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Ali Shalan L, Al-Huwaizi HF. Microhardness and energy dispersive X-ray evaluation of dentinal walls following chemical and electrochemical dissolution of fractured nickel-titanium file: An in vitro study. Heliyon 2024; 10:e35902. [PMID: 39224390 PMCID: PMC11367024 DOI: 10.1016/j.heliyon.2024.e35902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 08/02/2024] [Accepted: 08/06/2024] [Indexed: 09/04/2024] Open
Abstract
Purpose Chemical dissolution of nickel-titanium (NiTi) files involves the application of a fluoride solution in direct contact with a damaged instrument, whereas electrochemical dissolution involves the application of an electrical current to the electrolyte, which accelerates fragment dissolution. This study aimed to determine the hardness and concentration of calcium and phosphorus (Ca and P) ions in dentinal walls following chemical and electrochemical dissolution of fractured ProTaper F2 files with a novel chemical solution. Materials & Methods : Thirty human maxillary first molar palatal roots with fractured ProTaper F2 files in the middle third (length, 2.5 mm were divided into three groups according to the treatment techniques used with a novel solution (NaF 12 g/L + NaCl2 60 g/L + MgCl2 60 g/L + CaCl2 60 g/L) at pH 5: Group 1: distilled water (control group), Group 2: electrochemical dissolution, and Group 3: chemical dissolution using the novel solution. The novel solution was placed for 10 min using an electrochemical technique, and for 30 min in contact with the separated instrument in the chemical group. The Vickers microhardness test was performed in three areas: at 3, 6, and 9 mm from the apex, and an energy-dispersive X-ray test for both Ca and P ions was performed. The analysis of variance (ANOVA) and Tukey's tests were used for statistical analysis. Results According to the one-way ANOVA analysis, no difference was observed between the tested approaches (P > 0.05) in the three areas evaluated (3, 6, and 9 mm), with no difference in the Ca/P ratio between the tested groups. Conclusion Compared to the control group, the use of chemical and electrochemical dissolution methods with the novel solution did not affect dentin hardness or dentinal structure in terms of the Ca/P ratio, thereby indicating promising results while saving time.
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Affiliation(s)
- Linz Ali Shalan
- Department of Conservative and Esthetic Dentistry, College of Dentistry, University of Baghdad, Iraq
| | - Hussain F. Al-Huwaizi
- Department of Conservative and Esthetic Dentistry, College of Dentistry, University of Baghdad, Iraq
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Aminsobhani M, Hashemi N, Hamidzadeh F, Sarraf P. Broken Instrument Removal Methods with a Minireview of the Literature. Case Rep Dent 2024; 2024:9665987. [PMID: 38919975 PMCID: PMC11196850 DOI: 10.1155/2024/9665987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 03/24/2024] [Accepted: 05/16/2024] [Indexed: 06/27/2024] Open
Abstract
Instrument fracture in the root canal system is an unpleasant incident that may occur during root canal treatment. Comprehensive cleaning of the root canal system is often impossible in the presence of a broken instrument. Therefore, it is often imperative to remove the broken fragment from the root canal system. To date, various methods have been proposed for the removal of broken instruments from the root canal system. However, no consensus has been reached on a safe technique with a high success rate for broken instrument removal. This case series reports six cases of successful removal of broken instruments using different methods including the ultrasonic, tube-and-glue, tube-and-wire, tube-and-internal shaft, and the forceps techniques and also provides a brief review of the relevant literature.
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Affiliation(s)
- Mohsen Aminsobhani
- Department of EndodonticsSchool of DentistryTehran University of Medical Sciences, Tehran, Iran
- School of DentistryAJA University of Medical Sciences, Tehran, Iran
| | - Nasim Hashemi
- Department of EndodonticsSchool of DentistryTehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Hamidzadeh
- Department of EndodonticsSchool of DentistryTehran University of Medical Sciences, Tehran, Iran
| | - Pegah Sarraf
- Department of EndodonticsSchool of DentistryTehran University of Medical Sciences, Tehran, Iran
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Namour A, El Mobadder M, Matamba P, Misoaga L, Magnin D, Arany P, Nammour S. The Safety of Removing Fractured Nickel-Titanium Files in Root Canals Using a Nd: YAP Laser. Biomedicines 2024; 12:1031. [PMID: 38790993 PMCID: PMC11117853 DOI: 10.3390/biomedicines12051031] [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: 03/30/2024] [Revised: 04/24/2024] [Accepted: 05/02/2024] [Indexed: 05/26/2024] Open
Abstract
The fracture of nickel-titanium (Ni-Ti) instruments during root canal instrumentation leads to compromised outcomes in endodontic treatments. Despite the significant impact of instrument facture during a root canal treatment, there is still no universally accepted method to address this complication. Several previous studies have shown the ability of a Neodymium: Yttrium-Aluminum-Perovskite (Nd: YAP) laser to cut endodontic files. This study aims to determine safe irradiation conditions for a clinical procedure involving the use of a Neodymium: Yttrium-Aluminum-Perovskite (Nd: YAP) laser for removing fractured nickel-titanium files in root canals. A total of 54 extracted permanent human teeth (n = 54) were used. This study involved nine distinct groups, each employing different irradiation conditions. Groups 1 s, 3 s, 5 s, 10 s, and 15 s simply consist of irradiation for 1, 3, 5, 10, and 15 s, respectively. After identifying the longest and safest duration time, four additional groups were proposed (labeled A, B, C, and D). Group A was composed of three series of irradiations of 5 s each separated by a rest time of 30 s (L5s + 30 s RT). Group B consisted of three series of irradiations of 5 s each separated by a rest time of 60 s (L5s + 60 s RT). Group C consisted of two series of irradiations of 5 s each separated by a rest time of 30 s (L5s + 30 s RT), and group D consisted of two series of irradiations of 5 s each separated by a rest time of 5 s (L5s + 5 s RT). In all groups, during the rest time, continuous irrigation with 2.5 mL of sodium hypochlorite (3% NaOCl) was carried out. The variation in temperature during irradiation was registered with a thermocouple during irradiation with different protocols. The mean and standard deviation of the temperature increase was noted. The calculation of the temperature was made as the Δ of the highest recorded temperature at the root surface minus (-) that recorded at baseline (37°). Additionally, scanning electron microscopy (SEM) was used after irradiation in all groups in order to assess the morphological changes in the root dentinal walls. The Nd: YAP laser irradiation parameters were a power of 3W, an energy of 300 mJ per pulse, a fiber diameter of 200 µm, a pulsed mode of irradiation with a frequency of 10 Hz, a pulse duration of 150 µs, and an energy density of 955.41 J/cm2. Our results show that the safest protocol for bypassing and/or removing broken instruments involves three series of irradiation of 5 s each with a rest time of 30 s between each series. Furthermore, our results suggest that continuous irradiation for 10 s or more may be harmful for periodontal tissue.
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Affiliation(s)
- Amaury Namour
- Department of Dental Science, Faculty of Medicine, University of Liege, 4000 Liege, Belgium; (A.N.); (M.E.M.); (P.M.); (L.M.)
| | - Marwan El Mobadder
- Department of Dental Science, Faculty of Medicine, University of Liege, 4000 Liege, Belgium; (A.N.); (M.E.M.); (P.M.); (L.M.)
- Laser Laboratory, Oral Surgery Department, Wroclaw Medical University, 50-425 Wroclaw, Poland
| | - Patrick Matamba
- Department of Dental Science, Faculty of Medicine, University of Liege, 4000 Liege, Belgium; (A.N.); (M.E.M.); (P.M.); (L.M.)
| | - Lucia Misoaga
- Department of Dental Science, Faculty of Medicine, University of Liege, 4000 Liege, Belgium; (A.N.); (M.E.M.); (P.M.); (L.M.)
| | - Delphine Magnin
- Bio- and Soft Matter Division, Institute of Condensed and Nanosciences, Université Catholique de Louvain (UCL), 1348 Louvain-la-Neuve, Belgium;
| | - Praveen Arany
- Oral Biology, Biomedical Engineering & Surgery, University at Buffalo, Buffalo, NY 14214, USA;
| | - Samir Nammour
- Department of Dental Science, Faculty of Medicine, University of Liege, 4000 Liege, Belgium; (A.N.); (M.E.M.); (P.M.); (L.M.)
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Karim MH, Faraj BM. Comparative Evaluation of a Dynamic Navigation System versus a Three-dimensional Microscope in Retrieving Separated Endodontic Files: An In Vitro Study. J Endod 2023; 49:1191-1198. [PMID: 37393950 DOI: 10.1016/j.joen.2023.06.014] [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: 05/14/2023] [Revised: 06/22/2023] [Accepted: 06/22/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION This study aimed to compare the effectiveness of a dynamic navigation system and a three-dimensional microscope in retrieving broken rotary Nickel-Titanium files when using trepan burs and the extractor system. MATERIALS AND METHODS Thirty maxillary first bicuspids with 60 separate roots were split into 2 comparable groups based on a comprehensive cone beam computed tomography analysis of the root length and curvature. After standardized access opening, glide paths, and patency attainment with the K file (sizes 10 and 15), the teeth were arranged on 3D models (three per quadrant, six per model). Subsequently, controlled-memory heat-treated Nickel-Titanium rotary files (#25/0.04) were notched 4 mm from the tips and fractured at the apical third of the roots. The C-FR1 Endo file removal system was employed under both guidance to retrieve the fragments, and the success rate, canal aberration, treatment time, and volumetric changes were measured. The statistical analysis was performed using IBM SPSS software at a significance level of 0.05. RESULTS The microscope-guided group had a higher success rate than the dynamic navigation system guidance, but the difference was insignificant (P > .05). In addition, the microscope-guided drills resulted in a substantially lower proportion of canal aberration, shorter time to retrieve the fragments and less change in the root canal volume (P < .05). CONCLUSION Although dynamically guided trephining with the extractor can retrieve separated instruments, it is inferior to three-dimensional microscope guidance regarding treatment time, procedural errors, and volume change.
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Affiliation(s)
- Mohammed H Karim
- Conservative Department, University of Sulaimani, College of Dentistry, Iraq.
| | - Bestoon M Faraj
- Conservative Department, University of Sulaimani, College of Dentistry, Iraq
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Wang H, Yang X, Zou L, Huang D, Zhou X, Xu J, Gao Y. Shaping outcome of ProTaper NEXT for root canal preparation in mandibular incisors: a micro-CT study. BMC Oral Health 2022; 22:302. [PMID: 35869473 PMCID: PMC9308234 DOI: 10.1186/s12903-022-02335-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/13/2022] [Indexed: 11/23/2022] Open
Abstract
Background Relatively high incidence of single canals with oval or round shape were observed in human mandibular incisors. In order to investigate the influence of the root canal morphology on root canal preparation, the shaping outcome of ProTaper NEXT in oval and round canals of mandibular incisors were evaluated by using micro-computed tomography (micro-CT) analysis. Methods This experiment was approved by the School Medical Ethics Committee. The sample size calculation was conducted using G*Power software. Intact mandibular incisors with a single canal were selected. Oval canals (2 < aspect ratio (AR) ≤ 4) and round canals (AR ≤ 2) were pair-matched according to canal length, and assigned to two experimental groups (13 per group). ProTaper NEXT was used for root canal preparation for both groups. Untouched canal wall (UCW), root canal morphological parameters and three-dimensional (3D) dentin thickness were evaluated in the entire root canal and each canal third after micro-CT scanning. Statistical analysis: Data were collected and analyzed with Mann–Whitney test and Friedman test using SPSS statistics software 25 (P < 0.05). Additionally, correlations of UCW area with canal morphological parameters were also investigated. Results After root canal preparation, no significant difference was observed in all analyzed parameters in the apical third between oval and round canal groups (P > 0.05). In the coronal two thirds of the canal, the post-operative structure model index (SMI), form factor and roundness were significantly increased, while the AR was significantly decreased in both groups (P < 0.05). In addition, in the coronal two thirds, significantly more UCW and higher UCWΔ% was observed in oval canal group (P < 0.05). Furthermore, UCW correlated very strongly to canal major diameter (0.924) and initial volume (0.938), and strongly to canal form factor (− 0.724), minor diameter (0.799) and canal area (0.882). Proximal dentin wall was associated with significantly thinner pre-operative dentin thickness and higher amount of dentin removal after root canal preparation in both oval and round canal groups. Conclusions (1) Both types of canals were more conical after root canal preparation, but oval root canals tend to leave more UCW area than round canals in the coronal two thirds of mandibular incisors, which contributes to the challenge for endodontic infection control. (2) Root canal preparation usually results in excessive dentin removal in the proximal dentin wall comparing with buccal and lingual walls in both types of canals of mandibular incisors. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-022-02335-7.
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Bordone A, Ciaschetti M, Perez C, Couvrechel C. Guided Endodontics in the Management of Intracanal Separated Instruments: A Case Report. J Contemp Dent Pract 2022; 23:853-856. [PMID: 37283022 DOI: 10.5005/jp-journals-10024-3395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIM The aim of this case report is to describe the removal of a fractured file in mandibular right first premolar through the application of an endodontic template to guide a trephine until the file. BACKGROUND The fracture of an endodontic instrument is a rare complication that requires therapeutic management. Removal procedures often cause excessive dentine loss. To limit this inconvenience, several techniques describing the removal of fractured files in the coronal third of the canal have been proposed. The guide facilitates the use of the Zumax removal kit (Zumax Medical Co. Ltd., Suzhou, China). CASE DESCRIPTION A 30-year-old patient was referred to dental office for the endodontic retreatment of his mandibular right first premolar. The tooth was painful to percussion and buccal palpation. The periapical radiograph showed a periapical lesion, a defective root canal treatment, and the presence of a fractured file. It was decided to use the Zumax kit in order to remove the instrument. By using digital implantology software, a guide was constructed with a tube to guide a trephine and achieve straight-line access. The trephine was later driven by the resin guide. After completing the drilling, the instrument was removed with the Zumax extractor and the canal was then prepared, disinfected, and filled. CONCLUSION The current case describes the removal of a separated instrument by use of a new approach that is planned on computer software and guided by a resin guide. CLINICAL SIGNIFICANCE The guided endodontic technique avoids excessive loss of dental structure and simplifies the procedure by reducing chair time and increasing the operator's confidence.
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Affiliation(s)
| | | | - Cyril Perez
- Private Practice, 14 Rue des Capucines, Paris, France, Phone: +33 627717742, e-mail:
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Roda-Casanova V, Pérez-González A, Zubizarreta-Macho A, Faus-Matoses V. Influence of Cross-Section and Pitch on the Mechanical Response of NiTi Endodontic Files under Bending and Torsional Conditions—A Finite Element Analysis. J Clin Med 2022; 11:jcm11092642. [PMID: 35566767 PMCID: PMC9101501 DOI: 10.3390/jcm11092642] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 11/16/2022] Open
Abstract
In this article, the effects of cross-section and pitch on the mechanical response of NiTi endodontic files is studied by means of finite element analyses. The study was conducted over a set of eight endodontic rotary files, whose geometry was obtained from combinations of two cross-sections(square and triangular) and four pitches. Each file was subjected to bending and torsional analyses, simulating the testing conditions indicated in the ISO 3630 Standard, in order to assess their stiffness and mechanical strength. The results indicate that endodontic files with a square cross-section have double the stiffness of those with triangular cross-sections, both in terms of bending and torsion. For both loading modes, endodontic files with a triangular cross-section can undergo larger deformations before overload failure than those with a square cross-section: up to 20% more in bending and 40% in torsion. Moreover, under equivalent boundary conditions, endodontic files with triangular cross-sections present a higher fatigue life than those with square cross-sections: up to more than 300% higher for small pitches. The effect of pitch on the stiffness and strength of the file is smaller than that of the cross-section shape, but smaller pitches could be beneficial when using a triangularcross-section, as they increase the bending flexibility, fatigue life, and torsion stiffness. These results suggest a clinical recommendation for the use of files with a triangular-shaped cross-section and a small pitch in order to minimize ledging and maximize fatigue life. Finally, in this study, we reveal the sensitivity of the orientation of files with respect to the bending direction, which must be taken into account when designing, reporting, and interpreting test results under such loading conditions.
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Affiliation(s)
- Victor Roda-Casanova
- Department of Mechanical Engineering and Construction, Universitat Jaume I, 12071 Castelló de la Plana, Spain; (V.R.-C.); (A.P.-G.)
| | - Antonio Pérez-González
- Department of Mechanical Engineering and Construction, Universitat Jaume I, 12071 Castelló de la Plana, Spain; (V.R.-C.); (A.P.-G.)
| | - Alvaro Zubizarreta-Macho
- Department of Dentistry, Alfonso X el Sabio University, 28691 Madrid, Spain
- Department of Orthodontics, University of Salamanca, 37008 Salamanca, Spain
- Correspondence:
| | - Vicente Faus-Matoses
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain;
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Terauchi Y, Ali WT, Abielhassan MM. Present status and future directions - Removal of fractured instruments. Int Endod J 2022; 55 Suppl 3:685-709. [PMID: 35377473 DOI: 10.1111/iej.13743] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/31/2022] [Accepted: 03/31/2022] [Indexed: 11/28/2022]
Abstract
Success rate of fractured instrument retrieval varies because it is dependent mainly on several factors including the visibility of the fractured instrument, the length of the fractured instrument in relation to the curvature of the canal, and the techniques applied to each case. This review aims to update the present status on removal of fractured instruments to identify factors and variables that could affect the success of fractured instrument retrieval based on both the preparation techniques and the instrument retrieval techniques. On the other hand, future directions of fractured instrument retrieval should focus on management of non-visible fractured instruments since the removal of those instruments are deemed unpredictable with the current techniques, whereas the removal of visible fractured instruments are considered predictable now. Another possible direction of it is there might be no more instrument fracture due to possible significant changes in the root canal preparation technique which may dispense with the use of rotary instruments.
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Affiliation(s)
- Yoshi Terauchi
- CT & MicroEndodontic center, 3-3-1 Chuorinkan, Yamato-Shi, KANAGAWA, 242-0001, Japan.,Yoshitsugu Terauchi, 9-8-14 Chuorinkan, Yamato City, KANAGAWA, 2420007, Japan
| | - Wagih Tarek Ali
- Endodontic Department, Faculty of Dentistry, Cairo University, Cairo, Egypt
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Faus-Matoses V, Burgos Ibáñez E, Faus-Llácer V, Ruiz-Sánchez C, Zubizarreta-Macho Á, Faus-Matoses I. Comparative Analysis of Ease of Removal of Fractured NiTi Endodontic Rotary Files from the Root Canal System-An In Vitro Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020718. [PMID: 35055540 PMCID: PMC8775915 DOI: 10.3390/ijerph19020718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 11/16/2022]
Abstract
This study aimed at analyzing and comparing the ease of removal of fractured nickel-titanium (NiTi) endodontic rotary files from the root canal system between the ultrasonic tips and the Endo Rescue appliance removal systems, as well as comparing the volume of dentin removed between ultrasonic tips and the Endo Rescue appliance using a micro-computed tomography (micro-CT) scan. MATERIAL AND METHODS Forty NiTi endodontic rotary files were intentionally fractured in 40 root canal systems of 20 lower first molar teeth and distributed into the following study groups: A: Ultrasonic tips (n = 20) (US) and B: Endo Rescue device (n = 20) (ER). Preoperative and postoperative micro-CT scans were uploaded into image processing software to analyze the volumetric variations of dentin using an algorithm that enables progressive differentiation between neighboring pixels after defining and segmenting the fractured NiTi endodontic rotary files and the root canal systems in both micro-CT scans. A non-parametric Mann-Whitney-Wilcoxon test or t-test for independent samples was used to analyze the results. RESULTS The US and ES study groups saw 8 (1 mesiobuccal and 7 distal root canal system) and 3 (distal root canal system) fractured NiTi endodontic rotary files removed, respectively. No statistically significant differences were found in the amount of dentin removed between the US and ER study groups at the mesiobuccal (p = 0.9109) and distal root canal system (p = 0.8669). CONCLUSIONS Ultrasonic tips enable greater ease of removal of NiTi endodontic rotary files from the root canal system, with similar amounts of dentin removal between the two methods.
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Affiliation(s)
- Vicente Faus-Matoses
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (V.F.-M.); (E.B.I.); (V.F.-L.); (C.R.-S.); (I.F.-M.)
| | - Eva Burgos Ibáñez
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (V.F.-M.); (E.B.I.); (V.F.-L.); (C.R.-S.); (I.F.-M.)
| | - Vicente Faus-Llácer
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (V.F.-M.); (E.B.I.); (V.F.-L.); (C.R.-S.); (I.F.-M.)
| | - Celia Ruiz-Sánchez
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (V.F.-M.); (E.B.I.); (V.F.-L.); (C.R.-S.); (I.F.-M.)
| | - Álvaro Zubizarreta-Macho
- Department of Endodontics, Faculty of Health Sciences, Alfonso X El Sabio University, 28691 Madrid, Spain
- Department of Surgery, Faculty of Medicine and Dentistry, University of Salamanca, 37008 Salamanca, Spain
- Correspondence:
| | - Ignacio Faus-Matoses
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (V.F.-M.); (E.B.I.); (V.F.-L.); (C.R.-S.); (I.F.-M.)
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ORMIGA F, AMARAL CCF, VIEIRA FM, RISSO PDA, SILVA ABD, ALMEIDA M, SENA R, FERES-FILHO EJ, GRANJEIRO JM, GOMES JADCP. Ionic concentration in periradicular medium after dissolution of endodontic file fragments: an in vitro study. Braz Oral Res 2022; 36:e015. [DOI: 10.1590/1807-3107bor-2022.vol36.0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/09/2021] [Indexed: 11/22/2022] Open
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Portela NN, Rech JP, Marchionatti AME, Barasuol JC. Techniques to address fractured instruments in the middle or apical third of the root canal in human permanent teeth: a systematic review of the in vitro studies. Clin Oral Investig 2021; 26:131-139. [PMID: 34698940 DOI: 10.1007/s00784-021-04235-6] [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: 05/05/2021] [Accepted: 10/15/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The objective of this study is to investigate techniques for approaching fractured instruments in the root canal and to present possible outcomes in relation to dentin thickness, fracture resistance, technique success, and clinical time. MATERIALS AND METHODS The bibliographic research was carried out in PubMed, Cochrane, Lilacs, Web of Science, Scopus, grey literature, and manual search. Following the inclusion and exclusion criteria, the titles and abstracts of 506 articles were read. Of these, 60 articles were selected and read in full. Fourteen articles were included in this systematic review. RESULTS The most studied technique was the ultrasonic technique and obtained good general results. The more apically the instrument is located, the more difficult it is to remove, the more dentin is removed, and the lower the fracture resistance of the tooth. When removal is not possible, the bypass technique can be performed (bypassing), and on weakened teeth or with little dental remnants, the GentleWave System technique can be used. CONCLUSION This systematic review shows the evidence from laboratory studies that the curvature and the root third in which the fracture of instruments occurred is relevant to fracture resistance and success. The ultrasonic technique got the best results. Well-conducted clinical studies should be performed for clinical practice. CLINICAL RELEVANCE The approach of fractured instruments in the root canal is efficient with the use of ultrasound, bypass technique, and Gentle Wave System.
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Affiliation(s)
- Nathalia Nadalon Portela
- Faculdade CNEC, R. Prof. Dr. João Augusto Rodrigues, 471 - Harmonia, Santo Ângelo, RS, 98801-015, Brazil
| | - Júlia Petry Rech
- Faculdade CNEC, R. Prof. Dr. João Augusto Rodrigues, 471 - Harmonia, Santo Ângelo, RS, 98801-015, Brazil
| | | | - Jéssica Copetti Barasuol
- Faculdade CNEC, R. Prof. Dr. João Augusto Rodrigues, 471 - Harmonia, Santo Ângelo, RS, 98801-015, Brazil.
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Zhang L, Wang X. Efficiency and Temperature Rise of File Ablation by Neodymium:Yttrium-Aluminum-Perovskite Laser In Vitro. J Endod 2021; 47:982-988. [PMID: 33737003 DOI: 10.1016/j.joen.2021.03.002] [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: 07/28/2020] [Revised: 03/04/2021] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Retrieving a separated file in the root canal system requires a skilled clinician. A metal file can be removed by ablation via the neodymium:yttrium-aluminum-perovskite (Nd:YAP) laser; however, the efficiency and potential hazards of the ablation procedure are still unclear. The aim of this study was 2-fold: to investigate the efficiency of file ablation using the Nd:YAP laser and to evaluate the rise in temperature of the root surface in vitro. METHODS In part 1 of this study, #10 and #15 C-files (VDW GmbH, Munich, Germany) and ProTaper Next X1 and X2 files (Dentsply Maillefer, Ballaigues, Switzerland) were selected. Under 8.5×, the Nd:YAP laser was used to ablate the files starting at the tip of the file. The length of the file was recorded after each 5-pulse ablation. In part 2 of this study, 3 files each of the #15 C-file and the ProTaper Next X2 were separated in 6 distal roots of mandibular second molars with single canals. Two-pulse and 5-pulse modes were used to ablate the separated files, and the rise in root surface temperature was recorded with an infrared camera. Another 3 unaltered distal roots served as the negative control. For scanning electron microscopic evaluation, the teeth were split with bone scissors and observed under a scanning electron microscope to evaluate the surface change of the file and the root canal wall. RESULTS The average length of the ablated files after each 5-pulse interval was 0.113-0.158 mm with no statistical difference between the different files.The temperature rise of the negative control group (mean ± standard deviation = 1.86° ± 0.11°C and 5.81° ± 0.35°C for the 2- and 5-pulse group) was significantly lower than the roots with separated files (mean ± standard deviation = 3.74° ± 0.20°C and 4.02° ± 0.11°C for 2-pulse C-file and ProTaper Next X2; 8.47° ± 0.19°C and 9.04° ± 0.20°C for 5-pulse C-file and ProTaper Next X2). The temperature rise of all groups was lower than 10°C. The 2-pulse group showed a lower temperature rise than the 5-pulse group. The diameter or the type of alloy had no effect on the temperature rise. CONCLUSIONS Separated files (stainless steel or nickel-titanium alloy) can be ablated by the Nd:YAP laser. When the number of pulses is less than 5, the temperature rise of the root surface is considered safe to the surrounding periodontium.
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Affiliation(s)
- Lu Zhang
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology, Beijing, China; and National Clinical Research Center for Oral Diseases and National Engineering Laboratory for Digital and Material Technology of Stomatology and Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Xiaoyan Wang
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology, Beijing, China; and National Clinical Research Center for Oral Diseases and National Engineering Laboratory for Digital and Material Technology of Stomatology and Beijing Key Laboratory of Digital Stomatology, Beijing, China.
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PradeepKumar A, Kumar B, Krishnamoorthy S, Shanmugam S. The time taken for retrieval of separated instrument and the change in root canal volume after two different techniques using CBCT: An in-vitro study. Indian J Dent Res 2021; 32:489-494. [DOI: 10.4103/ijdr.ijdr_403_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Amaral CCF, Ormiga F, Araújo OMO, Lopes RT, Gomes JACP. Electrochemical dissolution of nickel-titanium instrument fragments in root canals of extracted human maxillary molars using a small reservoir of electrolyte. Int Endod J 2020; 53:1559-1568. [PMID: 32767773 DOI: 10.1111/iej.13381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/03/2020] [Indexed: 01/29/2023]
Abstract
AIM To evaluate the viability of the electrochemical dissolution of fragments of fractured NiTi instruments in root canals of extracted human maxillary molars, using two electrodes and the solution restricted to a small reservoir coupled to the pulp chamber. The primary hypothesis was that this method enables the reduction of fragment volume and re-establishment of the root canal path with a size 08 K-file, both in simulated canals and in extracted human maxillary molars. METHODOLOGY Fragments of F1 ProTaper instruments were polarized in simulated root canals and in distobuccal root canals of extracted maxillary molars using a new method, with the solution restricted to a small acrylic microcell coupled to each resin block or pulp chamber. Two electrodes were used, where one was kept in contact with the intracanal fragment and another was positioned in the solution present in the acrylic microcell. After the tests, a size 08 K-file was used passively to verify the possibility of bypassing the fragment, which was also confirmed by radiographic analysis. Micro-CT analysis of the teeth was used before and after fragment dissolution to evaluate the volume, length and porosity of the fragments. The D'Agostino-Pearson normality test was used to verify the distribution of the data. A paired t-test (P < 0.05) was used to compare the volume, length and porosity of the fragments before and after the dissolution tests. RESULTS After dissolution, all fragments could be bypassed with a size 08 K-file in both simulated canals and in extracted teeth. The dissolution process did not result in significant reduction of neither the fragment length nor the fragment porosity. However, it resulted in a significant reduction of fragment volume (paired t-test, P < 0.05). CONCLUSION The electrochemical dissolution of fragments of NiTi files in root canals of extracted human maxillary molars using two electrodes, and the solution restricted to a small reservoir coupled to the pulp chamber resulted in a significant reduction of fragment volume. The re-establishment of the root canal path with the passive insertion of size 08 K-files was possible in all samples after the tests, both in simulated canals and in extracted teeth.
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Affiliation(s)
- C C F Amaral
- Department of Metallurgy and Materials, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - F Ormiga
- Department of Dental Clinic, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - O M O Araújo
- Nuclear Engineering Program, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - R T Lopes
- Nuclear Engineering Program, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - J A C P Gomes
- Department of Metallurgy and Materials, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Microcomputed tomographic investigation of the trepan bur/microtube technique for the removal of fractured instruments from root canals without a dental operating microscope. Clin Oral Investig 2019; 24:1717-1725. [PMID: 31346785 DOI: 10.1007/s00784-019-03032-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 07/16/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the removal of fractured instruments in mandibular incisor canals by using the trepan bur/microtube technique without a dental operating microscope (DOM). MATERIALS AND METHODS Thirty-four mandibular incisors were selected, and 5-mm apical segments of #25/.06 taper K3 NiTi instruments were fractured in the apical portion of each canal. Coronal enlargement was performed, and a staging platform was prepared at the coronal aspect of the fractured instrument. Then, a trepan bur was used to expose 1-1.5 mm of the fragmented instrument, and a microtube device was used to withdraw the fragment. Microcomputed tomographic (micro-CT) imaging was used to evaluate the geometric changes in the root canal and dentin. The time required for fractured instrument removal in each sample was recorded, and the results were statistically analyzed with a paired t test. RESULTS The trepan bur/microtube technique exhibited a success rate of 76.47%, and the average fractured instrument removal time was 8.55 ± 5.81 min. The changes in canal volume and dentin volume from the coronal end of the fractured instrument to 1.5 mm apical to the end were significantly greater than those from the cementoenamel junction (CEJ) to the coronal end of the fractured instrument during fractured instrument removal (P < 0.0001). CONCLUSIONS The study showed that the trepan bur/microtube technique had a significant impact on geometric changes in the root canal and dentin from the coronal end of the fractured instrument to 1.5 mm apical to the end. CLINICAL RELEVANCE These findings suggest that the trepan bur/microtube technique may be an optional method for fractured instrument removal from relatively straight canals.
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Lohar J, Sood H, Gosai P, Shekh TM. 3P's in Retreatment Endodontics-An Often Forgotten Virtue. J Pharm Bioallied Sci 2019; 11:S76-S80. [PMID: 30923435 PMCID: PMC6398303 DOI: 10.4103/jpbs.jpbs_197_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Separation of instrument in the root canal is a common mishap that occurs during the cleaning and shaping procedure. So many different methods have been developed to retrieve fractured instruments from root canal. Separated instrument leads to incomplete cleaning of root canal and eventually causes posttreatment disease. For successful completion of treatment, a separated instrument must be retrieved and if not, a bypass must be attempted. This article presents four cases requiring removal of separated instruments from the root canal. All four cases were successfully treated by conservative means of instrument retrieval by using two different techniques.
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Affiliation(s)
- Jitendra Lohar
- Reader, Department of Conservative Dentistry and Endodontics, Darshan Dental College and Hospital, Udaipur, India
| | - Himanshu Sood
- Sr.Lecturer, Desh Bhagat Dental College, Mandi Gobindgarh, India
| | | | - Tariq M Shekh
- Reader, Department of Conservative Dentistry and Endodontics Pacific, Dental College And Research Centre, Udaipur, Rajasthan, India
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Amaral CCF, Ormiga F, Boldrini LC, Miranda PG, Mendonça TA, Granjeiro JM, Gomes JACP. Evaluation of the effects of the solution used for electrochemical dissolution of nickel-titanium endodontic files on dentine structure, microhardness and cell viability. Int Endod J 2018; 51:1434-1445. [PMID: 29763971 DOI: 10.1111/iej.12950] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 05/08/2018] [Indexed: 12/27/2022]
Abstract
AIM To evaluate the effects of the [NaF 12 g L-1 + NaCl 1 g L-1 ] solution used in the electrochemical dissolution process of fractured endodontic files, as well as its NiTi-containing product, on dentine hardness, topography and human fibroblast viability. METHODOLOGY Sixty single-rooted human teeth were evaluated for dentine microhardness using the Vickers hardness test and the area and number of dentinal tubules by scanning electron microscopy. The samples were divided according to the dentine surface treatment: distilled water; 17% EDTA; [NaF 12 g L-1 + NaCl 1 g L-1 ]; and 17% EDTA + [NaF 12 g L-1 + NaCl 1 g L-1 ]. Thirty-six single-rooted human teeth were divided according to the irrigation protocol: Dulbecco's Modified Eagle's Medium + 10% foetal bovine serum; 5.25% NaOCl; [NaF 12 g L-1 + NaCl 1 g L-1 ]; and [NaF 12 g L-1 + NaCl 1 g L-1 + NiTi]. The extracts in contact with the apical foramen were used in the MTT assay to evaluate human fibroblast viability, with dilutions of 100%, 50%, 25% and 12.5%. Statistical tests used were paired t-tests, one-way anova, Tukey's test, Kruskal-Wallis test and Dunn's post-test. RESULTS The [NaF 12 g L-1 + NaCl 1 g L-1 ] solution did not modify dentine microhardness or the average dentinal tubule area. However, EDTA induced changes in dentine structure and microhardness (P < 0.05). The [NaF 12 g L-1 + NaCl 1 g L-1 ] solution, and its NiTi-containing product had lower cytotoxicity than NaOCl at dilutions of 25% and 50% (P < 0.01). CONCLUSIONS The [NaF 12 g L-1 + NaCl 1 g L-1 ] solution did not alter dentine microhardness or damage the dentine structure. It also demonstrated lower cytotoxicity than NaOCl.
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Affiliation(s)
- C C F Amaral
- Department of Metallurgy and Materials, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - F Ormiga
- Department of Dental Clinic, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - L C Boldrini
- Bioengineering Laboratory, National Institute of Metrology, Quality and Technology (INMETRO), Duque de Caxias, Brazil.,Postgraduate Program in Translational Biomedicine - BIOTRANS - Unigranrio, Inmetro, Uezo, Rio de Janeiro, Brazil
| | - P G Miranda
- Bioengineering Laboratory, National Institute of Metrology, Quality and Technology (INMETRO), Duque de Caxias, Brazil
| | - T A Mendonça
- Postgraduate Program in Translational Biomedicine - BIOTRANS - Unigranrio, Inmetro, Uezo, Rio de Janeiro, Brazil.,Department of Endodontics, UNIGRANRIO - University of Grande Rio, Duque de Caxias, Brazil
| | - J M Granjeiro
- Bioengineering Laboratory, National Institute of Metrology, Quality and Technology (INMETRO), Duque de Caxias, Brazil.,Postgraduate Program in Translational Biomedicine - BIOTRANS - Unigranrio, Inmetro, Uezo, Rio de Janeiro, Brazil.,Department of Dental Technic,, Dental School, Fluminense Federal University, Rio de Janeiro, Brazil
| | - J A C P Gomes
- Department of Metallurgy and Materials, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Özyürek T, Gündoğar M, Yılmaz K, Uslu G. Bending resistance and cyclic fatigue life of Reciproc Blue, WaveOne Gold, and Genius files in a double (S-shaped) curved canal. J Dent Res Dent Clin Dent Prospects 2017; 11:241-246. [PMID: 29354251 PMCID: PMC5768957 DOI: 10.15171/joddd.2017.042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/29/2017] [Indexed: 12/05/2022] Open
Abstract
Background. This study compared the cyclic fatigue resistance, bending resistance and cross-sectional areas of Reciproc Blue (RPC Blue), WaveOne Gold (WOG), and Genius File (GF) NiTi rotary systems.
Methods. Forty RPC Blue R25 (25/.08), 40 WOG Primary (25/.07) and 40 GF (25/.04) files were used in the present study. Flexibility of the files was determined by 45° bending test. The instruments were also subjected to cyclic fatigue resistance, calculating the number of cycles to fracture (NCF) in an S-shaped artificial stainless steel canal. Also the cross-sectional areas of the files were measured at D5 level. The length of the fractured file tips was measured. The fracture surface of all the fragments was examined with a scanning electron microscope. Data was statistically analyzed using one-way ANOVA and post hoc Tukey tests.
Results. In both the apical and coronal curvatures, the NCF of the GF was significantly higher than that of the RPC Blue and WOG files. There was no significant difference between the GF, WOG and Reciproc Blue files with respect to the lengths of the fractured file fragments in either the apical or coronal curvature. The bending resistance of the GF was signif-icantly higher than that of the RPC Blue and WOG files. The RPC Blue had the largest cross-sectional area, and the GF had the smallest cross-sectional area.
Conclusion. Within the limitations of the present study, the GF NiTi system exhibited the highest cyclic and bending re-sistance among the experimental groups.
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Affiliation(s)
- Taha Özyürek
- Department of Endodontics, Faculty of Dentistry, Ondokuz Mayis University, Samsun, Turkey
| | - Mustafa Gündoğar
- Department of Endodontics, Faculty of Dentistry, Medipol University, Samsun, Turkey
| | - Koray Yılmaz
- Samsun Oral and Dental Health Hospital, Samsun, Turkey
| | - Gülşah Uslu
- Department of Endodontics, Faculty of Dentistry, Ondokuz Mayis University, Samsun, Turkey
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Xu J, He J, Yang Q, Huang D, Zhou X, Peters OA, Gao Y. Accuracy of Cone-beam Computed Tomography in Measuring Dentin Thickness and Its Potential of Predicting the Remaining Dentin Thickness after Removing Fractured Instruments. J Endod 2017; 43:1522-1527. [DOI: 10.1016/j.joen.2017.03.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 02/05/2017] [Accepted: 03/16/2017] [Indexed: 10/19/2022]
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