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Nathani TI, Olivieri JG, Tomás J, Elmsmari F, Abella F, Durán-Sindreu F. Post-operative pain after single-visit root canal treatment using resin-based and bioceramic sealers in teeth with apical periodontitis: A randomised controlled-trial. AUST ENDOD J 2024. [PMID: 38887839 DOI: 10.1111/aej.12864] [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: 02/12/2024] [Revised: 04/15/2024] [Accepted: 05/21/2024] [Indexed: 06/20/2024]
Abstract
The present study aimed to compare postoperative pain in teeth with symptomatic and asymptomatic apical periodontitis (AP) following a single-visit endodontic treatment using BioRoot™ RCS or AH Plus at 8 h, 24 h and 48 h postoperatively. Postgraduate students performed endodontic treatment on 101 teeth with AP, randomised into two obturation groups. A 100-mm Visual Analog Scale was used to document the intensity of pain at preoperative, 8-h, 24-h and 48-h intervals. The Kolmogorov-Smirnov test was used for normality, and the median and interquartile ranges were compared using the Mann-Whitney U test. Preoperative pain (1.90 ± 3.50) was more frequent in teeth with symptomatic AP (p < 0.05). However, no significant differences were observed in postoperative pain at the 8-h, 24-h and 48-h intervals. Pre and postoperative pain were directly associated (p < 0.05). Single-visit root canal treatment in teeth with AP using both sealers resulted in similar levels of postoperative pain.
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Affiliation(s)
- Tousif Iqbal Nathani
- Department of Endodontics, Universitat Internacional de Catalunya, Barcelona, Spain
| | | | - Jordi Tomás
- Department of Endodontics, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Firas Elmsmari
- Department of Clinical Sciences, College of Dentistry, Ajman University, Ajman, United Arab Emirates. Center of Medical and bio-Allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
| | - Francesc Abella
- Department of Clinical Sciences, College of Dentistry, Ajman University, Ajman, United Arab Emirates. Center of Medical and bio-Allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
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Mansour MM, Moussa SM, Meheissen MA, Aboelseoud MR. Bacterial sealing ability of calcium silicate-based sealer for endodontic surgery: an in-vitro study. BMC Oral Health 2024; 24:584. [PMID: 38773504 PMCID: PMC11107006 DOI: 10.1186/s12903-024-04309-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 04/29/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Apical surgery with standard retrograde maneuvers may be challenging in certain cases. Simplifying apical surgery to reduce operating time and streamline retrograde manipulation is an emerging need in clinical endodontics. AIM OF THE STUDY The aim of the study was to compare the bacterial sealing ability of a calcium silicate-based sealer with the single cone technique combined with root end resection only, and calcium silicate-based sealer as a retrograde filling versus MTA retrofilling, and to analyze bacterial viability using confocal laser scanning microscope (CLSM). MATERIALS AND METHODS In this in vitro experimental study, 50 extracted human maxillary incisor teeth were instrumented and randomly divided into five groups: three experimental groups, a positive control group, and a negative control group (n = 10/group). In the experimental groups, the roots were obturated using the single cone technique (SCT) and a calcium silicate-based sealer. In group 1, the roots were resected 3 mm from the apex with no further retrograde preparation or filling. In groups 2 and 3, the roots were resected, retroprepared, and retrofilled with either a calcium silicate-based sealer or MTA, respectively. Group 4 (positive control) was filled with a single gutta-percha cone without any sealer. In group 5 (negative control), the canals were left empty, and the roots were sealed with wax and nail varnish. A bacterial leakage model using Enterococcus faecalis was employed to assess the sealing ability over a 30-day period, checking for turbidity and analyzing colony forming units (CFUs) per milliliter. Five specimens from each group were examined using CLSM for bacterial viability. Data for the bacterial sealing ability were statistically analyzed using chi-squared and Kruskal-Wallis tests. RESULTS The three experimental groups did not show significant differences in terms of bacterial leakage, or bacterial counts (CFUs) (P > 0.05). However, significant differences were observed when comparing the experimental groups to the positive control group. Notably, the calcium silicate-based sealer, when used as a retrofilling, yielded the best sealing ability. CLSM imaging revealed viable bacterial penetration in all the positive control group specimens while for the experimental groups, dead bacteria was the prominent feature seen. CONCLUSION Within the limitations of this study, it could be concluded that the bacterial sealing ability of calcium silicate-based sealer with the single cone technique combined with root end resection only and calcium silicate-based sealer as a retrograde filling were comparable with MTA retrofilling during endodontic surgical procedures.
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Affiliation(s)
- Mai M Mansour
- Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, 21527, Egypt.
| | - Sybel M Moussa
- Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, 21527, Egypt
| | - Marwa A Meheissen
- DMedical Microbiology & Immunology, Faculty of Medicine, Alexandria University, Alexandria, 21527, Egypt
| | - Mahmoud R Aboelseoud
- Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, 21527, Egypt
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Liu SM, Peng L, Zhao YJ, Han B, Wang XY, Wang ZH. Accuracy and efficiency of dynamic navigated root-end resection in endodontic surgery: a pilot in vitro study. BMC Oral Health 2024; 24:582. [PMID: 38764019 PMCID: PMC11103819 DOI: 10.1186/s12903-024-04306-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 04/29/2024] [Indexed: 05/21/2024] Open
Abstract
BACKGROUND The operation accuracy and efficiency of dynamic navigated endodontic surgery were evaluated through in vitro experiments. This study provides a reference for future clinical application of dynamic navigation systems in endodontic surgery. MATERIALS AND METHODS 3D-printed maxillary anterior teeth were used in the preparation of models for endodontic surgery. Endodontic surgery was performed with and without dynamic navigation by an operator who was proficient in dynamic navigation technology but had no experience in endodontic surgery. Optical scanning data were applied to evaluate the length and angle deviations of root-end resection. And the operation time was recorded. T tests were used to analyze the effect of dynamic navigation technology on the accuracy and duration of endodontic surgery. RESULTS With dynamic navigation, the root-end resection length deviation was 0.46 ± 0.06 mm, the angle deviation was 2.45 ± 0.96°, and the operation time was 187 ± 22.97 s. Without dynamic navigation, the root-end resection length deviation was 1.20 ± 0.92 mm, the angle deviation was 16.20 ± 9.59°, and the operation time was 247 ± 61.47 s. Less deviation was achieved and less operation time was spent with than without dynamic navigation (P < 0.01). CONCLUSION The application of a dynamic navigation system in endodontic surgery can improve the accuracy and efficiency significantly for operators without surgical experience and reduce the operation time.
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Affiliation(s)
- Si-Min Liu
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, PR China
- Fourth Clinical Division, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, PR China
| | - Li Peng
- Department of General Dentistry II, National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Peking University School and Hospital of Stomatology, Beijing, PR China
| | - Yi-Jiao Zhao
- Center for Digital Dentistry, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, PR China
| | - Bing Han
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, PR China
| | - Xiao-Yan Wang
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, PR China
| | - Zu-Hua Wang
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, PR China.
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Liu J, Zhao X, Liu Y, Dong N, Zhang X. Prevalence and anatomic associations of middle mesial canals and isthmi in mandibular first molars: A CBCT-based study in a Northern Chinese population. AUST ENDOD J 2024; 50:69-77. [PMID: 37902140 DOI: 10.1111/aej.12807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/12/2023] [Accepted: 10/17/2023] [Indexed: 10/31/2023]
Abstract
This study investigated the prevalence of the middle mesial canal (MMC) and isthmus in a northern Chinese subpopulation using cone-beam computed tomography (CBCT). CBCT images of 1060 mandibular first molars (MFMs) were analysed. Data analysis was performed using the chi-square test, t-test, and multiple logistic regression analysis (p < 0.05). The prevalence of MMC and isthmus was 15.2% and 40.6%, respectively. The average dentinal thickness in the danger zone was 1.61 ± 0.14 mm. Patients younger than 40 years were two times more likely to have MMC (odds ratio [OR] = 2.204). Additionally, for every 1 mm reduction in the MB-ML orifice distance, the likelihood of detection of MMC in MFM nearly doubled (OR = 1.738). Furthermore, MFMs with MB-ML isthmus were five times more likely to exhibit MMC than those without it (OR = 4.756). The findings revealed that the prevalence of MMC and isthmus in MFMs is high and suggested that anatomical and demographic variables can serve as valuable indicators for clinicians in anticipating their presence.
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Affiliation(s)
- Jiaojiao Liu
- Department of Stomatology, General Hospital of Northern Theater Command, Shenyang, China
| | - Xiangyu Zhao
- Department of Oral Emergency, Shenyang Stomatological Hospital, Shenyang, China
| | - Ying Liu
- Department of Stomatology, General Hospital of Northern Theater Command, Shenyang, China
| | - Nannan Dong
- Department of Stomatology, General Hospital of Northern Theater Command, Shenyang, China
| | - Xiaodong Zhang
- Department of Stomatology, General Hospital of Northern Theater Command, Shenyang, China
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Keskin C, Pirimoğlu B, Çiftçioğlu E, Dinger E, Kömeç O, Keleş A. Shaping outcomes of Reciproc Blue and Rotate in roots canals with band-shaped isthmuses: micro-CT study. Clin Oral Investig 2023; 27:7337-7344. [PMID: 37861748 DOI: 10.1007/s00784-023-05324-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 10/10/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE This study assessed the outcome of shaping the mesial roots of mandibular first molars containing band-shaped isthmuses with an isthmus floor located at the apical third with Reciproc Blue and Rotate instruments in terms of canal transportation, canal aberrations and unprepared apical canals. MATERIALS AND METHODS Pair-matched mesial roots of mandibular first molars according to their isthmus location (distance from apical foramina) and size were constructed based on quantitative measurements (length, major and minor diameter at isthmus roof and floor) on preoperative micro-CT scanning (n = 10). The pair-matched specimens were prepared either using Reciproc Blue R25 (25.08v) or Rotate (15.04, 20.05, 25.06) instruments and then subjected to a second micro-CT scanning. Micro-CT scans were analysed to evaluate the canal transportation at the apical foramen and isthmus floor levels and the frequency of procedural errors (separated instruments, artificial canal preparation, cross shaping and unprepared apical canals). Canal transportation values were compared using Mann-Whitney U, and the distribution of procedural errors was compared with chi-square tests with a 5% significance threshold. RESULTS Greater transportation values were detected in the apical foramen level compared to the isthmus floor in both groups. No significant difference was detected between Rotate and Reciproc Blue groups in terms of absolute transportation values and the incidence of procedural errors (p > .05). CONCLUSION Preparation of mesial root canals containing a band-shaped isthmus at the apical portion with Reciproc Blue and Rotate instruments caused transportation of the original canal position at the isthmus floor and the apical foramen levels and resulted in procedural errors. CLINICAL RELEVANCE This ex vivo micro-CT study using controlled pair-matched specimens showed that presence of a band-shaped isthmus complicates canal preparation procedure irrespective of the preparation systems.
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Affiliation(s)
- Cangül Keskin
- Department of Endodontics, Faculty of Dentistry, Ondokuz Mayis University, Samsun, Turkey.
| | - Burcu Pirimoğlu
- Department of Endodontics, Faculty of Dentistry, Ondokuz Mayis University, Samsun, Turkey
| | - Elif Çiftçioğlu
- Department of Endodontics, Faculty of Dentistry, Okan University, Istanbul, Turkey
| | - Esma Dinger
- Department of Endodontics, Faculty of Dentistry, Bolu Abant İzzet Baysal University, Bolu, Turkey
| | | | - Ali Keleş
- Department of Endodontics, Faculty of Dentistry, Ondokuz Mayis University, Samsun, Turkey
- Department of Endodontics, Faculty of Dentistry, Bolu Abant İzzet Baysal University, Bolu, Turkey
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Gioster-Ramos ML, Pivoto-João MMB, Pinto JC, Guerreiro-Tanomaru JM, Tanomaru-Filho M. Diamond-coated ultrasonic tip decreases debris and uninstrumented surface after preparation of curved canals with isthmus. Braz Oral Res 2023; 37:e102. [PMID: 38055520 DOI: 10.1590/1807-3107bor-2023.vol37.0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/29/2023] [Indexed: 12/08/2023] Open
Abstract
The aim of this study was to evaluate root canal preparation with nickel titanium rotary instruments and complementary preparation with ultrasonic tip in curved canals of mandibular molars with isthmus. Twenty-eight mesial roots of mandibular molars with curvature between 20° and 40° and presence of isthmus throughout the entire extension of the root canals were prepared using ProDesign Logic CM (PDL) up to size 40.05, or HyFlex EDM (HFEDM) up to size 40.04. Complementary preparation was performed in the isthmus region using the ultrasonic insert E18D (Helse, Istmo Diamantada). The root canals were scanned using micro-CT (SkyScan 1176) at 9 µm voxel size before and after each preparation step. Transportation, percentage of increase in volume, debris and uninstrumented surface (UNS) were evaluated. Mann Whitney, Wilcoxon, paired and non-paired t-tests were used for statistical analysis (α = 0.05). The canals prepared with PDL and HFEDM obtained similar results for all the variables assessed before using E18D (p > 0.05). E18D significantly decreased the percentage of debris and UNS values in both Groups (p < 0.05). The complementary preparations with E18D caused a smaller quantity of debris in the isthmus of the canals previously prepared with PDL in comparison with HFEDM (p < 0.05). PDL and HFEDM provided similar root canal preparation. PDL promoted a smaller quantity of Debris in the isthmus than HFEDM after using E18D. E18D significantly improved cleaning, and reduced Debris and UNS.
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Affiliation(s)
- Maria Luiza Gioster-Ramos
- Universidade Estadual Paulista - Unesp, School of Dentistry, Department of Restorative Dentistry, Araraquara, SP, Brazil
| | | | - Jáder Camilo Pinto
- Universidade Estadual Paulista - Unesp, School of Dentistry, Department of Restorative Dentistry, Araraquara, SP, Brazil
| | | | - Mário Tanomaru-Filho
- Universidade Estadual Paulista - Unesp, School of Dentistry, Department of Restorative Dentistry, Araraquara, SP, Brazil
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Plotino G, Özyürek T, Gündoğar M, Uslu G, Pedullà E, Careddu R, Franco V. Efficacy of different irrigant activation devices in removing dentin debris from an artificial isthmus connecting curved canals. AUST ENDOD J 2023; 49 Suppl 1:353-358. [PMID: 36960975 DOI: 10.1111/aej.12748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 01/27/2023] [Accepted: 03/06/2023] [Indexed: 03/25/2023]
Abstract
The aim of this study was to evaluate the debridement efficacy of sonic irrigation (EDDY; VDW, Munich, Germany and EndoActivator; Dentsply-Sirona, Ballaigues, Switzerland) and ultrasonically activated irrigation (Irrısafe; Satelec Acteon, Merignac, France) in a simulated canal isthmus connecting curved canals. Transparent resin blocks were produced containing two curved canals connected with an isthmus. The isthmus was then filled with dentin debris. Three irrigant activation cycles were performed and the amount of remaining debris was compared analysing pictures taken after each activation cycle. Data were statistically analysed using one-way ANOVA and post hoc Tukey tests at a significance level of p < 0.05. EDDY showed greater efficiency in removing dentin debris from the simulated isthmus than the other techniques tested. An increase in the activation time enhanced the efficiency of both EDDY and ultrasonically activated irrigation in debris removal.
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Affiliation(s)
- Gianluca Plotino
- Private Practice, Grande Plotino & Torsello - Studio di Odontoiatria, Rome, Italy
| | - Taha Özyürek
- Department of Endodontics, Faculty of Dentistry, Istanbul Medeniyet University, İstanbul, Turkey
| | - Mustafa Gündoğar
- Department of Endodontics, Faculty of Dentistry, Istanbul Medipol University, İstanbul, Turkey
| | - Gülşah Uslu
- Department of Endodontics, Faculty of Dentistry, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Eugenio Pedullà
- Department of General Surgery and Medical - Surgical Specialties, University of Catania, Catania, Italy
| | - Roberto Careddu
- Division of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, Dublin, Ireland
| | - Vittorio Franco
- Private Practice, Studio di Odontoiatria Digitale, Rome, Italy
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Singi SR, Ikhar A, Sibal A, Reche A, Madhu PP. Unveiling Hidden Canals: Middle Mesial Canal Prevalence in Mandibular First Molars Using Cone-Beam Computed Tomography Analysis in Central India. Cureus 2023; 15:e45944. [PMID: 37885509 PMCID: PMC10599634 DOI: 10.7759/cureus.45944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
Background The most frequent reason involving failure of root canal treatment in molar teeth is the inability to locate additional canals. While much research has been conducted on the morphology of mandibular molars, little is known about isthmuses and middle mesial (MM) canals in the Indian population. The primary aim of the present research was to determine the prevalence of MM canals and isthmuses of mandibular first molars in the Central India population using cone-beam computed tomography (CBCT) images. Methodology CBCT of 140 mandibular first molar teeth was analyzed from the institutional database images in the coronal, sagittal, and axial planes. Data concerning the number of root canals, the presence of middle mesial canals, and the presence of isthmus were noted. Information collected was transferred into an Excel sheet and analyzed using the Statistical Package for Social Sciences (IBM Corp., Armonk, NY, USA). Results Eight images (5.71%) revealed the presence of middle mesial canals with no statistically significant occurrence. The incidence of isthmi in the mandibular first molar was 84.3%, and the presence of isthmi in the coronal third was about 38.6%. This showed a considerable presence. Conclusion There is incidence of the middle mesial canal, which emphasizes the need to locate extra canals in patients undergoing root canal endodontic treatment. The implementation of CBCT will help identify the extra canal before the treatment. This will help ultimately in providing better patient care.
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Affiliation(s)
- Shriya R Singi
- Department of Research and Development, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Anuja Ikhar
- Department of Conservative Dentistry and Endodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Akash Sibal
- Department of Public Health Dentistry, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Amit Reche
- Department of Public Health Dentistry, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Priyanka P Madhu
- Department of Public Health Dentistry, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
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Seghayer I, Lee AHC, Cheung GSP, Zhang C. Effect of Passive Ultrasonic Irrigation, Er,Cr:YSGG Laser, and Photon-Induced Photoacoustic Streaming against Enterococcus faecalis Biofilms in the Apical Third of Root Canals. Bioengineering (Basel) 2023; 10:bioengineering10040490. [PMID: 37106677 PMCID: PMC10135464 DOI: 10.3390/bioengineering10040490] [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: 03/08/2023] [Revised: 04/08/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
PURPOSE This study aimed to compare the antibacterial effectiveness of passive ultrasonic irrigation (PUI), Er,Cr:YSGG laser (WTL), and photon-induced photoacoustic streaming (PIPS) using an Er:YAG laser against Enterococcus faecalis biofilms in the apical third of root canals. METHODS Root canals of 70 single-rooted human teeth were instrumented and infected with E. faecalis for 3 weeks to form biofilms. The samples were randomly divided into five groups as follows: (i) PUI + 3% NaOCl (n = 16); (ii) Er,Cr:YSGG laser (n = 16); (iii) PIPS + 3% NaOCl (n = 16); (iv) positive control group (n = 10); and (v) negative control group (n = 10). The bacterial content in the root canal was sampled using (a) the paper-point sampling method before (S1) and after (S2) treatment and (b) pulverising the apical 5 mm of the root. The number of bacteria recovered from each group was counted as colony-forming units (CFUs). The amount of reduction between the groups was compared with the Kruskal-Wallis test and post-test Dunn's multiple comparisons tests. The significance level was set at 5% (p < 0.05). RESULTS The samples from the paper-point sampling method showed that the amount of bacteria before (S1) and after treatment (S2) was significantly different between PIPS and WTL, as well as between the PUI and WTL groups. In contrast, no significant difference was found between the PIPS and PUI groups. From the pulverised samples, the results indicated no significant difference among all experimental groups in the amount of bacterial reduction in the apical 5 mm of the root. CONCLUSIONS PUI and PIPS showed a significantly greater reduction in bacterial content within the main root canal compared with the WTL. There was no difference among all experimental groups in the apical third of the root.
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Affiliation(s)
- Ibrahim Seghayer
- Endodontology, Division of Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Angeline H C Lee
- Endodontology, Division of Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Gary S P Cheung
- Endodontology, Division of Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Chengfei Zhang
- Endodontology, Division of Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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Ng YL, Gulabivala K. Factors that influence the outcomes of surgical endodontic treatment. Int Endod J 2023; 56 Suppl 2:116-139. [PMID: 36710526 DOI: 10.1111/iej.13896] [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: 08/11/2022] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023]
Abstract
Surgical endodontic treatment encompasses a broad spectrum of procedures, amongst which root-end cavity preparation and filling, retrograde root canal treatment and through-and-through endodontic surgery, may be classified under the umbrella term 'Root-end surgery'. This narrative review considers the available data on periapical healing, soft tissue healing, tooth survival and oral health-related quality of life (OHRQoL), following root-end surgery and the factors that affect its outcomes. The pooled periapical healed rate for the studies published up to 2021 was 69% (95% CI: 65%, 73%) but increased to 76% (95% CI: 66%, 86%) when only data from the 2020's studies were analysed. The prognostic factors consistently reported for periapical healing have included: pre-operative periapical lesion with complete loss of buccal plate, quality of root-end preparation, remaining thickness of apical root dentine and restorative status. Soft tissue healing of the reflected flap was found to have a positive association with periapical healing. The survival rates following root-end surgery range from 48% to 93%, with failure of periapical healing associated with root and crown fracture, being the predominant reasons for tooth extraction. The factors influencing impact of root-end surgery on patients' quality of life could not be adequately evaluated due to design flaws in the available studies. In conclusion, if root canal treatment failure due to leakage through cracks, fractures or restoration margin are excluded, the remaining cases may represent localized residual infection and inflammation at the periapex that should be amenable to predictable management with the aid of modern root-end surgery.
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Affiliation(s)
- Yuan-Ling Ng
- Unit of Endodontology, Department of Restorative Dentistry, UCL Eastman Dental Institute, London, UK
| | - Kishor Gulabivala
- Unit of Endodontology, Department of Restorative Dentistry, UCL Eastman Dental Institute, London, UK
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11
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Robberecht L, Delattre J, Meire M. Isthmus morphology influences debridement efficacy of activated irrigation: A laboratory study involving biofilm mimicking hydrogel removal and high-speed imaging. Int Endod J 2023; 56:118-127. [PMID: 36148855 PMCID: PMC10092478 DOI: 10.1111/iej.13836] [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: 05/09/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 12/13/2022]
Abstract
AIM Little is known about the influence of isthmus morphology on the debridement efficacy of activated irrigation. The aim of this study was to investigate the influence of isthmus morphology on the debridement efficacy of laser-activated irrigation (LAI), EDDY and needle irrigation (NI), and to explain the methods of isthmus cleaning by LAI and EDDY. METHODOLOGY Four root canal models (apical diameter: 0.30 mm, taper: 0.06, curvature: 23°, length: 20 mm) were produced by CAD-CAM with different isthmus morphologies: long-wide (4 mm; 0.4 mm), long-narrow (4 mm; 0.15 mm), short-wide (2 mm; 0.4 mm) and short-narrow (2 mm; 0.15 mm). The isthmuses were filled with a hydrogel containing dentine debris. The canals were filled with irrigant and models were assigned to the following irrigation protocols (n = 240): needle irrigation (NI) with a 30G needle, Eddy, and LAI (2940 nm Er:YAG-laser, 15 Hz, 40 mJ, SWEEPS, tip at the canal entrance). Standardized images of the isthmuses were taken before and after irrigation, and the amount of removed hydrogel was determined using image analysis software and compared across groups using Kruskal-Wallis test followed by Dunn's multiple comparison. Visualization of the isthmus during activation was achieved using a high-speed camera. The pattern and speed of the flow in the isthmus as well as transient and stable cavitation were analysed using imaging software. RESULTS Laser-activated irrigation, EDDY and NI removed more hydrogel in short-wide isthmuses than in narrow isthmuses (p < .001). LAI and EDDY removed more hydrogel than NI in every isthmus configuration (p < .001). EDDY showed eddies and stable cavitation, and LAI showed transient cavitation at each pulse, and pulsed horizontal flow with the highest particle speed in closed short isthmuses. CONCLUSIONS Isthmus morphology influences debridement in all irrigation groups. Short-wide isthmuses were the easiest to clean while narrow isthmuses were the most challenging to clean. Width seems to be a more critical anatomical parameter than length. LAI and EDDY resulted in the greatest biofilm removal and performed better than NI. EDDY produced eddies and stable cavitation in the isthmus, and LAI showed transient cavitation and pulsed horizontal flow.
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Affiliation(s)
- Lieven Robberecht
- Section of Endodontology, Department of Oral Health Sciences, Ghent University, Ghent, Belgium.,Department of Restorative Dentistry and Endodontics, Faculty of Odontology, Univ. Lille, Inserm, CHU Lille, U1008, Lille, France
| | | | - Maarten Meire
- Section of Endodontology, Department of Oral Health Sciences, Ghent University, Ghent, Belgium
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Li J, Chen L, Zeng C, Liu Y, Gong Q, Jiang H. Clinical outcome of bioceramic sealer iRoot SP extrusion in root canal treatment: a retrospective analysis. Head Face Med 2022; 18:28. [PMID: 36045447 PMCID: PMC9429671 DOI: 10.1186/s13005-022-00332-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 08/08/2022] [Indexed: 11/10/2022] Open
Abstract
Background During the obturation procedure, sealer extrusion occurs in some cases. iRoot SP is a kind of bioceramic sealer with superior physicochemical and biological properties. This article reports the outcome of iRoot SP extrusion in root canal treatment and the potential factors associated with the outcome. Methods Ninety-nine patients and one hundred and eighty-five teeth treated between 2014 and 2020 were included in this retrospective study. All of the cases were filled with a single-cone technique and the iRoot SP sealer. The minimum follow-up visit period was 1 year. The outcome was evaluated by clinical examination and radiographic examination at recall and was classified as healed, healing (success), or not healed (failure). Results The overall success rate of all teeth was 96.8%. The success rate of adequately filled teeth was 97.3%, while that of iRoot SP extrusion was 95.8%; the difference was not statistically significant. Factors such as gender, age, tooth position, follow-up visit period, size of periapical lesion, treatment type and extruding sealer amount had no influence on the outcome of iRoot SP extruded teeth. Conclusions The results suggested that iRoot SP extrusion has no adverse effect on the outcome of root canal treatment, which may contribute to the endodontic treatment.
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Affiliation(s)
- Jing Li
- Stomatology Department, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Liuchi Chen
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University and Guangdong Provincial Key Laboratory of Stomatology, 56 Ling Yuan Xi Road, Guangzhou, 510055, Guangdong, China
| | - Chunmei Zeng
- Department of Operative Dentistry and Endodontics, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Yiwen Liu
- Department of Endodontics, Stomatological Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Qimei Gong
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University and Guangdong Provincial Key Laboratory of Stomatology, 56 Ling Yuan Xi Road, Guangzhou, 510055, Guangdong, China.
| | - Hongwei Jiang
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University and Guangdong Provincial Key Laboratory of Stomatology, 56 Ling Yuan Xi Road, Guangzhou, 510055, Guangdong, China.
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Evaluation of the band-shaped isthmuses in the mesiobuccal root canal system using micro-computed tomography. Clin Oral Investig 2022; 26:5909-5914. [PMID: 35578113 DOI: 10.1007/s00784-022-04548-0] [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: 10/26/2021] [Accepted: 05/08/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES This micro-computed tomography (micro-CT) study analyzed band-shaped isthmuses having their floor at the apical third of the mesiobuccal roots of maxillary molars in terms of 2D and 3D morphological parameters. MATERIALS AND METHODS A total of 199 maxillary first molars were scanned with micro-CT. Twenty-seven specimens, confirmed to have a band-shaped isthmus, were further examined in terms of the isthmus length, volume, structure model index (SMI), and surface area. The distance of apical foramina of mesial canals from the isthmus floor and major-minor diameters, roundness, perimeter, and area of the isthmus roof and floor were compared. Statistical analyses were performed with descriptive statistics and t-test with a 5% significance threshold. RESULTS The band-shaped isthmus frequency was 13.5% and its length reached up to 5.5 mm. The distances of the apical foramina of mesiobuccal canals (MB1 and MB2) from the isthmus floor were similar (p > .05). Isthmus roof and floor showed significant differences in terms of their major diameter and area (p < .05), whereas their minor diameter, roundness, and perimeter values were similar (p > .05). CONCLUSION The band-shaped isthmuses are not rare and can reach through the half of the root length with oval cross-sections in the floor and roof anatomy. The distance between the isthmus floor and apical foramina did not differ between MB1 and MB2. CLINICAL RELEVANCE The band-shaped isthmus morphology contributes to the complexity of the apical anatomy of maxillary first molar teeth with various lengths and diameters.
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Lai PT, Wu SL, Huang CY, Yang SF. A retrospective cohort study on outcome and interactions among prognostic factors of endodontic microsurgery. J Formos Med Assoc 2022; 121:2220-2226. [PMID: 35450740 DOI: 10.1016/j.jfma.2022.04.005] [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: 03/23/2022] [Accepted: 04/07/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND/PURPOSE Endodontic microsurgery (EMS) is a reliable treatment for teeth with non-healing apical periodontitis. This study evaluated the outcome of EMS with mineral trioxide aggregate as the retrograde filling material and identified potential prognostic factors associated with the EMS outcome. METHODS Consecutive clinical and radiographic records of EMS performed in a teaching hospital from 2013 to 2017 were reviewed. Cases of root fracture, cemental tear, re-surgery, and incomplete records were excluded. After selection, 268 EMS-treated teeth with the follow-up period more than one year were included. Surgical outcome as success or failure was evaluated according to Molven's criteria. For analysis of potential prognostic factors, multivariate logistic regression was performed followed by bivariate chi-square tests. Stratified analysis was performed to understand the interactions between two prognostic factors. RESULTS The overall EMS success rate was 89.9% in this study. Tooth type (anteriors vs. molars, odds ratio (OR) = 6.83, P = 0.001, anteriors vs. premolars, OR = 4.27, P = 0.010) and endodontic-periodontal (endo-perio) communicating defects (with vs. without, OR = 4.92, P = 0.005) both had a significant influence on the EMS outcome. The negative impact of endo-perio communicating defects was closely associated with tooth type. Premolars with endo-perio communicating defects had significantly higher rates of failure. CONCLUSION The EMS outcome is significantly affected by the tooth type and endo-perio communicating defect. The presence of endo-perio communicating defects has a greater negative influence on the success rate for premolars than for anteriors and molars.
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Affiliation(s)
- Po-Tang Lai
- Division of Endodontics and Periodontology, Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Dentistry, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Shang-Liang Wu
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Yang Huang
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Biological Science and Technology, China Medical University, Taichung, Taiwan; Cardiovascular and Mitochondria Related Diseases Research Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan; Department of Biotechnology, Asia University, Taichung, Taiwan; Holistic Education Center, Tzu Chi University of Science and Technology, Hualien, Taiwan
| | - Shue-Fen Yang
- Division of Endodontics and Periodontology, Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Dentistry, School of Dentistry, National Yang-Ming University, Taipei, Taiwan.
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Chaves GS, Capeletti LR, Miguel JG, Antônio Z Loureiro M, Silva EJNL, Decurcio DA. A novel simplified workflow for guided endodontic surgery in mandibular molars with a thick buccal bone plate: a Case report. J Endod 2022; 48:930-935. [DOI: 10.1016/j.joen.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/15/2022] [Accepted: 04/01/2022] [Indexed: 10/18/2022]
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Glera-Suárez P, Pallarés-Serrano A, Penarrocha-Oltra D, Penarrocha-Diago M, Penarrocha-Diago M. Is healing of periapical surgery influenced by endoscopic findings detected on the cut root surface? J Oral Maxillofac Surg 2022; 80:902-912. [DOI: 10.1016/j.joms.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 10/19/2022]
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17
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Marconi DF, da Silva GS, Weissheimer T, Silva IA, Só GB, Jahnke LT, Skupien JA, Só MVR, da Rosa RA. Influence of the root canal filling technique on the success rate of primary endodontic treatments: a systematic review. Restor Dent Endod 2022; 47:e40. [DOI: 10.5395/rde.2022.47.e40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/18/2022] [Accepted: 08/10/2022] [Indexed: 12/03/2022] Open
Affiliation(s)
- Daniel Feijolo Marconi
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Giovana Siocheta da Silva
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Theodoro Weissheimer
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Isadora Ames Silva
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Gabriel Barcelos Só
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Leonardo Thomasi Jahnke
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Jovito Adiel Skupien
- Health and Life Sciences Master’s and Dental School, Franciscan University (UFN), Santa Maria, RS, Brazil
| | - Marcus Vinicius Reis Só
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Ricardo Abreu da Rosa
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
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Outcome of Periapical Surgery in Molars: A Retrospective Analysis of 424 Teeth. J Endod 2021; 47:1703-1714. [PMID: 34499889 DOI: 10.1016/j.joen.2021.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/28/2021] [Accepted: 08/29/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The objective of this retrospective study was to assess the outcome of periapical surgery in a large number of molars in order to identify possible variables that might affect the outcome. METHODS The healing outcome of patients undergoing periapical surgery of molars from October 1999 to October 2019 was retrospectively evaluated. Outcome was dichotomized into "healed" and "nonhealed" using well-established clinical and radiographic healing criteria. The potential influence of patient-, tooth-, and treatment-related parameters on the healing outcome was analyzed. RESULTS A total of 424 molars in the same number of patients (45.5% male and 54.5% female) were evaluated. Three hundred seventy-two molars were classified as healed (87.7%). Three significant outcome predictors were identified: 1-year follow-up versus >1-5 years, >5-10 years, and >10 years (95.3% vs 82.2%, 76.3%, and 76.5% healed, respectively; P < .0001); root end filling material with bioceramic root repair material versus mineral trioxide aggregate (96.9% vs. 86.3% healed, respectively; P = .001); and preoperative evaluation based on cone-beam computed tomographic imaging versus 2-dimensional radiography (90.2% vs 81.4% healed, respectively; P = .02). Sex, age, tooth location, type of restoration, attachment level, presence of a post, quality of the root canal filling, technique of root end preparation, administration of antibiotics, and type of surgery had no significant impact on the healing outcome. CONCLUSIONS The healed rate for the concave (Retroplast) and cavity (mineral trioxide aggregate, SuperEBA [Staident International, Staines, UK], and bioceramic root repair material) root end preparation technique over all follow-up periods was 84% and 88.5%, respectively. The follow-up period, root end filling material, and preoperative evaluation based on cone-beam computed tomographic imaging had a significant influence on the healing outcome.
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Zhang P, Yuan K, Jin Q, Zhao F, Huang Z. Presence of voids after three obturation techniques in band-shaped isthmuses: a micro-computed tomography study. BMC Oral Health 2021; 21:227. [PMID: 33933066 PMCID: PMC8088625 DOI: 10.1186/s12903-021-01584-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 04/22/2021] [Indexed: 01/19/2023] Open
Abstract
Background The objective of the present micro-computed tomography (micro-CT) study was to assess the presence of voids in band-shaped isthmuses obturated using three different filling techniques. Methods Twenty-four artificial molar teeth with a band-shaped isthmus were allocated to three groups (n = 8) for obturation, according to the filling technique: single-cone (SC), continuous wave of condensation (CWC) or lateral condensation (LC). Obturation was performed with gutta-percha (GP) cones and iRoot SP (Innovative Bioceramix, Vancouver, Canada).
Post-filling micro-CT scanning was performed. The percentage of filling materials and void volumes were calculated in the isthmus areas and data were analyzed using one-way ANOVA and Tukey tests. Results The mean percentage of void volumes and corresponding filling percentages in the isthmus areas after obturation in the SC groups was 22.98 % ± 1.19 %, 77.02 % ± 1.19 %; in the CWC groups 10.46 % ± 2.28 %, 89.54 % ± 2.28 %; and in the LC groups was 13.14 % ± 1.85 %, 86.86 % ± 1.85 %, respectively. Conclusions In band-shaped isthmus area, the obturation quality of CWC was superior to SC and LC techniques.
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Affiliation(s)
- Pengfei Zhang
- Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011, China.,National Clinical Research Center for Oral Diseases, National Center for Stomatology; Shanghai Key Laboratory of Stomatology, Shanghai, 200011, China
| | - Keyong Yuan
- Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011, China.,National Clinical Research Center for Oral Diseases, National Center for Stomatology; Shanghai Key Laboratory of Stomatology, Shanghai, 200011, China
| | - Qiaoqiao Jin
- Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011, China.,National Clinical Research Center for Oral Diseases, National Center for Stomatology; Shanghai Key Laboratory of Stomatology, Shanghai, 200011, China
| | - Fen Zhao
- Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011, China.,National Clinical Research Center for Oral Diseases, National Center for Stomatology; Shanghai Key Laboratory of Stomatology, Shanghai, 200011, China
| | - Zhengwei Huang
- Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011, China. .,National Clinical Research Center for Oral Diseases, National Center for Stomatology; Shanghai Key Laboratory of Stomatology, Shanghai, 200011, China.
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An Update on Endodontic Microsurgery of Mandibular Molars: A Focused Review. ACTA ACUST UNITED AC 2021; 57:medicina57030270. [PMID: 33809673 PMCID: PMC8002302 DOI: 10.3390/medicina57030270] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/03/2021] [Accepted: 03/12/2021] [Indexed: 11/17/2022]
Abstract
Endodontic microsurgery is a highly predictable treatment option in most cases when conventional endodontic treatment is not feasible. Nevertheless, mandibular molars are still considered by clinicians to be the most difficult type of teeth, with the lowest success rate. In recent years, endodontic microsurgery has been attempted more frequently with the emergence of modern cutting-edge technologies such as dental operating microscopes, various microsurgical instruments, and biocompatible materials, and the success rate is increasing. This review describes the current state of the art in endodontic microsurgical techniques and concepts for mandibular molars. Notably, this review highlights contemporary equipment, technology, and materials.
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21
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Do S, Seo MS. The effect of different confluence confirmation strategies on the obturation of Vertucci type II canal: micro-CT analysis. Restor Dent Endod 2021; 46:e12. [PMID: 33680901 PMCID: PMC7906847 DOI: 10.5395/rde.2021.46.e12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/07/2020] [Accepted: 06/17/2020] [Indexed: 11/11/2022] Open
Abstract
Objectives The present study aims to compare the obturation quality of 2 confluence confirmation techniques in artificial maxillary first premolars showing Vertucci type II root canal configuration. Materials and Methods Thirty artificial maxillary premolars having Vertucci type II root canal configuration were made. They were divided into 3 groups according to the confluence confirmation technique as follows. Gutta-percha indentation (GPI) group (confluence confirmation using a gutta-percha cone and a K file); electronic apex locator (EAL) group (confluence confirmation using K files and EAL); and no confluence detection (NCD) group. In the GPI group and the EAL group, shaping and obturation were performed with the modified working length (WL). In the NCD group, shaping was performed without WL adjustment and obturation was carried out with an adjusted master cone. Micro-computed tomography was used before preparation and after obturation to calculate the percentage of gutta-percha occupied volume (%GPv) and the volume increase in the apical 4 mm. Data were analyzed using 1-way analysis of variance and post hoc Tukey's test. Results Statistically significant difference was not found in terms of the %GPv from the apex to apical 4 mm. However, the NCD group showed a statistically significant volume increase compared with the EAL group (p < 0.05). Conclusions In terms of gutta-percha occupied volume, no significant difference was observed among the 3 groups. Confluence confirmation using an EAL in teeth with Vertucci type II configuration showed less volume increase during canal shaping compared with no confluence confirmation.
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Affiliation(s)
- Seungjae Do
- Department of Conservative Dentistry, Wonkwang University Daejeon Dental Hospital, Daejeon, Korea
| | - Min-Seock Seo
- Department of Conservative Dentistry, Wonkwang University Daejeon Dental Hospital, Daejeon, Korea
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22
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Azim AA, Albanyan H, Azim KA, Piasecki L. The Buffalo study: Outcome and associated predictors in endodontic microsurgery- a cohort study. Int Endod J 2020; 54:301-318. [PMID: 32975855 DOI: 10.1111/iej.13419] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 02/06/2023]
Abstract
AIM To (i) evaluate and compare the outcome of endodontic microsurgery (EMS) using periapical radiographs (PAs) and cone-beam computed tomography (CBCT) scans; (ii) identify prognostic factors affecting the outcome; and (iii) correlate the effect of guided tissue regeneration (GTR) on the pattern of apical bone remodelling. METHODOLOGY Eighty-two patients (101 teeth) who received EMS were included and followed-up using clinical and radiographic examinations (PAs and CBCT scans). Two calibrated endodontists evaluated the radiographic healing (favourable or unfavourable) by assessing PAs and CBCT. The success (favourable radiographic outcome with no clinical symptoms) and survival rates (tooth retention without clinical symptoms) were calculated, and the cause of failure (diseased or fractured) was identified. Pre-treatment (age, sex, tooth type, position, sequence of treatment, quality of root canal before surgery, presence/absence of through-and-through lesion, presence/absence apico-marginal defect) and treatment (presence/absence of errors during surgery, type of error (major or minor), retro-preparation depth, presence/absence of an isthmus, retro-filling material used, presence/absence bone graft material and/or resorbable membrane) factors were recorded. Data were analysed statistically to determine the inter-observer, intra-observer and inter-radiographic agreements. Univariate, bivariate and logistic regression analysis were used to determine prognostic factors affecting the outcome and the effect of GTR on the pattern of apical bone remodelling. The significance level was set at 5%. RESULTS Sixty-eight patients (83 teeth) presented for outcome evaluation (recall rate: 84%). The survival rate was 93%. The success rate was 88% using PA and 86% using CBCT when vertical root fracture (VRF) cases were included and 94% using PAs, and 91% using CBCT when VRF cases were excluded. The intra- and inter-observer agreements were substantial using CBCT, slight to a fair agreement using PA (P < 0.001), and slight to moderate for inter-radiographic agreement. The occurence of a major procedural error during surgery was the only negative predictor for the outcome of EMS (P = 0.013). GTR did not affect the success rate or the type of healing when assessed using PA but it affected the type of healing on CBCT scans (complete vs incomplete healing) and the pattern of cortical plate remodelling (P < 0.001). CONCLUSION The success and survival rate of endodontic microsurgery was very high, and the occurrence of a major procedural error during surgery was the only factor affecting the outcome. GTR did not improve the outcome, but did affect the quality of apical bone remodelling following EMS.
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Affiliation(s)
- A A Azim
- Division of Endodontics, University at Buffalo, Buffalo, NY, USA
| | - H Albanyan
- Division of Endodontics, University at Buffalo, Buffalo, NY, USA.,College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - K A Azim
- Department of Psychology, University at Buffalo, Buffalo, NY, USA
| | - L Piasecki
- Division of Endodontics, University at Buffalo, Buffalo, NY, USA
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23
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Loroño G, Zaldívar JMR, Jimenez-Octavio JR, Dorado S, Arias A, Cisneros R. CFD analysis on the effect of combining positive and negative pressure during the irrigation of artificial isthmuses. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2020; 36:e3385. [PMID: 32639658 DOI: 10.1002/cnm.3385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 06/16/2020] [Accepted: 07/05/2020] [Indexed: 06/11/2023]
Abstract
Fluid dynamics generated by irrigation needles have not been deeply analyzed in root canal irregularities such as apical ramifications or isthmus where the cleaning capacity of irrigants might be compromised and hence the treatment outcome. The goal of this study was to compare the key irrigation parameters (flow pattern, irrigant velocity, apical pressure, and shear stress) between two irrigation needles and the additional effect of aspiration cannulas through computational fluid dynamics. A 3D-model consisting of two canals linked by an isthmus was modeled. The abovementioned needles irrigated the primary canal, whereas an aspiration cannula was located inside the secondary canal. Both the geometry definition and spatial discretization were carried out with ANSYS 16.2, through which six different simulations were performed: lateral exit (LE) needle, frontal exit (FE) needle, LE and cannula in crown (LEC), FE and cannula in crown (FEC), LE and cannula in middle third (LEM), FE and cannula in middle third (FEM). FE and FEM showed that the irrigation flow only passes through the isthmus in the most apical section (maximum irrigant velocity / shear stress = 8.44 m/s / 1628.44 Pa and 8.63 m/s / 1185.69 Pa, respectively). However, the remaining simulations showed the irrigation flow passing through the isthmus twice, through the most apical section first and through the upper part of the isthmus later (maximum irrigant velocity / shear stress = 8.48 m/s / 1298.24 Pa (LE), 8.61 m/s / 1261.36 Pa (LEM), 8.61 m/s / 1355.24 Pa (LEC), 8.59 m/s / 1256.87 Pa (FEC)). Furthermore, the highest velocity values were detected when aspiration cannulas were added.
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Affiliation(s)
- Gaizka Loroño
- Departamento de Endodoncia, Universidad Europea de Madrid, Madrid, Spain
| | - J M R Zaldívar
- Departamento de Endodoncia, Universidad Europea de Madrid, Madrid, Spain
| | - J R Jimenez-Octavio
- Universidad Pontificia Comillas, Escuela Técnica Superior de Ingeniería ICAI, Instituto de Investigación Tecnológica, Madrid, Spain
| | - Saul Dorado
- Universidad Pontificia Comillas, Escuela Técnica Superior de Ingeniería ICAI, Instituto de Investigación Tecnológica, Madrid, Spain
| | - Ana Arias
- Departamento de Odontología Conservadora, Facultad (Estomatologia II) de Odontología, Universidad Complutense de Madrid, Madrid, Spain
| | - Rafael Cisneros
- Departamento de Endodoncia, Universidad Europea de Madrid, Madrid, Spain
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Jeon KJ, Lee C, Choi YJ, Han SS. Anatomical analysis of mandibular posterior teeth for endodontic microsurgery: a cone-beam computed tomographic evaluation. Clin Oral Investig 2020; 25:2391-2397. [PMID: 32901333 DOI: 10.1007/s00784-020-03562-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 09/01/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The purpose of this study was to analyze the anatomical structures relevant for endodontic microsurgery in the mandibular posterior teeth using a cone-beam computed tomography (CBCT). MATERIAL AND METHODS A total of 963 mandibular posterior teeth were analyzed in CBCT scans from 133 patients. The buccolingual and mesiodistal dimensions of the root and the buccal bone thickness overlying the root were measured at the site of root resection (apical 3 mm). At this location, the relationship between the buccal cortical bone and root was classified into three types (separated, contact, and exposed), and the distance from the root apex to the mandibular canal was measured. RESULTS The thickest buccolingual dimension of the roots was found in the mesial roots of first molars, at 5.59 ± 0.97 mm. The buccal bone thickness overlying the root became thicker in posterior tooth locations. In the first premolar and first molar mesial root, contact was the most common type of relationship between the buccal cortical bone and root. As the position of the teeth became more posterior, the distance from the apex to the mandibular canal became shorter. CONCLUSIONS As the position of the teeth became more posterior, the buccal bone thickness increased and the distance to the mandibular canal became closer; therefore, particular attention is required for posterior teeth. The first premolar and the first molar mesial root are often in contact with the buccal cortical bone, which may allow infections to spread to the buccal structure more easily and negatively affect for post-surgical healing. CLINICAL RELEVANCE When planning and performing endodontic microsurgery, understanding the anatomical structure of the surgical site will help minimize tissue damage and reduce complications.
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Affiliation(s)
- Kug Jin Jeon
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea
| | - Chena Lee
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea
| | - Yoon Joo Choi
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea
| | - Sang-Sun Han
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea.
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Kim U, Kim S, Kim E. The application of "bone window technique" using piezoelectric saws and a CAD/CAM-guided surgical stent in endodontic microsurgery on a mandibular molar case. Restor Dent Endod 2020; 45:e27. [PMID: 32839708 PMCID: PMC7431938 DOI: 10.5395/rde.2020.45.e27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/25/2020] [Accepted: 02/25/2020] [Indexed: 11/25/2022] Open
Abstract
Apical surgery for a mandibular molar is still challenging for many reasons. This report describes the applications of computer-guided cortical ‘bone-window technique’ using piezoelectric saws that prevented any nerve damage in performing endodontic microsurgery of a mandibular molar. A 49-year-old woman presented with gumboil on tooth #36 (previously endodontically treated tooth) and was diagnosed with chronic apical abscess. Periapical lesions were confirmed using cone-beam computed tomography (CBCT). Endodontic microsurgery for the mesial and distal roots of tooth #36 was planned. Following the transfer of data of the CBCT images and the scanned cast to an implant surgical planning program, data from both devices were merged. A surgical stent was designed, on the superimposed three-dimensional model, to guide the preparation of a cortical window on the buccal side of tooth #36. Endodontic microsurgery was performed with a printed surgical template. Minimal osteotomy was required and preservation of the buccal cortical plate rendered this endodontic surgery less traumatic. No postoperative complications such as mental nerve damage were reported. Window technique guided by a computer-aided design/computer-aided manufacture based surgical template can be considerably useful in endodontic microsurgery in complicated cases.
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Affiliation(s)
- Ukseong Kim
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry, Seoul, Korea
| | - Sunil Kim
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry, Seoul, Korea
| | - Euiseong Kim
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry, Seoul, Korea.,Department of Electrical & Electronic Engineering, Yonsei University College of Engineering, Seoul, Korea
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26
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Xu S, Dao J, Liu Z, Zhang Z, Lu Y, Zeng X. Cone-beam computed tomography investigation of middle mesial canals and isthmuses in mandibular first molars in a Chinese population. BMC Oral Health 2020; 20:135. [PMID: 32384929 PMCID: PMC7206827 DOI: 10.1186/s12903-020-01126-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 04/29/2020] [Indexed: 11/20/2022] Open
Abstract
Background While there is ample research into the anatomy of mandibular molars, little is known regarding isthmuses and middle mesial (MM) canals in Chinese populations. The goal of this study was to determine the prevalence of MM canals and isthmuses in the mesial root of mandibular first molars using Cone-beam Computed Tomography. Methods Cone-beam Computed Tomography images of 357 mature mandibular first molars were retrospectively analyzed. Presence of isthmuses and MM canals, and the length of isthmuses in the mesial root were recorded. Meanwhile, we also recorded possible correlated factors such as demographics, side of mandible, presence of separated distal-lingual roots. Results Of these 357 teeth, 209 showed evidence of either complete or partial communication in the mesial root. Of these, 11(3.1%) exhibited true MM canals while 198(55.5%) exhibited isthmuses. Sex or side of mandible was not correlated with the prevalence of isthmuses (P > 0.05). However, there was a significant association between the presence of a distal-lingual root and the prevalence of such communication (P < 0.001). The average length of isthmuses was 4.3 ± 3.1 mm. Conclusions We detected high rate of isthmuses and low rate of MM canals in mesial roots of mandibular first molars, which is important as such areas should be identified and cleaned during root canal treatment.
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Affiliation(s)
- Shuaimei Xu
- Department of Endodontics, Stomatological Hospital, Southern Medical University, No 366 Jiangnan Avenue South, Guangzhou, 510280, Guangdong, China
| | - Junfeng Dao
- Department of Prosthodontics, Stomatological Hospital, Southern Medical University, Guangzhou, China
| | - Zhongjun Liu
- Department of Endodontics, Stomatological Hospital, Southern Medical University, No 366 Jiangnan Avenue South, Guangzhou, 510280, Guangdong, China
| | - Zhiyong Zhang
- Department of Oral and Maxillofacial Radiology, Stomatological Hospital, Southern Medical University, Guangzhou, China
| | - Yu Lu
- Department of Endodontics, Stomatological Hospital, Southern Medical University, No 366 Jiangnan Avenue South, Guangzhou, 510280, Guangdong, China
| | - Xiongqun Zeng
- Department of Endodontics, Stomatological Hospital, Southern Medical University, No 366 Jiangnan Avenue South, Guangzhou, 510280, Guangdong, China.
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Loroño G, Zaldivar JR, Arias A, Cisneros R, Dorado S, Jimenez‐Octavio JR. Positive and negative pressure irrigation in oval root canals with apical ramifications: a computational fluid dynamics evaluation in micro‐CT scanned real teeth. Int Endod J 2020; 53:671-679. [DOI: 10.1111/iej.13260] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 12/05/2019] [Indexed: 12/17/2022]
Affiliation(s)
- G. Loroño
- Postgraduate Program in Endodontics European University of Madrid MadridSpain
| | - J. R. Zaldivar
- Department of Conservative and Prosthetic Dentistry School of Dentistry Complutense University MadridSpain
| | - A. Arias
- Department of Conservative and Prosthetic Dentistry School of Dentistry Complutense University MadridSpain
| | - R. Cisneros
- Postgraduate Program in Endodontics European University of Madrid MadridSpain
| | - S. Dorado
- Instituto de Investigación Tecnológica Escuela Técnica Superior de Ingeniería ICAI Universidad Pontificia Comillas Madrid Spain
| | - J. R. Jimenez‐Octavio
- Instituto de Investigación Tecnológica Escuela Técnica Superior de Ingeniería ICAI Universidad Pontificia Comillas Madrid Spain
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Kang S, Yu HW, Shin Y, Karabucak B, Kim S, Kim E. Topographic Analysis of the Isthmus in Mesiobuccal and Mesial Roots of First Molars in a South Korean Population. Sci Rep 2020; 10:1247. [PMID: 31988399 PMCID: PMC6985258 DOI: 10.1038/s41598-020-58364-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 01/13/2020] [Indexed: 11/09/2022] Open
Abstract
The purpose of this study was to evaluate the incidence and microscopic anatomy of the isthmus to provide more precise anatomical information about the mesiobuccal (MB) roots of the maxillary first molars and the mesial (M) roots of the mandibular first molars. Twenty-eight maxillary and 31 mandibular first molars were embedded, sectioned, stained, and observed at 30× magnification to evaluate the incidence and microscopic anatomy of the isthmus. The incidence of an isthmus 3 mm from the apex was 89.3% and 100% in the MB roots of the maxillary first molars and in the M roots of the mandibular first molars, respectively. The mean dentin thickness between the isthmus and the distal root surface was <1 mm at a distance of 3 mm from the apex in both types of roots. In this study, whenever two main canals were located in the MB roots of the maxillary first molars and in the M roots of the mandibular first molars, the likelihood of the presence of an isthmus increased. Therefore, clinicians should be aware of the thinnest dimensions in the distal surface of the MB roots of the maxillary first molars and the M roots of the mandibular first molars during nonsurgical and surgical root canal treatment.
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Affiliation(s)
- Sumi Kang
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, South Korea
| | - Hui-Wen Yu
- Department of Conservative Dentistry, National Health Insurance Ilsan Hospital, Goyang, South Korea
| | - Yooseok Shin
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, South Korea
| | - Bekir Karabucak
- Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sunil Kim
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, South Korea.
| | - Euiseong Kim
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, South Korea.
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Jung J, Kim S, Kim E, Shin SJ. Volume of Voids in Retrograde Filling: Comparison between Calcium Silicate Cement Alone and Combined with a Calcium Silicate-based Sealer. J Endod 2019; 46:97-102. [PMID: 31759678 DOI: 10.1016/j.joen.2019.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/04/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The aim of this study was to compare the volume of voids between retrograde filling using calcium silicate cement alone and retrograde filling using a combination of calcium silicate cement with a calcium silicate-based sealer. METHODS Twenty single-rooted, extracted human teeth were instrumented with nickel-titanium files and obturated with gutta-percha. We resected the roots at a point 3 mm from the apex, prepared the root ends, and filled the root-end cavities with Endocem Zr (Maruchi, Wonju, Korea) or Endoseal MTA (Maruchi) plus Endocem Zr. Then, we scanned the prepared samples using micro-computed tomographic imaging and performed 3-dimensional reconstruction. The percentage volume of the gap between the canal wall and root-end filling was calculated along with the percentage volume of voids in the filling materials. All data were analyzed using the Mann-Whitney U test. Selected specimens were further observed using scanning electron microscopy. RESULTS There were no significant differences in the percentage volumes of the gaps and internal voids between the 2 groups. Both calcium silicate and the calcium silicate-based sealer exhibited good adaptation to the cavity wall. CONCLUSIONS The findings of our micro-computed tomographic and scanning electron microscopic analyses suggested that the volume of voids in retrograde filling using a combination of calcium silicate cement and calcium silicate-based sealer was comparable with that in retrograde filling using calcium silicate cement only. Calcium silicate-based sealers could be used in retrograde filling for clinical convenience without harmful effects on the quality of filling.
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Affiliation(s)
- Jaeheon Jung
- Department of Conservative Dentistry, Gangnam Severance Dental Hospital, Yonsei University College of Dentistry, Seoul, Korea
| | - Sunil Kim
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry, Seoul, Korea
| | - Euiseong Kim
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry, Seoul, Korea; Department of Electrical and Electronic Engineering, Yonsei University College of Engineering, Seoul, Korea
| | - Su-Jung Shin
- Department of Conservative Dentistry, Gangnam Severance Dental Hospital, Yonsei University College of Dentistry, Seoul, Korea.
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Roizenblit RN, Soares FO, Lopes RT, Santos BC, Gusman H. Root canal filling quality of mandibular molars with EndoSequence
BC
and
AH
Plus sealers: A micro‐
CT
study. AUST ENDOD J 2019; 46:82-87. [DOI: 10.1111/aej.12373] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Rafael Nigri Roizenblit
- Department of Dental Clinic School of Dentistry Federal University of Rio de Janeiro Rio de Janeiro Brazil
| | - Fabiola Ormiga Soares
- Department of Dental Clinic School of Dentistry Federal University of Rio de Janeiro Rio de Janeiro Brazil
| | - Ricardo Tadeu Lopes
- Department of Nuclear Instrumentation Laboratory Technology Center Federal University of Rio de Janeiro Rio de Janeiro Brazil
| | - Bernardo Camargo Santos
- Department of Nuclear Instrumentation Laboratory Technology Center Federal University of Rio de Janeiro Rio de Janeiro Brazil
| | - Heloisa Gusman
- Department of Dental Clinic School of Dentistry Federal University of Rio de Janeiro Rio de Janeiro Brazil
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Kim D, Lee H, Chung M, Kim S, Song M, Kim E. Effects of fast- and slow-setting calcium silicate-based root-end filling materials on the outcome of endodontic microsurgery: a retrospective study up to 6 years. Clin Oral Investig 2019; 24:247-255. [PMID: 31081517 DOI: 10.1007/s00784-019-02937-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 05/02/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVES The purpose of this retrospective study was to evaluate and compare the effects of fast- and slow-setting calcium silicate-based materials (CSMs) used for root-end filling on the outcome of endodontic microsurgery. MATERIALS AND METHODS We searched a clinical database for patients who had received endodontic microsurgery between 2001 and 2016. Included cases were divided into two groups according to the type of CSM used for root-end filling: slow-setting CSM (SCSM) and fast-setting CSM (FCSM). The cases in two groups were subjected to 1:1 nearest neighbor propensity score matching for the following variables: age, sex, tooth type, quality of canal filling, lesion type, and postoperative restoration. For each matched case, the outcome was determined as success or failure according to clinical and radiographic evaluations performed at least 1 year after surgery. Multivariate logistic regression analysis was performed to identify prognostic factors and estimate their effects. RESULTS In total, 304 cases of endodontic microsurgery (179 SCSM and 125 FCSM) were identified, and 1:1 propensity score matching finally included 122 cases from each group. After matching, all covariates were associated with an absolute standardized difference of < 0.1. The overall success rates were 85.2% and 93.4% for the SCSM and FCSM groups, respectively (p = 0.062). Age, tooth type, lesion type, and CSM type were significantly associated with the outcome of endodontic microsurgery (p < 0.05). CONCLUSIONS Within the limitations, the outcome of endodontic microsurgery using FCSMs was comparable with that of SCSMs. The findings suggest that the type of CSM used for root-end filling, particularly in terms of the initial setting time, could affect the outcome of endodontic microsurgery. CLINICAL RELEVANCE FCSMs could be considered for use as root-end filling materials in endodontic microsurgery, particularly in complicated clinical situations which require rapid initial setting of the materials.
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Affiliation(s)
- Dohyun Kim
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hyunjung Lee
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Minsun Chung
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Sunil Kim
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Minju Song
- Department of Conservative Dentistry, College of Dentistry, Dankook University, 119 Dandae-ro, Dongnam-gu, Cheonan-si, Chungcheongnam-do, 31116, Republic of Korea
| | - Euiseong Kim
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
- Department of Electrical & Electronic Engineering, Yonsei University College of Engineering, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Kim S, Park SY, Lee Y, Lee CJ, Karabucak B, Kim HC, Kim E. Stress Analyses of Retrograde Cavity Preparation Designs for Surgical Endodontics in the Mesial Root of the Mandibular Molar: A Finite Element Analysis-Part I. J Endod 2019; 45:442-446. [PMID: 30827768 DOI: 10.1016/j.joen.2019.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 12/21/2018] [Accepted: 01/07/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The aim of this study was to investigate the influence of various apical preparation designs for surgical endodontics on stress concentrations in the mesial root of the mandibular molar under different experimental conditions using finite element analysis. METHODS We designed 2 apical preparation groups according to whether an isthmus was present or not. Each group contained 4 subgroups according to the size of the apical preparation. We constrained the displacement of all nodes at the base of the supporting bone and applied a force of 150 N to the vertical axis. We analyzed stress generation and concentrations numerically for the groups and subgroups. RESULTS In the subgroups, the von Mises and maximum principal stresses reduced gradually according to the enlargement of the prepared cavity. However, when the preparation extended excessively in the isthmus preparation groups, the situation reversed (ie, both von Mises and maximum principal stresses increased). CONCLUSIONS Within the limitations of this study, the apical preparation design influenced the distribution of stress concentration. Unlike the overall pattern in which stress decreased as the amount of apical preparation increased, stress increased when the amount of residual dentin was extremely thin.
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Affiliation(s)
- Sunil Kim
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry, Seoul, Korea
| | - So-Young Park
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry, Seoul, Korea
| | - Yoon Lee
- Department of Conservative Dentistry, Wonju Severance Christian Hospital, Yonsei University, Wonju, Korea
| | - Chan-Joo Lee
- Dongnam Regional Division, Korea Institute of Industrial Technology, Jinju, Korea
| | - Bekir Karabucak
- Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hyeon-Cheol Kim
- Department of Conservative Dentistry, School of Dentistry, Dental Research Institute, Pusan National University, Yangsan, Korea.
| | - Euiseong Kim
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry, Seoul, Korea; Department of Electrical & Electronic Engineering, Yonsei University College of Engineering, Seoul, Korea.
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Karunakaran JV, PremKumar MM, Aarthi G, Jayaprakash N, Kumar SS. Isthmus Incidence in Human Permanent Mandibular First Molars of a South Indian Population: A Cone-Beam Computerized Tomographic Study. J Pharm Bioallied Sci 2019; 11:S468-S473. [PMID: 31198389 PMCID: PMC6555315 DOI: 10.4103/jpbs.jpbs_80_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aim: This study aimed to analyze incidence of isthmus in human permanent mandibular first molar teeth using cone-beam computed tomographic imaging techniques in a South Indian population. Materials and Methods: Three hundred permanent mandibular first molar teeth were collected, cleaned, and stored in normal saline. They were divided into groups (GPs) I and II based on number of roots, and were further subdivided (right and left [RL] subgroups A and B for GP I; and RL subgroups C and D for GP-II). Samples were processed and isthmus incidence was evaluated by cone-beam tomography, compared, and statistically analyzed. Results: Overall in mandibular first molars, the isthmus incidence in mesial root was 97.2%, distal root was 39%, and distolingual root was 0%. There was no statistically significant difference between the right and left mandibular first molar teeth with regard to incidence of isthmus (P > 0.05). There was an incidence of type I (38.67%), type II (56.33%), type III (3%), and type IV (2%) isthmuses in mesial root and type I (12.33%), type II (16%), and type III (10.67%) in distal root. Conclusion: Incidence of isthmus was very high in the mesial root of the mandibular first molar and should be factored during nonsurgical and surgical endodontic treatment procedures to achieve successful treatment outcomes.
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Affiliation(s)
| | | | - Ganapathy Aarthi
- Department of Conservative Dentistry, Vinayaka Missions Sankarachariar Dental College, Salem Tamil Nadu, India
| | - Nachimuthu Jayaprakash
- Department of Conservative Dentistry, JKK Nattraja Dental College and Hospital, Komarapalayam, India
| | - Swaminathan Senthil Kumar
- Department of Conservative Dentistry, JKK Nattraja Dental College and Hospital, Komarapalayam, India
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Outcome of Endodontic Micro-resurgery: A Retrospective Study Based on Propensity Score–matched Survival Analysis. J Endod 2018; 44:1632-1640. [DOI: 10.1016/j.joen.2018.07.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/19/2018] [Accepted: 07/28/2018] [Indexed: 12/23/2022]
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35
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[Cone-beam computed tomography for determination of mesial root canal curvatures of human mandibular first molars]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2018; 38:824-829. [PMID: 33168507 PMCID: PMC6765546 DOI: 10.3969/j.issn.1673-4254.2018.07.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To investigate mesial root canal curvatures of human mandibular first molars using cone-beam computed tomography (CBCT). METHODS CBCT was performed for scanning the mandibular first molars of 1600 Chinese subjects, among whom the subjects identified to have middle mesial canals were divided into 5 age groups, namely group A (18-29 years), group B (30-39 years), group C (40-49 years), group D (50-59 years), and group E (60-80 years) for further analysis. All the CBCT images were reconstructed using Planmeca Romexis CBCT image reconstruction system, and the curvature of the mesial root was measured using the Schneider method. RESULTS A total of 2856 CBCT images were obtained from the 1600 subjects, among whom 168 (5.88%) were found to have middle mesial canals in the mandibular first molars. The prevalence of middle mesial canals was 37.50% in group A, 17.80% in group B, 14.88% in group C, 19.64% in group D, and 10.12% in group E. The moderate of the curvature in the mesiodistal direction was significantly higher in group A than in the other groups (P < 0.05); the curvature in mesiodistal direction differed significantly among the 5 groups (P < 0.05), and was the greatest in group A followed by group C and group D, and was the smallest in group E. The curvature in the buccolingual direction was similar among the 5 groups. The incidence of mesiodistal and buccolingual curvature of the middle mesial canals was significantly higher in the middle 1/3 of the root canal than in the upper 1/3 and apical 1/3 of the root canal. CONCLUSIONS The incidence of middle mesial canals in the mesial root of the mandibular first molars decreases with age. The middle mesial canal system of the mandibular first molar is complex and variable, and most of the first molars have obvious curvature in the mesiodistal and buccolingual directions. CBCT can provide reference for clinical treatment to reduce the treatment failure rate.
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Chybowski EA, Glickman GN, Patel Y, Fleury A, Solomon E, He J. Clinical Outcome of Non-Surgical Root Canal Treatment Using a Single-cone Technique with Endosequence Bioceramic Sealer: A Retrospective Analysis. J Endod 2018; 44:941-945. [DOI: 10.1016/j.joen.2018.02.019] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 02/17/2018] [Accepted: 02/19/2018] [Indexed: 01/26/2023]
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Outcome of Endodontic Surgery: A Meta-analysis of the Literature-Part 3: Comparison of Endodontic Microsurgical Techniques with 2 Different Root-end Filling Materials. J Endod 2018; 44:923-931. [PMID: 29681480 DOI: 10.1016/j.joen.2018.02.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/17/2018] [Accepted: 02/19/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The aim of the present study was to investigate the influence of root-end preparation and filling material on endodontic surgery outcome. A systematic review and meta-analysis was conducted to determine the outcome of resin-based endodontic surgery (RES, the use of high-magnification preparation of a shallow and concave root-end cavity and bonded resin-based root-end filling material) versus endodontic microsurgery (EMS, the use of high-magnification ultrasonic root-end preparation and root-end filling with SuperEBA [Keystone Industries, Gibbstown, NJ], IRM [Dentsply Sirona, York, PA], mineral trioxide aggregate [MTA], or other calcium silicate cements). METHODS An exhaustive literature search was conducted to identify prognostic studies on the outcome of root-end surgery. Human studies conducted from 1966 to the end of December 2016 in 5 different languages (ie, English, French, German, Italian, and Spanish) were searched in 4 electronic databases (ie, Medline, Embase, PubMed, and Cochrane Library). Relevant review articles on the subject were scrutinized for cross-references. In addition, 5 dental and medical journals (Journal of Endodontics; International Endodontic Journal; Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics; Journal of Oral and Maxillofacial Surgery; and International Journal of Oral and Maxillofacial Surgery) were hand checked dating back to 1975. All abstracts were screened by 3 independent reviewers (H.B., M.K., and F.S.). Strict inclusion-exclusion criteria were defined to identify relevant articles. Raw data were extracted from the full-text review of these selected articles independently by each of the 3 reviewers. In case of disagreement, an agreement was reached by discussion, and qualifying articles were assigned to group RES. For EMS, the same search strategy was performed for the time frame October 2009 to December 2016, whereas up to October 2009 the data were obtained from a previous systematic review with identical criteria and search strategy. Weighted pooled success rates and a relative risk assessment between RES and EMS were calculated. To make a comparison between groups, a random effects model was used. RESULTS Sixty-eight articles were eligible for full-text review. Of these, per strict inclusion exclusion criteria, 14 studies qualified, 3 for RES (n = 862) and 11 for EMS (n = 915). Weighted pooled success rates for RES were 82.20% (95% confidence interval [CI], 0.7965-0.8476) and 94.42% for EMS (95% CI, 0.9295-0.9590). This difference was statistically significant (P < .0005). CONCLUSIONS The probability for success for EMS proved to be significantly greater than the probability for success for RES, providing best available evidence on the influence of cavity preparation with ultrasonic tips and/or SuperEBA (Keystone Industries, Gibbstown, NJ), IRM (Dentsply Sirona, York, PA), MTA, or silicate cements as root-end filling material instead of a shallow cavity preparation and placement of a resin-based material. Additional large-scale randomized clinical trials are needed to assess other predictors of outcome.
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Ahn SY, Kim NH, Kim S, Karabucak B, Kim E. Computer-aided Design/Computer-aided Manufacturing–guided Endodontic Surgery: Guided Osteotomy and Apex Localization in a Mandibular Molar with a Thick Buccal Bone Plate. J Endod 2018; 44:665-670. [DOI: 10.1016/j.joen.2017.12.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 12/06/2017] [Accepted: 12/07/2017] [Indexed: 11/28/2022]
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Arx TV, Bosshardt D, Bingisser AC, Bornstein MM. Endoscopic Evaluation of Cut Root Faces and Histologic Analysis of Removed Apices Following Root Resection: A Clinical Study. Eur Endod J 2017; 3:18-23. [PMID: 32161851 PMCID: PMC7024722 DOI: 10.5152/eej.2017.17046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 08/14/2017] [Accepted: 11/23/2017] [Indexed: 11/22/2022] Open
Abstract
Objective: To evaluate the resection plane after root-end resection during apical surgery using endoscopy. Methods: Following apicectomy of 69 roots, the cut root faces were inspected with a rigid endoscope for the presence of unfilled areas of the root canal space, gaps between the obturated root canal and dentinal wall, isthmi, ‘opaque’ dentine and cracks. Endoscopic pictures were captured and assessed using a 12-sectorn transparent grid for determination of location of the studied elements. Furthermore, the removed apices were examined histologically (n=47). The surfaces of the removed apices opposite the cut root faces were histologically analysed for the same outcome measures. Results: Endoscopy revealed the following findings: opaque dentine in 84.1%, unfilled parts of the root canal system in 59.4%, gaps between the existing root canal filling and dentinal walls in 49.3%, and cracks in 10.1% of cases. With regard to isthmi, histology of the removed apices demonstrated an isthmus in two-thirds of those seen with endoscopy at the root end. Ramifications were histologically observed only in 6 root apices. Conclusion: The studied elements may cause failure of the root canal treatment, and conventional root canal retreatment or apical surgery may be indicated. The clinical significance of opaque dentine with regard to tooth prognosis after apical surgery remains unclear and warrants further research.
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Affiliation(s)
- Thomas Von Arx
- Department of Oral Surgery and Stomatology, University of Bern School of Dental Medicine, Bern, Switzerland
| | - Dieter Bosshardt
- Laboratory of Oral Histology, University of Bern School of Dental Medicine, Bern, Switzerland
| | - Andreas C Bingisser
- Department of Oral Surgery and Stomatology, University of Bern School of Dental Medicine, Bern, Switzerland
| | - Michael M Bornstein
- Department of Oral and Maxillofacial Radiology, Applied Oral Sciences, University of Hong Kong School of Dentistry, Prince Philip Dental Hospital, Sai Ying Pun, Hong Kong SAR, China
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Micro-CT evaluation of voids using two root filling techniques in the placement of MTA in mesial root canals of Vertucci type II configuration. Clin Oral Investig 2017; 22:1907-1913. [DOI: 10.1007/s00784-017-2282-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 11/20/2017] [Indexed: 02/02/2023]
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Keleş A, Keskin C. A micro-computed tomographic study of band-shaped root canal isthmuses, having their floor in the apical third of mesial roots of mandibular first molars. Int Endod J 2017; 51:240-246. [DOI: 10.1111/iej.12842] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 08/22/2017] [Indexed: 10/19/2022]
Affiliation(s)
- A. Keleş
- Faculty of Dentistry; Department of Endodontics; Ondokuz Mayıs University; Samsun Turkey
| | - C. Keskin
- Faculty of Dentistry; Department of Endodontics; Ondokuz Mayıs University; Samsun Turkey
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Wang ZH, Zhang MM, Wang J, Jiang L, Liang YH. Outcomes of Endodontic Microsurgery Using a Microscope and Mineral Trioxide Aggregate: A Prospective Cohort Study. J Endod 2017; 43:694-698. [DOI: 10.1016/j.joen.2016.12.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 11/20/2016] [Accepted: 12/10/2016] [Indexed: 10/20/2022]
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