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Yu Y, Yuan CY, Yin XZ, Wang XY. Assessment of isthmus filling using two obturation techniques performed by students with different levels of clinical experience. J Dent Sci 2024; 19:169-176. [PMID: 38303796 PMCID: PMC10829546 DOI: 10.1016/j.jds.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/07/2023] [Indexed: 02/03/2024] Open
Abstract
Background/purpose Root canal filling is a necessary skill for dental students and an important aspect of endodontic education. This study aimed to evaluate the effect of students' clinical experiences on isthmus filling using different techniques and sealers. Materials and methods One hundred eight three-dimensional-printed resin replicas of isthmus were divided into six groups and either continuous wave of condensation (CWC) or single-cone obturation (SC) was performed. One of three sealers (AH Plus Jet®, GuttaFlow2, iRoot SP) was used together with a size-fitted gutta-percha master cone. All the obturations were completed by students with three different levels of clinical experience including senior postgraduate students (SPS), junior postgraduate students (JPS), and undergraduate students (US). The percentages of filled areas (PFA) at 2, 4, 6, and 8 mm from the apex were analyzed using a light microscope. Data were analyzed using the Mann-Whitney U test or Kruskal-Wallis 1-way ANOVA with Dunn's tests (α = 0.05). Results The CWC group exhibited a higher PFA than the SC group (P < 0.05). The PFA was higher in the SPS group than in the JPS group or the US group with CWC (P < 0.05). The three clinical experience groups showed similar PFAs with SC (P > 0.05); however, when using SC with iRoot SP, the PFA was higher than with either of the other two sealers (P < 0.05). Conclusion CWC was found to be technique-sensitive and required clinical training. With SC, clinical experience did not improve the quality of isthmus filling without additional training. CWC was superior to SC for type IV isthmuses. When using SC, better filling quality was obtained with a bioceramic sealer.
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Affiliation(s)
- Yang Yu
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Chong-Yang Yuan
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Xing-Zhe Yin
- Department of Geriatric Dentistry, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Xiao-Yan Wang
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing, China
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Suassuna FCM, de Araújo DKM, Amorim AMAM, Melo SLS, Heck RJ, Antonino ACD, Bento PM, Silva DFB, de Melo DP. Thermal and volumetric assessment of endodontic filling techniques using infrared thermography and micro-CT. J Oral Sci 2023; 65:34-39. [PMID: 36543226 DOI: 10.2334/josnusd.22-0285] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE To assess root temperature during filling techniques and quantify the volume of endodontic filling materials using infrared thermography (IT) and micro-computed tomography (micro-CT). METHODS Ninety premolars were divided into three groups: lateral condensation (LC), single cone (SC) and thermomechanical compaction (TMC). For thermal analysis, 45 teeth were assessed using a FLIR T650sc IT camera during filling techniques and 45 teeth were scanned using a Nikon micro-CT to assess gutta-percha, cement, and void volumes. Descriptive and inferential statistical analyses were performed (non-parametric Mann-Whitney test, Kruskal-Wallis test, and Friedman test with Tukey's bidirectional analysis of variance). RESULTS TMC showed the highest temperature increase at 15 s after the procedure and a significant temperature decrease at 45 s after its completion. TMC showed the largest volume of gutta-percha and LC the highest void volume. CONCLUSION The temperature increase generated by gutta-percha endodontic filling techniques is within acceptable limits. A greater volume of endodontic cement was observed for the SL and LC filling techniques.
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Affiliation(s)
| | | | | | - Saulo Leonardo S Melo
- Department of Integrative Biomedical & Diagnostic Sciences School of Dentistry, Oregon Health & Science University
| | - Richard J Heck
- Department of Land Resource Science, University of Guelph
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Yu Y, Yuan CY, Dong MJ, Qu XB, Zhang JC, Wang XY. Influence of relative positions of the heat carrier and lateral canal opening on gutta-percha obturation of lateral canals in a three-dimensional-printed model. J Dent Sci 2023; 18:9-16. [PMID: 36643252 PMCID: PMC9831810 DOI: 10.1016/j.jds.2022.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 07/31/2022] [Indexed: 01/18/2023] Open
Abstract
Background/purpose Effective filling of the lateral canals is of great significance in successful root canal treatment, but it is generally being challenging. This study aimed to evaluate the influence of relative positions of the heat carrier and lateral canal opening on gutta-percha obturation of lateral canals in a three-dimensional (3D)-printed model. Materials and methods Thermal conductivity and real-time temperature transmission of gutta-percha were investigated using laser flash and thermal infrared analyses. 3D-printed root canal models with lateral canals at 1, 3, and 5 mm from the apex were fabricated, and different relative positions of the heat carrier were tested. The obturation process was recorded on video, and the obturation depth of the lateral canals was observed using X-ray micro-computed tomography. Results Gutta-percha showed low thermal conductivity of 1.07 W/(m·K), and heating increased the temperature of gutta-percha above 60 °C only within 1 mm beyond the heat carrier tip. For lateral canals at 1 and 3 mm from the apex, gutta-percha penetrated further with deeper penetration of the heat carrier (P < 0.05). For 5-mm lateral canals, the heat carrier was always at apical level and the gutta-percha obturation depth was more at 2 mm apically than at 3 or 4 mm (P < 0.05). Conclusion Gutta-percha is a poor thermal conductor. The position of the heat carrier in relation to the lateral canal opening affects obturation depth. Only when the heat carrier reaches or passes the lateral canal opening can gutta-percha penetrate a lateral canal.
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Affiliation(s)
- Yang Yu
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Chong-Yang Yuan
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Meng-Jie Dong
- Beijing Engineering Research Center of Advanced Elastomers, Beijing University of Chemical Technology, Beijing, China
| | - Xiu-Bo Qu
- Beijing Engineering Research Center of Advanced Elastomers, Beijing University of Chemical Technology, Beijing, China
| | - Ji-Chuan Zhang
- Beijing Engineering Research Center of Advanced Elastomers, Beijing University of Chemical Technology, Beijing, China
| | - Xiao-Yan Wang
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology, Beijing, China,Corresponding author. Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology, No.22, Zhongguancun South Avenue, Haidian District, Beijing, 100081, China.
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Tirez E, Pedano MS. Regeneration of the Pulp Tissue: Cell Homing versus Cell Transplantation Approach: A Systematic Review. MATERIALS (BASEL, SWITZERLAND) 2022; 15:8603. [PMID: 36500098 PMCID: PMC9736993 DOI: 10.3390/ma15238603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 11/19/2022] [Accepted: 11/23/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The main objective of this systematic review was to compare the apical healing, root maturation and histological characteristics of teeth treated with cell-based versus cell-free techniques. METHODS The methodology of this review was based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A literature search strategy was carried out on PubMed, EMBASE and the Web of Science databases. The last search was done on 1 August 2021. Articles written in languages other than English were excluded. Two researchers independently selected the studies and extracted the data. As no randomized clinical trials were available, animal studies were included. RESULTS In total, 26 studies were included in the systematic review: 22 articles only researched the cell-free technique, 3 articles compared the cell-based to the cell-free technique, and 1 article compared the cell-based technique to apexification. In terms of apical healing, qualitative analysis of the data suggested that there seems to be no significant difference between cell-free and cell-based techniques. The results regarding tooth maturation are contradictory. The main difference between the cell-free and the cell-based techniques seems to be the histology of the treated tooth. The cell-free technique seems to result in cementum-like, bone-like or periodontal ligament-like tissue. One study, on the other hand, found that the cell-based technique resulted in regeneration of the whole pulp with an odontoblast layer, connective tissue, blood vessels and neuronal tissue. CONCLUSIONS Currently, the number of randomized clinical trials on this topic are very scarce. This is probably due to the limited infrastructure and lack of resources to apply the cell-based technique. Even though both techniques seem to be promising for clinical application, long-term data need to be provided regarding the healing and reparative patterns.
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Liao SC, Wang HH, Hsu YH, Huang HM, Gutmann JL, Hsieh SC. The investigation of thermal behaviour and physical properties of several types of contemporary gutta-percha points. Int Endod J 2021; 54:2125-2132. [PMID: 34420210 PMCID: PMC9290796 DOI: 10.1111/iej.13615] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 08/13/2021] [Accepted: 08/19/2021] [Indexed: 11/30/2022]
Abstract
Aim To analyse the contents and thermal behaviour of several brands of contemporary gutta‐percha points due to the variable nature of the components of gutta‐percha, and the impact they can have on the physical properties of this unique material during canal filling. Methodology Six brands of gutta‐percha were investigated: Conform Fit TM Gutta‐Percha Points for ProTaper Gold® (PTG) (Dentsply Sirona), ProTaper® Universal Gutta‐Percha Points (PTU) (Dentsply Sirona), Autofit TM Feathered Tip Gutta Percha (Kerr), Mtwo® Gutta‐Percha (VDW), Gutta Percha Root Canal Points (GC, GC Corporation) and Gutta‐Percha Points ISO Color‐Coded (ISO; Dentsply Sirona). The organic and inorganic fractions of gutta‐percha points were separated by quantitative chemical analysis. Thermal conductivity was detected using a laser flash method. In addition, the thermal behaviour of gutta‐percha in response to temperature variations was analysed using differential scanning calorimetry (DSC). Kruskal–Wallis and Dunn tests were applied for comparisons amongst groups for chemical compositions and temperature obtained from DSC. The associations between compositions and thermal conductivity were determined using simple linear regression. A p value <.05 was considered to be statistically significant. Results There were significant difference in the inorganic fractions of the gutta‐percha points in percentage by weight amongst the groups (p < .05). PTG had the lowest thermal conductivity (0.42 W/m K). A positive correlation was observed between the percentage of inorganic fraction and thermal conductivity (r = 0.95). The initial phase changing temperature and peak temperature measured by DSC were significantly different when the β‐form transformed to α‐form (p < .05), whereas no significant difference was found during the α‐form to the amorphous‐phase transition (p > .05). Conclusions Chemical compositions and initial phase changing temperature by DSC varied according to the various brands of gutta‐percha points. Conform Fit TM gutta‐percha had the lowest percentage of inorganic fraction and thermal conductivity amongst these six brands of gutta‐percha. Thermal conductivity had the strongest positive correlation with the percentage of inorganic components and zinc, whilst there was a negative correlation to the amount (ratio) of gutta‐percha.
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Affiliation(s)
- Szu-Chin Liao
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Dentistry, Taipei Municipal Wan-Fang Hospital, Taipei, Taiwan
| | - Hsin-Hui Wang
- Department of Dentistry, Taipei Municipal Wan-Fang Hospital, Taipei, Taiwan
| | - Yung-Hao Hsu
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Dentistry, Taipei Municipal Wan-Fang Hospital, Taipei, Taiwan
| | - Haw-Ming Huang
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Biomedical Optomechatronics, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - James L Gutmann
- College of Dentistry, Nova Southeastern University, Ft. Lauderdale, Florida, USA
| | - Sung-Chih Hsieh
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Dentistry, Taipei Municipal Wan-Fang Hospital, Taipei, Taiwan
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Wolf TG, Willems L, Briseño-Marroquín B. An in vitro endodontic model to quantify the accessory canal filling potential of the vertical and lateral condensation techniques. AUST ENDOD J 2020; 47:245-251. [PMID: 33219588 DOI: 10.1111/aej.12465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/10/2020] [Accepted: 10/25/2020] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to determine the accessory canal filling potential of vertical and lateral condensation techniques in simulated root canals. A total of 130 prepared transparent, straight-simulated root canals with nine accessory canals (0.02 mm), prepared at different levels from the apical, were obturated with vertical (n = 100) and 30 lateral condensation (n = 30) techniques. 50.33% of the accessory canals obturated with vertical condensation were completely filled with gutta-percha; 37.78% completely filled with gutta-percha and sealer. 61.11% of the accessory canals were completely filled with sealer only using the lateral condensation technique. The vertical condensation technique filled the accessory canals more frequently than the lateral condensation techniques. The lateral condensation technique was not capable of delivering gutta-percha to any of the accessory canals. The apical third showed the lowest accessory canal filling frequency with both techniques.
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Affiliation(s)
- Thomas Gerhard Wolf
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland.,Department of Periodontology and Operative Dentistry, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Louisa Willems
- Department of Periodontology and Operative Dentistry, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Benjamín Briseño-Marroquín
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland.,Department of Periodontology and Operative Dentistry, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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Diegritz C, Gerlitzki O, Fotiadou C, Folwaczny M. Temperature changes on the root surface during application of warm vertical compaction using three different obturation units. Odontology 2019; 108:358-365. [DOI: 10.1007/s10266-019-00472-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 10/24/2019] [Indexed: 11/29/2022]
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Experimental Resin-Based Monoblock Endodontic Obturation System. BIOMED RESEARCH INTERNATIONAL 2019; 2019:3512606. [PMID: 31815132 PMCID: PMC6877987 DOI: 10.1155/2019/3512606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 10/09/2019] [Indexed: 11/18/2022]
Abstract
Objective. The aim of the present study was to characterize a novel resin-based monoblock endodontic obturation system consisting of a polymeric cone and a resin-based endodontic sealer. Methods. The preliminary tests performed for the experimental cone were as follows: cohesive strength, dimensional stability, standardization of the diameter and taper, calcium ion release, and radiopacity, for the characterization of the experimental sealer, film thickness and flow tests were performed. Tests were performed according to the American National Standards Institute/American Dental Association (ANSI/ADA) Standards Nos. 57 and 78. The experimental cone was compared to gutta-percha, whereas the experimental sealer was compared to AH Plus. Data were analyzed by Student’s t-test (α = 0.05). Results. The experimental cone had superior values for cohesive strength and dimensional stability compared to gutta-percha. Regarding calcium ion release, the experimental system continued to release calcium ions after 30 days. Film thickness was similar for both endodontic sealers; conversely, the experimental resin-based sealer achieved higher values for flow compared to AH Plus. Conclusion. The experimental resin-based monoblock obturation system fully met the requirements of the ANSI/ADA Standard No. 78 and the ANSI/ADA Standard No. 57, except for radiopacity. Considering this, further studies are still needed to evaluate other radiopacifiers and the effect of their incorporation on the physicochemical properties of this novel resin-based monoblock endodontic obturation system.
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How standard deviation contributes to the validity of a LDF signal: a cohort study of 8 years of dental trauma. Lasers Med Sci 2019; 34:1905-1916. [PMID: 31093798 DOI: 10.1007/s10103-019-02791-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 04/16/2019] [Indexed: 10/26/2022]
Abstract
The aim of this cohort study was to document the potential of laser Doppler flowmetry (LDF) for diagnosing tooth vitality in traumatized teeth in a population of 88 referred patients with dental trauma over a period of 8 years (2011-2018). The main reason to refer was tooth discoloration (26%), and the main trauma cause was a traffic injury (35%). Taking into account that referral for LDF is best given within the week after trauma, 66% of referrals were overdue. In 73% of cases, root canal treatment could be avoided, and in 65%, the presence of a fixed orthodontic retainer showed beneficial for pulp recovery. Data of 394 teeth were collected and submitted to multilevel modelling statistics. As a general conclusion, both LDF perfusion and concentration values proved to be highly reliable in the appreciation of tooth vitality. The difference of variability of standard deviation and range of LDF measurements involving intra-subject control teeth showed statistically significant in discriminating between vital and non-vital pulps. In non-vital teeth, the diagnostic combination of LDF, sensibility tests and peri-apical X-ray is advised.
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Roberts HW, Kirkpatrick TC, Bergeron BE. Thermal analysis and stability of commercially available endodontic obturation materials. Clin Oral Investig 2017; 21:2589-2602. [PMID: 28185092 DOI: 10.1007/s00784-017-2059-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 01/23/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the thermal stability of 23 commercially-available endodontic obturation materials. MATERIALS AND METHODS Specimens (n = 10) were sealed in aluminum differential scanning calorimetry (DSC) crucibles and subjected to thermal scan series consisting of a 25 to 70 °C at 5 °C/min followed by a rapid increase to 230 °C, followed by a second scan from 25 to 70 °C at 5 °C/min. The first scan evaluated the materials as-received followed by a worse-case-scenario thermal challenge simulating temperatures involved with warm vertical condensation obturation techniques. The second thermal scan observed any phase changes from the high temperature challenge. This two-scan process was repeated twice to observe changes encountered by repeat high heat exposure during obturation. Mean thermal enthalpies were analyzed with Kruskal-Wallis and Games-Howell post-hoc test. (p = 0.05). RESULTS Thermal behavior was material dependent. During the first thermal scan, materials typically demonstrated broad endothermic enthalpy curves suggesting either a gutta-percha phase mixture and/or an alpha crystalline phase. The first high-heat challenge produced definitive alpha/beta thermal phase signatures usually associated with gutta-percha. Changes in beta-phase enthalpies were noted with Therarmafil Plus and UltraFil Firmset while increase in alpha-phases was observed with GuttaCore, K3, Lexicon, and Schein Accessory Points. CONCLUSIONS Commercial endodontic gutta-percha obturation materials displayed thermal characteristics that were material dependent. However, all demonstrated stability at temperatures in excess to that experienced during warm vertical condensation techniques. CLINICAL RELEVANCE The gutta-percha obturation materials evaluated in this evaluation can be used successfully in warm vertical condensation techniques without fear of degradation.
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Affiliation(s)
- H W Roberts
- Graduate Dental Research, 81 Dental Squadron, 606 Fisher Street, Keesler Air Force Base, Biloxi, MS, 39534, USA.
| | - T C Kirkpatrick
- Advanced Education in Endodontics, 81 Dental Squadron, Keesler Air Force Base, Biloxi, MS, USA
| | - B E Bergeron
- Advanced Education in Endodontics, Georgia Regents University School of Dental Medicine, Augusta, GA, USA
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Temperature Changes on External Root Surfaces with the Use of Several Thermoplastic Filling Techniques. J Endod 2016; 42:1131-4. [PMID: 27233582 DOI: 10.1016/j.joen.2016.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 04/01/2016] [Accepted: 04/17/2016] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The purpose of this study was to measure the temperature rise on the external root surface of filled root canals using Touch'n Heat (Analytic Endodontics, Orange, CA), the TC System (TC; Tanaka de Castro & Minatel Ltda, Cascavel, PR, Brazil), and the Tagger technique. METHODS Forty-five single-canal mandibular premolar human teeth were used in the 3 experimental groups. The root canals were enlarged to accommodate up to an R40 Reciproc file (VDW, Munich, Germany). Next, the specimens were filled according to the technique evaluated. The measurement of the temperature was performed by K chromium-aluminum thermocouples attached to the coronal, middle, and apical root levels. RESULTS There was a significant difference among the 3 techniques (P < .001) in relation to the temperature variation between the highest temperature and the initial temperature. The highest temperature change was found with the Tagger technique at the middle third root level (11.8°C), and the lowest variation was in TC at the cervical third (2.05°C). CONCLUSIONS There was a rise of temperature on the external root surface for all of the techniques evaluated. TC showed the lowest temperature rise.
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