with symptomatic apical periodontitis, the most prevalent taxa were D. invisus, P. endodontalis, S. moorei, Propionibacterium acnes, and Streptococcus species (all in 69%). None of the targeted taxa were significantly associated with either sinus tract or pain (P > .05), except for Selenomonas sputigena, which was more frequently found in painful cases (P = .04). No taxa were found in significantly higher levels in any conditions (P > .05). Cluster analyses revealed bacterial groupings that differed between cases with and without pain. Although basically the same species were highly prevalent in the different conditions examined and none of the most prevalent taxa were positively associated with symptoms, results revealed that species formed different partnerships and associations in samples from teeth with or without pain. Therefore, it is possible that more virulent multispecies communities can form as a result of overall bacterial combinations and give rise to acute inflammation. Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
Bitter Root Irrigation district canal, looking east, typical section (canal full) - Bitter Root Irrigation Project, Bitter Root Irrigation Canal, Heading at Rock Creek Diversion Dam, West of U.S. Highway 93, Darby, Ravalli County, MT
Ji, Hai; Li, Hong; He, Yanyan; Hou, Benxiang
To study the prevalence of Parvimonas micra (Pm) and the associations between Pm and pulp dominant pathogens in order to reflect the colonization of Pm in the infected root canals with chronic periradicular periodontitis. A total of 120 teeth diagnosed as chronic periradicular periodontitis from 104 patients were included into the study. The teeth were allocated into untreated (primary infectious) and root-canal- treated (secondary infectious) groups with 60 in either group. Samples were collected from the root canals using sterile files and paper points, and subsequent extraction of bacterial DNA was undertaken. The Pm 16S rDNA level was evaluated using 16S rDNA PCR. The prevalence of Pm in chronic periradicular periodontitis was determined accordingly. Then, the associations of Pm and Enterococcus faecalis (Ef), Porphyromonas endodontalis (Pe) as well as Porphyromonas gingivalis (Pg) were analysed. Pm was detected in 40% (24/60) of the samples from the primary infectious group, 5% (3/60) from the secondary infectious group. The prevalences of Pm from the two groups were different significantly (χ² = 21.06, P < 0.05). Significant correlations (untreated group OR = 5.98, root-canal-treated group OR = 33.50) between Pm and Pe were identified in both groups, while the correlations between Pm and Pg as well as Ef were not of significance, respectively. A significantly higher relevance ratio of Pm was estimated in the primary infectious group than the secondary infectious one. Pm and Pe were correlated significantly in the infected root canals, suggesting a symbiotic relation between these two bacteria.
Rossi-Fedele, G; Guastalli, A R
Antiseptics used in endodontics for disinfection purposes include root canal dressings and irrigants. Osmotic shock is known to cause the alteration of microbial cell viability and might have a role in the mechanism of action of root canal antiseptics. The aim of this review was to determine the role of osmolarity on the performance of antiseptics in root canal treatment. A literature search using the Medline electronic database was conducted up to 30 May 2013 using the following search terms and combinations: 'osmolarity AND root canal or endodontic or antiseptic or irrigation or irrigant or medication or dressing or biofilm; osmolality AND root canal or endodontic or antiseptic or irrigation or irrigant or medication or dressing or biofilm; osmotic AND root canal or endodontic or antiseptic or irrigation or irrigant or medication or dressing or biofilm; osmosis AND root canal or endodontic or antiseptic or irrigation or irrigant or medication or dressing or biofilm; sodium chloride AND root canal or endodontic or antiseptic or irrigation or irrigant or medication or dressing or biofilm'. Publications were included if the effects of osmolarity on the clinical performance of antiseptics in root canal treatment were stated, if preparations with different osmolarities values were compared and if they were published in English. A hand search of articles published online, 'in press' and 'early view', and in the reference list of the included papers was carried out following the same criteria. A total of 3274 publications were identified using the database, and three were included in the review. The evidence available in endodontics suggests a possible role for hyperosmotic root canal medicaments as disinfectants, and that there is no influence of osmolarity on the tissue dissolution capacity of sodium hypochlorite. There are insufficient data to obtain a sound conclusion regarding the role of hypo-osmosis in root canal disinfection, or osmosis in any further desirable
Sousa, Ezilmara L R; Martinho, Frederico C; Nascimento, Gustavo G; Leite, Fabio R M; Gomes, Brenda P F A
This clinical study was conducted to measure the endotoxin levels in infected root canals (RCs) and exudates related to acute apical abscesses (AAAs). In addition, the effectiveness of RC procedures in reducing the endotoxin levels in RCs was monitored. Paired samples of infected RCs and exudates from AAAs were collected from 10 subjects by using paper points. RCs samples were collected before (RCS1) and after chemomechanical preparation (CMP) (RCS2), after 17% EDTA (RCS3), and after 30 days of intracanal medication (Ca[OH]2 + chlorhexidine) (RCS4). A turbidimetric kinetic limulus amebocyte lysate assay was used for the measurement of endotoxins. Endotoxins were detected in 100% of the baseline samples of AAAs and RCs (RCS1) with median values of 175 EU/mL and 41.5 EU/mL, respectively (P < .05). After CMP (RCS2), endotoxins were reduced to a median value of 0.54 EU/mL (P < .05). Subsequent irrigation with EDTA (RCS3) failed to present a significant effectiveness in reducing the endotoxin levels (median= 0.37 EU/mL) (P = .07). However, intracanal medication for 30 days (RCS4) reduced endotoxins to median values of 0.03 EU/mL (P < .01). The present study revealed a strong association between the high levels of endotoxins found in AAAs and RCs collected from the same tooth. Moreover, the effectiveness of CMP in reducing the endotoxin levels from RCs in acute endodontic infection was improved by the use of RC medication. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
Üreyen Kaya, B; Kececi, A D; Güldaş, H E; Çetin, E S; Öztürk, T; Öksuz, L; Bozduman, F
This study aimed to compare the antimicrobial efficacy of low-temperature atmospheric pressure plasma (LTAPP) design and gaseous ozone delivery system with 2.5% NaOCl on Enterococcus faecalis in root canal walls and dentine tubules. The samples were divided into LTAPP (n = 12), ozone (n = 12), NaOCl (positive control, n = 12) and saline (negative control, n = 6) groups. Microbial samples were collected using paper points and dentin chips from root canals. Antimicrobial efficacy was assessed by counting the colony-forming units of Ent. faecalis before and after each irrigation protocol. Data were analysed using Kruskal-Wallis, Wilcoxon signed-rank, Friedman and Bonferroni t (Dunn's test)-tests (P = 0.05). The microbial sampling with paper points showed antibacterial efficacy of NaOCl, LTAPP, ozone and saline in descending order, respectively (P < 0.05). The microbial sampling with dentin chips demonstrated a superior efficacy of LTAPP compared with NaOCl in the middle third (P < 0.05), while both had similar effects in coronal and apical thirds (P > 0.05). NaOCl and LTAPP were better than ozone at the coronal and middle parts of the root canals (P < 0.05). These findings led us to suggest that LTAPP, which has no thermal and chemical effects, may be of great aid in endodontic treatment. The present study handles different perspectives on chemomechanical preparation of root canals. Ozone and low-temperature atmospheric pressure plasma (LTAPP) were investigated to determine whether they could be an alternative for NaOCl. Up to now, chemical solutions (NaOCl, chlorhexidine digluconate, etc...) have been used to disinfect the root canals. When the reported effects of LTAPP on biological and chemical decontamination were taken into consideration, a question rose whether it has antimicrobial efficacy in root canals infected with E. faecalis. According to the findings of the present study, LTAPP may constitute a promising aid in endodontics in disinfection of root canals
Maciel, K F; Neves de Brito, L C; Tavares, W L F; Moreira, G; Nicoli, J R; Vieira, L Q; Ribeiro Sobrinho, A P
To examine cytokine expression profiles during periapical lesion development in response to synergetic human pathogens in a gnotobiotic mouse model. Human strains of Fusobacterium nucleatum and Peptostreptococcus prevotii were inoculated into the root canals of germ-free mice in either mono- or bi-association. Animals were killed 7 and 14 days after infection, and periapical tissues were collected. mRNA expression of the cytokines IFN-γ, TNF-α, Receptor activator of nuclear factor kappa-B ligand (RANKL), IL-10, IL-4 and transforming growth factor β (TGF-β) was assessed using real-time PCR. Levene's test was used to assess the equality of variance of the data, whereas a t-test for independent samples was used to evaluate the significance of the differences between groups (P < 0.05). The mRNA expression of IFN-γ and TNF-α was up-regulated by F. nucleatum during the acute (day 7) and chronic phase (day 14) of periapical lesion development. However, in bi-infection the expression of IFN-γ and TNF-α were effectively absent at both time-points. RANKL mRNA expression was down-regulated during dual infection at the chronic phase. As IL-4 expression was similar at both time-points, IL-4 does not appear to be involved in the periapical response to these bacterial strains. IL-10 was up-regulated during the chronic phase by mono-infection with either F. nucleatum or P. prevotii. Dual infection increased TGF-β mRNA expression on day 7, which paralleled the decrease in IFN-γ and TNF-α mRNA levels at the same time-point. F. nucleatum increased TGF-β mRNA expression during the chronic phase. Cytokine profiles depend on the nature of the bacterial challenge. Both TGF-β and IL-10 appeared to be regulating the proinflammatory cytokine responses at both time-points of the periapical immune response. © 2012 International Endodontic Journal.
Root canal filling is performed as the final and most important procedure of root canal treatment. The superior 3D filling is the key determinant of endodontic success. However, such procedure remains a challenge because of the complexity of the root canal system and the limitation of root canal filling materials and methods. This paper provides an overview of current principles and practices in root canal filling, focusing on advantages, disadvantages and indications. The process errors and countermeasures in various root canal filling methods are also discussed. This review provides guidance and help for clinical and practice to achieve a satisfactory root canal filling and improve root canal treatment outcome.
Sousa, E L R; Gomes, B P F A; Jacinto, R C; Zaia, A A; Ferraz, C C R
The aim of this investigation was to identify microorganisms from root canals with periapical abscesses and assess the susceptibility of specific anaerobic bacteria to selected antimicrobials and their β-lactamase production. Sixty root canals were microbiologically investigated. The susceptibility of Anaerococcus prevotii, Fusobacterium necrophorum, F. nucleatum, Parvimonas micra, and Prevotella intermedia/nigrescens to antimicrobials was evaluated with the Etest, whereas β-lactamase production was assessed with nitrocefin. A total of 287 different bacterial strains were recovered, including 201 strict anaerobes. The most frequently strict isolated anaerobes were A. prevotii, P. micra, and F. necrophorum. The selected bacteria were susceptible to all the tested antibiotics, except A. prevotii and Fusobacterium species to azithromycin and erythromycin, as well as A. prevotii and F. necrophorum to metronidazole. None of the microorganisms produced β-lactamase. Gram-positive anaerobic bacteria predominated in the root canals with periapical abscesses. All microorganisms tested were susceptible to benzylpenicillin, amoxicillin, amoxicillin + clavulanate, cefaclor, and clindamycin, producing no β-lactamase.
Fransson, H; Larsson, K M; Wolf, E
The aim was to evaluate the efficacy of various types of lasers used as an adjunct to chemo-mechanical disinfection of infected root canals with the outcome measures 'normal periapical condition' or 'reduction of microbial load'. PubMed, CENTRAL and ISI Web of Knowledge literature searches with specific indexing terms and a subsequent hand search were made with stated limits and criteria. Relevant publications were retrieved, followed by interpretation. The quality of each included publication was assessed as high, moderate or low. The initial search process yielded 234 publications. All abstracts of these publications were read, and the reference lists of relevant publications were hand-searched. Ten articles were read in full text and interpreted according to a data extraction form. Five were included in the systematic review and were assessed. A meta-analysis was impossible to perform because the included studies were heterogeneous with regard to study design, treatment and outcome measures. Positive effects were reported; however, no concluding evidence grade could be made because each included study was judged to have low quality, primarily due to lack of a power analysis, blinding and reproducibility. The evidence grade for whether lasers can be recommended as an adjunct to chemo-mechanical disinfection of infected root canals was insufficient. This does not necessarily imply that laser should not be used as an adjunct to root canal treatment but instead underscores the need for future high-quality studies.
Ghinzelli, Guilherme Cavagnoli; Souza, Matheus Albino; Cecchin, Doglas; Farina, Ana Paula; de Figueiredo, José Antônio Poli
The purpose of this study was to evaluate, in vitro, the influence of ultrasonic activation on photodynamic therapy over root canal system infected with Enterococcus faecalis. The root canals of 50 single-rooted human extracted teeth were enlarged up to a file 60, autoclaved, inoculated with Enterococcus faecalis and incubated for 30 days. The samples were divided into five groups (n=10) according to the protocol of decontamination: G1 (control group) - no procedure was performed; G2 - photosensitizer (0.01% methylene blue); G3 - ultrasonic activation of photosensitizer (0.01% methylene blue); G4 - photodynamic therapy with no ultrasonic activation; and G5 - photodynamic therapy with ultrasonic activation. Microbiological tests (CFU counting) and scanning electron microscopy (SEM) were performed to evaluate and illustrate, respectively, the effectiveness of proposed treatments. Data were subjected to one-way ANOVA followed by post hoc Tukey test (α=0.05). The microbiological test demonstrated that G5 (photodynamic therapy with ultrasonic activation) showed the lowest mean contamination (3.17 log CFU/mL), which was statistically different from all other groups (p<0.05). G4 (photodynamic therapy) showed a mean of contamination of 3.60 log CFU/mL, which was statistically different from groups 1, 2 and 3 (p<0.05). The use of ultrasonic activation on photodynamic therapy improved its potential for decontamination, resulting in the higher elimination Enterococcus faecalis from the root canal space. Copyright © 2014 Elsevier B.V. All rights reserved.
Samiei, M; Ghasemi, N; Divband, B; Balaei, E; Hosien Soroush Barhaghi, M; Divband, A
The aim of the present study was to compare the antibacterial properties of PLGA polymer containing ZnO, Ag and ZnO/Ag nanoparticles with those of 2.5% NaOCl in root canals contaminated with Enterococcus faecalis. A total of 100 maxillary central incisors were selected. After the crowns were removed to achieve 12-mm-length roots, the root canals were prepared with RaCe rotary system. The samples were sterilized; then 200 µL of E. faecalis suspension (ATCC 29212) was placed in each root canal. The samples were divided into 5 groups based on the antibacterial agent used. Group 1 served as the control group. In group 2 the polymer suspension containing ZnO nanoparticles, in group 3 the polymer solution containing ZnO/Ag nanoparticles, in group 4 the polymer solution containing Ag nanoparticles and in group 5, 2.5% NaOCl were used. After 24 hours, a solution was prepared using dentin chips from each root canal and placed on agar plates, followed by colony-forming units (CFU) count determination. Means ± standard deviations were calculated and Kruskal-Wallis test was used to evaluate the antibacterial properties of different irrigation agents. Mann-Whitney U test was used for two-by-two comparisons of the groups, with the level of significance being set at 0.05. The maximum and minimum CFU counts were observed in the control and NaOCl groups, respectively. In the polymer groups, the maximum and minimum CFU counts were observed in the Ag and ZnO/Ag groups, respectively. There were significant differences in CFU counts between the study groups after application of irrigation solutions (P<0.05). Two-by-two comparisons of the groups using Mann-Whitney U test showed significant differences between all the study groups (P<0.05), except for groups ZnO and Ag (P=0.7). Sodium hypochlorite solution was more effective than copolymer containing nanoparticles and of all the tested nanoparticles; ZnO/Ag nanoparticles exhibited the highest antibacterial activity.
Siqueira, José F; Rôças, Isabela N
Molecular genetic methods have significantly contributed to the knowledge about the microbiota associated with infected root canals. Albeit spirochetes have been commonly observed in primary root canal infections, only recently they have been identified. The purpose of the present study was to investigate the occurrence of four treponemes-Treponema maltophilum, Treponema lecithinolyticum, Treponema amylovorum, and Treponema medium-in cases of primary endodontic infections associated with different forms of periradicular diseases through a 16S rDNA-based nested PCR assay. Samples were taken from thirty-one infected root canals associated with either asymptomatic or symptomatic apical periodontitis. DNA extracted from the samples was initially amplified using universal 16S rDNA primers, followed by a second round of amplification using the first PCR products to detect a specific fragment of the 16S rDNA of each target Treponema species. All cases were positive for the universal bacterial primers, indicating that samples contained bacterial DNA. Of the four target species, T. maltophilum was the most prevalent, being detected in 39% of the cases (33% of the asymptomatic cases and 50% of the symptomatic cases). T. lecithinolyticum was the next more prevalent among the species tested, being found in 26% of the samples (33% of asymptomatic cases and 10% of the symptomatic cases). T. amylovorum was found in 7% of the cases (5% of the asymptomatic cases and 10% of the symptomatic cases), while T. medium was in 13% of the cases (14% of the asymptomatic cases and 10% of the symptomatic cases). None of the species tested was significantly associated with clinical symptoms. This was possibly the hitherto first study to report the occurrence of T. lecithinolyticum, T. amylovorum, and T. medium in infections of endodontic origin. Overall, findings suggested that these oral treponemes, particularly T. maltophilum and T. lecithinolyticum, can be involved in the pathogenesis of
Verhaagen, Bram; Boutsioukis, Christos; Jiang, Lei-Meng; Macedo, Ricardo; van der Sluis, Luc; Versluis, Michel
A crucial step during a dental root canal treatment is irrigation, where an antimicrobial fluid is injected into the root canal system to eradicate all bacteria. Agitation of the fluid using an ultrasonically vibrating miniature file has shown significant improvement in cleaning efficacy over conventional syringe irrigation. However, the physical mechanisms underlying the cleaning process, being acoustic streaming, cavitation or chemical activity, and combinations thereof, are not fully understood. High-speed imaging allows us to visualize the flow pattern and cavitation in a root canal model at microscopic scales, at timescales relevant to the cleaning processes (microseconds). MicroPIV measurements of the induced acoustic streaming are coupled to the oscillation characteristics of the file as simulated numerically and measured with a laser vibrometer. The results give new insight into the role of acoustic streaming and the importance of the confinement for the cleaning of root canals.
Henriques, LCF; Brito, LCN; Tavares, WLF; Teles, RP; Vieira, LQ; Teles, FRF; Ribeiro Sobrinho, AP
Introduction To combine Multiple Displacement Amplification (MDA) and checkerboard DNA–DNA hybridization to qualitatively and quantitatively evaluate the microbiota present in infections refractory to endodontic treatment. Methods The subjects of this study were 40 patients presenting periapical lesions refractory to endodontic treatment. Samples were taken by scraping or filing root canal walls with a #10 K-type hand file. Sample DNA was amplified by MDA, and the levels of 107 bacterial taxa were analyzed by checkerboard DNA–DNA hybridization. The taxa were divided into three distinct microbial populations, depending on their mean proportion in samples (% DNA probe counts ± SEM), as follows: dominant (≥3.0%), sub-dominant (>1.6 to 3.0%) and residual (≤1.6%) populations. The significance of differences was determined using the Mann-Whitney test. Results The taxa present with the highest mean proportions (constituting the dominant population) were Corynebacterium diphtheriae (8.03±0.98), Porphyromonas gingivalis (5.42±2.09), Streptococcus sobrinus (5.33±0.69), and Stenotrophomonas maltophilia (4.72±1.73). Among the sub-dominant population were Eubacterium saphenum (3.85±1.06), Helicobacter pylori (3.16±0.62), Dialister pneumosintes (3.12±1.1), Clostridium difficile (2.74±0.41), Enterobacter agglomerans (2.64±0.54), Salmonella enterica (2.51±0.52), Mobiluncus mulieris (2.44±0.6), and Klebsiella oxytoca (2.32±0.66). In the population of bacteria present at the lowest mean proportions (the residual population), Bacteroides ureolyticus (0.04±0.01), Haemophilus influenzae (0.04±0.02), and Prevotella oris (0.01±0.01) were found at the lowest mean proportions. Enterococcus faecalis was detected in the residual population (0.52±0.26). Conclusion The microbial climax community in teeth refractory to endodontic treatment not only harbor medically important species, but also contains distinct microbial consortia present with different population levels
Henriques, Luiz Carlos Feitosa; de Brito, Luciana Carla Neves; Tavares, Warley Luciano Faria; Teles, Ricardo Palmier; Vieira, Leda Quércia; Teles, Flávia Rodrigues; Sobrinho, Antônio Paulino Ribeiro
The purpose of this study was to combine multiple displacement amplification and checkerboard DNA-DNA hybridization to qualitatively and quantitatively evaluate the microbiota present in infections refractory to endodontic treatment. The subjects of this study were 40 patients presenting with periapical lesions refractory to endodontic treatment. Samples were taken by scraping or filing root canal walls with a #10 K-type hand file. Sample DNA was amplified by multiple displacement amplification, and the levels of 107 bacterial taxa were analyzed by checkerboard DNA-DNA hybridization. The taxa were divided into 3 distinct microbial populations depending on their mean proportion in samples (% DNA probe counts ± standard error of the mean) as follows: dominant (≥3.0%), subdominant (>1.6%-3.0%), and residual (≤1.6%) populations. The significance of differences was determined using the Mann-Whitney test. The taxa present with the highest mean proportions (constituting the dominant population) were Corynebacterium diphtheriae (8.03 ± 0.98), Porphyromonas gingivalis (5.42 ± 2.09), Streptococcus sobrinus (5.33 ± 0.69), and Stenotrophomonas maltophilia (4.72 ± 1.73). Among the subdominant population were Eubacterium saphenum (3.85 ± 1.06), Helicobacter pylori (3.16 ± 0.62), Dialister pneumosintes (3.12 ± 1.1), Clostridium difficile (2.74 ± 0.41), Enterobacter agglomerans (2.64 ± 0.54), Salmonella enterica (2.51 ± 0.52), Mobiluncus mulieris (2.44 ± 0.6), and Klebsiella oxytoca (2.32 ± 0.66). In the population of bacteria present at the lowest mean proportions (the residual population), Bacteroides ureolyticus (0.04 ± 0.01), Haemophilus influenzae (0.04 ± 0.02), and Prevotella oris (0.01 ± 0.01) were found at the lowest mean proportions. Enterococcus faecalis was detected in the residual population (0.52 ± 0.26). The microbial climax community in teeth refractory to endodontic treatment not only harbors medically
Rôças, I N; Lima, K C; Siqueira, J F
To compare the antibacterial efficacy of two instrumentation techniques, one using hand nickel-titanium (NiTi) instruments and the other using rotary NiTi instruments, in root canals of teeth with apical periodontitis. Root canals from single-rooted teeth were instrumented using either hand NiTi instruments in the alternated rotation motion technique or rotary BioRaCe instruments. The irrigant used in both groups was 2.5% NaOCl. DNA extracts from samples taken before and after instrumentation were subjected to quantitative analysis by real-time polymerase chain reaction (qPCR). Qualitative analysis was also performed using presence/absence data from culture and qPCR assays. Bacteria were detected in all S1 samples by both methods. In culture analysis, 45% and 35% of the canals were still positive for bacterial presence after hand and rotary NiTi instrumentation, respectively (P > 0.05). Rotary NiTi instrumentation resulted in significantly fewer qPCR-positive cases (60%) than hand NiTi instrumentation (95%) (P = 0.01). Intergroup comparison of quantitative data showed no significant difference between the two techniques. There was no significant difference in bacterial reduction in infected canals after instrumentation using hand or rotary NiTi instruments. In terms of incidence of positive results for bacteria, culture also showed no significant differences between the groups, but the rotary NiTi instrumentation resulted in more negative results in the more sensitive qPCR analysis. © 2013 International Endodontic Journal. Published by John Wiley & Sons Ltd.
Aim. To compare the disinfection effect of Er,Cr:YSGG laser using radial firing tips with NaOCI in root canals infected with C. albicans and to evaluate the irradiation effect on the dentinal surfaces. Material and Methods. In total seventy-six mandibular premolar teeth were used. In order to standardize the incubation and sterilization procedure, eight teeth were used. Sixty-eight of the root canals were incubated with C. albicans suspension for 72 hours. The specimens were divided into 5 experimental groups. Two groups were constituted as Group 1 was irradiated with 1.5 W laser (n = 8) and group 2, which was irradiated with 2 W laser (n = 8). Two more groups were formed as Group 3 (2 W laser (n = 25) and Group 4 NaOCI (5%) (n = 25). Group 5 (n = 2) did not receive any treatment. Mann-Whitney U and Kruskal-Wallis H tests were used to compare the different laser output powers. Wilcoxon Signed Ranks Test was used in order to compare the Candida cfu/ml levels according to treatment protocols (P < 0.05). Results. Both 1.5 W and 2 W laser resulted in a major reduction of C. albicans without a significant difference. The comparison of the dentin surfaces irradiated with Er,Cr:YSGG laser at two power settings resulted in similar morphological changes. However, NaOCI was found to be more effective in reduction of C. albicans than 2 W laser application. Conclusion. According to the results of the present study, the Er,Cr:YSGG laser with radial firing tips presented less antifungal effects on C. albicans in root canals of infected teeth than NaOCl solution. PMID:24955367
Provenzano, José Claudio; Rôças, Isabela N; Tavares, Luís Fernando D; Neves, Bianca Cruz; Siqueira, José F
Short-chain fatty acids (SCFAs) are bacterial metabolic end products that may function as virulence factors. This study evaluated the occurrence of SCFAs in infected root canals before and after treatment. Samples were taken from root canals of teeth with apical periodontitis before (S1) and after (S2) chemomechanical preparation with either NaOCl or chlorhexidine as the irrigant and then after interappointment medication with calcium hydroxide (S3). High-performance liquid chromatography was used for detection of SCFAs. Selected bacterial taxa that are recognized producers of the target SCFAs were identified by real-time polymerase chain reaction. Butyric acid was the most common fatty acid in S1, followed by propionic acid. Both molecules were also found in S2 and S3 from both NaOCl and chlorhexidine groups. Lactic acid was not present in detectable levels in S1, but it occurred in 1 postinstrumentation sample and in 9 samples taken after calcium hydroxide medication. Of the target taxa, Fusobacterium nucleatum was the most prevalent in S1 (76%), followed by members of the Actinobacteria phylum (71%), Streptococcus species (59%), and Parvimonas micra (53%). Gram-positive taxa, especially streptococci, were the most prevalent bacteria in S2 and S3. SCFA detection was matched with the respective potential producer species in most cases. This first report of SCFAs in infected root canals suggests that these molecules may play a role in the pathogenesis of apical periodontitis. Significance of persistence of SCFAs after treatment and its effects on the long-term outcome await elucidation. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
Brugnera, Aldo, Jr.; Zanin, Fatima A. A.; Sampaio Moura, Marcelo; Heredia Seixas, Fabio; Rodrigues de Araujo Estrela, Cyntia; Estrela, Carlos; Djalma Pecora, Jesus
The purpose of this study was to analyze the environment microbial contamination produced by Er:YAG laser irradiation in infected root canals. A total of 20 human anterior teeth were prepared, sterilized and, then, inoculated with a mixture of the following microorganisms: S. Aureus, E. Faecalis, P. Aeruginosa, B. Subtilis and C. Albicans. After the contamination period (28 days), the teeth were irrigated with sterile distilled water or 1% sodium hypochlorite and, then, irradiated with an Er:YAG laser with two different laser parameters: 52 mJ or 110 mJ output at the fiber tip. Eighteen Petri dishes with 20 ml of BHI Agar were used in the study. For each group, 3 plates with BHIA were used for the analysis of the microbial contamination of the environment during the activation of the laser in infected root canals. The plates were positioned in differing distances away from the irradiated tooth (plate 1 - distance of 15 cm, plate 2 - distance of 50 cm and plate 3 - distance of 3 meters). After the analysis of the results, it was observed that the larger microbial contamination occurred in Group 1 (teeth irrigated with sterile distilled water and irradiated with Er:YAG laser with 52 mJ output at the fiber tip), plate 1 (positioned 15 cm away from the irradiated tooth), with values greater than 30 Colony-Forming Units (CFU).
Preethee, Thomas; Kandaswamy, Deivanayagam; Arathi, Ganesh; Hannah, Rosaline
Aim: The aim of this study is to evaluate the bactericidal effect of 908 nm diode laser in conjunction with various irrigation regimes in disinfection of apical third of root dentin. Materials and Methods: Sixty prepared teeth with single canals were contaminated with Enterococcus faecalis. The specimens were divided into 6 groups (n = 10): Group 1 and 3 and 5 were subjected to chemo-mechanical preparation using 5.25% sodium hypochlorite (NaOCl), 17% Ethylenediaminetetraacetic acid (EDTA); 1.3% NaOCl, MTAD (mixture of doxycycline, citric acid and a detergent (Tween 80); and, 8.5% saline, respectively followed by 908 nm diode laser irradiation; Group 2 and 4, followed the same procedure as Group1 and 3, however without laser irradiation; and, Group 6, rinsed with saline solution (control). Dentin shavings from apical third were analyzed for the presence of E. faecalis using culture method and Polymerase Chain reaction (PCR). Results: One-way Analysis of variance showed statistically significant differences between the laser irradiated groups, non irradiated groups and the control group. Conclusion: 908 nm diode used in conjunction with conventional chemomechanical techniques demonstrated a significant elimination of E. faecalis in the apical third of root dentin. PMID:22368335
Wu, Z; Guo, X J; Qiao, F; Wu, L G
To evaluate antibacterial and residual antimicrobial activities of five root canal irrigants including Qmix, MTAD(mixture of a tetracycline isomer, an acid, and a detergent), 0.2% cetrimide(CTR), 2% chlorhexidine(CHX) and 17% ethylene diaminetetraacetic acid(EDTA) and to find the most optimal final irrigants for using in root canal therapy. The standard enterococcus infection models were built up in 100 single rooted incisors with single canal. Totally 30 teeth were selected by using random number tablefor detecting the quality of the bacteria model. Crown-down technique with rotary ProTaper system was used to prepare the root canals. Then the teeth were randomly divided into seven groups of which five groups were irrigated with five different irrigants respectively, one group was irrigated with distilled water(distilled water group) and one group was no-irrigation group. Each tooth was sectioned into three parts: apical 1/3, middle 1/3 and coronal 1/3. After irrigation, specimenswere cultivated from day 0 to day 14. All statistical analyses were performed by means of SPSS 17.0 software. Chi-squared test was used to evaluate antibacterial activities. Generalized estimating equations was used to evaluate residual antimicrobial activities. All samples rinsed with Qmix, MTAD, CTR, CHX were bacteria-free in 0 day. The samples rinsed with EDTA and distilled water had no bacteria in 7 coronal sections, 6 middle sections and 9 apical sections, respectively. The results of Qmix, MTAD, CTR and CHX groups showed significant difference when compared with that of distilled water, EDTA and control groups(P<0.05). Residual antimicrobial resultsin EDTA, distilled water, no-irrigation groups showed significant differences compared with that of Qmix, MTAD, CTR, CHX groups according to pairwise comparison(P<0.05) on day 1, 2 and 3. There was no significant difference between the other two groups(P>0.05). Antimicrobial properties on the coronal 1/3 and apical 1/3, middle 1/3 and
Schulz-Bongert, Udo; Weine, Franklin S.
The construction of visual and manipulative aids, clear resin blocks with root-canal-like spaces, for simulation of root canals is explained. Time, materials, and techniques are discussed. The method allows for comparison of canals, creation of any configuration of canals, and easy presentation during instruction. (MSE)
Schulz-Bongert, Udo; Weine, Franklin S.
The construction of visual and manipulative aids, clear resin blocks with root-canal-like spaces, for simulation of root canals is explained. Time, materials, and techniques are discussed. The method allows for comparison of canals, creation of any configuration of canals, and easy presentation during instruction. (MSE)
Camacho-Alonso, Fabio; Julián-Belmonte, Encarnación; Chiva-García, Fernando; Martínez-Beneyto, Yolanda
To evaluate the antibacterial efficacy of photodynamic therapy (PDT) and chitosan against Enterococcus faecalis and assess the possible enhancive effect of chitosan on the photosensitizer methylene blue in experimentally infected root canals of extracted human teeth in vitro. E. faecalis is frequently found in persistent endodontic infections. In this context, the antimicrobial PDT or newer antibacterial alternatives such as chitosan could become modern alternatives to existing antibacterial treatment approaches. One hundred two single-rooted extracted teeth were used. The teeth were contaminated with 0.1 mL E. faecalis (3 × 10(8) cell/mL). These were randomized into six treatment groups (n = 17 teeth): Group 1 (2.5% NaOCl); Group 2 (PDT); Group 3 (chitosan 3 mg/mL); Group 4 (PDT+chitosan 3 mg/mL); Group 5 (positive control, no treatment); and Group 6 (negative control, no inoculation, no treatment). The canal content was sampled with sterile paper points. The samples were cultured on blood agar plates to determine the number of colony-forming units (CFU)/mL. Five teeth in each group were analyzed by scanning electron microscope (SEM) to determine the percentage of area with contamination and debris. The positive control group showed the highest number of CFU/mL, with statistically significant differences in comparison with the other treatment groups (p ≤ 0.05). Group 4 (PDT+chitosan) showed the lowest CFU/mL count, followed by Group 2 (PDT alone), which obtained similar results to Group 1 (NaOCl), but there was no significance between the treated groups. SEM images showed that Group 4 (PDT+Chitosan) showed the lowest area of contamination. Combination of PDT and chitosan showed antibacterial potential against endodontic infection by E. faecalis.
Waplington, M; Lumley, P J; Walmsley, A D
Although hand instrumentation is considered the most acceptable method of preparing root canals, sonic instruments may be useful additions to the endodontic armamentarium. Sonic instrumentation may be incorporated as an adjunct to traditional techniques for shaping the root canal. The use of such instruments may assist the practitioner during root canal treatment in general practice.
Siqueira, José F; Paiva, Simone S M; Rôças, Isabela N
The present clinical study was conducted to assess the bacterial reduction after chemomechanical preparation using 0.12% chlorhexidine digluconate solution as an irrigant and the additive antibacterial effect of intracanal dressing with calcium hydroxide (Ca(OH)(2)) associated with 0.12% chlorhexidine digluconate gel. According to stringent inclusion/exclusion criteria, 13 teeth with primary intraradicular infections and chronic apical periodontitis were selected and followed in the study. Bacterial samples were taken at the baseline (before treatment) (S1), after chemomechanical preparation using chlorhexidine (CHX) as an irrigant (S2), and after a 7-day dressing with Ca(OH)(2)/CHX paste (S3). Cultivable bacteria recovered from infected root canals at the three stages were counted and identified by means of 16S ribosomal RNA gene sequencing analysis. At S1, all canals were positive for bacteria, with the mean number of 3.5 taxa per canal (range, 2-9). At S2, 7 cases (53.8%) still harbored cultivable bacteria, with a mean number of 1.7 taxon per canal (range, 1-4). At S3, only one case (7.7%) was positive for the presence of bacteria. The great majority of taxa found in posttreatment samples were gram-positive bacteria. A significantly high reduction in bacterial counts was observed between S1 and S2 and S1 and S3 (p<0.001). Also, significant differences were observed for comparisons involving S2 and S3 samples with regard to both quantitative bacterial reduction (p=0.014) and number of cases yielding negative cultures (p=0.01). It was concluded that chemomechanical preparation with 0.12% CHX solution as an irrigant significantly reduced the number of intracanal bacteria but failed to render the canal free of cultivable bacteria in about one half of the cases. Application of a 7-day intracanal dressing with Ca(OH)(2)/CHX paste further increased significantly the number of cases yielding negative cultures.
Valera, Marcia Carneiro; Maekawa, Lilian Eiko; Chung, Adriana; Cardoso, Flavia Goulart Rosa; Oliveira, Luciane Dias de; Oliveira, Carolina Lima de; Carvalho, Claudio Antonio Talge
This in vitro study sought to evaluate the biomechanical preparation action on microorganisms and endotoxins by using sodium hypochlorite (NaOCl) and an intracanal medication containing Zingiber officinale, with or without calcium hydroxide. Single-rooted teeth were contaminated, and root canal instrumentation (using 2.5% NaOCl) was performed. Samples were divided into 4 groups, according to the intracanal medication employed. The root canal content was gathered 28 days after contamination (baseline), immediately after biomechanical preparation, 7 days after biomechanical preparation, 14 days after intracanal medication, and 7 days after intracanal medication was removed. The results (submitted to Kruskal-Wallis and Dunn tests) showed that the NaOCl eliminated 100% of root canal microorganisms and reduced 88.8% of endotoxins immediately after biomechanical preparation, and 83.2% at 7 days after biomechanical preparation.
Gulabivala, K; Ng, Y-L; Gilbertson, M; Eames, I
Root canal treatment is a common dental operation aimed at removing the contents of the geometrically complex canal chambers within teeth; its purpose is to remove diseased or infected tissue. The complex chamber is first enlarged and shaped by instruments to a size sufficient to deliver antibacterial fluids. These irrigants help to dissolve dying tissue, disinfect the canal walls and space and flush out debris. The effectiveness of the procedure is limited by access to the canal terminus. Endodontic research is focused on finding the instruments and clinical procedures that might improve success rates by more effectively reaching the apical anatomy. The individual factors affecting treatment outcome have not been unequivocally deciphered, partly because of the difficulty in isolating them and in making the link between simplified, general experimental models and the complex biological objects that are teeth. Explicitly considering the physical processes within the root canal can contribute to the resolution of these problems. The central problem is one of fluid motion in a confined geometry, which makes the dispersion and mixing of irrigant more difficult because of the absence of turbulence over much of the canal volume. The effects of treatments can be understood through the use of scale models, mathematical modelling and numerical computations. A particular concern in treatment is that caustic irrigant may penetrate beyond the root canal, causing chemical damage to the jawbone. In fact, a stagnation plane exists beyond the needle tip, which the irrigant cannot penetrate. The goal is therefore to shift the stagnation plane apically to be coincident with the canal terminus without extending beyond it. Needle design may solve some of the problems but the best design for irrigant penetration conflicts with that for optimal removal of the bacterial biofilm from the canal wall. Both irrigant penetration and biofilm removal may be improved through canal fluid
Herrera, Daniel Rodrigo; Durand-Ramirez, Jorge Enrique; Falcão, Amanda; Silva, Emmanuel João Leal Nogueira da; Santos, Elizabete Brasil Dos; Gomes, Brenda Paula Figueiredo de Almeida
The aim of this study was to analyze the antimicrobial activity and substantivity of Uncaria tomentosa Willd DC (cat's claw, CC) in root dentin contaminated with Enterococcus faecalis. Forty-eight human premolars were contaminated with E. faecalis (ATCC 29212) and randomly divided into four groups according to the irrigant used during chemomechanical preparation (CMP): CC group: 2% CC gel; CHX group: 2% chlorhexidine digluconate gel (CHX); NaOCl group: 5.25% sodium hypochlorite (NaOCl); and SS group: sterile saline (SS). Microbiological samples were collected before (S1) and after (S2) CMP and after 7 days (S3). Colony-forming units (CFU/mL) at the different sampling times and comparisons among the groups were statistically analyzed by Wilcoxon and Kruskal-Wallis tests (p < 0.05). Significant bacterial reduction was achieved in all groups after CMP (p < 0.05). Results show no significant difference between S3 and S2 (p > 0.05) in the CC and CHX groups. Bacterial load was higher in S3 than in S2 samples (p < 0.05) in the NaOCl and SS groups. Our results suggest antibacterial effect of 2% CC gel against E. faecalis in infected dentin, in addition to antibacterial substantivity of 2% CC and 2% CHX up to 7 days.
van der Meer, W J; Stegenga, B
Failure of root canal therapy is usually due to re-infection of the root canal system. In most of these cases, an endodontic retreatment is indicated. Patients with persisting apical periodontitis frequently are referred to an oral surgeon for apical surgery, although endodontic retreatment would have been possible in a majority of these cases. When endodontic retreatment is not possible or does not resolve the patient's problems, surgical apicoectomy or extraction might be the only possibilities left. Apical surgery is usually performed by an oral sugeon or by a specially trained dentist. In most surgical clinics beveled resection, followed by an preparation and restoration is performed. New developments, such as microscopic sugery, ultrasonic preparation and newly developed restorative materials are described in this article. Since there is a lack of well-designed comparative clinical studies, no definite conclusions can be drawn with regard to the clinical value of these modern techniques.
Leonardo, Renato de Toledo; Puente, Carlos Garcia; Jaime, Alejandro; Jent, Carol
Cleaning and shaping are important steps in the root canal treatment. Despite the technological advances in endodontics, K and Hedstroen files are still widely used. In an attempt to be more effective in preparing the root canals, faster and more cutting efficient kinematic, alloys and design alternatives utilizing mechanically oscillating or rotary files are proposed. Even with all these technological innovating alternatives, the preparation of root canals remains a challenge.
Mohammadi, Zahed; Jafarzadeh, Hamid; Shalavi, Sousan; Bandi, Shilpa; Patil, Shankargouda
Successful root canal treatment depends on having comprehensive information regarding the root(s)/canal(s) anatomy. Dentists may have some complication in treatment of third molars because the difficulty in their access, their aberrant occlusal anatomy and different patterns of eruption. The aim of this review was to review and address the number of roots and root canals in third molars, prevalence of confluent canals in third molars, C-shaped canals, dilaceration and fusion in third molars, autotransplantation of third molars and endodontic treatment strategies for third molars.
Gomes, Fabio de Almeida; Sousa, Bruno Carvalho
Success in root canal treatment is achieved after thorough cleaning, shaping, and obturation of the root canal system. This clinical case describes conventional root canal treatment of an unusual mandibular first molar with six root canals. The prognosis for endodontic treatment in teeth with abnormal morphology is unfavorable if the clinician fails to recognize extra root canals. PMID:25685156
This case report presents surgical endodontic management outcomes of maxillary incisors that were infected via the lateral canals. Two cases are presented in which endodontically-treated maxillary central incisors had sustained lateral canal infections. A surgical endodontic treatment was performed on both teeth. Flap elevation revealed vertical bone destruction along the root surface and infected lateral canals, and microscopy revealed that the lateral canals were the origin of the lesions. After the infected lateral canals were surgically managed, both teeth were asymptomatic and labial fistulas were resolved. There were no clinical or radiographic signs of surgical endodontic management failure at follow-up visits. This case report highlights the clinical significance and surgical endodontic management of infected lateral canal of maxillary incisor. It is important to be aware of root canal anatomy variability in maxillary incisors. Maxillary central incisors infected via the lateral canal can be successfully managed by surgical endodontic treatment. PMID:25671217
Janani, Maryam; Jafari, Farnaz; Samiei, Mohammad; Lotfipour, Farzaneh; Nakhlband, Ailar; Ghasemi, Negin; Salari, Tannaz
Bacteria like E. faecalis can produce intra- and extra-radicular biofilms. Theoretically, the adjustable penetration ability of lasers enables better access to root canal system. Therefore the aim of the present study was to compare the ability of photoactivated laser and 2.5% NaOCl irrigation solution to eliminate E. faecalis from the root canals by real-time PCR technique. Sixty extracted human upper central incisors were selected and sterilized in an autoclave. The root canals were infected with E. faecalis (PTCC 1237, Persian Type Culture Collection, Iran) and then incubated for 24 hours. The samples were randomly divided into 3 groups. No intervention was made in the control group (group 1). In group 2, laser therapy was performed with a power of 100 mW by diode laser for 120 seconds. In group 3, the canals were irrigated with 5 mL of 2.5% NaOCl; then all the samples were sonicated in 15 mL of normal saline in test tubes in order to isolate the bacteria. DNA extraction was performed followed by real-time PCR technique for all the samples. Inhibition of bacterial growth in all the experimental samples was significantly more than that in the control group. There was a significant difference between photodynamic therapy and 2.5% NaOCl. The effect of NaOCl in all the samples was better than photodynamic therapy. The results of the mean CT (cyclic threshold) were 40, 30.2 and 15.35 for 2.5% NaOCl, photodynamic therapy and control group, respectively. Based on the results of this experimental study, 2.5% NaOCl eliminated E. faecalis from infected root canals more effectively compared to photodynamic therapy. Key words:Photoactivated laser, Enterococcus faecalis, antibacterial agents, sodium hypochlorite.
Janani, Maryam; Samiei, Mohammad; Lotfipour, Farzaneh; Nakhlband, Ailar; Ghasemi, Negin; Salari, Tannaz
Background Bacteria like E. faecalis can produce intra- and extra-radicular biofilms. Theoretically, the adjustable penetration ability of lasers enables better access to root canal system. Therefore the aim of the present study was to compare the ability of photoactivated laser and 2.5% NaOCl irrigation solution to eliminate E. faecalis from the root canals by real-time PCR technique. Material and Methods Sixty extracted human upper central incisors were selected and sterilized in an autoclave. The root canals were infected with E. faecalis (PTCC 1237, Persian Type Culture Collection, Iran) and then incubated for 24 hours. The samples were randomly divided into 3 groups. No intervention was made in the control group (group 1). In group 2, laser therapy was performed with a power of 100 mW by diode laser for 120 seconds. In group 3, the canals were irrigated with 5 mL of 2.5% NaOCl; then all the samples were sonicated in 15 mL of normal saline in test tubes in order to isolate the bacteria. DNA extraction was performed followed by real-time PCR technique for all the samples. Results Inhibition of bacterial growth in all the experimental samples was significantly more than that in the control group. There was a significant difference between photodynamic therapy and 2.5% NaOCl. The effect of NaOCl in all the samples was better than photodynamic therapy. The results of the mean CT (cyclic threshold) were 40, 30.2 and 15.35 for 2.5% NaOCl, photodynamic therapy and control group, respectively. Conclusions Based on the results of this experimental study, 2.5% NaOCl eliminated E. faecalis from infected root canals more effectively compared to photodynamic therapy. Key words:Photoactivated laser, Enterococcus faecalis, antibacterial agents, sodium hypochlorite. PMID:28469819
Golmohammadi, Maryam; Jafarzadeh, Hamid
Accurate diagnosis of the root canal morphology and anatomy is essential for thorough shaping and cleaning of the entire root canal system and consequent successful treatment. This report describes a case of maxillary second premolar with two roots and three root canals (two mesial and distal palatal canals). The case report underlines the importance of complete knowledge about root canal morphology and possible variations, coupled with clinical and radiographic examination in order to increase the ability of clinicians to treat difficult cases. PMID:27471538
Samiei, Mohammad; Shahi, Shahriar; Abdollahi, Amir Ardalan; Eskandarinezhad, Mahsa; Negahdari, Ramin; Pakseresht, Zahra
Introduction: This study compared the efficacy of light-activated low-power laser, 2% chlorhexidine (CHX) and 2.5% NaOCl in eliminating Enterococcus faecalis (E. faecalis) from the root canal system. Methods and Materials: The root canals of 60 maxillary central incisors were contaminated with E. faecalis and then the bacteria were incubated for 24 h. All the root canals were instrumented in a crown-down manner with #4 and 3 Gates-Glidden drills, followed by RaCe rotary files (40/0.10, 35/0.08, and 30/0.06). The samples were randomly assigned to three experimental groups and one control group (n=15). In the control group no intervention was made. In the photo-activated disinfection (PAD) group, laser therapy was undertaken with diode laser beams (with an output power of 100 mW/cm2) for 120 sec. For the other two experimental groups, root canals were irrigated either with 5 mL of 2% CHX or 2.5% NaOCl solutions, respectively. The Kruskal-Wallis test was used to compare the CFU values of the bacteria and post-hoc Bonferroni test was used for pairwise comparisons. The level of significance was set at 0.05. Results: The inhibition of bacterial growth in all the experimental groups was significantly superior to the control group (P<0.05). There was no significant difference between the effect of PAD and 2% CHX (P=0.05). The effect of 2.5% NaOCl was significantly better than that of the PAD technique (P<0.001). In addition, 2.5% NaOCl was significantly better than 2% CHX (P=0.007). Conclusion: Photodynamic therapy was effective in reducing the E. faecalis counts in comparison with the control group, but 2.5% NaOCl solution was the most effective protocol. PMID:27471527
Palit Madhu Chanda; Hegde, K Sundeep; Bhat, Sham S; Sargod, Sharan S; Mantha, Somasundar; Chattopadhyay, Sayan
Root canal revascularization attempts to make necrotic tooth alive by the use of certain simple clinical protocols. Earlier apexification was the treatment of choice for treating and preserving immature permanent teeth that have lost pulp vitality. This procedure promoted the formation of apical barrier to seal the root canal of immature teeth and nonvital filling materials contained within root canal space. However with the success of root canal revascularization to regenerate the pulp dentin complex of necrotic immature tooth has made us to rethink if apexification is at the beginning of its end. The objective of this review is to discuss the new concepts of tissue engineering in endodontics and the clinical steps of root canal revascularization.
Cardoso, Flávia G R; Ferreira, Nádia S; Martinho, Frederico C; Nascimento, Gustavo G; Manhães, Luiz R C; Rocco, Marco A; Carvalho, Cláudio A T; Valera, Marcia C
This clinical study was conducted to correlate the levels of endotoxins and bacterial counts found in primary endodontic infection with the volume of periapical bone destruction determined by cone-beam computed tomography (CBCT) analysis. Moreover, the levels of bacteria and endotoxins were correlated with the development of clinical features. Twenty-four root canals with primary endodontic disease and apical periodontitis were selected. Clinical features such as pain on palpation, pain on percussion, and previous episode of pain were recorded. The volume (cubic millimeters) of periapical bone destruction was determined by CBCT analysis. Endotoxins and bacterial samplings were collected by using sterile/apyrogenic paper points. Endotoxins were quantified by using limulus amebocyte lysate assay (KQCL test), and bacterial count (colony-forming units [CFU]/mL) was determined by using anaerobic culture techniques. Data were analyzed by Pearson correlation and multiple logistic regression (P < .05). Endotoxins and bacteria were detected in 100% of the root canal samples (24 of 24), with median values of 10.92 endotoxin units (EU)/mL (1.75-128 EU/mL) and 7.5 × 10(5) CFU/mL (3.20 × 10(5)-8.16 × 10(6) CFU/mL), respectively. The median volume of bone destruction determined by CBCT analysis was 100 mm(3) (10-450 mm(3)). The multiple regression analysis revealed a positive correlation between higher levels of endotoxins present in root canal infection and larger volume of bone destruction (P < .05). Moreover, higher levels of endotoxins were also correlated with the presence of previous pain (P < .05). Our findings revealed that the levels of endotoxins found in root canal infection are related to the volume of periapical bone destruction determined by CBCT analysis. Moreover, the levels of endotoxin are related to the presence of previous pain. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
Velasco-Loera, N; De Alba-Vazquez, Y; Garrocho-Rangel, A; Gonzalez-Amaro, A M; Flores-Reyes, H; Pozos-Guillen, A J
The aim of this study was to evaluate in vitro the antimicrobial efficacy of a modified 3-mix paste and to compare it with an iodoform paste (Ultrapex) against anaerobic microorganisms isolated from root canals of infected or necrotic primary teeth. An in vitro experimental assay was performed over isolated and identified anaerobic microorganisms of 21 samples, in order to compare the antimicrobial ability of both root canal filling materials, using a disc-diffusion method. A total of 21 microbial samples (15 polymicrobial and 6 monomicrobial) were obtained, from which 19 different strains were identified. Modified 3-mix paste showed an excellent antimicrobial effect against most of both kinds of microbial samples, although some of them exhibited resistance; on the other hand, Ultrapex showed only minimal antimicrobial ability (null or low categories). Clostridium ramosum exhibited the most resistance to both materials. The bactericidal effect of the modified 3-mix paste was superior to Ultrapex, with a statistically significant difference, against anaerobic microorganisms isolated from infected root canals of primary teeth.
Lee, Dong-Keun; Kim, Sue Vin; Limansubroto, Adelheid Nerisa; Yen, Albert; Soundia, Akrivoula; Wang, Cun-Yu; Shi, Wenyuan; Hong, Christine; Tetradis, Sotirios; Kim, Yong; Park, No-Hee; Kang, Mo K; Ho, Dean
Root canal therapy (RCT) represents a standard of treatment that addresses infected pulp tissue in teeth and protects against future infection. RCT involves removing dental pulp comprising blood vessels and nerve tissue, decontaminating residually infected tissue through biomechanical instrumentation, and root canal obturation using a filler material to replace the space that was previously composed of dental pulp. Gutta percha (GP) is typically used as the filler material, as it is malleable, inert, and biocompatible. While filling the root canal space with GP is the standard of care for endodontic therapies, it has exhibited limitations including leakage, root canal reinfection, and poor mechanical properties. To address these challenges, clinicians have explored the use of alternative root filling materials other than GP. Among the classes of materials that are being explored as novel endodontic therapy platforms, nanodiamonds (NDs) may offer unique advantages due to their favorable properties, particularly for dental applications. These include versatile faceted surface chemistry, biocompatibility, and their role in improving mechanical properties, among others. This study developed a ND-embedded GP (NDGP) that was functionalized with amoxicillin, a broad-spectrum antibiotic commonly used for endodontic infection. Comprehensive materials characterization confirmed improved mechanical properties of NDGP over unmodified GP. In addition, digital radiography and microcomputed tomography imaging demonstrated that obturation of root canals with NDGP could be achieved using clinically relevant techniques. Furthermore, bacterial growth inhibition assays confirmed drug functionality of NDGP functionalized with amoxicillin. This study demonstrates a promising path toward NDGP implementation in future endodontic therapy for improved treatment outcomes.
Olivi, Giovanni; DiVito, Enrico; Peters, Ove; Kaitsas, Vassilios; Angiero, Francesca; Signore, Antonio; Benedicenti, Stefano
In 2010, one of the authors proposed that lasers could be used to enhance the decontaminating action of sodium hypochlorite (NaOCl). The authors conducted a study to compare the disinfection efficacy of laser-activated irrigation (LAI) by using a photon-induced photoacoustic streaming (PIPS) tip with conventional irrigation and specifically LAI's ability to remove bacterial film formed on root canal walls. The authors shaped 26 human anterior teeth to a master apical file size of International Organization for Standardization 25/06 (size 25 tip and size .06 taper) and then sterilized the teeth, infected them with Enterococcus faecalis and incubated them for four weeks. The authors used two irrigation protocols. Group A received two cycles of 30 seconds each of 5 percent NaOCl laser activation and one cycle of 30 seconds with laser activation involving the use of 17 percent ethylenediaminetetraacetic acid (EDTA). The erbium:yttrium-aluminum-garnet (Er:YAG) laser's settings were 20 millijoules, 15 hertz, 50-microsecond pulse duration, and it had a 600-micrometer PIPS tip. Group B received two cycles of 30 seconds each of 5 percent NaOCl and 17 percent EDTA irrigation alone, delivered via a syringe with a 25-gauge needle. The authors found that group A had significantly better disinfection compared with group B (P < .05). The results of cultures obtained after 48 hours showed that disinfection was maintained better in group A compared with group B (P < .0001). Scanning electron microscopic images showed absence of bacterial biofilm remaining after LAI using PIPS. Er:YAG laser activation of 5 percent NaOCl and 17 percent EDTA was more effective than conventional irrigation for eradicating E. faecalis and preventing new bacterial growth ex vivo. Additional clinical studies are needed to clarify the effect on endodontic treatment outcomes. PIPS appears to be effective in enhancing the effect of the irrigants commonly used in endodontics.
Cretella, Gilda; Lajolo, Carlo; Castagnola, Raffaella; Somma, Francesco; Inchingolo, MariaTeresa; Marigo, Luca
This study examined the bactericidal effect of diode laser irradiation against intracanal Enterococcus faecalis. m total of 128 extracted single-rooted and single-canal teeth were treated with ProTaper instruments (Dentsply Maillefer, Ballaigues, Switzerland). A total of 120 root canals were inoculated with E. faecalis for 21 days, and the samples were randomly divided into five groups: Group 1 (n = 24) samples were irrigated with only saline solution (positive controls); Group 2 (n = 24) was treated with only 5.25% sodium hypochlorite; Group 3 (n = 24) was irrigated with saline solutions activated by diode laser; Group 4 (n = 24) was treated with 5.25% sodium hypochlorite activated by diode laser; and Group 5 (n = 24) was irrigated with saline solution with methylene blue dye activated by the diode laser Fox (Sweden & Martina, Padova, Italy); additionally, eight teeth were not contaminated and their canals were irrigated with saline solution and used as a negative control. The Uro-Quick system was used to determine the microbial residual charge. The data were analyzed using Pearson's chi-square test (p < 0.001). A statistically significant reduction in bacterial count was observed in Group 2 and Group 4 (p < 0.001). There were no statistically significant differences among the other groups (p > 0.001). Evidence indicates that the diode laser was not more effective than sodium hypochlorite in reducing free bacteria.
Nica, Luminita; Todea, Carmen; Furtos, Gabriel; Baldea, Bogdan
Bonding to root canal dentin may be difficult due to various factors: the structural characteristic of the root canal dentin, which is different from that of the coronal dentin; the presence of the organic tissue of the dental pulp inside the root canal, which has to be removed during the cleaning-shaping of the root canal system; the smear-layer resulted after mechanical instrumentation, which may interfere with the adhesion of the filling materials; the type of the irrigants used in the cleaning protocol; the type of the sealer and core material used in the obturation of the endodontic space; the type of the materials used for the restoration of the endodontically treated teeth. The influence of the cleaning protocol, of the root canal filling material, of the type of the adhesive system used in the restoration of the treated teeth and of the region of the root canal, on the adhesion of several filling and restorative materials to root canal dentin was evaluated in the push-out bond strength test on 1-mm thick slices of endodontically treated human teeth. The results showed that all these factors have a statistically significant influence on the push-out bond strength. Formation of resin tags between radicular dentin and the investigated materials was observed in some of the samples at SEM analysis.
Tang, Gaoyan; Samaranayake, Lakshman P; Yip, Hak-Kong; Chu, Frederick C S; Tsang, Peter C S; Cheung, Becky P K
The poor sensitivity of phenotypic identification techniques has hampered the taxonomic differentiation of Actinomyces. Hence we developed a sensitive and specific, PCR-based oligonucleotide-DNA hybridization technique to detect Actinomyces spp. and, used this method to detect these organisms in samples directly obtained from infected root canals. A total of 32 samples from 28 Chinese patients, with primary root canal infections, aseptically exposed at the first patient visit, were studied. Whole bacterial genomic DNA was isolated directly from paper point samples. The variable regions of 16S ribosomal DNA of bacteria were amplified and labeled with digoxigenin for further hybridization and detection. A total of seven oligonucleotide probes specific for A. bovis, A. gerencseriae, A. israelii, A. meyeri, catalase-negative A. naeslundii (genospecies 1 and 2), catalase-positive A. naeslundii genospecies 2 and A. odontolyticus were used. 16 of the 32 teeth were infected with one or more Actinomyces species. The prevalence rates of the examined species were: A. odontolyticus 31.3%, A. meyeri 9.4%, A. naeslundii 9.4%, A. israelii 6.3% and A. gerencseriae 3.1%; no A. bovis was detected in any of the canals. Furthermore, A. odontolyticus was isolated more frequently from root canals with caries or a history of caries (Fisher's exact test: P=0.0496; Odds ratio=9.00, 95% confidence interval: 0.97-83.63), and A. naeslundii was significantly associated with traumatized teeth (Fisher's exact test: P=0.0121; Odds ratio=57.00, 95% confidence interval: 2.10-1546.90). However, no significant correlation was found between Actinomyces spp. and clinical symptoms and signs, such as pain, swelling, percussion to tenderness, sinus and periapical radiolucency. Actinomyces spp. may be important pathogens of root canal infections. A. naeslundii in particular may be related with traumatized teeth. A. odontolyticus appears to be involved in infections related to caries, exposure of dentinal
Siqueira, José F; Guimarães-Pinto, Tatiana; Rôças, Isabela N
This clinical study was conducted to assess the bacterial reduction after chemomechanical preparation with 2.5% NaOCl as an irrigant and the additive antibacterial effect of intracanal dressing with calcium hydroxide. According to stringent inclusion criteria, 11 teeth with primary intraradicular infections and chronic apical periodontitis were selected and monitored in the study. Bacterial samples were taken at the baseline (before treatment) (S1), after chemomechanical preparation with 2.5% NaOCl as an irrigant (S2), and after a 7-day dressing with a calcium hydroxide paste in glycerin (S3). Cultivable bacteria recovered from infected root canals at the 3 stages were counted and identified by means of 16S rRNA gene sequencing analysis. At S1, all canals were positive for bacteria, with the mean number of 2.8 taxa per canal (range, 1-6). At S2, 5 cases (45.5%) still harbored cultivable bacteria, with 1 or 2 species per canal. At S3, bacteria were cultured from 2 cases (18.2%), with 1 species per positive case. There was no indication that any specific bacterial taxon was more resistant to treatment. A significant reduction in bacterial counts was observed between S1 and S2, and S1 and S3. However, no statistically significant difference was observed for comparisons involving S2 and S3 samples with regard to the number of cases yielding negative cultures (P = .18) or quantitative bacterial reduction (P = .19). It was concluded that the whole antibacterial protocol used in this study significantly reduced the number of bacteria in the canal and rendered most canals free of cultivable bacteria.
... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Root canal post. 872.3810 Section 872.3810 Food... DEVICES DENTAL DEVICES Prosthetic Devices § 872.3810 Root canal post. (a) Identification. A root canal... of the platinum group intended to be cemented into the root canal of a tooth to stabilize and...
... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Root canal post. 872.3810 Section 872.3810 Food... DEVICES DENTAL DEVICES Prosthetic Devices § 872.3810 Root canal post. (a) Identification. A root canal... of the platinum group intended to be cemented into the root canal of a tooth to stabilize and...
... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Root canal post. 872.3810 Section 872.3810 Food... DEVICES DENTAL DEVICES Prosthetic Devices § 872.3810 Root canal post. (a) Identification. A root canal... of the platinum group intended to be cemented into the root canal of a tooth to stabilize and...
... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Root canal post. 872.3810 Section 872.3810 Food... DEVICES DENTAL DEVICES Prosthetic Devices § 872.3810 Root canal post. (a) Identification. A root canal... of the platinum group intended to be cemented into the root canal of a tooth to stabilize and...
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Root canal post. 872.3810 Section 872.3810 Food... DEVICES DENTAL DEVICES Prosthetic Devices § 872.3810 Root canal post. (a) Identification. A root canal... of the platinum group intended to be cemented into the root canal of a tooth to stabilize and...
Souza, Matheus Albino; Lima, Guilherme; Pazinatto, Bianca; Bischoff, Karolina Frick; Palhano, Huriel Scartazzini; Cecchin, Doglas
The aim of the present study was to evaluate, in vitro, the influence of the addition of chlorhexidine to photosensitiser in the antimicrobial activity of photodynamic therapy in root canals infected by Enterococcus faecalis. The root canals of 50 single-rooted human extracted teeth were enlarged up to a file F3 of Pro-Taper system, autoclaved, inoculated with Enterococcus faecalis and incubated for 14days. The samples were divided into five groups (n=10) according to the protocol of decontamination: G1 (control group) - no procedure was performed; G2-photosensitiser (0.01% methylene blue); G3-2% chlorhexidine gel; G4-photodynamic therapy; and G5-photodynamic therapy with photosensitiser modified by chlorhexidine. Microbiological test (CFU counting) was performed to evaluate the effectiveness of proposed treatments. Data were subjected to one-way ANOVA followed by post-hoc Tukey test (α=0.05). Group 3 (CHX) showed the lowest mean contamination (2.03 log10 CFU/mL), being statistically different from all other all groups (p<0.05). There was no statistically significant difference between groups 4 (PDT) and 5 (PDT+CHX) (p<0.05), being more effectives against E. faecalis when compared to groups 1 (NT) and 2 (MB), and less effective when compared to group 2 (CHX). The addition of chlorhexidine to photosensitiser did not result in a better decontamination potential of photodynamic therapy alone over root canals infected by E. faecalis. Copyright © 2017 Elsevier B.V. All rights reserved.
Siqueira, José F; Magalhães, Karen M; Rôças, Isabela N
This clinical study investigated the bacterial reduction after instrumentation using 2.5% sodium hypochlorite (NaOCl) as an irrigant and further interappointment dressing with a calcium hydroxide (Ca(OH)(2))/camphorated paramonochlorophenol (CPMC) paste. Eleven teeth with primary intraradicular infections and chronic apical periodontitis selected according to stringent inclusion/exclusion criteria followed in the study. Bacterial samples were taken before treatment (S1), after chemomechanical preparation using hand NiTi files and 2.5% NaOCl (S2), and following a 7-day medication with a Ca(OH)(2) paste in CPMC (S3). Cultivable bacteria recovered from infected root canals at the three stages were counted and identified by means of 16S rRNA gene sequencing analysis. At S1, all cases harbored bacteria, with a mean number of 2.8 taxa per canal (range, 1-6). At S2, 6 of 11 (54.5%) of the cases yielded positive cultures, with one to three species per canal. At S3, only one case (9.1%) was positive for the presence of bacteria, with Propionibacterium acnes as the only taxon isolated. A significantly high reduction in bacterial counts was observed between S1 and S2, and S1 and S3. Significant differences were also observed for comparisons involving S2 and S3 samples with regard to both quantitative bacterial reduction (p = 0.029) and number of culture-negative cases (p = 0.03). It was concluded that chemomechanical preparation with 2.5% NaOCl as an irrigant significantly reduced the number of bacteria in the canal but failed to render the canal free of cultivable bacteria in more than one-half of the cases. A 7-day intracanal dressing with Ca(OH)(2)/CPMC paste further significantly increased the number of culture-negative cases.
Kitagawa, R; Kitagawa, H; Izutani, N; Hirose, N; Hayashi, M; Imazato, S
An antibacterial monomer 12-methacryloyloxydodecylpyridinum bromide (MDPB)-containing experimental, chemically cured primer was prepared to develop a new resin-based root canal filling system. This study investigated the antibacterial effects of the MDPB-containing primer (experimental primer [EP]) against Enterococcus faecalis and assessed the in vitro bonding and sealing abilities of the filling system, consisting of EP and a Bis-GMA-based sealer resin. Antibacterial effects of EP were evaluated by contact with planktonic or adherent bacteria for 30 or 60 sec, and the viable bacterial number was counted. The antibacterial effects against E. faecalis in dentinal tubules were also assessed, according to a root canal infection model. Bonding and sealing abilities of the experimental filling system were examined by microtensile bond strength tests and leakage tests based on fluid filtration methods. Significantly greater reduction in viable bacteria in planktonic and adherent form was obtained by short-period contact with EP compared with the control primer (without MDPB) or with the proprietary (Epiphany) primer (p < .05). Significantly greater bactericidal effects of the EP inside the dentinal tubule of root, as opposed to the control primer or Epiphany primer, were confirmed according to a root canal infection model (p < .05), and 100% killing of E. faecalis could be obtained by the application of EP after irrigation with a 5% sodium hypochlorite solution. The experimental endodontic filling system demonstrated significantly greater bond strength to root dentin than Epiphany sealer system (Epiphany primer and Epiphany Root Canal Sealant; p < .05), showing formation of resin tags and a hybridized layer. Leakage tests clarified that the experimental system provided excellent sealing. This study confirmed that the MDPB-containing experimental antibacterial primer has the ability to effectively disinfect the root canal. Additionally, the experimental root canal
Anderson, Annette Carola; Hellwig, Elmar; Vespermann, Robin; Wittmer, Annette; Schmid, Michael; Karygianni, Lamprini; Al-Ahmad, Ali
Persistence of microorganisms or reinfections are the main reasons for failure of root canal therapy. Very few studies to date have included culture-independent methods to assess the microbiota, including non-cultivable microorganisms. The aim of this study was to combine culture methods with culture-independent cloning methods to analyze the microbial flora of root-filled teeth with periradicular lesions. Twenty-one samples from previously root-filled teeth were collected from patients with periradicular lesions. Microorganisms were cultivated, isolated and biochemically identified. In addition, ribosomal DNA of bacteria, fungi and archaea derived from the same samples was amplified and the PCR products were used to construct clone libraries. DNA of selected clones was sequenced and microbial species were identified, comparing the sequences with public databases. Microorganisms were found in 12 samples with culture-dependent and -independent methods combined. The number of bacterial species ranged from 1 to 12 in one sample. The majority of the 26 taxa belonged to the phylum Firmicutes (14 taxa), followed by Actinobacteria, Proteobacteria and Bacteroidetes. One sample was positive for fungi, and archaea could not be detected. The results obtained with both methods differed. The cloning technique detected several as-yet-uncultivated taxa. Using a combination of both methods 13 taxa were detected that had not been found in root-filled teeth so far. Enterococcus faecalis was only detected in two samples using culture methods. Combining the culture-dependent and –independent approaches revealed new candidate endodontic pathogens and a high diversity of the microbial flora in root-filled teeth with periradicular lesions. Both methods yielded differing results, emphasizing the benefit of combined methods for the detection of the actual microbial diversity in apical periodontitis. PMID:23152922
Bitter Root Irrigation district canal, looking east, typical section and crossing - Bitter Root Irrigation Project, Bitter Root Irrigation Canal, Heading at Rock Creek Diversion Dam, West of U.S. Highway 93, Darby, Ravalli County, MT
Gu, Yongchun; Lu, Qun; Wang, Hanguo; Ding, Yuefeng; Wang, Ping; Ni, Longxing
Racial variations in root form and canal anatomy present endodontic challenges for clinicians. This study examined root canal morphology of three-rooted mandibular first molars by micro-computed tomography scans. A total of 122 extracted mandibular first molars were collected from a native Chinese population. After calculating the frequency of occurrence, 20 three-rooted (experimental group) and 25 two-rooted first molars (control group) were scanned and reconstructed three-dimensionally. The frequency of three-rooted mandibular first molars was 31.97% (39/122). The mean interorifice distances from the distolingual (DL) canal to the distobuccal (DB) and mesiolingual canal were 2.93 mm and 2.86 mm, respectively. The mesial root predominately contained a type 2-2 root canal, with an incidence of 65% in the experimental group and 64% in the control group. Type 1-1 canals were seen more frequently in the DL and DB roots of the three-rooted first molars as well as in the distal roots of the two-rooted first molars. The incidences were 100% (20/20), 95% (19/20), and 72% (18/25), respectively. Accessory and lateral canals rarely occurred in the extra DL roots. The incidence was only 10% (2/20). A furcation canal extending from the floor to the furcation region was not observed. Three-rooted mandibular first molars commonly have 4 separate canals with high incidences of accessory canals in the mesial and DB root. The geometric data of pulp floors are useful for locating the extra DL canal. Copyright 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
Root canal therapy (RCT) represents a standard of treatment that addresses infected pulp tissue in teeth and protects against future infection. RCT involves removing dental pulp comprising blood vessels and nerve tissue, decontaminating residually infected tissue through biomechanical instrumentation, and root canal obturation using a filler material to replace the space that was previously composed of dental pulp. Gutta percha (GP) is typically used as the filler material, as it is malleable, inert, and biocompatible. While filling the root canal space with GP is the standard of care for endodontic therapies, it has exhibited limitations including leakage, root canal reinfection, and poor mechanical properties. To address these challenges, clinicians have explored the use of alternative root filling materials other than GP. Among the classes of materials that are being explored as novel endodontic therapy platforms, nanodiamonds (NDs) may offer unique advantages due to their favorable properties, particularly for dental applications. These include versatile faceted surface chemistry, biocompatibility, and their role in improving mechanical properties, among others. This study developed a ND-embedded GP (NDGP) that was functionalized with amoxicillin, a broad-spectrum antibiotic commonly used for endodontic infection. Comprehensive materials characterization confirmed improved mechanical properties of NDGP over unmodified GP. In addition, digital radiography and microcomputed tomography imaging demonstrated that obturation of root canals with NDGP could be achieved using clinically relevant techniques. Furthermore, bacterial growth inhibition assays confirmed drug functionality of NDGP functionalized with amoxicillin. This study demonstrates a promising path toward NDGP implementation in future endodontic therapy for improved treatment outcomes. PMID:26452304
Kim, Sin-Young; Shin, Yooseok; Lee, Chan-Young; Jung, Il-Young
For selective detection of viable bacteria with molecular methods, propidium monoazide (PMA) treatment has been successfully applied to a wide range of bacteria. The purpose of this study was to compare the quantity of live cells with the total amounts of both live and dead cells before and after chemomechanical preparation by using PMA in combination with real-time polymerase chain reaction (qPCR). Twenty-one teeth with pulp necrosis and a periapical lesion were included. Bacterial sampling of the root canals was performed before (S1) and after (S2) chemomechanical root canal treatment. Each sample was separated into 2 different tubes. PMA was added to one of the tubes, and the other was left untreated. Then, DNA extraction and qPCR were performed. To evaluate the validity of the PMA treatment, the defined mixtures containing different ratios of live and dead cell suspensions of Enterococcus faecalis were either subjected to PMA treatment or not subjected to PMA treatment, followed by qPCR quantification. A paired t test showed a highly significant difference in the mean threshold cycle values between S1 with and without PMA (P = .0002), and this difference (0.89) was similar to that (0.96) obtained from the samples consisting of 80% live cell suspension and 20% dead cell suspension of E. faecalis. The threshold cycle values between the S2 samples with and without PMA were also significantly different (P = .0134), and this difference (0.37) was similar to that obtained from the 100% live cell suspension of E. faecalis (0.42). PMA in conjunction with qPCR appeared to be useful in analyzing the primary infections of root canals because there were significant amounts of dead bacteria in the root canals. Although the use of PMA treatment in post-preparation samples significantly reduced the detection of dead bacteria, this difference was still small, so further studies should be carried out to confirm the necessity of PMA treatment. Copyright © 2013 American
Martinho, Frederico C; Leite, Fábio R M; Nascimento, Gustavo G; Cirelli, Joni A; Gomes, Brenda P F A
This study investigated the presence of different Gram-negative bacterial species and the levels of endotoxins found in primary endodontic infection (PEI), determining their stimulation ability against macrophages through the levels of interleukin (IL)-1, IL-6, IL-10, and tumor necrosis factor alpha (TNF-α), and evaluated their relationship with clinical and radiographic findings. Samples were taken from 21 root canals with primary endodontic infection with apical periodontitis (PEIAP). Molecular techniques were used for bacterial detection. Limulus amebocyte lysate assay was used to measure endotoxins. Pro-inflammatory cytokines were measured by ELISA assay. All samples were positive for bacterial DNA (21/21). Prevotella nigrescens (57.2 %) was the most frequent species. Higher levels of endotoxins were found in teeth with pain on palpation and exudation (all p < 0.05). Positive correlations were found between endotoxins and the levels of TNF-α and IL-1β, whereas a negative correlation was found between endotoxin and the amount of IL-10 (p < 0.05). Endotoxin levels were found to be a risk factor for exudation and increased the number of Gram-negative bacterial species for the presence of a larger area of bone destruction (all p < 0.05). A wide variety of Gram-negative bacterial species are involved in primary endodontic infection, with participation of different Treponema species. Thus, the levels of endotoxins and the number of Gram-negative bacteria species present in root canals were considered risk factors for the severity of endodontic infection. The present study revealed that Gram-negative bacterial species and endotoxins play an important role in the development of signs/symptoms and the severity of bone destruction, this knowledge is essential for the establishment of an effective therapy.
Background Successful root canal treatment depends on proper cleaning, disinfecting and shaping of the root canal space. Pulpless teeth have lower dentin microhardness value compared to that of vital teeth. A material which can cause change in dentin composition may affect the microhardness. Thus the aim of this study was to evaluate and compare the effect of two root canal sealers on dentin microhardness. Material and Methods Forty two single rooted teeth were selected and divided into 3 equal groups; Apexit, iRootSP and control groups (n=14) Each group was then divided into 2 subgroups according to the post evaluation period; 1 week and 2 months (n=7). Root canal procedure was done in the experimental groups and obturation was made using either; Apexit, iRootSP or left unprepared and unobturated in the control group. Roots were sectioned transversely into cervical, middle and apical segments. The three sections of each root were mounted in a plastic chuck with acrylic resin. The coronal dentin surfaces of the root segments werepolished. Microhardness of each section was measured at 500 µm and 1000 µm from the canal lumen. Results Four way-ANOVA revealed that different tested sealer materials, canal third, measuring distance from the pulp and time as independent variables had statistically non significant effect on mean microhardness values (VHN) at p≤0.001. Among iRootSP groups there was a statistically significant difference between iRoot SP at coronal root portion (87.79±17.83) and iRoot SP at apical root portion (76.26±9.33) groups where (p=0.01). IRoot SP at coronal canal third had higher statistically significant mean microhardness value (87.79±17.83) compared to Apexit at coronal third (73.61±13.47) where (p=0.01). Conclusions Root canal sealers do not affect dentin microhardness. Key words:Root canal, dentin, sealers, microhardness, bioceramic. PMID:28149466
Tang, Lu; Sun, Tuo-qi; Gao, Xiao-jie; Zhou, Xue-dong; Huang, Ding-ming
The aim of this study was to analyze the specific influence of root canal anatomy on the accessibility of working length during root canal therapy. Four hundred seventy-six root canal therapy cases (amounting to a total of 1 005 root canals) were examined. The anatomy risk factors assessed in each case included: tooth type (tooth location), root canal curvature, and root canal calcification, as well as endodontic retreatment. The investigation examined the correlation between each of these anatomic factors and the working length, with statistical analysis consisting of Chi-square tests and multiple logistic regression analysis. In an independent factor analysis, tooth type (tooth location), root canal curvature, canal calcification, and endodontic retreatment were determined to be the primary risk factors. In a multiple-factor regression model, root curvature and canal calcification were found to most significantly influence root canal working length accessibility (P<0.05). Root canal anatomy increases the difficulty of root canal preparation. Appropriate consideration of tooth anatomy will assist in accurate determination of preparation difficulty before instrumentation. This study alerts clinical therapists to anatomical factors influencing the working length accessibility, and allows for a direct estimate of success rate given in situ measurements of tooth factors during the root canal treatment procedure. PMID:21789962
... concerns, such as the need for dentures or dental implants." Bertassoni is an assistant professor of restorative dentistry and biomedical engineering at OHSU. His team developed a way to engineer new blood vessels in teeth with root canals. "This result proves that fabrication ...
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Root canal filling resin. 872.3820 Section 872...) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices § 872.3820 Root canal filling resin. (a) Identification. A root canal filling resin is a device composed of material, such as methylmethacrylate,...
... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Root canal filling resin. 872.3820 Section 872...) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices § 872.3820 Root canal filling resin. (a) Identification. A root canal filling resin is a device composed of material, such as methylmethacrylate,...
... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Root canal filling resin. 872.3820 Section 872...) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices § 872.3820 Root canal filling resin. (a) Identification. A root canal filling resin is a device composed of material, such as methylmethacrylate,...
Jaju, Sushma; Jaju, Prashant P.
Sodium hypochloride is the most commonly used endodontic irrigant, despite limitations. None of the presently available root canal irrigants satisfy the requirements of ideal root canal irrigant. Newer root canal irrigants are studied for potential replacement of sodium hypochloride. This article reviews the potential irrigants with their advantages and limitations with their future in endodontic irrigation. PMID:22190936
... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Root canal filling resin. 872.3820 Section 872...) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices § 872.3820 Root canal filling resin. (a) Identification. A root canal filling resin is a device composed of material, such as methylmethacrylate, intended...
... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Root canal filling resin. 872.3820 Section 872...) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices § 872.3820 Root canal filling resin. (a) Identification. A root canal filling resin is a device composed of material, such as methylmethacrylate, intended...
Yong, Tao; Yong, Wei; Jin, Guofan; Gao, Xuejun
Dental pulp is located in root canal of tooth. To modern root canal therapy, "Root canal preparation" is the main means to debride dental pulp infection. The shape of root canal will be changed after preparation, so, when assessing the preparation instruments and techniques, the root canal shaping ability especially the apical offset is very important factor. In this paper, a novel digital image processing and measurement system is designed and applied to quantitative analysis of simulated canal shape. By image pretreatment, feature extraction, registration and fusion, the variation of the root canals' characteristics (before and after preparation) can be accurately compared and measured, so as to assess the shaping ability of instruments. When the scanning resolution is 1200dpi or higher, the registration and measurement precision of the system can achieve 0.021mm or higher. The performance of the system is tested by a series of simulated root canals and stainless steel K-files.
The Editorial Board of the Journal of Endodontics has developed a literature-based study guide of topical areas related to endodontics. This study guide is intended to give the reader a focused review of the essential endodontic literature and does not cite all possible articles related to each topic. Although citing all articles would be comprehensive, it would defeat the idea of a study guide. This section will present root canal debridement including subdivisions on canal access, canal debridement, orifice enlargement and preflaring, crown-down technique, balanced force, nickel titanium and other shape memory alloys, rotary engine-driven techniques, endodontic instruments, irrigation, electronic apex locators, sonics/ultrasonics, smear layer, and intracanal medicaments.
Bansal, Parul; Nikhil, Vineeta; Goyal, Ayush; Singh, Ritu
Traditional configuration of maxillary second premolars has been described to have two cusps, one root and one or two root canals. The endodontic literature reports considerable anatomic aberrations in the root canal morphology of maxillary second premolar but the literature available on the variation in cuspal anatomy and its relationship to the root canal anatomy is sparse. The purpose of this clinical report was to describe the root and root canal configuration of a maxillary second premolar with four cusps. PMID:27563190
Khalifa, Leron; Shlezinger, Mor; Beyth, Shaul; Houri-Haddad, Yael; Coppenhagen-Glazer, Shunit; Beyth, Nurit; Hazan, Ronen
Antibiotic resistance is an ever-growing problem faced by all major sectors of health care, including dentistry. Recurrent infections related to multidrug-resistant bacteria such as methicillin-resistant Staphylococcus aureus, carbapenem-resistant Enterobacteriaceae, and vancomycin-resistant enterococci (VRE) in hospitals are untreatable and question the effectiveness of notable drugs. Two major reasons for these recurrent infections are acquired antibiotic resistance genes and biofilm formation. None of the traditionally known effective techniques have been able to efficiently resolve these issues. Hence, development of a highly effective antibacterial practice has become inevitable. One example of a hard-to-eradicate pathogen in dentistry is Enterococcus faecalis, which is one of the most common threats observed in recurrent root canal treatment failures, of which the most problematic to treat are its biofilm-forming VRE strains. An effective response against such infections could be the use of bacteriophages (phages). Phage therapy was found to be highly effective against biofilm and multidrug-resistant bacteria and has other advantages like ease of isolation and possibilities for genetic manipulations. The potential of phage therapy in dentistry, in particular against E. faecalis biofilms in root canals, is almost unexplored. Here we review the efforts to develop phage therapy against biofilms. We also focus on the phages isolated against E. faecalis and discuss the possibility of using phages against E. faecalis biofilm in root canals. PMID:27640530
Khalifa, Leron; Shlezinger, Mor; Beyth, Shaul; Houri-Haddad, Yael; Coppenhagen-Glazer, Shunit; Beyth, Nurit; Hazan, Ronen
Antibiotic resistance is an ever-growing problem faced by all major sectors of health care, including dentistry. Recurrent infections related to multidrug-resistant bacteria such as methicillin-resistant Staphylococcus aureus, carbapenem-resistant Enterobacteriaceae, and vancomycin-resistant enterococci (VRE) in hospitals are untreatable and question the effectiveness of notable drugs. Two major reasons for these recurrent infections are acquired antibiotic resistance genes and biofilm formation. None of the traditionally known effective techniques have been able to efficiently resolve these issues. Hence, development of a highly effective antibacterial practice has become inevitable. One example of a hard-to-eradicate pathogen in dentistry is Enterococcus faecalis, which is one of the most common threats observed in recurrent root canal treatment failures, of which the most problematic to treat are its biofilm-forming VRE strains. An effective response against such infections could be the use of bacteriophages (phages). Phage therapy was found to be highly effective against biofilm and multidrug-resistant bacteria and has other advantages like ease of isolation and possibilities for genetic manipulations. The potential of phage therapy in dentistry, in particular against E. faecalis biofilms in root canals, is almost unexplored. Here we review the efforts to develop phage therapy against biofilms. We also focus on the phages isolated against E. faecalis and discuss the possibility of using phages against E. faecalis biofilm in root canals.
Jadhav, Ganesh Ranganath
It is important to assess the root canal morphology and its variations before initiating the endodontic procedure. This is because the inability to clean the complete root canal system forms the seat for the persistent infection which ultimately leads to endodontic treatment failure. This case reports the use of dental operating microscope for the successful endodontic management of a two rooted and three canaled mandibular canine with the fractured instrument in the middle canal of a 38-year-old healthy Asian woman. This case report highlights the need to use the dental operating microscope and ultrasonics in locating the elusive canal orifices. It is important to note the internal and external root canal morphological variations before starting the endodontic treatment without any pre-operative assumptions about the usual anatomy of the toot. PMID:24778521
Chang, Seok Woo; Lee, Young-Kyu; Zhu, Qiang; Shon, Won Jun; Lee, Woo Cheol; Kum, Kee Yeon; Baek, Seung Ho; Lee, In Bog; Lim, Bum-Soon; Bae, Kwang Shik
The flowability of a root canal sealer is clinically important because it improves the penetration of the sealer into the complex root canal system. The purpose of this study was to compare the flowabilities of four root canal sealers, measured using the simple press method (ISO 6876), and their viscosities, measured using a strain-controlled rheometer. A newly developed, calcium phosphate-based root canal sealer (Capseal) and three commercial root canal sealers (AH Plus, Sealapex and Pulp Canal Sealer EWT) were used in this study. The flowabilities of the four root canal sealers were measured using the simple press method (n=5) and their viscosities were measured using a strain-controlled rheometer (n=5). The correlation between these two values was statistically analysed using Spearman's correlation test. The flow diameters and the viscosities of the root canal sealers were strongly negatively correlated (ρ=−0.8618). The viscosity of Pulp Canal Sealer EWT was the lowest and increased in the following order: AH Plus
Celikten, Berkan; Tufenkci, Pelin; Aksoy, Umut; Kalender, Atakan; Kermeoglu, Fatma; Dabaj, Pervin; Orhan, Kaan
Microorganisms in untreated or overlooked root canals can cause endodontic failure or infection and inflammation. Therefore, clinicians should familiarize themselves with patient's root canal anatomy and morphology. The objective of this retrospective study was to analyze and characterize mandibular root canal morphology using cone beam computed tomography (CBCT) in a Turkish Cypriot population. This cross-sectional study consisted of retrospective evaluation of CBCT scans from 272 adult patients (aged 16-80 years). The number of roots and canals and the canal configuration in each root were evaluated using Vertucci's classification. The incidence of additional roots and of C-shaped canals in the mandibular first and second molars was also noted. Pearson chi-square tests were performed to analyze canal configurations, laterality, and gender (p ≤ 0.05). For the female and male patients, 94.5 and 94.4 % of the mandibular first and 96.7 and 97.2 % of the mandibular second molars had two roots, respectively. In females, 4.4 % of mandibular first molars had three roots versus 2.7 % of mandibular first molars in male patients. Type IV was the most prevalent canal configuration regardless of the gender (female 61.3 % and male 64.2 %) in the mesial roots. No statistically significant differences according to gender or laterality were found in the incidence of additional canals for either maxillary first or second molars. Type IV was the most prevalent canal configuration of both the mandibular first and second molar teeth. There was a low prevalence of three-rooted mandibular molars in this particular population. The current study is the first of its kind to include a Turkish Cypriot population and, thus, provides baseline data for these patients regarding appropriate root canal treatments.
George, Gingu Koshy; Varghese, Anju Mary; Devadathan, Aravindan
Anatomical variations in root canal morphology are an enigma and it is this variability, which is often a complicating factor in a successful root canal treatment. To achieve success in endodontic therapy it is imperative that all the canals are located, cleaned and shaped and obturated three dimensionally. Maxillary first premolar having three separate roots has an incidence of 0.5-6%. Even rarer are reported clinical case reports of maxillary second premolar with three separate roots and three canals. This case report describes the endodontic management of maxillary second premolar with two palatal roots and one buccal root having three root canals PMID:24944457
Wen, Shan-hui; Lin, Zi-tong; Zhu, Min; Ge, Jiu-yu; Wang, Tie-mei
To compare the root canal morphology of mandibular incisors by using cone-beam CT (CBCT) and canal staining and clearing technique. Sixty-one extracted mandibular incisors with complete dental root and apex which received no endodontic treatment and no post crown restoration were selected. Each tooth was radiographed with CBCT, and the root canal system was stained by canal staining and clearing technique. The consistency of the number of root canal, root canal Vertucci type of mandibular permanent incisors between the two methods were compared, and the differences of the detection rate on root canal branch structure between the two methods were analyzed. The results were statistically analyzed with SPSS 17.0 software package. The Kappa value of single and double root canal types between CBCT and canal staining and clearing technique was 0.847 (P<0.001). The Kappa value of Vertucci root canal types between CBCT and canal staining and clearing technique was 0.861 (P<0.001). The detection rates of root canal branch structure were 8.19% and 22.95%, respectively, with significant difference between the two methods (P=0.025). The canal staining and clearing technique was significantly better than CBCT in detection of root canal branch structure. CBCT can reflect the root canal types nearly perfectly, but inferior to canal staining and clearing technique in detection of root canal branch structure, CBCT is a relatively accurate clinical diagnosis tool of root canal morphology.
Sulaiman, A.O; Dosumu, O.O; Amedari, McKing
The maxillary first premolar is the most commonly bi- rooted tooth with occasional presentation of three roots system; it is a transitional tooth between incisors and molars. Although it usually has two canals, it may rarely have three and this third canal can easily be missed. Thus meticulous knowledge of tooth morphology, careful interpretation of angled radiographs, proper access cavity preparation and a detailed exploration of the interior of the tooth is needed to ensure a proper endodontic treatment. This article reports a rare finding of three canals in a maxillary first premolar with non well defined root outline radiographically during an elective root canal treatment. PMID:25161429
Siqueira, José F; Alves, Flávio R F; Rôças, Isabela N
Bacterial biofilm communities established in the apical part of infected root canals are conceivably of utmost importance in the pathogenesis of apical periodontitis. This study investigated the diversity of the apical endodontic microbiota by using cryopulverized root segments and massive parallel pyrosequencing analysis. Ten extracted teeth with attached apical periodontitis lesions were sectioned to obtain 2 root fragments (apical and middle/coronal segments). Apical root fragments were cryogenically ground, and DNA was extracted from samples and subjected to multiplex tag-encoded FLX-titanium amplicon pyrosequencing. Pyrosequencing analysis yielded partial 16S rRNA gene sequences that were taxonomically classified into 187 bacterial species-level phylotypes (at 3% divergence), 84 genera, and 10 phyla. The most represented, abundant, and prevalent phyla were Proteobacteria, Firmicutes, Bacteroidetes, Fusobacteria, and Actinobacteria. The majority of species-level phylotypes occurred at low levels. The mean number of species-level phylotypes per sample was 37 (range, 13-80). A great interindividual variation in the composition of the apical microbiota was disclosed. This study extensively describes the diversity of the bacterial communities present selectively in the apical part of root canals of teeth with apical periodontitis and revealed a previously unanticipated high bacterial diversity. Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
Plotino, Gianluca; Cortese, Teresa; Grande, Nicola M; Leonardi, Denise P; Di Giorgio, Gianni; Testarelli, Luca; Gambarini, Gianluca
Effective irrigant delivery and agitation are prerequisites to promote root canal disinfection and debris removal and improve successful endodontic treatment. This paper presents an overview of the currently available technologies to improve the cleaning of the endodontic space and their debridement efficacy. A PubMed electronic search was conducted with appropriate key words to identify the relevant literature on this topic. After retrieving the full-text articles, all the articles were reviewed and the most appropriate were included in this review. Several different systems of mechanical activation of irrigants to improve endodontic disinfection were analysed: manual agitation with gutta-percha cones, endodontic instruments or special brushes, vibrating systems activated by low-speed hand-pieces or by sonic or subsonic energy, use of ultrasonic or laser energy to mechanically activate the irrigants and apical negative pressure irrigation systems. Furthermore, this review aims to describe systems designed to improve the intracanal bacterial decontamination by a specific chemical action, such as ozone, direct laser action or light-activated disinfection. The ultrasonic activation of root canal irrigants and of sodium hypochlorite in particular still remains the gold standard to which all other systems of mechanical agitation analyzed in this article were compared. From this overview, it is evident that the use of different irrigation systems can provide several advantages in the clinical endodontic outcome and that integration of new technologies, coupled with enhanced techniques and materials, may help everyday clinical practice.
Cheng, X; Chen, B; Qiu, J; He, W; Lv, H; Qu, T; Yu, Q; Tian, Y
This study evaluated the bactericidal effect of Er:YAG laser radiation combined with sodium hypochlorite (NaOCl) irrigation in the treatment of Enterococcus faecalis deep inside dentinal tubules. The Er:YAG laser was activated, respectively, at 0.3, 0.5 and 1.0 W for either 20 or 30 s; 52.5 g l(-1) NaOCl and normal saline were used for the control groups. Root canals before and after treatments were examined using scanning electron microscopy (SEM). Bacterial reductions both on the root canal walls and at 100, 200, 300, 400 and 500 μm inside the dentinal tubules were analysed using a one-way analysis of variance. SEM results showed that the Er:YAG laser combined with NaOCl disinfected the dentinal tubules from 200 to over 500 μm depth as irradiation power and time increased. This combination killed significantly more bacteria than both the negative control group at each level tested and the positive control group at 300, 400 and 500 μm inside the dentinal tubules. It reached 100% in all experimental groups, both on the root canal walls and at 100 and 200 μm inside the dentinal tubules. However, at 300, 400 and 500 μm inside the dentinal tubules, only the groups treated with 0.5 and 1.0 W for 30s exhibited no bacterial growth. Of the two groups in which no bacteria were detected at all tested depths, Er:YAG laser irradiation at 0.5 W for 30 s combined with NaOCl irrigation was preferable because of the lower emission power and shorter irradiation time, and may serve as a new option for effective root canal disinfection.
Negrutiu, Meda L.; Sinescu, Cosmin; Topala, Florin; Nica, Luminita; Ionita, Ciprian; Marcauteanu, Corina; Goguta, Luciana; Bradu, Adrian; Dobre, George; Rominu, Mihai; Podoleanu, Adrian Gh.
Endodontic therapy consists in cleaning and shaping the root canal system, removing organic debris and sealing the intra-canal space with permanent filling materials. The purpose of this study was to evaluate various root canal fillings in order to detect material defects, the marginal adaptation at the root canal walls and to assess the quality of the apical sealing. 21 extracted single-root canal human teeth were selected for this study. We instrumented all roots using NiTi rotary instruments. All canals were enlarged with a 6% taper size 30 GT instrument, 0,5 mm from the anatomical apex. The root canals were irrigated with 5% sodium hypochlorite, followed by 17% ethylenediaminetetraacetic acid (EDTA). After the instrumentation was completed, the root canals were obturated using a thermoplasticizable polymer of polyesters. In order to assess the defects inside the filling material and the marginal fit to the root canal walls, the conebeam micro-computed tomography (CBμCT) was used first. After the CBμCT investigation, time domain optical coherence tomography working in en face mode (TDefOCT) was employed to evaluate the previous samples. The TDefOCT system was working at 1300 nm and was doubled by a confocal channel at 970 nm. The results obtained by CBμCT revealed no visible defects inside the root-canal fillings and at the interfaces with the root-canal walls. TDefOCT investigations permit to visualize a more complex stratificated structure at the interface filling material/dental hard tissue and in the apical region.
Gutknecht, Norbert; Wilkert-Walter, Cornelia; Lampert, Friedrich
The purpose of this study was to determine the bactericidal effect of a CO2 laser used in a continuous mode. Classically prepared root canals were irradiated under standardized conditions with power settings of 2, 4, and 6 Watts. The mean elimination of Enterococcus faecalis in prepared and infected root canals of extracted teeth was 98.97%, 99.51% and 99.34% respectively. Minimum elimination was 91.67% and maximum 99.696%.
Eliyas, Shiyana; Briggs, Peter F; Porter, Richard W J
This paper highlights the importance of root canal disinfection. It discusses the different endodontic irrigants available and comments on how these can be used most effectively. Eliminating bacteria from the root canal system is an essential stage in endodontic therapy. Practitioners should be adequately informed and skilled in this vital aspect of endodontics.
Zhang, Qiyuan; Chen, Hao; Fan, Bing; Fan, Wei; Gutmann, James L
Root fusion is an anatomic variation in maxillary second molars (MSMs); however, the nature of this canal morphology as it relates to its root anatomy has not been fully clarified. The purpose of this study was to investigate the relationship between features of fused roots and root canal anatomy in MSMs using micro-computed tomographic imaging. One hundred eighty-seven extracted MSMs were scanned with the μCT50 (Scanco Medical, Bassersdorf, Switzerland), and their root and canal morphology was classified and analyzed using the classifications proposed by Yang and Vertucci. The number and position of canals that merged were recorded and compared among different root fusion types. One hundred eight (57.75%) MSMs had 3 separate roots, and 79 (42.25%) had fused roots. Of the 79 fused roots, 22 showed partial canal merging, and 6 had complete canal merging. Canal merging was found with teeth with 3-root fusion more often than in those with 2-root fusion (P < .05). Of 28 merged canals, 16 occurred between mesiobuccal and distobuccal canals and 9 among mesiobuccal, distobuccal, and palatal canals. MSMs with fused roots may present a complicated root canal system as a result of canal merging. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
High-altitude illness may occur after recent pulmonary infection, but high-altitude illness after root canal therapy has not been described previously. A 44-year-old man is presented who skied to a 3333 m high peak in the Eastern Alps one day after he had undergone root canal therapy because of a tooth root infection. After 4 hours above 3000 m severe symptoms of high-altitude illness, including pulmonary oedema, developed. His condition improved after immediate descent. The next day he presented with local and general signs of infection which were successfully treated with gingival incisions and antibiotics. In conclusion, acute tooth root infection and root canal therapy may induce high-altitude illness at an altitude just above 3000 m. Keywords: high-altitude illness; pulmonary oedema; root canal therapy; tooth root infection PMID:10715764
Singh, Shishir; Pawar, Mansing
The purpose of this study was to study the root canal morphology of South Asian Indian mandibular premolars using a tooth clearing technique. Two hundred mandibular premolar teeth were collected from different dental schools and clinics in India. After pulp tissue removal and root canal staining with Indian ink, the specimens were decalcified with 5% nitric acid, dehydrated in ethyl alcohol, and subsequently cleared in methyl salicylate. Of the 200 mandibular premolars, 100 were first premolars and 100 were second premolars. Of the first premolars, 94% had a single root, whereas 6% were 2 rooted. Seventy-six percent had a single canal, 22% had 2 canals, and 2% had 3 canals. Eighty-two percent had a single apical foramen, 16% had 2 foramens, and 2% teeth had 3 apical foramens. Eighty percent of teeth had type I, 6% had type II, 10% had type IV, 2% had type V, and 2% teeth had type IX root canal anatomy. Of the 100 second premolars, 92% had a single root, whereas 8% teeth were 2 rooted and fused. Fifty-eight percent of teeth had a single canal, and 42% had two canals. Eighty-eight percent had a single apical foramen, and 12% had 2 foramens. Sixty-six percent had type I, 30% had type II, and 4% had type V root canal anatomy. A high prevalence of 2 canals was noted in the first and second premolars. Also, 20% of first premolars and 34% of second premolars had a root canal anatomy other than type I. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
Lin, Louis M; Ricucci, Domenico; Lin, Jarshen; Rosenberg, Paul A
It is a general belief that large cyst-like periapical lesions and apical true cysts caused by root canal infection are less likely to heal after nonsurgical root canal therapy. Nevertheless, there is no direct evidence to support this assumption. A large cyst-like periapical lesion or an apical true cyst is formed within an area of apical periodontitis and cannot form by itself. Therefore, both large cyst-like periapical lesions and apical true cysts are of inflammatory and not of neoplastic origin. Apical periodontitis lesions, regardless of whether they are granulomas, abscesses, or cysts, fail to heal after nonsurgical root canal therapy for the same reason, intraradicular and/or extraradicular infection. If the microbial etiology of large cyst-like periapical lesions and inflammatory apical true cysts in the root canal is removed by nonsurgical root canal therapy, the lesions might regress by the mechanism of apoptosis in a manner similar to the resolution of inflammatory apical pocket cysts. To achieve satisfactory periapical wound healing, surgical removal of an apical true cyst must include elimination of root canal infection.
Zehnder, Matthias; Schmidlin, Patrick; Sener, Beatrice; Waltimo, Tuomas
The aim of this study was to assess interactions of EDTA and citric acid (CA) with sodium hypochlorite (NaOCl), the indispensable endodontic irrigant. Other chelators were simultaneously evaluated as possible alternatives: sodium triphosphate (STP), amino tris methylenephosphonic acid (ATMA), and 1- hydroxyethylidene-1, 1-bisphosphonate (HEBP). Available chlorine was titrated in chelator-NaOCl solutions. All chelators other than HEBP and STP caused an almost complete, immediate loss of available chlorine in solution. Atomic absorbtion spectrometry and SEM evaluation of root canal walls of instrumented teeth indicated that NaOCl had no negative effect on calcium-complexing ability of chelators. STP was too weak a complexing agent to warrant further studies. Finally, CA-, EDTA-, and HEBP-NaOCl mixtures were evaluated for their antimicrobial capacity. Again, EDTA and CA negatively interfered with NaOCl, while HEBP did not.
Luca, Ruxandra; Todea, Carmen; Bǎlǎbuc, Cosmin; Nica, Luminita; Armani, Giacomo; Locovei, Cosmin
Studies have demonstrated that conventional chemo-mechanical preparation is limited regarding the decontamination of the endodontic space, which is why alternative techniques such as laser radiation have their importance in the modern endodontic treatment. The present study aims to assess the possibility of improving the debridement of the root canals by removing smear layer using Er: YAG laser radiation. We used 18 extracted teeth, which were subjected to the same initial protocol and then divided into 5 study groups: the control group has not been treated with laser; the other 4 groups were exposed to laser radiation using two different geometries peaks of quartz and two energy levels. Scanning electronic microscopy revealed an increased efficiency in the debridement of all interested areas when using PIPS and XPulse tips at proper energy. In the two groups treated with inferior laser energy, the debridement didn't prove to be superior to the conventional treatment.
van der Waal, Suzette V; Oonk, Charlotte A M; Nieman, Selma H; Wesselink, Paul R; de Soet, Johannes J; Crielaard, Wim
The aim of this study is to investigate the disinfecting properties of a modified salt solution (MSS) and calcium hydroxide (Ca(OH)2) in a non-direct-contact ex-vivo model. Seventy-four single-canal roots infected with Enterococcus faecalis were treated with 1% sodium hypochlorite (NaOCl) irrigation or with NaOCl irrigation with subsequent dressing with MSS or Ca(OH)2. After removal of the dressings, the roots were filled with bacterial growth medium and incubated for seven days to enable the surviving bacteria to repopulate the root canal lumen. Growth was determined by sampling the root canals with paper points before treatment (S1), after treatment (S2) and incubation after treatment (S3). The colony forming units were counted at S1 and S2. At S3, growth was determined as no/yes regrowth. The Kruskal-Wallis, McNemar and χ(2) test were used for statistical analyses. At S2, in the NaOCl group, growth was found in 5 of 19 root canals. After the removal of MSS or Ca(OH)2 bacteria were retrieved from one root canal in both groups. At S3, repopulation of the root canals had occurred in 14 of 19 roots after sole NaOCl irrigation, 6 of 20 roots after MSS-dressing and in 14 of 20 roots after Ca(OH)2-dressing. MSS was more effective in preventing regrowth than Ca(OH)2 (P=0.009). The modified salt solution prevented regrowth in roots which indicates that it can eliminate persistent bacteria. Dressing the root canals with Ca(OH)2 did not provide additional disinfection after NaOCl irrigation. Copyright © 2015 Elsevier Ltd. All rights reserved.
Blank, Molly A. B.; Friedrich, Michal; Hamilton, Jeffrey D.; Lee, Peggy; Berg, Joel; Seibel, Eric J.
Complications that arise during endodontic procedures pose serious threats to the long-term integrity and health of the tooth. Potential complexities of root canals include residual pulpal tissue, cracks, mesial-buccal 2 and accessory canals. In the case of a failed root canal, a successful apicoectomy can be jeopardized by isthmuses, accessory canals, and root microfracture. Confirming diagnosis using a small imaging probe would allow proper treatment and prevent retreatment of endodontic procedures. An ultrathin and flexible laser scanning endoscope of 1.2 to 1.6mm outer diameter was used in vitro to image extracted teeth with varied root configurations. Teeth were opened using a conventional bur and high speed drill. Imaging within the opened access cavity clarified the location of the roots where canal filing would initiate. Although radiographs are commonly used to determine the root canal size, position, and shape, the limited 2D image perspective leaves ambiguity that could be clarified if used in conjunction with a direct visual imaging tool. Direct visualization may avoid difficulties in locating the root canal and reduce the number of radiographs needed. A transillumination imaging device with the separated illumination and light collection functions rendered cracks visible in the prepared teeth that were otherwise indiscernible using reflected visible light. Our work demonstrates that a small diameter endoscope with high spatial resolution may significantly increase the efficiency and success of endodontic procedures.
Grande, Nicola Maria; Butti, Andrea; Plotino, Gianluca; Somma, Francesco
Post placement in oval-shaped root canals implies the sacrifice of sound dental tissue to adapt the canal shape to fit the post, which can result in one of several significant complications. A semidirect, single-visit, chairside procedure is proposed, which permits the use of an almost anatomically shaped post, starting from a preformed fiber-reinforced composite root canal post of the largest size commercially available. The utilization of this post capitalizes on the advantages of both the fiber post and the anatomical post in oval- and ribbon-shaped canals to provide restoration of endodontically treated teeth.
Zhou, Hui-min; Shen, Ya; Zheng, Wei; Li, Li; Zheng, Yu-feng; Haapasalo, Markus
The aim of this study was to evaluate the pH change, viscosity and other physical properties of 2 novel root canal sealers (MTA Fillapex and Endosequence BC) in comparison with 2 epoxy resin-based sealers (AH Plus and ThermaSeal), a silicone-based sealer (GuttaFlow), and a zinc oxide-eugenol-based sealer (Pulp Canal Sealer). ISO 6876/2001 specifications were followed. The pH change of freshly mixed and set sealers was evaluated during periods of 1 day and 5 weeks, respectively. The viscosity was investigated at different injection rates (72, 10, and 5 mm/min) at room temperature by using a syringe-based system that was based on the Instron 3360 series universal testing system. The flow, dimensional change, solubility, and film thickness of all the tested sealers were in agreement with ISO 6876/2001 recommendations. The MTA Fillapex sealer exhibited a higher flow than the Endosequence BC sealer (P < .05). The MTA Fillapex and Endosequence BC sealers showed the highest film thicknesses among the tested samples. The Endosequence BC sealer exhibited the highest value of solubility, which was in accordance with 3% mass fraction recommended by the ISO 6876/2001, and showed an acceptable dimensional change. The MTA Fillapex and Endosequence BC sealers presented an alkaline pH at all times. The pH of fresh samples of the AH Plus and ThermaSeal sealers was alkaline at first but decreased significantly after 24 hours. The viscosity of the tested sealers increased with the decreased injection rates. The tested sealers were pseudoplastic according to their viscosities as determined in this study. The MTA Fillapex and Endosequence BC sealers each possessed comparable flow and dimensional stability but higher film thickness and solubility than the other sealers tested. Copyright © 2013 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
de la Torre, Francisco; Cisneros-Cabello, Rafael; Aranguren, José Luis; Estévez, Roberto; Velasco-Ortega, Eugenio; Segura-Egea, Juan José
This case report presents an unusual root canal system in a maxillary first molar tooth: a single canal in a single root. The endodontic access cavity displayed only 1 canal orifice. This case demonstrated that: 1) clinicians must have adequate knowledge about root canal morphology and its variations; 2) the location and morphology of root canals should be identified radiologically before the root canal treatment; and 3) careful examination of radiographs and the internal anatomy of teeth is essential.
Grande, Nicola M; Plotino, Gianluca; Lavorgna, Luca; Ioppolo, Pietro; Bedini, Rossella; Pameijer, Cornelis H; Somma, Francesco
The aims of this study were to compare Resilon (Resilon Research LLC, Madison, CT) in conjunction with either a bonding (Epiphany; Pentron Clinical Technologies, Wallingford, CT) or a nonbonding endodontic sealer (Pulp Canal Sealer; Kerr Corporation, Orange, CA) to EndoRez (Ultradent Products Inc, South Jordan, UT) and gutta-percha with regards to the physical properties and flexural stress in standardized dentin cylinders and the flexural stress of Resilon and gutta-percha. The external surface of 50 maxillary central incisors was reduced by means of mechanical milling to obtain dentin cylinders with an external diameter of 3 mm and minimum length of 12 mm. Root canals were prepared to obtain a standardized cylindrical preparation of 1.3 mm in diameter at the center of the root. The cylinders were randomly divided into five groups (n = 10): group 1: obturation with gutta-percha and Pulp Canal Sealer; group 2: obturation with Resilon, Epiphany primer, and Epiphany; group 3: obturation with Resilon and Pulp Canal Sealer; group 4: obturation with EndoRez methacrylate-based endodontic sealer; and group 5: dentin cylinders were not obturated. Ten gutta-percha (group 6) and Resilon (group 7) pellets for the Obtura gun were also tested. A three-point bending test was used to measure the maximum load values of specimens from groups 1 to 5 and the flexural strength and flexural modulus values for specimens from groups 6 and 7. Statistical analysis was performed to determine significance differences (p < 0.05). An analysis of variance test showed no significant difference among groups 1 to 5 (p = 0.697; F = 0.60). An independent sample t test showed statistically significant differences between groups 6 and 7 in flexural strength (p = 0.000) and flexural modulus (p = 0.000). Within the limits of this study, it may be concluded that the currently available endodontic-filling materials and their recommended adhesive procedures are not able to influence the mechanical
Hariharavel, V. P.; Kumar, A. Ashok; Ganesh, C.; Aravindhan, R.
Anatomic and internal morphology of a root canal system is more complex and differs for each individual tooth of which mandibular premolars have earned the reputation for having aberrant anatomy. The occurrence of three canals with three separate foramina in mandibular second premolars is very rare. A wider knowledge on both clinical and radiological anatomy especially spiral computed tomographic is absolutely essential for the success of endodontic treatment. These teeth may require skillful and special root canal special shaping and obturating techniques. This paper reports an unusual case of a mandibular second premolar with atypical canal pattern that was successfully treated endodontically. PMID:25101187
Adorno, C G; Yoshioka, T; Suda, H
To investigate the vertical and horizontal distribution and the incidence of accessory canals in Japanese maxillary anterior teeth following root filling. The study included maxillary teeth; 69 central incisors, 61 lateral incisors and 31 canines. After the canal systems had been dyed and root canal instrumentation had been carried out, all prepared canals were filled with gutta-percha without using sealer. Transparent specimens were then obtained and examined with a digital microscope for horizontal and vertical distributions of accessory canals. The incidence of teeth with accessory canals in the apical 3 mm was 46%, 29% and 38% for the maxillary central incisors, lateral incisors and canines, respectively. The horizontal distribution was mainly buccal for central incisors, palatal for lateral incisors and distal and palatal for canines. There was a significant difference (P < 0.05) between the apical 3 mm and the rest of the root (16%, 20% and 19% for the maxillary central incisors, lateral incisors and canines, respectively) in terms of the presence of accessory canals. A high percentage of accessory canals can be found in apical 3 mm of the root. The horizontal distribution of accessory canals differed amongst the tooth types studied.
Guo, Huijie; Gao, Chengzhi; Zhang, Chengfei; Zheng, Shuying; Yue, Lin
Apical abscess is an inflammatory process in the peri-radicular tissues caused by biofilms in the necrotic root canal systems. Therefore, a comprehensive analysis of the bacterial colonization is required for a better understanding of the pathogenesis. This study aimed to investigate the patterns of bacterial infection of root canals of teeth with apical abscesses and to determine whether histological and microbiological findings correlated with clinical conditions. Eighteen samples from 18 teeth with apical pathological lesions were analyzed. Nine patients with acute apical abscesses experienced severe pain, and nine patients were asymptomatic with a sinus tract. After extraction, each affected root was divided into two halves. One half was processed for histobacteriologic analysis and examined using light microscopy, and the other half was analyzed using scanning electron microscopy (SEM) to determine the patterns of microbial colonization of the root canals. The appearance of each sample subjected to SEM was consistent with the histobacteriologic findings despite the presence or absence of clinical symptoms. Intraradicular biofilms comprising cocci, rods, and/or filaments of amorphous materials were observed in the apical third of the main root canals in all samples. The bacterial biofilms covering the main root canal walls also penetrated the dentinal tubules to varying depths. The morphologies of biofilms varied, and a unique pattern of intraradicular infection was not identified. Intraradicular infections formed complex and variable multispecies biofilms and their presence did not correlate with clinical symptoms.
Erdemir, Ali; Eldeniz, Ayce Unverdi; Belli, Sema; Pashley, David H
The long-term success of resin cementation of post/cores is likely increased with improvement in resin-root canal dentin bonding. The adverse effect of some irrigation constituents (NaOCl, H2O2) or medications (eugenol) on the bond strengths of resins to dentin have been reported. The purpose of this in vitro study was to evaluate the effect of two gutta-percha solvents (chloroform versus halothane) on microtensile bond strength to root canal dentin. Thirty, extracted, human, single-rooted teeth were instrumented to a #70 file and randomly divided into 3 groups of 10 each. The root canals were treated with water, chloroform, or halothane for 60 s. All root canals were obturated using C&B Metabond. After 24 h of storage in distilled water, serial 1-mm-thick cross-sections were cut and trimmed. Microtensile bond strength to apical, middle, and coronal root canal dentin were measured using an Instron machine. Using pooled data, the results indicated that water-treated roots had significantly higher resin-dentin bond strengths compared with chloroform or halothane treatment groups (control: 23.9 MPa; chloroform: 18.3 MPa; halothane: 17 MPa; p < 0.05). Gutta-percha solvents have an adverse effect on bond strengths of adhesive cements to root canal dentin.
Analoui, Mostafa; Krisnamurthy, Satthya; Brown, Cecil
Determining root canal length is a crucial step in success of root canal treatment. Root canal length is commonly estimated based on pre-operation intraoral radiography. 2D depiction of a 3D object is the primary source of error in this approach. Techniques based on impedance measurement are more accurate than radiographic approaches, but do not offer a method for depicting the shape of canal. In this study, we investigated a stererotactic approach for modeling and measurement of root canal of human dentition. A weakly perspective model approximated the projectional geometry. A series of computer-simulated objects was used to test accuracy of this model as the first step. The, to assess the clinical viability of such an approach, endodontic files inserted in the root canal phantoms were fixed on an adjustable platform between a radiographic cone and an image receptor. Parameters of projection matrix were computed based on the relative positions of image receptors, focal spot, and test objects. Rotating the specimen platform from 0 to 980 degrees at 5-degree intervals set relative angulations for stereo images. Root canal is defined as the intersection of two surfaces defined by each projection. Computation of error for length measurement indicates that for angulations greater than 40 degrees the error is within clinically acceptable ranges.
Royer, Kinga; Liu, Xue Jun; Zhu, Qiang; Malmstrom, Hans; Ren, Yan-Fang
To investigate the apical sealing ability of glass ionomer and resin-based root canal obturation systems in comparison to a conventional vertical compaction of warm guttapercha. Forty-five extracted human teeth were randomly assigned into 3 groups of 15 each: a resin-based (EndoRez), a glass ionomer-based (Activ GP), and a conventional gutta-percha plus pulp sealer obturation system (GP/EWT). Apical and root canal space sealing abilities were assessed on five cross-sections 1.0 mm apart starting from the apex. Cross-section images were analysed using a focus-variation 3D scanning microscope and unsealed space was calculated as the percentage of total root canal space occupied by voids and debris. EndoRez had significantly higher rate of apical leakage and deeper dye penetration as compared to GP/EWT and Activ GP. EndoRez group had also more voids and debris (22.5%) in the root canal spaces as compared to GP/EWT (10.5%) and Activ GP (10.8%). Apical leakages occurred not only along the root canal walls, but also along the gutta-percha cones with EndoRez as a result of significant polymerisation shrinkage of the resin sealer. Resin-based EndoRez did not form an adequate apical seal of filled root canals. Glass ionomer-based Activ GP was comparable to a vertical compaction of warm guttapercha plus EWT sealer in sealing root canal spaces.
Singh, Shishir; Pawar, Mansing
Objective: The objective was to study the root canal morphology of South Asian Indian Maxillary molars using a tooth clearing technique. Materials and Methods: Hundred teeth each comprising of first, second, and third molars collected from different dental schools and clinics in India were subjected to standard dye penetration, decalcification and clearing procedure before being studied. Results: The first molar mesiobuccal roots exhibited 69% Type I, 24% Type II, 4% Type IV, 2% Type V, and 1% exhibited a Vertuccis Type VIII canal anatomy. In the group with three separate roots the second molar mesiobuccal roots in exhibited 80.6% Type I, 15.3% Type II, 2.7% Type IV, and 1.4% Type V canal anatomy while the third molars mesiobuccal roots exhibited 57.4% Type I, 32% Type II, 2.1% Type III, 8.5% Type IV, 1% had a Type V canal anatomy in the similar group. Conclusion: A varied root canal anatomy was seen in the mesiobuccal root canal of the maxillary molars. PMID:25713497
Shahani, M N; Subba Reddy, V V
Disinfection of the root canal system is one of the primary aims of root canal treatment. This can be achieved through the use of various antimicrobial agents in the form of irrigants and medicaments. The antimicrobial substantivity of 2% chlorhexidine gluconate, 1% povidone iodine, 2.5% hydrogen peroxide followed by 2% sodium hypochlorite, and 2% sodium hypochlorite alone as irrigants was assessed in instrumented root canals. 2% chlorhexidine showed antimicrobial substantivity lasting up to 72 h, followed by 1% povidone iodine, and 2% sodium hypochlorite. Thus 2% chlorhexidine should be used as a final rinse irrigant in endodontic treatment protocols.
Pekiner, Filiz Namdar; Borahan, M Oğuz; Dumlu, Asım
The objectives of this study were to identify the bilateral distolingual (DL) canals / roots of the mandibular first molars and second mesiobuccal (MB2) canals of the maxillary first molars in the same Turkish individuals using cone-beam computed tomography (CBCT). A total of 150 CBCT images including all mandibular and maxillary first molars were retrospectively investigated in a Turkish subpopulation. The patient age, sex and presence of roots and root canals were assessed. The frequency, of bilateral DL canals, DL roots, and MB2 canals were reviewed. Data were analyzed using Fisher'sexact test and Chi-square test. The prevalences of right DL canals, DL roots and MB2 canals were 31.3, 14.0 and 34.7%, respectively. The prevalences of left DL canals, DL roots and MB2 canals were 31.3, 4 and 27.3%, respectively. There was no statistically difference in the frequency of right and left DL canals, DL roots of mandibular first molars and MB2 canals of maxillary first molars according to gender. CBCT is a competent tool for the detection of additional distolingual canals/roots and second mesio buccal canals, and it is a valuable aid for dentists providing root canal treatment.
van der Waal, S V; de Soet, J J
Apical periodontitis is an inflammatory response around the root tip of a tooth to microbial infection of the root canal system. Therefore, disinfection of the root canal system is the most important aim of root canal treatment. There are various mechanical and chemical ways to clean and disinfect. Most methods, however, cannot be relied upon to fully decontaminate in all cases. There are problems, for example, with the proper concentrations of disinfectant agents, like sodium hypochlorite. But the more recent agents, like ethylenediaminetetraacetic acid, calcium hydroxide or antibiotic pastes also have disadvantages, which are mostly a result of poor access of the irrigant to the biofilm bacteria in the affected root canals. Currently, a new strategy with a modified salt solution is under investigation that offers the prospect of being used as a root canal irrigant. At this moment the preferred treatment still seems to be to remove infected tissue as much as possible and to create access for irrigation procedures. The best results are achieved with 1-2% sodium hypochlorite as a disinfectant, possibly alternating with ethylenediaminetetraacetic acid as a cleansing agent. There is no scientific evidence for the successful use of calcium hydroxide.
Capar, Ismail Davut; Ertas, Huseyin; Ok, Evren; Arslan, Hakan; Ertas, Elif Tarim
We compared the effects of 6 different rotary systems on transportation, canal curvature, centering ratio, surface area, and volumetric changes of curved mesial root canals of mandibular molar via cone-beam computed tomographic (CBCT) imaging. Mesiobuccal root canals of 120 mandibular first molars with an angle of curvature ranging from 20°-40° were divided into 6 groups of 20 canals. Based on CBCT images taken before instrumentation, the groups were balanced with respect to the angle and radius of canal curvature. Root canals were shaped with the following systems with an apical size of 25: OneShape (OS) (MicroMega, Besancon, France), ProTaper Universal (PU) F2 (Dentsply Maillefer, Ballaigues, Switzerland), ProTaper Next X2 (Dentsply Maillefer), Reciproc (R) R25 (VDW, Munich, Germany), Twisted File Adaptive (TFA) SM2 (SybronEndo, Orange, CA), and WaveOne primary (Dentsply Tulsa Dental Specialties, Tulsa, OK). After root canal preparation, changes were assessed with CBCT imaging. The significance level was set at P = .05. The R system removed a significantly higher amount of dentin than the OS, PU, and TFA systems (P < .05). There was no significant difference among the 6 groups in transportation, canal curvature, changes of surface area, and centering ratio after instrumentation. The 6 different file systems straightened root canal curvature similarly and produced similar canal transportation in the preparation of mesial canals of mandibular molars. R instrumentation exhibited superior performance compared with the OS, TFA, and PU systems with respect to volumetric change. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
Pezelj-Ribaric, Sonja; Roguljić, Marija; Miletic, Ivana
Objective The aim of this study was to investigate the cytotoxicity of two different bioactive root canal sealers: one based on mineral trioxide aggregate, MTA Fillapex (Angelus, Solucoes Odontologicas, Londrina, PR, Brazil), and the other based on bioceramics, Endosequence BC Sealer (Brasseler, Savannah, Georgia, USA), in culture of mouse L929 fibroblasts. Materials and methods Mouse fibroblasts (L929), obtained from subcutaneous connective tissue of mouse line C3Hf, were cultivated in plastic culture flasks in an incubator at 37şC, with 5% CO2 and 90% humidity. Freshly mixed Endosequence BC Sealer and MTA Fillapex (0.1 g each) were placed on sterile teflon discs, 6 mm in diameter. Teflon discs with the materials as well as empty discs serving as control were placed in wells of 12-well plate. After incubation times of 1, 6, 20 and 24 hours, the teflon discs were removed from the wells and the number of viable cells was determined using trypan blue in Neubauer chamber. Results In comparison to the control group, MTA Fillapex had significantly less viable cells for all incubation periods (p≤0.05), while Endosequence BC sealer had significantly less viable cells after 6, 20, and 24 hours of incubation (p≤0.05). MTA Fillapex comprised significantly less viable cells in comparison to Endosequence BC sealer after the first hour and after 20 hours of incubation (p≤0.05), while for the other incubation periods there were no significant differences (p≥0.05). Conclusion MTA Fillapex and Endosequence BC sealer were both cytotoxic in cultures of mouse L929 fibroblasts. PMID:27688421
Baraba, Anja; Pezelj-Ribaric, Sonja; Roguljić, Marija; Miletic, Ivana
The aim of this study was to investigate the cytotoxicity of two different bioactive root canal sealers: one based on mineral trioxide aggregate, MTA Fillapex (Angelus, Solucoes Odontologicas, Londrina, PR, Brazil), and the other based on bioceramics, Endosequence BC Sealer (Brasseler, Savannah, Georgia, USA), in culture of mouse L929 fibroblasts. Mouse fibroblasts (L929), obtained from subcutaneous connective tissue of mouse line C3Hf, were cultivated in plastic culture flasks in an incubator at 37şC, with 5% CO2 and 90% humidity. Freshly mixed Endosequence BC Sealer and MTA Fillapex (0.1 g each) were placed on sterile teflon discs, 6 mm in diameter. Teflon discs with the materials as well as empty discs serving as control were placed in wells of 12-well plate. After incubation times of 1, 6, 20 and 24 hours, the teflon discs were removed from the wells and the number of viable cells was determined using trypan blue in Neubauer chamber. In comparison to the control group, MTA Fillapex had significantly less viable cells for all incubation periods (p≤0.05), while Endosequence BC sealer had significantly less viable cells after 6, 20, and 24 hours of incubation (p≤0.05). MTA Fillapex comprised significantly less viable cells in comparison to Endosequence BC sealer after the first hour and after 20 hours of incubation (p≤0.05), while for the other incubation periods there were no significant differences (p≥0.05). MTA Fillapex and Endosequence BC sealer were both cytotoxic in cultures of mouse L929 fibroblasts.
Comparative evaluation of calcium hypochlorite and sodium hypochlorite associated with passive ultrasonic irrigation on antimicrobial activity of a root canal system infected with Enterococcus faecalis: an in vitro study.
de Almeida, Ana Paula; Souza, Matheus Albino; Miyagaki, Daniela Cristina; Dal Bello, Yuri; Cecchin, Doglas; Farina, Ana Paula
The purpose of this study was to compare in vitro the effectiveness of calcium hypochlorite (Ca[OCl]2) and sodium hypochlorite (NaOCl) associated with passive ultrasonic irrigation in root canals of bovine teeth infected with Enterococcus faecalis. The root canals of 60 single-rooted bovine extracted teeth were enlarged up to a file 45, autoclaved, inoculated with Enterococcus faecalis, and incubated for 30 days. The samples were divided into 6 groups (n = 10) according to the protocol for decontamination: G1: no treatment; G2: distilled water; G3: 2.5% NaOCl; G4: 2.5% Ca(OCl)2; G5: 2.5% NaOCl with ultrasonic activation; and G6: 2.5% Ca(OCl)2 with ultrasonic activation (US). Microbiological testing (colony-forming unit [CFU] counting) was performed to evaluate and show, respectively, the effectiveness of the proposed treatments. Data were subjected to 1-way analysis of variance followed by the post hoc Tukey test (α = 0.05). Groups 1 and 2 showed the highest mean contamination (3.26 log10 CFU/mL and 2.69 log10 CFU/mL, respectively), which was statistically different from all other groups (P < .05). Group 6 (Ca[OCl]2 + US) showed the lowest mean contamination (1.00 log10 CFU/mL), with no statistically significant difference found in groups 3 (NaOCl), 4 (Ca[OCl]2), and 5 (NaOCl + US) (P < .05). Ca(OCl)2 as well as passive ultrasonic irrigation can aid in chemomechanical preparation, contributing in a significant way to the reduction of microbial content during root canal treatment. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
Sadeghi, Shiva; Poryousef, Vahideh
Introduction: The purpose of this in vitro study was to introduce a new method to describe root canal curvatures and to assess the degree of curvature of human permanent mandibular teeth with curved root canals. Materials and Methods: One hundred and thirty five mesial root canals of mandibular first and second molar teeth were selected. Access cavities were prepared. After inserting a K-file size #10 into each canal, radiographs were taken. Canal curvature was determined by measuring the Schneider angle, canal access angle, as well as the canal radius, length, height and curvature starting distance on scanned radiographs using a computerized image processing system. Data was evaluated statistically using Pearson correlation. Results: The mean canal access angle (CAA) and Schneider angle (S) were 8.04◦ (3.46) and 19◦ (6.99), respectively. The Pearson correlation analysis found significant positive correlation between S and CAA (r=0.826, P<0.0001). Negative correlations were found between radius and length (r= –0.4, P<0.0001), radius and Schneider angle (r= –0.4, P<0.0001), radius and CAA (r= –0.24, P=0.004) and CAA and curvature starting distance (r= 0.4, P<0.0001). There was no correlation between height and distance (r=0.013, P=0.789), as well as CAA and height (r=0.654, P=0.001). Conclusion: Under the limitations of this study, the results indicated that the shape of root canal curvature can be more accurately described using two angles, Schneider in combination with Canal access angle. The related parameters included radius, length, distance and height of curvature. [Iranian Endodontic Journal 2009;4(4):131-4] PMID:24019833
Hasan, Muhammad; Rahman, Munawar; Saad, Najeeb
Recently, there has been an ongoing trend of case reports that highlight the presence of more than four root canals in mandibular first molars. This tendency warns clinicians to be more prudent when dealing with mandibular first molars requiring endodontic treatment. Moreover, radiographic examination should be taken as a clue providing tool rather than as an absolute guide to anatomy and its associated aberrances. This case reports the successful non-surgical endodontic management of a mandibular first molar with six root canal systems with three canals in the mesial root and three in the distal root. The classification of root canal systems found in this case was Sert and Bayirli type XV in both the roots. After non-surgical endodontic treatment, the tooth was restored definitively with a resin composite core followed by porcelain fused to the metal crown. This case adds to the library of previously reported cases of mandibular first molars with six root canals and further emphasises on the importance of rare morphological deviations that may occur in the mandibular first molars. PMID:25082869
Jena, Amit; Sahoo, Sanjit Kumar; Govind, Shashirekha
Endodontic treatment success depends on a combination of appropriate instrumentation, effective irrigation and decontamination of root canal spaces to apices, and obturation of the root canals. Irrigation of the root canal is paramount in determining periapical tissue healing. This article reviews presently available root canal irrigants, their interactions, advantages, and limitations. For this review, the authors performed a Medline search for all English language articles published through January 2014 with "root canal irrigants" and "endodontic irrigants" as keywords.
Staehle, H J; Spiess, V; Heinecke, A; Müller, H P
The effect of root canal filling pastes containing calcium oxide resp. calcium hydroxide on the alkalinity of extracted human teeth was investigated using a colour indicator (cresol red). An aqueous suspension of calcium hydroxide (Pulpdent), which is normally used for temporary root canal filling, most consistently produced alkalinity. Removal of the smear layer following instrumentation of the root canal led to increased proportion of alkaline-positive spots in dentinal locations distant from the canal. A clearly smaller effect was found with a calcium salicylate cement (Sealapex) and an oil-paste (Gangraena Merz), both of which are available for definite root canal fillings. Following removal of the smear layer, these hard-setting preparations caused moderate alkalinity in dentin adjacent to the canal but no effect was observed in locations more distant from the canal. Neither at locations adjacent to nor distant from the root canal was alkalinity found when another calcium salicylate cement (Apexit) was used. Apparently the release of hydroxyl ions into root dentin from calcium hydroxide containing root canal filling materials is not solely influenced by the absolute amount of calcium hydroxide, but also depends on other ingredients which variably inhibit the release of these ions.
da SILVA, Emmanuel João Nogueira Leal; SANTOS, Carolina Carvalho; ZAIA, Alexandre Augusto
Objectives: The aim of the present study was to investigate the effects of root canal sealers on the cytotoxicity of 3T3 fibroblasts during a period of 5 weeks. Material and Methods: Fibroblasts (3T3, 1x105 cells per well) were incubated with elutes of fresh specimens from eight root canal sealers (AH Plus, Epiphany, Endomethasone N, EndoReZ, MTA Fillapex, Pulp Canal Sealer EWT, RoekoSeal and Sealapex) and with elutes of the same specimens for 5 succeeding weeks after immersing in simulated body fluid. The cytotoxicity of all root canal sealers was determined using the MTT assay. Data were analyzed using ANOVA and Tukey's test. Results: RoekoSeal was the only sealer that did not show any cytotoxic effects (p<0.05). All the other tested sealers exhibited severe toxicity initially (week 0). MTA Fillapex remained moderately cytotoxic after the end of experimental period. Toxicity of the other tested sealers decreased gradually over time. The evaluated root canal sealers presented varying degrees of cytotoxicity, mainly in fresh mode. Conclusions: RoekoSeal had no cytotoxic effect both freshly mixed and in the other tested time points. MTA Fillapex was associated with significantly less cell viability when compared to the other tested root canal sealers. PMID:23559111
Borzini, Letizia; Condò, Roberta; De Dominicis, Paolo; Casaglia, Adriano; Cerroni, Loredana
Background: There are various microorganisms related to intra and extra-radicular infections and many of these are involved in persistent infections. Bacterial elimination from the root canal is achieved by means of the mechanical action of instruments and irrigation as well as the antibacterial effects of the irrigating solutions. Enterococcus faecalis can frequently be isolated from root canals in cases of failed root canal treatments. Antimicrobial agents have often been developed and optimized for their activity against endodontic bacteria. An ideal root canal irrigant should be biocompatible, because of its close contact with the periodontal tissues during endodontic treatment. Sodium hypoclorite (NaOCl) is one of the most widely recommended and used endodontic irrigants but it is highly toxic to periapical tissues. Objectives: To analyze the literature on the chemotherapeutic agent and plant extracts studied as root canal irrigants. In particularly, the study is focused on their effect on Enterococcus faecalis. Method: Literature search was performed electronically in PubMed (PubMed Central, MEDLINE) for articles published in English from 1982 to April 2015. The searched keywords were “endodontic irrigants” and “Enterococcus faecalis” and “essential oil” and “plant extracts”. Results: Many of the studied chemotherapeutic agents and plant extracts have shown promising results in vitro. Conclusion: Some of the considered phytotherapic substances, could be a potential alternative to NaOCl for the biomechanical treatment of the endodontic space. PMID:28217184
Sooriaprakas, Chandrasekaran; Ballal, Suma; Velmurugan, Natanasabapathy
Successful endodontic management of mandibular first molar with a single root and single canal is diagnosed with the aid of dental operating microscope and multiple angled radiographs. In addition all the mandibular molars and premolars were single rooted on either side. PMID:24715990
Goodis, Harold E.; White, Joel M.; Marshall, Sally J.; Marshall, Grayson W.; Moskowitz, Emrey
Conventional cleaning and shaping of root canal systems employs hand and/or rotary instrumentation to remove the contents of the canal and shape the canal to receive a filling material. With the advent of the Nd:YAG laser system another method of accomplishing proper cleaning and shaping is evaluated. Single rooted teeth were radiographed bucco- lingually and mesio-distally and were divided into 2 groups. The first group was accessed and the root canal systems cleaned and shaped with a step back technique utilizing hand files and gates glidden burs. At completion of the procedure the teeth were again radiographed at the same positions as those prior to the procedure. The teeth were split longitudinally and examined under scanning electron microscopy to assess cleaning. The second group of teeth were accessed, and cleaning and shaping was accomplished using the Nd:YAG laser in combination with hand files and rotary instruments. These teeth were subjected to the same analysis as those in the first group. The before and after radiographs of each group were subjected to image analysis to determine effectiveness of the two methods in shaping the canal systems. We will discuss the ability of Nd:YAG to clean and shape root canal spaces and remove smear layer and organic tissue remnants from those areas.
Ahmed, H M A; Hashem, A A
Anterior teeth may have aberrant anatomical variations in the number of roots and root canals. A review of the literature was conducted using appropriate key words in major endodontic journals to identify the available reported cases as well as experimental and clinical investigations on accessory roots and root canals in anterior teeth. After retrieving the full text of related articles, cross-citations were identified, and the pooled data were then discussed. Results revealed a higher prevalence in accessory root/root canal variations in mandibular anterior teeth than in maxillary counterparts. However, maxillary incisor teeth revealed the highest tendency for accessory root/root canal aberrations caused by anomalies such as dens invaginatus and palato-gingival groove. Primary anterior teeth may also exhibit external and internal anatomical variations in the root, especially maxillary canines. Therefore, dental practitioners should thoroughly assess all teeth scheduled for root canal treatment to prevent the undesirable consequences caused by inadequate debridement of accessory configurations of the root canal system. © 2015 International Endodontic Journal. Published by John Wiley & Sons Ltd.
Zehnder, Matthias; Belibasakis, Georgios N.
Infections of the root canal space and their sequelae can be extremely painful and potentially dangerous, yet they do not necessarily have to be. Chronic, asymptomatic inflammatory lesions around the apex of a tooth with a necrotic dental pulp or an insufficient root canal treatment can develop unnoticed by the patient, and remain so for years. The course of disease is modulated by both the virulence of the microbiota established in the root canal space and the capacity of the immune system to curb the infection. To both ends, highly convincing investigations to help us understand when and why the tissues around an endodontically involved tooth become acutely inflamed are missing. We will discuss how recent advances in molecular identification of microorganisms have altered our understanding of root canal infections, and which information is currently missing to link clinical experience with observations from experimental research. PMID:25654162
Rôças, I. N.; Siqueira, J. F.
Samples from infected root canals of 43 teeth with chronic apical periodontitis were analyzed for the presence and relative levels of 83 oral bacterial species and/or phylotypes using a reverse-capture checkerboard hybridization assay. Associations between the most frequently detected taxa were also recorded. The most prevalent taxa were Olsenella uli (74%), Eikenella corrodens (63%), Porphyromonas endodontalis (56%), Peptostreptococcus anaerobius (54%), and Bacteroidetes oral clone X083 (51%). When prevalence was considered only for bacteria present at levels >105, Bacteroidetes clone X083 was the most frequently isolated bacterium (37%), followed by Parvimonas micra (28%), E. corrodens (23%), and Tannerella forsythia (19%). The number of target taxa per canal was directly proportional to the size of the apical periodontitis lesion, with lesions >10 mm in diameter harboring a mean number of approximately 20 taxa. Several positive associations for the most prevalent taxa were disclosed for the first time and may have important ecological and pathogenic implications. In addition to strengthening the association of several cultivable named species with chronic apical periodontitis, the present findings using a large-scale analysis allowed the inclusion of some newly named species and as-yet-uncultivated phylotypes in the set of candidate pathogens associated with this disease. PMID:18768651
Abnormalities in the root canal anatomy are commonly occurring phenomenon. A thorough knowledge of root canal anatomy and its variation is necessary for successful completion of endodontic treatment. Mandibular anteriors are known for having extra canals. The role of genetics and racial variations may result in difference of incidence of root number and canal number. This paper attempts at explaining a rare case of successful endodontic management of two-rooted lateral incisor with awareness of data pertaining to number of canals, knowledge of canal morphology, correct radiographic interpretation, and tactile examination of canal wall which are important in detecting the presence of multiple canals. PMID:27003981
Takeuchi, Shuhei; Sekita, Toshiaki; Kobayashi, Ken'ichi
Vertical root fractures are often observed in teeth with endodontic treatment and post space preparation. Frequently, because such teeth have flared root canals with thin dentin walls, conventional treatments are disadvantageous in terms of adhesiveness, sealability and risk of refracture. Here we devised an intentional replantation method that uses internal resin coping, with a reinforcing effect on thin root canal dentin. In two patients treated with this method, satisfactory conditions have been maintained. This report suggests that an intentional replantation method in which an internal resin coping is employed may be a useful therapy for fractured teeth with flared root canals.
Wu, Daming; Shi, Wei; Wu, Jintao; Wu, Younong; Liu, Weihong; Zhu, Qingping
To evaluate the clinical application of the dental operating microscope (DOM) in the management of complicated root canal therapy. 345 teeth with 546 root canals which could not be successfully managed by conventional methods received therapy under the DOM with ultrasonic instruments by the same endodontists. The aetiology of the canals included calcification, broken instrument, missed canal and canal perforation. The teeth and canals successfully managed were then calculated. 406 canals were successfully managed with a rate of 74.4%; 246 teeth were successfully managed with a rate of 71.3%. The rates in each category of the complicated root canals were: 74.0% for calcified canals, 72.3% for canals blocked by broken instruments, 82.5% for missed canals and 72.7% for canal perforations. The clinical application of the DOM is an effective way of managing complicated root canal therapy. © 2011 FDI World Dental Federation.
Chourasia, Hemant Ramesh; Meshram, Ganesh K.; Warhadpande, Manjusha; Dakshindas, Darshan
An in vitro study was performed to determine the number of roots, root canals per tooth, root canal configurations, and frequency of isthmi and apical deltas in mandibular first permanent molars in an Indian population. Hundred and fifty mandibular first permanent molars were collected and subjected to clearing technique. The cleared teeth were examined in a stereomicroscope under 7.5x magnifications. The canal configurations were categorized using Vertucci's classification. Overall 94.6% of the mandibular first molars had two roots, and 5.3% had extradistal roots (distolingual root). In addition, 64% of the specimens had three root canals, and 36% had four root canals. The most common canal configurations of mesial and distal roots were Vertucci type IV (54%) and type I (65.3%), respectively. Clinician should be aware of the complex root canal morphology of mandibular first molars among the Indian population before and during the root canal treatment. PMID:22287965
Mohan, S Murali; Kaushik, S K
The management of pulpally and apically infected teeth has evolved into a modality of conservation with predictable degree of success. Root canal treatment often requires protracted chairside time. A new technique involving placement of thermoplasticized core carrier obturators was compared with conventional lateral condensation technique. A prospective, comparative, in-vivo cohort study was carried out on randomly selected 100 patients visiting a tertiary care centre from July 2005 to July 2007, for primary, non-surgical conservative management of teeth requiring root canal treatment. Two groups of fifty cases each were managed with lateral condensation and thermoplasticized core carrier obturation techniques. Outcome variables were rate of obturation and failure rates as assessed by clinical and radiological evaluation. The time taken in case of lateral condensation of maxillary central incisor was 17.30 ± 3.373 minutes and 28.07 ± 2.586 minutes in case of mandibular molar. In the thermoplasticized carrier condensation technique, for the central incisors it took 13.00 ± 1.376 minutes and 21.07 ± 2.463 minutes for mandibular molars. The mean rank value for time taken for obturation as per Mann Whitney U test (p < 0.01) were 27.88 for maxillary incisor and 44.73 for mandibular molar in the lateral condensation technique and 13.13 and 16.27 respectively for thermoplasticized gutta percha carrier condensation. The values were statistically significant. With 16% and 14% cases having unsatisfactory filling as evaluated by post filling radiograph, Chi square test two tailed p value was 0.6836 and there was no statistically significant difference between the two groups. An absolute failure rate of 10% was seen in lateral condensation group and 6% in thermo-plasticized carrier condensation group. Fisher exact 2-tailed p value was 0.71 and the difference in failure rate was not statistically significant. Root canal obturation by thermoplasticized core carrier
Weinstock, Robert J; Clarkson, Earl
Root canal therapy (RCT) is a commonly performed dental procedure that has a good success rate. Complications of RCT usually are minor, but severe complications can occur. A 59-year-old Hispanic man with no history of coagulopathy started to hemorrhage profusely from the mesiolingual canal of the right mandibular first molar (tooth no. 30) during RCT. The general dentist practitioner briefly controlled the hemorrhaging by packing a gutta-percha point into the mesiolingual canal. Shortly afterward, the patient developed an expanding hematoma in the submandibular space. The authors extracted tooth no. 30, raised buccal and lingual flaps, and evacuated the hematoma. It is possible for clinicians to encounter significant hemorrhaging and airway compromising swelling when performing root canal therapy. Clinicians must recognize and understand how to manage such complications when they occur.
Somasundaram, Pavithra; Rawtiya, Manjusha; Wadhwani, Shefali; Uthappa, Roshan; Shivagange, Vinay; Khan, Sheeba
Abnormal root canal morphologies of third molars can be diagnostically and technically challenging during root canal treatment. The aim of this retrospective study was to investigate the root and canal morphology of mandibular third molars in Central India population by using Cone Beam Computed Tomography (CBCT) analysis. CBCT images of 171 mandibular third molars were observed and data regarding number of roots, number of canals, Vertucci's classification in each root, prevalence of C shaped canal, gender and topographical relation of morphology in mandibular third molar was statistically evaluated. Majority of mandibular third molars had two roots (84.2%) and three canals (64.3%). Most mesial root had Vertucci Type II (55.6%) and Vertucci Type IV (22.2%), distal root had Type I canals (87.5%). Over all prevalence of C shaped canals in mandibular third molars was 9.4%. There was a high prevalence of two rooted mandibular third molars with three canals.
Asnaashari, Mohammad; Safavi, Nassimeh
Removal of smear layer and disinfection of canals are important objectives of teeth root canal cleaning. In order to achieve this purpose, rinsing substances, intra canal drugs as well as ultrasound are used. Today, use of laser to remove smear layer and to disinfect root canals has increasingly attracted the attentions. Till now different lasers such as CO2, Nd:YAG, Er:YAG, Er,Cr:YSGG have been used for debris and smear removal from the canals. Numerous studies have shown that Er:YAG is the most appropriate laser for intra canal debris and smear removal. In addition different laser wavelengths have been used directly or as an adjunctive to disinfect canals. Laser light can penetrate areas of canals where irrigating and disinfecting solutions cannot reach, like secondary canals and deep dentinal tubules and also can eliminate microorganisms. Different studies have confirmed the penetration of Nd:YAG laser in deep dentin and reduction of microorganisms penetration. But studies on comparison of antibacterial effects of Nd:YAG laser with sodium hypochlorite showed effectiveness of both, with a better effect for sodium hypochlorite. Studies performed in relation with anti-microbial effects of Diode laser with various parameters show that this laser can be effective in reducing intra canal bacterial count and penetration in the depth of 500 microns in dentin. In studies performed on Diode laser in combination with canal irrigating solutions such as sodium hypochlorite and oxygenated water better results were obtained. Although studies on disinfection by the Erbium laser family show that use of this laser alone can be effective in disinfecting canals, studies evaluating the disinfecting effects of this laser and different concentrations of sodium hypochlorite show that the latter alone is more effective in disinfecting canals. And better results were obtained when Erbium laser was used in combination with sodium hypochlorite irrigating solution in canals. Results of the
Asnaashari, Mohammad; Safavi, Nassimeh
Removal of smear layer and disinfection of canals are important objectives of teeth root canal cleaning. In order to achieve this purpose, rinsing substances, intra canal drugs as well as ultrasound are used. Today, use of laser to remove smear layer and to disinfect root canals has increasingly attracted the attentions. Till now different lasers such as CO2, Nd:YAG, Er:YAG, Er,Cr:YSGG have been used for debris and smear removal from the canals. Numerous studies have shown that Er:YAG is the most appropriate laser for intra canal debris and smear removal. In addition different laser wavelengths have been used directly or as an adjunctive to disinfect canals. Laser light can penetrate areas of canals where irrigating and disinfecting solutions cannot reach, like secondary canals and deep dentinal tubules and also can eliminate microorganisms. Different studies have confirmed the penetration of Nd:YAG laser in deep dentin and reduction of microorganisms penetration. But studies on comparison of antibacterial effects of Nd:YAG laser with sodium hypochlorite showed effectiveness of both, with a better effect for sodium hypochlorite. Studies performed in relation with anti-microbial effects of Diode laser with various parameters show that this laser can be effective in reducing intra canal bacterial count and penetration in the depth of 500 microns in dentin. In studies performed on Diode laser in combination with canal irrigating solutions such as sodium hypochlorite and oxygenated water better results were obtained. Although studies on disinfection by the Erbium laser family show that use of this laser alone can be effective in disinfecting canals, studies evaluating the disinfecting effects of this laser and different concentrations of sodium hypochlorite show that the latter alone is more effective in disinfecting canals. And better results were obtained when Erbium laser was used in combination with sodium hypochlorite irrigating solution in canals. Results of the
Liu, Wenzhe; Wu, Buling
Root canal anatomy and canal preparation instruments affect the outcome of endodontic treatment. The purpose of this study was to determine the root surface strain (SS) generated and the extent of canal center transportation during canal shaping using 3 different nickel-titanium instruments. Simulated root canals in resin blocks (n = 10 per group) were prepared using adaptive rotary motion with twisted files (Twisted File Adaptive [TFA]; SybronEndo, Orange, CA), reciprocating rotary motion with WaveOne (WO; Dentsply Maillefer, Ballaigues, Switzerland) files, and continuous rotary motion with ProTaper Next files (PTN, Dentsply Maillefer). Electrical strain gauges at 3 sites recorded SS real time during canal shaping, and the blocks were scanned by micro-computed tomographic imaging to assess the canal center deviation at 3 sections after root canal instrumentation. The mean maximum SS and the canal center transportation for all groups and sites were derived and analyzed for a possible correlation between them. An overall increase in root SS was observed after root canal instrumentation. A significant difference in the induced mean maximum SS between TFA, WO, and PTN at specific sites of curved root canals was observed. A statistically significant difference in the mean distance of canal center transportation was observed among the 3 shaping techniques at the apical section. Finally, the mean maximum SS values induced during canal shaping strongly correlated with canal center transportation in the apical section and the coronal section. The curved canals prepared using TFA exhibited lower SS and less canal center transportation at the apical section than the WO and PTN systems. SS generated during canal shaping correlated with canal center transportation in a site-specific manner. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
Peiris, Roshan; Malwatte, Uthpala; Abayakoon, Janak; Wettasinghe, Anuradha
The present study was conducted to determine the number of roots and morphology of the root canal system of permanent mandibular first molars (M1) in a Sri Lankan population. Sample of 529 M1 teeth was used. The number of roots was examined and the lengths of the mesial and distal roots were measured to the nearest 0.01 mm. Vacuum injection protocol was used to inject China ink into the root canal system, making it transparent. Root canal morphology was recorded using Vertucci's classification. Presence of furcation canals, position of lateral canals, intercanal communications, level of bifurcation, and convergence of the root canal system were recorded. M1 showed three roots in 4.1% of the sample. Commonest root canal morphology of the mesial root was type IV and the distal root was type I. The level of bifurcation of the root canals was commonly observed in the cervical one-third of the root while convergence was observed in the apical one-third in both roots. Prevalence of three rooted mandibular first molars is less than 5%. Mesial root showed the most variable canal morphology. Prevalence of furcation canals was 1.5% while that of middle mesial canals was 0.2%. PMID:26351583
Tanomaru-Filho, Mário; Miano, Lucas Martinati; Chávez-Andrade, Gisselle Moraima; Torres, Fernanda Ferrari Esteves; Leonardo, Renato de Toledo; Guerreiro-Tanomaru, Juliane Maria
The aim of this study was to compare the cleaning of main and lateral canals using the irrigation methods: negative pressure irrigation (EndoVac system), passive ultrasonic irrigation (PUI) and manual irrigation (MI). Resin teeth were used. After root canal preparation, four lateral canals were made at 2 and 7 mm from the apex. Root canals were filled with contrast solution and radiographed pre- and post-irrigation using digital radiographic system [radiovisiography (RVG)]. The irrigation protocols were: MI1-manual irrigation [22 G needle at 5 mm short of working length-WL]; MI2-manual irrigation (30G needle at 2 mm short of WL); PUI; EV1-EndoVac (microcannula at 1 mm short of WL); EV2-Endovac (microcannula at 3 mm short of WL). The obtained images, initial (filled with contrast solution) and final (after irrigation) were analyzed by using image tool 3.0 software. Statistical analysis was performed by analysis of variance (ANOVA) and Tukey tests (5% significance level). EV1 and EV2, followed by PUI showed better cleaning capacity than manual irrigation (MI1 and MI2) (p < 0.05). Negative pressure irrigation and PUI promoted better cleaning of main and simulated lateral canals. Conventional manual irrigation technique may promote less root canal cleaning in the apical third. For this reason, the search for other irrigation protocols is important, and EndoVac and PUI are alternatives to contribute to irrigation effectiveness.
Al-Haddad, Afaf; Che Ab Aziz, Zeti A
Bioceramic-based root canal sealers are considered to be an advantageous technology in endodontics. The aim of this review was to consider laboratory experiments and clinical studies of these sealers. An extensive search of the endodontic literature was made to identify publications related to bioceramic-based root canal sealers. The outcome of laboratory and clinical studies on the biological and physical properties of bioceramic-based sealers along with comparative studies with other sealers was assessed. Several studies were evaluated covering different properties of bioceramic-based sealers including physical properties, biocompatibility, sealing ability, adhesion, solubility, and antibacterial efficacy. Bioceramic-based sealers were found to be biocompatible and comparable to other commercial sealers. The clinical outcomes associated with the use of bioceramic-based root canal sealers are not established in the literature.
Che Ab Aziz, Zeti A.
Bioceramic-based root canal sealers are considered to be an advantageous technology in endodontics. The aim of this review was to consider laboratory experiments and clinical studies of these sealers. An extensive search of the endodontic literature was made to identify publications related to bioceramic-based root canal sealers. The outcome of laboratory and clinical studies on the biological and physical properties of bioceramic-based sealers along with comparative studies with other sealers was assessed. Several studies were evaluated covering different properties of bioceramic-based sealers including physical properties, biocompatibility, sealing ability, adhesion, solubility, and antibacterial efficacy. Bioceramic-based sealers were found to be biocompatible and comparable to other commercial sealers. The clinical outcomes associated with the use of bioceramic-based root canal sealers are not established in the literature. PMID:27242904
Shemesh, A; Levin, A; Katzenell, V; Itzhak, J B; Avraham, Z; Levinson, O; Solomonov, M
Furcated root and root canal separation are anatomic variations of mandibular canines. Other studies found that up to 20% of mandibular canines have root canal separation and up to 6.8% are bifurcated teeth. The purpose of this study was to investigate the prevalence of two-rooted mandibular canines and the root canal morphology of mandibular canines. A total of 1,020 Israeli patients' cone-beam computed tomography (CBCT) scans were screened and evaluated. A total of 1,981 mandibular canines were examined and the prevalence of furcated mandibular canines and root canal separation was recorded and analyzed. The overall prevalence of furcated mandibular canines and root canal separation in mandibular canines were 1.9% and 10.3% respectively. The bilateral prevalence of furcated mandibular canines was 22.5%. Statistically significant difference was detected by the side of occurrence (left vs right side, p < 0.05) and by gender in right mandibular canine (p < 0.05). the prevalence of furcated roots and root canal separation in mandibular canines was not frequent. Clinicians should be aware of the special characteristic of those anatomic variations.
Fernandes, Marina; de Ataide, Ida; Wagle, Rahul
The aim is to review and discuss the etiology, incidence, anatomic features, classification, diagnosis and management of the C-shaped canal configuration. C-shaped canal configuration is a variation that has a racial predilection and is commonly seen in mandibular second molars. The intricacies present in this variation of canal morphology can pose a challenge to the clinician during negotiation, debridement and obturation. Manual and electronic searches of literature were performed from 1979 to 2012, in Pub Med by crossing the keywords: C-shaped canals, mandibular second molar, mandibular first premolar, root canal morphology. Knowledge of the C-shaped canal configuration is essential to achieve success in endodontic therapy. Radiographic and clinical diagnoses can aid in identification and negotiation of the fan-shaped areas and intricacies of the C-shaped anatomy. Effective management of this anomalous canal configuration can be achieved with rotary and hand instrumentation assisted with sonics and ultrasonics. Modifications in the obturation techniques will ensure a 3-dimensional fill of the canal system and chamber retained restorations like amalgam or composites, serve as satisfactory post endodontic restorations.
Fernandes, Marina; de Ataide, Ida; Wagle, Rahul
The aim is to review and discuss the etiology, incidence, anatomic features, classification, diagnosis and management of the C-shaped canal configuration. C-shaped canal configuration is a variation that has a racial predilection and is commonly seen in mandibular second molars. The intricacies present in this variation of canal morphology can pose a challenge to the clinician during negotiation, debridement and obturation. Manual and electronic searches of literature were performed from 1979 to 2012, in Pub Med by crossing the keywords: C-shaped canals, mandibular second molar, mandibular first premolar, root canal morphology. Knowledge of the C-shaped canal configuration is essential to achieve success in endodontic therapy. Radiographic and clinical diagnoses can aid in identification and negotiation of the fan-shaped areas and intricacies of the C-shaped anatomy. Effective management of this anomalous canal configuration can be achieved with rotary and hand instrumentation assisted with sonics and ultrasonics. Modifications in the obturation techniques will ensure a 3-dimensional fill of the canal system and chamber retained restorations like amalgam or composites, serve as satisfactory post endodontic restorations. PMID:25125841
Bayram, Emre; Dalat, Dilek; Bayram, Melike
To evaluate the solubility of five different root canal sealers (AH Plus Jet, RealSeal SE, MTA Fillapex, Tubli-Seal, and Acroseal) in chloroform, eucalyptol and Endosolv-E solvents. Ninety root canal sealer samples were prepared and then divided into three groups for immersion in a solvent for 2, 5 or 10 minutes. The mean values of the root canal sealers' dissolution in the solvents were obtained by the difference between the preimmersion original weight and the post-immersion weight on a digital analytical scale. Data were statistically analyzed by a Kruskal-Wallis test with a Bonferroni correction. Chloroform was a more effective solvent than eucaly-ptol or Endosolv E for all root canal sealers, except for RealSeal SE, at all time points (p < 0.003). RealSeal SE was the least soluble sealer in all solvents at all time points. Chloroform demonstrated a superior ability over other solvents in dissolving canal sealing materials, and eucaly-ptol was found to be the least effective solvent in this study. This study can help to the clinicians about which solvent should be preferred for solving the filling materials in retreatment cases.
Adorno, C G; Yoshioka, T; Suda, H
To evaluate the effects of working length and root canal preparation technique on crack development in the apical root canal wall. Seventy extracted mandibular premolars were mounted in a resin block with simulated periodontal ligaments and divided into seven groups according to preparation technique and working length: group A, step-back preparation with stainless steel files with working length set at the apical foramen and defined as root canal length (CL); group B, same as for A, except that the working length was CL-1 mm; group C, crown-down preparation with Profile instruments followed by an apical enlargement sequence with CL as working length and group D, same as for C, except that the working length was CL-1 mm. Groups E, F and G served as controls. Groups E and F were prepared only with the crown-down sequence up to CL and CL-1 mm, respectively. Group G was left unprepared. Digital images of the apical root surface (AS) were recorded before preparation, immediately after instrumentation and after removing the apical 1 mm (AS-1 mm) and 2 mm (AS-2 mm) of the root end. Working length significantly affected crack development at AS (P < 0.05). Preparation technique significantly affected crack development at AS-1 mm (P < 0.05). At AS-2 mm, there was no significant difference between preparation technique and working length in terms of crack development on the canal wall. Root canal preparation alone, regardless of the technique used, can potentially generate cracks on the apical root canal wall as well as the apical surface. Working 1- mm short of the apical foramen might produce fewer cracks in the apical region.
Lukač, Nejc; Gregorčič, Peter; Jezeršek, Matija
Laser-activated irrigation is a powerful endodontic treatment for smear layer, bacteria, and debris removal from the root canal. In this study, we use shadow photography and the laser-beam-transmission probe to examine the dynamics of laser-induced vapor bubbles inside a root canal model and compare ultrasonic needle irrigation to the laser method. Results confirm important phenomenological differences in the two endodontic methods with the laser method resulting in much deeper irrigation. Observations of simulated debris particles show liquid vorticity effects which in our opinion represents the major cleaning mechanism.
Dinapadu, Sainath; Pasari, Srikanth; Admala, Shilpa Reddy; Marukala, Narender Reddy; Gurram, Sindhurareddy; Peddi, Ravigna
To evaluate the accuracy of Root ZX-II (J Morita Corp) apex locator in enlarged root canals with different root canal irrigants. 48 freshly extracted single rooted mandibular premolar teeth were used. The apical enlargement was done up to #45 K-file as the master apical file (MAF). The teeth were randomly divided into 4 groups and mounted in an experimental apparatus. The following irrigants were used during electronic canal measurements: group 1: saline; group 2: 3% NaOCl; group 3: 2% chlorhexidine; group 4: 17% EDTA. The canal measurement was done with Root ZX-II apex locator using #10 and #45 K-file. Data were analyzed by two way ANOVA and Bonferroni multiple comparison test. Statistical analysis showed that there was statistically significant difference between #10 and #45 K-file for group 1 (p < 0.01). Root ZX-II was accurate in the presence of 3% NaOCl and 17% EDTA when measured with smaller and larger files. However, it was accurate in the presence of saline and 2% CHX when larger files were used.
Tello-Barbaran, Javier; Nakata, Hilda Moromi; Salcedo-Moncada, Doris; Bramante, Clovis M; Ordinola-Zapata, Ronald
The aim of this study was to evaluate the antibacterial activity of 2% iodine potassium iodide (IKI) used as a final rinse after the cleaning and shaping procedures in mesial root canals of mandibular molars infected with Enterococcus faecalis. Seventy two mandibular first molars were used. The root canals were infected with Enterococcus faecalisfor 30 days. After the infection procedures, the root canals were cleaned and shaped by using the Pro Taper rotary system and manual files. The teeth were randomly assigned to four experimental groups (N = 18). In group 1, the root canals were irrigated with sterile distilled water (control). In group 2, the root canals were irrigated with 1% Sodium hypochlorite (NaOCl) during instrumentation. In group 3, root canals were irrigated with 1% NaOCl during instrumentation and a five minute final irrigation using 2% IKI. In group 4, the root canals were irrigated with 1% NaOCl during instrumentation and a 15 minutes final irrigation with 2% IKI. Bacteria colony-forming units (CFU) from root canals were semi-quantified and the presence of negative cultures among the groups was compared using Fisher's test (p < 0.05). The order of effectiveness was: 1% NaOCI plus 2% IKl for 15 minutes (95%), 1% NaOCl plus 2% IKl for 5 minutes (44%), 1% NaOCl (17%) and sterile distilled water (0%). Fisher's exact test showed a significant difference among the groups (p < 0.05). It was concluded that under in vitro conditions, IKI was able to eliminate the Enterococcus faecalis from infected dentin significantly in a 15-minute time frame after the cleaning and shaping procedures.
Sadaf, Durre; Ahmad, Muhammad Zubair
Objectives: To assess the consistency and accuracy of Electronic Apex Locator (EAL) (Root ZXII) in individual canals and its association with other clinical variables. Study Design: Cross-Sectional study. Place of study: Dental section of the Aga Khan University Hospital, Karachi, Pakistan. Materials and Methods: Working length was measured by EAL in 180 patients requiring endodontic therapy in molar and premolar teeth. The effects of clinical variables e.g. gender and pulpal status on the consistency and accuracy of EAL were recorded. Performance of apex locator was considered “Consistent” when the scale bar was stable and moved only in correspondence to the movement of file in the root canal. Accuracy was determined by inserting the file at the working length determined by the EAL and periapical view of radiograph was taken using paralleling technique. Estimated working length was considered accurate when the file tip was located 0-2mm short of the radiographic apex. If the file was overextended from the radiographic apex, it showed dysfunction of the EAL. Results: Consistency of EAL was found 97.6% in distobuccal canals, 91.1% in palatal canals, 73.7% in mesiolingual canals, 83.3% in mesiobuccal and 80.2% in distal canals. Accuracy of EAL was 91.4% in mesiolingual canal, 92% in mesiobuccal, and 90.2% in Palatal and 93.2% in distal canal. Conclusion: Consistency of electronic apex locator vary in different canals, however consistent measurements are highly accurate. No significant association was found between other clinical variables with the consistency and accuracy of EAL.
Furusawa, Masahiro; Asai, Yasuhiro
The purpose of this study was to examine the apical foramen of root apices extracted during apicotomies. A total of 25 teeth extracted from 25 patients admitted to the Department of Conservative Dentistry at Tokyo Dental College's Chiba Hospital were used for the study. All patients were between 22 to 56 years of age at the time of the study, and each of the 25 cases was determined clinically on radiographs to be chronic apical suppurative periodontitis. Microsurgery was performed on all cases, and the extracted root apices were then observed using SEM. The results demonstrated a wide opening, greater than 350 microns as measured along the major axis, of the apical foramen in 80% of the cases. Various characteristics indicative of resorption were observed around the apical foramen. These features included those believed to have been caused by overinstrumentation during root canal treatment as well as irregularly shaped areas presumed to be apical lesions that had enlarged and eroded. We observed a high frequency of manifestations of cementum resorption surrounding the root apices of teeth with apical lesions. Furthermore, we concluded that in the majority of cases in the present study, due to the fact that the apical foramen exceeded normal opening dimensions as a result of overinstrumentation during root canal treatment or resorption around the root apex, prolongation of the lesions had occurred in response to direct contact of microbial infectious matter and tissues surrounding the root apex over a large area. The above finding suggested that, in cases in which the apical foramen is destroyed through overinstrumentation larger than #35 or in which the apical foramen opens up to dimensions greater than 350 microns due to pathologic resorption, surgical intervention may be indicated. On the other hand, in 64% of the cases, an accessory canal was observed in the root apical lesion. Based on this observation, the presence of an accessory canal in the root apex may
Badole, Gautam P; Warhadpande, Manjusha M; Shenoi, Pratima R; Lachure, Chandrakant; Badole, Shital G
The complexity of the root canal system of maxillary molars presents a constant challenge in the diagnosis and treatment of these teeth. This case report describes the importance of a surgical operating microscope and cone-beam computed tomographic (CBCT) imaging. Root canal treatment of a left maxillary first molar with 3 roots and 7 canals was successfully performed. Seven canals were identified with the help of a surgical operating microscope and CBCT imaging. CBCT images also confirmed the 3 roots and 7 canals in the right maxillary first molar. CBCT images confirmed a type IV canal pattern in the distal and palatal root, whereas the mesial root had a type VIII canal pattern. The use of a surgical operating microscope and CBCT imaging helps the clinician to diagnose unusual anatomy of a tooth and facilitate successful endodontic treatment. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
Mathew, Joan; Emil, Jonathan; Paulaian, Benin; John, Bejoy; Raja, Jacob; Mathew, Jean
Background: Several disinfection techniques have been recently introduced with the main objective of improving root canal disinfection in the inaccessible areas of the root canal system. This in vitro study was done to evaluate the antimicrobial effect and viability of Enterococcus faecalis biofilms using conventional irrigation, EndoActivator (Dentsply, Tulsa Dental, USA), diode laser irradiation and photon-initiated photoacoustic streaming (PIPS). Materials and Methods: Root canals of 130 single rooted mandibular premolars, standardized to a uniform length of 20 mm were instrumented until finishing file, F1 (Universal Protaper Rotary System, Dentsply, Tulsa Dental Specialties, USA). After smear layer removal and sterilization, five teeth were randomly selected to assure sterility before bacterial inoculation. The remaining 125 samples were contaminated with E. faecalis suspension, incubated for 21 days and divided into five groups (n = 25). In Group 1; untreated group (positive control), the root canals were not subjected to any disinfection procedure. Sampling was performed within the canals and the colony-forming unit count was evaluated for 20 samples. Five samples were selected to visualize the pattern of colonization at Level 1 (4 mm from the apex) and Level 2 (1 mm from the apex) by confocal laser scanning microscopy. Samples in Groups 2-5 namely conventional needle irrigation, EndoActivator, diode laser and PIPS were subjected to their respective disinfection procedures. Postdisinfection sample evaluation criteria was followed for all groups as same as that for Group 1. Results: Diode laser displayed the highest antibacterial efficacy and least viable bacteria than the other three disinfection techniques. Conclusion: Diode laser group showed better antibacterial efficacy and least viable bacteria when compared to conventional needle irrigation, PIPS and EndoActivator groups in minimally instrumented, experimentally infected root canals. PMID:25298645
Antonijevic, Djordje; Milovanovic, Petar; Brajkovic, Denis; Ilic, Dragan; Hahn, Michael; Amling, Michael; Rakocevic, Zlatko; Djuric, Marija; Busse, Björn
The objective of this study was to determine the effects of various irrigation solutions on root canal dentine and gutta-percha surface properties. In addition, the effects of disinfectant chemicals on the wettability and surface morphological properties of the filling materials were evaluated. Ethylenediaminetetraacetic acid (EDTA), citric acid, and ozone were employed as irrigation solutions for dentine and gutta-percha treatment. Thereafter, the samples' microstructure, degree of mineralization, and mechanical properties were assessed by means of quantitative backscattered electron imaging (qBEI) and reference point indentation (RPI). A contact angle analyzer was used to measure adhesion on the tested materials. Here, EDTA had the most significant affect on both the mechanical properties and the adhesive behavior of dentine. Citric acid did not affect dentine wettability, whereas the indentation properties and the mineralization were reduced. Similar effects were observed when ozone was used. The dentinal tubules were significantly widened in citric acid compared to the ozone group. EDTA causes considerable micromechanical surface alteration of dentine and gutta-percha, but represents the best option in clinical cases where a high adhesiveness of the filling materials is desired.
Nam, K C; Kim, S C; Lee, S J; Kim, Y J; Kim, N G; Kim, D W
Electronic root canal length measurement devices have made it easier and faster to measure the root canal length of a tooth compared with the conventional radiographic method. Of these electronic apex locators, the frequency-dependent type features greater accuracy and convenience in operation. However, its accuracy is still influenced by the presence of blood and/or the various electrolytes used in root canal therapy. This study describes the development of a new frequency-dependent electronic apex locator featuring electrolyte compensation, utilising an impedance ratio and voltage difference technique to minimise the influence of electrolytes on the accuracy of root canal length measurement. The errors for distances from file tips to apical constrictions were determined in vivo with the device operating with electrolyte compensation. The measured lengths were compared with the true lengths of the extracted teeth determined using a microscope. The mean error was +0.14+/-0.27mm, and 95.2% of the measurements were within the clinical tolerance of +/-0.5mm. It was also found that the degree of accuracy was not dependent on the size of the apical foramen (p = 0.74).
Zan, Recai; Alacam, Tayfun; Hubbezoglu, Ihsan; Tunc, Tutku; Sumer, Zeynep; Alici, Oguzhan
Background The success of endodontic treatment depends on a few crucial factors. One of these factors is the complete chemomechanic preparation of root canal against various bacteria. In particular, the effect of resistant bacteria may cause intense pain with flare-up and formation of periapical lesions. Therefore, the strong effect of irrigants plays an important role in terms of the complete elimination of these bacteria to achieve long-term successful treatment. Objectives The aim of this study was to investigate the antibacterial effects of super-oxidized water (SPO) in root canals infected with Enterococcus faecalis biofilms. Methods One hundred twenty single-root, premolar teeth were selected. Initially, the teeth were prepared and then disinfected. E. faecalis were inoculated and kept at 37°C for 24 hours in the root canals. The re-inoculation procedure was repeated on the first, fourth, seventh, and tenth days. The infected root canals were divided into one negative (saline) and one positive (sodium hypochlorite) control group and four experimental groups (super-oxidized water: 1, 2, 3, or 5 minutes) (n = 20). Paper points were placed in the root canals to control and evaluate the biofilm formation. Biofilms were counted on blood agar plates, and data was evaluated and statistically analyzed using one-way ANOVA and Tukey’s test. Results Although sodium hypochlorite (NaOCl) showed no statistically significant difference when compared with three and five minutes of SPO irrigation (P > 0.05), NaOCl showed statistically significant differences among all other groups (P < 0.05). Conclusions Super-oxidized water indicated a remarkable and similar bactericidal effect to that of traditional NaOCl against E. faecalis biofilms. In terms of successful endodontic treatment approaches, super-oxidized water may be used as an effective irrigation solution in clinics. PMID:27800142
RIPPE, Marília Pivetta; SANTINI, Manuela Favarin; BIER, Carlos Alexandre Souza; BALDISSARA, Paolo; VALANDRO, Luiz Felipe
Objective To evaluate the impact of the type of root canal preparation, intraradicular post and mechanical cycling on the fracture strength of roots. Material and Methods eighty human single rooted teeth were divided into 8 groups according to the instruments used for root canal preparation (manual or rotary instruments), the type of intraradicular post (fiber posts- FRC and cast post and core- CPC) and the use of mechanical cycling (MC) as follows: Manual and FRC; Manual, FRC and MC; Manual and CPC; Manual, CPC and MC; Rotary and FRC; Rotary, FRC and MC; Rotary and CPC; Rotary, CPC and MC. The filling was performed by lateral compactation. All root canals were prepared for a post with a 10 mm length, using the custom #2 bur of the glass fiber post system. For mechanical cycling, the protocol was applied as follows: an angle of incidence of 45°, 37°C, 88 N, 4 Hz, 2 million pulses. All groups were submitted to fracture strength test in a 45° device with 1 mm/ min cross-head speed until failure occurred. Results The 3-way ANOVA showed that the root canal preparation strategy (p<0.03) and post type (p<0.0001) affected the fracture strength results, while mechanical cycling (p=0.29) did not. Conclusion The root canal preparation strategy only influenced the root fracture strength when restoring with a fiber post and mechanical cycling, so it does not seem to be an important factor in this scenario. PMID:25025556
MARINHO, Ariane Cassia Salustiano; MARTINHO, Frederico Canato; ZAIA, Alexandre Augusto; FERRAZ, Caio Cezar Randi; GOMES, Brenda Paula Figueiredo de Almeida
Gram-negative bacteria play an essential role in endodontic infections because they have virulence factors such as endotoxin. Due to its potential cytotoxic activity, special attention has been given to the removal/neutralization of this endotoxin in the root canal system. Objective The aim of this study was to evaluate the influence of the apical enlargement size (AES) by using rotary instruments on the endotoxin level reduction of dental root canals. Material and Methods Forty root canals of the mandibular premolar teeth were used. Escherichia coli endotoxin (055: B55) was inoculated into thirty root canals. Ten teeth served as the negative control group. After the incubation period, the first endotoxin samples were collected from the root canals with a sterile/apyrogenic paper point for the analysis of the endotoxin units (EU/mL) present before instrumentation (S1). Specimen instrumentation was performed with the Mtwo® rotary system in the sequence 10/.04, 15/.05, 20/.06, 25/.06, 30/.05, 35/.04 and 40/.04. To monitor the effectiveness of increasing apical enlargement on endotoxin removal, the second endotoxin samples were collected from all the root canals after instrumentation with the following instruments: #25/.06- (S2); #30/.05- (S3); # 35/.04- (S4); and #40/.04- (S5). Limulus amebocyte lysate (LAL) was used to quantify the levels of endotoxin. The results were statistically compared by using repeated measures of ANOVA with post hoc Tukey testing. Results Increasing levels of endotoxin removal was achieved by large sized apical enlargement: S2 (AES #25/.06)- 89.2%, S3 (AES #30/.05)- 95.9%, S4 (AES #35/.04)- 97.8% and S5 (AES #40/.04)- 98.2%. Substantial reduction of endotoxin content was obtained in S4 and S5 compared to S2 (p<0.05), however, the root canal preparation was not able to eliminate the endotoxin. Conclusions Under the conditions of this study, it was concluded that the reduction of endotoxin levels of the dental root canals could be predicted
Moura-Netto, Cacio; Mello-Moura, Anna Carolina Volpi; Palo, Renato Miotto; Prokopowitsch, Igor; Pameijer, Cornelis H.; Marques, Marcia Martins
This research analyzed the quality of resin-based sealer adaptation after intracanal laser irradiation. Extracted teeth (n=168) were root canal treated and divided into four groups, according to dentin surface treatment: no laser; Nd:YAG laser (1.5 W, 100 mJ, 15 Hz) diode laser (2.5 W in CW), and Er:YAG laser (1 W, 100 mJ, 10 Hz). The teeth were divided into four subgroups according to the sealer used: AH Plus, EndoREZ, Epiphany, and EpiphanySE. For testing the sealing after root canal obturation, the penetration of silver nitrate solution was measured, whereas to evaluate the adaptation and penetration of the sealer into the dentin, environmental scanning electron microscopy (ESEM) was used. The ESEM images were analyzed using a four-grade criteria score by three evaluators. The inter-examiner agreement was confirmed by Kappa test and the scores statistically compared by the Kruskal-Wallis' test (p<0.05). Both adaptation and sealer penetration in root canals were not affected by the laser irradiation. Nd:YAG and diode laser decreased the tracer penetration for AH Plus, whereas EndoREZ and EpiphanySE performances were affected by Nd:YAG irradiation (p<0.05). It can be concluded that intracanal laser irradiation can be used as an adjunct in endodontic treatment; however, the use of hydrophilic resin sealers should be avoided when root canals were irradiated with Nd:YAG laser.
Dickers, B; Lamard, L; Peremans, A; Geerts, S; Lamy, M; Limme, M; Rompen, E; De Moor, R J G; Mahler, P; Rocca, J P; Nammour, S
The aim of this study was to determine whether it is safe to use photo-activated disinfection (PAD) during root canal treatment without heating the periodontal tissues. Root canals of 30 freshly extracted single-rooted teeth were prepared using ProFiles up to size ISO 40 and then filled with photo-sensitiser: tolonium blue (1.2 mg/l). The 635 nm diode laser was used with the manufacturer's endo-tip. Samples were irradiated for 150 s (output power 100 mW, approximate energy density 106.16 J/cm(2)). Temperatures were recorded at working length on the external root surface. After 150 s of PAD irradiation, the average temperature rise was 0.16 +/- 0.08 degrees C. All values were lower than the 7 degrees C safety level for periodontal injury. It was concluded that, regarding the temperature increase, the use of PAD in root canals could be considered harmless for periodontal tissues.
Romano, Nayara; Souza-Flamini, Luis Eduardo; Mendonça, Isabela Lima; Silva, Ricardo Gariba
This paper reports a case of gemination in a maxillary lateral incisor with two root canals and crown-root dilaceration. A 16-year-old male patient was referred for endodontic treatment of the maxillary left lateral incisor and evaluation of esthetic and functional complaints in the anterior region. The patient reported trauma to the anterior primary teeth. There was no spontaneous pain, but the tooth responded positively to the vertical percussion test and negatively to the pulp vitality test. Clinical examination showed esthetic and functional alterations and normal periodontal tissues. CBCT imaging confirmed the suspicion of gemination and crown-root dilaceration and also revealed the presence of two root canals and periapical bone rarefaction. The root canals were instrumented with Reciproc R40 and 1% NaOCl irrigation and were filled by lateral condensation of gutta-percha and AH Plus sealer. The tooth was definitely restored with composite resin to recover esthetics. Continued follow-up over 6 months has shown absence of pain or clinical alterations as well as radiographic image suggestive of apical repair. PMID:28119787
McCullagh, J J; Biagioni, P A; Lamey, P J; Hussey, D L
The temperature changes on the root surface of 30 extracted human premolar teeth during thermomechanical root canal obturation with gutta-percha were determined using an infrared thermal imaging camera. Three handpiece rotational speeds of 8, 12 and 16 x 10(3) r.p.m. were used, in conjunction with a Gutta Condensor. On completion of the procedure, the quality of tooth canal obturation was examined radiographically. Under the conditions of this experiment, surface root temperature rises of > 97 degrees C were recorded during all three speed settings. The radiographic quality of obturation between the groups appeared not to be significantly different. The clinical relevance of these findings is uncertain, but the temperatures reported are of a magnitude to be of biological importance.
Whitbeck, Evan R; Swenson, Kelli; Tordik, Patricia A; Kondor, Shayne A; Webb, Terry D; Sun, Jirun
The aim of this study was to evaluate whether rotary instrumentation using saline, EDTA 17% solution, or RC-Prep (Premier Dental, Philadelphia, PA) resulted in differences in root canal transportation. The secondary objective was to assess if instrumentation using these agents caused changes in the working length and canal volume. Moderately curved mesiobuccal roots of 24 maxillary molars were standardized in length and randomized into 1 control and 2 experimental groups. The canals were instrumented with 0.04 taper rotary files to size #30. All groups were irrigated with saline. Group 1 was also irrigated using EDTA 17% solution (Pulpdent Corp, Watertown, MA), and in group 2, RC-Prep was used. X-ray micro-computed tomographic scans and working length measurements were made before and after instrumentation. Three-dimensional models were created from the pre- and postinstrumentation scan data and compared for volume changes. Centroid points were calculated in cross-sectional slices of the canals, and transportation was determined by measuring the distance between the pre- and postinstrumentation points. The data were analyzed with 1-way analysis of variance (α = 0.05) and the Tukey post hoc test. Less transportation was observed in group 2 than in group 1 (P = .001) and the control group (P = .014). Transportation in group 1 and the control group was not significantly different. Canal volume in group 1 was increased relative to group 2 (P = .004) and the control group (P = .022). No significant differences in the working length were observed. The use of chelating agents during root canal instrumentation did not significantly increase apical transportation. Published by Elsevier Inc.
Vignolo, Valeria; Fuentes, Maria-Victoria; Garrido, Miguel-Angel; Rodríguez, Jesús; Ceballos, Laura
To compare microhardness along the root canal post space of two resin cements in different shades and a dual-cure resin core material. Root canals of 21 bovine incisors were prepared for post space. Translucent posts (X∘Post, Dentsply DeTrey) were luted using one the following resin luting agent: Calibra (Dentsply DeTrey) in Translucent, Medium and Opaque shades, RelyX Unicem (3M ESPE) in Translucent, A2 and A3 shades and the dual-cure resin core material Core∘X flow. All materials were applied according to manufacturers' instructions and were all photopolymerized (Bluephase LED unit, Ivoclar Vivadent, 40s). After 24 hours, roots were transversally cut into 9 slices 1 mm thick from the coronal to apical extremes, three corresponding to each root third. Then, VHNs were recorded (100gf, 30 s) on the resin luting materials along the adhesive interface in all sections. Data were analyzed by two-way ANOVA and SNK tests (α=0.05). A significant influence on microhardness of resin luting material in their respective shades (p<0.0001), root third (p<0.0001) and interactions between them was detected (p<0.0001). RelyX Unicem cement showed the highest microhardness values and Calibra the lowest, regardless of the shade selected. All resin luting materials tested exhibited a significantly higher microhardness in the cervical third. Microhardness of resin luting agents tested inside the canal is dependent on material brand and resin cement shade seems to be a less relevant factor. Microhardness decreased along the root canal, regardless of the shade selected.
Dehon, P; Van Nieuwenhuysen, J P
The endpoint of an endodontic treatment must be situated at the cemen-to-dentinal junction to preserve the biological potential of the periapical area and to realize a complete disinfection of the principal root canal system. Thus, the determination of working length is a crucial factor in endodontic therapy. The conventional radiographic method cannot provide the accurate location of the apical constriction. For this reason, the electronic apex locators have been developed. Now, the last generation of apex locators has become more sophisticated and the electronic measurements seem to be accurate and reliable with electrolytic solutions in the canal.
Sübay, Rüstem Kemal; Kara, Özlem; Sübay, Melike Ordulu
The objective of this study is to evaluate the performance of four electronic root canal length measurement devices (ERCLMDs) [Root ZX, Raypex 6, ProPex II, and VDW Gold with ERCLMD] in wet and dry root canals with different major foramen diameters, in association with three file positions within the final 1 mm of canals. Fifty roots were divided into five groups that were instrumented apically to the terminus diameter using K-files 15, 20, 30, 40, and 60. ERCLMD measurements were made when the file tip was at major foramen, 0.5 mm and 1.0 mm short of the foramen, when the apex touched to the surface of saline or was immersed 3 mm into saline, and when the canal was dry or was irrigated with saline. The differences between the electronic lengths and the actual lengths were calculated. The data were analyzed using the three-, two-, and one-way ANOVA and the LSD test (p < .05). Overall, the four ERCLMDs demonstrated 12.8% unstable and beyond the foramen measurements (11.3%). About 85% of the beyond the foramen measurements had foramen diameters 0.40 and 0.60. ERCLMD comparisons related to the file positions in the foramen diameters showed significant differences between ERCLMDs in each foramen diameter (p < .05). All ERCLMDs provided highly accurate measurements within the final 1 mm of the foramen. Wet or dry canals and apex conditions did not adversely affect the accuracy of the ERCLMDs' readings. ProPex II located the file positions in the teeth with different foramen diameters more accurately than the other ERCLMDs.
Jaikailash, Shanmugam; Kavitha, Mahendran; Ranjani, Muthukrishnan Sudharshana; Saravanan, Balasubramaniam
This case report describes endodontic treatment completed in a peg-shaped maxillary lateral incisor, with single root and five root canals of which, one is due to dens invaginatus. Cone beam computed tomogram scanning confirmed the unique morphology of the tooth. New nomenclature for the five canals is proposed. PMID:25125854
Tran, Kenny T; Torabinejad, Mahmoud; Shabahang, Shahrokh; Retamozo, Bonnie; Aprecio, Raydolfo M; Chen, Jung-Wei
The purpose of this study was to compare the efficacy of the pulverization and sterile paper point techniques for sampling root canals using 5.25% NaOCl/17% EDTA and 1.3% NaOCl/MTAD (Dentsply, Tulsa, OK) as irrigation regimens. Single-canal extracted human teeth were decoronated and infected with Enterococcus faecalis. Roots were randomly assigned to 2 irrigation regimens: group A with 5.25% NaOCl/17% EDTA (n = 30) and group B with 1.3% NaOCl/MTAD (n = 30). After chemomechanical debridement, bacterial samplings were taken using sterile paper points and pulverized powder of the apical 5 mm root ends. The sterile paper point technique did not show growth in any samples. The pulverization technique showed growth in 24 of the 60 samples. The Fisher exact test showed significant differences between sampling techniques (P < .001). The sterile paper point technique showed no difference between irrigation regimens. However, 17 of the 30 roots in group A and 7 of the 30 roots in group B resulted in growth as detected by pulverization technique. Data showed a significant difference between irrigation regimens (P = .03) in pulverization technique. The pulverization technique was more efficacious in detecting viable bacteria. Furthermore, this technique showed that 1.3% NaOCl/MTAD regimen was more effective in disinfecting root canals. Published by Elsevier Inc.
Sohrabi, Khosrow; Sooratgar, Aidin; Zolfagharnasab, Kaveh; Kharazifard, Mohammad Javad; Afkhami, Farzaneh
The aim of the present in vitro study was to evaluate the disinfection ability of 980-nm diode laser in comparison with sodium hypochlorite (NaOCl) as a common root canal irrigant in canals infected with Enterococcus faecalis (E. faecalis). The root canals of 18 extracted single-rooted premolars were prepared by rotary system. After decoronation, the roots were autoclaved. One specimen was chosen for the negative control, and the remaining teeth were incubated with E. faecalis suspension for two weeks. Subsequently, one specimen was selected as the positive control and the remaining samples were divided into two groups (n=8). The samples of the first group were irrigated with 5.25% NaOCl and the second group were treated with a 980-nm diode laser. Microbial samples were taken from the root canals and bacterial cultivation was carried out. The average value and the standard deviation of colony-forming units (CFU) of each specimen were measured using descriptive statistics. The student's t-test was used to compare the reduction in CFU in each group. The equality of variance of CFU was measured by the Levene's test. NaOCl resulted in 99.87% removal of the bacteria and showed significantly more antibacterial effect compared to the 980-nm diode laser which led to 96.56% bacterial reduction (P<0.05). Although 5.25% NaOCl seems to reduce E. faecalis more effectively, the diode laser also reduced the bacterial count. Therefore a 980-nm diode laser could be considered as a complementary disinfection method in root canal treatment.
Mohammadi, Zahed; Asgary, Saeed; Shalavi, Sousan; V. Abbott, Paul
One of the main causes of endodontic treatment failure is the clinician’s inability to localize all the root canals. Due to the complex anatomy of the root canal system, missed canals are not uncommon. There are several strategies to decrease the possibility of missed root canals starting with good pre-operative radiographies. In order to overcome the limitations of conventional radiographies, cone-beam computed tomography (CBCT) can be considered. A correct access cavity preparation is of pivotal importance in localizing the orifices of the root canals. Furthermore, ultrasonics are very important devices to find missed canals. Increasing magnification and illumination enhance the possibility of finding all root canals during root canal treatment. The purpose of the present paper was to review all of the above techniques and devices. PMID:27471533
Schaudinn, C; Jaramillo, D; Freire, M O; Sedghizadeh, P P; Nguyen, A; Webster, P; Costerton, J W; Jiang, C
Aim To evaluate the efficacy of a non-thermal plasma (NTP) at atmospheric pressure on ex vivo biofilm in root canals of extracted teeth. Methodology Intra-canal contents from three teeth with root canal infections were collected, pooled, and grown in thirty-five microCT-mapped root canals of extracted and instrumented human teeth. One group of teeth was treated with NTP, another with 6% NaOCl, and one set was left untreated. The intra-canal contents from twenty-seven teeth (nine teeth in each group) were plated on agar and colony forming units were determined. Parametric test of one-way Analysis of Variance (ANOVA) was used to analyze statistical significance. The remaining teeth were cut open, stained with LIVE/DEAD® and examined with confocal laser scanning microscopy. Results The untreated root canals were covered with biofilm of varying thickness. The treatment with the non-thermal plasma decreased the number of viable bacteria in these biofilms by one order of magnitude, while the NaOCl control achieved a reduction of more than four magnitudes. Both the NTP and the NaOCl treatment results were significantly different from the negative control (P< 0.05). Conclusion The non-thermal plasma displayed antimicrobial activity against endodontic biofilms in root canals, but was not as effective as the use of 6 % NaOCl. PMID:23480318
Markvart, M; Darvann, T A; Larsen, P; Dalstra, M; Kreiborg, S; Bjørndal, L
To compare the effectiveness of two rotary hybrid instrumentation techniques with focus on apical enlargement in molar teeth and to quantify and visualize spatial details of instrumentation efficacy in root canals of different complexity. Maxillary and mandibular molar teeth were scanned using X-ray microcomputed tomography. Root canals were prepared using either a GT/Profile protocol or a RaCe/NiTi protocol. Variables used for evaluation were the following: distance between root canal surfaces before and after preparation (distance after preparation, DAP), percentage of root canal area remaining unprepared and increase in canal volume after preparation. Root canals were classified according to size and complexity, and consequences of unprepared portions of narrow root canals and intraradicular connections/isthmuses were included in the analyses. One- and two-way anova were used in the statistical analyses. No difference was found between the two techniques: DAP(apical-third) (P = 0.590), area unprepared(apical-third) (P = 0.126) and volume increase(apical-third) (P = 0.821). Unprepared root canal area became larger in relation to root canal size and complexity, irrespective of the technique used. Percentage of root canal area remaining unprepared was significantly lower in small root canals and complex systems compared to large root canals. The isthmus area per se contributed with a mean of 17.6%, and with a mean of 25.7%, when a narrow root canal remained unprepared. The addition of isthmuses did not significantly alter the ratio of instrumented to unprepared areas at total root canal level. Distal and palatal root canals had the highest level of unprepared area irrespective of the two instrumentation techniques examined. © 2011 International Endodontic Journal.
Lana, M A; Ribeiro-Sobrinho, A P; Stehling, R; Garcia, G D; Silva, B K; Hamdan, J S; Nicoli, J R; Carvalho, M A; Farias, L de M
The knowledge about causative agents involved in endodontic infections is increasing, especially due to the improvement of culture techniques for anaerobic bacteria, showing that these microorganisms are predominant in this pathology. In this study, 31 canals with pulp necrosis were microbiologically analyzed before and after manipulation. Obligate and facultative anaerobes, microaerophilic bacteria and yeasts were recovered from 24, 14, 5 and 2 clinical specimens, respectively. The most frequent genera were Prevotella, Fusobacterium, Lactobacillus, Streptococcus, Clostridium and Peptostreptococcus for bacteria and Candida and Saccharomyces for yeasts. Strong positive associations, using an odds ratio system, were found between Clostridium and Prevotella and between Peptostreptococcus and Fusobacterium. Even after the instrumentation and the use of Ca(OH)2, facultative anaerobes were detected in two root canals and yeasts in three. Microorganisms were isolated from seven canals at the end of the endodontic treatment: facultative anaerobes from five and yeasts from one. The microbiological evaluation of root canals with pulp necrosis suggests the presence of polymicrobial infections, mainly involving obligate anaerobes, and shows that the infection may persist after treatment.
Srikumar, G.P.V.; Sekhar, K.S.; Nischith, K.G.
Background Root canal irrigants play an indispensable role for the complete disinfection of the root canal system, in particular those areas of the root canal that are not accessible for instrumentation. Sodium hypochlorite, ethylene diamine tetra acetic acid, hydrogen peroxide and chlorhexidine are the most commonly used root canal irrigants in endodontic practice, but they do not satisfy all the properties of an ideal root canal irrigant. Mixture tetracycline, citric acid and detergent, a root canal irrigant, is commercially available as BioPure MTAD (Dentsply, Tulsa Dental, Tulsa, OK). Methodology The literature was searched for root canal irrigants used in the last 3 decades in PubMed. Data showed 83 relevant articles, of which 24 were found most suitable on the basis of description of properties, advantages and disadvantages of MTAD, hence were included. The aim of this study was to evaluate the properties of MTAD for its antibacterial efficiency, biocompatibility, chelating action with removal of endodontic smear layer and compare it with other commonly used root canal irrigants like sodium hypochlorite, ethylene diamine tetra acetic acid, hydrogen peroxide, chlorhexidine. Results MTAD was found to be highly effective intracanal irrigant compared to other commonly used root canal irrigants with excellent disinfection of the entire root canal system. Conclusion MTAD is biocompatible with superior antimicrobial efficiency compared to other commonly used root canal irrigants. PMID:25737877
Matloff, I.R.; Jensen, J.R.; Singer, L.; Tabibi, A.
The purpose of the study was to compare several methods that have been used to assess marginal leakage of root canal fillings. Sixty-three extracted, single-rooted teeth were instrumented and filled in a standardized manner. Teeth were randomly divided into groups of twenty and exposed to solutions containing methylene blue dye, calcium-45, carbon-14-labeled urea, and iodine-125-labeled albumin for 48 hours to compare the degree of leakage indicated by each technique. Methylene blue dye was found to penetrate farther up the canal than any of the isotope tracers. Carbon-14-labeled urea penetrated farther than the calcium-45- or iodine-125-labeled albumin. The mean volume of solution penetrating the teeth was exceedingly small (0.0011 ml) and probably unimportant physiologically.
Weng, Xi-Li; Yu, Shi-Bin; Zhao, Shou-Liang; Wang, Han-Guo; Mu, Tong; Tang, Rong-Yin; Zhou, Xue-Dong
The purpose of this study was to investigate the canal morphology of 504 maxillary permanent teeth of subjects of Han nationality in Chinese Guanzhong area. Maxillary permanent teeth were randomly collected in Guanzhong area. After regular preparation, the teeth were immersed into ink without preparing access cavities and then put into hyperbaric oxygen chamber (0.6 Mpa) for 2 hours to let the ink penetrate into root canal from apical foramen, apical deltas and foramen of lateral canals under stable positive pressure. After demineralization and clearing, the following observations were made: (1) number of root canals, (2) root canal configuration by using Vertucci's classification, (3) presence of lateral canals, and (4) frequency of apical deltas. All the teeth were well-stained, and the fine details were well-revealed. Apical deltas (12.2%-83.3%) and lateral canals (13.7%-68.8%) could be frequently found in all types of maxillary teeth. Most of central incisors (95.8%), lateral incisors (91.4%), and canines (75.4%) displayed type I canal configuration, whereas most of first premolars (87.3%) and second premolars (72.3%) possessed 2 canals with type II, IV, or VI canal configuration. The majority of distobuccal roots and palatal roots of first molars (88.9%, 97.8%), second molars (92.0%, 94.0%), and third molars (87.5%, 91.6%) possessed type I canal configuration. The prevalence of mesiobuccal roots with type I configuration was 66.7% in maxillary first molars, 82% in second molars, and 62.5% in third molars. The modified technique of canal staining can effectively reveal detailed root canal system. The canal configuration of maxillary teeth in subjects of Han nationality in Chinese Guanzhong area is consistent with previous reports in other races.
Nishimura, Hiroyuki; Higo, Yukari; Ohno, Maki; Tsutsui, Takeo W; Tsutsui, Takeki
Root canal antiseptics are topically applied to root canals within the pulpless teeth to treat the root canal and periapical infections. Because the antiseptics that are applied to root canals can penetrate through dentin or leak out through an apical foramen into the periodontium and distribute by the systemic circulation, it is important to study the safety of these antiseptics. In the present study, we examined the ability to induce chromosome aberrations in human dental pulp cells of five root canal antiseptics, namely, carbol camphor (CC), camphorated p-monochlorophenol (CMCP), formocresol (FC), calcium hydroxide, and iodoform which are most commonly used in dental practice. Statistically significant increases in the levels of chromosome aberrations were induced by CC, FC, or iodoform in a concentration-dependent manner. Conversely, CMCP and calcium hydroxide failed to induce chromosome aberrations in the absence or presence of exogenous metabolic activation. The percentages of cells with polyploid or endoreduplication were enhanced by FC or iodoform. Our results indicate that the root canal antiseptics that exhibited a positive response are potentially genotoxic to human cells.
Bortoluzzi, Eduardo A; Carlon, Daniel; Meghil, Mohamed M; El-Awady, Ahmed R; Niu, Lina; Bergeron, Brian E; Susin, Lisiane; Cutler, Christopher W; Pashley, David H; Tay, Franklin R
To evaluate the effectiveness of TRUShape® 3D Conforming Files, compared with Twisted Files, in reducing bacteria load from root canal walls, in the presence or absence of irrigant agitation. Extracted human premolars with single oval-shaped canals were infected with Enterococcus faecalis. Teeth in Group I (N=10; NaOCl and QMix® 2in1 as respective initial and final irrigants) were subdivided into 4 subgroups: (A) TRUShape® instrumentation without irrigant activation; (B) TRUShape® instrumentation with sonic irrigant agitation; (C) Twisted Files without irrigant agitation; (D) Twisted Files with sonic irrigant agitation. To remove confounding factor (antimicrobial irrigants), teeth in Group II (N=10) were irrigated with sterile saline, using the same subgroup designations. Specimens before and after chemomechanical débridement were cultured for quantification of colony-forming units (CFUs). Data from each group were analyzed separately using two-factor ANOVA and Holm-Sidak multiple comparison (α=0.05). Canal wall bacteria were qualitatively examined using scanning electron microscopy (SEM) and light microscopy of Taylor-modified Brown and Brenn-stained demineralised sections. CFUs from subgroups in Group I were not significantly different (P=0.935). For Group II, both file type (P<0.001) and irrigant agitation (P<0.001) significantly affected log-reduction in CFU concentrations. The interaction of these two factors was not significant (P=0.601). Although SEM showed reduced canal wall bacteria, bacteria were present within dentinal tubules after rotary instrumentation, as revealed by light microscopy of longitudinal root sections. TRUShape® files removed significantly more canal wall bacteria than Twisted Files when used without an antibacterial irrigant; the latter is required to decontaminate dentinal tubules. Root canal disinfection should not be focused only on a mechanistic approach. Rather, the rational choice of a rotary instrumentation system should be
Heintz, C E; Deblinger, R; Oliet, S
Enterococci that persisted in debrided, medicated root canals were tested by the Kirby-Bauer procedure for sensitivity to various antibiotics. The 50 strains tested were uniformly sensitive to ampicillin and vancomycin. More than 90% were also sensitive to erythromycin. Varying degrees of sensitivity and resistance were noted to bacitracin, cephaloridine, cephalothin, chloramphenicol, gentamicin, and tetracycline. All organisms were either partly or wholly resistant to clindamycin; penicillin; streptomycin; and sulfadiazine, sulfamerazine, and sulfamethazine (triple sulfas).
Tosić, Goran; Miladinović, Milan; Kovaević, Milorad; Stojanović, Miodrag
Root canal treatment is considered to be the one of the most important procedures in endodontic treatment. To irrigate the root canal it is most common to use sodium hypochlorite (NaOCl), chlorhexodine, ethylenediaminetetraacetic acid (EDTA), local anesthetic solution, while the most used in Serbia is hydrogen peroxide (H2O2). The aim of this survey was to reveal the preferred root canal irrigants used by general dental practitioners in Serbia and to determine the influence of the continuing education program, delivered over the 3-year observation period, on work habits of dental practitioners. This was the first comprehensive survey of this nature carried out in Serbia. The survey was conducted in two instances, a 4-month observation period each, from November 1, 2009 to March 1, 2010 and from November 1, 2012 to March 1, 2013. Internet Web Page Survey was posted on the official web site of the Serbian Association of Private Dentists. In the first survey, 569 completed questionnaires were subjected to analysis. In the next attempt (3 years later), the survey was launched again and 615 completed questionnaires were analyzed using the same criteria. The statistical analysis was carried out with simple descriptive statistics applying the x2 test, at a significance level of p < 0.05. The first survey included 569 dental practitioners, while 3 years later the number of them was 615. Analyzing the questionnaires revealed the number of 10 to 30 interventins on the root canal montly. The most commonly used irrigant solution was H2O2 in 2009, while in 2012 it was yet H2O2, but also NaOCl, chlorhexodine, and a little less EDTA. This study shows significant changes in the irrigation protocol applied in Serbian dental community. After 3 years of observation, NaOCl became widely accepted as the irrigant of choice, whereas H2O2 lost its popularity.
Mohan, Dennis; Maruthingal, Sunith; Indira, Rajamani; Divakar, Darshan Devang; Al Kheraif, Abdulaziz Abdullah; Ramakrishnaiah, Ravikumar; Durgesh, B.H.; Basavarajappa, Santhosh; John, Jacob
Aim To investigate the efficacy of photo activated disinfection (PAD) in reducing colony-forming unit (CFU) counts of Enterococcus faecalis (E. faecalis) in infected dental root canals. The study compared the efficacy of PAD with conventional endodontic treatment (CET) and also a combination of CET along with PAD. Material and Methods 53 maxillary incisors were taken for the study. Teeth were divided into 3 groups, CET (Group I) (n = 11), PAD (Group II) (n = 21), and a combination of CET and PAD (Group III) which consisted of (n = 21) samples, Group II and Group III were further divided into 2 subgroups, Group IIa, IIb and Group IIIa, IIIb. Strains of E. faecalis were inoculated in all the root canals. CET group samples were treated by chemo-mechanical preparation (CMP) alone, PAD samples were treated with laser alone at 2 different exposure time (4 min and 2 min). In the combination treatment, samples were treated initially by CET and then by PAD for a time period of 4 min and 2 min. Contents of the root canal were aspirated, diluted and plated in Tryptone Soya Broth (TSB) and plates were incubated for 24 h to observe the bacterial regrowth. Results Showed PAD used along with CMP reduced the bacterial load of E. faecalis by 99.5% at 4 min and 98.89% at 2 min. Conclusion PAD may be an adjunctive procedure to kill residual bacteria in the dental root canal systems after standard endodontic root canal preparation. PMID:26858548
Schipper, M; Peters, L B
A 53-year-old woman with continuing pain coming from a lower first molar was diagnosed with apical periodontitis, with a retained fractured instrument in the root canal. There are a variety of treatment options for dealing with a corpus alienum in a root canal. In this case it was decided to treat the tooth endodontically, and leave the fractured instrument fragment in situ. The selection of this treatment option was made on the basis of knowledge of the original diagnosis and the success rates of the various treatment options as described in the relevant literature, weighed against the possible risks and their effects on the prognosis. This suggested that the use of a dental operating microscope has a positive impact on the success rates of endodontic treatment The prognosis for endodontic treatment when a fractured instrument fragment is left within the root canal, as in this case, is not significantly reduced. The presence of preoperative periapical pathology, however, is a more clinically significant prognostic indicator.
Nassar, Mohannad; Hiraishi, Noriko; Tamura, Yukihiko; Otsuki, Masayuki; Aoki, Kazuhiro; Tagami, Junji
The objectives of this study were to investigate the effect of phytic acid, inositol hexakisphosphate (IP6), as a final rinse on the surface of instrumented root canals and smear-layered flat dentin surfaces treated with sodium hypochlorite (NaOCl) and to evaluate its effect on the viability and alkaline phosphatase activity of osteoblast-like cells (MC3T3-E1). The universally accepted chelating agent EDTA was used as the control in all conducted experiments. Root canals of human canines were instrumented with rotary files and irrigated with 5% NaOCl, followed by a final rinse of 17% EDTA (1 minute), 1% IP6 (1 minute or 30 seconds), or distilled water. NaOCl-treated flat coronal dentin surfaces were also treated with 17% EDTA (1 minute), 1% IP6 (1 minute or 30 seconds), or distilled water. The presence or absence of smear layer was evaluated with scanning electron microscopy. Cell viability and alkaline phosphatase assays were performed to evaluate the effect of IP6 and EDTA on cultured MC3T3-E1 cells. The results demonstrated the ability of IP6 to remove the smear layer from instrumented root canals and flat coronal dentin surfaces. When compared with EDTA, IP6 was less cytotoxic and did not affect the differentiation of MC3T3-E1 cells. IP6 shows the potential to be an effective and biocompatible chelating agent. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
Tay, Franklin R.; Pashley, David H.
The term “monoblock” has become a familiar term in the endodontic literature with recent interest in the application of dentin adhesive technology to endodontics. Endodontic “monoblocks” have generated controversial discussions among academicians and clinicians as to whether they are able to improve the quality of seal in root fillings and to strengthen roots. This review attempts to provide a broader meaning to the term “monoblock” and see how this definition may be applied to the materials that have been used in the past and present for rehabilitation of the root canal space. The potential of currently available bondable materials to achieve mechanically homogeneous units with root dentin is then discussed in relation to the classical concept in which the term “monoblock” was first employed in restorative dentistry, and subsequently in endodontics. PMID:17368325
Sarp, Ayşe. S.; Gülsoy, Murat
Although conventional method carries all the debris, studies on persisting infections in root canals show bacteria and their toxins spread from the root canal and contaminate the apical region. Thus developes apical periodontitis or symptoms, and loss of tooth. Even if the treatment has adequate success, anatomy of root canal system can be very complexwith accessory canals. The disinfecting effect of laser radiation has only recently been used in dentistry. Laser irradiation has a bactericidal effect. Each wavelength has its own advantages and limitations according to their different absorption characteristics, depending on their 'absorption coefficient'. The sterilizing efficiency of two types of wavelengths, a new fiber laser 1940- nm Thulium fiber Laser and an 2940 nm Er:YAG Laser were compared in this study. Irradiation with a power of 0.50 W with 1940- nm Thulium fiber Laser disinfected 95,15% of bacteria, however irradiation with same laser power with Er:YAG Laser caused a reduction of 96,48 %. But there was no significant difference in the disinfection effect of two different laser groups ( p < 0.05, Mann- U-Whitney Test). In addition to this, Er :YAG Laser caused three times more reduction from its own positive control group where 1940- nm Thulium fiber Laser caused 2,5 times effective disinfection.
Gutknecht, N; van Gogswaardt, D; Conrads, G; Apel, C; Schubert, C; Lampert, F
The aim of this study was to investigate the antibacterial effect of a diode laser in deep root canal dentin. The microbial colonization of root canal dentin can lead to failures in conventional endodontic treatment if an inadequate bacterial reduction only is achieved through canal treatment and chemical disinfection. 100 microm, 300 microm and 500 microm bovine dentin slices obtained by longitudinal sections were sterilized and inoculated on one side with an Enterococcus faecalis suspension. Laser radiation was performed on the opposite side with the diode laser (810 nm) at a setting of 3 W in continuous mode (CW). Radiation was performed using a 400-microm tapered fiber tip at an angle of approximately 5 degrees to the surface over a period of 30 seconds. The output power at the distal end of the tip was 0.6 W. The bacteria were then eluted through vibration and cultured on blood agar plates. The colony count reflected the antibacterial effect of laser radiation as a function of the layer thickness. A mean bacterial reduction of 74% was achieved even with a 500-microm thick slice. This investigation indicates that the diode laser radiation reduces the number of bacteria in deep layers of infected root canal wall dentin.
Fu, Mei; Hou, Ben-Xiang; Zhang, Zhi-Ling
To evaluate effect of root canal curvature and location of the fragment on the removal of broken file from root canal. Sixty extracted mandibular premolars were divided equally into six groups according to location of fragment (2 mm or 8 mm below root canal orifice) and root canal curvature (20 degrees, 30 degrees or 40 degrees). Broken files were removed using ultrasonic tips combined with dental operating microscope. Number of successfully removed case and operating time were recorded. Pre- and post-operative digital radiographs were input into image analyzing software to calculate diameter variance of root canal at the level of tip of broken file. All the 6 groups of broken files were successfully removed with out perforation. Among same fragment location groups, diameter variance was increased in greater curvature groups and the difference was significant (P < 0.05), while operation time was not significantly different (P > 0.05). Among same root canal curvature groups, the deeper the fragment, the longer operation time, difference being significant (P < 0.05), while difference of diameter variance was not significant (P > 0.05). The more curvature of root canal, the more dentine removal amount at the level of broken file tip. Location of fragment has no effect on dentine removal amount. Safe straight-line access and adequate thickness of dentine are essential to removal of broken file from root canal.
Alves, Flávio R F; Almeida, Bernardo M; Neves, Mônica A S; Moreno, Jaime O; Rôças, Isabela N; Siqueira, José F
This study compared the ability of different approaches to supplement the antibacterial effects of chemomechanical preparation in oval-shaped root canals. Long oval canals from extracted teeth infected with Enterococcus faecalis (ATCC 29212) were chemomechanically prepared up to a 40/04 rotary BioRaCe instrument using 2.5% NaOCl irrigation and then subjected to two supplementary protocols. In the passive ultrasonic irrigation (PUI)/chlorhexidine (CHX) group, canals were subjected to PUI for the activation of NaOCl followed by a final rinse with 0.2% CHX digluconate solution. In the Hedström group, canals received additional Hedström filing directed towards the buccal and lingual canal recesses. Bacteriological samples were taken before and after preparation, after PUI or Hedström instrumentation, and after CHX final rinsing. Chemomechanical preparation and the supplementary steps promoted a highly significant bacterial reduction (P < .001). Quantitative (reduction in levels) and qualitative (frequency of negative cultures) analyses showed that PUI alone or Hedström filing did not significantly increase bacterial reduction (P > .05). Further rinsing with CHX also failed to significantly increase bacterial elimination when compared with post-PUI samples. However, the cumulative antibacterial effects of PUI and CHX final rinse were effective in significantly reducing bacterial counts to levels below those achieved after preparation (P = .03). This combined PUI/CHX approach also resulted in a significant increase in the incidence of negative cultures (P = .04). Findings suggest that there may be a benefit of using the PUI for the activation of NaOCl followed by a final rinse with CHX as supplementary steps in the treatment of infected oval-shaped root canals. Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
Maniglia-Ferreira, Cláudio; Valverde, Guilherme Bönecker; Silva, João Batista Araújo; de Paula, Regina Célia Monteiro; Feitosa, Judith Pessoa Andrade; de Souza-Filho, Francisco José
This in vivo study investigated the time of degradation of root filling material (trans 1,4-polyisoprene) retrieved from endodontically treated teeth and correlated the occurrence of degradation with the longevity of endodontics. Thirty-six root-filled teeth with different filling times (2 to 30 years) and with and without periapical lesions were selected. All teeth presented clinical indication for root canal retreatment. The association among filling time, presence of periapical lesion and root filling material degradation was investigated. Root filling samples were retrieved from the root canals using a Hedströ m file without solvent. The trans 1,4-polyisoprene was isolated by root filling solubilization in chloroform followed by filtration and centrifugation. GPC and FT-IR were the analytical techniques utilized. Degradation of trans 1,4-polyisoprene occurred with time, as a slow process. It is an oxidative process, and production of carboxyl and hydroxyl groups in the residual polymer were observed. Statistically significant decrease of molar mass was observed after 5 (p=0.0001) and 15 (p=0.01) years in teeth with and without periapical lesion, respectively. Bacteria participated in polymer degradation. Gutta-percha aging was proven an important factor for the long-term success of endodontic treatment. The findings of the present study showed that, after 15 years, polymer weight loss may decrease the capacity of the filling mass to seal the root canal space and prevent re-infection, thus compromising significantly the longevity of root canal therapy.
Chauhan, Raju; Singh, Shweta
The variations in root canal anatomy of multirooted teeth represent a continuous challenge to endodontic diagnosis and treatment. Although the most common configuration of mandibular molars is one containing 2 roots and 3 root canals, there are many different combinations. Very rarely, an additional third (supernumerary) root is seen. When it is located distolingually to the main distal root, this third root is called radix entomolaris (RE), and when it is located mesiobuccally to the mesial root, it is called radix paramolaris (RP). Variations of root canal systems need not always be in the form of extra roots or extra canals. Single roots with single canals can also occur. A general dentist should be aware of these unusual root canal morphologies in mandibular molars for the success of endodontic treatment. These case reports describe the root canal treatment of a case of RE in the mandibular first molar, 2 rare cases of RP (1 each in the mandibular first and second molars), and a mandibular second molar with a single root and root canal.
Marceliano-Alves, Marília; Alves, Flávio Rodrigues Ferreira; Mendes, Daniel de Melo; Provenzano, José Claudio
A thorough knowledge of root canal anatomy is critical for successful root canal treatments. This study evaluated the internal anatomy of the palatal roots of maxillary first molars with micro-computed tomography (microCT). The palatal roots of extracted maxillary first molars (n = 169) were scanned with microCT to determine several anatomic parameters, including main canal classification, lateral canal occurrence and location, degree of curvature, main foramen position, apical constriction presence, diameters 1 and 2 mm from the apex and 1 mm from the foramen, minor dentin thickness in those regions, canal volume, surface area, and convexity. All canals were classified as Vertucci type I. The cross sections were oval in 61% of the canals. Lateral canals were found in 25% of the samples. The main foramen did not coincide with the root apex in 95% of the cases. Only 8% of the canals were classified as straight. Apical constriction was identified in 38% of the roots. The minor and major canal diameters and minor dentin thickness were decreased near the apex. The minor dentin thickness 1 mm from the foramen was 0.82 mm. The palatal canals exhibited a volume of 6.91 mm(3) and surface area of 55.31 mm(2) and were rod-shaped. The root canals of the palatal roots were classified as type I. However, some factors need to be considered during the treatment of these roots, including the frequent ocurrence of moderate/severe curvatures, oval-shaped cross-sections, and lateral canals, noncoincidence of the apical foramen with the root apex, and absence of apical constriction in most cases. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
Zeng, Chang; Shen, Ya; Guan, Xiaoyue; Wang, Xin; Fan, Mingwen; Li, Yuhong
The aim of this article was to present a right maxillary second molar with an unusual root canal morphology of 4 roots and 5 canals as confirmed by cone-beam computed tomographic (CBCT) imaging. The tooth had a C-shaped mesiobuccal root (CBCT imaging revealed that the root was closer to the palate than the buccal side) with 2 canals, 2 fused distobuccal roots with 2 separate canals, and 1 normal bulky palatal root with 1 canal. After thoroughly examining the rare anatomy, root canal treatment was applied on the tooth. This article shows the complexity of maxillary second molar variation and shows the significance of CBCT imaging in the confirmation of the 3-dimensional anatomy of teeth and endodontic treatment. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
Du, Tianfeng; Wang, Zhejun; Shen, Ya; Ma, Jingzhi; Cao, Yingguang; Haapasalo, Markus
The present study aimed to evaluate the antibacterial effect of the combined use of sodium hypochlorite (NaOCl) and root canal sealers on Enterococcus faecalis biofilms using a dentin infection model. Cells of E. faecalis were introduced into the dentinal tubules by centrifugation and incubated in brain-heart infusion for 3 weeks. The biofilms in dentin were first subjected to 5% NaOCl or sterile water for 10 minutes followed by an equal thickness of AH Plus (Dentsply International Inc, York, PA), Endosequence BC Sealer (Brasseler USA, Savannah, GA), or MTA Fillapex (Angelus Indústria de Produtos Odontológicos S/A, Londrina, Brazil) placed on the root canal wall of the dentin specimens for 7, 30, and 60 days. Gutta-percha and water were used in a similar manner as controls. The proportions of dead and live bacteria inside the dentinal tubules were assessed by confocal laser scanning microscopy and viability staining. The combined use of NaOCl and sealers (30 and 60 days) killed significantly more bacteria than NaOCl or sealers alone (P < .05). NaOCl + MTA Fillapex was the most effective antibacterial combination by killing 83% bacteria in dentin tubules in 60 days. Thirty and 60 days of exposure to the sealers resulted in significantly more dead bacteria in dentin biofilms than 7-day exposures (P < .05). The placement of root canal sealer after NaOCl treatment enhanced antibacterial effects against E. faecalis in the dentinal tubules. Little additional effect was obtained after 30 days of exposure to sealers. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
Degerness, Randy A; Bowles, Walter R
To increase our understanding of the root canal system, we examined the mesiobuccal (MB) roots of maxillary first and second molars, which are considered to be one of the most complex root canal systems. Uninstrumented MB roots from 153 teeth were imbedded, sectioned, and observed at 8x using a stereomicroscope for main canal numbers, isthmus presence, and dimensional size of canals and dentin walls. The number of canals observed in maxillary first and second molars was 20% and 38.1% for one canal, 79.8% and 60.3% for two canals, and 1.1% and 1.6% for three canals, respectively. The buccal canal was larger than lingual or middle canals at all levels of the root. The average distance between the two main canals was 1.2 +/- 0.6 mm in first molars and 1.78 +/- 0.6 mm in second molars. Isthmus tissue increased greatly at 3.6 mm from the apex, suggesting optimal root resection at this level. Little differences in thickness between mesial and distal canal walls were seen until reaching the coronal sections of the root where the average canal wall thickness was found to be thinner (33%) on the distal, suggesting a "danger zone" for maxillary molars at a level where the root joins the crown of the tooth. The observations made here provide a more precise understanding of the maxillary MB root system. Orthograde and retrograde root canal therapy might be improved with a comprehensive understanding of pulpal morphology throughout the entire MB root. Copyright 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
Gonçalves, Silvana Beltrami; Brosco, Viviane Haiub; Bramante, Clovis Monteiro
Root canal preparation has been considered one of the most important steps in root canal therapy, thus many techniques and instruments have been developed. The aim of this study was to evaluate the cleaning of the root canal through three different instrumentation techniques. Thirty mandibular incisors were selected and submitted to lingual access cavities. Afterwards, the canals were filled with India ink dye previously stored in carpules, which was inserted into the root canal by means of anesthetic syringe and anesthetic needles. After 48 hours, during which the dye was allowed to dry inside the root canal, the teeth were divided in three groups: G1- GT rotatory instrumentation; G2- manual instrumentation; G3- association of both. After instrumentation, the teeth were longitudinally sectioned. The cleaning process accomplished through the different instrumentation techniques was evidenced by dye removal at the cervical, middle and apical thirds of the root canal. The results of this study showed that were not statistically significant differences between these three instrumentation techniques for all three thirds of the root canal.
Khalid, K; Yousif, S; Satti, A
Forensic Odontology is a vital component of forensic science and one branch involves the application of dental science to the identification of unknown human remains. The aim of this study is to investigate the discriminatory potential for identification of the radiographic morphology of obturated single root canals. Thirty periapical radiographs of patients having endodontic treatment of single rooted canals were selected randomly from the data bank of the digital X- ray system present in the restorative department, University of Science and Technology, Sudan. The post-operative radiographs were considered as an ant-mortem data "Set 1". Ten radiographs from the thirty were reprinted, labelled from (A-J) and considered as a post-mortem data "Set 2". This post-mortem group of 10 radiographs "Set 2" would be compared with the ante-mortem group of 30 radiographs comprising "Set 1". These two sets of radiographs would be examined by 40 dentally trained personnel. The thirty radiographs comprising "Set 1" and the 10 radiographs comprising "Set 2" were provided to each of the examiners who were asked to match the individual post-mortem radiographs ("Set 2") with the ante-mortem radiographs ("Set1"). The result demonstrated that 34 examiners achieved a success rate of 100%, 4 examiners achieved a success rate of 97.5% (1 mismatch) and 2 examiners achieved a success rate of 95% (2 mismatches). The radiographic images of obturated single-rooted teeth in this study were shown to have highly- specific morphological features. It is proposed that, in cases where the ante and post-mortem radiographs of a single-rooted obturated canal show similar morphology, this commonality of morphology can be used as a tool in the identification process.
Bhaskar, Dara John; Agali, Chandan R; Punia, Himanshu; Gupta, Vipul; Singh, Vikas; Kadtane, Safalya; Chandra, Sneha
Context: The success of endodontic treatment therapy depends on how well we eliminate pathogenic microflora from the root canal system as micro organism as the major cause of root canal infection. Conventional root canal treatment can fail if microorganisms cannot be removed sufficiently by thorough cleaning, shaping of root canal. Newer modalities such as photodynamic therapy are being tried now a days for disinfection of root canals. Aim & Objectives: The basic aim of this study was assessment of the antimicrobial efficacy of Photodynamic Therapy in deeper dentinal tubules for effective disinfection of root canals using microbiological and scanning electron microscopic examination in vitro. Materials and Methods: The study was conducted at Teerthanker Mahaveer Dental College & Research Centre. The teeth required for study was collected from Department of Oral and Maxillofacial Surgery. Only freshly extracted 20 intact, non carious single rooted teeth which were indicated for orthodontic treatment were taken for this study. Statistical analysis was done using Student’s Unpaired t-test were at (p<0.001) was found to be highly significant. Microbiological examination of samples were done and colony forming units were counted to assess the disinfection potential of photodynamic therapy. Scanning electron microscopic examination of samples was done to check penetration of bacteria’s into deeper dentinal tubules. Results: On examination, there was a marked reduction in microbial growth after use of photodynamic therapy. On scanning electron microscopic examination, it was observed that there were less number of bacteria’s in deeper dentinal tubules in case of PDT group as compared to control group. Conclusion: The results of the present study indicate that PDT can be effectively used during antimicrobial procedures along with conventional disinfection procedure for sterilization of root canals. PMID:25584321
Venturi, M; Prati, C; Capelli, G; Falconi, M; Breschi, L
This study used a modified tooth-clearing technique to allow observation of accessory canals following filling with a warm gutta-percha technique and one of two endodontic cements. Ten extracted human maxillary molars with three roots were selected and divided into two equal groups of five teeth. Each group had 15 canals. Root canal preparation was performed with a modified double flared technique; irrigation with 5% NaOCl and lubrication with RC-Prep were used. The canals were then filled with gutta-percha and cement utilizing a warm vertical condensation technique in the apical third followed by thermo-mechanical compaction in the middle and coronal thirds. Pulp Canal Sealer or AH-Plus were used in the experimental groups. The teeth were demineralized with a modified buffered acid solution, cleared in methylsalicylate and examined under a stereomicroscope. Accessory canals were evaluated in the apical, middle and coronal thirds of each root canal and categorized as narrow or wide, following observation on four surfaces. The depth of penetration of gutta-percha and cement into lateral canals was scored using a 5-point system. Complete transparency of the roots was achieved. Accessory canals were detected in all specimens. In coronal ramifications, gutta-percha filled the empty spaces (coronal thirds, grades 3 and 4: 70.9% in AH-Plus group and 68.8% in Pulp Canal Sealer group). In the apical accessory canals, gutta-percha entered less frequently (apical thirds, grades 3 and 4: 17.9% in the AH-Plus group and 3.2% in the Pulp Canal Sealer group); cement without gutta-percha (grades 1 and 2) was present in 55.5% in the AH-Plus group and 38.7% of the Pulp Canal Sealer group. Analysis showed that AH-Plus cement resulted in significantly greater filling of the apical accessory canals compared to Pulp Canal Sealer. The modified tooth-clearing technique allowed observation of fine morphological details in all specimens. Effective gutta-percha filling was evident in most of
Martos, Josué; Tatsch, Gustavo Henrique; Tatsch, Augusto César; Silveira, Luiz Fernando Machado; Ferrer-Luque, Carmen María
The purpose was to determine the diameter of the main root canal and wall thickness in the apical dentin in mesial roots of maxillary and mandibular molars. Forty mesiobuccal and mesial root specimens were sectioned horizontally at 1, 2 and 3 mm from the apex, and measured at each top surface by using optical microscopy to an accuracy of ×20 magnification. The anatomical parameters were established as the following points of reference: AB, two points connected by a line from the outer edge of the mesial wall to the outer edge of the distal one through the center of the root canal to measure the thickness of the root and mesiodistal diameter of the root canal (CD). A second line (EF) was designed to evaluate the diameter of the root canal in the buccolingual direction. All data were summarized, and values were assessed statistically by ANOVA and Bonferroni multiple comparisons. The buccolingual (BL) root canal diameters at 1, 2 and 3 mm in the mandibular and maxillary molars were greater than in the mesiodistal (MD), showing statistically significant differences (p < 0.05). The MD root thicknesses at 1, 2 and 3 mm in mandibular and maxillary molars were statistically significant (p < 0.05). The lowest value to 1 mm from the apex in the mandibular molars was 1.219 mm and the highest at 3 mm from the root apex in maxillary molars was 1.741 mm. The BL diameters in maxillary and mandibular molars were higher than the MD diameter. The thickness (MD) of maxillary and mandibular molars decreased as a function of apical proximity.
Guo, Jiang-li; Zhang, Yan; Zhen, Lei
To develope the influence of different ultrasonic irrigations after root canal preparation with nickel titanium ProTaper on micro-hardness of root canal dentin. Sixty of maxillary anterior teeth with single-canal were collected and randomly divided into 6 groups. Group A was control group, group B was prepared to F3 with nickel titanium ProTaper by machine, group C was ultrasonic irrigated with 3% hydrogen peroxide solution for 1 minute after preparation, group D was ultrasonic irrigated with koutai mouthwash for 1 minute after preparation, group E was ultrasonic irrigated with 17% EDTA solution for 1 minute after preparation, group F was ultrasonic irrigated with distilled water for 1 minute after preparation. The roots were then sectioned horizontally into 3 parts, split longitudinally into halves and examined under a micro Vickers hardness test machine. The data was analyzed by one-way ANOVA and t test with SPSS 17.0 software package. The micro-hardness of group A was (52.66 ± 1.64) HV,(52.08 ± 1.53) HV and (51.47 ± 2.53) HV. There was no significant difference in all parts of the root canal in group A (P>0.05). The micro-hardness of the apical third of root canal was lower than that of the cervical and middle of root canal in the other groups (P<0.05). In the cervical and middle third of the root canals, the micro-hardness of group E was (44.65 ± 1.33) HV and(42.55 ± 1.12) HV, and there were statistical significances between group E and the other groups (P<0.05). In the apical third of root canal,the micro-hardness of group E was (37.82 ± 1.60) HV, and group C was (44.14±1.73) HV, both of the comparative differences with other groups were statistically significant (P<0.05). There was no significant difference among group B, group D and group F (P>0.05). Root canal preparation to F3 with nickel titanium ProTaper by machine can make the micro-hardness of the apical third of root canal decrease. Ultrasonic irrigation with 17% EDTA solution for 1 minute can
Yadav, Hemant Kumar; Saini, Gaurav Kumar; Chhabra, Harpreet Singh; Panwar, Pratyaksha Singh
The main objective of this case report is to present a rare root canal configuration of maxillary molar with seven root canals; three mesiobuccal, two palatal and two distobuccal canals diagnosed during treatment procedure confirmed by spiral computed tomography. A thorough knowledge of root canal morphology, proper clinical and radiographic examination, and use of dental operating microscopes are necessary for successful clinical outcomes. This article highlights the variations in the morphology of maxillary first molar and use of the latest techniques in successful diagnosis and negotiation of the additional canals. PMID:28293666
Eskandarinezhad, Mahsa; Ghasemi, Negin
Successful endodontic treatment requires thorough knowledge regarding each root canal system of any tooth and probability of extra canals should be considered. Second maxillary molar with two palatal root canals is not frequent and its incidence reported in literatures is about 0.4-2%. The present case report describes non-surgical retreatment of maxillary second mo-lar with two palatal root canals. Radiographic interpretation is difficult in this region; so, very careful examination of pulpal space and using supportive devices such as loupe and operating microscope is recommended to discover any unusual anat-omic features like extra canals.
Castelo-Baz, Pablo; Varela-Patiño, Purificación; Cantatore, Giuseppe; Domínguez-Perez, Ana; Ruíz-Piñón, Manuel; Martín-Biedma, Benjamín
Background The efficacy of endodontic irrigation procedures can be compromised by the complexity of the root canal system. Delivering irrigants to the apical third of curved canals presents a particular challenge to endodontists. This study compared the effects of two ultrasonic irrigation techniques on the penetration of sodium hypochlorite into the main canal and simulated lateral canals of curved roots in extracted teeth. Material and Methods Two sets of simulated lateral canals were created at 2, 4, and 6 mm from the working length in 60 single-rooted teeth (6 canals/tooth, n = 360 canals). The teeth were randomly divided into three experimental irrigation groups: group 1 (n = 20), positive pressure irrigation (PPI); group 2 (n = 20), passive ultrasonic irrigation (PUI); and group 3 (n = 20), continuous ultrasonic irrigation (CUI). To assess the irrigation solution penetration, 20% Chinese ink (Sanford Rotring GmbH, Hamburg, Germany) was added to a 5% sodium hypochlorite solution and delivered into the curved root canals. The penetration of contrast solution into the simulated lateral canals was scored by counting the number of lateral canals (0-2) penetrated to at least 50% of the total length. Results The CUI group showed significantly higher (P < 0.05) irrigant penetration into the lateral canals and into the apical third of the main canals. The PPI group showed significantly lower sodium hypochlorite penetration (P < 0.001) into the main and lateral canals compared with that in the CUI and PUI groups. Significantly higher irrigant penetration was observed in the PUI group than the PPI group. Conclusions Using CUI as the final rinse significantly increased the penetration of irrigant solution into the simulated lateral canals and apical third of curved roots. Key words:Continuous ultrasonic irrigation, curved root canals, passive ultrasonic irrigation, positive pressure irrigation, root canal irrigation. PMID:27703613
Ito, Izabel Yoko; Junior, Fumio Matoba; Paula-Silva, Francisco Wanderley Garcia; Da Silva, Léa Assed Bezerra; Leonardo, Mário Roberto; Nelson-Filho, Paulo
To investigate the root canal microbiota of primary teeth with apical periodontitis and the in vivo antimicrobial effects of a calcium hydroxide/chlorhexidine paste used as root canal dressing. Baseline samples were collected from 30 root canals of primary teeth with apical periodontitis. Then, the root canals were filled with a calcium hydroxide paste containing 1% chlorhexidine for 14 days and the second bacteriologic samples were taken prior to root canal filling. Samples were submitted to microbiologic culture procedure to detect root canal bacteria and processed for checkerboard DNA-DNA hybridization. Baseline microbial culture revealed high prevalence and cfu number of anaerobic, black-pigmented bacteroides, Streptococcus, and aerobic microorganisms. Following root canal dressing, the overall number of cfu was dramatically diminished compared to initial contamination (P <0.05), although prevalence did not change (P > 0.05). Of 35 probes used for checkerboard DNA-DNA hybridization, 31 (88.57%) were present at baseline, and following root canal dressing, the number of positive probes reduced to 13 (37.14%). Similarly, the number of bacterial cells diminished folowing application of calcium hydroxide/chlorhexidine root canal dressing (P = 0.006). Apical periodontitis is caused by a polymicrobial infection, and a calcium hydroxide/chlorhexidine paste is effective in reducing the number of bacteria inside root canals when applied as a root canal dressing. 2011 The Authors. International Journal of Paediatric Dentistry © 2011 BSPD, IAPD and Blackwell Publishing Ltd.
Ebihara, Arata; Anjo, Tomoo; Takeda, Atsushi; Suda, Hideaki
The aim of this study was to determine the appropriateness of Nd:YAG laser irradiation for root canal preparation. Tooth crowns were removed from single-rooted human teeth and a quartz optical fiber (diameter 400 μm) was inserted into the root canal orifice towards the apical foramen. The length of the fiber within the root canal was measured, and the irradiating length determined. Root canals were then filled with 3% TiO2 emulsion solution (a photosensitizer) and irradiated using a pulsed Nd:YAG laser at 600 mJ/pulse (pulse frequency; 5 or 10 pps). During laser irradiation, the fiber was moved coronally from the apical region towards the canal orifice at a rate of 1 mm/s. Contact microradiographs (CMR) were taken before and after laser irradiation. Each root was then halved longitudinally, and the root canal surface observed by scanning electron microscopy (SEM). The CMR images of the tooth revealed that the root canal was slightly enlarged as a result of treatment. Carbonization of the root canal dentin was not seen, but a smear layer and melted dentin were observed by SEM. Nd:YAG laser irradiation using TiO2 emulsion solution appears to be a useful tool for root canal preparation.
Alrahabi, Mothanna K; Ali, Mahmoud M
Endodontic management of immature anterior teeth with necrotic pulps is a great challenge. Although there are different treatment procedures to deal with this problem such as apexification by using calcium hydroxide dressings or applying a barrier of mineral trioxide aggregate and gutta-percha obturation, the outcomes are still unsatisfactory and the root might still be weak. Recently, a new treatment protocol by revascularization of immature non-vital, infected teeth was introduced to regenerate dental structure and complete the root maturation. However, larger case series with longer follow-up periods are required to accept revascularization as the standard protocol for management of immature non-vital, infected teeth. In this review, we discuss the concept of root canal revascularization, revascularization mechanisms, and the structure of the regenerated tissues.
Filpo-Perez, Carolina; Bramante, Clovis Monteiro; Villas-Boas, Marcelo Haas; Húngaro Duarte, Marco Antonio; Versiani, Marco Aurélio; Ordinola-Zapata, Ronald
The aim of this study was to evaluate the morphologic aspects of the root canal anatomy of the distal root of a mandibular first molar using micro-computed tomographic analysis. One-hundred distal roots of mandibular first molars were scanned using a micro-computed tomographic device at an isotropic resolution of 19.6 μm. The percentage frequency distribution of the morphologic configuration of the root canal was performed according to the Vertucci classification system. Two-dimensional parameters (area, perimeter, roundness, aspect ratio, and major and minor diameters) and the cross-sectional shape of the root canal were analyzed in the apical third at every 1-mm interval from the main apical foramen in roots presenting Vertucci types I and II configurations (n = 79). Data were statistically compared using the Kruskal-Wallis and Dunn tests with a significance level set at 5%. Seventy-six percent of the distal roots had a single root canal. Two, three, and four canals were found in 13%, 8%, and 3% of the sample, respectively. In 13 specimens, the configuration of the root canal did not fit into Vertucci's classification. Overall, 2-dimensional parameter values significantly increased at the 3-mm level (P < .05). The prevalence of oval canals was higher at the 1-mm level and decreased at the 5-mm level in which long oval and flattened canals were more prevalent. The distal roots of the mandibular first molars showed a high prevalence of single root canals. The prevalence of long oval and flattened canals increased in the coronal direction. In 13% of the samples, canal configurations that were not included in Vertucci's configuration system were found. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
Gaddala, Naresh; Veeramachineni, Chandrasekhar; Tummala, Muralidhar
Smear layer which was formed during the instrumentation of root canals hinders the penetration of root canal sealers to root dentin and affect the bond strength of root canal sealers to root dentin. Final irrigant such as demineralizing agents are used to remove the inorganic portion of the smear layer. In the present study, peracetic acid used as a final rinse, to effect the bond strength of root canal sealers to root dentin. The purpose of the present study was to evaluate the efficacy of peracetic acid as a final irrigant on bond strength of root canal sealers to root dentin. Sixty six freshly extracted human single rooted mandibular premolars were used for this study. After decoronation the samples were instrumented with Protaper upto F3 and irrigated with 5.25% NaOcl. The teeth were then divided into three groups based on final irrigant used: Group-1(control group) Canals were irrigated with distilled water. Group-2: Canals were irrigated with peracetic acid. Group-3: Canals were irrigated with smear clear. Each group was further divided into three subgroups (n=30) based on the sealer used to obturate the canals. Subgroup-1: kerr, Subgroup-2: Apexit plus, Subgroup-3: AH PLUS. Each sealer was mixed and coated to master cone and placed in the canal. The bonding between sealer and dentin surface was evaluated using push out bond strength by universal testing machine. The mean bond strength values of each group were statistically evaluated using Two-way ANOVA followed by Tukey post-hoc test. Significant difference was found among the bond strength of the sealers. But, there is no statistically significant difference between the groups irrigated with peracetic acid and smear clear compared to control group. AH Plus showed highest bond strength irrespective of the final irrigant used. Peracetic acid when employed as final irrigant improved the bond strength of root canal sealers compared to control group but not statistically significant than smear clear.
Antibiotics are a valuable addition to health practitioners for the management of bacterial infections. During endodontic treatment and when managing trauma to the teeth, antibiotics may be applied systemically or locally. Due to the potential risk of adverse effects of systemic applications, and the ineffectiveness of systemic prescribed antibiotics in necrotic or pulpless teeth and the periradicular tissues, the local application of antibiotics may be a more effective mode for delivering antibiotics to infected root canals. The purpose of this article is to review the history, rationale, and applications of antibiotics and antibiotic-containing irrigants in endodontics. PMID:24171012
Somma, F; Leoni, D; Plotino, G; Grande, N M; Plasschaert, A
To investigate ex vivo, the root canal morphology of the MB root of maxillary first molar teeth by means of micro-computed tomography. Thirty extracted intact human maxillary first molar teeth were selected for micro-tomographic analysis (SkyScan 1072, Aartselaar, Belgium) with a slice thickness of 38.0 mum. The following data regarding the MB root were analysed and recorded: number and type of root canals, prevalence of isthmuses, prevalence of intercanal connections, presence of accessory canals, presence of loops and number of apical foramina. The MB2 canal was present in 80% of specimens and was independent in 42% of these cases. When present, the MB2 canal merged with the MB1 canal in 58% of cases. Communications between the two canals were found in all specimens, with isthmuses in 71% of the cases. These communications and isthmuses were respectively in 42% and 54% of the cases in the coronal third, in 59% and 79% of the cases in the middle third and in 24% and 50% of the cases in the apical third. A single apical foramen was found in 37% of specimens, two apical foramina were present in 23% of the cases, with three or more separate apical foramina occurring in 40% of the specimens. The MB root canal anatomy was complex: a high incidence of MB2 root canals, isthmuses, accessory canals, apical delta and loops was found.
Aswinkumar, Vijayakumar; Nandini, Suresh; Velmurgan, Natanasabapathy
Endodontic management of teeth with aberrant root canal morphology can be challenging. This article presents a case in which multiple angulated radiographs and a dental operating microscope clearly revealed the presence of 3 root canals in a right mandibular central incisor with 2 different canal patterns. This case report emphasizes the importance of utilizing a dental operating microscope to understand unusual root canal morphology.
Faria-E-Silva, André Luís; Pedrosa, Celso de Freitas; Menezes, Murilo de Sousa; da Silveira, Daniele Machado; Martins, Luís Roberto Marcondes
One of the clinically relevant problems dentists face when restoring endodontically treated teeth is the mismatch between fiber post and post space diameters, which results in an excessively thick resin cement layer. Fiber post relining appears as a solution for this problem. Objectives: The aim of this study was to evaluate the effect of fiber post relining with composite resin on push-out bond strength. Material and Methods: Twenty bovine incisors were selected to assess post retention. The crowns were removed below the cementoenamel junction and the root canals were treated endodontically and flared with diamond burs. The roots were allocated into two groups (n=10): G1: fiber posts without relining and G2: fiber posts relined with composite resin. The posts were cemented with a dual-cured resin cement and the specimens were sectioned transversally. Three 1.5-mm thick slabs were obtained per root and identified as cervical, medium and apical thirds. The push-out test was performed at a crosshead speed of 0.5 mm/min until post dislodgement occurred. The failure mode of fractured specimens was analyzed under scanning electron microscopy. Data were analyzed by split-plot ANOVA and post-hoc Tukey's test at a pre-set alpha of 0.05. Results: Relined fiber posts presented higher retention values than non-relined post in all thirds. No statistically significant differences (p>0.05) were found among thirds for relined posts. All failures occurred at the interface between resin cement and root dentin. Conclusions: Relining with composite resin seems to be an effective method to improve the retention of fiber posts to flared root canals. PMID:20027434
Faria-e-Silva, André Luís; Pedrosa-Filho, Celso de Freitas; Menezes, Murilo de Sousa; Silveira, Daniele Machado da; Martins, Luís Roberto Marcondes
One of the clinically relevant problems dentists face when restoring endodontically treated teeth is the mismatch between fiber post and post space diameters, which results in an excessively thick resin cement layer. Fiber post relining appears as a solution for this problem. The aim of this study was to evaluate the effect of fiber post relining with composite resin on push-out bond strength. Twenty bovine incisors were selected to assess post retention. The crowns were removed below the cementoenamel junction and the root canals were treated endodontically and flared with diamond burs. The roots were allocated into two groups (n=10): G1: fiber posts without relining and G2: fiber posts relined with composite resin. The posts were cemented with a dual-cured resin cement and the specimens were sectioned transversally. Three 1.5-mm thick slabs were obtained per root and identified as cervical, medium and apical thirds. The push-out test was performed at a crosshead speed of 0.5 mm/min until post dislodgement occurred. The failure mode of fractured specimens was analyzed under scanning electron microscopy. Data were analyzed by split-plot ANOVA and post-hoc Tukey's test at a pre-set alpha of 0.05. Relined fiber posts presented higher retention values than non-relined post in all thirds. No statistically significant differences (p>0.05) were found among thirds for relined posts. All failures occurred at the interface between resin cement and root dentin. Relining with composite resin seems to be an effective method to improve the retention of fiber posts to flared root canals.
Purton, D G; Payne, J A
This in vitro study compared physical properties of root canal posts made of carbon fiber-reinforced epoxy resin with those of stainless steel posts. Three-point bending tests were used to derive the transverse modulus of elasticity of the posts. Resin composite cores on the posts were subjected to tensile forces to test the bonds between the cores and posts. Carbon fiber posts appeared to have adequate rigidity for their designed purpose. The bond strength of the resin composite cores to the carbon fiber posts was significantly less than that to the stainless steel posts.
Ferguson, David B; Kjar, Kirby S; Hartwell, Gary R
This article describes the identification and treatment of a maxillary first molar exhibiting three canals in the mesiobuccal root. An 18-yr-old male patient presented for nonsurgical root canal therapy of tooth #3. After accessing the pulp chamber, and probing with 2.5x magnification, only one canal was located in the mesiobuccal root initially. Subsequent to troughing the groove between the mesiobuccal and palatal canals with a #2 round bur, two additional canals were located. An electronic apex locator was utilized to ensure a perforation of the pulpal floor had not occurred. A working film confirmed the presence of three canals in the mesiobuccal root, and the canals were cleaned, shaped, and obturated.
Somasundaram, Pavithra; Wadhwani, Shefali; Uthappa, Roshan; Shivagange, Vinay; Khan, Sheeba
Introduction Abnormal root canal morphologies of third molars can be diagnostically and technically challenging during root canal treatment. Aim The aim of this retrospective study was to investigate the root and canal morphology of mandibular third molars in Central India population by using Cone Beam Computed Tomography (CBCT) analysis. Materials and Methods CBCT images of 171 mandibular third molars were observed and data regarding number of roots, number of canals, Vertucci’s classification in each root, prevalence of C shaped canal, gender and topographical relation of morphology in mandibular third molar was statistically evaluated. Results Majority of mandibular third molars had two roots (84.2%) and three canals (64.3%). Most mesial root had Vertucci Type II (55.6%) and Vertucci Type IV (22.2%), distal root had Type I canals (87.5%). Over all prevalence of C shaped canals in mandibular third molars was 9.4%. Conclusion There was a high prevalence of two rooted mandibular third molars with three canals. PMID:28764294
Gergova, Raina; Georgieva, Tzvetelina; Angelov, Ivan; Mantareva, Vanya; Valkanov, Serjoga; Mitov, Ivan; Dimitrov, Slavcho
The study presents the PDT with metal phthalocyanines on biofilms grown in root canals of ten representatives of the Gram-positive and the Gram-negative bacterial species and a fungus Candida albicans which cause aqute teeth infections in root canals.. The extracted human single-root teeth infected for 48 h with microorganisms in conditions to form biofilms of the above pathogens were PDT treated. The stage of biofilm formation and PDT effect of the samples of the teeth were determined by the scaning electron microscopy and with standard microbial tests. The PDT treating procedure included 10 min incubation with the respected phthalocyanine and irradiated with 660 nm Diode laser for 10 min. The most strongly antibacterial activity was achieved with zinc(II) phthalocyanine (ZnPc) against Enterococcus faecalis, Staphylococcus aureus and Moraxella catarrhalis. The other Gram-negative bacteria and Candida albicans were 10-100 times more resistant than the Gram-positive species. The Gram-negative Moraxella catarrhalis and Acinetobacter baumannii were more sensitive than the enterobacteria, but eradication of Pseudomonas aeruginosa in biofilm was insignificant. The influence of the stage of biofilm formation and the initial conditions (bacterial density, photosensitizer concentration and energy fluence of radiation) to the obtained level of inactivation of biofilms was investigated. The PDT with ZnPc photosensitizers show a powerful antimicrobial activity against the most frequent pathogens in endodontic infections and this method for inactivation of pathogens may be used with sucsses for treatment of the bacterial biofilms in the root canals.
Chávez de Paz, Luis E
The development of multispecies biofilm models are needed to explain the interactions that take place in root canal biofilms during apical periodontitis. The aim of this study was to investigate the ability of 4 root canal bacteria to establish a multispecies biofilm community and to characterize the main structural, compositional, and physiological features of this community. Four clinical isolates isolated from infected root canals, Actinomyces naeslundii, Lactobacillus salivarius, Streptococcus gordonii, and Enterococcus faecalis, were grown together in a miniflow cell system. Simultaneous detection of the 4 species in the biofilm communities was achieved by fluorescence in situ hybridization in combination with confocal microscopy at different time points. The LIVE/DEAD BacLight technique (Molecular Probes, Carlsbad, CA) was used to assess cell viability and to calculate 3-dimensional architectural parameters such as biovolume (μm(3)). Redox fluorescence dye 5-cyano-2,3-ditolyl tetrazolium chloride was used to assess the metabolic activity of biofilm bacteria. The 4 species tested were able to form stable and reproducible biofilm communities. The biofilms formed in rich medium generally showed continuous growth over time, however, in the absence of glucose biofilms showed significantly smaller biovolumes. A high proportion of viable cells (>90%) were generally observed, and biofilm growth was correlated with high metabolic activity of cells. The community structure of biofilms formed in rich medium did not change considerably over the 120-hour period, during which E. faecalis, L. salivarius, and S. gordonii were most abundant. The ability of 4 root canal bacteria to form multispecies biofilm communities shown in this study give insights into assessing the community lifestyle of these microorganisms in vivo. This multispecies model could be useful for further research simulating stresses representative of in vivo conditions. Copyright Â© 2012 American
Parirokh, Masoud; V. Abbott, Paul; Yosefi, Mohammad Hosein; Hosseini, Hamid Reza
Most mandibular second molars have one and two canals in distal and mesial roots, respectively. This report represents four cases of mandibular second molars with a single mesial and two distal root canals with two different canal configurations. After access cavity preparation, two teeth had one distal and two mesial orifices, whereas in the two other teeth one mesial and two distal orifices were found. In the teeth with two mesial canal orifices, the distal root canal and one of root canals with a mesial orifice joined together in the apical part of the root, whereas in the two other teeth with one mesial and two distal canal orifices, three separate canals each with a different apical foramen were detected. Dental practitioners should be aware that despite higher prevalence of one distal and two mesial root canals, the mandibular second molars may also have one mesial and two distal root canals. PMID:25031600
Parirokh, Masoud; V. Abbott, Paul
Introduction: Achieving successful anesthesia and performing pain-free root canal treatment are important aims in dentistry. This is not always achievable and therefore, practitioners are constantly seeking newer techniques, equipments, and anesthetic solutions for this very purpose. The aim of this review is to introduce strategies to achieve profound anesthesia particularly in difficult cases. Materials and Methods: A review of the literature was performed by electronic and hand searching methods for anesthetic agents, techniques, and equipment. The highest level of evidence based investigations with rigorous methods and materials were selected for discussion. Results: Numerous studies investigated to pain management during root canal treatment; however, there is still no single technique that will predictably provide profound pulp anesthesia. One of the most challenging issues in endodontic practice is achieving a profound anesthesia for teeth with irreversible pulpitis especially in mandibular posterior region. Conclusion: According to most investigations, achieving a successful anesthesia is not always possible with a single technique and practitioners should be aware of all possible alternatives for profound anesthesia. PMID:24396370
The aim of this scientific work is to illustrate the technique of shaping the root canal system using the multistep technique. Over time, various endodontic instrumentation techniques have been put forward, from the "step-back" technique (apical-coronal) to the "crown-down" technique (coronal-apical), the "double-flared" technique, and the most recent "single-length" technique. The multistep technique involves six steps, one of the main objectives of these being the safety of the use of mechanical instruments with a reduction in the risk that they fracture. This technique ("mixed") provides for the use of both manual instruments in stainless steel and mechanical instruments in nickel titanium (Ni-Ti). The multistep technique is based on a standardized, flexible, and clinical protocol, which can provide for a reduction in the number of endodontic passages and instruments used and, therefore, a simplification of the operating procedure depending on both the difficulty of the root canals and the competence of the operator. This technique is a technique for shaping the endodontic space that allows the set objectives of endodontic therapy to be reached in a predictable way with a reduced risk of iatrogenic complications.
Guedes, Orlando Aguirre; da Costa, Marcus Vinícius Corrêa; Dorilêo, Maura Cristiane Gonçales Orçati; de Oliveira, Helder Fernandes; Pedro, Fábio Luis Miranda; Bandeca, Matheus Coelho; Borges, Álvaro Henrique
Background: This study investigated procedural errors made during root canal preparation with nickel-titanium (NiTi) instruments, using cone beam computed tomography (CBCT) imaging method. Materials and Methods: A total of 100 human mandibular molars were divided into five groups (n = 20) according to the NiTi system used for root canal preparation: Group 1 - BioRaCe, Group 2 - K3, Group 3 - ProTaper, Group 4 - Mtwo and Group 5 - Hero Shaper. CBCT images were obtained to detect procedural errors made during root canal preparation. Two examiners evaluated the presence or absence of fractured instruments, perforations, and canal transportations. Chi-square test was used for statistical analyzes. The significance level was set at a=5%. Results: In a total of 300 prepared root canals, 43 (14.33%) procedural errors were detected. Perforation was the procedural errors most commonly observed (58.14%). Most of the procedural errors were observed in the mesiobuccal root canal (48.84%). In the analysis of procedural errors, there was a significant difference (P < 0.05) between the groups of NiTi instruments. The root canals instrumented with BioRaCe had significantly less procedural errors. Conclusions: CBCT permitted the detection of procedural errors during root canal preparation. The frequency of procedural errors was low when root canals preparation was accomplished with BioRaCe system. PMID:25878475
Xue, Ming; Zhan, Fu-liang; Yu, Jing-tao; Qiu, Li-hong
To evaluate the clinical effect of root canal filling with warm vertical condensation with or without dental operating microscope. Fifty maxillary anterior teeth with single, straight canals were divided into two groups. Each tooth was instrumented by X-Smart rotary nickel-titanium files to a master file 0.06 taper F3, root canal in the group 1 was obturated with warm vertical condensation using system B for downpack and Obtura II for backfilling without dental operating microscope; root canal in the group 2 was obturated using the same methods under the dental operating microscope. The effect of quality of root canal filling was evaluated by X-ray radiograph post-operatively and after two years of treatment. SPSS10.0 software package was used for Chi-square test. Significant difference was found between the two groups on the quality of root canal filling post-operatively (P < 0.05),with better quality of root canal filling in the group using dental operating microscope, no significant difference was found between the two groups after two years (P > 0.05). Warm vertical condensation under the dental operating microscope is a good method for root canal filling. It may improve the quality of root canal filling effectively, and therefore, worthy of clinical application.
Moraes, Ludmila Coutinho; Fatturi-Parolo, Clarissa Cavalcanti; Ferreira, Maria Beatriz Cardoso; Só, Marcus Vinicius Reis; Montagner, Francisco
This study aimed to determine the presence of Prevotella strains and genes associated with resistance to lactamics in different oral niches from patients with/without primary endodontic infections. Saliva (S) and supragingival biofilm (SB) were collected from three patient groups: Group I - no endodontic infection (n = 15); Group II - acute endodontic infection (n = 12); and Group III - chronic endodontic infection (n = 15). Root canal (RC) samples were collected from Groups II and III. The presence of P. intermedia, P nigrescens, P. tannerae and cfxA/cfxA2 gene was assessed by PCR. The cfxA/cfxA2 gene was not detected in all environments within the same patient. The cfxA/cfxA2 gene was present in 23.81% of S samples, 28.57% of SB samples, and 7.41% of RC samples. Prevotella species were detected in 53.97%, 47.62% and 34.56% of the S, SB, and RC samples, respectively. P. intermedia had a high frequency in saliva samples from Group 3. Saliva samples from Group 1 had higher detection rates of P. nigrescens than did Groups 2 and 3. Patients without endodontic disease had high frequencies of P. nigrescens in the SB samples. The presence or absence of spontaneous symptoms was not related to the detection rates for resistance genes in the RC samples. Saliva, supragingival biofilm and root canals can harbor resistant bacteria. The presence of symptomatology did not increase the presence of the cfxA/cfxA2 gene in the supragingival biofilm and inside root canals.
Xu, Qiong; Liu, Hong-yan; Ling, Jun-qi; Luo, Dan-feng
To evaluate the role of dental operating microscope in clinical treatment of lower incisors with multiple root canals. 143 mandibular incisors in 128 patients were treated endodontically. Two kinds of preoperative radiographs were taken for each tooth, using straight projection and eccentric projection. The root canal morphology was recorded according to Vertucci's classification. Under dental operating microscope, the teeth with multiple root canals were shaped using Ni-Ti rotary instruments Hero 642, cleaned using sodium hypochlorite, and obturated with vertical condensation technique. The following information was recorded: The number of teeth that were found to have multiple canals in two kinds of preoperative radiographs, and when using and without using microscope. The efficiency of preparation and obturation was analyzed with radiographs before, during and after operation. The mandibular central incisor with one canal was 73.53% and multiple canals was 26.47% in treated teeth. The mandibular lateral incisor with one canal was 70.67% and multiple canals was 29.33% in treated teeth. By eccentric projection radiograph and treatment using microscope, more teeth with multiple canals were found. No complication was found during root canal preparation. 134 teeth were well filled and 9 showed slight over-filling. With dental operating microscope, the mandibular incisors with multiple root canals could be treated well in combination with rotary instrumentation and vertical condensation technique.
Hasan, Muhammad; Umer, Fahad
The objective of root canal treatment is to perform complete debridement of the root canals and subsequent obturation to facilitate healing of periapical pathosis. However, this process becomes complicated with the presence of additional root canal systems. The purpose of the present article is to report successful non-surgical retreatment of a mandibular first molar with five canals. This case report discusses the clinical management of a previously root filled mandibular firstmolar with two missed canal systems; distolingual and an additional mesial canal known as the middle mesial canal. The post-treatment radiographs show successful obturation to length in all canals. The middle mesial canal was found to be associated with mesiolingual canal and categorised as confluent. The configuration of canals in the mesial root was type XV, based on the classification given by Sert and Bayirli. This case report highlights the importance of knowledge and its application in the management of abnormal anatomic variants which play a crucial role in the success of endodontic retreatment. PMID:24654237
Hasan, Muhammad; Umer, Fahad
The objective of root canal treatment is to perform complete debridement of the root canals and subsequent obturation to facilitate healing of periapical pathosis. However, this process becomes complicated with the presence of additional root canal systems. The purpose of the present article is to report successful non-surgical retreatment of a mandibular first molar with five canals. This case report discusses the clinical management of a previously root filled mandibular firstmolar with two missed canal systems; distolingual and an additional mesial canal known as the middle mesial canal. The post-treatment radiographs show successful obturation to length in all canals. The middle mesial canal was found to be associated with mesiolingual canal and categorised as confluent. The configuration of canals in the mesial root was type XV, based on the classification given by Sert and Bayirli. This case report highlights the importance of knowledge and its application in the management of abnormal anatomic variants which play a crucial role in the success of endodontic retreatment.
Miranda, Tatiana Teixeira; Vianna, Cristina R; Rodrigues, Leonardo; Rosa, Carlos Augusto; Corrêa, Ary
Proteinases play pivotal roles in Candida albicans infections. Although the yeast can colonize the pulpal environment, there is no information about the enzymatic profile of this organism. This in vitro study aimed to determine the proteolysis levels and to investigate differences in the expression of aspartyl proteinase genes (Sap 1, Sap 2, and Sap 4) among various root canal strains and clinical isolates from the lingual dorsum. The extracellular proteinase activity of 104 C. albicans samples isolated from the lingual dorsum and from necrotic root canals was measured with respect to bovine serum albumin degradation after 5 days of incubation at 37°C. We used reverse-transcription polymerase chain reaction, a highly sensitive method, to detect messenger RNA transcripts of aspartyl proteinase genes (Sap 1, Sap 2, and Sap 4). The C. albicans strain SC 5314 was used as a positive control for both experiments because it is recognized as being highly proteolytic. All tests were performed in triplicate. Regardless of the isolation site, all C. albicans strains produced an opaque precipitation halo around the colonies, indicating some proteinase activity. However, the production of proteinase on the plates was significantly greater (P < .05) by the endodontic samples. Sap 2 was the most commonly expressed gene in all samples. Among the root canal samples, the detection of Sap 1 transcripts was always associated with the expression of Sap 2 and Sap 4. Sap 4 gene expression was detected in all root canal samples. The simultaneous expression of the 3 investigated Sap genes (Sap 1, Sap 2, and Sap 4) was more common in strains isolated from the lingual dorsum (50%) than in those isolated from root canals (29.4%). The increased proteolytic activity as well as the distinct pattern of Sap expression observed among the root canal samples may suggest a pathogenic role for C. albicans in endodontic infections. Copyright © 2015 American Association of Endodontists. Published by
Background Root canal treatment is a debridement process which disrupts and removes entire microorganisms from the root canal system. Identification of microorganisms may help clinicians decide on treatment alternatives such as using different irrigants, intracanal medicaments and antibiotics. However, the difficulty in cultivation and the complexity in isolation of predominant anaerobic microorganisms make clinicians resort to empirical medical treatments. For this reason, identification of microorganisms is not a routinely used procedure in root canal treatment. In this study, we aimed at classifying 7 different standard microorganism strains which are frequently seen in root canal infections, using odor data collected using an electronic nose instrument. Method Our microorganism odor data set consisted of 5 repeated samples from 7 different classes at 4 concentration levels. For each concentration, 35 samples were classified using 3 different discriminant analysis methods. In order to determine an optimal setting for using electronic-nose in such an application, we have tried 3 different approaches in evaluating sensor responses. Moreover, we have used 3 different sensor baseline values in normalizing sensor responses. Since the number of sensors is relatively large compared to sample size, we have also investigated the influence of two different dimension reduction methods on classification performance. Results We have found that quadratic type dicriminant analysis outperforms other varieties of this method. We have also observed that classification performance decreases as the concentration decreases. Among different baseline values used for pre-processing the sensor responses, the model where the minimum values of sensor readings in the sample were accepted as the baseline yields better classification performance. Corresponding to this optimal choice of baseline value, we have noted that among different sensor response model and feature reduction method
Raghavendra, Srinidhi Surya; Hindlekar, Ajit Narayan; Desai, Niranjan Nanasaheb; Vyavahare, Nishant Kishor; Napte, Bandu Devrao
The main objective of root canal treatment is thorough cleaning and shaping of the entire pulp space and its complete filling with an inert filling material. A major cause of post-treatment disease is the inability to locate, debride or adequately fill all canals of the root canal system. The form, configuration, and number of root canals in the maxillary first molars have been discussed for more than half a century. Maxillary first molars commonly present with three roots and three canals, with a second mesiobuccal canal (MB2) also present. With the advent of improved magnification there are reports of multiple root canals in the maxillary first molars. Nonsurgical endodontic therapy of a left maxillary first molar with three roots and seven root canals was successfully performed under a dental operating microscope. The diagnosis of multiple root canals was confirmed with the help of Cone Beam Computed Tomography (CBCT) images.
Grischke, J; Müller-Heine, A; Hülsmann, M
The aim of this study was to compare the efficiency of sonic, ultrasonic, and hydrodynamic devices in the removal of a root canal sealer from the surface and from simulated irregularities of root canals. Fifty-three root canals with two standardized grooves in the apical and coronal parts of longitudinally split roots were covered with AH Plus root canal sealer. Compared were the effects of (control) syringe irrigation, (1) CanalBrush, (2) passive ultrasonic irrigation, (3) EndoActivator, and (4) RinsEndo on the removal of the sealer. The specimens were divided into four groups (N = 12) and one control group (N = 5) via randomization. The amount of remaining sealer in the root canal irregularities was evaluated under a microscope using a 4-grade scoring system, whereas the remaining sealer on the root canal surface was evaluated with a 7-grade scoring system. Passive ultrasonic irrigation is more effective than the other tested irrigation systems or syringe irrigation in removing sealer from root canal walls (p < 0.01). None of the techniques had a significant effect on cleaning the lateral grooves. Within the limitations of this study protocol ultrasonic irrigation shows a superior effect on sealer removal from the root canal surface during endodontic retreatment. Cleaning of lateral grooves seems not to be possible with one of the techniques investigated. Incomplete removal of root canal sealer during re-treatment may cause treatment failure. Passive Ultrasonic irrigation seems to be the most effective system to remove sealer from a root canal.
Siqueira, José F; Alves, Flávio R F; Almeida, Bernardo M; de Oliveira, Julio C Machado; Rôças, Isabela N
Oval-shaped root canals might represent a great challenge for proper disinfection. This study compared the capability of a newly developed instrument, the self-adjusting file (SAF), and rotary nickel-titanium (NiTi) instrumentation to eliminate Enterococcus faecalis populations from long oval root canals of extracted human teeth. As a secondary purpose, the ability of a modification in sampling technique to recover bacteria lodged in recesses of oval canals was evaluated. Long oval canals from mandibular incisors and maxillary second premolars were infected with E. faecalis (ATCC 29212) for 30 days and then randomly distributed into 2 experimental groups. In group 1, canals were prepared up to a 40/04 rotary BioRaCe instrument by using irrigation with NaviTip needles; in group 2, canals were prepared by using the SAF system with continuous irrigation. NaOCl and ethylenediaminetetraacetic acid were used as irrigants. Bacteriologic samples were taken before (S1) and after preparation (S2a and S2b). Reduction in the bacterial populations was highly significant in both groups (P < .001). Preparation of long oval canals with the SAF was significantly more effective than rotary NiTi instrumentation in reducing intracanal E. faecalis counts (P = .01). Frequency of positive cultures in S2 samples was 11 of 20 (55%) for rotary instrumentation and 4 of 20 (20%) for SAF instrumentation (P = .048). S2b samples (modified method) yielded more positive samples than S2a (12/40 vs 5/40), but this difference reached no statistical significance (P > .05). The SAF system was significantly more effective than rotary NiTi instrumentation used with syringe/needle irrigation in disinfecting long oval root canals in vitro. A modified sampling technique might be necessary for oval canals. Copyright © 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
Mohan, Ajit George; Rajesh, Ebenezar A. V.; George, Liza; Sujathan; Josy, Susan Ann
Variation in the roots and root canal anatomy seems to be the norm rather than an exception. For a successful endodontic treatment, a clinician should have a thorough knowledge of the internal and external dental anatomy and its variations. Maxillary lateral incisors usually exhibit single canal with a single root. In this case, clinical examination and radiographs clearly demonstrates the presence of two root canals with two separate curved roots. This case report emphasizes the need for attention during endodontic management of maxillary lateral incisors. PMID:23633825
Chang, Seok-Woo; Lee, So-Youn; Kang, Soo-Kyung; Kum, Kee-Yeon; Kim, Eun-Cheol
The objective of this study was to compare the cytotoxicity, inflammatory response, osteogenic effect, and the signaling mechanism of these biologic activities of 4 calcium compound-based root canal sealers (ie, Sealapex [Sybron Kerr, WA], apatite root sealer [ARS; Dentsply Sankin, Tokyo, Japan], MTA Fillapex [Angelus Indústria de Produtos Odontológicos S/A, Londrina, PR, Brazil], and iRoot SP [Innovative BioCreamix Inc, Vancouver, Canada]) in human periodontal ligament cells. Cytotoxicity was assessed using the 3-(4,5-dimethylthiazolyl-2-yl)-2,5-diphenyltetrazolium bromide assay. Levels of inflammatory mediators were measured by enzyme-linked immunosorbent assay, reverse-transcription polymerase chain reaction, and Western blot analysis. Osteogenic potential was evaluated by alkaline phosphatase activity, alizarin red staining, and marker genes by reverse-transcription polymerase chain reaction. The signal transduction pathways were examined by Western blotting. None of the sealers were cytotoxic. ARS, MTA Fillapex, and iRoot SP induced a lower expression of proinflammatory mediators than Sealapex. All sealers increased ALP activity and the formation of mineralized nodules and up-regulated the expression of osteoblastic marker messenger RNA. ARS, MTA Fillapex, and iRoot SP showed superior osteogenic potential compared with Sealapex. The expression and/or activation of integrin receptors and downstream signaling molecules, including focal adhesion kinase, paxillin, Akt, mitogen-activated protein kinase, and nuclear factor κB, was induced by ARS, MTA Fillapex, and iRoot SP treatment but not by Sealapex treatment. We show for the first time that ARS, MTA Fillapex, and iRoot SP induce a lower expression of inflammatory mediators and enhance osteoblastic differentiation of PDLCs via the integrin-mediated signaling pathway compared with Sealapex. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
Dannemann, Martin; Kucher, Michael; Kirsch, Jasmin; Binkowski, Alexander; Modler, Niels; Hannig, Christian; Weber, Marie-Theres
Root canal geometry is an important factor for instrumentation and preparation of the canals. Curvature, length, shape, and ramifications need to be evaluated in advance to enhance the success of the treatment. Therefore, the present study aimed to design and realize a method for analyzing the geometric characteristics of human root canals. Two extracted human lower molars were radiographed in the occlusal direction using micro-computed tomographic imaging. The 3-dimensional geometry of the root canals, calculated by a self-implemented image evaluation algorithm, was described by 3 different mathematical models: the elliptical model, the 1-circle model, and the 3-circle model. The different applied mathematical models obtained similar geometric properties depending on the parametric model used. Considering more complex root canals, the differences of the results increase because of the different adaptability and the better approximation of the geometry. With the presented approach, it is possible to estimate and compare the geometry of natural root canals. Therefore, the deviation of the canal can be assessed, which is important for the choice of taper of root canal instruments. Root canals with a nearly elliptical cross section are reasonably approximated by the elliptical model, whereas the 3-circle model obtains a good agreement for curved shapes. Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
Rodrigues, Evaldo; Braitt, Antônio Henrique; Galvão, Bruno Ferraz
Root canal anatomy is complex, and the recognition of anatomic variations could be a challenge for clinicians. This case report describes the importance of cone beam computed tomographyic (CBCT) imaging during endodontic treatment. A 23 year old woman was referred by her general dental practitioner with the chief complaint of spontaneous pain in her right posterior maxilla. From the clinical and radiographic findings, a diagnosis of symptomatic irreversible pulpitis was made and endodontic treatment was suggested to the patient. The patient underwent CBCT examination, and CBCT scan slices revealed seven canals: three mesiobuccal (MB1, MB2, and MB3), two distobuccal (DB1 and DB2), and two palatal (P1 and P2). Canals were successfully treated with reciprocating files and filled using single-cone filling technique. Precise knowledge of root canal morphology and its variation is important during root canal treatment. CBCT examination is an excellent tool for identifying and managing these complex root canal systems. PMID:28194366
Grecca, Fabiana Soares; Garcia, Roberto Brandão; Bramante, Clóvis Monteiro; de Moraes, Ivaldo Gomes; Bernardineli, Norberti
Objective: The efficiency of rotary, manual and ultrasonic root canal instrumentation techniques was investigated in proximally flattened root canals. Material and Methods: Forty human mandibular left and right central incisors, lateral incisors and premolars were used. The pulp tissue was removed and the root canals were filled with red die. Teeth were instrumented using three techniques: (i) K3 and ProTaper rotary systems; (ii) ultrasonic crown-down technique; and (iii) progressive manual technique. Roots were bisected longitudinally in a buccolingual direction. The instrumented canal walls were digitally captured and the images obtained were analyzed using the Sigma Scan software. Canal walls were evaluated for total canal wall area versus noninstrumented area on which dye remained. Results: No statistically significant difference was found between the instrumentation techniques studied (p<0.05). Conclusion: The findings of this study showed that no instrumentation technique was 100% efficient to remove the dye. PMID:19089108
Dadresanfar, Bahareh; Khalilak, Zohreh; Shahmirzadi, Solaleh
The maxillary first premolar may present large number of anatomic variations. The clinician should be aware of the configuration of the pulp system. Maxillary first premolars usually have two canals. The incidence of three canals in these teeth is quite rare. This case report presents the diagnosis and clinical management of a maxillary first premolar with two distinct canals in the apical third of buccal root (type IV), drawing particular attention to tactile examination of all the canal walls. PMID:23864875
Sydney, G B; Batista, A; Estrela, C; Pesce, H F; de Melo, L L
Scanning electron microscopy was used to analyze the smear layer removal after root canal preparation by a manual technique and by an automated handpiece, the Canal Finder System (CFS). When 1% sodium hypochlorite was used as the irrigating solution, both manual and CFS techniques showed root canal walls with a dense smear layer obscuring the dentinal tubules entrance plus a large amount of debris. Root canal walls of the group of teeth treated with a chelating agent (EDTA) for 5 min and a final flush, after the preparation, with 1% sodium hypochlorite as an irrigating solution showed the cervical, middle and apical thirds extremely smooth and clear.
Neuhaus, Klaus W; Liebi, Melanie; Stauffacher, Simone; Eick, Sigrun; Lussi, Adrian
Passive ultrasonic irrigation (PUI) is the most widespread method used to activate irrigation solutions. Concerns have been raised that PUI is less effective in curved root canals and is not passive at all. Our aim was to compare a novel passive sonic irrigation (PSI) device (6000 Hz) with PUI and manual irrigation (MI) with respect to their efficiency in removing different endodontic microorganisms from curved and straight root canals. We performed 2 experiments as follows. In a 3-day infection model, we included 8 groups of single or dual microbial species that were rinsed with 0.9% sodium chloride using PSI, PUI, or MI. Colony-forming units (CFUs) were counted after incubation, and log10 transformations were performed for statistical comparisons. In a 21-d infection model, we tested the same irrigation protocols on 4 groups of microorganisms and used 1.5% sodium hypochlorite as an irrigant. Infection control samples were taken at day 0, 3, 5, and 7 after treatment and were subsequently reincubated. Using sodium chloride as an irrigant, the amount of reduction in CFUs compared with the negative control was approximately 3 log10 units for PSI at 6000 Hz, 2 log10 units for PUI, and 1 log10 unit for MI. PSI reduced the microorganism CFUs significantly better than PUI. Using sodium hypochlorite led to a significant reduction in microorganism CFUs even with MI. After 3 days, compared with MI, microorganism regrowth significantly reduced after PSI and PUI treatment, but in these groups, in at least half of the samples, microorganisms were detectable after 7 days. PSI at 6000 Hz might be at least equal to PUI with respect to reduction of the microbial load in curved and straight root canals. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
Biezanek, Tomasz; Bachanek, Teresa
Endodontic treatment consists in necrotic pulp removal, proper root canal preparation, and sealed obliteration. The effectiveness of treatment depends on careful root canal disinfection of existing bacteria. Modern endodontics recommends the use of a rubber dam, not only to protect the patient from endodontic instrument aspiration, but also to protect root canals from bacteria existing in saliva. The aim of the study is a comparison of root canal disinfection among patients treated with and without rubber dam protection. Endodontic treatient of 36 patients who came to the Department of Conservative Dentistry and Endodontics was performed. 36 teeth were qualified to the treatment. In 17 patients the whole treatment was done with rubber dam protection. In the other 19 (II group) the treated tooth was isolated only by cotton rolls. After chamber trepanation, and after chemo-mechanical root canal preparation, samples of root canal bacteria were taken. After 24h incubation, the density of bacterial suspension was checked using a spectrophotometer. In both groups of patients very similar results were obtained: a high density of bacterial suspension in samples taken before treatment, and a significantly lower density in samples taken after chemo-mechanical root canal preparation. In our research the use or lack of use of a rubber dam does not change the effectiveness of root canal disinfection.
Kqiku, Lumnije; Miletic, Ivana; Gruber, Hans Jürgen; Anic, Ivica; Städtler, Peter
Epiphany/Resilon and GuttaFlow are newly developed methods for obturation of the root canal system. Epiphany/Resilon is a thermoplastic, synthetic polymer-based root canal filling material which enables the bonding to the dentin root canal wall during root canal obturation. GuttaFlow is a cold flowable filling system for the obturation of root canals, combining sealer and gutta-percha in one product. The purpose of this study was to assess the leakage of the Epiphany/Resilon or GuttaFlow root canal filling compared with lateral condensation of gutta-percha. For this study were used 45 human extracted teeth, chemo mechanically prepared, divided into three groups and obturated with gutta-percha/AH Plus, Epiphany/Resilon and GuttaFlow. For dye penetration all teeth were centrifuged for three minutes at 30 g in 2% methylene blue and dissolved in 65% nitric acid for 3 days. The extracted methylene blue was determined with Photometer. Root Canal fillings with Epiphany/Resilon showed less dye penetration than lateral condensation of gutta-percha and GuttaFlow. Epiphany/Resilon is ideally suited as a root canal filling material.
Rôças, Isabela N; Siqueira, José F
This study evaluated the microbiota of root canals undergoing retreatment. The most prevalent taxa detected by checkerboard included Propionibacterium species, Fusobacterium nucleatum, streptococci, and Pseudoramibacter alactolyticus. Quantitative real-time PCR detected Enterococcus faecalis and streptococci in 38% and 41% of the cases, comprising 9.76% and 65.78% of the total bacterial counts, respectively. The findings call into question the status of E. faecalis as the main pathogen and suggest that other species can be candidate pathogens associated with persistent/secondary endodontic infections.
Rôças, Isabela N.
This study evaluated the microbiota of root canals undergoing retreatment. The most prevalent taxa detected by checkerboard included Propionibacterium species, Fusobacterium nucleatum, streptococci, and Pseudoramibacter alactolyticus. Quantitative real-time PCR detected Enterococcus faecalis and streptococci in 38% and 41% of the cases, comprising 9.76% and 65.78% of the total bacterial counts, respectively. The findings call into question the status of E. faecalis as the main pathogen and suggest that other species can be candidate pathogens associated with persistent/secondary endodontic infections. PMID:22403423
Sreekrishnan, B; Ajithkumar, K; Sadashivshetty, K
Various methods have been used to study the root canal morphology of human teeth. The purpose of this study was to develop a technique for the formation of a resin replica of the root canal morphology of maxillary first premolars. 30 recently extracted maxillary first premolars were used for the study. An occlusal access cavity was prepared and the teeth placed in 5% sodium hypochlorite solution to dissolve the pulp remnants. The teeth were then rinsed in water. A two-part resin system was then introduced into the root canal through the access cavity opening. Subsequent to curing the resin using a specific curing cycle the specimens were put in 20% hydrochloric acid. This facilitated the dissolution of the tooth and the retrieval of the resin replica of the root canal. The different types of root canal morphology observed are discussed. The relevance and utility of the resin models and further possibilities in this field are discussed.
Nickel-Titanium (Ni-Ti) instrument are widely used for root canal preparation in permanent tooth compared to primary teeth. Hand instrumentation technique remains the conventional method for root canal preparation in primary teeth. The time taken for root canal preparation with the conventional method is more resulting in patients and clinicians fatigue. Recently Ni-Ti rotary files designed for permanent tooth has been used for root canal preparation in primary teeth. Using rotary instruments for primary tooth pulpectomies resulted in better and predictable root canal filling. This article presents case reports of pulpectomy treatment performed using Kedo-S an exclusive paediatric Ni-Ti rotary files. The advantages and disadvantages in use of Ni-Ti rotary files in primary teeth are discussed in this article.
Kim, Su-Hyeon; Oh, Tack-Oon; Kim, Ju-Young; Park, Chun-Woong; Baek, Seung-Ho; Park, Eun-Seok
The aim of this study was to observe the effects of different test conditions on the flexural properties of root canal post. Metal- and fiber-reinforced composite root canal posts of various diameters were measured to determine flexural properties using a threepoint bending test at different conditions. In this study, the span length/post diameter ratio of root canal posts varied from 3.0 to 10.0. Multiple regression models for maximum load as a dependent variable were statistically significant. The models for flexural properties as dependent variables were statistically significant, but linear regression models could not be fitted to data sets. At a low span length/post diameter ratio, the flexural properties were distorted by occurrence of shear stress in short samples. It was impossible to obtain high span length/post diameter ratio with root canal posts. The addition of parameters or coefficients is necessary to appropriately represent the flexural properties of root canal posts.
Ozcan, Gozde; Sekerci, Ahmet Ercan; Cantekin, Kenan; Aydinbelge, Mustafa; Dogan, Salih
Knowledge of primary tooth morphology is essential for clinical dentistry, especially for root canal treatment and dental traumatology. However, this has not been well documented to date with a large sample. This study was carried out to investigate the variation in number and morphology of the root canals of the primary molars, to study the applicability of cone beam computerized tomography (CBCT) in assessing the same and to provide a comprehensive review of the literature. A total of 343 primary molars, without any root resorption, were divided into four main groups including the maxillary first molars, maxillary second molars, mandibular first molars and mandibular second molars. All of them were analysed in CBCT images in the axial, sagittal and coronal planes. Various parameters such as the number of roots, number of canals, the root canal type, diameter of root and root canal and root canal curvature were studied. Primary molars in all four groups showed variability in the number of roots and root canals. As far as length of the roots was concerned, the palatal root of the maxillary molar was found to be longest, while the distobuccal root was shortest. In mandibular molars, the mesial root was longer than the distal root. The length of distobuccal root canal of the maxillary molars and the distolingual canal of the mandibular molars was found to be shortest. The number of roots and root canals varied from two to four and three to four, respectively. The maxillary molars exhibited more one-canal than two-canal roots. The present study provides comprehensive information to the existing literature concerning the variation in root canal morphology of the maxillary and mandibular primary molar teeth. These data may help clinicians in the root canal treatment of these teeth.
Fedorowicz, Zbys; Nasser, Mona; Sequeira-Byron, Patrick; de Souza, Raphael Freitas; Carter, Ben; Heft, Marc
Root canal treatment is carried out on teeth in which irreversible pulpitis has led to necrosis of the dental pulp. As a treatment option it is an alternative to dental extraction. Mechanical preparation and irrigation with antiseptic or antibacterial solutions destroys bacteria and cleans the infected root canal. Irrigants should be effective in deactivating bacteria in the entire root canal space without causing any adverse tissue reactions. Sodium hypochlorite (NaOCl) and chlorhexidine are commonly used but there is uncertainty as to which solution, concentration or combination is the most effective. To assess the effects of irrigants used in the non-surgical root canal treatment of mature permanent teeth. We searched the Cochrane Oral Health Group's Trials Register (to 5 July 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 4), MEDLINE via Ovid (1950 to 5 July 2012), EMBASE via Ovid (1980 to 5 July 2012), LILACS via BIREME (1980 to 5 July 2012). There were no restrictions regarding language or date of publication. Randomised controlled trials in single or multi-rooted permanent teeth with pulpal or periapical pathology or both, which require root canal treatment. Irrigants either against each other or against inactive irrigant or placebo. Combinations of irrigants were allowed and if used in conjunction with EDTA (ethylenediaminetetra-acetic acid) or similar chelating agents. Two review authors independently assessed risk of bias of included trials and extracted data. We included 11 trials involving 851 participants with 879 teeth which had undergone root canal treatment and involved the use of irrigants. Two trials were assessed as being at low risk of bias, with six unclear and three high. Four trials compared sodium hypochlorite versus chlorhexidine, however, no primary outcomes and only one secondary outcome, bacterial growth cultures, was reported for two of these trials (20% and 50% of teeth in the
Wang, Qian-Qian; Zhang, Cheng-Fei; Chu, Chun-Hung; Zhu, Xiao-Fei
To investigate the prevalence of Enterococcus faecalis in saliva and filled root canals of patients requiring endodontic retreatment for apical periodontitis. Patients with apical periodontitis who were referred for endodontic retreatment were examined. The type and quality of the restoration, symptoms, quality of obturation were recorded. During retreatment, an oral rinse sample and root canal sample were cultured using brain-heart infusion agar and bile esculinazide agar to select for E. faecalis. The 16S rRNA technique was used to identify E. faecalis. A total of 32 women and 22 men (mean age: 38 years; s.d.: 11 years) and 58 teeth were studied. The prevalence of E. faecalis was 19% in the saliva and 38% in the root canals. The odds that root canals harbored E. faecalis were increased if the saliva habored this bacterium (odds ratio=9.7; 95% confidence interval=1.8–51.6; P<0.05). Teeth with unsatisfactory root obturation had more cultivable bacterial species in root canals than teeth with satisfactory root obturation (P<0.05). E. faecalis is more common in root canals of teeth with apical periodontitis than in saliva. The prevalence of E. faecalis in root canals is associated with the presence of E. faecalis in saliva. PMID:22422085
Wang, Qian-Qian; Zhang, Cheng-Fei; Chu, Chun-Hung; Zhu, Xiao-Fei
To investigate the prevalence of Enterococcus faecalis in saliva and filled root canals of patients requiring endodontic retreatment for apical periodontitis. Patients with apical periodontitis who were referred for endodontic retreatment were examined. The type and quality of the restoration, symptoms, quality of obturation were recorded. During retreatment, an oral rinse sample and root canal sample were cultured using brain-heart infusion agar and bile esculinazide agar to select for E. faecalis. The 16S rRNA technique was used to identify E. faecalis. A total of 32 women and 22 men (mean age: 38 years; s.d.: 11 years) and 58 teeth were studied. The prevalence of E. faecalis was 19% in the saliva and 38% in the root canals. The odds that root canals harbored E. faecalis were increased if the saliva habored this bacterium (odds ratio=9.7; 95% confidence interval=1.8-51.6; P<0.05). Teeth with unsatisfactory root obturation had more cultivable bacterial species in root canals than teeth with satisfactory root obturation (P<0.05). E. faecalis is more common in root canals of teeth with apical periodontitis than in saliva. The prevalence of E. faecalis in root canals is associated with the presence of E. faecalis in saliva.
Torbjörner, A; Karlsson, S; Syverud, M; Hensten-Pettersen, A
The aim of this study was to compare the mechanical properties of a prefabricated root canal post made of carbon fiber reinforced composites (CFRC) with metal posts and to assess the cytotoxic effects elicited. Flexural modulus and ultimate flexural strength was determined by 3 point loading after CRFC posts had been stored either dry or in water. The bending test was carried out with and without preceding thermocycling of the CFRC posts. The cytotoxicity was evaluated by an agar overlay method after dry and wet storage. The values of flexural modulus and ultimate flexural strength were for dry stored CFRC post 82 +/- 6 GPa and 1154 +/- 65 MPa respectively. The flexural values decreased significantly after water storage and after thermocycling. No cytotoxic effects were observed adjacent to any CFRC post. Although fiber reinforced composites may have the potential to replace metals in many clinical situations, additional research is needed to ensure a satisfying life-span.
Ceyhanli, K. Tolga; Turkun, Murat; Erdilek, Necdet; Peskersoy, Cem; Kose, Timur
Objective: The aim of this study was to evaluate the apical root canal adaptation performance of various root canal instruments. Materials and Methods: A total of 40 freshly extracted single-rooted mandibular incisors were used in this study. Coroner parts of all teeth were removed from cemento-enamel junction and root canal of each tooth was explored with a size 8 K-file until the tip of the file was just visible at the apex. Working lengths (WLs) were determined as 1 mm short of these measurements. ProTaper, K-file, profile and hedstroem files were inserted into the root canals of 10 teeth to the WL following the flaring of the coronal and middle thirds. Instruments were fixed in the root canals with acrylic resin. The apical 1 mm of each root tip was ground on wet sandpaper to expose the canal and the instrument at the WL and the apical region of each tooth was examined under stereomicroscope. The stereoscopic images of the teeth were digitized and analyzed with software in order to determine the differences between the areas of root canals and file tips. Result data were analyzed using the one-way analysis of variance test (P = 0.05). Results: There were no significant differences between apical file/root canal areas of the evaluated instruments (P > 0.05). Conclusions: None of the evaluated instruments performed a perfect adaptation with the apical root canal surface at the WL in mandibular incisors. Therefore, total removal of the debris from the apical canal surface may not be achieved when these filing instruments are used. PMID:24966727
Martín-González, Jenifer; Echevarría-Pérez, Marta; Sánchez-Domínguez, Benito; Tarilonte-Delgado, Maria L.; Castellanos-Cosano, Lizett; López-Frías, Francisco J.
Objective: To analyse the influence of root canal instrumentation and obturation techniques on intra-operative pain experienced by patients during endodontic therapy. Method and Materials: A descriptive cross-sectional study was carried out in Ponferrada and Sevilla, Spain, including 80 patients (46 men and 34 women), with ages ranged from 10 to 74 years, randomly recruited. Patient gender and age, affected tooth, pulpal diagnosis, periapical status, previous NSAID or antibiotic (AB) treatment, and root canal instrumentation and obturation techniques were recorded. After root canal treatment (RCT), patients completed a 10-cm visual analogue scale (VAS) that ranked the level of pain. Results were analysed statistically using the Chi-square and ANOVA tests and logistic regression analysis. Results: The mean pain level during root canal treatment was 2.9 ± 3.0 (median = 2) in a VAS between 0 and 10. Forty percent of patients experienced no pain. Gender, age, arch, previous NSAIDs or AB treatment and anaesthetic type did not influence significantly the pain level (p > 0.05). Pain during root canal treatment was significantly greater in molar teeth (OR = 10.1; 95% C.I. = 1.6 - 63.5; p = 0.013). Root canal instrumentation and obturation techniques did not affect significantly patient’s pain during root canal treatment (p > 0.05). Conclusion: Patients feel more pain when RCT is carried out on molar teeth. The root canal instrumentation and obturation techniques do not affect significantly the patients’ pain during RCT. Key words:Anaesthesia, endodontic pain, pulpitis, root canal instrumentation, root canal obturation, rotary files. PMID:22549694
Lipski, Mariusz; Trąbska-Świstelnicka, Marlena; Woźniak, Krzysztof; Dembowska, Elżbieta; Droździk, Agnieszka
Alginate as a substitute for root-surrounding tissue was investigated. The electronic working lengths of root canals under clinical conditions were compared with an in vitro simulation of the same teeth extracted and embedded in alginate. The working lengths in 26 teeth were determined on two occasions using an electronic apex locator, before extraction and after extraction with the same teeth embedded in an alginate mass. The apical 4 mm of the root canals were exposed following the measurements, and the distances between the apical constrictions and the tips of files repositioned in the canals were measured and recorded. The mean distance between the file tip and the constriction was +0.33 mm (±0.38) in vivo and +0.32 mm (±0.30) in vitro. The Wilcoxon signed-rank test indicated that these means were not significantly different. The apical constriction was assessed to be within the limits of 0.5 mm in 80.7% of in vivo cases and in 76.9% of extracted teeth. Statistical analysis demonstrated that there was no significant difference between the results recorded in vivo and in vitro regarding apical constriction localisation. Based on the results of this study, the alginate mass is a useful tool in evaluating the performance of electronic apex locators.
Kheirieh, Sanam; Fazlyab, Mahta; Torabzadeh, Hassan; Eghbal, Mohamad Jafar
Inflammatory external root resorption (IERR) after orthodontic treatments is an unusual complication. This case report describes a non-vital maxillary premolar with symptomatic extensive IERR (with a crown/root ratio of 1:1) after receiving orthodontic treatment. The first appointment included drainage, chemo-mechanical preparation of the canal and intra-canal medication with calcium hydroxide (CH) along with prescription of analgesic/antibiotic. The subsequent one-week follow-up revealed the persistence of symptoms and formation of a sinus tract. Finally, extraoral endodontic treatment was planned; the tooth was atraumatically extracted and retrograde root canal filling with calcium enriched mixture (CEM) cement was placed followed by tooth replantation. Clinical signs/symptoms subsided during 7 days postoperatively. The sinus tract also resolved after one week. Six-month and one-year follow-ups revealed complete healing and a fully functional asymptomatic tooth. This case study showed favorable outcomes in a refractory periapical lesion associated with orthodontically induced extensive IERR. The chemical as well as biological properties of CEM cement may be a suitable endodontic biomaterial for these cases. PMID:24688586
Jain, Atul; Bahuguna, Rachana
Knowledge about root canal morphology and its frequent variations can exert considerable influence on the success of endodontic treatment. The aim of this study was to survey the root canal morphology of mandibular first premolar teeth in a Gujarati population by decalcification and clearing technique. One hundred thirty eight extracted mandibular first premolar teeth were collected from a Gujarati population. After decalcifying and clearing, the teeth were examined for tooth length, number of cusps and roots, number and shape of canal orifices and canal types. The average length of mandibular first premolar teeth was 21.2 mm. All the teeth had 2 cusps. One hundred thirty four teeth (97.1%) had one root, and just 4 teeth (2.89%) had two roots. Mesial invagination of root was found in 21 teeth (15.21%). One canal orifice was found in 122 teeth (88.4%) and two canal orifices in 16 teeth (11.59%). Shape of orifices was found to be round in 46 teeth (33.33%), oval in 72 teeth (52.17%) and flattened ribbion in 20 teeth (14.49%). According to Vertucci's classification, Type I canal system was found in 93 teeth (67.39%), Types II,III,IV,V,and VI in 11 teeth (7.97%), 5 teeth (3.62%), 4 teeth (2.89%), 24 teeth (17.39%), and 1 tooth (0.72%) respectively. Mandibular first premolar teeth were mostly found to have one root and Type I canal system.
Pécora, J D; Sousa Neto, M D; Saquy, P C; Woelfel, J B
The external anatomy of 435 maxillary second premolars and the internal anatomy of 300 of these premolars were studied in vitro. For the study of the internal anatomy, the teeth were decalcified and cleared. One canal was found in 67.3% of the second premolars, two canals in 32.4% and three canals in 0.3% of these premolars. A total of 90.3% had one root and 9.7% two roots. A predominance of root curvature toward the distal was found in maxillary second premolars with both one or two roots.
Gillen, Brian M.; Looney, Stephen W.; Gu, Li-Sha; Loushine, Bethany A.; Weller, Roger N.; Loushine, Robert J.; Pashley, David H.; Tay, Franklin R.
Introduction Thorough cleaning and shaping of root canals are essential for periapical healing. Restoration of endodontically-treated teeth is also required for them to function and prevent coronal leakage. This study compared the impact of the quality of root canal treatment versus the quality of coronal restoration in treatment outcomes. Methods Literature search was conducted using the search terms “coronal restoration”, “root canal”, “periapical status” and “quality”. Articles that evaluated the effect of the quality of root filling and coronal restoration or both on the success of root canal treatment were selected. Nine articles were identified and were reviewed by three investigators. Data were collected based on pre-determined criteria. Percentages of teeth without apical periodontitis were recorded for each category: Adequate Root Canal Treatment (AE), Inadequate Root Canal Treatment (IE), Adequate Restoration (AR), Inadequate Restoration (IR). Data were analyzed using meta-analysis for odds ratios (ORs). Results After adjusting for significant covariates to reduce heterogeneity, the results were combined to obtain pooled estimates of the common OR for the comparison of AR/AE vs AR/IE (OR 2.734; 95% CI 2.61–2.88; p<0.001) and AR/AE vs IR/AE (OR 2.808; 95% CI 2.64–2.97; p<0.001). Conclusion On the basis of the current best available evidence, the odds for healing of apical periodontitis increase with both adequate root canal treatment and adequate restorative treatment. Although poorer clinical outcomes may be expected with adequate root filling-inadequate coronal restoration and inadequate root filling-adequate coronal restoration, there is no significant difference in the odds of healing between these two combinations. PMID:21689541
Wang, Su-Hsin; Chung, Ming-Pang; Su, Wen-Song; Cheng, Jen-Chan; Shieh, Yi-Shing
This case report describes the continued root formation following replantation and conventional root canal therapy of a traumatically avulsed open-apex tooth with suppurative apical periodontitis. A 7-year-old male patient had an avulsed upper left central incisor (tooth 21) replanted approximately 50 min after traumatic avulsion. A root canal procedure was initiated due to pulp necrosis and periapical abscess detected in the follow-up period. After endodontic treatment with calcium hydroxide (Ca(OH)(2)) dressing, a normal root length developed including an apical segment beyond the hard tissue barrier. Regeneration of the root occurred without pathology or ankylosis at 1-year of follow up.
Ma, Xiangyu; Li, Chunjie; Jia, Liuhe; Wang, Yan; Liu, Wenwen; Zhou, Xuedong; Johnson, Trevor M; Huang, Dingming
Root canal therapy is a sequence of treatments involving root canal cleaning, shaping, decontamination and obturation. It is conventionally performed through a hole drilled into the crown of the affected tooth, namely orthograde root canal therapy. For teeth that cannot be treated with orthograde root canal therapy, or for which it has failed, retrograde root filling, which seals the root canal from the root apex, is a good alternative. Many materials, such as amalgam, zinc oxide eugenol and mineral trioxide aggregate (MTA), are generally used. Since none meets all the criteria an ideal material should possess, selecting the most efficacious material is of utmost importance. To determine the effects of different materials used for retrograde filling in children and adults for whom retrograde filling is necessary in order to save the tooth. Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 13 September 2016); the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 8) in the Cochrane Library (searched 13 September 2016); MEDLINE Ovid (1946 to 13 September 2016); Embase Ovid (1980 to 13 September 2016); LILACS BIREME Virtual Health Library (1982 to 13 September 2016); and OpenSIGLE (1980 to 2005). ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. We also searched Chinese BioMedical Literature Database (in Chinese, 1978 to 20 September 2016); VIP (in Chinese, 1989 to 20 September 2016); China National Knowledge Infrastructure (in Chinese, 1994 to 20 September 2016); and Sciencepaper Online (in Chinese, to 20 September 2016). No restrictions were placed on the language or date of publication when searching the electronic databases. We selected randomised controlled trials (RCTs) only that compared different retrograde filling materials, with reported success rate that was assessed by clinical or
Plotino, G; Grande, N M; Falanga, A; Di Giuseppe, I L; Lamorgese, V; Somma, F
To measure the root canal area and the reduction of the mesial and buccal/lingual wall thickness at the level of the coronal interference in mesial roots of mandibular molars after instrumentation with a crown-down or a simultaneous root canal preparation technique. Twenty mesial roots of first mandibular molars with a moderate root canal curvature were embedded in resin and sectioned horizontally at the level of the coronal interference, using a modification of the Bramante technique. After scanning and processing, the sections were reassembled. One root canal of each root was prepared using ProTaper instruments, while Mtwo instruments were used in the other root canal of the same mesial root. After scanning and processing, the data obtained were analysed for two parameters: changes in root canal area after instrumentation (Delta A) and reduction of the mesial and buccal/lingual wall thickness (Delta T). The data were subjected to Student's t-tests for statistical analysis at a significance level of P < 0.05. No statistically significant differences were found between the two groups with respect to the changes in the areas (Delta A) at the level considered (P = 0.410). No statistically significant differences were noticed between the two groups for dentine thickness (Delta T) of both the mesial wall (P = 0.077) and the buccal or lingual wall (P = 0.171). There was no difference between the ProTaper and Mtwo groups for the amount of dentine removed.
Rôças, Isabela N; Alves, Flávio R F; Santos, Adriana L; Rosado, Alexandre S; Siqueira, José F
Bacteria located in the apical root canal system potentially participate in the pathogenesis of apical periodontitis. Detection and identification of apical bacteria can be compromised because of limitations in conventional sampling and identification procedures. This study identified several bacterial taxa in the apical and middle/coronal segments of primarily infected root canal system by using pulverized root segments and a culture-independent molecular method. Seventeen extracted teeth with attached apical periodontitis lesions were sectioned to obtain 2 root fragments (apical and middle/coronal segments). Root fragments were cryogenically ground, and DNA was extracted from samples. After multiple displacement amplification, DNA from samples was used as template in a reverse-capture checkerboard hybridization assay targeting 28 bacterial taxa. Bacterial DNA was detected in all samples. The most prevalent taxa in the apical root canal system were Olsenella uli (76.5%), Prevotella baroniae (71%), Porphyromonas endodontalis (65%), Fusobacterium nucleatum (53%), and Tannerella forsythia (47%). O. uli, P. endodontalis, and Propionibacterium acnes were as frequently detected in apical samples as they were in middle/coronal samples. P. baroniae, T. forsythia, and F. nucleatum were found more frequently in the apical part of the canal as compared with matched coronal segments. Streptococcus species were more prevalent in middle/coronal samples. The median and mean of shared bacterial taxa between matched apical and middle/coronal segments were 27% and 41%, respectively. Several candidate endodontic pathogens were very prevalent in the apical root canal system. The apical microbiota was usually complex and differed in species composition when compared with the microbiota of middle/coronal samples from the same tooth. Copyright © 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
Prasanthi, Nalam NVD; Rambabu, Tanikonda; Sajjan, Girija S; Varma, K Madhu; Satish, R Kalyan; Padmaja, M
Aim: The aim of this study was to measure the increase in root canal surface area and canal transportation after biomechanical preparation at 1, 3, and 5 mm short of the apex with three different rotary systems in both continuous rotary and reciprocating rotary motions. Materials and Methods: Sixty freshly extracted human mandibular molars with mesial root canal curvatures between 20° and 30° were included in the study. Teeth were randomly distributed into three groups (n = 20). Biomechanical preparations were done in all the mesial canals. In Group 1, instrumentation was done with ProTaper universal rotary files, Group 2, with K3XF rotary files, and Group 3, with LSX rotary files. Each group was further subdivided into subgroups A and B (n = 10) where instrumentation was done by continuous rotary and reciprocating rotary techniques, respectively. Increase in root canal surface area and canal transportation was measured using the preoperative and postoperative cone-beam computed tomography scans. Statistical Analysis: The data were analyzed by one-way ANOVA followed by Tukey pairwise multiple comparison tests. Results: Increase in root canal surface area was significantly more (P < 0.05) in ProTaper and K3XF groups when compared to LSX group. Canal transportation was significantly more (P < 0.05) in ProTaper group when compared to K3XF and LSX groups. There was no significant difference (P > 0.05) in increase of root canal surface area and canal transportation between continuous rotary and reciprocating rotary techniques for ProTaper Universal, K3XF and LSX groups. Conclusion: LSX rotary system showed minimal increase of root canal surface area and minimal canal transportation when compared to ProTaper and K3XF rotary systems. PMID:27656062
Camilo, Carla Cristina; Brito-Júnior, Manoel; Faria-E-Silva, André Luis; Quintino, Alex Carvalho; de Paula, Adrianne Freire; Cruz-Filho, Antônio Miranda; Sousa-Neto, Manoel Damião
Despite the advantages of cone-beam computed tomography (CBCT), the images provided by this diagnostic tool can produce artifacts and compromise accurate diagnostic assessment. This paper describes an endodontic treatment of a maxillary molar where CBCT images suggested the presence of a nonexistent third root canal in the palatal root. An endodontic treatment was performed in a first maxillary molar with palatal canals, and the tooth was restored with a cast metal crown. The patient returned four years later presenting with a discomfort in chewing, which was reduced after occlusal adjustment. CBCT was prescribed to verify additional diagnostic information. Axial scans on coronal, middle, and apical palatal root sections showed images similar to a third root canal. However, sagittal scans demonstrated that these images were artifacts caused by root canal fillings. A careful interpretation of CBCT images in root-filled teeth must be done to avoid mistakes in treatment.
Camilo, Carla Cristina; Brito-Júnior, Manoel; Faria-e-Silva, André Luis; Quintino, Alex Carvalho; de Paula, Adrianne Freire; Cruz-Filho, Antônio Miranda; Sousa-Neto, Manoel Damião
Despite the advantages of cone-beam computed tomography (CBCT), the images provided by this diagnostic tool can produce artifacts and compromise accurate diagnostic assessment. This paper describes an endodontic treatment of a maxillary molar where CBCT images suggested the presence of a nonexistent third root canal in the palatal root. An endodontic treatment was performed in a first maxillary molar with palatal canals, and the tooth was restored with a cast metal crown. The patient returned four years later presenting with a discomfort in chewing, which was reduced after occlusal adjustment. CBCT was prescribed to verify additional diagnostic information. Axial scans on coronal, middle, and apical palatal root sections showed images similar to a third root canal. However, sagittal scans demonstrated that these images were artifacts caused by root canal fillings. A careful interpretation of CBCT images in root-filled teeth must be done to avoid mistakes in treatment. PMID:23606995
Shivashankar, Mayuri Biccodu; Jayasheel, Arun; Kenchanagoudra, Mallikarjun Goud
Introduction Complete cleaning and shaping of root canal system is of paramount importance to achieve a successful root canal treatment. There are various rotary Ni-Ti systems available in the market to achieve mechanical goal of root canal preparation. But aggressive preparation of root canal with such systems would result in canal transportation and excess root dentin removal that would be one of the major reasons to decide the prognosis of root canal treated tooth. Aim The present study was conducted to compare the root canal preparation in terms of canal transportation and volumetric changes in the root canal dentin among three Ni-Ti file systems, namely Mtwo, ProTaper (PT) and ProTaper NEXT (PTN) file system, using Computed Tomography (CT). Materials and Methods A total of 45 mesiobuccal root canals of extracted first molar teeth with completely formed root apices and angle of curvature ranging between 10°- 35° were selected. These teeth were randomly divided into three experimental groups containing 15 teeth each, based on rotary system used. Group-I: Mtwo files, Group-II: PT files and Group-III: PTN files. Pre-instrumentation CT images were obtained at three cross-sectional planes – 3mm, 7mm and 11mm from apical end of the root. Similarly, post-instrumentation images were obtained. Shortest distance from the edge of the canal to the periphery of the root was analyzed by using Analysis of Variance. Results All three file systems tested in the present study presented similar behaviour with respect to the root canal transportation. Lesser canal transportation was recorded in Mtwo. But no statistically significant difference was seen in terms of canal transportation and volume of dentin removed between all three rotary systems (p>0.05). Conclusion Mtwo, PT and PTN rotary systems have similar behaviour with respect to canal transportation and volume of dentin removed. PMID:28050495
Mohammadzadeh Akhlaghi, Nahid; Khalilak, Zohreh; Vatanpour, Mehdi; Mohammadi, Saman; Pirmoradi, Sakineh; Fazlyab, Mahta; Safavi, Kamran
Introduction: The aim of this study was to evaluate root canal anatomy of mandibular first molars (MFM) in a selected Iranian Population using clearing technique. Methods and Materials: A total of 150 extracted MFMs were cleared. The root canal morphology (including the root numbers and root length) and the anatomy of the root canal system (including is the number and type of canals based on Vertucci’s classification, canal curvature according to Schneider's method and the presence of isthmus) was evaluated using the buccolingual and mesiodistal parallel x-rays and stereomicroscope. The data were analyzed using the chi-square test. Results: Two and three roots were present in 96.7% and 33% of the teeth, respectively (P=0.0001). All the teeth (100%) had two canals in the mesial root, while 61.3% of the samples had one distal root canal (P=0.006). The root canal configuration in the mesial canal included type IV (55.3%) and type II (41.3%) (P=0.0001). In doubled-canalled distal roots, 68.8% and 24.3% were type II and type IV, respectively (P=0.0001). Isthmii were observed in 44.6% of mesial and 27.3% of distal roots (P=0.0001). Conclusion: The notable prevalence of type IV configuration in both roots of mandibular first molars, presence of isthmus and root curvature, necessitates the careful negotiation and cleaning of all accessible canal spaces. PMID:28179932
Sakhaei Manesh, Vahid; Giacomin, Paul; Stoll, Richard
Obtaining clean and smooth root canal walls is the ideal clinical outcome of the cleaning and shaping stage in root canal treatment. This study compares the surface roughness of root canal surfaces instrumented with a NiTi filing system with either adaptive reciprocating (AR) or continuous rotation (CR). Root canal cleaning and shaping was carried out on the mesial canals of 24 extracted first molars roots with either AR or CR. Roots were split in half and the surface roughness of their canals was evaluated in 12 three dimensional roughness reconstructions using a scanning electron microscope. Rz (nm) values were calculated in three areas of each reconstruction and analyzed (α = 0.05). Mann-Whitney tests showed that surface roughness was significantly higher overall in the AR group (Rz = 967 ± 250 nm) compared with the CR group (Rz = 739 ± 239 nm; p = 0.044). The roughness values generally increased from apical towards the coronal third in both groups. A less aggressive finishing file or a continuous rotary system to end the cleaning and shaping stage may be beneficial to reduce roughness of the root canal surface.
The outcome of root canal treatment is based on efficient disinfection of the root canal system and prevention of reinfection. Current chemomechanical cleaning methods do not always achieve these goals, and insufficient root canal disinfection is the main reason for endodontic failure. Due to high energy content and specific characteristics of laser light, laser treatment has been proposed for cleaning and disinfecting the root canal system. This paper reviews the literature covering the effect of Er:YAG, Er,Cr:YSGG, Nd:YAG and diode laser on the root canal wall in the removal of smear layer and against intracanal bacteria. Recently, the use of laser energy to induce cavitation and acoustic streaming of intracanal irrigants has been investigated. Based on recent literature, it can be concluded that lasers have bactericidal effects. However, they still cannot replace sodium hypochlorite and should be considered as an adjunct to the current chemical root canal disinfection protocols. Certain lasers can help in removing the smear layer and debris and can modify the morphology of the root canal wall. Unfortunately, there have not been enough randomized clinical studies evaluating endodontic treatment outcome following the use of laser. PMID:27688346
Jurič, Ivona Bago; Anić, Ivica
The outcome of root canal treatment is based on efficient disinfection of the root canal system and prevention of reinfection. Current chemomechanical cleaning methods do not always achieve these goals, and insufficient root canal disinfection is the main reason for endodontic failure. Due to high energy content and specific characteristics of laser light, laser treatment has been proposed for cleaning and disinfecting the root canal system. This paper reviews the literature covering the effect of Er:YAG, Er,Cr:YSGG, Nd:YAG and diode laser on the root canal wall in the removal of smear layer and against intracanal bacteria. Recently, the use of laser energy to induce cavitation and acoustic streaming of intracanal irrigants has been investigated. Based on recent literature, it can be concluded that lasers have bactericidal effects. However, they still cannot replace sodium hypochlorite and should be considered as an adjunct to the current chemical root canal disinfection protocols. Certain lasers can help in removing the smear layer and debris and can modify the morphology of the root canal wall. Unfortunately, there have not been enough randomized clinical studies evaluating endodontic treatment outcome following the use of laser.
Rodriguez, Fabiola-Regina; Paganoni, Nadine; Eickholz, Peter; Weiger, Roland; Walter, Clemens
The aim of this study was to compare the interproximal bone level at root canal-filled teeth and non-root canal-filled teeth. The records of patients from the department were consecutively screened from January 2009 to October 2011. The distance between the coronal reference point to the alveolar bone crest (AC) was assessed at the mesial and distal aspects of root canal-filled teeth (RCF+) and their contralateral non-root canal-filled teeth (RCF-) on periapical radiographs. Generalised linear mixed-effects models were applied. The sample consisted of 128 pairs of teeth comprising data from 72 patients. The results for AC revealed a median distance of 3.2 mm for RCF+ and 3.4 mm for RCF- (p = 0.61). Using the maximal distance on either the distal or the mesial tooth surface, a median distance of 3.6 mm was detected for RCF+ and 3.8 mm for RCF-, respectively (p = 0.42). Even after taking several tooth- and subject-specific variables into account, the differences between AC on RCF+ and RCF- were statistically not significant (p > 0.05). The interproximal bone loss did not differ statistically significant between root canal-filled teeth and non-root canal-filled teeth. Existence of appropriately done root canal fillings in periodontitis patients has no effect on the prognosis of periodontal disease.
Rafeek, Reisha N; Smith, William A; Mankee, Melissa S; Coldero, Larry G
The objective of this study was to evaluate radiographically the technical quality of root canal fillings performed by dental students at the School of Dentistry, University of the West Indies. The school's database between 2000 and 2004 was investigated for patients with completed root canal treatment. The final sample consisted of 198 patients with 288 root-filled teeth and 460 canals. The length, presence of voids, taper, curvature of canal and fractured instruments were recorded and scored. Chi-squared analysis was used to determine statistically significant differences between the technical quality of root fillings and tooth type. Sixty-three per cent, 27.6% and 72.2% of root-filled canals had adequate length, density and taper respectively. The overall acceptability of root fillings having adequate length and taper, absence of voids and no fractured instruments was found in 10.9% of canals. Changes in teaching methods may be required to improve the technical quality of root canal treatment done by dental students. © 2010 The Authors. Australian Endodontic Journal © 2010 Australian Society of Endodontology.
Wong, Jason Gilbert; Caputo, Angelo Anthony; Li, Ping; White, Shane Newport
Aim: The purpose of this study was to compare the in vitro micro-leakage resistance of adhesive resin materials to long-used zinc oxide-eugenol and epoxy resin sealers. Materials and Methods: Seven materials, five test (Real Seal, Real Seal XT, Panavia F 2.0, Infinity Syringeable, GCEM) and two controls (Tubliseal, AH Plus), were evaluated for micro-leakage resistance in a bovine incisor root model, with 12 roots per material. Teeth were root canal treated, stored in water, artificially aged by thermal-cycling, stained with silver nitrate, sectioned to yield eight measurement points per tooth (four coronal and four apical), giving 672 measurement points. Stain penetration was measured using digital positioners and a toolmakers microscope; then analyzed using descriptive statistics, two-way analysis of variance and multiple comparisons testing (P < 0.05). Results: All modern adhesive resinous materials leaked significantly less than long-used zinc oxide-eugenol and epoxy resin sealers (P < 0.05). Mean leakage values and their associated (standard deviations) in mm were: Infinity Syringeable 2.5 (1.5), Real Seal XT 3.2 (1.4), Real Seal 3.4 (1.6), Panavia F 2.0 3.8 (2.7), GCEM 4.2 (1.8), Tubli-seal 5.4 (2.8), AH Plus 6.3 (2.3). Overall, more leakage occurred apically than coronally (P < 0.0001). Many materials exhibited dimensional instability: Marked contraction, expansion, or lack of cohesion. Conclusion: A variety of adhesive resinous materials, endodontic sealers and crown cements, reduced micro-leakage in comparison to long and widely used zinc oxide- eugenol and epoxy sealers. PMID:23833453
Gaddala, Naresh; Veeramachineni, Chandrasekhar
Background Smear layer which was formed during the instrumentation of root canals hinders the penetration of root canal sealers to root dentin and affect the bond strength of root canal sealers to root dentin. Final irrigant such as demineralizing agents are used to remove the inorganic portion of the smear layer. In the present study, peracetic acid used as a final rinse, to effect the bond strength of root canal sealers to root dentin. Aim The purpose of the present study was to evaluate the efficacy of peracetic acid as a final irrigant on bond strength of root canal sealers to root dentin. Materials and Methods Sixty six freshly extracted human single rooted mandibular premolars were used for this study. After decoronation the samples were instrumented with Protaper upto F3 and irrigated with 5.25% NaOcl. The teeth were then divided into three groups based on final irrigant used: Group-1(control group) Canals were irrigated with distilled water. Group-2: Canals were irrigated with peracetic acid. Group-3: Canals were irrigated with smear clear. Each group was further divided into three subgroups (n=30) based on the sealer used to obturate the canals. Subgroup-1: kerr, Subgroup-2: Apexit plus, Subgroup-3: AH PLUS. Each sealer was mixed and coated to master cone and placed in the canal. The bonding between sealer and dentin surface was evaluated using push out bond strength by universal testing machine. The mean bond strength values of each group were statistically evaluated using Two-way ANOVA followed by Tukey post-hoc test. Results Significant difference was found among the bond strength of the sealers. But, there is no statistically significant difference between the groups irrigated with peracetic acid and smear clear compared to control group. AH Plus showed highest bond strength irrespective of the final irrigant used. Conclusion Peracetic acid when employed as final irrigant improved the bond strength of root canal sealers compared to control group but
Stavileci, Miranda; Hoxha, Veton; Görduysus, Ömer; Tatar, Ilkan; Laperre, Kjell; Hostens, Jeroen; Küçükkaya, Selen; Berisha, Merita
Background Root canal shaping without any procedural error is of the utmost preference. Therefore, the purpose of this study was to use micro-computed tomography to evaluate and compare the root canal shaping efficacy of ProTaper rotary files and standard stainless steel K-files. Material/Methods Sixty extracted upper second premolars were selected and were divided into 2 groups of 30. Before preparation, all samples were scanned by micro-CT. Then, 30 teeth were prepared with stainless steel files and the remaining 30 with ProTaper rotary files. Canal transportation and centering ability before and after root canal shaping were assessed using micro-CT. The amount and direction of canal transportation and the centering ratio of each instrument were determined in the coronal, middle, and apical parts of the canal. The 2 groups were statistically compared using one-way ANOVA. Results ProTaper rotary files gave less transportation (p<0.001) and better centering ability (p<0.00001) compared with stainless steel files. Conclusions The manual technique for preparation of root canals with stainless steel files produces more canal transportation, whereas rotary files remain more centered in the canal. PMID:23760162
Seelan, R Gnana; Kumar, A Arvind; Emil Sam, R Jonathan; Maheswari, S Uma
Background: Root canal sealers help to minimize leakage, provides antimicrobial activity to reduce the possibility of residual bacteria, and to resolve periapical lesion. Aim: To compare five different root canal sealers against Enterococcus faecalis in an infected root canal model by using real-time polymerase chain reaction (RT-PCR). Settings and Design: Sixty human mandibular premolars were sectioned to standardize a uniform length of 14 mm. Fifty microliters of the inoculum containing E. faecalis were transferred into each microcentrifuge tube (n = 60). The samples were divided into six groups Tubli-Seal, Apexit Plus, Fillapex, AH Plus, RoekoSeal, and Positive control, respectively. Materials and Methods: Five groups after the incubation with the microorganism E. faecalis were coated with different root canal sealers and obturated using F3 ProTaper Gutta-percha point. The dentinal shavings were collected and analyzed for RT-PCR. Statistical Analysis: The mean difference between six groups was calculated using analysis of variance and post-hoc test. Results: The highest antibacterial activity was achieved with Tubli-Seal (1938.13 DNA in pictogram [pg]) and least by RoekoSeal (3034.54 DNA in pg). Conclusion: The maximum antimicrobial activity was achieved AH Plus and Tubli-Seal. RT-PCR can be used as a valuable and accurate tool for testing antimicrobial activity. PMID:26752843
Al-Sulaiman, Alaa; Al-Rasheed, Fellwa; Alnajjar, Fatimah; Al-Abdulwahab, Bander; Al-Badah, Abdulhakeem
Objectives This in vitro study aimed to investigate the ability of Candida albicans (C. albicans) and Enterococcus faecalis (E. faecalis) to penetrate dentinal tubules of instrumented and retreated root canal surface of split human teeth. Materials and Methods Sixty intact extracted human single-rooted teeth were divided into 4 groups, negative control, positive control without canal instrumentation, instrumented, and retreated. Root canals in the instrumented group were enlarged with endodontic instruments, while root canals in the retreated group were enlarged, filled, and then removed the canal filling materials. The teeth were split longitudinally after canal preparation in 3 groups except the negative control group. The teeth were inoculated with both microorganisms separately and in combination. Teeth specimens were examined by scanning electron microscopy (SEM), and the depth of penetration into the dentinal tubules was assessed using the SMILE view software (JEOL Ltd). Results Penetration of C. albicans and E. faecalis into the dentinal tubules was observed in all 3 groups, although penetration was partially restricted by dentin debris of tubules in the instrumented group and remnants of canal filling materials in the retreated group. In all 3 groups, E. faecalis penetrated deeper into the dentinal tubules by way of cell division than C. albicans which built colonies and penetrated by means of hyphae. Conclusions Microorganisms can easily penetrate dentinal tubules of root canals with different appearance based on the microorganism size and status of dentinal tubules. PMID:25383343
Azim, A A; Griggs, J A; Huang, G T-J
To determine factors that may influence treatment outcome and healing time following root canal treatment. Root filled and restored teeth by pre-doctoral students were included in this study. Teeth/roots were followed-up regularly, and treatment outcome was evaluated at every follow-up appointment (healed, healing, uncertain or unsatisfactory). Host (age, immune condition, pulp/periapical diagnosis, tooth/root type, location and anatomy) and treatment factors (master apical file size, apical extension, voids and density of root filling) were recorded from patient dental records. Univariate, bivariate and multivariate analyses were performed to determine the impact of the factors on treatment outcomes and healing times. A total of 422 roots from 291 teeth met the inclusion criteria with a mean follow-up period of 2 years. The preoperative pulp condition, procedural errors during treatment, apical extension and density of root fillings significantly affected the treatment outcome. The average time required for a periapical lesion to heal was 11.78 months. The healing time increased in patients with compromised healing, patients older than 40 years, roots with Weine type II root canal systems, root canal systems prepared to a master apical file size <35, and roots with overextended fillings (P < 0.1). Multiple host and treatment factors affected the healing time and outcome of root canal treatment. Follow-up protocols should consider these factors before concluding the treatment outcome: patient's age, immune condition, as well as roots with overextended fillings, root canal systems with smaller apical preparations (size <35) or roots with complex canal systems. Intervention may be recommended if the treatment quality was inadequate or if patients became symptomatic. © 2015 International Endodontic Journal. Published by John Wiley & Sons Ltd.
Pirani, C; Friedman, S; Gatto, M R; Iacono, F; Tinarelli, V; Gandolfi, M G; Prati, C
This retrospective study explored survival and periapical healing outcomes in teeth root filled with Thermafil obturators. Root canals of 213 teeth (94 subjects, mean age 48 ± 13 years), instrumented with a step-down technique, irrigated with 5% NaOCl and 10% EDTA and filled with Thermafil and AH Plus sealer, were involved in a recall programme. Teeth were retrospectively re-examined after 5 ± 1 years in a controlled environment. Clinical and radiographic data that were collected included the following: preoperative Periapical Index (PAI) score and signs/symptoms, treatment type, root filling length and presence/absence of voids, restoration type, follow-up PAI score and signs/symptoms. Teeth were considered 'healthy' (PAI ≤ 2, no signs/symptoms) or 'diseased' (PAI ≥ 3, signs/symptoms present, retreated, extracted for endodontic reasons). Two PAI-calibrated examiners assessed outcomes blinded to preoperative status. Bivariate and multilevel analyses were performed at level of patient and tooth (α = 5%). Of 213 teeth treated, 187 (88%) survived and 26 were extracted, six (3%) for persistent endodontic infection (considered 'diseased'), and 20 (9%) for root fracture, periodontal disease or coronal fracture (excluded from analysis). Whilst survival was significantly associated with tooth type (P = 0.015), type of treatment (P = 0.012) and pulpal/periapical diagnosis (P = 0.035), none of these variables were substantiated as survival predictors by the multilevel analysis. A total of 164 of 193 teeth (85%) were assessed as 'healthy', with significantly higher (chi-square; P < 0.04) 'healthy' rates for teeth with PAI score ≤2 and root fillings of adequate length. Multilevel analysis identified PAI score ≤2 (P = 0.002) as the only predictor of periapical health. In this 5 ± 1 year retrospective assessment, survival and healing rates after root canal treatment with Thermafil root fillings were comparable to those previously reported for
Gu, Y; Zhang, Y; Liao, Z
To investigate the relation between the radicular groove (RG) and the internal root canal morphology in mandibular first premolars by using micro-computed tomography. A total of 249 extracted mandibular first premolars were collected from a native Chinese population. After scoring the RGs according to the Arizona State University dental anthropology scoring system (ASUDAS), 148 teeth were selected and scanned by using micro-computed tomography. The root canal systems were examined two- and three-dimensionally under the software Mimics 10.01. The depth and angle of the RGs at different levels were measured. The presence of Tomes' root trait (ASU=3-5) was identified in 47/249 of the sample teeth (18.9%). The mean depths of the shallow (ASU=1), moderately deep (ASU=2) and deep grooves (ASU=3) were 0.18, 0.36 and 1.24 mm, and the mean angles were 28.8°, 47.5° and 101.7°, respectively. The incidences of complicated root canal systems were 15.5% (ASU=0), 18.7% (ASU=1), 37.0% (ASU=2) and 90.0% (ASU=3). In nine scanned specimens, accessory canals were found communicating between the main canal and the RG. Invagination canals were observed in four specimens, and C-shaped canals were found in 29 specimens (19.6%). The complexity of root canal systems in mandibular first premolars is determined by the severity of RGs, which can be scored by the ASUDAS. Detecting the incidence of various root canal forms corresponding to each ASUDAS score is useful for calculating the standardized rates from published data of dental anthropology. Understanding the anatomic features of the RG and the internal root canal system is essential for successful dental treatment. Copyright © 2013 Elsevier Ltd. All rights reserved.
Ayad, Mohamed F; Bahannan, Salma A; Rosenstiel, Stephen F
Thin-walled root canals always present a challenge to dentists to select a restorative treatment that does not further weaken the thin tooth structure. The prognosis of dowel and core restorations can be unpredictable. This clinical report describes the treatment of a patient with extensive caries extending into the root canal of an endodontically treated maxillary central incisor. The use of a flowable composite resin in combination with a quartz fiber reinforced post is described, resulting in the rehabilitation of a structurally compromised root canal with satisfactory esthetic and functional outcomes.
Parirokh, Masoud; Talebizad, Mohammad; Forghani, Farshid Reza; Haghdoost, Ali Akabar; Asgary, Saeed; Eghbal, Mohammad Jafar; Goddousi, Jamileh
This study was carried out to evaluate the bacterial leakage of root canal fillings when cavity varnish containing 5% fluoride (Duraflur) was used as root canal sealer. Root canals of 88 straight single-rooted teeth were prepared. Eighty teeth were randomly divided into 3 experimental groups (n=20) and two positive and negative control groups of ten each. The roots in group I and II were obturated with gutta-percha and AH-26 sealer using lateral condensation technique. The root canal walls in group II were coated with a layer of varnish before obturation. In group III the canals were obturated with gutta-percha and fluoride varnish as the sealer. Enterococcus faecalis (E. faecalis) was used to determine the bacterial leakage during 90 days. The Kaplan Meier survival analysis was used for assessing the leakage and log rank test was used for pairwise comparison. The rest of eight single rooted teeth were selected for scanning electron microscopy (SEM) evaluation with 5000× magnification. Leakage occurred between 20 to 89 days. Group III showed significantly less bacterial penetration than groups I and II (P=0.001 and P=0.011, respectively). However, there was no significant difference between group I and II (P>0.05). SEM evaluation showed that the varnish had covered all dentinal tubules. The present study showed promising results for the use of fluoride varnish as root canal sealer but further in vitro and in vivo studies are needed.
Parirokh, Masoud; Talebizad, Mohammad; Forghani, Farshid Reza; Haghdoost, Ali Akabar; Asgary, Saeed; Eghbal, Mohammad Jafar; Goddousi, Jamileh
Introduction: This study was carried out to evaluate the bacterial leakage of root canal fillings when cavity varnish containing 5% fluoride (Duraflur) was used as root canal sealer. Methods and Materials: Root canals of 88 straight single-rooted teeth were prepared. Eighty teeth were randomly divided into 3 experimental groups (n=20) and two positive and negative control groups of ten each. The roots in group I and II were obturated with gutta-percha and AH-26 sealer using lateral condensation technique. The root canal walls in group II were coated with a layer of varnish before obturation. In group III the canals were obturated with gutta-percha and fluoride varnish as the sealer. Enterococcus faecalis (E. faecalis) was used to determine the bacterial leakage during 90 days. The Kaplan Meier survival analysis was used for assessing the leakage and log rank test was used for pairwise comparison. The rest of eight single rooted teeth were selected for scanning electron microscopy (SEM) evaluation with 5000× magnification. Results: Leakage occurred between 20 to 89 days. Group III showed significantly less bacterial penetration than groups I and II (P=0.001 and P=0.011, respectively). However, there was no significant difference between group I and II (P>0.05). SEM evaluation showed that the varnish had covered all dentinal tubules. Conclusion: The present study showed promising results for the use of fluoride varnish as root canal sealer but further in vitro and in vivo studies are needed. PMID:25598813
Naseri, Mandana; Kharazifard, Mohammad Javad
Objectives: It is essential for clinicians to have adequate knowledge about root canal configurations; although its morphology varies largely in different ethnicities and even in different individuals with the same ethnic background. The current study aims to review the root canal configurations of mesiobuccal roots of maxillary first molars in an Iranian population based on different epidemiological studies. Materials and Methods: A comprehensive search was conducted to retrieve articles related to root canal configuration and prevalence of each type of root canal based on Vertucci’s classification for the mesiobuccal root of maxillary first molars. An electronic search was conducted in Medline, Scopus and Google Scholar from January 1984 to September 2015. The articles were evaluated and methods, population, number of teeth and percentage of each root canal type evaluated in each study were summarized in the data table. Websites such as http://www.magiran.com/ , http://health.barakatkns.com/journal-internal-list and www.sid.ir were used to search all related studies published in Persian. Results: Totally, out of nine studies conducted on the Iranian populations in nine provinces of Iran and 798 teeth, the Vertucci’s type I was the most common type (35.70%), followed by type II (30.37%), type IV (16.66%), type III (7.93%) and type V (2.61%). Conclusions: From this review article, it is concluded that the root canal morphology of mesiobuccal roots of maxillary first molars in the Iranian population predominantly has more than one canal. Therefore, careful evaluation of radiographs and anatomy of the pulp chamber is essential in order to achieve a successful root canal therapy. PMID:28243306
Hülsmann, M; Rümmelin, C; Schäfers, F
The root canals of 150 extracted mandibular incisors were prepared to ISO 30 using eight different automated devices and hand instruments. The automated devices investigated were: Endoplaner, Excalibur, Ultrasonics (Piezon Master 400) with H2O2 (5%), or NaOCl (1%) as irrigants, Giromatic, Intra-Endo 3-LDSY, Canal Finder System, Canal Leader 2000, and Endolift. Hand instrumentation was performed using reamers and Hedstroem files. Fifteen teeth were instrumented with each device, cracked longitudinally, and investigated under the scanning electron microscope using five category scoring systems based on reference photographs for debris and smear layer. No preparation system or technique resulted in complete removal of smear layer and debris. The ultrasonic unit performed best followed by the Canal Leader 2000 and hand instrumentation, whereas the use of the Giromatic, the Endolift, the Canal Finder System, and the Intra-Endo-3-LDSY-handpiece resulted in insufficiently cleaned root canal walls.
Zargar, Nazanin; Dianat, Omid; Asnaashari, Mohammad; Ganjali, Mojtaba; Zadsirjan, Saeede
One of the main goals of endodontic treatment is to decrease the harboring bacteria within the root canal system and dentinal tubules. This experimental study attempted to investigate the antibacterial efficacy of three root canal irrigants in the presence and absence of smear layer (SL). A total of 210 sound extracted human single-rooted teeth were prepared. After creating the SL and its removal in half of the samples, they were infected with Candida albicans (C. albicans) and Actinomyces israelii (A. israelii). A total of 180 specimen were used to assess the antimicrobial efficacy of the three irrigants in presence and absence of SL, 24 specimen were placed in the positive and negative controls, 2 samples were utilized for scanning electron microscopy (SEM) analysis and 2 were used for Gram staining. Then, they were exposed to irrigants including 2.61% sodium hypochlorite (NaOCl), 0.2% chlorhexidine gluconate (CHX) and 1% povidone-iodine (PI) for 5, 30 and 60 min. Presence/absence of test microorganisms was determined by incubation of specimens in test tubes containing brain-heart infusion (BHI) broth and then measuring the colony forming units (CFU) on BHI agar. A cumulative logistic model was used to analyze the ordinal response. The 2.61% solution of NaOCl was significantly more effective than 0.2% CHX and the latter was more efficient than 1% PI for decreasing fungal and microbial infection of dentinal tubules in the presence and absence of SL. The presence of smear layer decreased the efficacy of antimicrobial irrigants. The minimum time required for elimination of fungal/microbial infection was 30 min.
Zargar, Nazanin; Dianat, Omid; Asnaashari, Mohammad; Ganjali, Mojtaba; Zadsirjan, Saeede
Introduction: One of the main goals of endodontic treatment is to decrease the harboring bacteria within the root canal system and dentinal tubules. This experimental study attempted to investigate the antibacterial efficacy of three root canal irrigants in the presence and absence of smear layer (SL). Methods and Materials: A total of 210 sound extracted human single-rooted teeth were prepared. After creating the SL and its removal in half of the samples, they were infected with Candida albicans (C. albicans) and Actinomyces israelii (A. israelii). A total of 180 specimen were used to assess the antimicrobial efficacy of the three irrigants in presence and absence of SL, 24 specimen were placed in the positive and negative controls, 2 samples were utilized for scanning electron microscopy (SEM) analysis and 2 were used for Gram staining. Then, they were exposed to irrigants including 2.61% sodium hypochlorite (NaOCl), 0.2% chlorhexidine gluconate (CHX) and 1% povidone-iodine (PI) for 5, 30 and 60 min. Presence/absence of test microorganisms was determined by incubation of specimens in test tubes containing brain-heart infusion (BHI) broth and then measuring the colony forming units (CFU) on BHI agar. A cumulative logistic model was used to analyze the ordinal response. Results: The 2.61% solution of NaOCl was significantly more effective than 0.2% CHX and the latter was more efficient than 1% PI for decreasing fungal and microbial infection of dentinal tubules in the presence and absence of SL. Conclusion: The presence of smear layer decreased the efficacy of antimicrobial irrigants. The minimum time required for elimination of fungal/microbial infection was 30 min. PMID:26213540
Dostálová, T.; Jelínková, H.; Šulc, J.; Němec, M.; Koranda, P.; Bartoňová, M.; Radina, P.; Miyagi, M.; Shi, Y.-W.; Matsuura, Y.
The interest in endodontic use of dental laser systems has been increasing. With the development of thin and flexible delivery systems for various wavelengths, laser applications in endodontics may become even more desirable. The aim of this study is to check the X-ray opacity of a hollow waveguide and to observe the results after laser root canal treatment. The root canal systems of 10 molars were treated endodontically by laser. For the laser radiation source, an Er:YAG laser system generating a wavelength of 2940 nm and an Alexandrite laser system generating a wavelength of 375 nm were used. The hollow waveguide used was checked under X-ray . A root canal surface treated by laser radiation was analyzed by a scanning electron microscope (SEM). The special hollow glass waveguide used was visible in the root canal system under X-ray imaging. Surface modification of the root canal after laser treatment was not found. After conventional treatment the root canal was enlarged. The surface was covered with a smear layer. After application of both laser systems, the smear layer was removed. The resulting canal surface was found to be clean and smooth. Under SEM observation open dentinal tubules were visible. No cracks were present, nor were surface modifications observed.
Yoo, Yeon‐Jee; Baek, Seung‐Ho; Kum, Kee‐Yeon; Shon, Won‐Jun; Woo, Kyung‐Mi
Summary The application of mineral trioxide aggregates (MTA) cement during the root canal obturation is gaining concern due to its bioactive characteristic to form an apatite in dentinal tubules. In this regard, this study was to assess the biomineralization of dentinal tubules following root canal obturation by using pozzolan‐based (Pz‐) MTA sealer cement (EndoSeal MTA, Maruchi). Sixty curved roots (mesiobuccal, distobuccal) from human maxillary molars were instrumented and prepared for root canal obturation. The canals were obturated with gutta‐percha (GP) and Pz‐MTA sealer by using continuous wave of condensation technique. Canals obturated solely with ProRoot MTA (Dentsply Tulsa Dental) or Pz‐MTA sealer were used for comparison. In order to evaluate the biomineralization ability under different conditions, the PBS pretreatment before the root canal obturation was performed in each additional samples. At dentin‐material interfaces, the extension of intratubular biomineralization was analyzed using scanning electron microscopy (SEM) and energy dispersive spectroscopy. When the root canal was obturated with GP and Pz‐MTA sealer, enhanced biomineralization of the dentinal tubules beyond the penetrated sealer tag was confirmed under the SEM observation (p < 0.05). Mineralized apatite structures (calcium/phosphorous ratio, 1.45–1.89) connecting its way through the dentinal tubules were detected at 350–400 μm from the tubule orifice, and the pre‐crystallization seeds were also observed along the intra‐ and/or inter‐tubular collagen fiber. Intratubular biomineralization depth was significantly enhanced in all PBS pretreated canals (p < 0.05). Pz‐MTA cement can be used as a promising bioactive root canal sealer to enhance biomineralization of dentinal tubules under controlled environment. SCANNING 38:50–56, 2016. © 2015 The Authors. Scanning Published by Wiley Periodicals, Inc. PMID:26179659
Vivekananda Pai, A R; Mir, Shugufta; Jain, Rachit
A metallic obstruction in the root canal blocks canal cleaning and shaping procedures and requires either bypassing or retrieval. Many methods have been recommended to retrieve a metallic obstruction from the root canal. This article describes the retrieval of a metallic obstruction from the root canal of a premolar using Masserann technique to facilitate endodontic retreatment. Masserann technique is said to have limited application in posteriors. However, in this case, the obstruction was successfully retrieved by employing Masserann technique which consisted of using a trephan to cut the dentine and extractor tube to retrieve the obstruction. The retrieved obstruction was found to be a separated H-file. Endodontic retreatment was completed following the detection and negotiation of an extra canal in the same tooth. PMID:24403807
Kang, Sung Hyun; Kim, Bom Sahn; Kim, Yemi
The aims of this study were to analyze the distribution and characteristic features of cracked teeth and to evaluate the outcome of root canal treatments (RCTs) for cracked teeth. The prognostic factors for tooth survival were investigated. Over the 5-year study period, 175 teeth were identified as having cracks. Data were collected regarding the patients' age, sex, tooth type, location and direction of cracks, probing depth, pulp vitality, type of restoration, cavity classification, opposing teeth, and previous endodontic treatment history. Cracked teeth were managed via various treatment methods, and the 2-year survival rate after RCT was analyzed using the Kaplan-Meier method in which significance was identified using the log-rank test. Possible prognostic factors were investigated using Cox multivariate proportional hazards modeling. One hundred seventy-five teeth were diagnosed with cracks. Most of the patients were aged 50-60 years (32.0%) or over 60 (32.6%). The lower second molar was the most frequently (25.1%) affected tooth. Intact teeth (34.3%) or teeth with class I cavity restorations (32.0%) exhibited a higher incidence of cracks. The 2-year survival rate of 88 cracked teeth after RCT was 90.0%. A probing depth of more than 6 mm was a significant prognostic factor for the survival of cracked teeth restored via RCT. The survival rate of root-filled cracked teeth with a probing depth of more than 6 mm was 74.1%, which is significantly lower than that of teeth with probing depths of less than 6 mm (96.8%) (P = .003). Cracks were commonly found in lower second molars and intact teeth. RCT was a reliable treatment for cracked teeth with a 2-year survival rate of 90.0%. Deep probing depths were found to be a significant clinical factor for the survival of cracked teeth treated with RCT. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
Abdullah, Mariam; Ng, Yuan-Ling; Gulabivala, Kishor; Moles, David R; Spratt, David A
This study aimed to investigate and compare the efficacy of selected root canal irrigants and a medicament on a clinical isolate of Enterococcus faecalis grown as biofilm or planktonic suspension phenotype. A cell-dense pellet "presentation" prepared from planktonic phenotype was also tested. Each bacterial presentation was exposed to calcium hydroxide (pH 12.3), 0.2% chlorhexidine gluconate, 17% ethylene-diamine-tetra-acetic acid, 10% povidone iodine, or 3.0% sodium hypochlorite (NaOCl) for a range of time periods (1, 2, 4, 8, 15, 30, and 60 min). Phosphate buffered saline was used as a control agent. The difference in gradients of bacterial killing among the biofilm, planktonic suspension or pellet presentation was significant (p < 0.05) and dependent upon the test agent except in the case of NaOCl and calcium hydroxide where no difference could be detected. NaOCl was the most effective agent and achieved 100% kills for all presentations of E. faecalis after a 2 min contact time.
Segato, Raquel Assed Bezerra; Pucinelli, Carolina Maschietto; Ferreira, Danielly Cunha Araújo; Daldegan, Andiara De Rossi; Silva, Roberto S da; Nelson-Filho, Paulo; Silva, Léa A B da
This study evaluated physiochemical proprieties of a calcium hydroxide-based paste (Calen®) combined with a zinc oxide cement at different ratios (1:0.5, 1:0.65, 1:0.8 and 1:1). Materials were compared regarding setting time, pH variation, radiopacity, solubility, dimensional changes, flow and release of chemical elements. Data were analyzed statistically by ANOVA and Tukey's test (α=0.05). Longer setting time and higher dimensional changes and solubility values were exhibited by 1:0.65 and 1:0.5 ratios (p<0.05). The 1:0.5 and 1:0.65 ratios exhibited the highest pH values at all time points. All materials exhibited high radiopacity values. Significant differences were found only between 1:0.5 and 1:1 ratios for calcium and zinc release (p<0.05), whereas the amount of zirconium was similar among all groups (p>0.05). Considering the evaluated proprieties, combinations of Calen® paste with ZO at 1:0.5 and 1:0.65 ratios had the best results as root canal filling materials for use in primary teeth.
Martos, J; Gastal, M T; Sommer, L; Lund, R G; Del Pino, F A B; Osinaga, P W R
The aim of this study was to evaluate the solubility of three types of root canal sealers in three organic solvents used in endodontics. The solubility of calcium-hydroxide-based (Sealer 26), silicon-polydimethylsiloxane-based (RoekoSeal), and zinc-oxide-eugenol based (Endofill and Intrafill) sealers was assessed in eucalyptol, xylol, orange oil, and distilled water. Eighty samples of each filling material were prepared according to the manufacturers' instructions and then divided into four groups for immersion in solvent for 2 or 10 min. The means of sealer dissolution in solvents were obtained by the difference between the original preimmersion weight and the postimmersion weight in a digital analytical scale. Data were statistically analyzed with the Student's t test, and multiple comparisons were performed with Student-Newman-Keuls. Xylol and orange oil showed similar effects, with significant solubilization (P<0.05) of the tested cements. Endofill and Sealer 26 did not show any significant difference in solubilization at the two immersion times, whereas RoekoSeal and Intrafill showed a more pronounced solubility at 10 min. The lowest levels of solubilization occurred in RoekoSeal, Sealer 26, Endofill, and Intrafill. It is concluded that xylol and orange oil presented similar solvent effects with a significant solubility of the tested cements.
Harlamb, S C
Endodontic management of the permanent immature tooth continues to be a challenge for both clinicians and researchers. Clinical concerns are primarily related to achieving adequate levels of disinfection as 'aggressive' instrumentation is contraindicated and hence there exists a much greater reliance on endodontic irrigants and medicaments. The open apex has also presented obturation difficulties, notably in controlling length. Long-term apexification procedures with calcium hydroxide have proven to be successful in retaining many of these immature infected teeth but due to their thin dentinal walls and perceived problems associated with long-term placement of calcium hydroxide, they have been found to be prone to cervical fracture and subsequent tooth loss. In recent years there has developed an increasing interest in the possibility of 'regenerating' pulp tissue in an infected immature tooth. It is apparent that although the philosophy and hope of 'regeneration' is commendable, recent histologic studies appear to suggest that the calcified material deposited on the canal wall is bone/cementum rather than dentine, hence the absence of pulp tissue with or without an odontoblast layer. © 2016 Australian Dental Association.
Kierklo, Anna; Tabor, Zbisław; Petryniak, Rafał; Dohnalik, Marek; Jaworska, Małgorzata
The aim of the study was to apply microcomputed tomography to quantitative evaluation of voids and to test any specific location of voids in tooth's root canal obturations. Twenty root canals were prepared and obturated with gutta-percha and Tubli-Seal sealer using the thermoplastic compaction method (System B+Obtura II). Roots were scanned and three-dimensional visualization was obtained. The volume and Feret's diameter of I-voids (at the filling/dentine interface) and S-voids (surrounded by filling material) were measured. The results revealed that none of the scanned root canal fillings were void-free. For I-voids, the volume fraction was significantly larger, but their number was lower (P=0.0007), than for S-voids. Both types of voids occurred in characteristic regions (P<0.001). I-voids occurred mainly in the apical third, while S-voids in the coronal third of the canal filling. Within the limitations of this study, our results indicate that microtomography, with proposed semi-automatic algorithm, is a useful tools for three-dimensional quantitative evaluation of dental root canal fillings. In canals filled with thermoplastic gutta-percha and Tubli-Seal, voids at the interface between the filling and canal dentine deserve special attention due to of their periapical location, which might promote apical microleakage. Further studies might help to elucidate the clinical relevance of these results.
Pan, Hui; Cheng, Can; Hu, Jia; Liu, He; Sun, Zhi-hui
To find absorbable adhesives with suitable bonding properties for the absorbable polylactic acid root canal post. To test and compare the bond strengths of absorbable polylactic acid root canal post with three different adhesives. The absorbable polylactic acid root canal posts were used to restore the extracted teeth, using 3 different adhesives: cyanoacrylates, fibrin sealant and glass ionomer cement. The teeth were prepared into slices for micro-push-out test. The bond strength was statistically analyzed using ANOVA. The specimens were examined using microscope and the failure mode was divided into four categories: cohesive failure between absorbable polylactic acid root canal posts and adhesives, cohesive failure between dentin and adhesives, failure within the adhesives and failure within the absorbable polylactic acid root canal posts. The bond strength of cyanoacrylates [(16.83 ± 6.97) MPa] and glass ionomer cement [(12.10 ± 5.09) MPa] were significantly higher than fibrin sealant [(1.17 ± 0.50) MPa], P<0.001. There was no significant difference between cyanoacrylates and glass ionomer cement (P=0.156). In the group of cyanoacrylates, the cohesive failure between the absorbable polylactic acid root canal posts and the adhesives was 25.0%, the cohesive failure between the dentin and the adhesives was 16.7%, the failure within the adhesives was 33.3%, and the failure within the absorbable polylactic acid root canal posts was 25.0%. In the group of fibrin sealant, the cohesive failure between the absorbable polylactic acid root canal posts and the adhesives was 66.7%, the cohesive failure between the dentin and the adhesives was 22.2%, the failure within the adhesives was 11.1%. In the group of glass ionomer cement, the cohesive failure between the absorbable polylactic acid root canal posts and the adhesives was 87.5%, the failure within the adhesives was 12.5%. The major failure mode in fibrin sealant and glass ionomer cement was the cohesive failure
Ok, Evren; Ertas, Huseyin; Saygili, Gokhan; Gok, Tuba
The aim of this in vitro study was to assess and compare the effect of photoactivated disinfection (PAD) on the bond strength of root canal sealers to human root canal dentin using the push-out test. Fifteen extracted human mandibular premolar teeth with single and straight roots were used. After the clinical crowns were removed from the cementoenamel junction, root canals were prepared with the ProTaper (Dentsply Maillefer, Ballaigues, Switzerland) rotary system to the size of the F3 file. The smear layer of the roots was removed using 17% EDTA followed by 5.25% sodium hypochlorite (NaOCl) and distillate water. The roots were then randomly divided into 3 groups (n = 5) according to the final irrigation regimen. In group 1, PAD (FotoSan; CMS Dental, Copenhagen, Denmark) was applied to the root canals and light cured for 20 seconds. Group 2 was finally irrigated with a 2% solution of chlorhexidine gluconate, and group 3 served as the control group (NaOCl + EDTA). All the canals were then obturated with the lateral condensation technique using gutta-percha and AH Plus sealer (Dentsply Maillefer) sealer. One-millimeter-thick horizontal sections from the coronal and midthirds of each root (n: 5 × 4 = 20) were sliced for the push-out bond strength measurement. The data were converted to megapascals and statistically analyzed using 1-way analysis of variance and the post hoc Tukey test. There was no significant difference among the bond strength of PAD, chlorhexidine gluconate, and NaOCl (P > .05). We conclude that PAD does not adversely affect the bond strength of the AH Plus sealer to root canal dentin and that it can be used for the final disinfection of root canals. Copyright © 2013 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
Kayaoglu, Guven; Peker, Ilkay; Gumusok, Mustafa; Sarikir, Cigdem; Kayadugun, Aylin; Ucok, Ozlem
The aims of this study were to evaluate the number of roots/root canals in the mandibular anterior teeth of a Turkish population, to assess the relationship between gender or age and the frequency of two canals in a single root, and to determine the symmetry in root/root canal numbers between contralateral sides among patients. Cone-beam computed tomography images (n = 1128; 6253 teeth) taken at the Department of Dentomaxillofacial Radiology of the Faculty of Dentistry of Gazi University were examined by three observers and a supervisor, all of whom were blinded to patient gender and age. Axial, sagittal, and cross-sectional slices with a thickness of 1 mm were used. Numbers of roots and canals for each type of tooth were recorded. Most teeth had a single root and single root canal. Roots with two canals were more frequent in the incisors (14.9%, 17.2%, and 6.1% of the central incisors, lateral incisors, and canines, respectively). Teeth with two roots were more frequent in the canines (3.1% vs. 0% or 0.1%). Females more often had canines with double root canals (p < 0.001). When at least one tooth had two root canals, bilateral symmetry between contralateral teeth was found in 45.0%, 29.0%, and 28.0% of cases for central incisors, lateral incisors, and canines, respectively. Patients older than 56 years had fewer teeth with double root canals (p ≤ 0.001). A small proportion of the mandibular anterior teeth had two roots or root canals. Double root canals were mostly unilateral. Age and gender were associated with the number of root canals.
Deleu, Ellen; Meire, Maarten A; De Moor, Roeland J G
In root canal therapy, irrigating solutions are essential to assist in debridement and disinfection, but their spread and action is often restricted by canal anatomy. Hence, activation of irrigants is suggested to improve their distribution in the canal system, increasing irrigation effectiveness. Activation can be done with lasers, termed laser-activated irrigation (LAI). The purpose of this in vitro study was to compare the efficacy of different irrigant activation methods in removing debris from simulated root canal irregularities. Twenty-five straight human canine roots were embedded in resin, split, and their canals prepared to a standardized shape. A groove was cut in the wall of each canal and filled with dentin debris. Canals were filled with sodium hypochlorite and six irrigant activation procedures were tested: conventional needle irrigation (CI), manual-dynamic irrigation with a tapered gutta percha cone (manual-dynamic irrigation (MDI)), passive ultrasonic irrigation, LAI with 2,940-nm erbium-doped yttrium aluminum garnet (Er:YAG) laser with a plain fiber tip inside the canal (Er-flat), LAI with Er:YAG laser with a conical tip held at the canal entrance (Er-PIPS), and LAI with a 980-nm diode laser moving the fiber inside the canal (diode). The amount of remaining debris in the groove was scored and compared among the groups using non-parametric tests. Conventional irrigation removed significantly less debris than all other groups. The Er:YAG with plain fiber tip was more efficient than MDI, CI, diode, and Er:YAG laser with PIPS tip in removing debris from simulated root canal irregularities.
Lukač, Nejc; Zadravec, Jure; Gregorčič, Peter; Lukač, Matjaž; Jezeršek, Matija
Laser-enhanced irrigation of complex root canals appears to be a very promising technique to improve the outcome of root canal treatment. This applies, in particular, if the technique can be effective at very low laser energies in irrigating not only the main canal but also the small lateral canals. This is important in order to avoid potential undesirable effects at higher laser energies such as temperature increase, dentin ablation, or extrusion of irrigating solution beyond the apical foramen. An improved understanding of the role of laser parameters, such as laser wavelength and pulse duration, in irrigation of lateral canals is therefore desired in order to optimize treatment efficacy. The influence of laser wavelength and pulse duration on cavitation phenomena was studied using shadow photography and a method of measuring fluid flow in lateral canals based on tracking of movements of small air bubbles naturally forming in liquid as a result of laser agitation. A simulated model of a root canal including a narrow lateral canal designed to represent typical root canal morphology was used for the water flow measurements. The following three laser wavelengths with relatively high absorption in water were studied: Er:YAG (2.94 μm), Er,Cr:YSGG (2.73 μm), and Nd:YAP (1.34 μm). Among the three wavelengths studied, the Er:YAG laser wavelength was found to be the most effective in formation of cavitation bubbles and in generating fluid motions within narrow lateral canals. A comparison between the shadow photography and fluid motion data indicates that it is the bubble's radius and not the bubble's volume that predominantly influences the fluid motion within lateral canals. Based on the results of our study, it appears that effective minimally invasive laser-assisted irrigation can be performed with low Er:YAG laser pulse energies below 10 mJ.
Chrepa, Vanessa; Kotsakis, Georgios A; Pagonis, Tom C; Hargreaves, Kenneth M
Effective root canal disinfection is a fundamental component of successful root canal treatment. Photodynamic therapy (PDT) has been proposed as a new adjunctive method for additional disinfection of the root canal system with the possibility of improved treatment outcomes. The aim of this systematic review was to investigate the effect of PDT on bacterial load reduction during root canal disinfection. Two reviewers independently conducted a comprehensive literature search using a combination of medical subject heading terms and key words to identify studies relevant to the Population Intervention Control Outcome question. The selection of articles for inclusion was performed in 2 phases based on predetermined eligibility criteria according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inter-reviewer agreement for each phase was recorded. The effect of PDT on bacterial load reduction during root canal disinfection was evaluated as the primary outcome variable during data extraction. The literature search provided 57 titles and abstracts. Three articles met the inclusion criteria and were selected for this systematic review. The reasons for study exclusion in each phase were recorded. Because of the heterogeneity in clinical indications and PDT protocols among the included studies, a meta-analysis could not be performed. All included studies showed a positive effect of PDT in the reduction of microbial load in root canal treatment ranging from 91.3%-100%. Limited clinical information is currently available on the use of PDT in root canal disinfection. If supported by future clinical research, PDT may have efficacy for additional root canal disinfection, especially in the presence of multi-drug-resistant bacteria. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
Gandiban, Kanimozhi; Ramakrishnan, Mahesh
Endodontic management of the geminated tooth requires a proper understanding of root canal morphology. The use of cone beam computed tomography (CBCT) in the diagnosis of complex endodontic morphology, and in revealing morphological variations, has been well documented in the literature. A case involving endodontic management of a geminated primary central incisor with CBCT is presented here. A CBCT analysis was vital in the diagnosis of this unusual root canal system and its successful endodontic treatment.
Percha Materials Used in Root Canal Treatment INVESTIGATOR: Howard W. Roberts, Col, USAF, DC Director, Graduate Dental Research 81 DS/SGD 81...is the most widely used dental material for the obturation of root canal systems and has been used for over 100 years.1 The gutta-percha polymer...Commercially-available dental gutta-percha cones are heterogeneous materials with the polyisoprene component paradoxically not being the main constituent. Zinc
DE OLIVEIRA, BRUNA PALOMA; AGUIAR, CARLOS MENEZES; CÂMARA, ANDRÉA CRUZ; DE ALBUQUERQUE, MIRACY MUNIZ; CORREIA, ANA CRISTINA REGIS DE BARROS; SOARES, MONICA FELTS DE LA ROCA
Objective This in vitro study aimed to evaluate the efficacy of the disinfection of root canal systems carried out with ReciprocTM and ProTaper UniversalTM systems using 1% sodium hypochlorite (NaOCl). Methods Forty human single-rooted mandibular premolars were infected with Enterococcus faecalis, Pseudomonas aeruginosa, Staphylococcus aureus and Candida albicans, and twenty were not infected. The specimens were randomly divided into 6 groups (n = 10): Group 1: ProTaper UniversalTM + 1% NaOCl; Group 2 (positive control): ProTaper UniversalTM + saline; Group 3 (negative control without microorganisms): ProTaper UniversalTM + saline; Group 4: ReciprocTM + 1% NaOCl; Group 5 (positive control): ReciprocTM + saline; Group 6 (negative control without microorganisms): ReciprocTM + saline. Samples were collected before and after the completion of specific treatments, and plated in specific media cultures. The Fisher exact test was used for the statistical analysis of differences in terms of presence or absence of microbial growth among groups. For all tested pathogens, significant differences (p < 0.001) were verified between the instrumentation systems used. Results ProTaper UniversalTM associated with 1% NaOCl completely eliminated all microorganisms. Microbial growth, however, was observed when ReciprocTM was used associated with 1% NaOCl. Conclusion According to the protocol executed for this study, the ReciprocTM system associated with 1% NaOCl was not able to completely eliminate E. faecalis, P. aeruginosa, S. aureus and C. albicans from the root canal systems. PMID:27688413
Caprylic acid in the effective treatment of intractable medical problems of frequent urination, incontinence, chronic upper respiratory infection, root canalled tooth infection, ALS, etc., caused by asbestos & mixed infections of Candida albicans, Helicobacter pylori & cytomegalovirus with or without other microorganisms & mercury.
Omura, Yoshiaki; O'Young, Brian; Jones, Marilyn; Pallos, Andrew; Duvvi, Harsha; Shimotsuura, Yasuhiro
There are many causes of frequent urination. Whenever water or fluids are consumed, the patient has to urinate within 10 or 20 min. Often urinary bladder examinations & blood tests show no significant abnormalities, & treatment by anti-bacterial or anti-viral agents does not improve the symptoms significantly. In intractable frequent urination with difficulty holding urine, as well as other intractable medical problems such as frequent coughing, white pus in gingiva, infection of the apex of a root canalled tooth, slow-healing wounds, & ALS, the authors often found coexisting mixed infections of Candida albicans (C.A.), Helicobacter pylori (H.P.), & Cytomegalovirus (CMV) with or without additional bacterial (Chlamydia trachomatis, etc.) or viral infections & increased Asbestos, with or without Hg deposits. We often found various degrees of mixed infections with C.A., H.P., & CMV in the external sphincters of the urethra & in the Trigone of the urinary bladder which consists of (1) a horizontal, band-like area between the 2 ureter openings & (2) the funnel shaped part of the Trigone at the lower half of the urinary bladder. In the coexistence of significant amounts of C.A., H.P. & CMV, the infection cannot be reduced by otherwise effective medicines for H.P. & CMV. However, one optimal dose of Diflucan, or Caprylic acid taken orally or externally applied, rapidly reduced the symptoms significantly. We found the best treatment is to give a combination of an optimal dose of Caprylic acid orally in the form of "CaprilyCare" or "Caprylic Acid," with a capsule of Omega-3 Fish Oil as an anti-viral agent, Amoxicillin, Substance Z & a Cilantro tablet. We found that an optimal dose of Caprylic acid increases normal cell telomere (NCT) to a desirable 750 ng BDORT units while Diflucan increases NCT by only 25 ng BDORT units, & with Omega-3 fish oil, leads to a mutual cancellation of both drugs. Thus, Caprylic acid is superior to & less expensive than Diflucan, & has potential
Monga, Prashant; Bajaj, Nitika; Mahajan, Pardeep; Garg, Shiwani
Biomechanical preparation is one of the most important steps in endodontic therapy. Rotary instrumentation has facilitated this step. Nowadays the market is flooded with different types of rotary instruments. The present study compared the root dentinal crack formation with continuous rotating versus reciprocating root canal preparation methods. One hundred and fifty freshly extracted teeth were used for the study. They were divided into 5 groups with 30 teeth in each group. Thirty teeth were kept under control group A and no root canal preparation was done for this group. Another 30 teeth were prepared with hand files which were kept under control group B. In the experimental groups (sample size, n=30 each) root canals were prepared with ProTaper, K3XF rotary system and WaveOne. Sectioning of these teeth was done at 3, 6 and 9mm from the apex and were evaluated for the presence of any defects. Root dentinal cracks were produced with each type of rotary instruments. Statistical analysis showed no significant difference in root dentinal crack formation between control groups and WaveOne system. There was statistically significant difference in root dentinal crack formation when the canals were prepared with ProTaper and K3XF rotary system. So it was concluded, that continuous rotating instruments could produce dentinal crack formation. Root canal instruments with reciprocating movement appear to be a better option than continuous rotation movement.
Santos, Suelleng Maria Cunha; Soares, Janir Alves; César, Carlos Augusto Santos; Brito-Júnior, Manoel; Moreira, Allyson Nogueira; Magalhães, Cláudia Silami de
The aim of this study was to evaluate the standard quality of 1,347 root fillings performed by postgraduate students in Endodontics according to 3 radiographic quality parameters. The analyzed quality parameters included apical extension (AE), taper (TA) and homogeneity (HO), which received scores S2 (ideal standard), S1 (slight deviation) or S0 (accentuated deviation). A perfect filling (PF) received S2 for all parameters. In the absence of one or two S2 score, the fillings were deemed as satisfactory (SF) or deficient (DF), respectively. The results showed 51.7%, 41.5% and 6.8% of PF, SF, and DF, respectively. AE, TA, and HO presented equivalent quality parameters in root-filled canals of mandibular incisors and mandibular premolars (p>0.05). Conversely, in maxillary incisors, canines and distal root of mandibular molars, significant differences (p<0.05) were found between 2 parameters. Besides, there were significant differences (p<0.05) among the measured parameters in root-filled canals of maxillary premolars, all root canals of the maxillary molars and mesial root of the mandibular molars. AE showed the lowest frequency of S2 score for all groups. In conclusion the prevalence of perfect, satisfactory and deficient fillings varied significantly according to the root canal group. The quality parameters categorized fillings in 3 complexity degrees. AE was the most critical parameter of quality in root canal fillings.
Rao, Dhanu G; Trivedi, Malay Vishnuprasad; Havale, Raghavendra; Shrutha, S P
The aim of the present study was to evaluate and compare the sealing ability of root canal obturation after the application of fluoride varnish (MI Varnish) containing 5% sodium fluoride and casein phosphopeptide-amorphous calcium phosphate, fluoride varnish, and AH Plus and AH-Plus as root canal sealer by bacterial penetration test. Root canals of 65 single-rooted and single-canalled teeth were prepared. They were divided into three experimental groups (n = 15) and two control groups (n = 10). The root canal walls in Group I were coated with AH Plus, Group II were coated with AH Plus and fluoride varnish, and Group III were coated with fluoride varnish. All the teeth were obturated with gutta-percha using the lateral condensation technique. Enterococcus faecalis were used as test bacteria to determine the leakage during 100 days. The data were analyzed using log-rank test and Kaplan-Meier survival analysis. Group III showed significantly less bacterial penetration as compared to Group I (P = 0.01) and Group II (P = 0.03). However, there was no statistical significance between Groups I and II (P = 0.672). It can be concluded from the present study that fluoride varnish can be used as a root canal sealer. However, further in vitro and in vivo studies are required.
Verhaagen, B.; Boutsioukis, C.; Heijnen, G. L.; van der Sluis, L. W. M.; Versluis, M.
During a root canal treatment the root canal is irrigated with an antimicrobial fluid, commonly performed with a needle and a syringe. Irrigation of a root canal with two different types of needles can be modeled as an impinging axisymmetric or non-axisymmetric jet. These jets are investigated experimentally with high-speed Particle Imaging Velocimetry, inside and outside the confinement (concave surface) of a root canal, and compared to theoretical predictions for these jets. The efficacy of irrigation fluid refreshment with respect to the typical reaction time of the antimicrobial fluid with a biofilm is characterized with a non-dimensional Damköhler number. The pressure that these jets induce on a wall or at the apex of the root canal is also measured. The axisymmetric jet is found to be stable and its velocity agrees with the theoretical prediction for this type of jet, however, a confinement causes instabilities to the jet. The confinement of the root canal has a pronounced influence on the flow, for both the axisymmetric and non-axisymmetric jet, by reducing the velocities by one order of magnitude and increasing the pressure at the apex. The non-axisymmetric jet inside the confinement shows a cascade of eddies with decreasing velocities, which at the apex does not provide adequate irrigation fluid refreshment.
Niu, Li-na; Luo, Xiao-juan; Li, Guo-hua; Bortoluzzi, Eduardo A; Mao, Jing; Chen, Ji-hua; Gutmann, James L; Pashley, David H; Tay, Franklin R
The effects of different EndoActivator® (EA) sonic activation protocols on root canal debridement efficacy were examined. Root canals in 48 single-rooted teeth were instrumented, irrigated initially with NaOCl and divided into 6 groups (N=8) based on the application time of QMix (antimicrobial calcium-chelating irrigant), and the time and sequence of EA irrigant activation - Positive Control: 90s QMix; Negative Control: 90s saline; Group 1A: 15s QMix+15s QMix with EA-activation; Group 1B: 30s QMix+30s of QMix with EA-activation; Group 2A: 15s QMix with EA-activation+15s QMix; Group 2B: 30s QMix with EA-activation+30s QMix. Split roots were examined with scanning electron microscopy for assignment of smear and debris scores in locations along the coronal, middle and apical thirds of the canals. The overall cleanliness of pooled canal locations in the Positive Control and the 4 experimental groups were compared with chi-square tests. Significant differences were detected among the 5 groups (P<0.001). Post hoc pairwise comparisons indicated that the overall canal cleanliness was in the order (from best to worst): 1B=2B>2A>1A>Positive Control. Completely clean canals could not be achieved due to the absence of continuous irrigant flow for EA to clear intraradicular debris. Irrespective of the sonic activation sequence, irrigant activation for 30s during a 60-s period of QMix application appears to maximise the smear layer and debris removal potential of the EndoActivator® system. Sonic activation of root canal irrigants produces cleaner root canals and reduces the time required for final delivery of a canal wall smear later-removing irrigant when compared to the use of needle irrigation alone. Published by Elsevier Ltd.
Nur, Bilge Gulsum; Ok, Evren; Altunsoy, Mustafa; Tanriver, Mehmet; Capar, Ismail Davut
Objective: The aim of this study was to compare the fracture strength of roots instrumented with three different single file rotary systems in curved mesial root canals of maxillary molars. Materials and Methods: Curvatures of 25°–35° on mesial roots of 60 maxillary molar teeth were sectioned below the cementoenamel junction to obtain roots 11 mm in length. The roots were balanced with respect to buccolingual and mesiodistal diameter and weight. They were distributed into three experimental groups and one control group (no instrumentation) (n = 15): Reciproc rotary file (R25, VDW, Munich, Germany), WaveOne Primary rotary file (Dentsply Tulsa Dental Specialties, Tulsa, UK) and OneShape (Micro-Mega, Besancon, France) rotary file. Vertical load was applied until fracture occurred. Data were statistically analyzed using one-way analysis of variance test (P < 0.05). Results: The mean fracture load was 412 ± 72 Newton (N) for the control group, 395 ± 69 N for the Reciproc group, 373 ± 63 N for the WaveOne group and 332 ± 68 N for the OneShape group. The fracture load differences among three experimental groups were not statistically significant (P > 0.05.) Whereas, the fracture loads of control and OneShape groups were significantly different (P = 0.012). Conclusions: Fracture resistance of the roots instrumented with WaveOne and Reciproc file systems were similar to the control group whereas it was observed that OneShape rotary file systems enhance the fracture strength of standardized curved roots when compared with the control group. PMID:26038648
Nur, Bilge Gulsum; Ok, Evren; Altunsoy, Mustafa; Tanriver, Mehmet; Capar, Ismail Davut
The aim of this study was to compare the fracture strength of roots instrumented with three different single file rotary systems in curved mesial root canals of maxillary molars. Curvatures of 25°-35° on mesial roots of 60 maxillary molar teeth were sectioned below the cementoenamel junction to obtain roots 11 mm in length. The roots were balanced with respect to buccolingual and mesiodistal diameter and weight. They were distributed into three experimental groups and one control group (no instrumentation) (n = 15): Reciproc rotary file (R25, VDW, Munich, Germany), WaveOne Primary rotary file (Dentsply Tulsa Dental Specialties, Tulsa, UK) and OneShape (Micro-Mega, Besancon, France) rotary file. Vertical load was applied until fracture occurred. Data were statistically analyzed using one-way analysis of variance test (P < 0.05). The mean fracture load was 412 ± 72 Newton (N) for the control group, 395 ± 69 N for the Reciproc group, 373 ± 63 N for the WaveOne group and 332 ± 68 N for the OneShape group. The fracture load differences among three experimental groups were not statistically significant (P > 0.05.) Whereas, the fracture loads of control and OneShape groups were significantly different (P = 0.012). Fracture resistance of the roots instrumented with WaveOne and Reciproc file systems were similar to the control group whereas it was observed that OneShape rotary file systems enhance the fracture strength of standardized curved roots when compared with the control group.
Stavileci, Miranda; Hoxha, Veton; Görduysus, Ömer; Tatar, Ilkan; Laperre, Kjell; Hostens, Jeroen; Küçükkaya, Selen; Muhaxheri, Edmond
Background Complete mechanical preparation of the root canal system is rarely achieved. Therefore, the purpose of this study was to evaluate and compare the root canal shaping efficacy of ProTaper rotary files and standard stainless steel K-files using micro-computed tomography. Material/Methods Sixty extracted upper second premolars were selected and divided into 2 groups of 30 teeth each. Before preparation, all samples were scanned by micro-computed tomography. Thirty teeth were prepared with the ProTaper system and the other 30 with stainless steel files. After preparation, the untouched surface and root canal straightening were evaluated with micro-computed tomography. The percentage of untouched root canal surface was calculated in the coronal, middle, and apical parts of the canal. We also calculated straightening of the canal after root canal preparation. Results from the 2 groups were statistically compared using the Minitab statistical package. Results ProTaper rotary files left less untouched root canal surface compared with manual preparation in coronal, middle, and apical sector (p<0.001). Similarly, there was a statistically significant difference in root canal straightening after preparation between the techniques (p<0.001). Conclusions Neither manual nor rotary techniques completely prepared the root canal, and both techniques caused slight straightening of the root canal. PMID:26092929
Stavileci, Miranda; Hoxha, Veton; Görduysus, Ömer; Tatar, Ilkan; Laperre, Kjell; Hostens, Jeroen; Küçükkaya, Selen; Muhaxheri, Edmond
Complete mechanical preparation of the root canal system is rarely achieved. Therefore, the purpose of this study was to evaluate and compare the root canal shaping efficacy of ProTaper rotary files and standard stainless steel K-files using micro-computed tomography. Sixty extracted upper second premolars were selected and divided into 2 groups of 30 teeth each. Before preparation, all samples were scanned by micro-computed tomography. Thirty teeth were prepared with the ProTaper system and the other 30 with stainless steel files. After preparation, the untouched surface and root canal straightening were evaluated with micro-computed tomography. The percentage of untouched root canal surface was calculated in the coronal, middle, and apical parts of the canal. We also calculated straightening of the canal after root canal preparation. Results from the 2 groups were statistically compared using the Minitab statistical package. ProTaper rotary files left less untouched root canal surface compared with manual preparation in coronal, middle, and apical sector (p<0.001). Similarly, there was a statistically significant difference in root canal straightening after preparation between the techniques (p<0.001). Neither manual nor rotary techniques completely prepared the root canal, and both techniques caused slight straightening of the root canal.
Ghasemi, Negin; Rahimi, Saeed; Shahi, Shahriar; Samiei, Mohammad; Frough Reyhani, Mohammad; Ranjkesh, Bahram
Introduction: The complexity of the root canal system presents a challenge for the practitioner. This systematic review evaluated the papers published in the field of root canal anatomy and configuration of the root canal system in permanent maxillary second molars. Methods and Materials: All articles related to the root morphology and root canal anatomy of the permanent maxillary second molars were collected by suitable keywords from PubMed database. The exhaustive search included all publications from 1981 to December 2015. The articles relevant to the study were evaluated and data was extracted. The author/year of publication, country, number of the evaluated teeth, type of study (method of the evaluation), number of roots and the canals, type of canals and the morphology of the apical foramen was noted. Results: The highest studied populations were in Brazil and United States. A total of 116 related papers were found, which had investigated 11945 teeth in total. Across all the studied populations, the three-rooted anatomy was most common, while the four-rooted anatomy had the lowest prevalence. The presence of the second mesiobuccal canal ranged from 11.53 % to 93.7%, where type II (2-1) configuration was the predominant type in Brazil and USA and types II and III (1-2-1) in Chinese populations. In 8.8-44% of cases, fusion was observed. The main reported cases were related to palatal root. The major method of anatomical investigation in case reports was periapical radiography, and the chief method in morphological studies was CBCT. Conclusion: The clinicians should be aware of normal morphology and anatomic variations to reduce the treatment failure. PMID:28179915
Chandak, Manoj; Jain, Pradeep; Patni, Mona Jain; Jain, Sumeet; Mishra, Prashant; Jain, Vikas
Introduction The most commonly used core material for root canal filling is gutta-percha and as the gutta-percha by itself cannot obturate the complete root canal system, owing to its poor sealing properties hence, a sealer is used in combination with root filling material. Sealer is more important than the core obturating material. Sealer plays a secondary role by merely reinforcing (binding or luting) the gutta-percha to the canal walls, however, it is now confirmed that the sealer has a prime role in sealing the canal by blocking the irregularities between the canal space and the core filling material. Aim To investigate the effectiveness of the apical seal obtained by different sealers used in conjugation with cold lateral condensation technique of obturation using gutta-percha under stereomicroscope. Materials and Methods One hundred single-rooted extracted human permanent teeth with a single root canal were used in this in-vitro study. The sealers tested were conventional Zinc oxide eugenol sealer, Apexit, AH-Plus and Roekoseal Automix (RSA). The specimens were examined under a stereomicroscope. For the analysis of data Snedocor’s F test for the quality of variances among the experimental group and control group (One-Way ANOVA) were employed. Results The polydimethylsiloxane endodontic root canal sealer RSA provided a significantly better apical seal followed by AH plus and Apexit whereas conventional zinc oxide eugenol showed the lowest sealing ability. Conclusion It was concluded that there were statistically significant differences amongst the experimental groups. The shrinkage related to setting and potential dissolution might risk the proper seal of the root canal leading to treatment failure. PMID:27656560
Jain, Atul; Bahuguna, Rachana
Background: Knowledge about root canal morphology and its frequent variations can exert considerable influence on the success of endodontic treatment. The aim of this study was to survey the root canal morphology of mandibular first premolar teeth in a Gujarati population by decalcification and clearing technique. Methods: One hundred thirty eight extracted mandibular first premolar teeth were collected from a Gujarati population. After decalcifying and clearing, the teeth were examined for tooth length, number of cusps and roots, number and shape of canal orifices and canal types. Results: The average length of mandibular first premolar teeth was 21.2 mm. All the teeth had 2 cusps. One hundred thirty four teeth (97.1%) had one root, and just 4 teeth (2.89%) had two roots. Mesial invagination of root was found in 21 teeth (15.21%). One canal orifice was found in 122 teeth (88.4%) and two canal orifices in 16 teeth (11.59%). Shape of orifices was found to be round in 46 teeth (33.33%), oval in 72 teeth (52.17%) and flattened ribbion in 20 teeth (14.49%). According to Vertucci's classification, Type I canal system was found in 93 teeth (67.39%), Types II,III,IV,V,and VI in 11 teeth (7.97%), 5 teeth (3.62%), 4 teeth (2.89%), 24 teeth (17.39%), and 1 tooth (0.72%) respectively. Conclusion: Mandibular first premolar teeth were mostly found to have one root and Type I canal system. PMID:22013473
Karagöz-Küçükay, Işil; Ersev, Handan; Engin-Akkoca, Ece; Küçükay, Sedat; Gürsoy, Tankut
The purpose of this study was to evaluate the influence of Hero 642 rotary Ni-Ti instruments driven at 300, 400, or 600 rpm on root canal straightening, loss of working length, and instrument breakage. Sixty mesial root canals from extracted human mandibular molars were divided into 3 groups of 20 each and were instrumented at the aforementioned rotational speeds with a crown-down technique. Using a digital intraoral radiography system directly on the images of pre- and postoperative radiographs, degrees of canal curvatures were measured and recorded. Statistical analysis showed that final canal curvatures and working lengths were significantly reduced compared with those of original values in each group (p < 0.001). However, using Hero 642 rotary Ni-Ti system at different rotational speeds had no effect on canal curvature and working length alterations (p > 0.05). No file breakage was observed in any of the groups.
Yang, Ying-Ming; Guo, Bin; Guo, Li-Yang; Yang, Yan; Hong, Xiao; Pan, Hong-Ying
Root canal calcification is considered a great challenge during root canal treatment. Although the application of ultrasonic instruments and dental operating microscope (DOM) has advantages, dealing with calcified root canals still suffers a great risk of failure because of limited information about the location, length, and direction of obliteration on periapical radiographs. In this work, a cone-beam computed tomography- (CBCT-) aided method aimed at solving complicated calcified root canals in which conventional approaches could not work was proposed. Thirteen teeth with sixteen calcified canals (12 calcified in the upper third, 4 calcified in the middle third), which cannot be negotiated with conventional methods, were treated with the aid of CBCT. The location of calcification and depth of instrumentation and operating direction were calculated and assessed in three dimensions with ultrasonic instruments under DOM. In all thirteen teeth, canals with upper and middle thirds calcification were treated successfully. Finally, a guideline was proposed to help achieve consistent apical patency in calcified canals. PMID:27525269
Jang, Ju-Kyong; Peters, Ove A; Lee, Woocheol; Son, Sung-Ae; Park, Jeong-Kil; Kim, Hyeon-Cheol
The purpose of this study was to evaluate the prevalence of three-rooted permanent mandibular first molars (PMFMs) with four canals and their morphological characteristics among a Korean population from using cone-beam computed tomography scans (CBCTs). Among the 705 CBCTs screened, 472 patient cases possessing at least one PMFM were identified. A total of 780 PMFMs were evaluated in axial section series to determine the number of roots and canals. The incidences of three-rooted PMFMs were compared with regard to gender and location. For distal root(s) with two canals, inter-orifice distances (IOD) between distobuccal and distolingual canals were measured at pulpal floor and furcation levels. The difference of IOD between males and females was also analyzed using chi-square tests. Among the 472 CBCTs of 225 females and 247 males, 84 females and 107 males were found to have at least one three-rooted PMFM. Among the 780 PMFMs, 191 PMFMs (24.5%, 89 of 397 left and 102 of 383 right) were found to have three roots. The prevalence of distal root(s) with two canals was 34.2% (267 of 780). From the molars with two distal canals, the mean IOD between distobuccal and distolingual canals at the pulpal floor level was 3.1 mm in males and 2.9 mm in females (p = 0.0428). The occurrence of three-rooted PMFMs among a Korean population was 24.5% and was higher than other countries and ethnicities. Understanding the prevalence of PMFMs with a distolingual root and/or canal in a Korean population and the IOD between distobuccal and distolingual canals may be useful for successful endodontic treatments. Acknowledgment of potential incidence of three-rooted permanent mandibular first molars with four canals and the distance between two distal canals may increase the success rate of root canal treatment by reducing the missing canal untreated.
Cecchin, Doglas; Farina, Ana Paula; Souza, Matheus Albino; Pereira, Charles Da Cunha
To evaluate the effects of different root-canal sealers on the bond strength of a fiberglass post cemented with self-adhesive resin cements. Forty extracted maxillary single-rooted canines were prepared with the crown-down technique and randomly divided into four groups according to the tested sealer: Group 1: control group, gutta-percha cone only (no sealer); Group 2: EndoREZ; Group 3: Sealapex; Group 4: Endofill. The roots were obturated with the gutta-percha cone using the cold lateral compaction technique. Fiberglass posts were cemented into the prepared post spaces with the self-adhesive cement RelyX Unicem. Bonded specimens were sectioned into 1-mm thick slabs and a push-out test was performed in a universal machine. Data were subjected to ANOVA and Tukey tests (α = 0.05). No significant difference was detected between Groups 1-3 (P > 0.05). Group 4 showed a lower bond strength than the other sealers (P < 0.05). Endofill negatively interfered with the bond to root dentine; however, EndoRez and Sealapex did not affect the bond strength of the fiberglass post cemented with self-adhesive resin cements.
Lassila, Lippo V J; Tanner, Johanna; Le Bell, Anna-Maria; Narva, Katja; Vallittu, Pekka K
Fiber-reinforced composite (FRC) root canal posts have been introduced to be used instead of metal alloys and ceramics. The aim of this study was to investigate the flexural properties of different types of FRC posts and compare those values with a novel FRC material for dental applications. Seventeen different FRC posts of various brands (Snowpost, Carbopost, Parapost, C-post, Glassix, Carbonite) and diameters, (1.0-2.1 mm) and a continuous unidirectional E-glass FRC polymerized by light activation to a cylindrical form (everStick, diameter 1.5 mm) as a control material were tested. The posts (n=5) were stored at room's humidity or thermocycled (12.000 x, 5 degrees C/55 degrees C) and stored in water for 2 weeks before testing. A three-point bending test (span=10 mm) was used to measure the flexural strength and modulus of FRC post specimens. Analysis of ANOVA revealed that thermocycling, brand of material and diameter of specimen had a significant effect (p<0.001) on the fracture load and flexural strength. The highest flexural strength was obtained with the control material (everStick, 1144.9+/-99.9 MPa). There was a linear relationship between fracture load and diameter of posts for both glass fiber and carbon fiber posts. Thermocycling decreased the flexural modulus of the tested specimens by approximately 10%. Strength and fracture load decreased approximately 18% as a result of thermocycling. Considerable variation can be found in the calculated strength values of the studied post brands. Commercial prefabricated FRC posts showed lower flexural properties than an individually polymerised FRC material.
Bahrololoomi, Zahra; Ghafourifard, Roya; Soleimani, Ali Asghar
Single rooted primary mandibular first molar is a rare developmental anomaly. Literatures reveal that failure of invagination of Hertwig’s epithelial root sheath leads to this unusual root form. Thorough knowledge of root canal morphology and anatomical variations of primary teeth can help a pediatric dentist in successful root canal treatment. Hereby, we describe two cases of primary mandibular first molars with an unusual morphology as a single root called pyramidal molar. PMID:25628671
Mente, Johannes; Werner, Sabine; Koch, Martin Jean; Henschel, Volkmar; Legner, Milos; Staehle, Hans Joerg; Friedman, Shimon
This study assessed the apical leakage of ultrasonically condensed root fillings in extremely large canals, compared to cold lateral condensation and thermoplastic compaction. Ninety single-rooted teeth were used. In 45 teeth canals were enlarged to size 70 (large). The remaining 45 canals were enlarged to size 140 (extremely large). Each set of teeth was subdivided into three root-filling groups (n = 15): (1) cold lateral condensation (LC); (2) thermoplastic compaction (TC); and (3) ultrasonic lateral condensation (UC). Teeth in all six subgroups were subjected to drawing ink penetration, cleared, and evaluated for linear apical dye leakage. Significantly deeper dye penetration (p < 0.04, Wilcoxon rank-sum test) was observed for LC than for UC. TC did not differ significantly from LC and UC. Dye penetration was significantly deeper (p < 0.0001) in canals enlarged to size 140 than to size 70, independent of root-filling method. Apical leakage associated with ultrasonically condensed root fillings was less than that with cold lateral condensation. It was consistently greater in extremely large canals than that in large ones.
Soleymani, Ali; Namaryan, Nafiseh; Moudi, Ehsan; Gholinia, Ali
Introduction: The present study was conducted to assess the morphology of mandibular canines using cone-beam computed tomography (CBCT) in a north Iranian population. Methods and Materials: For the morphological assessment of mandibular canines, 150 CBCT images taken from patients for different reasons were used. The mandibular canines were examined in sagittal, coronal and axial dimensions. The canal pattern, number of roots/canals, the tooth length, the orientation of the roots and the position of the apical foramina were evaluated and the effect of gender on each variable was assessed. The obtained data were analyzed using the Chi-square and student’s t-tests. Results: According to the Vertucci’s criteria, the most common pattern was type I morphology (89.7%), followed by types III (5.7%), II (3.7%) and V (1%). No significant differences were observed between the male and female patients in terms of canal type (P>0.05). Gender difference is a factor which affected the root length and the number of mandibular canine root and root canal. There were 296 single-root and four double-root canines. The double-root canines and mandibular canine with two canals were significantly more common among men than women (P=0.00). The apical foramen was laterally positioned in 68.3% and centrally in 31.7% of the cases, and the root curvatures were mostly oriented toward the buccal region. No significant statistical difference was observed for mentioned parameters in right and left half of the jaw. Conclusion: Due the diverse morphology and the potential presence of a second mandibular canine among Iranians, dentists should perform endodontic treatments with greater care. CBCT is an accurate tool for the morphological assessment of root canals. PMID:28179930
Bodrumlu, Emre; Parlak, Esra; Bodrumlu, Ebru Hazar
The aim of this study was to assess the effect of three root canal irrigation solutions on the apical sealing ability of three root canal obturation materials: gutta-percha/AH plus or MM-seal and Resilon/Epiphany SE. A total of 100 teeth with single straight root canals were randomly divided into three equal groups of 30 samples each, with the other 10 teeth (5 positive and 5 negative) used as controls. Each irrigation group was divided into three groups according to the use of three different root canal obturation materials (n = 10): Gutta-percha with AH plus or MM-seal, Resilon with Epiphany SE. The crowns were removed at the cementoenamel junction with a diamond disc under water coolant. The root canals were prepared using step-back technique and irrigation with either sodium hypochlorite (2.5%), chlorhexidine (2%), or MTAD solutions. The roots were obturated with lateral condensation technique using one of the obturation materials. The root surfaces was coated with two layer nail varnish (except apex), placed in 2% methylene blue dye solution, and centrifuged at 3,000 rpm for 5 minutes. Irrigation solutions affected the apical sealing ability of all the sealers. The chlorhexidine irrigation solution exhibited higher apical leakage values than did MTAD and NaOCl in all canal sealers, although the MTAD irrigation solution groups showed the least leakage values. The apical sealing ability of AH plus, Epiphany SE and MM-seal root canal sealers decreased when the chlorhexidine was used as an irrigation solution.
Krishnaswamy, Manjunath Mysore
Introduction Success of any endodontic treatment depends on strict adherence to ‘endodontic triad’. Preparation of root canal system is recognized as being one of the most important stages in root canal treatment. At times, we inevitably end up damaging root dentin which becomes a Gateway for infections like perforation, zipping, dentinal cracks and minute intricate fractures or even vertical root fractures, thereby resulting in failure of treatment. Several factors may be responsible for the formation of dentinal cracks like high concentration of sodium hypochlorite, compaction methods and various canal shaping methods. Aim To compare and evaluate the effects of root canal preparation techniques and instrumentation length on the development of apical root cracks. Materials and Methods Seventy extracted premolars with straight roots were mounted on resin blocks with simulated periodontal ligaments, exposing 1-2 mm of the apex followed by sectioning of 1mm of root tip for better visualization under stereomicroscope. The teeth were divided into seven groups of 10 teeth each – a control group and six experimental groups. Subgroup A & B were instrumented with: Stainless Steel hand files (SS) up to Root Canal Length (RCL) & (RCL –1 mm) respectively; sub group C & D were instrumented using ProTaper Universal (PTU) up to RCL and (RCL -1mm) respectively; subgroup E & F were instrumented using ProTaper Next (PTN) up to RCL & (RCL -1 mm) respectively. Stereomicroscopic images of the instrumentation sequence were compared for each tooth. The data was analyzed statistically using descriptive analysis by ‘Phi’ and ‘Cramers’ test to find out statistical significance between the groups. The level of significance was set at p< 0.05 using SPSS software. Results Stainless steel hand file group showed most cracks followed by ProTaper Universal & ProTaper Next though statistically not significant. Samples instrumented up to 1mm short of working length (RCL-1mm) showed
Kumari, Manju Raj; Krishnaswamy, Manjunath Mysore
Success of any endodontic treatment depends on strict adherence to 'endodontic triad'. Preparation of root canal system is recognized as being one of the most important stages in root canal treatment. At times, we inevitably end up damaging root dentin which becomes a Gateway for infections like perforation, zipping, dentinal cracks and minute intricate fractures or even vertical root fractures, thereby resulting in failure of treatment. Several factors may be responsible for the formation of dentinal cracks like high concentration of sodium hypochlorite, compaction methods and various canal shaping methods. To compare and evaluate the effects of root canal preparation techniques and instrumentation length on the development of apical root cracks. Seventy extracted premolars with straight roots were mounted on resin blocks with simulated periodontal ligaments, exposing 1-2 mm of the apex followed by sectioning of 1mm of root tip for better visualization under stereomicroscope. The teeth were divided into seven groups of 10 teeth each - a control group and six experimental groups. Subgroup A & B were instrumented with: Stainless Steel hand files (SS) up to Root Canal Length (RCL) & (RCL -1 mm) respectively; sub group C & D were instrumented using ProTaper Universal (PTU) up to RCL and (RCL -1mm) respectively; subgroup E & F were instrumented using ProTaper Next (PTN) up to RCL & (RCL -1 mm) respectively. Stereomicroscopic images of the instrumentation sequence were compared for each tooth. The data was analyzed statistically using descriptive analysis by 'Phi' and 'Cramers' test to find out statistical significance between the groups. The level of significance was set at p< 0.05 using SPSS software. Stainless steel hand file group showed most cracks followed by ProTaper Universal & ProTaper Next though statistically not significant. Samples instrumented up to 1mm short of working length (RCL-1mm) showed lesser number of cracks. All groups showed cracks formation
Pazelli, Luciana Cunha; Freitas, Aldevina Campos de; Ito, Izabel Yoko; Souza-Gugelmin, Maria Cristina Monteiro de; Medeiros, Alexandra Sárzyla; Nelson-Filho, Paulo
The objective of this study was to evaluate bacterial prevalence in 31 root canals of human deciduous teeth with necrotic pulp and periapical lesions using bacterial culture. After crown access, the material was collected using absorbent paper points for microbiological evaluation and determination of colony forming units (CFU). Anaerobic microorganisms were found in 96.7% of the samples, black-pigmented bacilli in 35.5%, aerobic microorganisms in 93.5%, streptococci in 96.7%, and S. mutans in 48.4%. We concluded that in human deciduous teeth root canals with necrotic pulp and periapical lesions the infection is polymicrobial, with a large number of microorganisms and a predominance of streptococci and anaerobic microorganisms.
The most common configuration of the mandibular first molar is the presence of two roots and three root canals. The objective of this work is to present two rare anatomic configurations with six root canals on two mandibular left first molars diagnosed during endodontic therapy. Root canal therapy was performed using a dental operating microscope. Ultrasonic troughing in the grooves in between the mesial root canals and in between the distal root canals was able to show the middle root canals. Large samples population characterization researches and systematic reviews were unable to detect a single case of six root canals configuration in a mandibular first molar in their investigations. Although it is a rare configuration, a six root canal configuration is possible to be found in the mandibular first molar. Three different pulp chamber configurations are possible to be found. Two or three roots may be present and the root configuration more common in the mesial root is the Type 8 and Type 12 for the distal root. Some concepts about the required technique to approach these cases are also debated. PMID:26023651
Amoroso-Silva, Pablo Andrés; Ordinola-Zapata, Ronald; Duarte, Marco Antonio Hungaro; Gutmann, James L; del Carpio-Perochena, Aldo; Bramante, Clovis Monteiro; de Moraes, Ivaldo Gomes
The goal of the present study was to evaluate the morphometric aspects of the internal anatomy of the root canal system of mandibular second molars with C-shaped canals. Fifty-two extracted second mandibular molars with C-shaped canals, fused roots, and radicular grooves were selected from a Brazilian population. The samples were scanned with a micro-computed tomographic scanner at a voxel size of 19.6 μm. The root canal cross sections were recorded as C1, C2, C3, and C4 root canal configurations according to the modified Melton classification. Morphometric parameters, including the major and minor diameters of the root canals, the aspect ratio, the roundness, and the tridimensional configuration (merging, symmetric, and asymmetric), were evaluated. The 3-dimensional reconstruction images of the teeth indicated an even distribution within the sample. The analysis of the prevalence of the different cross-sectional configurations of the C-shaped molars revealed that these were predominantly of the C4 and C3 configurations (1 mm from the apex) and the C1 and C2 configurations in the cervical third. According to the morphometric parameters, the C1 and the distal aspect of the C2 configurations exhibited the lowest roundness values and higher values for the area, major diameter, and aspect ratio in the apical third. Mandibular molars with C-shaped root canals exhibited similar distributions of symmetric, asymmetric, and merging type canals. The C1 configuration and the distal aspect of the C2 configuration exhibited the highest area values, low roundness values, and large apical diameters. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
Background Previous reports indicate that worldwide, the technical quality of root canal fillings is poor. There are few reports from sub-Saharan Africa and none yet from Nigeria where most patients access treatment from non-specialists especially at general dental clinics. The aim of this study was to evaluate the technical quality of root canal fillings done in a general dental clinic with emphasis on the effects of professional experience of the operator, whether tooth was anterior or posterior and whether it was a maxillary or mandibular tooth. Methods Retrospective study of case notes and periapical radiographs of patients with completed root canal fillings seen between 2008 and 2011. Inclusion criteria included cases of primary treatment with available case notes, good quality pre-operative and post-operative periapical radiographs. Technical quality that was assessed was root canal length and homogeneity. Root canal fillings were classified either as Good Quality Endodontic Work (GQEW) or Non- Good Quality Endodontic Work (NGQEW). Results Fifty-one patients aged between 8 and 54 years (mean 28) fulfilled the inclusion criteria for this study. From these, there were 62 root filled teeth giving a ratio of 1.2 root canal filled teeth per person. There were acceptable length of root canal fillings in 71% of teeth, 58.1% were homogeneous while 53.2% were GQEW. There was no statistically significant difference in whether tooth was root filled by junior or senior dentist (p = 0.43), anterior or posterior (p = 0.11). There was significant association between GQEW and maxillary teeth (p = 0.03). Conclusion This study showed that the overall technical quality of root canal fillings done by non-specialists was better than earlier reports but lower than that done by endodontists. Since many patients receive treatment from non-specialists in developing countries, it is necessary to improve technical quality of root canal fillings done in general dental
Adebayo, Ezekiel Taiwo; Ahaji, Lilian Ejije; Nnachetta, Rita Nneka; Nwankwo, Olaitan; Akabogu-Okpeseyi, Nonye; Yaya, Morufu Olasunkanmi; Hussain, Nurudeen Ayoola
Previous reports indicate that worldwide, the technical quality of root canal fillings is poor. There are few reports from sub-Saharan Africa and none yet from Nigeria where most patients access treatment from non-specialists especially at general dental clinics. The aim of this study was to evaluate the technical quality of root canal fillings done in a general dental clinic with emphasis on the effects of professional experience of the operator, whether tooth was anterior or posterior and whether it was a maxillary or mandibular tooth. Retrospective study of case notes and periapical radiographs of patients with completed root canal fillings seen between 2008 and 2011. Inclusion criteria included cases of primary treatment with available case notes, good quality pre-operative and post-operative periapical radiographs. Technical quality that was assessed was root canal length and homogeneity. Root canal fillings were classified either as Good Quality Endodontic Work (GQEW) or Non- Good Quality Endodontic Work (NGQEW). Fifty-one patients aged between 8 and 54 years (mean 28) fulfilled the inclusion criteria for this study. From these, there were 62 root filled teeth giving a ratio of 1.2 root canal filled teeth per person. There were acceptable length of root canal fillings in 71% of teeth, 58.1% were homogeneous while 53.2% were GQEW. There was no statistically significant difference in whether tooth was root filled by junior or senior dentist (p=0.43), anterior or posterior (p=0.11). There was significant association between GQEW and maxillary teeth (p=0.03). This study showed that the overall technical quality of root canal fillings done by non-specialists was better than earlier reports but lower than that done by endodontists. Since many patients receive treatment from non-specialists in developing countries, it is necessary to improve technical quality of root canal fillings done in general dental clinics. These could be through improvement in the quality of
Solovyeva, A M; Dummer, P M
The aim of this study was to evaluate the potential of electrochemically activated (ECA) anolyte and catholyte solutions to clean root canals during conventional root canal preparation. Twenty extracted single-rooted human mature permanent teeth were allocated randomly into four groups of five teeth. The pulp chambers were accessed and the canals prepared by hand with conventional stainless steel endodontic instruments using a double-flared technique. One or other of the following irrigants was used during preparation: distilled water, 3% NaOCl, anolyte neutral cathodic (ANC) (300 mg L-1 of active chlorine), and a combination of anolyte neutral cathodic (ANC) (300 mg L-1 of active chlorine) and catholyte. The teeth were split longitudinally and the canal walls examined for debris and smear layer by scanning electron microscopy. SEM photomicrographs were taken separately in the coronal, middle and apical parts of canal at magnification of x800 to evaluate the debridement of extracellular matrix and at a magnification of x2500 to evaluate the presence of smear layer. Irrigation with distilled water did not remove debris in the apical part of canals and left a continuous and firm smear layer overlying compressed low-mineralized predentine. All chemically active irrigants demonstrated improved cleaning potential compared to distilled water. The quality of loose debris elimination was similar for NaOCl and the anolyte ANC solution. The combination of anolyte ANC and catholyte resulted in improved cleaning, particularly in the apical third of canals. The evaluation of smear layer demonstrated that none of the irrigants were effective in its total removal; however, chemically active irrigants affected its surface and thickness. Compared to NaOCl, the ECA solutions left a thinner smear layer with a smoother and more even surface. NaOCl enhanced the opening of tubules predominantly in the coronal and middle thirds of canals, whereas combination of ANC and catholyte resulted
Li, Guo-Hua; Niu, Li-Na; Zhang, Wei; Olsen, Mark; De-Deus, Gustavo; Eid, Ashraf A; Chen, Ji-Hua; Pashley, David H; Tay, Franklin R
New obturation biomaterials have been introduced over the past decade to improve the seal of the root canal system. However, it is not clear whether they have really produced a three-dimensional impervious seal that is important for reducing diseases associated with root canal treatment. A review of the literature was performed to identify models that have been employed for evaluating the seal of the root canal system. In vitro and in vivo models are not totally adept at quantifying the seal of root canals obturated with classic materials. Thus, one has to resort to clinical outcomes to examine whether there are real benefits associated with the use of recently introduced materials for obturating root canals. However, there is no simple answer because endodontic treatment outcomes are influenced by a host of other predictors that are more likely to take precedence over the influence of obturation materials. From the perspective of clinical performance, classic root filling materials have stood the test of time. Because many of the recently introduced materials are so new, there is not enough evidence yet to support their ability to improve clinical performance. This emphasizes the need to translate anecdotal information into clinically relevant research data on new biomaterials. Copyright © 2013 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.
Metska, Maria Elissavet; Liem, Vania May Ling; Parsa, Azin; Koolstra, Jan Harm; Wesselink, Paul Rudolf; Ozok, Ahmet Rifat
The primary aim of this study was to compare the precision of root canal length determination on cone-beam computed tomographic (CBCT) scans and periapical radiographs (PAs) with the actual root canal length. The secondary aim was to examine the influence of tooth type on root canal length measurements as assessed on CBCT scans and PAs. In total, 40 root canals of 33 teeth (molars, premolars, canines, and incisors) out of 5 dentate maxillas of human cadavers were included. Root canal length measurement was performed by a consensus panel (2 examiners) on CBCT scans (3D Accuitomo 170; J Morita, Kyoto, Japan) and digital PAs. After straight-line access opening, a #15 file was fixated in every root canal at the length measured on CBCT scans. All teeth were extracted, and the root canal containing the file was uncovered. Measurements made on images taken with a digital camera (AxioCam; Carl Zeiss, Sliedrecht, The Netherlands) linked to a stereozoom microscope (Stemi SV6, Carl Zeiss) were used as the actual root canal length. When all roots were examined together, it was not clear which method is better for all types of teeth. For root canals of anterior teeth, there was no significant difference between the 2 methods. For root canals of posterior teeth, CBCT images gave results significantly closer to the actual root canal length in comparison with PAs (t value = -1.96; critical value is 1.74 with a significance level of 0.05). Root canal length measurements of posterior maxillary teeth were more accurate when assessed by CBCT images than PAs. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
A study of the projection of root canals of natural teeth on dental roentgenograms was carried out as a sequel to an earlier phantom study. The material consisted of extracted teeth and teeth in situ in jaw preparations. The same radiation source and focus-film distance were used throughout, but the exposure times and tube voltages were varied. The roentgenographic images of the root canals were analysed densitometrically and compared with measurements of the actual object dimensions. The root were sectioned at the level studied and their cross sections were traced and measured with the aid of a profile projector. There was good agreement between the true breadth of the canal and that projected on the film. The maximum contrast in the image of the canal and the densitometrically measured difference in substance, expressed in metal equivalents, were proportional to the depth of the canal in the direction of radiation. The breadth of the canal in the plane of the film was the same regardless of whether the tube voltage was 50, 60 or 90 kV. On the other hand, the tube voltage affected the photographic density differences between the canal and the dentine walls. Changing the voltage from 50 to 60 kV did not affect the results, but there was a highly significant difference between 90 and 50 or 60 kV. The clinical significance of tube voltage and exposure time is discussed.
Ilgüy, Dilhan; Ilgüy, Mehmet; Fisekçioglu, Erdogan; Ersan, Nilüfer; Tanalp, Jale; Dölekoglu, Semanur
The aim of this study was to evaluate radiographically the periapical status and technical standard of root canal therapies performed by a group of undergraduate dental students in Turkey two years following completion of the treatments. A random sample of 264 patients who received root canal treatment from undergraduate students at the Yeditepe University Faculty of Dentistry in 2009 were recalled after two years. The study sample consisted of 319 root-filled teeth in 158 dental patients (females=97, males=61) who presented to the student clinics during that time frame. For each root-filled tooth, two periapical radiographs were examined to identify the periapical status, one showing pre-treatment and the other showing post-treatment status. The quality of endodontic treatment was examined according to the distance between the end of root filling and radiographic apex and the density of the obturation according to presence of voids within the root filling material. This examination found that 54.2 percent of roots had fillings of acceptable length, while 37.3 percent were short, 7.8 percent were overfilled, and 0.6 percent was unfilled; 2.5 percent of the teeth were observed with broken root canal instruments. After two years, PAI scores of teeth with acceptable length of root canal filling (0-2 mm from the radiographic apex) were found to be lower than those of the overfilling and short filling cases (>2mm) (p<0.01). Moreover, voids were detected in the root canal fillings of 52.7 percent of endodontically treated teeth. The PAI scores of root fillings with inadequate density were significantly higher than adequate ones (p<0.01). Although endodontic treatments performed by undergraduate students do not appear to be unqualified compared to those performed by general practitioners, more emphasis must be placed on the technical quality of endodontic treatment to obtain better results.
Neves, Mônica A S; Provenzano, José C; Rôças, Isabela N; Siqueira, José F
This in vivo study compared the antibacterial effectiveness of a reciprocating single-instrument system (Reciproc; VDW, Munich, Germany) and a rotary multi-instrument system (BioRaCe; FKG Dentaire, La Chaux-de-Fonds, Switzerland) during the preparation of infected root canals of teeth with primary apical periodontitis. Root canals from single-rooted teeth with necrotic pulps and apical periodontitis were instrumented using either Reciproc (n = 29) or BioRaCe (n = 30) instruments under irrigation with 2.5% sodium hypochlorite. DNA was extracted from samples taken before and after preparation and subjected to quantitative analysis of total bacteria and streptococci by using the quantitative real-time polymerase chain reaction. All initial samples were positive for the presence of bacteria, with median numbers of 7.1 × 10(5) and 1.31 × 10(5) bacterial cells for the Reciproc and BioRaCe groups, respectively. After preparation with Reciproc and BioRaCe, 16 (55%) and 15 (50%) root canals still had detectable bacteria with median counts of 7.05 × 10(2) and 6.03 × 10(1), respectively. Both systems were highly effective in reducing the total bacterial counts (P < .001), and there were no significant differences between them (P > .05). Streptococci were highly frequent, and both systems succeeded in significantly reducing their levels (P < .001). Both reciprocating single-instrument and rotary multi-instrument systems were highly effective in reducing the counts of total bacteria and streptococci in root canals of teeth with apical periodontitis. Regardless of the system used, approximately one half of the teeth still had detectable bacteria. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
Rippe, Marília Pivetta; Santini, Manuela Favarin; Bier, Carlos Alexandre Souza; Borges, Alexandre Luiz Souto; Valandro, Luiz Felipe
The aims of this study were to evaluate the effect of root canal filling techniques on root fracture resistance and to analyze, by finite element analysis (FEA), the expansion of the endodontic sealer in two different root canal techniques. Thirty single-rooted human teeth were instrumented with rotary files to a standardized working length of 14 mm. The specimens were embedded in acrylic resin using plastic cylinders as molds, and allocated into 3 groups (n=10): G(lateral) - lateral condensation; G(single-cone) - single cone; G(tagger) - Tagger's hybrid technique. The root canals were prepared to a length of 11 mm with the #3 preparation bur of a tapered glass fiber-reinforced composite post system. All roots received glass fiber posts, which were adhesively cemented and a composite resin core was built. All groups were subjected to a fracture strength test (1 mm/min, 45°). Data were analyzed statistically by one-way ANOVA with a significance level of 5%. FEA was performed using two models: one simulated lateral condensation and Tagger's hybrid technique, and the other one simulated the single-cone technique. The second model was designed with an amount of gutta-percha two times smaller and a sealer layer two times thicker than the first model. The results were analyzed using von Mises stress criteria. One-way ANOVA indicated that the root canal filling technique affected the fracture strength (p=0.004). The G(lateral) and G(tagger) produced similar fracture strength values, while G(single-cone) showed the lowest values. The FEA showed that the single-cone model generated higher stress in the root canal walls. Sealer thickness seems to influence the fracture strength of restored endodontically treated teeth.
Huang, Yao-Der; Wu, Jay; Sheu, Rong-Jiun; Chen, Mu-Hsiung; Chien, Der-Lan; Huang, Ya-Ting; Huang, Chih-Chia; Chen, Yunn-Jy
Cone-beam computed tomography (CBCT) can provide valuable data for root canal systems of human teeth in vivo. This study used CBCT to evaluate the number of roots and canals of 300 mandibular first premolars in 150 northern Taiwanese patients. The root canal systems of 300 mandibular first premolars in 150 northern Taiwanese patients with bilateral premolars were analyzed by CBCT. Of the 300 mandibular first premolars, 197 (65.7%) had one root with one canal (1R1C), 49 (16.3%) had one root with two canals (1R2C), 51 (17.0%) had two roots with one canal in each root (2R2C), and three (1.0%) had three roots with one canal in each root (3R3C). Statistical analyses showed that women had a significantly higher incidence of 1R1C mandibular first premolars (71.4%) than men (58.8%, p = 0.031), and men had a significantly higher incidence of 2R2C mandibular first premolars (27.2%) than women (8.5%, p < 0.001). One hundred and twenty-two (81.3%) of the 150 patients had a symmetrical root and root canal system between the right and left mandibular first premolars. Men had a significantly higher symmetrical rate of 2R2C mandibular first premolars (26.5%) than women (8.2%, p = 0.013). Approximately 82% of mandibular first premolars in northern Taiwanese patients have one root with either one or two canals. There are significant differences in the number of roots and canals and symmetry of the root canal system of bilateral mandibular first premolars between male and female northern Taiwanese patients. Copyright © 2014. Published by Elsevier B.V.
Pladisai, Patinee; Ampornaramveth, Ruchanee Salingcarnboriboon; Chivatxaranukul, Pavena
This study compared the effectiveness of different disinfection protocols in reducing bacteria in an Enterococcus faecalis biofilm in teeth with large root canals. Fifty-five roots were prepared from human mandibular premolars with large single root canals, and 50 roots were infected with E. faecalis for 21 days. Four roots were observed using scanning electron microscopy to verify biofilm formation. The remaining specimens were assigned into 5 experimental groups and a sterile control group: mechanical instrumentation using files size 60-90 and 2.5% sodium hypochlorite (NaOCl) (MI-N), irrigation with 2.5% NaOCl (IR-N), irrigation with 2.5% NaOCl using intermittent passive ultrasonic irrigation (PUI-N), irrigation with normal saline, and no intervention (initial). After root canal disinfection, dentin specimens were collected for microbial analysis. Mean colony forming units were determined and compared between groups using 1-way analysis of variance. The lowest number of intracanal bacteria (24.5 colony-forming units/mL) was recovered from the MI-N group followed by the PUI-N and IR-N groups. The irrigation with normal saline group did not show a significant reduction compared with the initial group. However, there were significant differences between groups (P < .01). The remaining bacteria in the PUI-N group was 4.5-fold lower compared with the IR-N group; however, it was 1862-fold higher compared with the MI-N group. MI-N was the most effective method to disinfect large root canals. Although ultrasonic activation enhanced the efficacy of root canal irrigation, it could not substitute for mechanical instrumentation even in large root canals with unlimited irrigant access to the apical portion. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
Wolf, Thomas Gerhard; Paqué, Frank; Zeller, Maximilian; Willershausen, Brita; Briseño-Marroquín, Benjamín
The aim of this study was to investigate the root canal system morphology of the mandibular first molar by means of micro-computed tomography. The root canal configuration, foramina, and accessory canals frequency of 118 mandibular first molars were investigated by means of micro-computed tomography and 3-dimensional software imaging. A 4-digit system describes the root canal configuration from the coronal to apical thirds and the main foramina number. The most frequent root canal configurations in mesial root were 2-2-2/2 (31.4%), 2-2-1/1 (15.3%), and 2-2-2/3 (11.9%); another 24 different root canal configurations were observed in this root. A 1-1-1/1 (58.5%), 1-1-1/2 (10.2%), and 16 other root canal configurations were observed in the distal root. The mesiobuccal root canal showed 1-4 foramina in 24.6%, and the mesiolingual showed 1-3 foramina in 28.0%. One connecting canal between the mesial root canals was observed in 30.5% and 2 in 3.4%. The distolingual root canal showed 1-4 foramina in 23.7%, whereas a foramen in the distobuccal root canal was rarely detected (3.4%). The mesiobuccal, mesiolingual, and distolingual root canals showed at least 1 accessory canal (14.3, 10.2, and 4.2%, respectively), but the distobuccal had none. The root canal configuration of mandibular first molars varies strongly. According to our expectations, both the mesial and distal roots showed a high number of morphologic diversifications. The root canal system of the mesial root showed more root canal configuration variations, connecting and accessory canals than the distal root. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
Nekoofar, M H; Ghandi, M M; Hayes, S J; Dummer, P M H
It is generally accepted that root canal treatment procedures should be confined within the root canal system. To achieve this objective the canal terminus must be detected accurately during canal preparation and precise control of working length during the process must be maintained. Several techniques have been used for determining the apical canal terminus including electronic methods. However, the fundamental electronic operating principles and classification of the electronic devices used in this method are often unknown and a matter of controversy. The basic assumption with all electronic length measuring devices is that human tissues have certain characteristics that can be modelled by a combination of electrical components. Therefore, by measuring the electrical properties of the model, such as resistance and impedance, it should be possible to detect the canal terminus. The root canal system is surrounded by dentine and cementum that are insulators to electrical current. At the minor apical foramen, however, there is a small hole in which conductive materials within the canal space (tissue, fluid) are electrically connected to the periodontal ligament that is itself a conductor of electric current. Thus, dentine, along with tissue and fluid inside the canal, forms a resistor, the value of which depends on their dimensions, and their inherent resistivity. When an endodontic file penetrates inside the canal and approaches the minor apical foramen, the resistance between the endodontic file and the foramen decreases, because the effective length of the resistive material (dentine, tissue, fluid) decreases. As well as resistive properties, the structure of the tooth root has capacitive characteristics. Therefore, various electronic methods have been developed that use a variety of other principles to detect the canal terminus. Whilst the simplest devices measure resistance, other devices measure impedance using either high frequency, two frequencies, or
Tandjung, L; Waltimo, T; Hauser, I; Heide, P; Decker, E-M; Weiger, R
The aim of the present study was to investigate the antimicrobial activity of octenidine on Enterococcus faecalis ATCC 29212 in a dentine block model. Fifty-six root segments of extracted human teeth were infected with E. faecalis for 4 weeks. Octenidine-phenoxyethanol gel (1 : 1) was applied for different timing: 1 min, 10 min, 7 days and in a different formula (1 : 3) for 10 min. Three samples were chosen for the group with placebo gel and for the group without infection (negative control). Dentine samples were collected, and the total count of bacteria and colony-forming units were determined. In addition, for controls and the 10 min group with 1 : 1 gel, the proportion of viable bacteria (PVB) was assessed. Octenidine was particularly effective after incubation periods of 10 min and 7 days. The mean PVB decreased significantly from 57.2% to 5.7% after 10 min application. After 7 days, only one of 10 samples showed positive culture. The present study showed the effectiveness of octenidine against E. faecalis in dentine disinfection. Further laboratory and clinical studies are required.
Cuadros-Sanchez, Johanna; Szesz, Anna; Hass, Viviane; Patzlaff, Rafael Tiago; Reis, Alessandra; Loguercio, Alessandro D
Luting posts inside the root canal is still a challenge because of the difficulty of bonding adhesive materials in the apical third of roots. This study evaluated the effect of the application mode of 3 simplified etch-and-rinse adhesives on the push-out bond strength (PBS), nanoleakage (NL), and in situ degree of conversion (DC) of fiber posts in the root canal. The roots of human premolars were endodontically prepared and divided into 6 groups according to the combination of the main factors: adhesive (Ambar, FGM, Joinville, SC, Brazil; Adper Single Bond 2, 3MESPE, St Paul, MN; and XP Bond+self-cure activator, DeTrey Dentsply, Konstanz, Germany) and application mode (manual or sonic). The posts were cemented and the PBS tested at 0.5 mm/min. The NL was evaluated by scanning electron microscopy after the immersion of specimens in 50% silver nitrate. Micro-Raman spectroscopy was used to measure the in situ DC. Root third was also considered in the statistical evaluation. Data were analyzed by 3-way repeated measures analysis of variance and Tukey tests (5%). Under sonic application, the PBS and the in situ DC increased, whereas NL decreased significantly for all groups in the middle and apical thirds (P < .05). The application of simplified adhesives by sonic mode in the root canal is a feasible tool to increase the fiber post bond to root canals. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
Parirokh, Masoud; Jalali, Shahrzad; Haghdoost, Ali Akbar; Abbott, Paul Vincent
Several factors can influence the amount of apically extruded debris. The aim was to quantitatively compare the amount of debris extruded apically from root canals when 3 different irrigants were used during canal preparation with rotary instruments. Ninety-one extracted single-rooted human mandibular premolar teeth with straight root canals were used. The teeth were randomly divided into 1 control group (group 1, n = 4) and 3 experimental groups of 29 teeth each. Hero 642 instruments were used for root canal preparation in all teeth, and 3 different irrigants were used (group 2, 2% chlorhexidine; group 3, 5.25% sodium hypochlorite; group 4, 2.5% sodium hypochlorite). Seven Eppendorf tubes served as a second control group. Debris extruded from the apical foramen during root canal preparation was collected into preweighed Eppendorf tubes. The weight of the dry extruded debris was established by subtracting the preinstrumentation and postinstrumentation weight of the Eppendorf tubes for each group. The data obtained were analyzed by using one-way analysis of variance and Tukey honestly significant difference. Group 3 (sodium hypochlorite 5.25%) had the highest amount of extruded debris, which was significantly different from the other groups (P < .05). The type of irrigant used can affect the amount of apically extruded debris. The 5.25% solution of sodium hypochlorite had the greatest amount of debris. Copyright © 2012 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
Van der Velden, U; Koster, T J G; Feilzer, A J; Timmerman, M F; Van der Weijden, G A
To evaluate in vitro the thermal effects induced by four different ultrasonic scalers on the temperature in the root canal during ultrasonic scaling. An extracted lower central incisor provided with a thermocouple in the root canal and a tube, entering the tooth incisally and exiting it apically to simulate an artificial bloodstream, was placed in a model of the lower jaw with soft artificial gingiva. Tested ultrasonic scaler systems included: EMS PM-600, Satelec P-max, Dürr Vector and Dentsply Cavitron. The tooth was scaled with each system at full water supply of 21°C. Furthermore, the amount of water supply was determined to maintain during scaling a constant temperature in the root canal. Finally, thermal changes due to scaling without water were assessed. Except for the Vector all scaler systems showed a temperature decrease in the root canal. The Vector with water/polish suspension showed a trend towards an increase in temperature. To maintain a constant temperature in the root canal the Cavitron needed twice the amount of water compared with PM-600 and P-max. Without water, all scaling systems induced a temperature increase. For safe ultrasonic scaling, care should be taken that the cooling water has room temperature and that, dependent on the scaler system, the proper amount of water is supplied. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
De-Deus, Gustavo; Silva, Emmanuel João Nogueira Leal; Marins, Juliana; Souza, Erick; Neves, Aline de Almeida; Gonçalves Belladonna, Felipe; Alves, Haimon; Lopes, Ricardo Tadeu; Versiani, Marco Aurélio
This study aimed to evaluate the frequency of dentinal microcracks observed after root canal preparation with 2 reciprocating and a conventional full-sequence rotary system using micro-computed tomographic analysis. Thirty mesial roots of mandibular molars presenting a type II Vertucci canal configuration were scanned at an isotropic resolution of 14.16 μm. The sample was randomly assigned to 3 experimental groups (n = 10) according to the system used for the root canal preparation: group A-Reciproc (VDW, Munich, Germany), group B-WaveOne (Dentsply Maillefer, Baillagues, Switzerland), and group C-BioRaCe (FKG Dentaire, La-Chaux-de-Fonds, Switzerland). Second and third scans were taken after the root canals were prepared with instruments sizes 25 and 40, respectively. Then, pre- and postoperative cross-section images of the roots (N = 65,340) were screened to identify the presence of dentinal defects. Dentinal microcracks were observed in 8.72% (n = 5697), 11.01% (n = 7197), and 7.91% (n = 5169) of the cross-sections from groups A (Reciproc), B (WaveOne), and C (BioRaCe), respectively. All dentinal defects identified in the postoperative cross-sections were also observed in the corresponding preoperative images. No causal relationship between dentinal microcrack formation and canal preparation procedures with Reciproc, WaveOne, and BioRaCe systems was observed. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
Sedgley, Christine; Applegate, Bruce; Nagel, Aaron; Hall, Dan
The detection of microorganisms in root canals is generally limited to qualitative or semiquantitative methods. We describe a new and nondestructive in vitro method to quantify root-canal bacteria over sequential treatment procedures using real-time imaging in conjunction with the bioluminescent reporter strain Pseudomonas fluorescens 5RL. Induced bacterial photon emission can be monitored by sensitive optical photonic imaging and luminometry, providing images as well as spatial and quantitative measurements. Bioluminescence imaging and luminometry determined that the lower limit of detection of bacteria in root canals occurred between 2 x 10(2) and 2 x 10(3) cells, with high correlation between cell counts and detection devices (r > or = 0.981). A preliminary study assessed the efficacy of sequential irrigation procedures to remove 5 x 10(6) bacteria from root canals (n = 5; apical size 60) using a 28-gauge, endodontic needle positioned 1 mm from working length; 9.2% +/- 3.1% and 8% +/- 3.6% of bacteria remained after 3 and 6 ml irrigation, respectively (p = 0.03), corresponding to approximately 4 x 10(5) bacteria remaining after 6 ml. This method can be used to study the efficacy of sequential endodontic treatment procedures in removing bacteria from root canals.
Marfisi, K; Mercade, M; Plotino, G; Duran-Sindreu, F; Bueno, R; Roig, M
To evaluate the efficacy of ProTaper Retreatment files, Mtwo Retreatment files and Twisted Files for removal of gutta-percha and Resilon in straight root canals. Ninety single root canals were instrumented and randomly allocated into 6 groups of 15 specimens each with regards to the filling material and instruments used. Group 1: gutta-percha/ProTaper; Group 2: Resilon/ProTaper; Group 3: gutta-percha/Mtwo; Group 4: Resilon/Mtwo; Group 5: gutta-percha/Twisted Files; Group 6: Resilon/Twisted Files. For all roots, the following data were recorded: procedural errors, duration of retreatment, canal wall cleanliness through optical microscope and cone beam computed tomography (CBCT). Data were statistically analysed, and the level of significance was set at P=0.05. No system completely removed the root filling material from root canal walls. No significant differences were observed between the rotary systems in terms of the area of filling material left within the canals (P>0.05). There were statistically significant differences between the filling materials: Resilon/Real Seal had less residual material than gutta-percha/AH plus (CBCT: P=0.01; microscope: P=0.018). Mtwo Retreatment files were more rapid when removing filling material than ProTaper Retreatment files (P=0.19) and Twisted Files (P=0.04). No system removed the root filling materials entirely. Mtwo Retreatment files required less time to remove root filling material than the other instruments. Resilon was removed significantly better from the canal walls than gutta-percha, irrespective of the rotary instruments used. © 2010 International Endodontic Journal.
Simşek, Neslihan; Akpinar, Kerem Engin; Sümer, Zeynep
The aim of this study was to evaluate bacterial microleakage of the root canals irrigated with different irrigation solutions and the potassium-titanyl-phosphate (KTP) laser system and filled with gutta-percha and AH26 root canal sealer. In addition, the effect of the irrigation solutions on dentin surface was evaluated with a scanning electron microscope (SEM). A few studies have reported that KTP laser has the capacity to remove the smear layer. Many researchers have demonstrated that propolis has a bactericidal effect. Both are important effects on root canal treatments. One hundred and twenty single-root single-canal mandibular premolar teeth were used for this study. The root canals were prepared by Dentaport Root ZX and ProTaper rotary instruments with the crown-down technique. The specimens were randomly divided into five groups of 20 teeth each. Each group was irrigated with 17% ethylenediaminetetraacetic acid (EDTA), 20% propolis, 2.5% sodium hypochlorite (NaOCl), 2% chlorhexidine gluconate (CHX), and KTP laser, respectively. A total of 20 teeth were used as controls-10 positive controls and 10 negative controls-which were irrigated with distilled water. The root canals were filled with gutta-percha and AH-26. The external surfaces of specimens were covered with three layers of nail varnish except the apical third. The teeth were inserted into Eppendorf plastic tubes and suspended in glass bottles containing sterile broth. All specimens were inoculated every 5 days with Enterococcus faecalis. The contamination onset time was continuously recorded, as turbidity was the first indication of contamination in a period of 30 days. All statistical analysis was performed using the SPSS for Windows version 15.0 software. A χ(2) test was computed and the statistical significance was set at p<0.05. The controls behaved as expected. This study showed that different irrigation solutions and KTP laser allowed microleakage of E. faecalis.
Rosen, Eyal; Azizi, Hadas; Friedlander, Clara; Taschieri, Silvio; Tsesis, Igor
The aim of the study was to compare the diagnostic ability to radiographically detect separated stainless steel (SS) versus nickel-titanium (NiTi) instruments located at the apical third of filled root canals with either AH 26 (Dentsply DeTrey GmbH, Konstanz, Germany) or Roth sealer (Roth International Ltd, Chicago, IL). Sixty single-rooted extracted human teeth with 1 straight root canal were instrumented to a size 25 apical diameter. In 40 teeth, apical 2-mm segments of SS (n = 20) or NiTi (n = 20) files were intentionally fractured in the apical part of the root canal. The remaining 20 teeth without fractured files served as a control group. Subsequently, the root canals were filled using laterally condensed gutta-percha and either AH 26 sealer (AH) or Roth sealer (Roth). All teeth were radiographed using conventional Kodak film (Eastman Kodak Co, Rochester, NY) and a charge-coupled device digital sensor. The evaluation of the images for the presence of a fractured instrument was performed independently by 2 blinded observers. The data were statistically analyzed using McNemar and Fisher exact tests. The kappa values were 0.76 and 0.615 for the first and second observers, respectively, and 0.584 between the observers. There were no significant differences in the diagnostic ability between digital and conventional radiography or the different root canal sealers (AH vs Roth, P > .05). The sensitivity to detect fractured SS was significantly higher than NiTi (P < .05). It may be difficult to radiographically detect a retained separated instrument. It is easier to radiographically detect fractured SS than NiTi instruments retained at the apical third of the root canal. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
Zand, Vahid; Mokhtari, Hadi; Zonouzi, Hamid Rm; Shojaei, Sahand N
The aim of this study was to evaluate the accuracy of the results of cone beam computed tomography (CBCT) examinations, confirm the presence or absence of the second mesiobuccal (MB2) root canal in maxillary first and second molars, estimate the distance between the root canal orifices, observe the root types based on Vertucci classification system, and make comparisons between CBCT and periapical techniques in relation to the identification of the root canal form and the second root canal of the MB root. The CBCT and periapical radiographic data from the Department of Maxillofacial Radiology were used to select 156 individuals (78 females and 78 males) for the evaluation of the anatomy of maxillary first and second molars. The prevalence rate of the second root canal in the MB root in the maxillary first molars was 55.1%, with 44.1 and 63.3% in females and males respectively. The prevalence rate in maxillary second molars was 23.7%, with 15.7 and 30.2% in females and males respectively. In addition, the longest and shortest distances between the root canal orifices were 2.4 and 0.3 mm respectively, with a mean of 1.3 mm. There was a significant difference between the results of periapical and CBCT radiographic techniques in relation to the presence or absence of the second root canal in the MB roots of maxillary first and second molars (p < 0.01), with better results being provided by the CBCT technique. The results of CBCT images about the existence of the second root canal in the MB roots of maxillary first and second molars are more reliable, and we can use this technique in the finding of additional canals in the clinic. Keyword: Cone beam computed tomography, Dental radiography, Root canal therapy.
Kvinnsland, S R; Bårdsen, A; Fristad, I
To present a case where a traumatized, immature tooth still showed capacity for continued root development and apexogenesis after root canal treatment was initiated based on an inaccurate pulpal diagnosis. Traumatic dental injuries may result in endodontic complications. Treatment strategies for traumatized, immature teeth should aim at preserving pulp vitality to ensure further root development and tooth maturation. A 9-year-old boy, who had suffered a concussion injury to the maxillary anterior teeth, was referred after endodontic treatment was initiated in tooth 21 one week earlier. The tooth had incomplete root length, thin dentinal walls and a wide open apex. The pulp chamber had been accessed, and the pulp canal instrumented to size 100. According to the referral, bleeding from the root made it difficult to fill the root canal with calcium hydroxide. No radiographic signs of apical breakdown were recorded. Based on radiographic and clinical findings, a conservative treatment approach was followed to allow continued root development. Follow-up with radiographic examination every 3rd month was performed for 15 months. Continued root formation with apical closure was recorded. In the cervical area, a hard tissue barrier developed, which was sealed with white mineral trioxide aggregate (MTA). Bonded composite was used to seal the access cavity. At the final 2 years follow-up, the tooth showed further root development and was free from symptoms.
Hashem, Ahmed Abdel Rahman; Ghoneim, Angie Galal; Lutfy, Reem Ahmed; Foda, Manar Yehia; Omar, Gihan Abdel Fatah
A great number of nickel-titanium (NiTi) rotary systems with noncutting tips, different cross-sections, superior resistance to torsional fracture, varying tapers, and manufacturing method have been introduced to the market. The purpose of this study was to evaluate and compare the effect of 4 rotary NiTi preparation systems, Revo-S (RS; Micro-Mega, Besancon Cedex, France), Twisted file (TF; SybronEndo, Amersfoort, The Netherlands), ProFile GT Series X (GTX; Dentsply, Tulsa Dental Specialties, Tulsa, OK), and ProTaper (PT; Dentsply Maillefer, Ballaigues, Switzerland), on volumetric changes and transportation of curved root canals. Forty mesiobuccal canals of mandibular molars with an angle of curvature ranging from 25° to 40° were divided according to the instrument used in canal preparation into 4 groups of 10 samples each: group RS, group TF, group GTX, and group PT. Canals were scanned using an i-CAT CBCT scanner (Imaging Science International, Hatfield, PA) before and after preparation to evaluate the volumetric changes. Root canal transportation and centering ratio were evaluated at 1.3, 2.6, 5.2, and 7.8 mm from the apex. The significance level was set at P ≤ .05. The PT system removed a significantly higher amount of dentin than the other systems (P = .025). At the 1.3-mm level, there was no significant difference in canal transportation and centering ratio among the groups. However, at the other levels, TF maintained the original canal curvature recording significantly the least degree of canal transportation as well as the highest mean centering ratio. The TF system showed superior shaping ability in curved canals. Revo-S and GTX were better than ProTaper regarding both canal transportation and centering ability. Copyright © 2012 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
Gani, Omar A; Boiero, Claudio F; Correa, Carolina; Masin, Ivana; Machado, Ricardo; Silva, Emmanuel J N L; Vansan, Luiz Pascoal
The aim of this study was to evaluate age-related morphological canal changes in mesial root canals of mandibular first molars of known ages. Fifty-six specimens were selected for this study and distributed into the following four age groups (n. 14): a) Group of children under 13 years, b) Group of adolescents (from 14 to 19 years), c) Group of young adults (from 20 to 39 years) and d) Group of older adults (over 40 years). The specimens were in perfect condition because after extraction they were carefully cleaned, sterilized, identified and stored in water. In order to improve the cleaning, they were placed in 1% sodium hypochlorite solution for four hours and rinsed in 10 vol. hydrogen peroxide for 8 hours. After that, a clearing technique was performed to illustrate root canal anatomy. Digitalized images of all samples were obtained by use of a stereomicroscope. Canals were noticeably simpler in older adults: they were sharply defined and narrow, sometimes too narrow. Calcification nuclei were not found and there were only a few remains of internuclear spaces. The canal system appeared cleaner, clearer and more sharply defined than in the other age groups. It may be concluded that there is a correlation between aging and morphological changes in the mesial root canals of mandibular first molars.
Karataş, Ertuğrul; Kol, Elif; Bayrakdar, İbrahim Şevki; Arslan, Hakan
The purpose of the present study was to assess the effect of solvents on root canal transportation in endodontic retreatment. Sixty extracted human permanent mandibular first molars with curved root canals were selected. All of the root canals were prepared using Twisted File Adaptive instruments (SybronEndo, Orange, CA, USA) and filled with gutta-percha and AH Plus sealer (Dentsply DeTrey, Konstanz, Germany) using the cold lateral compaction technique. The teeth were assigned to four retreatment groups as follows (n = 15): eucalyptol, chloroform, orange oil and control. The canals were scanned using cone-beam computed tomography scanning before and after instrumentation. The chloroform group showed a significantly higher mean transportation value than the orange oil and control groups at the 3 and 5 mm levels (P = 0.011 and P = 0.003, respectively). There was no significant difference among the orange oil, eucalyptol and control groups in terms of canal transportation (P > 0.61). The chloroform led to more canal transportation than the eucalyptol and orange oil during endodontic retreatment. © 2015 Australian Society of Endodontology.
Niemi, Tuomas K; Marchesan, Melissa A; Lloyd, Adam; Seltzer, Robert J
The aim of this study was to compare the effectiveness of TRUShape (TS) instruments with ProFile Vortex Blue (VB) instruments for the removal of obturation materials during retreatment of single-canal mandibular premolars performed through 2 access outlines. Initial root canal treatment was completed through a contracted endodontic cavity (CEC) design. Canals were instrumented to an F2 ProTaper instrument, obturated with warm lateral condensation of gutta-percha with AH Plus sealer, and allowed to set for 30 days at 37°C and 100% humidity. For retreatment, specimens were divided into 2 groups (n = 24) on the basis of access outline, CEC or traditional endodontic cavity (TEC). Retreatment was initiated by using ProTaper Retreatment instruments (D1-D3). Specimens were then stratified, further divided (n = 12), and reinstrumented up to TS 40 .06v or 40 .06 VB. Irrigation was performed by using 8.25% NaOCl and QMix 2in1. Retreatment time was recorded. Teeth were sectioned and photographed, and the percentage of remaining obturation materials was measured. Data were analyzed with Kruskal-Wallis analysis of variance for two-factor tests (α < 0.05). The interaction between access design and instrument type showed that the combination of CEC-VB presented significantly higher amounts of remaining obturation materials on the canal surface when compared with TEC-VB, CEC-TS, and TEC-TS (P ≤ .05). None of these other combinations were different from each other (P > .05). Significantly more time was required for retreatment with CEC-TS (27.68 ± 1.4 minutes) than the other groups (P < .05). Neither retreatment protocol was able to completely eliminate all obturation materials from the root canal surface of mandibular premolars. However, in the presence of a CEC access design, using TS instruments removed more obturating material in single-rooted, oval-shaped canals. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights
Moinzadeh, Amir T; Zerbst, Wilhelm; Boutsioukis, Christos; Shemesh, Hagay; Zaslansky, Paul
Gutta percha is commonly used in conjunction with a sealer to produce a fluid-tight seal within the root canal fillings. One of the most commonly used filling methods is lateral compaction of gutta percha coupled with a sealer such as calcium silicate cement. However, this technique may result in voids and worse, the filling procedures may damage the root. We compared the volume of the voids associated with two root canal filling methods, namely lateral compaction and single cone. Micro-computed tomography was used to assess the porosity associated with each method in vitro. An automated, observer-independent analysis protocol was used to quantify the unfilled regions and the porosity located in the sealer surrounding the gutta percha. Significantly less porosity was observed in root canals filled with the single cone technique (0.445% versus 3.095%, p<0.001). Porosity near the crown of the tooth was reduced 6 fold, whereas in the mid root region porosity was reduced to less than 10% of values found in the lateral compaction filled teeth. Our findings suggest that changing the method used to place the endodontic biomaterials improves the quality and homogeneity of root canal fillings. Copyright © 2015 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.
Rosa, V.; Zhang, Z.; Grande, R.H.M.; Nör, J.E.
The clinical translation of stem-cell-based dental pulp regeneration will require the use of injectable scaffolds. Here, we tested the hypothesis that stem cells from exfoliated deciduous teeth (SHED) can generate a functional dental pulp when injected into full-length root canals. SHED survived and began to express putative markers of odontoblastic differentiation after 7 days when mixed with Puramatrix™ (peptide hydrogel), or after 14 days when mixed with recombinant human Collagen (rhCollagen) type I, and injected into the root canals of human premolars in vitro. Roots of human premolars injected with scaffolds (Puramatrix™ or rhCollagen) containing SHED were implanted subcutaneously into immunodeficient mice (CB-17 SCID). We observed pulp-like tissues with odontoblasts capable of generating new tubular dentin throughout the root canals. Notably, the pulp tissue engineered with SHED injected with either Puramatrix™ or rhCollagen type I presented similar cellularity and vascularization when compared with control human dental pulps. Analysis of these data, collectively, demonstrates that SHED injected into full-length human root canals differentiate into functional odontoblasts, and suggests that such a strategy might facilitate the completion of root formation in necrotic immature permanent teeth. PMID:24056227
Rosa, V; Zhang, Z; Grande, R H M; Nör, J E
The clinical translation of stem-cell-based dental pulp regeneration will require the use of injectable scaffolds. Here, we tested the hypothesis that stem cells from exfoliated deciduous teeth (SHED) can generate a functional dental pulp when injected into full-length root canals. SHED survived and began to express putative markers of odontoblastic differentiation after 7 days when mixed with Puramatrix™ (peptide hydrogel), or after 14 days when mixed with recombinant human Collagen (rhCollagen) type I, and injected into the root canals of human premolars in vitro. Roots of human premolars injected with scaffolds (Puramatrix™ or rhCollagen) containing SHED were implanted subcutaneously into immunodeficient mice (CB-17 SCID). We observed pulp-like tissues with odontoblasts capable of generating new tubular dentin throughout the root canals. Notably, the pulp tissue engineered with SHED injected with either Puramatrix™ or rhCollagen type I presented similar cellularity and vascularization when compared with control human dental pulps. Analysis of these data, collectively, demonstrates that SHED injected into full-length human root canals differentiate into functional odontoblasts, and suggests that such a strategy might facilitate the completion of root formation in necrotic immature permanent teeth.
Liesenhoff, Tim; Folwaczny, Matthias; Lehn, Norbert
Conventional root canal treatments often fail due to insufficient removal of root canal contents and due to ineffective reduction of bacterial growth. In vitro investigations on the 308 nm excimer laser root canal preparation showed excellent results concerning the preparation quality. The aim of the present study was to investigate the influence of 308 nm excimer laserlight on the growth of bacteria. Bacterial suspensions of Staph. aureus, E. coli, and Enterococcus faec. were irradiated with various energy densities and different time duration. In order to exclude thermal side effects the temperature rise inside the suspensions was registered during irradiation. It was able to demonstrate that 308 nm excimer laserlight effects a log reduction of germ concentration at energy densities of 0.5 - 2.4 J/cm2. Laserlight effects germ reduction even without tissue removal. The effectiveness is dependent on the type of bacteria, the energy density, and the time of irradiation. The antimicrobial effect is independent from temperature.
Leyhausen, G; Heil, J; Reifferscheid, G; Waldmann, P; Geurtsen, W
Previous studies with four rapid in vitro and in vivo test systems have shown that the epoxy resin-based root canal sealer AH26 may be genotoxic and cytotoxic (9). The purpose of this study was to determine the cytotoxic and genotoxic effects of the new resinous root canal sealer AH Plus by means of the growth inhibition test with primary human periodontal ligament fibroblasts and permanent 3T3 monolayers, the procaryotic umu test, the eucaryotic DNA synthesis inhibition test, and the in vivo alkaline filter elution test. In addition, Ames tests were performed with extracts from AH Plus. AH Plus caused only slight or no cellular injuries. Furthermore, no genotoxicity and mutagenicity were revealed by AH Plus. These data should be taken into consideration when deciding about a root canal sealer.
Beling, K L; Marshall, J G; Morgan, L A; Baumgartner, J C
Many clinicians use ultrasonics for root-end preparations. The purpose of this study was to evaluate resected root-end surfaces of bilaterally matched human teeth for cracks before and after ultrasonic root-end preparation. Twenty matched pairs of extracted single rooted teeth were divided into two experimental groups. In group 1, root-end resection was performed on uninstrumented teeth. In group 2, root-end resection was performed after the canals were instrumented and filled with gutta-percha. All teeth in both groups received root-end preparations using ultrasonic instrumentation at low power. Two examiners evaluated the root-ends after root-end resection and again after root-end preparation using zoom magnification of 20x to 63x. The number, types, and location of cracks were mapped. There were no significant differences when gutta-percha filled roots were compared to uninstrumented roots with regard to the number or type of cracks after root-end resection or root-end preparation. In addition, there were no significant differences in the number or type of cracks following root resection and ultrasonic root-end preparation when compared to teeth with root resection alone.
Abraham, Sheela Balu; Gopinath, Vellore Kannan
Objective: The purpose of this study was to determine the root canal anatomy of mandibular first premolar teeth in an Emirati subpopulation using a decalcification and clearing method. Materials and Methods: One hundred permanent mandibular first premolar teeth extracted for orthodontic purposes from an Emirati subpopulation from the United Arab Emirates were used for this study. They were subjected to decalcification and clearing. The tooth length, the canal orifice shape, mesial invagination, canal pattern, the location of apex, presence of lateral canals, and intercanal communications were determined. Results: The most common canal pattern was the Vertucci Type I (65%) followed by Type V (14%) and Type IV (13%). The most common type of canal orifice seen was the oval shape (36%) followed by the round shape (25%). Mesial invaginations were seen in 44% of the teeth. The mean tooth length was 19.9 mm, and apical deltas were seen in 24% of teeth. Conclusion: The Vertucci Type I canal pattern was the most prevalent in the mandibular first premolars while the occurrence of multiple canals was noted in 35% of this population. PMID:26929684
Hu, R C; Cao, L L; Xie, W; Hu, Y Q; Piao, Z G
To observe the morphological changes of root canals with aging in maxillary first premolars by using cone-beam computerized tomography(CBCT)in order to facilitate endodontic management of root canals in various aged patients. The digital CBCT data of the maxillary first premolars in 405 cases from the patients in Oral Medical Center of The First Affiliated Hospital, Jinan University from March 2011 to June 2015 were collected. The CBCT images were divided into 6 groups according to the patients' ages: groups 11-20, 21-30, 31-40, 41-50, 51-60 and >60 years-olds, respectively. Changes of morphologies of root canals with aging including such parameters as types of the root canal, incidence of double root canals in single rooted teeth, distance between both root canal orifices of double rooted canals, and morphological change of the cross section of roots. Chi-square test and liner trend test were adopted in statistical analysis in the present study. The distribution of various types of the root canals were significantly different amongst various aged groups(P<0.05). Type Ⅳ is the most common type(210/405, 51.8%), and the following groups were typeⅡ(65/405, 16.0%), typeⅠ(55/405, 13.6%)and type Ⅲ(27/405, 6.7%). Along with aging, the percentages of type Ⅰ and type Ⅲ decreased while type Ⅱ increased. However, there were no remarkable changes of type Ⅳ observed. The incidence of double rooted canals in single rooted teeth gradually increased with aging especially in 20-years-old and above groups, e.g. 51.7%(31/60)in group 11-20 years-olds and 83.0%(44/53)in group 21-30 years-olds. However, there was no significant increase observed after the age of 40. The distance between both root canal orifices of double rooted canals became shorter with aging except in groups of 40-years-olds and above. The morphologies of the cross sections in most aged groups were flat shaped(1 020/2 105, 48.5%)and oval shape(594/2 105, 28.2%). Along with aging, the percentage of
Valera, Marcia Carneiro; Maekawa, Lilian Eiko; Chung, Adriana; de Oliveira, Luciane Dias; Carvalho, Claudio Antonio Talge; Koga-Ito, Cristiane Yumi; Jorge, Antonio Olavo Cardoso
This in vitro study sought to evaluate the effectiveness of castor oil extract used as an irrigating solution on Escherichia coli and its endotoxins in root canals. Sixty single-rooted teeth were prepared (using castor oil extract as irrigating solution) and divided into five groups (n = 12): Group 1 samples were treated with calcium hydroxide (Ca(OH)2), Group 2 samples were treated with polymyxin B, Group 3 samples were treated with Ca(OH)2 and 2% chlorhexidine gel (CHX), and Group 4 samples were treated with castor oil extract. A control group used physiological saline solution as an irrigant. Canal content samples were collected at four different times: immediately after instrumentation, seven days after instrumentation, after 14 days of intracanal medication, and seven days after removal of intracanal medication. A plating method was used to assess antimicrobial activity and the quantification of endotoxins was evaluated by the chromogenic Limulus lysate assay. Data were submitted to ANOVA and a Dunn test (a = 5%). Irrigation with castor oil extract decreased E. coli counts but had no effect on the level of endotoxins. Samples taken seven days after removal of medication revealed a significant reduction in endotoxin levels in Groups 3 and 4. Compared to the saline solution irrigation, castor oil extract decreased microorganism counts in root canals immediately after canal preparation. None of the medications used completely eliminated endotoxins in the root canal.
Briseño-Marroquín, Benjamín; Paqué, Frank; Maier, Karolin; Willershausen, Brita; Wolf, Thomas Gerhard
The objective of this study was to propose a root canal configuration description method and to investigate the root canal system morphology of the maxillary first molar by means of micro-computed tomographic imaging. The root canal configuration, foramina, and accessory canal frequency of 179 maxillary first molars were investigated by means of micro-computed tomographic imaging and 3-dimensional software imaging. The root canal configuration and main foramina number are described from coronal to apical with a 4-digit system. The most frequent root canal configurations were 1-1-1/1 (45.8%), 2-2-2/2 (25.1%) and 2-2-1/1 (10.1%) in mesiobuccal roots and 1-1-1/1 in distobuccal (97.2%) and palatal (98.9%) roots. The first mesiobuccal (MB1) root canal had 1 accessory canal in 26.3% of the teeth, the distobuccal root canal had 12.3%, and the palatal root canal had 9.5%; in the second mesiobuccal root canal, there was rarely 1 accessory canal. There was 1 accessory canal in 26.3%, 12.3%, and 9.5% in the MB1, distobuccal, and palatal root canals, respectively. The MB1, distobuccal, and palatal root canals had 1 main foramen. The MB2 had 1 main foramen in 39.0% of the teeth and no main foramen in 61.0%. The root canal configuration of maxillary first molars is quite diversified. Contrary to our expectations in this research, the mesiobuccal root has predominantly 1 root canal entrance and only 1 main foramen. Anatomic variations including connecting and accessory canals occur in any third of root. Copyright © 2015 American Association of Endodontists. All rights reserved.
Rôças, Isabela N; Hülsmann, Michael; Siqueira, José F
Posttreatment apical periodontitis is usually associated with persistent or secondary intraradicular infection. This study evaluated the presence and relative levels of 28 bacterial taxa in treated root canals of teeth with posttreatment apical periodontitis from German patients using 16S ribosomal RNA (rRNA) gene probes in a reverse-capture checkerboard hybridization assay. Species-specific polymerase chain reaction (PCR) was also performed to detect Enterococcus faecalis and Candida albicans. Bacterial DNA was detected in all samples. Twenty of the 28 taxon-specific probes tested were reactive with at least one sample. Taxa detected more frequently included Streptococcus species (47%), Lactobacillus species (35%), Dialister invisus (29%), Eubacterium infirmum (29%), Prevotella intermedia (29%), Selenomonas sputigena (29%), Synergistes oral clone BA121 (29%), and Treponema denticola (29%). Only eight taxa were present at levels >10(5). Of these, streptococci and T. denticola were the most prevalent. Species-specific PCR detected E. faecalis in 47% of the cases and C. albicans in 6%. Findings of this study confirm the strong association between persistent/secondary intraradicular infection and posttreatment apical periodontitis. Most cases harbored a mixed infection, and E. faecalis, if present, was never the most dominant species in the consortium. Several other bacterial taxa were detected, and an involvement with the etiology of posttreatment apical periodontitis is suspected.
AlRahabi, Mothanna K
This study evaluated the technical quality of root canal treatment (RCT) and detected iatrogenic errors in an undergraduate dental clinic at the College of Dentistry, Taibah University, Saudi Arabia. Dental records of 280 patients who received RCT between 2013 and 2016 undertaken by dental students were investigated by retrospective chart review. Root canal obturation was evaluated on the basis of the length of obturation being ≤2 mm from the radiographic apex, with uniform radiodensity and good adaptation to root canal walls. Inadequate root canal obturation included cases containing procedural errors such as furcal perforation, ledge, canal transportation, strip perforation, root perforation, instrument separation, voids in the obturation, or underfilling or overfilling of the obturation. In 193 (68.9%) teeth, RCT was adequate and without procedural errors. However, in 87 (31.1%) teeth, RCT was inadequate and contained procedural errors. The frequency of procedural errors in the entire sample was 31.1% as follows: underfilling, 49.9%; overfilling, 24.1%; voids, 12.6%; broken instruments, 9.2%; apical perforation, 2.3%; and root canal transportation, 2.3%. There were no significant differences (p > 0.05) in the type or frequency of procedural errors between the fourth- and fifth-year students. Lower molars (43.1%) and upper incisors (19.2%) exhibited the highest and lowest frequencies of procedural errors, respectively. The technical quality of RCT performed by undergraduate dental students was classified as 'adequate' in 68.9% of the cases. There is a need for improvement in the training of students at the preclinical and clinical levels.
Soares, Adriana de Jesus; Lins, Fernanda Freitas; Nagata, Juliana Yuri; Gomes, Brenda Paula Figueiredo de Almeida; Zaia, Alexandre Augusto; Ferraz, Caio Cezar Randi; de Almeida, José Flávio Affonso; de Souza-Filho, Francisco José
Pulp revascularization may be considered a promising alternative for necrotic immature teeth. Many studies have accomplished passive decontamination associated with an antibiotic paste. To date, there is no report evaluating calcium hydroxide associated with 2% chlorhexidine gel for revascularization therapy. The aim of this case report was to describe a new proposal for pulp revascularization with mechanical decontamination and intracanal medication composed of calcium hydroxide and 2% chlorhexidine gel. The patient, a 9-year-old girl, suffered an intrusion associated with pulp exposure caused by an enamel-dentin fracture in her maxillary left central incisor. After diagnosis, treatment consisted of revascularization therapy with gentle manual instrumentation of the cervical and medium thirds of the root in addition to intracanal medication with calcium hydroxide and 2% chlorhexidine gel for 21 days. In the second session, a blood clot was stimulated up to the cervical third of the root canal. Mineral trioxide aggregate (MTA; Angelus, Londrina, Paraná, Brazil) was used for cervical sealing of the canal. Coronal sealing was performed with temporary filling material and composite resin. During the follow-up period, the root canal space showed a progressive decrease in width, mineralized tissue deposition on root canal walls, and apical closure. A cone-beam computed tomography scan taken at the 2-year follow-up confirmed these findings and did not show complete root canal calcification. This new proposal for revascularization therapy with 2% chlorhexidine gel may be used for the treatment of necrotic immature root canals. Copyright © 2013 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
Goztas, Zeynep; Onat, Halenur; Tosun, Gul; Sener, Yagmur; Hadimli, Hasan Huseyin
Objective: The aim was to determine the antimicrobial effect of ozonated water, ozonated water with ultrasonication, sodium hypochloride and chlorhexidine (CHX) in human primary root canals contaminated by Enterococcus faecalis (E. faecalis). Materials and Methods: Fifty-eight extracted human primary molar teeth were used. Crowns were cut off using a diamond saw under water-cooling. One hundred roots were obtained and mechanically prepared. The roots were then sterilized by autoclaving in water for 15 min at 121°C. All samples were contaminated with E. faecalis for 24 h and the root canals were randomly divided into five groups (n = 20). Group I: 25 mg/L of Ozonated water (O3aq), Group II: 25 mg/L of O3aq with ultrasonication, Group III: 2.5% Sodium hypochloride (NaOCl), Group IV: 2% CHX and Group V: Positive control. The canal of each specimen was irrigated for 4 min and positive control was untreated. All root canals were agitated with sterile saline solution. The saline solution was collected from canals with sterile paper points. For each specimen, the paper points were transposed to eppendorf vials containing 2 ml of brain heart infusion. According to bacterial proliferation, the mean values of optical density were achieved by ELİSA (Biotek EL ×800, Absorbance Microplate Reader, ABD) and the data were analyzed. Results: NaOCI, CHX and two types of O3aq were found statistically different than positive control group. NaOCI irrigation was found significantly most effective. Conclusions: NaOCl, CHX and O3aq applications provide antibacterial effect in vitro conditions in primary root canals. PMID:25512726
Gupta, Saurabh Kumar; Saxena, Payal
Objectives Root canal anatomy has been proved to be a complex canal configuration system. The negotiation and cleaning of this system is essential for successful root canal treatment. The present root canal classification systems are unable to transfer the clinically relevant information about the canal system from the oral radiologist to the treating clinician. Thus, a simple and effective diagrammatic representation of the canal system, depicting the major canals, important changes during their course along with other relevant information has been presented. Methods The proposed representation consists of five horizontal lines dividing the tooth into four segments from the point of reference to apical foramen. Each line has been designated with different line style. The diagrammatic images, one anterior and one posterior multi-rooted tooth, are given for easy understanding of the orientation of image. The whole image can be saved in portable network graphics format and can be imported to any word processing document. The image can be printed in the reporting sheet. Result Applying the same proposal, some of the diagrammatic representations have been showed. Conclusion This proposal for diagrammatic representation of root canal configuration can be helpful in getting an approximate distribution of the canals in a relatively simple manner. This scheme also provides valuable clinical information about the root canal system, which the other classifications fail to represent. PMID:26937372
Endal, Unni; Shen, Ya; Knut, Arving; Gao, Yuan; Haapasalo, Markus
The aim of this study was to obtain a three-dimensional analysis of the isthmus area of the mesiobuccal root canal system in mandibular molars using high-resolution micro-computed tomography (μ-CT) scanning and to measure the amount of debris and root filling material in the isthmus after instrumentation/irrigation and root filling. Mandibular molars with two separated mesial root canals (10 teeth) were scanned by using the Skyscan 1172 μ-CT system (Skyscan, Aartselaar, Belgium) before and after instrumentation and after filling using the Thermafil root filling technique. An isthmus was defined as the ribbon-shaped or thin connecting structure between two root canals after instrumentation. The characteristics of the isthmuses were quantitatively monitored during the whole treatment. The images were segmented and quantified. The surface area of the isthmus, volume of debris after rotary instrumentation, and volume of the filled space in the isthmus after obturation were evaluated. Of the seven mesial roots, two had isthmus/anastomoses somewhere along its length in the apical 5 mm, and five had an isthmus that was continuous all the way from the coronal part to the apical part. The average percentage of isthmus surface area and isthmus volume after instrumentation was 21.4% and 9.4% of the whole root canal system, respectively. About 35.2% of the isthmus volume was filled with apparent hard tissue debris after instrumentation/irrigation. The average percentage of volume of filling material in the isthmus areas was significantly lower (57.5%) than in the main root canals (98.5%, p < 0.001). A considerable amount of dentin debris is produced and packed into the isthmus area during rotary instrumentation of mesial canals of lower molars despite continuous irrigation during and after instrumentation. The debris may partly prevent penetration of the filling material and sealer into the isthmus area. Copyright Â© 2011 American Association of Endodontists. Published by
Celikten, Berkan; Uzuntas, Ceren Feriha; Orhan, Ayse Isıl; Orhan, Kaan; Tufenkci, Pelin; Kursun, Sebnem; Demiralp, Kemal Özgür
The aim of this study was to evaluate and compare the presence of voids in oval root canals filled with different root canal sealers (EndoSequence BC Sealer, Smartpaste bio, ActiV GP) and to compare those with root canals filled with AH Plus sealer using micro-CT. In total, 40 freshly extracted human single-root maxillary premolars were used. Specimens instrumented with the EndoSequence NiTi rotary instrument were assigned randomly into four groups. In each group, root canals were filled with single-cone gutta-percha and one of the tested sealers. Each specimen was then scanned using micro-CT at a voxel resolution of 13.47 μm. Proportions of sections with voids in cross-sectional images and void volumes for each sealer were calculated in the apical, middle, and coronal thirds. Differences according to root canal sealers were evaluated statistically using the Kruskal-Wallis test and the Mann-Whitney U-test at a significance level of 5%. The analysis showed a decrease in void formation in the apical third, with a significant difference between the apical and coronal thirds among bioceramic sealers, ActiV GP, and AH Plus (p < 0.05) but no significant difference between the apical and middle thirds or between the middle and coronal thirds was found for the sealers tested (p > 0.05). All root canal sealers tested resulted in voids. The bioceramic sealers (EndoSequence BC Sealer, Smartpaste bio) produced similar voids which had the fewest in the apical third of root canals among the sealers tested which can be related due to root canal anatomy variations.
Deepa, Velagala L.; Bollu, Indira Priyadharsini; Dhamaraju, Bhargavi; Yadla, Padmasri
This case report discusses the identification and management of complex canal configuration of 3-2-1 in the mesiobuccal (MB) root of the maxillary left first molar. Careful attention to details of the pulpal floor and applying the knowledge of the laws of orifice location along with deepening the subpulpal groove with ultrasonic tips helped in identifying the three MB canals. Manual scouting helped in understanding the anatomic configuration; the use of three-dimensional imaging technique and spiral computed tomography (SCT) confirmed the same. SCT images showed buccolingually wide and bulbous mesiobuccal root with three separate canals at coronal third that merged into two canals in the middle and exited as a single canal at the apex. This article highlights the role of SCT in three-dimensionally analyzing the unseen rarest canal configurations that ultimately enabled the clinician to thoroughly explore, debride, and obturate the entire root canal system. PMID:27195233
Mônika, Chaves Medici; Fröner, Izabel Cristina
The purpose of this study was to assess the effectiveness of endodontic irrigants in removing the smear layer from instrumented root canal walls using Scanning Electron Microscopy (SEM). The endodontic irrigants used were: 1% sodium hypochlorite (NaOCl); 1% NaOCl mixed to 17% EDTAC; 2% chlorhexidine gel; and Ricinus communis gel. Photomicrographs of the middle and apical thirds were evaluated with the aid of the Fotoscore - v. 2.0 software. The results indicated that the mixture of sodium hypochlorite and EDTAC completely removed the smear layer from dentinal walls. The other endodontic irrigants were not as efficient in cleansing the root canals.
Pagliosa, André; Sousa-Neto, Manoel Damião; Versiani, Marco Aurélio; Raucci-Neto, Walter; Silva-Sousa, Yara Teresinha Corrêa; Alfredo, Edson
The endodontic preparation of curved and narrow root canals is challenging, with a tendency for the prepared canal to deviate away from its natural axis. The aim of this study was to evaluate, by cone-beam computed tomography, the transportation and centering ability of curved mesiobuccal canals in maxillary molars after biomechanical preparation with different nickel-titanium (NiTi) rotary systems. Forty teeth with angles of curvature ranging from 20° to 40° and radii between 5.0 mm and 10.0 mm were selected and assigned into four groups (n = 10), according to the biomechanical preparative system used: Hero 642 (HR), Liberator (LB), ProTaper (PT), and Twisted File (TF). The specimens were inserted into an acrylic device and scanned with computed tomography prior to, and following, instrumentation at 3, 6 and 9 mm from the root apex. The canal degree of transportation and centering ability were calculated and analyzed using one-way ANOVA and Tukey's tests (α = 0.05). The results demonstrated no significant difference (p > 0.05) in shaping ability among the rotary systems. The mean canal transportation was: -0.049 ± 0.083 mm (HR); -0.004 ± 0.044 mm (LB); -0.003 ± 0.064 mm (PT); -0.021 ± 0.064 mm (TF). The mean canal centering ability was: -0.093 ± 0.147 mm (HR); -0.001 ± 0.100 mm (LB); -0.002 ± 0.134 mm (PT); -0.033 ± 0.133 mm (TF). Also, there was no significant difference among the root segments (p > 0.05). It was concluded that the Hero 642, Liberator, ProTaper, and Twisted File rotary systems could be safely used in curved canal instrumentation, resulting in satisfactory preservation of the original canal shape.
Saoud, Tarek Mohamed A; Huang, George T-J; Gibbs, Jennifer L; Sigurdsson, Asgeir; Lin, Louis M
Regenerative endodontic therapy (RET) is currently used to treat immature teeth with necrotic pulp and/or apical periodontitis. However, recently RET has been used to treat mature teeth with necrotic pulp and/or apical periodontitis and resulted in regression of clinical signs and/or symptoms and resolution of apical periodontitis. The purpose of this case report was to describe the potential of using RET to treat 2 mature teeth with persistent apical periodontitis after root canal therapy using RET. Two male patients, one 26-year old and another 12-year old, presented for retreatment of persistent apical periodontitis after root canal treatment of 2 mature teeth (#9 and #19). The gutta-percha fillings in the canals of teeth #9 and #19 were removed with Carvene gutta-percha solvent (Prevest DenPro, Jammu, India) and ProTaper Universal rotary retreatment files (Dentsply Maillefer, Ballaigues, Switzerland). The canals of both teeth were further chemomechanically debrided with rotary retreatment files and copious amounts of sodium hypochlorite irrigation and dressed with Metapaste (Meta Biomed, Chungbuk, Korea). RET was performed on teeth #9 and #19. Periapical bleeding was provoked into the disinfected root canals. The blood clots were covered with mineral trioxide aggregate plugs, and the access cavities were restored with intermediate restorative material. Teeth #9 and #19 showed regression of clinical signs and/or symptoms and healing of apical periodontitis after 13-month and 14-month follow-ups, respectively. Tooth #9 revealed narrowing of the canal space and apical closure by deposition of hard tissue. RET has the potential to be used to retreat teeth with persistent apical periodontitis after root canal therapy. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
Olivi, M.; Stefanucci, M.; Todea, C.
Aim: to compare the bactericidal efficiency of conventional method and LAI for root canal decontamination. Material and method: 22 human single root teeth, extracted for periodontal problems, mechanically prepared up to ISO 25 at the working lenght were divided in 2 groups: after sterilization, the teeth were infected with enterococcus faecalis and incubated for 4 weeks. Group A: 10 teeth were irrigated with conventional hand technique (CI): 3ml of 5% NaClO were used for two times of 30s each and after washing with sterile bi-distilled water for 20s, a final irrigation was performed with 3ml of 17% EDTA. Group B: 10 teeth were irrigated with 3ml of NaClO and activated by erbium laser, two cycles of 30s; also the final irrigation with 3ml of 17% EDTA was activated by erbium laser. In both the groups a resting time of 30s was used between the two sessions to allow the reaction rate of NaClO. The Erbium laser 2940 nm (LightWalker AT, Fotona; Lublijana, Slovenia) was used with 50microsecond pulse duration, at 15Hz, 20mJ, with a 600micron PIPS tip. Two samples were used as positive and negative control.
Sonntag, D; Stachniss-Carp, S; Stachniss, C; Stachniss, V
The aim of this paper is to present a new method based on numeric calculus to provide data on any type of root canal curvature at any point of the long axis of the canal. Twenty severely curved, simulated root canals were prepared with rotary FlexMaster and Profile instruments in the crown-down technique and manually in the step-back technique. The inner and outer curvatures were registered in a system of coordinates before and after preparation in increments of 0.5 mm. Using an equalising function, the curvatures were first represented in graphic and algebraic form. The maximum and the mean curvature as well as the length of the arc from the apical foramen to the point of maximum curvature were determined mathematically. An increase in maximum curvature was registered for all four shaping systems investigated. The radius of the inner curvature decreased by 0.5-1.2 mm in the manual systems as a result of the preparation. The Profile system displayed the smallest changes in radius (-0.9 mm) even with the outer curvature, and manual preparation with stainless steel files the most pronounced change (-1.8 mm). The point of maximum curvature at the inner curvature was displaced by 1.6 mm to the apical foramen through manual preparation with Ni-Ti files. At the outer curvature, the maximum displacement (1.8 mm) recorded was also the result of preparation with Ni-Ti hand files, while a displacement of only 0.3 mm to the apical foramen was recorded with the other systems. The method offers a means of determining curvatures precisely without random specification of reference points. The method is also capable of registering only minor changes in curvature in the two-dimensional long axis of the canal.
Dadresanfar, Bahareh; Mehrvarzfar, Payman; Saghiri, Mohammad Ali; Ghafari, Sedigh; Khalilak, Zohreh; Vatanpour, Mehdi
The aim of this in vitro study was to compare the efficacy of two retreatment rotary systems in removal of gutta-percha (GP) and sealer from the root canal walls with and without use of solvent. Sixty single-canalled distal roots of mandibular molars were prepared and root filled with gutta-percha and AH26. Each canal was randomly allocated to receive one of the retreatment techniques, Mtwo R or ProTaper. The groups were further divided into two subgroups: with or without the use of solvent. The cleanliness of canal walls was determined by stereomicroscope and scanning electron microscopy. The results showed that Mtwo R without the use of solvent was more efficient in material removal compared to ProTaper D (P<0.05). Most remnants were found in the apical third of the canals (P<0.05). Mtwo R seems to be an efficient rotary system for endodontic retreatment of root canal with GP.
Thakur, Sophia; Emil, Jonathan; Paulaian, Benin
Aim: The aim of this study was to compare the clinical and radiological outcome of mineral trioxide aggregate (MTA) or epoxy resin as a root canal sealer compared with zinc oxide eugenol sealer. Materials and Methods: 45 single rooted teeth with periapical index Score 2 or more were allotted to three groups with 15 teeth in each group. Root canal treatment was performed in two visits and obturated with Gutta-percha as obturating material and zinc oxide eugenol as sealer in Group 1, epoxy resin as sealer in Group 2 and MTA mixed with propylene glycol as sealer in Group 3. Visual analog scale, periapical index and VixWin digital Pro image analysis software were used for evaluation. The quantitative data was analyzed by t-test and analysis of variance. Ordinal data was analyzed by Wilcoxon's signed rank test, Mann-Whitney and Kruskall-Wallis test. Results: Results suggested that there exists no statistically significant difference in clinical or radiological outcome of root canal therapy with three different types of sealers used in this study. Conclusions: MTA could be used as a root canal sealer with equal effectiveness compared with epoxy resin and zinc oxide eugenol sealers. Further long-term studies should be carried out to prove the effectiveness. PMID:24347880
Guedes, Orlando A; Chaves, Gustavo S; Alencar, Ana H G; Borges, Alvaro H; Estrela, Cyntia R A; Soares, Carlos J; Estrela, Carlos
The purpose of this study was to investigate the influence of gutta-percha solvents on the bond strength of fiberglass post to root canal dentin. Forty bovine incisors were decoronated, prepared, filled, and randomly distributed into four groups (n = 10) according to the gutta-percha solvent used: control, xylene, eucalyptol and orange oil. After root canal treatment, the posts were cemented into the prepared root canals using a resin-based cement. A micro push-out test was executed, and the patterns of failure were assessed with microscopy. The data were analyzed using two-way ANOVA followed by Tukey's test. The control group exhibited greater bond strength compared to the eucalyptol group in the cervical and middle thirds of the root (P < 0.05); however, it did not differ significantly from the xylene and orange oil groups (P > 0.05). No difference was observed in the values of the xylene, orange oil, and eucalyptol groups (P > 0.05). The cervical third had higher values than the apical third for all tested solvents (P < 0.05). Adhesive failure between resin cement and dentin was the most frequent type of failure. The use of xylene and orange oil as gutta-percha solvents did not influence the bond strength of fiberglass posts to root canal dentin.
Poggio, Claudio; Dagna, Alberto; Vinci, Andrea; Beltrami, Riccardo; Cucca, Lucia; Giardino, Luciano
Background: Chelating agents are believed to aid root canal irrigation and to be able to remove the inorganic smear layer. Aims: The purpose of the present study was to evaluate and to compare the decalcifying capability of different irrigating solutions (Tubuliclean, Largal Ultra, ethylenediaminetetraacetic acid 17%, Tetraclean, Tetraclean NA). Materials and Methods: Sixty maxillary central incisors were used. Root canals were instrumented and irrigated. From each root, four comparable slices of cervical dentin were obtained. At three successive 5-min interval immersion times, the concentration of calcium extracted from root canal dentin was assessed with an inductively coupled plasma-atomic emission spectrometer. Statistical Analysis Used: Data were analyzed by means of Kruskal Wallis and Mann–Whitney tests. Significance was predetermined at P < 0.05. Results and Conclusions: For all irrigating solutions, the maximum amount of Ca2+ extracted from root canal dentin samples was reached after 10 min contact time except for citric acid-based agents (Tetraclean and Tetraclean NA) which induced a higher and still increasing calcium release even after 10 min contact time. In order to obtain an efficient decalcifying action on dentin and to facilitate the biomechanical procedures, citric acid-based irrigants can be applied. PMID:26097355
Sherwood, I Anand
Objectives The aim of this study was to evaluate which radicular radiographic features general dentists want to interpret, determine which of the radicular radiographic features general dentists interpret and which ones they miss in a diagnostic radiograph and correlate how accurately general dentists are able to interpret radiographic features. Methods 20 general dental practitioners were selected and given 2 sets of questionnaires. The first set asked them to fill out the findings they would elucidate in a diagnostic radiograph while the second set consisted of 30 randomly selected intraoral radiographs to interpret. Results In the first set of questionnaires, more than 50% of dentists said they would interpret periapical changes, calcification, root curvature and the number of root canals. Less than 50% said they would interpret canal morphology, open apex, resorption, fracture, number of roots and lamina dura. In the second set of questionnaires, more than 90% missed grade 1 or 2 periapical changes (according to periapical index scoring), resorption and canal calcification. More than 80% of dentists missed extra roots and root curvature buccally while no dentists were able to interpret the periodontal ligament width changes, lamina dura and canal variation (C-shape). Using a paired t-test, there was significant variation in answers between the first set and second set of questionnaires. Conclusion It is concluded from this study that general dental practitioners are able to detect radiographic changes when they are extensive but they miss periodontal ligament width and lamina dura changes. PMID:22074878
Reddy, S; Ramakrishna, Y
The primary goal of endodontic treatment in primary teeth is to eliminate infection, and to retain the tooth in a functional state until their nornal exfoliation time without endangering the permanent dentition or the general health of the child. The complexity of the pulp canal system in primary teeth presents a discerning problem for chemo-mechanical preparation. One of the factors determining the success of endodontic treatment in infected primary teeth is the sealing material that should encompass among other factors a potent bactericidal effect and the capacity to resorb along with the roots of primary teeth. This study evaluated the antimicrobial effectiveness of 5 root canal filing materials and a negative control agent against 23 strains of bacteria isolated from infected root canals of primary molar teeth and 3 non standard bacterial strains using agar diffusion assay. The materials were Zinc oxide and Eugenol (ZOE), Zinc oxide-Eugenol and Formocresol (ZOE+FC), Calcium hydroxide and sterile water (CAOH+H2O), Zinc oxide and Camphorated phenol (ZO+CP), Calcium hydroxide and Iodoform (Metapex) and Vaseline (Control). All the materials except Vaseline showed varied antimicrobial activity against the test bacteria. The zones of inhibition were ranked into 4 inhibition categories based on the proportional distribution of the data. All the 26 bacterial isolates were classified under 4 groups based on Aerobic/Anaerobic and Gram positive/Gram negative. Statistical analysis was carried out to compare the antimicrobial effectiveness between materials tested with each of the bacterial groupings. ZOE+FC produced strong inhibtion against most bacteria when compared to ZOE, ZO+CP and CAOH+H2O. Metapex and Vaseline were found to be non inhibitory
Kazemipoor, Maryam; Azad, Shaghayegh; Farahat, Farnaz
Introduction: The aim of the present study was to evaluate the concurrent effect of root canal preparation size and intra coronal bleaching on dentin microhardness. Methods and Materials: Seventy-two intact anterior teeth were root canal treated and randomly divided into two groups (n=36) according to the size of coronal root canal preparation. The coronal portions of the canals were then enlarged with #2 and 4 Peeso reamers, respectively. Following root canal obturation, teeth were assigned into three groups (n=12) to be treated with bleaching agents containing 35% hydrogen peroxide (HP), sodium perborate (SP) and distilled water as control group. The teeth were stored at 37ºC and 100% humidity for 7 days. Dentinal blocks with 3 mm thickness were obtained from the cervical region and Vickers microhardness number (VHN) were measured for outer and inner dentin in each tooth sample. Data were analyzed using two-way ANOVA and Tukey’s HSD tests. Results: In the outer dentin, the mean VHN in the HP and control groups showed statistically significant differences (P=0.047). The mean VHN of inner dentin for the large preparation size was statistically higher in comparison to the small preparation size (P=0.042). There was a statistically significant difference in the mean VHN of inner dentin with small preparation size between HP and SP groups (P=0.029) and HP and control groups (P=0.021). Conclusion: Intra coronal bleaching with 35% hydrogen peroxide, affects the inner and outer dentin significantly. Excessive removal of cervical dentin, following root canal preparation, alongside the adverse effect of bleaching materials on dentin could result in the tooth fracture. PMID:28808454
Gomes, João Eduardo; Hopp, Renato Nicolás; Bernabé, Pedro Felício Estrada; Nery, Mauro Juvenal; Otoboni, José Arlindo; Dezan, Elói
The aim of this study was to evaluate two root canal filling techniques used in teeth that had their apical foramen disrupted and compare the apical infiltration with an ideal clinical situation. Twenty-seven freshly extracted single-rooted teeth were selected and radiographed to confirm the existence of a single and straight root canal. The crowns were removed at a mean distance of 11 mm from the apex. The teeth had the root canals instrumented and were randomly assigned to 3 groups (n=9): ND group - root canals were filled using the lateral compaction technique and no disruption was performed; DRF group - the apical constriction was disrupted by advancing a #40 K-file 1 mm beyond the original working length, the canals were reinstrumented to create an apical ledge at 1 mm from the apical foramen and were obturated with a master gutta-percha cone with same size as the last file used for reinstrumentation; DF group - the teeth had the apical constriction disrupted and the canals were obturated with a master gutta-percha cone that fit at 1 mm from the apex. The teeth were submitted to dye leakage test with Rhodamine B for 7 days, using vaccum on the initial 5 min. The teeth were sectioned longitudinally and the leakage was measured in a linear fashion from apex to crown. There was no statistically significant difference (p>0.05) between the groups that had the apical foramen disrupted (DF, DRF), but significant difference was found between the disrupted groups and the non-disrupted one (p<0.01). In conclusion, none of the evaluated techniques was able to prevent apical infiltration, so working length so the working length determination has to be established and maintained carefully. PMID:19089232
Kazemipoor, Maryam; Azad, Shaghayegh; Farahat, Farnaz
The aim of the present study was to evaluate the concurrent effect of root canal preparation size and intra coronal bleaching on dentin microhardness. Seventy-two intact anterior teeth were root canal treated and randomly divided into two groups (n=36) according to the size of coronal root canal preparation. The coronal portions of the canals were then enlarged with #2 and 4 Peeso reamers, respectively. Following root canal obturation, teeth were assigned into three groups (n=12) to be treated with bleaching agents containing 35% hydrogen peroxide (HP), sodium perborate (SP) and distilled water as control group. The teeth were stored at 37(º)C and 100% humidity for 7 days. Dentinal blocks with 3 mm thickness were obtained from the cervical region and Vickers microhardness number (VHN) were measured for outer and inner dentin in each tooth sample. Data were analyzed using two-way ANOVA and Tukey's HSD tests. In the outer dentin, the mean VHN in the HP and control groups showed statistically significant differences (P=0.047). The mean VHN of inner dentin for the large preparation size was statistically higher in comparison to the small preparation size (P=0.042). There was a statistically significant difference in the mean VHN of inner dentin with small preparation size between HP and SP groups (P=0.029) and HP and control groups (P=0.021). Intra coronal bleaching with 35% hydrogen peroxide, affects the inner and outer dentin significantly. Excessive removal of cervical dentin, following root canal preparation, alongside the adverse effect of bleaching materials on dentin could result in the tooth fracture.
Nikoloudaki, Georgia E.; Kontogiannis, Taxiarchis G.; Kerezoudis