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Silva EJNL, Vianna PS, Lima CO, Barbosa AFA, Vieira VTL, Versiani MA. Exploring access cavity through non-carious cervical lesions: Impacts on instrumentation, obturation, and fracture resistance in mandibular incisors. Int Endod J 2024; 57:1689-1698. [PMID: 38984709 DOI: 10.1111/iej.14123] [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: 05/14/2024] [Revised: 06/04/2024] [Accepted: 07/01/2024] [Indexed: 07/11/2024]
Abstract
AIM To compare the effects of Cervical Access Cavity (CervAC) and Traditional Access Cavity (TradAC) on root canal preparation, root canal filling, and fracture resistance in mandibular incisors. METHODOLOGY Twenty recently extracted and intact mandibular incisors were initially scanned using a micro-CT device. The specimens were anatomically matched to create two groups (n = 10). A wedge-shaped non-carious cervical lesion (NCCL) was created on the buccal aspect of all teeth using a double-faced segmented diamond disc. In group 1, a TradAC was prepared, whilst in group 2, access was created through the simulated NCCL using a round diamond bur 1012. After root canal preparation with Rotate instruments sizes 15/0.04, 20/0.04, and 25/0.04, the teeth were scanned again and evaluated for root canal volume and surface area, static voxels, volume of removed dental tissue, and dentine thickness. After that, the root canals were filled using the single-cone technique, teeth were restored with composite resin, and subsequently rescanned to calculate the volume of filling materials and voids. Then, the restored teeth were subjected to fracture resistance tests using a universal testing machine. Statistical comparisons between groups were performed with the Mann-Whitney test or the Student's t-test, with a statistical significance level of 5%. RESULTS Statistical comparisons indicated no significant differences between groups in terms of root canal volume, surface area, static voxels, removed root dentine, root canal filling volume, percentage of voids, or fracture resistance load (p > .05). Conversely, teeth prepared with TradAC showed a significantly higher percentage of dental tissue removed from the crown (p = .001) and a greater volume of filling material remnants in the pulp chamber (p < .001) compared to the CervAC group. A significantly lower percentage reduction in dentine thickness was observed only on the mesial aspect of root at Level 1 in TradAC group (p = .008). CONCLUSIONS CervAC can be considered a viable alternative approach in the presence of NCCL in mandibular incisors.
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Affiliation(s)
- Emmanuel J N L Silva
- Department of Endodontics, School of Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Brazil
- Department of Endodontics, School of Dentistry, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Patrícia S Vianna
- Department of Endodontics, School of Dentistry, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Carolina O Lima
- Department of Dentistry, School of Dentistry, Federal University of Juiz de Fora, Governador Valadares, Brazil
| | - Ana Flávia A Barbosa
- Department of Endodontics, School of Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Brazil
| | - Victor T L Vieira
- Department of Endodontics, School of Dentistry, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Marco A Versiani
- Oral Health Center, Brazilian Military Police, Minas Gerais, Brazil
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2
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Collet P, Tra R, Reitmann A, Valette S, Hoyek N, Maurin JC, Ducret M, Villat C, Santamaria J, Richert R. Spatial Abilities and Endodontic Access Cavity Preparation: Implications for Dental Education. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2024. [PMID: 39312553 DOI: 10.1111/eje.13039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 08/02/2024] [Accepted: 08/23/2024] [Indexed: 09/25/2024]
Abstract
INTRODUCTION Access cavity preparation is a crucial step in root canal treatment but is one of the most complex procedures in the curriculum to learn, with students often reporting spatial orientation difficulties during drilling. The present study aimed to evaluate the influence of spatial abilities on the preparation of endodontic access cavities among third-year dental students. MATERIALS AND METHODS Students from Lyon dental faculty participated voluntarily. The mental rotation test (MRT) evaluated spatial ability. Students prepared access cavities on 3D-printed mandibular molars, subsequently scanned and assessed against eight evaluation points, including morphology, canal access, floor preservation and convergence angle. Principal component analysis (PCA) assessed dataset variations. RESULTS A total of 43 volunteers participated. PCA revealed two principal components accounting for 80.8% of variations: the first PC primarily consisted of MRT score (64.3%) and morphology (14.1%); the second comprised operative time (46.1%) and morphology (18.0%). There were significant differences in morphology based on MRT scores, but no correlation was found between other parameters. DISCUSSION Lower MRT scores were associated with larger cavity preparations, raising questions about potential curriculum adaptations to enhance spatial reasoning. The operative time was not correlated with higher MRT scores but did contribute to variations in cavity morphology. CONCLUSION Spatial abilities have a substantial impact on the quality of endodontic access cavity preparations; further studies should evaluate if the incorporation of 3D atlas exercises could be beneficial.
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Affiliation(s)
- Philippine Collet
- Faculté d'Odontologie, Université Claude Bernard Lyon 1, Lyon, France
- Service de Consultations et Traitements Dentaires, Hospices Civils de Lyon, Lyon, France
| | - Robenson Tra
- Faculté d'Odontologie, Université Claude Bernard Lyon 1, Lyon, France
| | - Anna Reitmann
- Centre de Recherche en Acquisition et Traitement de l'Image, UMR 5220, Lyon, France
| | - Sébastien Valette
- Centre de Recherche en Acquisition et Traitement de l'Image, UMR 5220, Lyon, France
| | - Nady Hoyek
- Laboratoire Interuniversitaire de Biologie de la Motricité, EA7424, Université Claude Bernard Lyon 1, Lyon, France
| | - Jean-Christophe Maurin
- Faculté d'Odontologie, Université Claude Bernard Lyon 1, Lyon, France
- Service de Consultations et Traitements Dentaires, Hospices Civils de Lyon, Lyon, France
- Laboratoire de Biologie Tissulaire et Ingénierie Thérapeutique, UMR 5305, Lyon, France
| | - Maxime Ducret
- Faculté d'Odontologie, Université Claude Bernard Lyon 1, Lyon, France
- Service de Consultations et Traitements Dentaires, Hospices Civils de Lyon, Lyon, France
- Laboratoire de Biologie Tissulaire et Ingénierie Thérapeutique, UMR 5305, Lyon, France
| | - Cyril Villat
- Faculté d'Odontologie, Université Claude Bernard Lyon 1, Lyon, France
- Service de Consultations et Traitements Dentaires, Hospices Civils de Lyon, Lyon, France
- Laboratoire des Multimatériaux et Interfaces, UMR 5615, Lyon, France
| | - Julie Santamaria
- Service de Consultations et Traitements Dentaires, Hospices Civils de Lyon, Lyon, France
| | - Raphaël Richert
- Faculté d'Odontologie, Université Claude Bernard Lyon 1, Lyon, France
- Service de Consultations et Traitements Dentaires, Hospices Civils de Lyon, Lyon, France
- Laboratoire de mécanique des Contacts et des Structures, UMR 5259, Lyon, France
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Ninkovic N, Opacic Galic V, Milosevic M, Trajkovic I, Kuzmanovic Pficer J, Bajuk-Bogdanović D, Milovanovic P, Yashin El-Bacha D, Djuric M, Miletic V. Effects of minimally invasive endodontic access cavity in molar teeth on polymerization, porosity and fracture resistance. Sci Rep 2024; 14:21635. [PMID: 39285200 PMCID: PMC11405530 DOI: 10.1038/s41598-024-72643-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 09/09/2024] [Indexed: 09/20/2024] Open
Abstract
Minimally invasive access cavities have been proposed in the last decade to reduce tooth tissue loss during endodontic treatment and mitigate compromised fracture resistance of endodontically treated teeth. Fracture resistance of molars with different types of access cavity design may be affected by restorative materials and aging. Insufficient literature data exist on the effect of cavity design and type of restorative materials on restorative aspects such as material adaptation or photo-polymerization in restricted access cavities. This study analyses quality of polymerization, material adaptation and fracture resistance of molars with different types of access cavities restored with glass-ionomer, high-viscosity fiber-reinforced bulk-fill and nanofilled resin composite. Plastic molar teeth with truss (TREC) and traditional endodontic access cavity (TEC) were restored with nanofilled composite (Filtek Supreme), glass-ionomer Fuji IX and Filtek or fiber-reinforced everX Posterior and Filtek. Porosity was determined using microcomputer tomography and the degree of conversion of resin-based materals using micro-Raman spectroscopy. Human molars prepared and restored in the same way were used for fracture resistance testing at baseline and after thermocycling. The results demonstrate that high-viscosity fiber-reinforced composite was difficult to adapt in TREC cavity leading to greater porosity than Filtek or Fuji. TREC design did not affect composite polymerization and led to higher fracture resistance of restored molars compared to TEC but also more unrestorable fractures.
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Grants
- 451-03-47/2024-01/200213, 451-03-66/2024-03/200146 Ministry of Education, Science and Technological Development of the Republic of Serbia
- 451-03-47/2024-01/200213, 451-03-66/2024-03/200146 Ministry of Education, Science and Technological Development of the Republic of Serbia
- 451-03-47/2024-01/200213, 451-03-66/2024-03/200146 Ministry of Education, Science and Technological Development of the Republic of Serbia
- 451-03-47/2024-01/200213, 451-03-66/2024-03/200146 Ministry of Education, Science and Technological Development of the Republic of Serbia
- 451-03-47/2024-01/200213, 451-03-66/2024-03/200146 Ministry of Education, Science and Technological Development of the Republic of Serbia
- project BoFraM Science Fund of the Republic of Serbia
- project BoFraM Science Fund of the Republic of Serbia
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Affiliation(s)
- Neda Ninkovic
- School of Dental Medicine, Department for Restorative Dentistry and Endodontics, University of Belgrade, Rankeova 4, Belgrade, 11000, Serbia
| | - Vanja Opacic Galic
- School of Dental Medicine, Department for Restorative Dentistry and Endodontics, University of Belgrade, Rankeova 4, Belgrade, 11000, Serbia
| | - Milos Milosevic
- Innovation Centre of Faculty of Mechanical Engineering in Belgrade, Kraljice Marije 16, Belgrade, 11141, Serbia
| | - Isaak Trajkovic
- Innovation Centre of Faculty of Mechanical Engineering in Belgrade, Kraljice Marije 16, Belgrade, 11141, Serbia
| | - Jovana Kuzmanovic Pficer
- School of Dental Medicine, Department for Medical Statistics and Informatics, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia
| | - Danica Bajuk-Bogdanović
- Faculty of Physical Chemistry, University of Belgrade, Studentski trg 12-16, Belgrade, 11158, Serbia
| | - Petar Milovanovic
- Center of Bone Biology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, Dr. Subotica no. 4/II, Belgrade, 11000, Serbia
| | - Dilara Yashin El-Bacha
- Faculty of Medicine and Health, Sydney Dental School, The University of Sydney, 2 Chalmers Street, Surry Hills NSW, 2010, Australia
| | - Marija Djuric
- Center of Bone Biology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, Dr. Subotica no. 4/II, Belgrade, 11000, Serbia
| | - Vesna Miletic
- Faculty of Medicine and Health, Sydney Dental School, The University of Sydney, 2 Chalmers Street, Surry Hills NSW, 2010, Australia.
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Peters OA, Rossi-Fedele G, George R, Kumar K, Timmerman A, Wright PP. Guidelines for non-surgical root canal treatment. AUST ENDOD J 2024; 50:202-214. [PMID: 38864671 DOI: 10.1111/aej.12848] [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: 03/25/2024] [Accepted: 04/04/2024] [Indexed: 06/13/2024]
Abstract
Guidelines were developed by the Australian Society of Endodontology Inc. with the intent to describe relevant aspects of contemporary evidence-based root canal treatment. The document aims to support clinicians by describing a Standard of Practice in the Australian context. The presented guidelines refer to Competence criteria and Quality standards for the main steps in root canal treatment. While the intent is not to replace individual clinical decision-making, it is envisaged that these periodically reviewable guidelines may help to improve clinical outcomes.
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Affiliation(s)
- Ove A Peters
- The University of Queensland, Brisbane, Queensland, Australia
| | | | - Roy George
- Griffith University, Gold Coast, Queensland, Australia
| | - Kiran Kumar
- The University of Queensland, Brisbane, Queensland, Australia
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Baabdullah FH, Elsherief SM, Hawsawi RA, Redwan HS. The Impact of Minimum Invasive Access Cavity Design on the Quality of Instrumentation of Root Canals of Maxillary Molars Using Cone-Beam Computed Tomography: An in Vitro Study. Cureus 2024; 16:e67705. [PMID: 39318923 PMCID: PMC11420695 DOI: 10.7759/cureus.67705] [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] [Accepted: 08/22/2024] [Indexed: 09/26/2024] Open
Abstract
Aim Minimally invasive dentistry has been facilitated by advances in instruments and restorative materials. This study aims to compare the change in the shaping ability of the RECIPROC blue rotary system in both traditional and conservative access cavities, using cone beam computed tomography (CBCT). Material and methods Sixty root canals of 20 artificial maxillary molars were assigned into two groups (n=30 root canals) according to the access cavity design used: Group I: traditional access cavity (TAC) and Group II: conservative access cavity (CAC). CBCT scans of samples were made before and after root canal preparation using the RECIPROC blue rotary system. The shaping parameters are evaluated in root canal transportation and the centering ability. Three CBCT sections per tooth were analyzed at 3, 6, and 9 mm from the apex to assess the canal transportation and centering ability at three levels, apical, middle, and coronal thirds. Data were analyzed using the GraphPad Prism (GraphPad Software, San Diego, CA). Results The results of this study showed a significant difference in transportation within the coronal and middle thirds. However, in apical thirds, there were no significant differences. Both groups observed a significant difference in the centering ability in the coronal third. Conclusion Within the limitations of this study, CAC can be recommended with caution as an alternative access to TAC.
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Affiliation(s)
- Fahad H Baabdullah
- Basic and Clinical Oral Sciences, Faculty of Dental Medicine, Umm Al-Qura University, Makkah, SAU
| | - Samia M Elsherief
- Restorative Dentistry, Faculty of Dental Medicine, Umm Al-Qura University, Makkah, SAU
- Endodontics, Cairo University, Cairo, EGY
| | - Rayan A Hawsawi
- Restorative Dentistry, Faculty of Dental Medicine, Umm Al-Qura University, Makkah, SAU
| | - Hetaf S Redwan
- Restorative Dentistry, Faculty of Dental Medicine, Umm Al-Qura University, Makkah, SAU
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Khare MV, Sivarajan RK, Venkatesh V. Comparative Evaluation of Three Access Cavity Preparation Techniques on Root Canal Instrumentation Using Micro-CT: An In Vitro Study. Cureus 2024; 16:e66424. [PMID: 39246971 PMCID: PMC11380629 DOI: 10.7759/cureus.66424] [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: 07/20/2024] [Accepted: 08/08/2024] [Indexed: 09/10/2024] Open
Abstract
Background Access cavity preparation is a crucial step in nonsurgical root canal treatment. Recent advancements in access cavity designs focus on preserving maximum tooth structure while ensuring sufficient access to canal orifices for effective cleaning and shaping, resulting in minimally invasive procedures. However, there is limited information on the impact of three-dimensional (3D)-guided access cavity preparation in molars. A literature review found no prior studies comparing the effects of various access cavity preparation techniques on apical transportation, untouched surfaces, and debris formation within the canal. Objective The objective of this study is to compare and evaluate the effects of three different access cavity techniques on apical transportation, untouched surfaces, and debris formation within the root canal. Material and methods Thirty extracted permanent mandibular first molars were selected and randomly assigned to three groups for this study: Group I received 3D-printed static guided cavity preparation, Group II underwent conservative access cavity preparation, and Group III was subjected to traditional access cavity (TAC) preparation. The mesial canals in all samples were cleaned and shaped using TruNatomy files. Preoperative and postoperative micro-CT imaging was performed on each sample to assess the effects of the different access cavity preparation techniques on apical transportation, untouched surfaces, and debris formation within the root canal. Results The study found that Group I, which used 3D-printed static guided cavity preparation, exhibited significantly less apical transportation compared to Groups II and III, with mean differences of -0.1677 and -0.2079, respectively. Debris accumulation was similar across all groups, with mean values of 0.928 ± 0.824 for Group I, 0.751 ± 0.495 for Group II, and 0.938 ± 0.681 for Group III, indicating no significant impact of cavity preparation type on debris levels. For untouched canal surfaces, Group III (TAC preparation) had the fewest untouched surfaces, with mean differences of 3.0380 and 3.9020 compared to Groups II and I, respectively. Conclusions While TAC preparation reduces substantial tooth structure, it shows higher instrumentation efficacy and better cleaning of the root canal system. However, in complex cases where tooth structure preservation is crucial, guided access cavity preparation provides an effective balance between structural conservation and adequate canal access. This approach offers a tailored solution, optimizing treatment outcomes based on the specific clinical scenario.
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Affiliation(s)
- Mrunmayee V Khare
- Department of Conservative Dentistry and Endodontics, Sri Ramaswamy Memorial (SRM) Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology (SRMIST), Chennai, IND
| | - Ranjith Kumar Sivarajan
- Department of Conservative Dentistry and Endodontics, Sri Ramaswamy Memorial (SRM) Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology (SRMIST), Chennai, IND
| | - Vijay Venkatesh
- Department of Conservative Dentistry and Endodontics, Sri Ramaswamy Memorial (SRM) Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology (SRMIST), Chennai, IND
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7
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Liu Y, Huang X, Ke H, Song X, Huang X, Sun S. Influence of Access Cavities on Maxillary Central Incisor Fracture Resistance: Finite Element Study. Int Dent J 2024:S0020-6539(24)00121-7. [PMID: 38692963 DOI: 10.1016/j.identj.2024.04.017] [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: 01/18/2024] [Revised: 03/26/2024] [Accepted: 04/08/2024] [Indexed: 05/03/2024] Open
Abstract
INTRODUCTION AND AIMS Altering the position and orientation of the root canal access cavity passway, or modifying the reduction of dentin volume, can influence the strength of dentition. This study aimed to compare the effects of different access cavities on the biomechanical performances of maxillary central incisors with a finite element analysis. METHODS Based on the micro-computed tomography (CT) scan of a maxillary central incisor, the finite element models of the intact tooth and teeth with 4 access cavity designs: conservative incisal access cavity, incisal access cavity, conservative access cavity, and traditional access cavity were generated. Simulated occlusal forces were applied at the incisal edge of the incisor in the finite element analysis procedure. RESULTS The maximum von Mises stress and maximum principal stress in the cervical area are highest in the traditional access cavity group, followed by the conservative access cavity group, incisal access cavity group, and conservative incisal access cavity group. CONCLUSION The conservative access cavities minimise the extent of dentin removal from the cervical region, protecting the mechanical behaviour of the incisor. Moving the access cavity entry point to the incisal edge also improves the fracture resistance of the incisor. CLINICAL RELEVANCE This study's findings would help clinicians select the most appropriate endodontics access cavity method when performing the root canal on maxillary central incisors.
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Affiliation(s)
- Yujiang Liu
- Hospital of Stomatology, Jilin University, Changchun, PR China
| | - Xinyao Huang
- Hospital of Stomatology, Jilin University, Changchun, PR China
| | - Haoyu Ke
- Hospital of Stomatology, Jilin University, Changchun, PR China
| | - Xinyi Song
- Hospital of Stomatology, Jilin University, Changchun, PR China
| | - Xinmeng Huang
- Hospital of Stomatology, Jilin University, Changchun, PR China
| | - Shufen Sun
- Hospital of Stomatology, Jilin University, Changchun, PR China.
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Al-Ani AM, Ali AH, Koller G. Assessment of Bacterial Load and Post-Endodontic Pain after One-Visit Root Canal Treatment Using Two Types of Endodontic Access Openings: A Randomized Controlled Clinical Trial. Dent J (Basel) 2024; 12:88. [PMID: 38668000 PMCID: PMC11049031 DOI: 10.3390/dj12040088] [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: 02/27/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024] Open
Abstract
The need for controlling bacteria and pain during root canal therapy is undeniable. This clinical trial aimed to assess whether there is a difference in colony-forming unit (CFU) reduction after instrumentation and post-endodontic pain after root canal treatment (RCT) using a traditional endodontic cavity (TEC) versus a conservative endodontic cavity (CEC). This clinical study was conducted on 89 patients designated for a single-visit RCT. Patients were allocated randomly (TEC n = 45 and CEC n = 44). The access opening was gained accordingly in each group by a single operator. A pre-instrumentation sample of root canal dentin was collected using an endodontic file; the second sample was collected similarly, right after shaping and cleaning the root canal. The CFU was calculated based on the samples collected. The pain level was recorded preoperatively and at 1, 7, and 21 days postoperatively utilizing a visual analog scale (VAS). There were no statistically significant differences in the CFU reduction between the TEC and CEC groups (p > 0.05). Additionally, there were no statistically significant differences found in postoperative pain levels between the TEC and CEC at 1, 7, and 21 days (p > 0.05). Despite the limitations of this study, both the CEC and TEC demonstrate a decrease in bacteria within the root canals and alleviate postoperative pain with no difference between them.
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Affiliation(s)
- Ahmed M. Al-Ani
- Aesthetic and Restorative Dentistry Department, College of Dentistry, University of Baghdad, Baghdad 10071, Iraq;
| | - Ahmed H. Ali
- Aesthetic and Restorative Dentistry Department, College of Dentistry, University of Baghdad, Baghdad 10071, Iraq;
| | - Garrit Koller
- Conservative and MI Dentistry (Including Endodontics), King’s College London Dental Institute at Guy’s Hospital, King’s Health Partners, London SE1 9RT, UK;
- Centre for Oral, Clinical and Translational Sciences, Faculty of Dentistry, Oral and Craniofacial Sciences, King’s College London, London WC2R 2LS, UK
- London Centre for Nanotechnology, London WC1H 0AH, UK
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9
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Elhakim A, Hwang J, Kim S, Kim E, Kang S. Three-dimensional accuracy of endodontic access preparations using novel nonrestrictive static guides: A laboratory study. AUST ENDOD J 2023; 49:631-640. [PMID: 37697890 DOI: 10.1111/aej.12792] [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: 11/30/2022] [Revised: 06/22/2023] [Accepted: 08/13/2023] [Indexed: 09/13/2023]
Abstract
This study compared the accuracy of traditional endodontic access to conservative access cavities prepared with or without novel nonrestrictive endodontic access guides by operators with different levels of clinical experience without visual aids, using a three-dimensional volumetric accuracy analysis method. The accuracy of the preparations was analysed using a novel 3D volumetric analysis by calculating the intersection and volume of the actual cavities to the planned model cavities. The experienced operator significantly outperformed the inexperienced operator in the free hand groups, while accuracy of conservative access cavities prepared using the novel guides were comparable and significantly higher than the other groups (p < 0.05). The results demonstrated clinical experience enhanced endodontic preparations accuracy and that nonrestrictive guides achieve accurate conservative access cavities which are independent of the operator skill level. Additionally, the three-dimensional volumetric analysis is a consistent and objective method to judge the accuracy of guided endodontic techniques.
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Affiliation(s)
- Ahmed Elhakim
- Department of Endodontics, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
- Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, Korea
| | - Junghwan Hwang
- Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, Korea
| | - Sunil Kim
- Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, Korea
| | - Euiseong Kim
- Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, Korea
| | - Sumi Kang
- Department of Dental Education, College of Dentistry, Yonsei University, Seoul, Korea
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Usta SN, Silva EJNL, Falakaloğlu S, Gündoğar M. Does minimally invasive canal preparation provide higher fracture resistance of endodontically treated teeth? A systematic review of in vitro studies. Restor Dent Endod 2023; 48:e34. [PMID: 38053776 PMCID: PMC10695733 DOI: 10.5395/rde.2023.48.e34] [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: 07/24/2023] [Revised: 08/17/2023] [Accepted: 08/27/2023] [Indexed: 12/07/2023] Open
Abstract
This systematic review aimed to investigate whether minimally invasive root canal preparation ensures higher fracture resistance compared to conventional root canal preparation in endodontically treated teeth (ETT). A comprehensive search strategy was conducted on the "PubMed, Web of Science, and Scopus" databases, alongside reference and hand searches, with language restrictions applied. Two independent reviews selected pertinent laboratory studies that explored the effect of minimally invasive root canal preparation on fracture resistance, in comparison to larger preparation counterparts. The quality of the studies was assessed, and the risk of bias was categorized as low, moderate, or high. The electronic search yielded a total of 1,767 articles. After applying eligibility criteria, 8 studies were included. Given the low methodological quality of these studies and the large variability of fracture resistance values, the impact of reduced apical size and/or taper on the fracture resistance of the ETT can be considered uncertain. This systematic review could not reveal sufficient evidence regarding the effect of minimally invasive preparation on increasing fracture resistance of ETT, primarily due to the inherent limitations of the studies and the moderate risk of bias.
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Affiliation(s)
- Sıla Nur Usta
- Department of Endodontics, Gulhane Faculty of Dentistry, University of Health Sciences, Ankara, Turkey
| | | | - Seda Falakaloğlu
- Department of Endodontics, Faculty of Dentistry, Istanbul Health and Technology University, Istanbul, Turkey
| | - Mustafa Gündoğar
- Department of Endodontics, Faculty of Dentistry, University of Medipol, İstanbul, Turkey
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11
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Ahmed HMA, El-Karim I, Duncan HF, Krastl G, Galler K. Implications of root, pulp chamber, and canal anatomy on pulpotomy and revitalization procedures. Clin Oral Investig 2023; 27:6357-6369. [PMID: 37870593 DOI: 10.1007/s00784-023-05284-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 09/26/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVES This review aims to discuss the implications of anatomy of the root, pulp chamber, and canals on pulpotomy and revitalization procedures (RPs) as treatment alternatives to root canal treatment procedures. METHODS This narrative review was undertaken to address two main questions - why remove vital pulp tissue in teeth with complex canal anatomy when it can be preserved? And why replace the necrotic pulp in teeth with mature roots with a synthetic material when we can revitalize? This review also aims to discuss anatomical challenges with pulpotomy and revitalization procedures. RESULTS Maintaining the vitality of the pulp via partial or full pulpotomy procedures avoids the multiple potential challenges faced by clinicians during root canal treatment. However, carrying out pulpotomy procedures requires a meticulous understanding of the pulp chamber anatomy, which varies from tooth to tooth. Literature shows an increased interest in the application of RPs in teeth with mature roots; however, to date, the relation between the complexity of the root canal system and outcomes of RPs in necrotic multi-rooted teeth with mature roots is unclear and requires further robust comparative research and long-term follow-up. CONCLUSIONS Whenever indicated, pulpotomy procedures are viable treatment options for vital teeth with mature roots; however, comparative, adequately powered studies with long-term follow-up are needed as a priority in this area. RPs show promising outcomes for necrotic teeth with mature roots that warrant more evidence in different tooth types with long-term follow-ups. CLINICAL RELEVANCE: Clinicians should be aware of the pulp chamber anatomy, which is subject to morphological changes by age or as a defensive mechanism against microbial irritation, before practicing partial and full pulpotomy procedures. RP is a promising treatment option for teeth with immature roots, but more evidence is needed for its applications in teeth with mature roots. A universal consensus and considerably more robust evidence are needed for the standardization of RPs in teeth with mature roots.
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Affiliation(s)
- Hany Mohamed Aly Ahmed
- Department of Restorative Dentistry, Faculty of Dentistry, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Ikhlas El-Karim
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
| | - Henry F Duncan
- Division of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland
| | - Gabriel Krastl
- Department of Conservative Dentistry and Periodontology, Center of Dental, Traumatology University Hospital of Würzburg Pleicherwall, 2, 97070, Würzburg, Germany
| | - Kerstin Galler
- Department of Restorative Dentistry and Periodontology, University Hospital Erlangen, Erlangen, Germany
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Easwaran HN, Swaminathan K, Haridoss S, Muthu M, Jayakumar P. Comparison of conventional preparation with modified access preparation on fracture resistance of primary molars - A finite element analysis. J Oral Biol Craniofac Res 2023; 13:663-670. [PMID: 37706175 PMCID: PMC10495646 DOI: 10.1016/j.jobcr.2023.08.010] [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: 04/26/2023] [Revised: 07/12/2023] [Accepted: 08/30/2023] [Indexed: 09/15/2023] Open
Abstract
Objective To investigate the influence of Conventional Straight (CS) line and Modified Straight (MS) line access preparations with various restorative materials on the fracture resistance of primary molars using Finite Element Analysis (FEA). Methodology Three FEA models for each of the primary molars were divided into Group I- Intact tooth model; Group II- Model with CS outline and Group III- Model with MS outline. Based on the restorative material used, Group II and III were further subdivided into subgroup 1- GIC restoration, subgroup 2 - composite resin with GIC base and subgroup 3- Stainless Steel Crown (SSC). Each model was subjected to 5 different force loads directed at the occlusal surface. Maximal von Mises (VM) stresses calculated from stress distribution patterns. Result The maximum displacement, in all the models of primary molars were seen in GIC restored models in molars with both CS and MS access whereas the minimal displacement was seen in the SSC restored molars of MS group. Conclusion In primary maxillary second molar and mandibular first and second molar with intact marginal ridges, the fracture resistance of tooth with MS outline restored with GIC base followed by Composite resin was comparable with the tooth restored with SSC and CS outline. Clinical outcome Based on the results of this FEA analysis, composite restorations with MS outline would be appropriate for endodontically treated primary molars that have intact margins.
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Affiliation(s)
- Harshini Nivetha Easwaran
- Department of Pediatric and Preventive Dentistry, Sri Ramachandra Dental College and Hospital, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Kavitha Swaminathan
- Department of Pediatric and Preventive Dentistry, Sri Ramachandra Dental College and Hospital, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Selvakumar Haridoss
- Department of Pediatric and Preventive Dentistry, Sri Ramachandra Dental College and Hospital, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - M.S. Muthu
- Centre for Early Childhood Caries Research, Department of Pediatric and Preventive Dentistry, Sri Ramachandra Dental College and Hospital, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
| | - Priya Jayakumar
- Department of Pediatric and Preventive Dentistry, Sri Ramachandra Dental College and Hospital, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
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Shirani F, saatchi M, Shirani M, Jafari N. Evaluation of the Fracture Resistance of Conservative and Ultraconservative Access Cavity Designs with Different Treatment Modalities: An In Vitro Study. BIOMED RESEARCH INTERNATIONAL 2023; 2023:7247375. [PMID: 37483655 PMCID: PMC10359140 DOI: 10.1155/2023/7247375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 10/27/2022] [Accepted: 06/09/2023] [Indexed: 07/25/2023]
Abstract
Introduction The aim of this study was to evaluate the fracture resistance of endodontically treated mandibular molars using traditional and conservative access cavity preparation. Materials and Methods In this in vitro study, 100 extracted healthy human mandibular molars were selected and divided into 10 groups (n = 10). Healthy teeth in one group were considered the control group. In three groups, traditional access cavity preparation was done (groups A) without two marginal ridges (A1), with one marginal ridge (A2), and with two marginal ridges (A3). In three groups (group B), two separate access cavities with a dentinoenamel roof without two marginal ridges (B1), with one marginal ridge (B2), and with two marginal ridges (B3) were prepared. In three other groups (groups C), two separate access cavities were prepared only with a dentinal roof without two marginal ridges (C1), with one marginal ridge (C2), and with two marginal ridges (C3), on which root canal treatment was performed afterward. Then, these teeth were subjected to force until fracture. The fracture force and fracture mode of each tooth were recorded and compared between groups by ANOVA, Tukey's post hoc, and chi-square tests using SPSS ver. 23 (IBM, Somers, NJ, USA). Results The control teeth had the highest mean fracture force (2804.5 ± 338.5 N), followed by a conservative access cavity with a dentinoenamel roof and two marginal ridges (2360.4 ± 181.72 N) and a conservative access cavity with a dentinoenamel roof and one marginal ridge (1812.8 ± 263.9 N), respectively. The lowest mean fracture force was found for the conventional access cavity group without two marginal ridges (399.4 ± 95.2 N). Conclusion In the condition of this study, with two separate access cavities in mandibular molars and maintenance of the marginal ridges, it is possible to provide teeth with higher fracture resistance against occlusal forces.
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Affiliation(s)
- Farzaneh Shirani
- Department of Restorative Dentistry, Dental Research Centre, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoud saatchi
- Dental Research Centre, Department of Endodontics, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehrangiz Shirani
- School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Niloufar Jafari
- Department of Restorative Dentistry, School of Dentistry, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
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Gündüz H, Özlek E. The effects of laser and ultrasonic irrigation activation methods on smear and debris removal in traditional and conservative endodontic access cavities. Lasers Med Sci 2023; 38:148. [PMID: 37358660 DOI: 10.1007/s10103-023-03816-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 06/17/2023] [Indexed: 06/27/2023]
Abstract
In this study, it was aimed to evaluate the smear and debris removal efficiency of laser and ultrasonic irrigation activation methods in traditional and conservative endodontic access cavity preparations. 60 freshly extracted human mandibular molar teeth were randomly divided into 2 groups according to the access cavity preparation (n = 30): Traditional endodontic access cavities (TEC) and Conservative endodontic access cavity (CEC). After the access cavity preparation, the mesiobuccal root canals were prepared to 35/0.4 with the VDW Rotate file system. Teeth with completed root canal preparation were randomly divided into 3 subgroups according to the final irrigation activation protocol (n = 30): Conventional needle irrigation, passive ultrasonic activation and laser activation. The crowns of the teeth were removed and the mesiobuccal roots were divided longitudinally into two halves, mesial and distal. Samples were scanned with scanning electron microscopy. Photomicrographs in the coronal, middle, and apical thirds of each specimen were taken at a magnification of 200 for debris and 1000 for evaluation of the smear layer. Data were analysed using the three-way Robust Anova test and Bonferroni test.The effect of access cavity design on remaining smear (p = 0.057) and debris (p = 0.5) was not statistically significant. The effect of the interaction of access cavity and irrigation activation on the remaining smear and debris was not statistically significant (p = 0.556, p = 0.333). Significantly fewer smears were detected in the laser activation group than in the ultrasonic activation and control groups. Conservative access cavities did not differ from conventional access cavities in terms of debris and smear.
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Affiliation(s)
- Hüseyin Gündüz
- Department of Endodontics, Faculty of Dentistry, Van Yüzüncü Yıl University, Van, Turkey.
| | - Esin Özlek
- Department of Endodontics, Faculty of Dentistry, Van Yüzüncü Yıl University, Van, Turkey
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The effect of different endodontic access cavity designs in combination with WaveOne Gold and TruNatomy on the fracture resistance of mandibular first molars: A nonlinear finite element analysis. J Endod 2023; 49:559-566. [PMID: 36924829 DOI: 10.1016/j.joen.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 03/17/2023]
Abstract
INTRODUCTION This study evaluated the effect of traditional and conservative endodontic access cavity designs in combination with WaveOne Gold and TruNatomy instrumentation systems on the fracture resistance of mandibular first molars by means of nonlinear finite element analysis (FEA). METHODS Micro-CT images of 4 human mandibular first molars were used to generate representative FEA models. The mandibular first molars samples were scanned before and after endodontic access cavity preparation and instrumentation of all 3 canals. Five nonlinear static loads were applied vertically and horizontally to specific contact points on the occlusal surface of the teeth. Maximum von Mises stress before failure and distribution of von Mises strains were recorded and compared between groups. RESULTS Molars with conservative endodontic access cavities required similar levels of loads to reach failure compared with their control samples, whereas molars with traditional endodontic access cavities required significantly reduced loads in order to fail. According to the numerical investigation, the type of instrumentation system was found to have an insignificant effect on the fracture resistance of the teeth under study. Von Mises stress was concentrated around the cervical region and in the larger distal roots for all numerical models. CONCLUSIONS The fracture resistance of mandibular first molars is influenced significantly by a reduction in dental hard tissue, which was found to control the level of the ultimate failure load for each tooth.
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Aazzouzi-Raiss K, Ramírez-Muñoz A, Mendez S PM, Vieira GCS, Aranguren J, Pérez AR. Effects of Conservative Access and Apical Enlargement on Shaping and Dentin Preservation with Traditional and Modern Instruments: A Micro-computed Tomographic Study. J Endod 2023; 49:430-437. [PMID: 36646164 DOI: 10.1016/j.joen.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/17/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
INTRODUCTION This ex vivo study aimed to evaluate the shaping abilities and preservation of dentin with traditional and modern instruments after using sizes 25 and 40 in oval canals of mandibular incisors with conservative access. METHOD Thirty mandibular incisors with single straight oval canals were selected and assigned into 2 groups (n = 15) according to the instrument system used during preparation, Slim Shaper (SS) plus Apical Shaper (AS) and Protaper Gold (PG). The samples were subjected to micro-computed tomography before and after preparation with sizes 25 and 40. The shaping parameters evaluated included canal volume and surface area, amount of unprepared root canal walls, and reduction in pericervical dentin. RESULTS Canal volume and surface area were significantly increased after enlargement with each instrument size (P < .01). The percentage of unprepared areas showed a significant intragroup decrease after using PG F2 and F4 or SS 3 and AS (P < .05). Intergroup comparison showed no significant differences. Pericervical dentin was reduced in all groups. The intragroup comparison only revealed a significant reduction (P < .01) between PG F2 and F4. In addition, a significant decrease in pericervical dentin (P < .05) was observed between PG F4 40/.06 and AS 40/.03. No significant differences were observed between PG F2 25/.08 and SS 3 25/.04. CONCLUSION Increasing the instrumentation size from 25 to 40 significantly reduces the percentage of unprepared areas regardless of the system used. In addition, using a modern system with a regressive taper allows the maintenance of pericervical dentin without compromising shaping efficacy in the apical third of the mandibular incisors with oval canals and conservative access.
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Affiliation(s)
| | - Ana Ramírez-Muñoz
- Department of Endodontics, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | | | | | - José Aranguren
- Department of Endodontics, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Alejandro R Pérez
- Department of Endodontics, Rey Juan Carlos University, Alcorcón, Madrid, Spain; Private Practice in Porto, Porto, Portugal.
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Motiwala MA, Gul M, Ghafoor R. Effect of different access cavity designs on fracture toughness of endodontically treated teeth: a systematic review and network meta-analysis. Evid Based Dent 2022:10.1038/s41432-022-0827-9. [PMID: 36460797 DOI: 10.1038/s41432-022-0827-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 11/24/2021] [Indexed: 06/17/2023]
Abstract
Objective To compare the effect of different endodontic access cavities on fracture toughness of extracted endodontically treated human teeth.Data/sources An electronic literature search was performed in seven databases as well as hand search until September 2020. Risk-of-bias tool was used to evaluate the quality of included studies. Random effects frequentist network meta-analysis was performed, with mean difference (MD) and 95% confidence interval (CI) as the effect measure. Confidence in the documented evidence was assessed through the newly fuelled Confidence in Network Meta-analysis (CINeMA) framework based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.Study selection A total of 844 articles were obtained in the electronic and hand search. After the application of the eligibility criteria and duplicate removal, 14 studies were included in this systematic review. All included studies were in vitro that evaluated the influence of conservative endodontic cavities (CECs) on fracture toughness in extracted endodontically treated human teeth and compared to traditional endodontic cavities (TECs). In total, ten studies (n = 456) were included in the network meta-analysis for molars. The overall risk of bias was moderate.Results The results showed that when compared to intact teeth, the greatest reduction in fracture resistance was reported for TEC (MD: -927.52; 95% CI [-1304.80; -550.24]) and CEC showed least reduction in fracture resistance (MD: -365.59; 95% CI [-759.02; 27.83]). The surface under the cumulative ranking curve (SUCRA) value for intact teeth was highest (85.4% probability of being ranked as first), followed by CEC (51.4% probability of being ranked as second), with CEC presenting the highest probabilities to be the most effective access cavity design, according to the RANK (receptor activator of NF-kappaB) table. Level of confidence varied from low to moderate across all formulated comparisons.Conclusion Overall, based on the included in vitro studies in this systematic review, CEC was the most favourable access cavity design when compared to other (truss access cavities, TEC and ninja cavities) and TEC was the least favourable for fracture resistance; however, the level of evidence was moderate.
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Affiliation(s)
- Momina A Motiwala
- Resident, Operative Dentistry, Aga Khan University Hospital, Karachi, Pakistan
| | - Meisha Gul
- Assistant Professor, Operative Dentistry, Bahria University Health Sciences, Karachi, Pakistan
| | - Robia Ghafoor
- Operative Dentistry Assistant Professor, Section of Dentistry, Aga Khan University Hospital, Karachi, Pakistan.
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Vorster M, van der Vyfer PJ, Markou G. The effect of different access cavity designs in combination with WaveOne Gold and TruNatomy instrumentation on remaining dentin thickness and volume. J Endod 2022; 49:83-88. [DOI: 10.1016/j.joen.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/24/2022] [Accepted: 11/02/2022] [Indexed: 11/13/2022]
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Wang M, Gao Y, Deng Q, Gao Y, Song D, Huang D. Assessment of the coronal root canal morphology of permanent maxillary first molars using digital 3D-reconstruction technology based on micro-computed tomography data. J Dent Sci 2022; 18:586-593. [PMID: 37021262 PMCID: PMC10068546 DOI: 10.1016/j.jds.2022.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/13/2022] [Indexed: 11/17/2022] Open
Abstract
Background The design of minimally invasive access has become a hotspot. This study aimed to evaluate the coronal root canal morphology of permanent maxillary first molars to facilitate the design of endodontic access cavities for minimally invasive linear access. Materials and methods A selection of 91 permanent maxillary first molars was evaluated. Three-dimensional tooth models were reconstructed using micro-computed tomography data. Root canal prevalence and coronal root canal landmarks were recorded. The positional coordinates of landmarks in the horizontal plane and the angles and directions of coronal root canal curvature in the horizontal and axial planes were also assessed. Results The detection rates of the mesiobuccal (MB), distobuccal (DB), and palatal (P) canals were 100%, whereas that of the second mesiobuccal (MB2) canals was 68.1%. All landmarks were located near the central fossa. In the axial plane, the average angles of coronal root canal curvature were DB (27.05°) > MB (25.43°) > P (20.71°) in teeth with three canals, and MB2 (33.20°) > MB (29.61°) > DB (28.40°) > P (23.69°) in teeth with four canals. In the horizontal plane, the average angles were P (78.15°) > DB (42.34°) > MB (32.41°) in teeth with three canals, and P (81.26°) > DB (43.44°) > MB (41.22°) > MB2 (9.41°) in teeth with four canals. Conclusion In maxillary first molars, coronal root canals tend to converge towards the occlusal surface. The results of this study could be applied to improve the precision of endodontic access cavity designs of minimally invasive access.
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Affiliation(s)
- Mudan Wang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Conservative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yuxuan Gao
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Conservative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Qi Deng
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Conservative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yuan Gao
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Conservative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Dongzhe Song
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Conservative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Corresponding author.
| | - Dingming Huang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Conservative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Corresponding author.
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Shroff M, Kishan KV, Shah N, Saklecha P. Impact of contracted endodontic cavities on instrumentation efficacy-A systematic review. AUST ENDOD J 2022; 49:202-212. [PMID: 36029227 DOI: 10.1111/aej.12679] [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: 05/08/2022] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 11/29/2022]
Abstract
The aim of the present systematic review was to summarise and evaluate the studies comparing the role of contracted endodontic cavities (CECs) and traditional endodontic cavities (TECs) in terms of instrumentation efficacy. The present systematic review comprised of a search of the online databases of Cochrane, PubMed, Google Scholar and grey literature. The articles which were pertaining to instrumentation efficacy in contracted and traditional endodontic cavities were selected based on the PRISMA checklist. Out of the 660 articles which were obtained, irrelevant articles were excluded and a total of 17 articles were selected for this systematic review which assessed the instrumentation efficacy. Eleven studies compared the volume of dentin removed and canal transportation ability. Four studies compared the pulp debridement, and two studies compared the anti-bacterial efficacy between the two groups. The extrusion of debris between the groups was compared by one study. Out of the 17 studies included, 11 studies proved that contracted endodontic cavities negatively impacted the instrumentation efficacy. Hence, the data suggest that the traditional endodontic access cavities have better results when comparing the instrumentation efficacy.
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Affiliation(s)
- Manan Shroff
- Department of Conservative Dentistry & Endodontics, K M Shah Dental College and Hospital, Vadodara, Gujarat, India
| | - Karkalla Venkappa Kishan
- Department of Conservative Dentistry and Endodontics, K.M.Shah Dental College, Vadodara, Gujarat, India
| | - Nimisha Shah
- Department of Conservative Dentistry and Endodontics, K.M.Shah Dental College, Vadodara, Gujarat, India
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Barbosa AFA, de Lima CO, Sarmento EB, Gonçalves da Cunha G, Sassone LM, Lopes RT, da Silva EJNL. Impact of minimally invasive endodontics procedures on the development of dentinal microcracks. J Endod 2022; 48:1146-1151. [PMID: 35697303 DOI: 10.1016/j.joen.2022.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/29/2022] [Accepted: 05/26/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION To evaluate the impact of root canal preparation in teeth with ultraconservative access cavities (UltraAC) on the development of dentinal microcracks using a non-destructive longitudinal micro-CT imaging experimental model. Root canal preparation in teeth with traditional access cavities (TradAC) was used as control. METHODS Forty mandibular molars were scanned in a micro-CT device, anatomically matched, and distributed into 4 groups according to the type of access cavity and instrumentation system: traditional/Reciproc (TradAC/RC); traditional/XP-endo Shaper (TradAC/XP); ultraconservative/Reciproc (UltraAC/RC) and ultraconservative/XP-endo Shaper (UltraAC/XP). After root canal preparation, the teeth were rescanned. After reconstruction and co-registration procedures, the images were screened from the furcation level to the apex to identify the presence of dentinal microcracks. RESULTS From a total of 15340 cross-section images, 19.65% (3014 slices) had some dentinal microcrack. The qualitative analysis demonstrated the presence of some dentinal microcrack in 11%, 33%, 19%, and 15% of the images of cross-sections in TradAC/RC, TradAC/XP, UltraAC/RC, and UltraAC/XP groups, respectively. All dentinal microcracks observed after root canal preparation were already present in the corresponding images before canal instrumentation. Therefore, no new microcracks were detected, regardless of the access cavity and root canal instrumentation system. CONCLUSIONS Root canal preparation with Reciproc or XP-Endo Shaper under traditional or ultraconservative access cavities did not create dentinal microcracks in extracted mandibular molars.
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Affiliation(s)
| | | | - Estéfano Borgo Sarmento
- Departament of Endodontics, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Nuclear Engineering Program, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Luciana Moura Sassone
- Departament of Endodontics, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Ricardo Tadeu Lopes
- Department of Dentistry, Federal University of Juiz de Fora, Governador Valadares, MG, Brasil
| | - Emmanuel João Nogueira Leal da Silva
- Departament of Endodontics, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Departament of Endodontics, Grande Rio University (UNIGRANRIO), Rio de Janeiro, RJ, Brazil.
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Rahbani Nobar B, Dianat O, Rahbani Nobar B, Kazem M, Hicks ML. Influence of minimally invasive access cavities on load capacity of root‐canal‐treated teeth: A systematic review and meta‐analysis. AUST ENDOD J 2022; 49:213-236. [PMID: 35665985 DOI: 10.1111/aej.12640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 01/20/2022] [Accepted: 05/15/2022] [Indexed: 11/30/2022]
Abstract
This systematic review (PROSPERO-CRD42020147333) aimed to compare the effects of conservative, ultraconservative and truss access cavities with traditional access cavities on the load capacity of root-canal-treated teeth. Online databases were searched until December 2021, and 25 ex vivo studies in which the effects of different access cavities on load capacity of permanent teeth had been investigated were included. Quality assessment was completed using a modified risk of bias tool for in vitro studies adapted from previous studies. Meta-analysis was performed using the maximum-likelihood-based random-effects model with similar groups. Conservative access cavities significantly improved the load capacity of maxillary premolars (p < 0.01 [-1.32, -0.028]) and molars (p < 0.05 [-0.89, -0.02]) compared to traditional access cavities. Additionally, truss access cavities significantly improved the load capacity of mandibular molars with (p < 0.05, [-1.18, -0.02]) mesio-occluso-distal cavity preparations. Higher levels of evidence are needed to determine the long-term implications of minimal preparations for treatment outcomes.
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Affiliation(s)
| | - Omid Dianat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of DentistryUniversity of MarylandBaltimoreMarylandUSA
| | - Behnam Rahbani Nobar
- Department of Endodontics, School of DentistryAlborz University of Medical SciencesKarajIran
| | - Majid Kazem
- Department of Endodontics, School of DentistryShahid Beheshti University of Medical SciencesTehranIran
| | - M. Lamar Hicks
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of DentistryUniversity of MarylandBaltimoreMarylandUSA
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Patel S, Bhuva B, Bose R. Vertical root fractures in root treated teeth-current status and future trends. Int Endod J 2022; 55 Suppl 3:804-826. [PMID: 35338655 PMCID: PMC9324143 DOI: 10.1111/iej.13737] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 11/28/2022]
Abstract
Vertical root fracture (VRF) is a common reason for the extraction of root filled teeth. The accurate diagnosis of VRF may be challenging due to the absence of clinical signs, whilst conventional radiographic assessment is often inconclusive. However, an understanding of the aetiology of VRFs, and more importantly, the key predisposing factors, is crucial in identifying teeth that may be susceptible. Thorough clinical examination with magnification and co-axial lighting is essential in identifying VRFs, and although CBCT is unable to reliably detect VRFs per se, the pattern of bone loss typically associated with VRF can be fully appreciated, and therefore, increases the probability of correct diagnosis and management. The prevalence of VRFs in root filled teeth is significantly greater than in teeth with vital pulps, demonstrating that the combination of loss of structural integrity, presence of pre-existing fractures and biochemical effects of loss of vitality, are highly relevant. Careful assessment of the occlusal scheme, presence of deflective contacts and identification of parafunctional habits is imperative in both preventing and managing VRFs. Furthermore, anatomical factors such as root canal morphology, may predispose certain teeth to VRF. The influence of access cavity design and root canal instrumentation protocols should be considered although the impact of these on the fracture resistance of root filled teeth is not clearly validated. The post-endodontic restoration of root filled teeth should be expedient and considerate to the residual tooth structure. Posts should be placed 'passively' and excessive 'post-space' preparation should be avoided. This narrative review aims to present the aetiology, potential predisposing factors, histopathology, diagnosis and management of VRF and present perspectives for future research. Currently, there are limited options other than extraction for the management of VRF, although root resection may be considered in multi-rooted teeth. Innovative techniques to 'repair' VRFs using both orthograde and surgical approaches require further research and validation. The prevention of VRFs is critical; identifying susceptible teeth, utilizing conservative endodontic procedures, together with expedient and appropriate post-endodontic restorative procedures is paramount to reducing the incidence of terminal VRFs.
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Affiliation(s)
- Shanon Patel
- Department of Endodontology, King's College London Dental Institute, London, UK.,Specialist Practice, London, UK
| | - Bhavin Bhuva
- Department of Endodontology, King's College London Dental Institute, London, UK
| | - Raul Bose
- Department of Endodontology, King's College London Dental Institute, London, UK
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Ordinola-Zapata R, Lin F, Nagarkar S, Perdigão J. A critical analysis of research methods and experimental models to study the load capacity and clinical behavior of the root filled teeth. Int Endod J 2022; 55 Suppl 2:471-494. [PMID: 35263455 PMCID: PMC9314814 DOI: 10.1111/iej.13722] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 03/04/2022] [Indexed: 12/04/2022]
Abstract
The prognosis of root‐filled teeth depends not only on a successful root canal treatment but also on the restorative prognosis. This critical review discusses the advantages and limitations of various methodologies used to assess the load capacity or clinical survivability of root‐filled teeth and restorations. These methods include static loading, cyclic loading, finite element analysis and randomized clinical trials. In vitro research is valuable for preclinical screening of new dental materials or restorative modalities. It also can assist investigators or industry to decide whether further clinical trials are justified. It is important that these models present high precision and accuracy, be reproducible, and present adequate outcomes. Although in vitro models can reduce confounding by controlling important variables, the lack of clinical validation (accuracy) is a downside that has not been properly addressed. Most importantly, many in vitro studies did not explore the mechanisms of failure and their results are limited to rank different materials or treatment modalities according to the maximum load capacity. An extensive number of randomized clinical trials have also been published in the last years. These trials have provided valuable insight on the survivability of the root‐filled tooth answering numerous clinical questions. However, trials can also be affected by the selected outcome and by intrinsic and extrinsic biases. For example, selection bias, loss to follow‐up and confounding. In the clinical scenario, hypothesis‐based studies are preferred over observational and retrospective studies. It is recommended that hypothesis‐based studies minimize error and bias during the design phase.
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Affiliation(s)
- Ronald Ordinola-Zapata
- Division of Endodontics, Department of Restorative Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Fei Lin
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology, Beijing, 100081, China.,Minnesota Dental Research Center for Biomaterials and Biomechanics, School of Dentistry, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Sanket Nagarkar
- Park Dental Group, Minneapolis, Minnesota, and Clinical Research Assistant Professor (affiliated), Department of Restorative Sciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jorge Perdigão
- Division of Operative Dentistry, Department of Restorative Sciences, University of Minnesota, Minneapolis, Minnesota, USA
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25
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Impact of Different Access Cavity Designs and Ni–Ti Files on the Elimination of Enterococcus faecalis from the Root Canal System: An In Vitro Study. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12042049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The present research aimed to reveal the in vitro effects of different endodontic file systems utilizing different endodontic access cavity designs on the elimination of Enterococcus faecalis from root canal systems. One hundred and fifty mandibular molar teeth were separated into three groups with respect to the access cavity design: traditional endodontic cavity (TEC), conservative endodontic cavity (CEC), and truss access cavity (TAC) (n = 50). After access cavity preparation, inolulation of teeth with E. faecalis was undertaken for 21 days. Following the first sampling (S1), further division of the groups into five subgroups (n = 10) was performed: ProTaper Gold, 2Shape, TruNatomy, Reciproc Blue, and WaveOne Gold. After instrumentation, bacterial sampling (S2) was performed. Bacterial reduction was evaluated in colony-forming units/mL, and statistical analysis was carried out. The E. faecalis count decreased significantly in all groups (p < 0.05). The range of mean values for a decrease in E. faecalis in log numbers was lowest in the TAC and Reciproc Blue groups, while the highest values of bacterial reduction were detected in the TEC and ProTaper Gold groups. The highest level of antibacterial action was obtained with the use of ProTaper Gold compared to the other file systems tested.
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Özdemir O, Kopac T. Cytotoxicity and biocompatibility of root canal sealers: A review on recent studies. J Appl Biomater Funct Mater 2022; 20:22808000221076325. [PMID: 35164598 DOI: 10.1177/22808000221076325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Many types of endodontic root canal sealers have been employed for the purpose of filling voids and irregularities in root canals, as well as reducing/removing bacterial remnants/remains. Sealers are available in various formulations, and research work to find the most appropriate ones is still ongoing. Recently, many kinds of novel root canal sealers have been introduced under various commercial names. However, most sealers are known to exhibit different levels of cytotoxicity on tissues which would result in prolonged wound healing, inflammation, and bone resorption. Preferably, sealers need to have tolerable biological and physico-chemical properties along with biocompatibility. Additives promoting the biocompatibility and bioactivity of sealers are of major concern in clinical applications. The aim of this review was to compare, evaluate, and analyze comparatively the cytotoxic effects, biocompatibility, and antimicrobial properties of recently used root canal sealers. A comprehensive literature search was made to identify their properties involving biocompatibility and cytotoxicity. In general, the sealers reported in recent literature exhibited favorable biological features in comparison to conventional ones. They promoted better cell viability and biocompatibility. The incorporation of additives influences favorably the potential negative effects. However, it has been highlighted that there is a lack of well-designed long-term clinical applications, and more in vitro and in vivo research work would be helpful to confirm the sustainability of the sealers for further clinical practice.
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Affiliation(s)
- Olcay Özdemir
- Department of Pedodontics, Faculty of Dentistry, Zonguldak Bülent Ecevit University, Zonguldak, Turkey.,Department of Endodontics, Faculty of Dentistry, Karabük University, Karabük, Turkey
| | - Turkan Kopac
- Department of Chemistry, Zonguldak Bülent Ecevit University, Zonguldak, Turkey
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27
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Celikten B, Koohnavard M, Oncu A, Sevimay FS, Orhan AI, Orhan K. A new perspective on minimally invasive endodontics: a systematic review. BIOTECHNOL BIOTEC EQ 2022. [DOI: 10.1080/13102818.2021.2014966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Berkan Celikten
- Department of Endodontics, Faculty of Dentistry, Ankara University, Ankara, Turkey
| | - Mehrdad Koohnavard
- Department of Endodontics, Faculty of Dentistry, Ankara University, Ankara, Turkey
| | - Aysenur Oncu
- Department of Endodontics, Faculty of Dentistry, Ankara University, Ankara, Turkey
| | - Fatma Semra Sevimay
- Department of Endodontics, Faculty of Dentistry, Ankara University, Ankara, Turkey
| | - Ayse Isil Orhan
- Department of Pediatric Dentistry, Faculty of Dentistry, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Kaan Orhan
- Department of DentoMaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara, Turkey
- Ankara University Medical Design Application and Research Center, Ankara University, Ankara, Turkey
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28
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Silva EJNL, De-Deus G, Souza EM, Belladonna FG, Cavalcante DM, Simões-Carvalho M, Versiani MA. Present status and future directions - Minimal endodontic access cavities. Int Endod J 2022; 55 Suppl 3:531-587. [PMID: 35100441 DOI: 10.1111/iej.13696] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 11/29/2022]
Abstract
In the last decades, the move of Medicine towards minimally invasive treatments is notorious and scientifically grounded. As Dentistry naturally follows its footsteps, minimal access preparation also became a trend topic in the endodontic field. This procedure aims to maximize preservation of dentine tissue, backed up by the idea that this is an effective way to reduce the incidence of post-treatment tooth fracture. However, with the assessment of the body of evidence on this topic, it is possible to observe some key-points (a) the demand for nomenclature standardization, (b) the requirement of specific tools such as ultra-flexible instruments, visual magnification, superior illumination, and three-dimensional imaging technology, (c) minimally invasive treatment does not seem to affect orifice location and mechanical preparation when using adequate armamentarium, but it (d) may impair adequate canal cleaning, disinfection, and filling procedures, and also (e) it displays contradictory results regarding the ability to increase the tooth strengthen compared to the traditional access cavity. In spite of that, it is undeniable that methodological flaws of some benchtop studies using extracted teeth may be responsible for the conflicting data, thus triggering the need for more sophisticated devices/facilities and specifically designed research in an attempt to make it clear the role of the access size/design on long-term teeth survival. Moreover, it is inevitable that a clinical approach like minimal endodontic access cavities that demands complex tools and skilled and experienced operators bring to the fore doubts on its educational impact mainly when confronted with the conflicting scientific output, ultimately provoking a cost-benefit analysis of its implementation as a routine technique. In addition, this review discusses the ongoing scientific and clinical status of minimally invasive access cavities aiming to input an in-depth and unbiased view over the rationale behind them, uncovering not only the related conceptual and scientific flaws, but also outlining future directions for research and clinical practices. The conclusions attempt to skip from passionate disputes highlighting the current body of evidence as weak and incomplete to guide decision making, demanding the development of a close-to-in-situ laboratory model or a large and well-controlled clinical trial to solve this matter.
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Affiliation(s)
- Emmanuel João Nogueira Leal Silva
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil.,Department of Endodontics, School of Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gustavo De-Deus
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Erick Miranda Souza
- Department of Dentistry II, Federal University of Maranhão, São Luís, Maranhão
| | | | | | - Marco Simões-Carvalho
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
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Three-dimensional analysis of coronal root canal morphology of 136 permanent mandibular first molars by micro-computed tomography. J Dent Sci 2022; 17:482-489. [PMID: 35028074 PMCID: PMC8740396 DOI: 10.1016/j.jds.2021.07.021] [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: 07/11/2021] [Revised: 07/25/2021] [Indexed: 02/05/2023] Open
Abstract
Background/purpose Minimally invasive endodontic approach become a research hotspot and may prevent the fracture of endodontically-treated teeth. This research aims to measure the coronal root canal morphology of permanent mandibular first molars in 3D and propose a new minimally invasive endodontic approach based on this measurement. Materials and methods Data of 136 permanent mandibular first molars were involved and reconstructed in 3D models with canals. Then, the morphology characteristics of the coronal root canal were measured. Results Overall, the distribution of root canal orifices was more centralized than other landmarks. The landmarks were located more mesiobuccally to the center of the occlusal plane of molars. Specifically, the measurements of the maximum curvature of coronal root canals in the axial direction were: in 3-canals 2-rooted teeth, the average angles of curvatures were 23°,25°,11° for mesiobuccal (MB), mesiolingual (ML) and distobuccal (DB) canals, respectively; in 4-canals 2-rooted teeth were 23°,25°,12°,16°for MB, ML, DB, and distolingual (DL) canals, respectively; in 4-canals 3-rooted teeth were 25°,27°,17°,39° for MB, ML, DB, and DL canals, respectively. The degrees of coronal root canal curvatures in the horizontal direction were: in 3-canals teeth, the average angles of curvatures were −1°,47°,-2° for MB, ML and DB canals, respectively; in 4-canals 2-rooted teeth were −4°,41°,-25°,48° for MB, ML, DB, and DL canals, respectively; in 4-canals 3-rooted teeth were −3°,33°,-43°,79° for MB, ML, DB, and DL canals, respectively. Conclusion The results of this study are similar to those previously obtained using CBCT and can help us design endodontic approaches.
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Faus-Llácer V, Pulido Ouardi D, Faus-Matoses I, Ruiz-Sánchez C, Zubizarreta-Macho Á, Ortiz AMR, Faus-Matoses V. Comparative Analysis of Root Canal Dentin Removal Capacity of Two NiTi Endodontic Reciprocating Systems for the Root Canal Treatment of Primary Molar Teeth. An In Vitro Study. J Clin Med 2022; 11:jcm11020338. [PMID: 35054032 PMCID: PMC8777590 DOI: 10.3390/jcm11020338] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 12/30/2021] [Accepted: 01/07/2022] [Indexed: 01/18/2023] Open
Abstract
The objective of the present study was to evaluate and compare the dentin removal capacity of Endogal Kids and Reciproc Blue NiTi alloy endodontic reciprocating systems for root canal treatments in primary second molar teeth via a micro-computed tomography (micro-CT) scan. Materials and Methods: Sixty root canal systems in fifteen primary second molar teeth were chosen and classified into one of the following study groups: A: EK3 Endogal Kids (n = 30) (EDG) and B. R25 Reciproc Blue (n = 30) (RB). Preoperative and postoperative micro-CT scans were uploaded into image processing software to analyze the changes in the volume of root canal dentin using a mathematical algorithm that enabled progressive differentiation between neighboring pixels after defining and segmenting the root canal systems in both micro-CT scans. Volumetric variations in the root canal system and the root canal third were calculated using a t-test for independent samples or a nonparametric Mann–Whitney–Wilcoxon test. Results: Statistically significant differences (p = 0.0066) in dentin removal capacity were found between the EDG (2.89 ± 1.26 mm3) and RB (1.22 ± 0.58 mm3) study groups for the coronal root canal third; however, no statistically significant differences were found for the middle (p = 0.4864) and apical (p = 0.6276) root canal thirds. Conclusions: Endogal and Reciproc Blue NiTi endodontic reciprocating systems showed similar capacity for the removal of root canal dentin, except for the coronal root canal third, in which the Reciproc Blue NiTi endodontic reciprocating system preserved more root canal dentin tissue.
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Affiliation(s)
- Vicente Faus-Llácer
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (V.F.-L.); (D.P.O.); (I.F.-M.); (C.R.-S.); (V.F.-M.)
| | - Dalia Pulido Ouardi
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (V.F.-L.); (D.P.O.); (I.F.-M.); (C.R.-S.); (V.F.-M.)
| | - Ignacio Faus-Matoses
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (V.F.-L.); (D.P.O.); (I.F.-M.); (C.R.-S.); (V.F.-M.)
| | - Celia Ruiz-Sánchez
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (V.F.-L.); (D.P.O.); (I.F.-M.); (C.R.-S.); (V.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
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X El Sabio University, Avenida Universidad, 1, Villanueva de la Cañada, 28691 Madrid, Spain
- Correspondence:
| | - Anabella María Reyes Ortiz
- Department of Pediatric Dentistry, Faculty of Health Sciences, Alfonso X El Sabio University, 28691 Madrid, Spain;
| | - Vicente Faus-Matoses
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (V.F.-L.); (D.P.O.); (I.F.-M.); (C.R.-S.); (V.F.-M.)
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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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Sundar S, Varghese A, Datta KJ, Natanasabapathy V. Effect of guided conservative endodontic access and different file kinematics on debris extrusion in mesial root of the mandibular molars: An in vitro study. J Conserv Dent 2022; 25:547-554. [PMID: 36506635 PMCID: PMC9733558 DOI: 10.4103/jcd.jcd_273_22] [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: 05/10/2022] [Revised: 06/02/2022] [Accepted: 06/07/2022] [Indexed: 12/15/2022] Open
Abstract
Background Guided conservative endodontic access is a novel technique and the influence of such access cavities on apical debris extrusion (ADE) can have a significant effect on postoperative pain. Objective This study compared ADE and preparation time (PT) in the mesial canals of the mandibular first permanent molars in different access cavity designs and the amount of sodium hypochlorite in the extruded debris using attenuated total reflection-Fourier transform infrared spectrometer (ATR-FTIR). Materials and Methods Human mandibular first permanent molars (N = 72) were selected and randomly divided into six groups (n = 12) based on type of cavity design and files used: Group 1, Conservative Access Cavity [ConsAC])-WaveOne Gold; Group 2, ConsAC-Mtwo; Group 3, ConsAC-XP-endo shaper; Group 4, Traditional Access Cavity [TradAC])-WaveOne; Group 5, TradAC-Mtwo; and Group 6, TradAC-XP-endo shaper. All the ConsAC were prepared with a customized template fabricated using cone beam computed tomography. ADE evaluation was done using the Myers and Montgomery set up. All the instruments were used according to the manufacturers' instructions, followed by a final irrigation using Endoactivator. The time taken for preparation was calculated using a digital watch. Five samples in each group was taken and subjected to ATR-FTIR analysis. Results There was no significant difference between the groups with respect to ADE (P > 0.05). Whereas, a statistically significant difference was seen in PT between the TradAC and ConsAC (P < 0.05). Using ATR-FTIR, it was found that all the samples of extruded debris had the presence of sodium hypochlorite. Conclusions All instrumentation systems produced ADE irrespective of access cavity design. The time taken for preparation of canals in ConsAC was significantly longer compared to TradAC. Clinical Relevance ADE can translate clinically as postoperative pain. Assessing the ADE in ConsAC could shed light on the type of file systems that can be used in such cavities in order to minimize postoperative pain clinically.
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Affiliation(s)
- Sathish Sundar
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Academy of Higher Education and Research University, Chennai, Tamil Nadu, India,Address for correspondence: Dr. Sathish Sundar, Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Academy of Higher Education and Research University, No. 1, Alapakkam Main Road, Maduravoyal, Chennai - 600 095, Tamil Nadu, India. E-mail:
| | - Aswathi Varghese
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Academy of Higher Education and Research University, Chennai, Tamil Nadu, India
| | - Krithika J. Datta
- Department of Conservative Dentistry and Endodontics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
| | - Velmurugan Natanasabapathy
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Academy of Higher Education and Research University, Chennai, Tamil Nadu, India
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Lin F, Ordinola-Zapata R, Fok ASL, Lee R. Influence of minimally invasive endodontic access cavities and bonding status of resin composites on the mechanical property of endodontically-treated teeth: A finite element study. Dent Mater 2021; 38:242-250. [PMID: 34930622 DOI: 10.1016/j.dental.2021.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/27/2021] [Accepted: 12/08/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To study the mechanical behavior of endodontically-treated teeth with minimally invasive endodontic access cavities and resin composite restorations under different bonding conditions using finite element analysis (FEA). METHODS Four Class-II endodontic access cavities including the mesio-occlusal minimally-invasive (MO-MIE), mesio-occlusal conventional (MO-CONV), disto-occlusal minimally-invasive (DO-MIE), and disto-occlusal conventional (DO-CONV) cavities were prepared in 3D-printed maxillary first molars. Each tooth was subjected to root canal preparation and scanned using micro-CT to provide a 3D structural model which was virtually restored with resin composite. An intact 3D-printed molar was used as control. FEA was conducted under a 250-N vertical load. Three different interfacial bonding conditions between dentin/enamel and resin composite were considered, i.e. fully bonded, partially debonded, and fully debonded. The maximum principal stress of dentin and the normal tensile stress at the interfaces were recorded. The risk factor of failure for each component was then calculated. RESULTS In the fully-bonded tooth, the dentin-composite interface showed significantly higher stress and a higher risk factor than dentin, indicating that debonding at the dentin-composite interface would occur prior to dentin fracture. With the dentin-composite interface debonded, the enamel-composite interface exhibited higher stress and a higher risk factor than dentin, indicating that debonding at the enamel-composite interface would occur next, also prior to dentin fracture. With the resin composite fully debonded from the tooth, stress in dentin increased significantly. Irrespective of the bonding status, the CONV groups exhibited higher median stresses in dentin than the MIE groups. SIGNIFICANCE Within the limitation of this study, it was shown that debonding of the resin composite restoration increased the stress in dentin and hence the risk of dentin fracture in endodontically-restored teeth. Minimally-invasive access cavities could better safeguard the fracture resistance of interproximally-restored teeth compared to conventional ones.
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Affiliation(s)
- Fei Lin
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology, Beijing 100081, China.
| | - Ronald Ordinola-Zapata
- Division of Endodontics, Department of Restorative Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN 55455, USA
| | - Alex S L Fok
- Minnesota Dental Research Center for Biomaterials and Biomechanics, School of Dentistry, University of Minnesota, Minneapolis, MN 55455, USA
| | - Roy Lee
- Division of Endodontics, Department of Restorative Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN 55455, USA
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Comparison of Herbal Agents with Sodium Hypochlorite as Root Canal Irrigant: A Systematic Review of In Vitro Studies. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:8967219. [PMID: 34868334 PMCID: PMC8639255 DOI: 10.1155/2021/8967219] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 11/10/2021] [Indexed: 11/18/2022]
Abstract
During endodontic treatment, eliminating microorganisms from the root canals should be considered with utmost importance. Before filling the canal, every effort should be made to ensure optimal shaping and adequate disinfection of the root canal system. This systematic review aimed to compare the efficacy of herbal agents with sodium hypochlorite (NaOCl) in reducing the microbial load while used as a root canal irrigant. The research question in the present study was to assess “Is there a significant difference in reducing microbial load comparing sodium hypochlorite (NaOCl) and herbal agents.” Electronic databases (PubMed, Scopus, and Web of Science) were searched from their start dates to November 2020 using strict inclusion and exclusion criteria and reviewed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Only in vitro studies comparing herbal agents with NaOCl regarding antimicrobial efficiency were included. Two reviewers independently assessed the included article. 825 articles were obtained from an electronic database. Twenty papers were included for review of the full text. Eleven papers were excluded because they did not meet the inclusion criteria. Finally, nine articles were included in the systematic review. The present systematic review was at the in vitro level; therefore, the result cannot translate the exact clinical conditions. This systematic review concludes that herbal agents cannot be used as a main irrigant for canal disinfection.
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Singhal Y, Srivastava N, Rana V, Kaushik N, Reddy V. Efficacy of Root Canal Instrumentation and Fracture Strength Assessment in Primary Molars after Preparing Two Different Shapes of Access Cavity: An Ex Vivo Histological Study. Int J Clin Pediatr Dent 2021; 14:518-524. [PMID: 34824507 PMCID: PMC8585889 DOI: 10.5005/jp-journals-10005-1997] [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] [Indexed: 11/23/2022] Open
Abstract
Aim and objective To evaluate the efficacy of root canal instrumentation and fracture strength assessment in primary molars after preparing different shapes of access cavity design. Materials and methods Sixty extracted primary mandibular molars with at least 2/3rd roots were randomly, equally divided into two groups based on shapes of the access cavities; Group I: Traditional access cavity (TAC), Group II: Conservative access cavity (CAC). Each group was further subdivided into two subgroups with 15 samples each. After, root canal debridement, samples in subgroup 1 were sectioned for histological evaluation of root canal instrumentation efficacy, while subgroup 2 were assessed for fracture strength using a Universal Testing Machine. The data were analyzed statistically using Mann–Whitney and post hoc Tukey tests, with a p value <0.05. Results Traditional access cavity showed statistically significant root canal debridement efficacy (p < 0.05) compared with CAC. Statistically significant differences were obtained between fracture strength values among the two groups (p < 0.05), with considerably higher fracture strength in the CAC group than TAC. Conclusion Traditional access cavity design resulted in complete root canal debridement but caused weakening of tooth structure due to low fracture strength, necessitating the use of full coverage restoration postendodontic therapy. How to cite this article Singhal Y, Srivastava N, Rana V, et al. Efficacy of Root Canal Instrumentation and Fracture Strength Assessment in Primary Molars after Preparing Two Different Shapes of Access Cavity: An Ex Vivo Histological Study. Int J Clin Pediatr Dent 2021;14(4):518–524.
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Affiliation(s)
- Yashika Singhal
- Department of Pediatric and Preventive Dentistry, Subharti Dental College and Hospital, Meerut, Uttar Pradesh, India
| | - Nikhil Srivastava
- Department of Pediatric and Preventive Dentistry, Subharti Dental College and Hospital, Meerut, Uttar Pradesh, India
| | - Vivek Rana
- Department of Pediatric and Preventive Dentistry, Subharti Dental College and Hospital, Meerut, Uttar Pradesh, India
| | - Noopur Kaushik
- Department of Pediatric and Preventive Dentistry, Subharti Dental College and Hospital, Meerut, Uttar Pradesh, India
| | - Vandana Reddy
- Department of Pediatric and Preventive Dentistry, Subharti Dental College and Hospital, Meerut, Uttar Pradesh, India
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Bayoumi A, Magdy Mohamed Aly, Hassan R. Impact of Contracted Endodontic Access Cavity on Shaping Ability of Hyflex Electrical Discharge Machining Single File Using Cone Beam Computed Tomography: An Ex Vivo Study. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM: The aim of the study was to evaluate and compare the effect of different access cavity designs, using cone-beam computed tomography (CBCT), on root canal transportation, and centralization performed on two rooted maxillary premolars.
METHODS: Twenty maxillary premolars were randomly divided into two groups. In Group 1, traditional endodontic cavities (TECs) were prepared. In Group 2, contracted endodontic cavities (CECs) were prepared. Mechanical preparation was done by HyFlex electrical discharge machining (EDM) single file in both groups. CBCT imaging was performed pre- and post-root canal preparation for calculations of root canal transportation and centering ability.
RESULTS: Data were analyzed using Mann–Whitney U test and Kruskal–Wallis test. For transportation, teeth with CECs showed the statistically significantly highest median amount of transportation, while as for centering ability, results showed no significant difference between both groups.
CONCLUSION: Under the conditions of this study, HyFlex EDM prepared canals with different access cavity designs without significant shaping errors. TEC showed less transportation than CEC, while both TEC and CEC had no effect on the file centering ability.
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Ballester B, Giraud T, Ahmed HMA, Nabhan MS, Bukiet F, Guivarc'h M. Current strategies for conservative endodontic access cavity preparation techniques-systematic review, meta-analysis, and decision-making protocol. Clin Oral Investig 2021; 25:6027-6044. [PMID: 34623506 DOI: 10.1007/s00784-021-04080-7] [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: 03/30/2021] [Accepted: 07/13/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To assess related studies and discuss the clinical implications of endodontic access cavity (AC) designs. MATERIALS AND METHODS A systematic review of studies comparing the fracture resistance and/or endodontic outcomes between different AC designs was conducted in two electronic search databases (PubMed and Web of Science) following the PRISMA guidelines. Study selection, data extraction, and quality assessment were performed. Meta-analyses were undertaken for fracture resistance and root canal detection, with the level of significance set at 0.05 (P = 0.05). RESULTS A total of 33 articles were included in this systematic review. The global evaluation of the risk of bias in the included studies was assessed as moderate, and the level of evidence was rated as low. Four types of AC designs were categorized: traditional (TradAC), conservative (ConsAC), ultraconservative (UltraAC), and truss (TrussAC). Their impact on fracture resistance, cleaning/disinfection, procedural errors, root canal detection, treatment time, apical debris extrusion, and root canal filling was discussed. Meta-analysis showed that compared to TradAC, (i) there is a significant higher fracture resistance of teeth with ConsAC, TrussAC, or ConsAC/TrussAC when all marginal ridges are preserved (P < 0.05), (ii) there is no significant effect of the type of AC on the fracture resistance of teeth when one or two marginal ridges are lost (P > 0.05), and (iii) there is a significantly higher risk of undetected canals with ConsAC if not assisted by dental operating microscope and ultrasonic troughing (P < 0.05). CONCLUSIONS Decreasing the AC extent does not necessarily present mechanical and biological advantages especially when one or more surfaces of the tooth structure are lost. To date, the evidence available does not support the application of TrussAC. UltraAC might be applied in limited occasions. CLINICAL RELEVANCE Maintaining the extent of AC design as small as practical without jeopardizing the root canal treatment quality remains a pragmatic recommendation. Different criteria can guide the practitioner for the optimal extent of AC outline form which varies from case to case.
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Affiliation(s)
- Benoit Ballester
- Assistance Publique Des Hôpitaux de Marseille, Marseille, France.,Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de L'Information Médicale, Marseille, France
| | - Thomas Giraud
- Assistance Publique Des Hôpitaux de Marseille, Marseille, France.,Aix Marseille Univ, CNRS, ISM, Inst Movement Sci, Marseille, France
| | - Hany Mohamed Aly Ahmed
- Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Frédéric Bukiet
- Assistance Publique Des Hôpitaux de Marseille, Marseille, France. .,Aix Marseille Univ, CNRS, ISM, Inst Movement Sci, Marseille, France.
| | - Maud Guivarc'h
- Assistance Publique Des Hôpitaux de Marseille, Marseille, France.,Aix Marseille Univ, EFS/CNRS, ADES, Marseille, France
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Silva EJNL, Lima CO, Barbosa AFA, Moreira T, Souza EM, De-Deus G, Versiani MA. Influence of access cavity preparation on the dentine thickness of mesial canals of mandibular molars prepared with reciprocating instruments. Int Endod J 2021; 55:113-123. [PMID: 34601728 DOI: 10.1111/iej.13642] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/24/2021] [Accepted: 09/30/2021] [Indexed: 11/29/2022]
Abstract
AIM To evaluate the influence of traditional and conservative access cavity preparations on the remaining dentine thickness in the coronal third of mesial canals of extracted mandibular molars prepared with reciprocating instruments using micro-computed tomography as the analytical tool. METHODOLOGY Seventy extracted mandibular molars were scanned at a pixel size of 19 μm. From this initial sample, 20 teeth were selected, pair-matched and distributed into two groups (n = 10) according to the access cavity preparation: traditional (TradAC) or conservative (ConsAC). The root canals were sequentially enlarged with Reciproc Blue R25 (size 25, 0.08v taper) and R40 (size 40, 0.06v taper) instruments. A new scan was performed and the postoperative stacks were coregistered with their respective preoperative datasets. A colour-coded cross sections of the roots were created and used to identify and measure the smallest dentine thickness related to both MB and ML canals at 1.0-mm intervals from the furcation level of up to 5 mm in the apical direction, in both mesial and distal aspects of the roots, before and after preparation. The statistical analyses were performed with paired-samples t-test, independent-samples Student T-test and Chi-Square test with a significance level of 5%. RESULTS At all levels of both groups, dentine thickness before preparation was greater than after preparation (p < .05). No difference in the percentage of dentine reduction was observed between TradAC and ConsAC groups (p > .05), but a significantly greater reduction was observed to the distal aspect of the roots (p < .05). After root canal preparation, dentine thinner than 0.5 mm was observed mostly along the distal aspect of the root (10% to 15%) of the MB and ML canals, with no influence of the access cavity type on its incidence to either mesial (X2 = 1.66; p = .2) or distal (X2 = 0.40; p = .5) directions. In the TradAC group, dentine thickness in most slices was greater than 1.0 mm after preparation (n = 124) whilst, in the ConsAC, it ranged from 0.5 to 1.0 mm (n = 136). CONCLUSION Traditional or conservative access cavity preparation in extracted mandibular molars did not influence the remaining dentine thickness in the coronal third of mesial canals enlarged with thermomechanically treated nickel-titanium reciprocating instruments.
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Affiliation(s)
- Emmanuel J N L Silva
- Department of Endodontics, School of Dentistry, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil.,Department of Endodontics, School of Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Brazil
| | - Carolina O Lima
- Department of Endodontics, School of Dentistry, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Ana Flávia A Barbosa
- Department of Endodontics, School of Dentistry, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Thiago Moreira
- Department of Endodontics, School of Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Brazil
| | - Erick M Souza
- Department of Dentistry II, Federal University of Maranhao, São Luis, Brazil
| | - Gustavo De-Deus
- Department of Endodontics, School of Dentistry, Fluminense Federal University (UFF), Niterói, Brazil
| | - Marco A Versiani
- Oral Health Center, Brazilian Military Police, Minas Gerais, Brazil
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Kapetanaki I, Dimopoulos F, Gogos C. Traditional and minimally invasive access cavities in endodontics: a literature review. Restor Dent Endod 2021; 46:e46. [PMID: 34513652 PMCID: PMC8410995 DOI: 10.5395/rde.2021.46.e46] [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: 08/06/2020] [Revised: 03/25/2021] [Accepted: 03/25/2021] [Indexed: 11/13/2022] Open
Abstract
The aim of this review was to evaluate the effects of different access cavity designs on endodontic treatment and tooth prognosis. Two independent reviewers conducted an unrestricted search of the relevant literature contained in the following electronic databases: PubMed, Science Direct, Scopus, Web of Science, and OpenGrey. The electronic search was supplemented by a manual search during the same time period. The reference lists of the articles that advanced to second-round screening were hand-searched to identify additional potential articles. Experts were also contacted in an effort to learn about possible unpublished or ongoing studies. The benefits of minimally invasive access (MIA) cavities are not yet fully supported by research data. There is no evidence that this approach can replace the traditional approach of straight-line access cavities. Guided endodontics is a new method for teeth with pulp canal calcification and apical infection, but there have been no cost-benefit investigations or time studies to verify these personal opinions. Although the purpose of MIA cavities is to reflect clinicians' interest in retaining a greater amount of the dental substance, traditional cavities are the safer method for effective instrument operation and the prevention of iatrogenic complications.
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Affiliation(s)
- Ioanna Kapetanaki
- Department of Endodontology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Fotis Dimopoulos
- Department of Endodontology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christos Gogos
- Department of Endodontology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Silva EJNL, Pinto KP, Ajuz NC, Sassone LM. Ten years of minimally invasive access cavities in Endodontics: a bibliometric analysis of the 25 most-cited studies. Restor Dent Endod 2021; 46:e42. [PMID: 34513648 PMCID: PMC8411007 DOI: 10.5395/rde.2021.46.e42] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/03/2020] [Accepted: 01/04/2021] [Indexed: 02/06/2023] Open
Abstract
Objectives This study aimed to analyze the main features of the 25 most-cited articles in minimally invasive access cavities. Materials and Methods An electronic search was conducted on the Clarivate Analytics' Web of Science ‘All Databases’ to identify the most-cited articles related to this topic. Citation counts were cross-matched with data from Elsevier's Scopus and Google Scholar. Information about authors, contributing institutions and countries, year and journal of publication, study design and topic, access cavity, and keywords were analyzed. Results The top 25 most-cited articles received a total of 572 (Web of Science), 1,160 (Google Scholar) and 631 (Scopus) citations. It was observed a positive significant association between the number of citations and age of publication (r = 0.6907, p < 0.0001); however, there was no significant association regarding citation density and age of publication (r = −0.2631, p = 0.2038). The Journal of Endodontics made the highest contribution (n = 15, 60%). The United States had the largest number of publications (n = 7) followed by Brazil (n = 4), with the most contributions from the University of Tennessee and Grande Rio University (n = 3), respectively. The highest number of most-cited articles were ex vivo studies (n = 16), and ‘fracture resistance’ was the major topic studied (n = 10). Conclusions This study revealed a growing interest for researchers in the field of minimally invasive access cavities. Future trends are focused on the expansion of collaborative networks and the conduction of laboratory studies on under-investigated parameters.
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Affiliation(s)
- Emmanuel João Nogueira Leal Silva
- Department of Endodontics, School of Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Brazil.,Department of Endodontics, School of Dentistry, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
| | - Karem Paula Pinto
- Department of Endodontics, School of Dentistry, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
| | - Natasha C Ajuz
- Department of Endodontics, School of Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Brazil
| | - Luciana Moura Sassone
- Department of Endodontics, School of Dentistry, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
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Wang D, Wang W, Li YJ, Wang YR, Hong T, Bai SZ, Tian Y. The effects of endodontic access cavity design on dentine removal and effectiveness of canal instrumentation in maxillary molars. Int Endod J 2021; 54:2290-2299. [PMID: 34459005 DOI: 10.1111/iej.13621] [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: 02/13/2021] [Accepted: 08/27/2021] [Indexed: 11/28/2022]
Abstract
AIM To evaluate in a laboratory setting, the impact of three designs of endodontic access cavities on dentine removal and effectiveness of canal instrumentation in extracted maxillary first molars using micro-computed tomography (micro-CT). METHODOLOGY A total of 30 extracted intact maxillary first molars were selected and scanned by micro-CT with a voxel size of 24 µm and randomly distributed into three groups: the traditional endodontic cavity (TEC) group, the conservative endodontic cavity (CEC) group and the guided endodontic cavity (GEC) group. The pulp chambers of teeth in the groups were accessed accordingly. After root canal preparation, the teeth were rescanned. The volume of dentine removed after canal preparation, the noninstrumented canal areas, canal transportation and centring ratio were analysed. Data were analysed statistically using one-way analysis of variance. Tukey's post hoc test was used for multiple comparisons. The significance level was set at p < .05. RESULTS The total volume of dentine removed was significantly greater in the TEC group after root canal preparation (p < .05). No significant differences in the volume of dentine removed occurred between the CEC and GEC groups (p > .05). The volume of dentine removed in the crown, pericervical dentine and coronal third of the canal was significantly lower in CEC and GEC groups when compared to that in the TEC group (p < .05), no difference was observed in the middle third of the canal and apical third of the canal amongst the three groups (p > .05). There was no significant difference in noninstrumented canal area, canal transportation and centring ratio amongst the TEC, CEC and GEC groups (p > .05). CONCLUSIONS In extracted maxillary molars tested in a laboratory setting, CEC and GEC preserved more tooth tissue in the crown, pericervical dentine and coronal third of the canal compared with TEC after root canal preparation. The design of the endodontic access cavity did not impact on the effectiveness of canal instrumentation in terms of noninstrumented canal area, canal transportation and centring ratio.
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Affiliation(s)
- Dan Wang
- Department of Endodontics, School of Stomatology, The Fourth Military Medical University & State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Xi'an, China
| | - Wei Wang
- Department of Endodontics, School of Stomatology, The Fourth Military Medical University & State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Xi'an, China
| | - Yu-Jiao Li
- Department of Endodontics, School of Stomatology, The Fourth Military Medical University & State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Xi'an, China
| | - Yi-Rong Wang
- Department of Endodontics, School of Stomatology, The Fourth Military Medical University & State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Xi'an, China
| | - Tao Hong
- Digital Dentistry Center, School of Stomatology, The Fourth Military Medical University & State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Xi'an, China
| | - Shi-Zhu Bai
- Digital Dentistry Center, School of Stomatology, The Fourth Military Medical University & State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Xi'an, China
| | - Yu Tian
- Department of Endodontics, School of Stomatology, The Fourth Military Medical University & State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Xi'an, China
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Özdemir O, Koçak S, Hazar E, Sağlam BC, Coşkun E, Koçak MM. Dentinal tubule penetration of gutta-percha with syringe-mix resin sealer using different obturation techniques: A confocal laser scanning microscopy study. AUST ENDOD J 2021; 48:258-265. [PMID: 34259369 DOI: 10.1111/aej.12546] [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: 04/11/2021] [Revised: 06/13/2021] [Accepted: 06/30/2021] [Indexed: 11/29/2022]
Abstract
This study aimed to evaluate dentinal tubule penetration of the root canal filling material using various techniques such as cold lateral compaction, new generation thermoplastic core carrier and continuous-wave obturation. The root canals of premolar teeth were instrumented, and the teeth were allocated randomly to three groups (n = 15/group). After the obturation with three different techniques, three sections of 2-mm thickness at 2, 5 and 8-mm from the apex were examined under a confocal laser scanning microscope. The data were analysed of variance with a significance level of P < 0.05. There was no significant difference between techniques when parameters were evaluated in total (penetration depth P = 0.418, penetration area P = 0.701). The mean value of the cold lateral compaction group for maximum penetration depth was obtained higher than continuous wave (P = 0.004), whilst there was no significant difference between the thermoplastic core carrier and the other groups.
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Affiliation(s)
- Olcay Özdemir
- Department of Pediatric Dentistry, Faculty of Dentistry, Zonguldak Bülent Ecevit University, Zonguldak, Turkey
| | - Sibel Koçak
- Department of Endodontics, Faculty of Dentistry, Zonguldak Bülent Ecevit University, Zonguldak, Turkey
| | - Ecehan Hazar
- Department of Endodontics, Faculty of Dentistry, Zonguldak Bülent Ecevit University, Zonguldak, Turkey
| | - Baran Can Sağlam
- Department of Endodontics, Faculty of Dentistry, Zonguldak Bülent Ecevit University, Zonguldak, Turkey
| | - Ezgi Coşkun
- Department of Endodontics, Faculty of Dentistry, Zonguldak Bülent Ecevit University, Zonguldak, Turkey
| | - Mustafa Murat Koçak
- Department of Endodontics, Faculty of Dentistry, Zonguldak Bülent Ecevit University, Zonguldak, Turkey
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Nagendrababu V, Murray PE, Ordinola-Zapata R, Peters OA, Rôças IN, Siqueira JF, Priya E, Jayaraman J, Pulikkotil SJ, Suresh N, Dummer PMH. PRILE 2021 guidelines for reporting laboratory studies in Endodontology: explanation and elaboration. Int Endod J 2021; 54:1491-1515. [PMID: 33982298 DOI: 10.1111/iej.13565] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 05/10/2021] [Indexed: 12/11/2022]
Abstract
Guidance to authors is needed to prevent their waste of talent, time and resources in writing manuscripts that will never be published in the highest-quality journals. Laboratory studies are probably the most common type of endodontic research projects because they make up the majority of manuscripts submitted for publication. Unfortunately, most of these manuscripts fail the peer-review process, primarily due to critical flaws in the reporting of the methods and results. Here, in order to guide authors, the Preferred Reporting Items for study Designs in Endodontology (PRIDE) team developed new reporting guidelines for laboratory-based studies: the Preferred Reporting Items for Laboratory studies in Endodontology (PRILE) 2021 guidelines. The PRILE 2021 guidelines were developed exclusively for the area of Endodontology by integrating and adapting the modified CONSORT checklist of items for reporting in vitro studies of dental materials and the Clinical and Laboratory Images in Publications (CLIP) principles. The process of developing the PRILE 2021 guidelines followed the recommendations of the Guidance for Developers of Health Research Reporting Guidelines. The aim of the current document is to provide authors with an explanation for each of the items in the PRILE 2021 checklist and flowchart with examples from the literature, and to provide advice from peer-reviewers and editors about how to solve each problem in manuscripts prior to their peer-review. The Preferred Reporting Items for study Designs in Endodontology (PRIDE) website (http://pride-endodonticguidelines.org/prile/) provides a link to the PRILE 2021 explanation and elaboration document as well as to the checklist and flowchart.
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Affiliation(s)
- Venkateshbabu Nagendrababu
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, UAE
| | | | - Ronald Ordinola-Zapata
- Division of Endodontics, University of Minnesota School of Dentistry, Minneapolis, MN, USA
| | - Ove A Peters
- School of Dentistry, University of Queensland, Herston, Australia.,Department of Endodontics, Arthur A Dugoni School of Dentistry, University of Pacific, San Francisco, USA
| | - Isabela N Rôças
- Department of Endodontics, Faculty of Dentistry, Grande Rio University, Rio de Janeiro, Brazil.,Department of Endodontics and Dental Research, Iguaçu University, Nova Iguaçu, Rio de Janeiro, Brazil
| | - José F Siqueira
- Department of Endodontics, Faculty of Dentistry, Grande Rio University, Rio de Janeiro, Brazil.,Department of Endodontics and Dental Research, Iguaçu University, Nova Iguaçu, Rio de Janeiro, Brazil
| | - Ekta Priya
- Division of Children and Community Oral Health, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - Jayakumar Jayaraman
- Department of Developmental Dentistry, University of Texas Health School of Dentistry, San Antonio, TX, USA
| | - Shaju J Pulikkotil
- Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - Nandini Suresh
- Faculty of Dentistry, Meenakshi Academy of Higher Education and Research, Meenakshi Ammal Dental College, Chennai, India
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Simon JC, Kwok JW, Vinculado F, Fried D. Computer-Controlled CO 2 Laser Ablation System for Cone-beam Computed Tomography and Digital Image Guided Endodontic Access: A Pilot Study. J Endod 2021; 47:1445-1452. [PMID: 34119563 PMCID: PMC8867881 DOI: 10.1016/j.joen.2021.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/03/2021] [Accepted: 06/05/2021] [Indexed: 11/25/2022]
Abstract
Introduction: Ideal endodontic access provides unobstructed entry to the pulp chamber and visualization of the canal orifices while preserving the maximum amount of tooth structure. The aim of this study was to implement the use of lasers to accurately and predictably access teeth to follow the principles of minimally invasive endodontics. Methods: Traditional, conservative, ultraconservative, bridge, truss, and orifice-directed accesses were performed. A computer-controlled 9.3-μm CO2 laser ablation system was assembled and coupled with custom software capable of combining cone-beam computed tomographic (CBCT) volumetric data with spatially calibrated digital images of teeth to provide an augmented reality environment for designing and preparing endodontic accesses. Twenty (N = 20) sound posterior teeth with fully developed root canal systems were imaged with CBCT scans and accessed via laser ablation in vitro. Results: All 20 (20/20) teeth were successfully accessed without iatrogenic errors. Volumetric renderings from post-access CBCT scans were used to verify the access and determine accuracy qualitatively. The volumetric measurements of hard tissue removed were as follows: traditional = 39.41 mm3, conservative = 9.76 mm3, ultraconservative = 7.1 mm3, bridge = 11.53 mm3, truss = 19.21 mm3, and orifice directed = 16.86 mm3. Conclusions: Digital image guidance based on feature recognition and registration with CBCT data is a viable method to address the challenge of dynamic navigation for accessing the pulp chamber. Modern lasers with high pulse repetition rates integrated with computer-controlled scanning systems are suitable for the efficient cutting of dental hard tissues.
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Affiliation(s)
- Jacob C Simon
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, California.
| | - Jason W Kwok
- Department of Endodontology, University of Connecticut, Farmington, Connecticut
| | - Frank Vinculado
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, California
| | - Daniel Fried
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, California
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Shabbir J, Zehra T, Najmi N, Hasan A, Naz M, Piasecki L, Azim AA. Access Cavity Preparations: Classification and Literature Review of Traditional and Minimally Invasive Endodontic Access Cavity Designs. J Endod 2021; 47:1229-1244. [DOI: 10.1016/j.joen.2021.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/16/2021] [Accepted: 05/21/2021] [Indexed: 12/18/2022]
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Lima CO, Barbosa AFA, Ferreira CM, Ferretti MA, Aguiar FHB, Lopes RT, Fidel SR, Silva EJNL. Influence of ultraconservative access cavities on instrumentation efficacy with XP-endo Shaper and Reciproc, filling ability and load capacity of mandibular molars subjected to thermomechanical cycling. Int Endod J 2021; 54:1383-1393. [PMID: 33811762 DOI: 10.1111/iej.13525] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 03/31/2021] [Indexed: 12/18/2022]
Abstract
AIM To evaluate the influence of ultraconservative access cavities (UltraAC) on canal shaping and filling ability and load capacity of mandibular molars after root canal preparation with XP-endo Shaper (XP) or Reciproc (RC), under simulated clinical conditions. Traditional access cavities (TradAC) were used for comparison. METHODOLOGY Forty extracted mandibular molars were scanned by micro-computed tomographic and, based on similar anatomical features, were divided into four groups (n = 10), according to the type of access cavity and canal instrumentation protocol: TradAC/RC, TradAC/XP, UltraAC/RC and UltraAC/XP. All root canal procedures were performed with the teeth placed in a dental mannequin. Teeth were scanned after root canal instrumentation and filling. Unprepared canal area, dentine removed, accumulated hard tissue debris (AHTD), canal transportation, presence of voids and filling material remnants within the pulp chamber were analysed. After restorative procedures, the teeth were subjected to thermomechanical cycling and to a load capacity test. Statistical analyses were performed using two-way anova test, considering the randomized blocks design (P < 0.05). RESULTS The percentage of unprepared canal area was significantly lower in TradAC groups when compared to UltraAC groups (P < 0.05), regardless of the instrument used. The UltraAC/XP group had significantly lower percentage of root dentine removed when compared to other groups (P < 0.05). UltraAC/XP and TradAC/XP groups had significantly lower percentages of AHTD than UltraAC/RC and TradAC/RC groups (P < 0.05). Regarding canal transportation, in the MB root canals, the TradAC/XP group had significantly lower values than other groups (P < 0.05). In general, in ML and distal root canals, TradAC/XP and UltraAC/XP groups had significantly lower values of canal transportation when compared to other groups (P < 0.05). Moreover, the UltraAC/RC had the greatest canal transportation values in MB and distal canals. The UltraAC groups had significantly greater percentages of voids and volume of remaining root filling material within the pulp chamber after cleaning procedures than TradAC groups (P < 0.05). There was no difference in the load capacity amongst groups (P < 0.05). CONCLUSION The UltraAC/XP and UltraAC/RC groups had significantly greater areas of unprepared canal walls, significantly more voids and volume of root filling material remnants within the pulp chamber after canal filling. UltraAC/XP was associated with significantly less root dentine removal and significantly more AHTD whilst TradAC/XP had overall significantly less canal transportation. No differences were observed in the load capacity amongst groups.
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Affiliation(s)
- C O Lima
- Department of Endodontics, School of Dentistry, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - A F A Barbosa
- Department of Endodontics, School of Dentistry, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - C M Ferreira
- Department of Endodontics, School of Dentistry, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - M A Ferretti
- Department of Restorative Dentistry, Piracicaba Dental School, University of Campinas, Campinas, Brazil
| | - F H B Aguiar
- Department of Restorative Dentistry, Piracicaba Dental School, University of Campinas, Campinas, Brazil
| | - R T Lopes
- Nuclear Engineering Program, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - S R Fidel
- Department of Endodontics, School of Dentistry, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - E J N L Silva
- Department of Endodontics, School of Dentistry, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil.,Department of Endodontics, School of Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Brazil
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Pereira RD, Leoni GB, Silva-Sousa YT, Gomes EA, Dias TR, Brito-Júnior M, Sousa-Neto MD. Impact of Conservative Endodontic Cavities on Root Canal Preparation and Biomechanical Behavior of Upper Premolars Restored with Different Materials. J Endod 2021; 47:989-999. [PMID: 33774045 DOI: 10.1016/j.joen.2021.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate the impact of conservative endodontic cavities (CECs) on root canal preparation, restoration, and biomechanical behavior of teeth prepared using different shaping systems and restorative materials. METHODS Ninety upper premolars with a bifurcated root were matched based on morphology and randomly assigned to a control group (n = 10) or 1 of the following experimental groups (n = 40): traditional endodontic cavity and CEC. Teeth were subdivided according to instrumentation (n = 10) as follows: ProTaper Universal (Dentsply Maillefer, Ballaigues, Switzerland), Reciproc (VDW GmbH, Munich, Germany), Reciproc Blue (VDW GmbH), and Hyflex EDM (Coltene/Whaledent, Altstätten, Switzerland). After canal obturation, teeth were restored using temporary material, conventional composite, regular bulk fill composite, or bulk fill flow combined with conventional composite. Before and after preparation and after obturation, the teeth were scanned using micro-computed tomographic imaging. Canal transportation (CT), the percentage of untouched canal surfaces (UCSs), voids in restoration (VRs), and residual filling material in the pulp chamber were evaluated. Finite element analysis, fracture resistance, and the failure pattern were recorded. The data were analyzed using analysis of variance and the Tukey and chi-square tests. RESULTS CECs had greater CT, percentage of filling material, and VRs compared with traditional endodontic cavities (P < .0001). The highest CT and UCSs were observed in CEC with ProTaper Universal. Bulk fill flow combined with conventional composite showed a lower percentage of VRs compared with other restorative materials (P < .05). Finite element analysis, fracture resistance, and failure pattern revealed similar behaviors in all groups (P > .05) . CONCLUSIONS CECs had a negative impact on root canal centralization, UCSs, cleaning of the pulp chamber, and percentage of VRs. Controlled memory instruments were the most adequate for the root canal preparation of CECs. The endodontic cavity did not influence the biomechanical behavior of restored teeth.
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Affiliation(s)
- Rodrigo Dantas Pereira
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | | | - Erica Alves Gomes
- School of Dentistry, University of Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil
| | - Tatiane Rocco Dias
- School of Dentistry, University of Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil
| | - Manoel Brito-Júnior
- Department of Dentistry, State University of Montes Claros, Montes Claros, Minas Gerais, Brazil
| | - Manoel Damião Sousa-Neto
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
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Ordinola-Zapata R, Fok ASL. Research that matters: debunking the myth of the "fracture resistance" of root filled teeth. Int Endod J 2021; 54:297-300. [PMID: 33570814 DOI: 10.1111/iej.13479] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- R Ordinola-Zapata
- Division of Endodontics, Department of Restorative Sciences, University of Minnesota, Minneapolis, MN, USA
| | - A S L Fok
- MDRCBB-Minnesota Dental Research Center for Biomaterials and Biomechanics, Department of Restorative Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
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Silva EJNL, Lima CO, Barbosa AFA, Augusto CM, Souza EM, Lopes RT, De-Deus G, Versiani MA. Preserving dentine in minimally invasive access cavities does not strength fracture resistance of restored mandibular molars. Int Endod J 2021; 54:966-974. [PMID: 33527413 DOI: 10.1111/iej.13487] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 12/21/2022]
Abstract
AIM To evaluate the correlation between the volume of dental hard tissues removed and the fracture resistance of mandibular molar teeth with ultraconservative (UltraAC) or traditional (TradAC) access cavity preparations. METHODOLOGY Sixty recently extracted and intact mandibular first molars were scanned in a microcomputed tomographic (micro-CT) device, anatomically matched and assigned at random to 2 groups (n = 30), according to the access cavity type: UltraAC or TradAC. After access preparation, mesial and distal canals were prepared using Reciproc instruments and a new scan was taken. The volumes of pulp chamber and dental hard tissues in each specimen were measured before and after the experimental procedures, and the percentage volume reduction of hard tissues calculated for the entire tooth and for the crown separately. Teeth were then root filled, restored and subjected to fracture resistance tests in an universal testing machine. The force required to fracture was recorded in Newtons (N). The adherence of the variables to a Gaussian curve was verified using a Shapiro-Wilk test. Skewed data were analysed with nonparametric Wilcoxon signed rank or Spearman correlation tests, whilst the normally distributed data were analysed with a dependent samples Student t-test. Level of significance was set at 5%. RESULTS Pre-operatively, no difference was observed between groups regarding the volume of pulp canal space or dental hard tissues (P > 0.05). After access preparation, volumes of the removed hard tissues from the entire tooth and from the crown were significantly greater in teeth prepared with TradAC than with UltraAC (P < 0.05). No significant difference was observed in the fracture resistance values between TradAC (902.9 ± 347.8 N) and UltraAC (948.7 ± 405.7 N) groups (P = 0.975). The Spearman test was unable to identify a correlation between fracture resistance and percentage volume of removed dental hard tissues in the entire root (P = 0.525, r = -0.084) or only in the crown (P = 0.152, r = -0.187). CONCLUSION The volume of hard dental tissues removed, although greater in teeth with TradAC compared to UltraAC, did not correlate with the fracture resistance results, indicating that a minimally invasive access cavity did not increase the resistance of restored mandibular first molars to fracture.
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Affiliation(s)
- E J N L Silva
- Department of Endodontics, School of Dentistry, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil.,Department of Endodontics, School of Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Brazil
| | - C O Lima
- Department of Endodontics, School of Dentistry, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - A F A Barbosa
- Department of Endodontics, School of Dentistry, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - C M Augusto
- Department of Endodontics, School of Dentistry, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - E M Souza
- Department of Dentistry II, Federal University of Maranhao, São Luis, Brazil
| | - R T Lopes
- Nuclear Engineering Program, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - G De-Deus
- Department of Endodontics, School of Dentistry, Fluminense Federal University (UFF), Niterói, Brazil
| | - M A Versiani
- Oral Health Center, Brazilian Military Police, Minas Gerais, Brazil
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Saeed M, Al-Obadi M, Salim A, Alsawaf AY, Hadi K. Impact of Access Cavity Design on Fracture Resistance of Endodontically Treated Molars: A Systematic Review. Clin Cosmet Investig Dent 2021; 13:1-10. [PMID: 33442299 PMCID: PMC7800454 DOI: 10.2147/ccide.s287995] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/10/2020] [Indexed: 12/24/2022] Open
Abstract
Objective The main aim of this present systematic review is to ascertain whether a conservative endodontic cavity (ConsAC) has a better fracture resistance than a traditional access cavity (TradAC) in endodontically treated molars. Materials and Methods Three independent reviewers researched without limits in multiple engines: PubMed, ScienceDirect, Scopus, ResearchGate, EBSCOhost, Wiley Online Library, and Google Scholar, in addition to reference and hand search. Articles were chosen according to a certain inclusion and exclusion criteria, which, in brief, are in vitro studies assessing the fracture resistance difference between ConsAC and TradAC performed on extracted sound human molar teeth. A quality assessment criteria was produced to evaluate the chosen articles and categorized them according to their risk of bias into low, moderate and high. Results Out of a total of 105 studies, which were obtained from seven different search engines, only eight in vitro studies were included after eliminating the duplicates followed by the application of the eligibility criteria. Five of the articles showed low risk of bias while the others revealed a moderate risk of bias. Conclusion To sum up, there is insufficient evidence to give a final decision whether ConsAC is more advantageous than TradAC in terms of fracture resistance and further studies regarding this topic are needed.
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Affiliation(s)
- Musab Saeed
- Department of Clinical Sciences, Ajman University, Ajman, United Arab Emirates
| | | | - Asma Salim
- Ajman University, Ajman, United Arab Emirates
| | | | - Karrar Hadi
- College of Dentistry, Ajman University, Ajman, United Arab Emirates
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