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Rathke A, Frehse H, Bechtold M. Ex vivo investigation on the effect of minimally invasive endodontic treatment on vertical root fracture resistance and crack formation. Sci Rep 2024; 14:13205. [PMID: 38851745 PMCID: PMC11162497 DOI: 10.1038/s41598-024-63396-y] [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: 03/06/2024] [Accepted: 05/28/2024] [Indexed: 06/10/2024] Open
Abstract
The evidence base on minimally invasive endodontic (MIE) treatment is limited. This study investigated the influence of MIE shaping on vertical root fracture (VRF) resistance and crack formation of root canal filled teeth. Human maxillary central incisors were randomized into six groups (n = 18, power = 0.9) and embedded in acrylic blocks with artificial periodontal ligaments. The root canals were either instrumented to size #40 and 0.04 taper (+MIE) or enlarged to ISO size #80 (-MIE). The canals were filled with cement-based (C) or adhesive resin-based (A) sealers in single-cone technique. The controls received no treatment or were left unfilled. After chewing simulation (staircase method, 25-150 N, 120,000×), the crack formation on the root surface was analyzed using stereomicroscope/digital imaging and classified (no defect, craze line, vertical crack, horizontal crack). Subsequently, the samples were loaded until fracture. The incidence of defects (56% vertical cracks) was not significantly different between the groups (p ≥ 0.077). VRF resistance was significantly higher in untreated teeth than in +MIE/C (p = 0.020) but did not significantly differ between the other groups (p ≥ 0.068). Minimal canal shaping did not reduce the risk of vertical root fracture and defects of root canal filled teeth.
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Affiliation(s)
- Andreas Rathke
- Faculty of Medicine, University of Ulm, Albert-Einstein-Allee 7, 89081, Ulm, Germany.
- Dentsply Sirona, DeTrey-Strasse 1, 78467, Konstanz, Germany.
| | - Henry Frehse
- Faculty of Medicine, University of Ulm, Albert-Einstein-Allee 7, 89081, Ulm, Germany
| | - Maria Bechtold
- Private Practice, Münchener Straße 1, 82362, Weilheim, Germany
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Nezir M, Dinçtürk BA, Sarı C, Alp CK, Altınışık H. Effect of fiber-reinforced direct restorative materials on the fracture resistance of endodontically treated mandibular molars restored with a conservative endodontic cavity design. Clin Oral Investig 2024; 28:316. [PMID: 38750289 PMCID: PMC11096213 DOI: 10.1007/s00784-024-05720-4] [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: 03/08/2024] [Accepted: 05/10/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE This study aimed to evaluate the fracture strength of teeth restored using fiber-reinforced direct restorative materials after endodontic treatment with a conservative mesio-occlusal access cavity design. MATERIALS AND METHODS A total of 100 extracted intact mandibular first molars were selected and distributed into a positive control group where teeth left intact and the following four test groups comprised of teeth with conservative mesio-occlusal access cavities that had undergone root canal treatment (n = 20/group): access cavity without restoration (negative control), bulk-fill resin composite with horizontal glass fiber post reinforcement, fiber-reinforced composite with bulk-fill resin and bulk-fill resin composite. Following thermocycling (10,000 cycles), fracture resistance was measured using a universal testing machine. Statistical analyses (one-way analysis of variance and the Tamhane test) were performed, and statistical significance was set at p < 0.05. RESULTS Groups with minimally invasive access cavities had lower fracture strength than intact teeth, regardless of the restoration material (p < 0.05). Fiber-reinforced composite groups demonstrated higher fracture strength than bulk-fill resin composite alone (p < 0.05). Fracture types varied among groups, with restorable fractures predominant in the fiber-reinforced composite groups. CONCLUSION This study suggests that using fiber-reinforced composite materials, especially in combination with bulk-fill resin composites, can effectively enhance the fracture strength of endodontically treated teeth with conservative access cavities. However, using only bulk-fill resin composite is not recommended based on the fracture strength results. CLINICAL SIGNIFICANCE When teeth that undergo endodontic treatment are restored using a conservative access cavity design and fiber-reinforced composite materials, especially in combination with bulk-fill resin composites, the fracture strength of the teeth can be effectively increased.
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Affiliation(s)
- Merve Nezir
- Department of Restorative Dentistry, Faculty of Dentistry, Gazi University, Emek, Ankara, 06510, Turkey
| | - Beyza Arslandaş Dinçtürk
- Department of Restorative Dentistry, Faculty of Dentistry, Gazi University, Emek, Ankara, 06510, Turkey
| | - Ceyda Sarı
- Department of Restorative Dentistry, Faculty of Dentistry, İstanbul Medipol University, İstanbul, Turkey
| | - Cemile Kedici Alp
- Department of Restorative Dentistry, Faculty of Dentistry, Gazi University, Emek, Ankara, 06510, Turkey
| | - Hanife Altınışık
- Department of Restorative Dentistry, Faculty of Dentistry, Gazi University, Emek, Ankara, 06510, Turkey.
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Langaliya AK, Parmar G, Panchal D, Thakkar J, Shah J, Patel R. Comparative Evaluation of Different Endodontic Access Cavity Designs with Different Burs-An in vitro Experimental Insight into the Aspect of Fracture Resistance. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S821-S824. [PMID: 38595593 PMCID: PMC11000921 DOI: 10.4103/jpbs.jpbs_1038_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 10/15/2023] [Accepted: 10/17/2023] [Indexed: 04/11/2024] Open
Abstract
Introduction In vitro fracture resistance of extracted mandibular molars treated with various access cavity designs, including traditional endodontic cavity (TradAC), conservative/contracted endodontic cavity (ConsAC), ninja endodontic cavity (UltraAC), truss endodontic cavity (TrussAC), caries-driven access cavity (CariesAC), and intact teeth, is the focus of this study. Materials and Methods Six groups of 20 mandibular molars, totaling 120, were used in the investigation. While the other five groups underwent various access cavity preparations, chemomechanical preparation, and obturation procedures before being repaired with composite resin, Group 1 was left unaltered (the control). A 6 mm round head tip was used to apply the fracture force, which was measured in newtons, at a crosshead speed of 1 mm/min until fracture developed. Results According to the current study, the intact control group had the maximum fracture resistance. The access cavity groups' mean values were maximum in CariesAC followed by ConsAC, TrussAC, UltraAC, and TraditonalAC respectively. Conclusion While among the four minimally invasive designs, CariesAC showed a higher fracture resistance despite the results being statistically insignificant, TradAC had a significantly lower resistance than other conservative access cavity designs.
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Affiliation(s)
- Akshayraj K. Langaliya
- Department of Conservative Dentistry and Endodontics (Ph.D. Scholar,) Gujarat University, India
| | - Girish Parmar
- Department of Conservative Dentistry and Endodontics (Additional Director, Dean and Ph.D. Guide), Government Dental College and Hospital, Gujarat University, Ahmedabad, India
| | - Drashti Panchal
- Department of Conservative Dentistry and Endodontics (Ex- Intern), AMC Dental College and Hospital, Ahmedabad, India
| | - Jainish Thakkar
- Department of Dentistry (Undergraduate Student), AMC Dental College and Hospital, Ahmedabad, India
| | - Jinali Shah
- Department of Conservative Dentistry and Endodontics (Ex- Postgraduate Student), AMC Dental College and Hospital, Ahmedabad, India
| | - Rushvi Patel
- Department of Dentistry (Ex- Intern), AMC Dental College and Hospital, Ahmedabad, India
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Abdelfattah RA, Nawar NN, Kataia EM, Saber SM. How loss of tooth structure impacts the biomechanical behavior of a single-rooted maxillary premolar: FEA. Odontology 2024; 112:279-286. [PMID: 37394683 PMCID: PMC10776703 DOI: 10.1007/s10266-023-00829-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 06/15/2023] [Indexed: 07/04/2023]
Abstract
To evaluate the influence of the loss of coronal and radicular tooth structure on the biomechanical behavior and fatigue life of an endodontically treated maxillary premolar with confluent root canals using finite element analysis (FEA). An extracted maxillary second premolar was scanned to produce intact (IT) 3D model. Models were designed with an occlusal conservative access cavity (CAC) with different coronal defects; mesial defect (MO CAC), occlusal, mesial and distal defect (MOD CAC), and 2 different root canal preparations (30/.04, and 40/.04) producing 6 experimental models. FEA was used to study each model. A simulation of cycling loading of 50N was applied occlusally to stimulate the normal masticatory force. Number of cycles till failure (NCF) was used to compare strength of different models and stress distribution patterns via von Mises (vM) and maximum principal stress (MPS). The IT model survived 1.5 × 1010 cycles before failure, the CAC-30.04 had the longest survival of 1.59 × 109, while the MOD CAC-40.04 had the shortest survival of 8.35 × 107 cycles till failure. vM stress analysis showed that stress magnitudes were impacted by the progressive loss of coronal tooth structure rather than the radicular structure. MPS analysis showed that significant loss of coronal tooth structure translates into more tensile stresses. Given the limited size of maxillary premolars, marginal ridges have a critical role in the biomechanical behavior of the tooth. Access cavity preparation has a much bigger impact than radicular preparation on their strength and life span.
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Affiliation(s)
- Roaa Abdelwahab Abdelfattah
- Department of Endodontics, Faculty of Dentistry, The British University in Egypt, Misr-Ismalia Road, El Sherouk City, Cairo, 11837, Egypt.
| | - Nawar Naguib Nawar
- Department of Endodontics, Faculty of Dentistry, The British University in Egypt, Misr-Ismalia Road, El Sherouk City, Cairo, 11837, Egypt
| | - Engy M Kataia
- Department of Endodontics, Faculty of Dentistry, The British University in Egypt, Misr-Ismalia Road, El Sherouk City, Cairo, 11837, Egypt
| | - Shehabeldin Mohamed Saber
- Department of Endodontics, Faculty of Dentistry, The British University in Egypt, Misr-Ismalia Road, El Sherouk City, Cairo, 11837, Egypt
- Department of Endodontics, Ain Shams University, Cairo, Egypt
- Centre for Innovative Dental Sciences (CIDS), Faculty of Dentistry, The British University in Egypt (BUE), El Sherouk City, 11837, Egypt
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Rahmatian M, Jafari Z, Moghaddam KN, Dianat O, Kazemi A. Finite Element Analysis of Fracture Resistance of Mandibular Molars with Different Access Cavity Designs. J Endod 2023; 49:1690-1697. [PMID: 37804945 DOI: 10.1016/j.joen.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/09/2023]
Abstract
INTRODUCTION This study aimed to assess the fracture resistance of mandibular first molars after preparation with 3 different access cavity designs and 2 rotary systems using finite element analysis. METHODS Six 3-dimensionally printed mandibular first molars simulating natural teeth received traditional, conservative, and ultraconservative (truss) access cavity preparations. The root canals in each group were instrumented with either XP-Endo Shaper (FKG Dentaire, La Chaux-de-Fonds, Switzerland) or TruNatomy (Dentsply Sirona, Ballaigues, Switzerland) rotary files. The models were individually digitized, and micro-computed tomographic scans were transferred to Mimics software (Materialise NV, Leuven, Belgium) to create a geometric model of the tooth. The designed model was exported to 3-matic software (Materialise NV), and STL files were transferred to Geomagic Design X (3D Systems, Rock Hill, SC). Point cloud data were used for surfacing and transferred to ANSYS software (Ansys, Canonsburg, PA). A 200-N superficial force was applied vertically to the buccal cusps and central fossa, and the maximum and minimum equivalent von Mises stress values were calculated and reported. RESULTS The traditional and ultraconservative access cavity designs yielded the highest and the lowest von Mises stress values, respectively. In the ultraconservative cavity design, the stress values in pericervical dentin were lower in canal preparation with TruNatomy compared with XP-Endo Shaper. In the traditional and conservative cavity designs, stress was lower in the first 2 mm from the cementoenamel junction in the XP-Endo Shaper group and in the next 3 mm in the TruNatomy group. CONCLUSIONS Stress was lower in the ultraconservative and conservative cavity designs compared with the traditional design. Also, root canal preparation with TruNatomy yielded lower stress values in general compared with XP-Endo Shaper.
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Affiliation(s)
| | - Zahra Jafari
- Department of Endodontics, Dental School, Shahed University, Tehran, Iran
| | | | - Omid Dianat
- Endodontic Division, Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, Maryland
| | - Ali Kazemi
- Department of Endodontics, Dental School, Shahed University, Tehran, Iran.
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Prado HS, Petean IBF, Franco NJS, Camargo RV, Carvalho KKTD, Mazzi-Chaves JF, Lopes-Olhê FC, Silva-Sousa YTC, Souza-Gabriel AE, Sousa-Neto MD. Impact of access cavities on root canal preparation, restorative protocol quality, and fracture resistance of teeth. Braz Oral Res 2023; 37:e096. [PMID: 38055514 DOI: 10.1590/1807-3107bor-2023.vol37.0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/15/2023] [Indexed: 12/08/2023] Open
Abstract
The survival of endodontically treated teeth depends on the remaining tooth structure. The aim of this study was to evaluate the impact of different access cavities on root canal preparation, restorative protocol, and fracture resistance of endodontically treated teeth. Fifty-six mandibular molars were divided into control (n=8) and experimental (n=16) groups according to access cavity: Traditional, Conservative, and Truss; and redistributed (n=8) according to instrumentation protocols: Reciproc Blue and R-motion. After, teeth were scanned in micro-CT and then filled and redistributed according to composite resin restoration (n=8): Filtek One BulkFill and Filtek Z350. A new micro-CT scan was performed to analyze the restorative material. Then, samples were submitted to fracture resistance testing and the failure pattern was determined. Data were analyzed using paired T-test, ANOVA, Tukey, and chi-square tests (α=0.05). In Truss, R-Motion promoted less transportation in different thirds of root canals. Higher percentages of voids (5.05%) and filling material (11.7%) were observed in Truss. Fracture resistance values were higher for the control group, followed by Truss, Conservative, and Traditional. The predominant failure pattern was type-II. In Truss, reciprocating instruments with smaller taper showed less canal transportation. Also, Truss provided higher values of fracture resistance, although it presented a higher percentage of voids and remaining filling material. Thus, in Truss, reciprocating files with smaller taper showed less canal transportation, and these cavities provided higher values of fracture resistance, although it presented a higher percentage of voids and remaining filling material.
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Affiliation(s)
- Heitor Silva Prado
- Universidade de São Paulo - USP, School of Dentistry of Ribeirão Preto, Department of Restorative Dentistry, Ribeirão Preto, SP, Brazil
| | - Igor Bassi Ferreira Petean
- Universidade de São Paulo - USP, School of Dentistry of Ribeirão Preto, Department of Restorative Dentistry, Ribeirão Preto, SP, Brazil
| | - Natália Junqueira Saud Franco
- Universidade de São Paulo - USP, School of Dentistry of Ribeirão Preto, Department of Restorative Dentistry, Ribeirão Preto, SP, Brazil
| | - Rafael Verardino Camargo
- Universidade de São Paulo - USP, School of Dentistry of Ribeirão Preto, Department of Restorative Dentistry, Ribeirão Preto, SP, Brazil
| | | | - Jardel Francisco Mazzi-Chaves
- Universidade de São Paulo - USP, School of Dentistry of Ribeirão Preto, Department of Restorative Dentistry, Ribeirão Preto, SP, Brazil
| | - Fabiane Carneiro Lopes-Olhê
- Universidade de São Paulo - USP, School of Dentistry of Ribeirão Preto, Department of Restorative Dentistry, Ribeirão Preto, SP, Brazil
| | | | - Aline Evangelista Souza-Gabriel
- Universidade de São Paulo - USP, School of Dentistry of Ribeirão Preto, Department of Restorative Dentistry, Ribeirão Preto, SP, Brazil
| | - Manoel Damião Sousa-Neto
- Universidade de São Paulo - USP, School of Dentistry of Ribeirão Preto, Department of Restorative Dentistry, Ribeirão Preto, SP, Brazil
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Zhang Q, Gu J, Shen J, Ma M, Lv Y, Wei X. Apically extruded debris, canal transportation, and shaping ability of nickel-titanium instruments on contracted endodontic cavities in molar teeth. J Oral Sci 2023; 65:203-208. [PMID: 37532528 DOI: 10.2334/josnusd.23-0050] [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] [Indexed: 08/04/2023]
Abstract
PURPOSE Apically extruded debris, canal transportation and shaping ability were compared between contracted endodontic cavities (CECs) and traditional endodontic cavities (TECs) after instrumentation with XP-endo Shaper (XPS), ProTaper Gold (PTG), ProTaper for hand-use (HPT) and Hero Shaper. METHODS The CECs or TECs groups were sub-divided into 24 groups according to root canal morphology and nickel-titanium (Ni-Ti) instruments. The weight of apically extruded debris was calculated using the Myers and Montgomery model. Pre- and postoperative images of teeth were scanned using micro-CT and the three-dimensional models were constructed and compared. RESULTS Under CECs or TECs, XPS and PTG produced less apical debris and formed less canal transportation than HPT and Hero Shaper (P < 0.05). XPS group under CECs extruded less apical debris than that under TCEs for round canals with curvature of 20°-35° (P < 0.05). The centering ratios of four tested instruments were higher under TECs than those under CECs (P < 0.05). The HPT and Hero Shaper had more transportation under CECs than that under TCEs (P < 0.05). No statistical difference was found regarding shaping ability among all the groups. CONCLUSION Under CECs, XPS preserves the original root canal anatomy, meanwhile it produces less apical debris than the other instruments.
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Affiliation(s)
- Qinqin Zhang
- Department of Endodontics, Affiliated Stomatological Hospital of Nanjing Medical University
| | - Jingyi Gu
- Department of Endodontics, Affiliated Stomatological Hospital of Nanjing Medical University
| | - Jiadi Shen
- Department of Endodontics, Affiliated Stomatological Hospital of Nanjing Medical University
| | - Ming Ma
- Department of Endodontics, Affiliated Stomatological Hospital of Nanjing Medical University
| | - Ying Lv
- Department of Endodontics, Affiliated Stomatological Hospital of Nanjing Medical University
| | - Xin Wei
- Department of Endodontics, Affiliated Stomatological Hospital of Nanjing Medical University
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Selvakumar RJ, Surendran S, Sundar S, Arul B, Natanasabapathy V. Impact of Contracted Endodontic Access Cavities on the Fracture Resistance of Endodontically Treated Teeth After Mechanical Aging by Simulated Chewing Forces. J Endod 2023; 49:1176-1182. [PMID: 37422251 DOI: 10.1016/j.joen.2023.06.018] [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: 05/12/2023] [Revised: 06/27/2023] [Accepted: 06/27/2023] [Indexed: 07/10/2023]
Abstract
INTRODUCTION This in vitro study aimed to comparatively evaluate the fracture resistance of contracted endodontic cavities (CECs) versus traditional endodontic cavities (TECs) in mandibular molars after subjecting the samples to a chewing simulator. METHODS A total of 24 freshly extracted human mandibular molars were included in the study. Teeth with intact crowns and mature root apices that were devoid of caries, attrition, restorations, and cracks were selected and randomly assigned to 3 groups (n = 8) as follows: Group 1: TECs, Group 2: CECs, and Group 3: intact teeth (control group). After endodontic treatment, the teeth were restored with EverX bulk-fill composite and layered occlusally with nanohybrid composite SolareX and subjected to a chewing simulator where 240,000 masticatory cycles were simulated, which translates to 1 year of clinical function. The teeth were then subjected to static loading in a universal testing machine and the maximum load to fracture and the pattern of failure (restorable/unrestorable) were recorded. Data were evaluated with analysis of variance and the Tukey post hoc test for multiple comparisons. RESULTS The CEC group had higher fracture resistance when compared with the TEC group; however, the difference was not statistically significant. The fracture resistance of the samples in the control group was statistically higher than those in the experimental groups (P < .005). CONCLUSIONS There was no difference observed in the fracture resistance of mandibular molars with TECs and CECs subjected to masticatory loading.
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Affiliation(s)
- Rene Jochebed Selvakumar
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Academy of Higher Education and Research (MAHER), Maduravoyal, Chennai, Tamil Nadu, India
| | - Smita Surendran
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Academy of Higher Education and Research (MAHER), Maduravoyal, Chennai, Tamil Nadu, India
| | - Satish Sundar
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Academy of Higher Education and Research (MAHER), Maduravoyal, Chennai, Tamil Nadu, India
| | - Buvaneshwari Arul
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Academy of Higher Education and Research (MAHER), Maduravoyal, Chennai, Tamil Nadu, India
| | - Velmurugan Natanasabapathy
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Academy of Higher Education and Research (MAHER), Maduravoyal, Chennai, Tamil Nadu, India.
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Selvaraj H, Krithikadatta J, Shrivastava D, Onazi MAA, Algarni HA, Munaga S, Hamza MO, Saad Al-Fridy T, Teja KV, Janani K, Alam MK, Srivastava KC. Systematic review fracture resistance of endodontically treated posterior teeth restored with fiber reinforced composites- a systematic review. BMC Oral Health 2023; 23:566. [PMID: 37574536 PMCID: PMC10423428 DOI: 10.1186/s12903-023-03217-2] [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: 03/31/2023] [Accepted: 07/10/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Large cavity designs and access cavities impair endodontically treated tooth fracture resistance. As the tooth's strength is known to reduce significantly after the root canal treatment, occlusal loading as a result of functions such as chewing, biting and certain parafunctional tendencies makes the endodontically treated tooth vulnerable to fracture. Hence, after endodontic treatment, it is vital to give adequate and appropriate restorative material to avoid tooth fractures. Accordingly, the choice of such restorative material should be dictated by the property of fracture resistance. OBJECTIVE The goal of this study was to conduct a systematic review and critical analysis of available data from in vitro studies examining the fracture resistance of endodontically treated posterior teeth restored with fiber-reinforced composites. METHODOLOGY The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRIS-MA) Statement was used to guide the reporting of this systematic review A comprehensive literature search was performed using MEDLINE (via PubMed), Scopus, ScienceDirect, Google Scholar, and LILACS. A manual search of the reference lists of the articles was also performed. The databases provided a total of 796 studies from the electronic systematic search. The databases provided a total of 796 studies from the electronic systematic search. Two reviewers scrutinized the papers for eligibility based on inclusion/exclusion criteria and extracted data. The studies were assessed for their potential risk of bias. Based on modified JBI & CRIS (checklist for reporting in vitro studies) guidelines, along with the methodology and treatment objective, we have formulated 13 parameters specifically to assess the risk of bias. A total of 18 studies met the inclusion criteria and were included for qualitative analysis. Considering the high heterogeneity of the studies included, a meta-analysis could not be performed. RESULTS The majority of the included studies had a moderate or high risk of bias. When compared to traditional hybrid composites, fiber-reinforced composites showed increased fracture resistance of endodontically treated teeth in the majority of investigations. On the other hand, limited evidence was found for the bulk fill composites. Moreover, moderate evidence was found for the fracture resistance of inlays and fiber posts with fiber-reinforced composites for core build-up in endodontically treated teeth. No evidence could be found comparing the fracture resistance of endo crowns and fiber-reinforced composites in endodontically treated teeth. CONCLUSION According to the research, using fiber-reinforced composites instead of conventional hybrid composites improves the fracture resistance of endodontically treated teeth. However, there was a high risk of bias in the research considered. No judgments could be reached about the superiority of one material over another based-on comparisons between other core restorations.
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Affiliation(s)
- Harish Selvaraj
- Department of Conservative Dentistry and Endodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, 152006005, India
| | | | - Deepti Shrivastava
- Department of Preventive Dentistry, College of Dentistry, Jouf University, Sakaka, Saudi Arabia
| | - Meshal Aber Al Onazi
- Department of Operative Dentistry and Endodontics, College of Dentistry, Jouf University, Sakaka, 72345, Saudi Arabia
| | - Hmoud Ali Algarni
- Department of Operative Dentistry and Endodontics, College of Dentistry, Jouf University, Sakaka, 72345, Saudi Arabia
| | - Swapna Munaga
- Restorative and Prosthetic Dental Sciences, College of Dentistry, King Saud Bin, Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - May Osman Hamza
- Department of Prosthetic Dental Sciences, College of Dentistry, Jouf University, Sakaka, Saudi Arabia
| | | | - Kavalipurapu Venkata Teja
- Department of Conservative Dentistry and Endodontics, Mamata Institute of Dental Sciences, Mamata Educational Society, Bachupally, Hyderabad, 500 090, India
| | - Krishnamachari Janani
- Department of Conservative Dentistry and Endodontics, SRM Dental College, SRM Institute of Science & Technology, Chennai, India
| | - Mohammad Khursheed Alam
- Department of Preventive Dentistry, College of Dentistry, Jouf University, Sakaka, Saudi Arabia
- Department of Dental Research Cell, Saveetha Institute of Medical and Technical Sciences, Saveetha Dental College and Hospitals, Chennai, 600077, India
- Department of Public Health, Faculty of Allied Health Sciences, Daffodil International University, Dhaka, 1207, Bangladesh
| | - Kumar Chandan Srivastava
- Department of Oral & Maxillofacial Surgery & Diagnostic Sciences, College of Dentistry, Jouf University, Sakaka, Saudi Arabia.
- Department of Oral Medicine and Radiology, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, 602105, 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] [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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Wang X, Wang D, Wang YR, Cheng XG, Ni LX, Wang W, Tian Y. Effect of access cavities on the biomechanics of mandibular molars: a finite element analysis. BMC Oral Health 2023; 23:196. [PMID: 37009868 PMCID: PMC10069102 DOI: 10.1186/s12903-023-02878-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/13/2023] [Indexed: 04/04/2023] Open
Abstract
INTRODUCTION This study aimed to predict the fracture resistance of a mandibular first molar (MFM) with diverse endodontic cavities using finite element analysis (FEA). METHODS Five experimental finite element models representing a natural tooth (NT) and 4 endodontically treated MFMs were generated. Treated MFM models were with a traditional endodontic cavity (TEC) and minimally invasive endodontic (MIE) cavities, including guided endodontic cavity (GEC), contracted endodontic cavity (CEC) and truss endodontic cavity (TREC). Three loads were applied, simulating a maximum bite force of 600 N (N) vertically and a normal masticatory force of 225 N vertically and laterally. The distributions of von Mises (VM) stress and maximum VM stress were calculated. RESULTS The maximum VM stresses of the NT model were the lowest under normal masticatory forces. In endodontically treated models, the distribution of VM stress in GEC model was the most similar to NT model. The maximum VM stresses of the GEC and CEC models under different forces were lower than those of TREC and TEC models. Under vertical loads, the maximum VM stresses of the TREC model were the highest, while under the lateral load, the maximum VM stress of the TEC model was the highest. CONCLUSION The stress distribution of tooth with GEC was most like NT. Compared with TECs, GECs and CECs may better maintain fracture resistance, TRECs, however, may have a limited effect on maintenance of the tooth resistance.
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Affiliation(s)
- Xiao Wang
- Department of Endodontics, School of Stomatology, State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, The Fourth Military Medical University, 710032, Xi'an, China
| | - Dan Wang
- Department of Endodontics, School of Stomatology, State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, The Fourth Military Medical University, 710032, Xi'an, China
| | - Yi-Rong Wang
- Department of Endodontics, School of Stomatology, State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, The Fourth Military Medical University, 710032, Xi'an, China
| | - Xiao-Gang Cheng
- Department of Endodontics, School of Stomatology, State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, The Fourth Military Medical University, 710032, Xi'an, China
| | - Long-Xing Ni
- Department of Endodontics, School of Stomatology, State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, The Fourth Military Medical University, 710032, Xi'an, China
| | - Wei Wang
- Department of Endodontics, School of Stomatology, State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, The Fourth Military Medical University, 710032, Xi'an, China.
| | - Yu Tian
- Department of Endodontics, School of Stomatology, State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, The Fourth Military Medical University, 710032, Xi'an, China.
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Gulabivala K, Ng YL. Factors that affect the outcomes of root canal treatment and retreatment-A reframing of the principles. Int Endod J 2023; 56 Suppl 2:82-115. [PMID: 36710532 DOI: 10.1111/iej.13897] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023]
Abstract
This paper undertakes a broad and comprehensive synthesis of relevant clinical, biological, biomechanical, technical and healthcare services data to understand the factors affecting outcomes of periapical healing after root canal (re)treatment. The medical and dental evidence-based era (1980-present) is contextualized with the earlier evidence drive in endodontics (1911-1940) triggered by the focal infection era. The current evidence-based approach has a sharper focus on evidence quality and derivation of practice guidelines. Contrary views question whether guideline-driven, or expertise-development-driven endeavours would best serve outcome improvement in society. The endodontic discipline functions in a broad healthcare framework and sustains industrial, economic and trend pressures that may be deemed to influence outcomes. The nature of root canal treatment and the challenges in determining the factors that affect its outcomes is discussed. The factors potentially affecting periapical healing after root canal treatment are classified into pre-operative, intra-operative and postoperative groups. These categories subsume multiple elements with interactive influences, creating a complex picture, further confounded by some apparently surprising, counter-intuitive and contradictory findings. The technical versus biological conundrum in root canal treatment continues to cause cognitive dissonance. However, due reflection and cross-discipline-synthesis resolve the apparent data conflicts into a very simple, consistent and plausible picture of how root canal treatment works and the key factors that affect periapical healing. Root canal retreatment is considered mainly in the context of its differences from primary treatment as the majority of factors influencing outcomes are common to both. The exceptional difference is that retreatments have a proportionately reduced probability of healing by virtue of compromised apical root canal ramification access or modified host/infection interactions. Root canal (re)treatment outcomes are dominantly influenced by the nature of prior dynamic host/infection interaction (pre-operative patient factors) and how the direction of this dynamic is influenced by two factors: (1) the active efficacy of the operators' root canal treatment protocol to sustain a microbial ecological shift (intra-operative treatment factors) and dampen periapical inflammation; and (2) the passive ability of the functional tooth (and its restoration margin) to maintain its integrity to resist infection reversal (postoperative restorative factors).
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Affiliation(s)
- Kishor Gulabivala
- Unit of Endodontology, Department of Restorative Dentistry, UCL Eastman Dental Institute, University College London, London, UK
| | - Yuan Ling Ng
- Unit of Endodontology, Department of Restorative Dentistry, UCL Eastman Dental Institute, University College London, London, UK
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Muacevic A, Adler JR, Makandar SD, Nik Abdul Ghani NR, Metgud S. Comparative Evaluation of Fracture Resistance of Endodontically Treated Teeth Instrumented With K3XF Rotary Files Using Different Tapers. Cureus 2023; 15:e34247. [PMID: 36843773 PMCID: PMC9957576 DOI: 10.7759/cureus.34247] [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: 01/24/2023] [Indexed: 01/28/2023] Open
Abstract
AIM To compare the effect of different tapers of the K3XF file system on the fracture resistance of endodontically treated mandibular premolars obturated with a three-dimensional (3-D) obturation system. METHODOLOGY For the study, 80 freshly extracted human mandibular premolars with single well-developed roots without any curvatures were taken and the tooth roots were wrapped in a single layer of aluminum foil, and they were placed vertically in a plastic mold filled with self-curing acrylic resin. The access was opened, and working lengths were determined. The canals were instrumented keeping an apical size of #30 by different taper rotary files: Group 1: un-instrumented (control group), Group 2: 30/.04, Group 3: 30/.06, Group 4: 30/.08 K3XF file system, and teeth were obturated using a 3-D obturation system, and access cavities were filled using composite. Both experimental and control groups were subjected to fracture load using a conical steel tip (0.5mm) attached to a universal testing machine to record force applied in newton until root fracture. RESULTS Root canal instrumented groups showed lower fracture resistance than the uninstrumented group. CONCLUSION Hence it could be concluded that endodontic instrumentation with increased taper rotary instruments caused a decrease in fracture resistance of the teeth, and biomechanical preparation of root canal system with rotary or reciprocating instruments caused a significant decrease in fracture resistance of endodontically treated teeth (ETT), thereby decreasing their prognosis and long-term survival.
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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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Divyasree V, Raghavendra Reddy JMV, Chandrasekhar V, Kasam S, Ramachandruni N, Penigalapati S, Aravelli S, Alam S. Influence of Access Cavity Design on the Fracture Strength of Endodontically Treated Teeth Restored Using Short Fiber-Reinforced Composite and High Strength Posterior Glass Ionomer Cement. Cureus 2022; 14:e28135. [PMID: 36134048 PMCID: PMC9482382 DOI: 10.7759/cureus.28135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2022] [Indexed: 11/05/2022] Open
Abstract
Aim: This in vitro study aimed to determine the influence of access cavity design and residual tooth structure and to compare the fracture resistance of the teeth post endodontically restored with short fiber-reinforced composite (GC everX Posterior; GC, India) and conventional posterior high-strength GIC (Glass Ionomer Cement) (GC Gold Label IX; GC, India). Methods: Ninety extracted human mandibular molars were classified into five groups, i.e., one control group (n = 10) and four test groups based on the access cavity design (n = 20): Traditional access cavity (TAC), Conservative access cavity (CAC), Ninja access cavity (NAC), and Truss access cavity (TRAC). Then 80 teeth in test groups were endodontically treated and further subdivided (n = 10) based on post-endodontic restorative materials, i.e., short fiber-reinforced composite (SFC) and Type 9 GIC. Samples were then subjected to fracture resistance under a universal testing machine and fracture loads were compared statistically. Results: The fracture resistance of various access cavity designs (TAC, CAC, NAC, and TRAC) varied significantly (P < .05). Regardless of access cavity design, teeth restored with SFC had higher fracture resistance than teeth restored with high strength posterior GIC (P = .001). Conclusion: Using newer access cavity designs like (CAC, NAC, and TRAC) and reinforcing the teeth with a post-endodontic restoration such as SFC, fracture resistance of endodontically treated teeth can be improved notably.
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Patil P, Newase P, Pawar S, Gosai H, Shah D, Parhad SM. Comparison of Fracture Resistance of Endodontically Treated Teeth With Traditional Endodontic Access Cavity, Conservative Endodontic Access Cavity, Truss Endodontic Access Cavity, and Ninja Endodontic Access Cavity Designs: An In Vitro Study. Cureus 2022; 14:e28090. [PMID: 36134072 PMCID: PMC9481229 DOI: 10.7759/cureus.28090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 08/16/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction: Endodontic access cavity preparation plays a vital role as preservation of enamel structure is of utmost importance for a tooth's strength to be maintained. As teeth become fragile after a root canal therapy, this study was designed to compare in vitro the fracture resistance of root-filled and restored teeth with traditional endodontic access cavity, conservative endodontic access cavity (CEC), ninja endodontic access cavity (NEC), and truss endodontic access cavity (TEC). Materials and methods: Control (intact teeth) and traditional endodontic access cavity as well as CEC, NEC, and TEC groups were each given a new human mandibular molar that was freshly removed. Cone beam computed tomography (CBCT) scans of the cone beam showed the values of CEC, NEC, and TEC. After that the teeth were endodontically treated and repaired. To test the specimens, universal testing equipment was used. In order to avoid tooth breakage, the maximum load was determined. Statistical analysis was used in the form of Kolmogorov-Smirnov and Levene tests, which were used to examine data for typical dispersion and consistency in change. Results: Intact teeth showed the highest resistance to fracture compared with other groups. TEC showed significantly higher resistance to fracture compared to the CEC design. Conclusions: It is possible, within the restrictions of this research, to infer that the TEC design enhanced tooth fracture strength in comparison with the CEC design.
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A Comparative Study of Two Martensitic Alloy Systems in Endodontic Files Carried out by Unskilled Hands. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12126289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The aim of this study was to compare the behavior of two heat-treated file systems on resin blocks in unskilled hands. For this purpose, an in vitro, randomized, cross-sectional study was conducted to compare ProTaper Gold (PTG) with BlueShaper (BS) files. A total of 81 resin blocks were used and analyzed photographically to assess the amount of material removed during instrumentation. PTG removed more material on the outside of the curve in the coronal and apical third, while BS removed more material on the inner part of the curve in the middle third. The procedural errors observed in the total sample were apical transportation (33.8%), blockages (4.9%), ledges (3.7%), and canal perforation. PTG produced more apical transportation, and there were no statistically significant differences between the groups in the formation of ledges, canal perforations, or blockages. No file fractures were recorded during the study. Within the limitations of this study, we can affirm that neither file excessively deformed the artificial canals, and the PTG file produced more apical transportation.
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Fracture resistance and biomechanical behavior of different access cavities of maxillary central incisors restored with different composite resins. Clin Oral Investig 2022; 26:6295-6303. [PMID: 35713701 DOI: 10.1007/s00784-022-04581-z] [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: 02/15/2022] [Accepted: 06/09/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The aim of this study was to compare the effect of three different access cavities on the tissue removal, deflection, fracture resistance, and stress distribution of extracted maxillary central incisors. MATERIALS AND METHODS Forty human maxillary central incisors were randomly assigned in four experimental group (n = 10) including conservative access cavity "CAC," traditional access cavity "TAC," invasive access cavity "IAC," and without access cavity (control group). Cone-beam computed tomography "CBCT" scans were used to evaluate the tissue removal during the different access cavities. All specimens were restored with composite resin (Admira Fusion, Voco, Cuxhaven, Germany) and embedded in acrylic resin blocks after simulating the periodontal ligament using red wax, then the specimens were submitted to the deflection test applying a load of 250 N and to the load-to-fracture test after artificial aging in a mechanical cycling machine (150 N, 5 × 106 cycles, 10 Hz). Lastly, stress distribution was assessed by three-dimensional finite element analysis (3D-FEA), simulating the specimens restoration by two types of composite resins of low and high elastic modulus (8 and 18 GPa respectively) after the access cavities. The data were submitted to Shapiro-Wilk and KS normality tests. Then, they were analyzed by one-way ANOVA and Tukey tests with a significance level (α ≤ 0.05). RESULTS CBCT scans showed a significant difference of worn tissues in CAC and TAC when compared to the IAC (P < 0.0001). In deflection test, CAC showed lower deformation values than the TAC and IAC. Load-to-fracture test presented no significant difference among the three experimental groups (P = 0.6901). 3D-FEA showed that the more conservative the access cavity, the higher the stress magnitude. CONCLUSIONS CAC promote less worn tissue; however, this does not improve the stress distribution or fracture resistance of endodontically treated maxillary incisors. CLINICAL RELEVANCE Clinicians should reconsider the pros and cons of the conservative access cavity.
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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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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: 3] [Impact Index Per Article: 1.5] [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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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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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: 21] [Impact Index Per Article: 10.5] [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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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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Vishwaja U, Surakanti J, Vemisetty H, Guntakandla V, Bingi S, Vantari S. In Vitro study of the effect of conservative endodontic cavities on fracture strength in mandibular molars using CBCT analysis. JOURNAL OF INDIAN ACADEMY OF ORAL MEDICINE AND RADIOLOGY 2022. [DOI: 10.4103/jiaomr.jiaomr_127_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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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: 3] [Impact Index Per Article: 1.0] [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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Sui H, Zhao B, Nie H, Hao X, Qiao F, Sun C, Li C, Zhou L, Wu L. Comparing the Traditional Versus Conservative Endodontic Access Cavities Design of the Maxillary First Molar: Using Cone-Beam Computed Tomography. Med Sci Monit 2021; 27:e932410. [PMID: 34642292 PMCID: PMC8522435 DOI: 10.12659/msm.932410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background This study aimed to compare the size and location of the traditional and conservative endodontic access cavities of the right maxillary first molar teeth, projected on the occlusal surface using cone-beam computed tomography (CBCT), to obtain an ideal access cavity. Material/Methods Five hundred CBCT images of the right maxillary first molars, including 198 males and 302 females, were retrospectively evaluated using KaVo eXam Vision software. First, a rectangular coordinate system was established. The coordinates of 4 pulp horns and 3 root canal orifices, which projected on the occlusal surface, were marked on it. Two different access cavities were then created by connecting these points: (1) traditional endodontic access cavity (TEC) required removal of the entire roof of the pulp chamber to establish a straight-line access to the root canal system; (2) conservative endodontic access cavity (CEC) was formed by connecting the projection of each root canal orifice on the occlusal. Data were analyzed using Kruskal-Wallis and Pearson’s correlation tests at a 5% significance level. Results The area of TEC was approximately 9.61 mm2 for males and 8.91 mm2 for females. The area of CEC was approximately 3.4 mm2 for males and 3.16 mm2 for females. The projections of all pulp horns and root canal orifices were in or near the central area of nine-rectangle-grid. Conclusions Compared with the traditional access cavity, creating a conservative access cavity was less invasive. Meanwhile, the access cavity should be limited to the central or near the central area of nine-rectangle-grid.
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Affiliation(s)
- Huachao Sui
- Department of Endodontics, College of Stomatology,Tianjin Medical University, Tianjin, China (mainland)
| | - Bo Zhao
- Department of Stomatology, The First Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Haidan Nie
- Department of Endodontics, College of Stomatology, Tianjin Medical University, Tianjin, China (mainland)
| | - Xin Hao
- Department of Endodontics, College of Stomatology,Tianjin Medical University, Tianjin, China (mainland)
| | - Feng Qiao
- Department of Maxillofacial Surgery, College of Stomatology, Tianjin Medical University, Tianjin, China (mainland)
| | - Cuicui Sun
- Department of Endodontics, College of Stomatology, Tianjin Medical University, Tianjin, China (mainland)
| | - Changyi Li
- School of Stomatology, Tianjin Medical University, Tianjin, China (mainland)
| | - Liwen Zhou
- Department of Endodontics, College of Stomatology, Tianjin Medical University, Tianjin, China (mainland)
| | - Ligeng Wu
- Department of Endodontics, College of Stomatology, Tianjin Medical University, Tianjin, China (mainland)
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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, 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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Santosh SS, Ballal S, Natanasabapathy V. Influence of Minimally Invasive Access Cavity Designs on the Fracture Resistance of Endodontically Treated Mandibular Molars Subjected to Thermocycling and Dynamic Loading. J Endod 2021; 47:1496-1500. [PMID: 34237385 DOI: 10.1016/j.joen.2021.06.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The aim of this study was to investigate the fracture resistance of endodontically treated and restored permanent mandibular molars with minimally invasive access cavities subjected to thermocycling and dynamic loading. METHODS Forty first and second mandibular molars were randomly assigned to 4 groups (n = 10/group) as follows: group 1, control (intact teeth); group 2, traditional access cavity (TradAC); group 3, conservative access cavity (ConsAC); and group 4, truss access cavity (TrecAC). After endodontic treatment, teeth were restored with SDR core (Dentsply Caulk, Milford, DE) and subjected to thermocycling followed by dynamic and static loading with a multiaxial fatigue testing machine (Instron, Canton, MA). The maximum load to fracture and pattern of failure (restorable/unrestorable) were recorded. Data were evaluated with analysis of variance and the Tukey post hoc test for multiple comparisons. RESULTS Fracture resistance of the samples in the control group were higher than those in the experimental groups (P < .005). TradAC exhibited the least resistance to fracture (P < .005). There was no statistically significant difference in the fracture resistance of ConsAC and TrecAC (P = .361) Unrestorable fractures were more frequent in the TradAC group compared with all other groups. CONCLUSIONS Mandibular molars with ConsAC and TrecAC exhibited superior fracture resistance compared with TradAC. TradAC had the highest number of unrestorable fractures.
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Affiliation(s)
- Sneha Susan Santosh
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Ammal Dental College and Hospital, Meenakshi Academy of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Suma Ballal
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Ammal Dental College and Hospital, Meenakshi Academy of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Velmurugan Natanasabapathy
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Ammal Dental College and Hospital, Meenakshi Academy of Higher Education and Research, Chennai, Tamil Nadu, India.
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Lin F, Ordinola-Zapata R, Xu H, Heo YC, Fok A. Laboratory simulation of longitudinally cracked teeth using the step-stress cyclic loading method. Int Endod J 2021; 54:1638-1646. [PMID: 33852743 DOI: 10.1111/iej.13530] [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: 08/05/2020] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 12/14/2022]
Abstract
AIM To simulate in a laboratory setting longitudinal cracking in root filled premolar teeth, using cyclic mechanical fatigue. METHODOLOGY Mesial-occlusal-distal (MOD) cavities were prepared in twenty root filled, single-rooted, mandibular premolars restored with fibre posts and resin composites. The samples were randomly divided into two groups based on the loading approaches: static loading with a crosshead speed of 0.5 mm/min and step-stress cyclic loading (1 Hz) with increasing amplitude. The loads and numbers of cycles to failure were recorded. Micro-CT was also used to identify the fracture modes. Statistical analysis was performed using Student's t-test. The level of significance was set at 0.05. RESULTS The mean fracture loads for the static loading and cyclic loading groups were 769 ± 171 N and 720 ± 92 N, respectively. There was no significant difference between the two groups (P > 0.05). The proportions of longitudinal, cuspal and mixed-mode fractures under cyclic loading were 50%, 20% and 30%, respectively. Longitudinal fractures occurred with larger numbers of cycles and higher average loads per cycle compared with the other fractures. Static loading produced only cuspal fractures. CONCLUSIONS Longitudinally cracked premolar teeth with root fillings were successfully produced using the step-stress cyclic loading method. This provides a more clinically representative methodology for studying cracked teeth in a laboratory setting.
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Affiliation(s)
- F Lin
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology, Beijing, China.,Minnesota Dental Research Center for Biomaterials and Biomechanics, School of Dentistry, University of Minnesota, Minneapolis, USA
| | - R Ordinola-Zapata
- Division of Endodontics, Department of Restorative Sciences, School of Dentistry, University of Minnesota, Minneapolis, USA
| | - H Xu
- Department of Stomatology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Y C Heo
- Minnesota Dental Research Center for Biomaterials and Biomechanics, School of Dentistry, University of Minnesota, Minneapolis, USA
| | - A Fok
- Minnesota Dental Research Center for Biomaterials and Biomechanics, School of Dentistry, University of Minnesota, Minneapolis, USA
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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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Smoljan M, Hussein MO, Guentsch A, Ibrahim M. Influence of Progressive Versus Minimal Canal Preparations on the Fracture Resistance of Mandibular Molars: A 3-Dimensional Finite Element Analysis. J Endod 2021; 47:932-938. [PMID: 33774046 DOI: 10.1016/j.joen.2021.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/14/2021] [Accepted: 03/16/2021] [Indexed: 12/28/2022]
Abstract
INTRODUCTION This study compared the residual tooth strength and stress distribution of a mandibular molar prepared with different variable tapered file systems using finite element analysis (FEA). METHODS Two preaccessed mandibular molar TruTeeth (Endo 3DP; Acadental, Lenexa, KS) were subjected to simulated endodontic treatment in this study. One tooth was instrumented with ProTaper Gold (Dentsply Tulsa Dental Specialties, Tulsa, OK), and the other was instrumented with V-Taper 2H (SS White Dental, Lakewood, NJ). The 2 teeth were scanned using micro-computed tomographic imaging, and stereolithographic surface meshes were developed for FEA. Each model was subjected to a 200-N multipoint load-simulating mastication. The results of the FEA provided quantitative and qualitative measurements for von Mises stress distribution and total deformation. RESULTS The maximum von Mises stress was greater in the ProTaper Gold-prepared model than the V-Taper 2H prepared model. In both models, total deformation values were highest in the clinical crown on the buccal aspect of the tooth. The highest stress values were found in the pericervical dentin, and stress decreased apically through the root. CONCLUSIONS Within the limitations of this study, it can be concluded that the maximum stress values within the tooth prepared by ProTaper Gold were higher than those in the tooth prepared by V-Taper 2H. Canal preparation with the V-Taper 2H system preserves more pericervical dentin, which may increase the resistance to fracture.
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Affiliation(s)
| | - Mostafa Omran Hussein
- Department of Prosthodontic Sciences, College of Dentistry in Ar Rass, Qassim Univesity, Al Qassim, Saudi Arabia
| | - Arndt Guentsch
- Program in Periodontics, Marquette University School of Dentistry, Milwaukee, Wisconsin
| | - Mohamed Ibrahim
- Program in Endodontics, Marquette University School of Dentistry, Milwaukee, Wisconsin; Program in Endodontics, Faculty of Dentistry, Mansoura University, Mansoura, Egypt.
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Sarvaiya UP, Rudagi K, Joseph J. A comparative evaluation of the effect of different access cavity designs on root canal instrumentation efficacy and resistance to fracture assessed on maxillary central incisors: An in vitro study. J Conserv Dent 2021; 23:609-614. [PMID: 34083918 PMCID: PMC8095689 DOI: 10.4103/jcd.jcd_600_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/13/2020] [Accepted: 12/21/2020] [Indexed: 11/13/2022] Open
Abstract
Aim: The purpose of this study is to evaluate and compare the effect of different access cavity designs on root canal instrumentation efficacy using micro-computed tomography (CT) scan and resistance to fracture evaluated using the universal testing machine on maxillary central incisor. Materials and Methodology: Forty extracted human permanent maxillary central incisors were divided into four groups for each access cavity. The access cavities were prepared according to predefined criteria and were further assessed under Micro-CT to evaluate pre and postoperative instrumentation efficacy. After biomechanical preparation and obturation, the teeth were wrapped with tin foil to maintain a thickness of 0.2–0.3 mm as periodontal ligament. Then, the silicon impression material was applied in the acrylic alveolus, to maintain and simulate the thickness of periodontal ligament and fracture resistance was checked using the universal testing machine. Statistical Analysis: Data were analyzed using one-way analysis of variance test. Pair-wise comparison was made using post hoc multiple comparison (Tukey) test. Results: Fracture resistance was highest (1272 N) for the control group followed by the Lingual Conventional Access Group (1153.90 N). Fracture resistance for Lingual Cingulum Access Group was 1130.70 N and least for the Lingual Incisal Straight-Line Access Group (1022.80 N). This difference in fracture resistance among all the groups was significant (P = 0.001). Overall comparison showed that dentin volume reduction (DVR) for Group II was 22.45 mm3, for Group III was 17.37 mm3 and for Group IV was 28. 41 mm3. This difference in DVR among the three groups was significant (P = 0.001). Conclusion: The most effective instrumentation efficacy was obtained in lingual incisal straight-line access group, followed by lingual cingulum access group, followed by lingual conventional access group. The most effective fracture resistance was obtained in the lingual conventional access group, followed by the lingual cingulum access group, followed by the lingual incisal straight-line access group.
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Affiliation(s)
- Umesh Prabhat Sarvaiya
- Department of Conservative Dentistry and Endodontics, ACPM Dental College, Dhule, Maharashtra, India
| | - Kavitarani Rudagi
- Department of Conservative Dentistry and Endodontics, ACPM Dental College, Dhule, Maharashtra, India
| | - Jinet Joseph
- Department of Conservative Dentistry and Endodontics, ACPM Dental College, Dhule, Maharashtra, India
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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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Matelski J, Rendahl A, Goldschmidt S. Effect of Alternative Palatal Root Access Technique on Fracture Resistance of Root Canal Treated Maxillary Fourth Premolar Teeth in Dogs. Front Vet Sci 2020; 7:600145. [PMID: 33363238 PMCID: PMC7759647 DOI: 10.3389/fvets.2020.600145] [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: 08/28/2020] [Accepted: 11/20/2020] [Indexed: 11/13/2022] Open
Abstract
A biomechanical study was performed to identify the effect of different treatment methods for difficult to instrument palatal roots on the fracture resistance of root canal treated maxillary fourth premolar teeth in dogs. Forty maxillary fourth premolar teeth with surrounding alveolar bone were harvested from beagle cadavers. Inclusion criteria included maxillary fourth premolars with no evidence of disease and similar distal root canal volumes on radiographic evaluation. The teeth were randomly divided into a control group and three treatment groups based on the endodontic treatment technique for the palatal root. The control group had a single 2 mm transcoronal access on the mesiobuccal aspect of the tooth to allow instrumentation of both the mesiobuccal and palatal root through a single small access. Alternative treatment modalities that are described for difficult to instrument palatal roots investigated in this study included enlarging the transcoronal mesiobuccal access to 4 mm, making an additional access directly over the palatal root (2 mm), and hemisection with extraction of the palatal root. All teeth had the same distal root access size (2 mm) and relative location. After access, all teeth were filed, shaped, obturated, and restored in the same fashion. Axial compression testing was performed at an angle of 60 degrees to the long axis of the tooth using a universal materials testing machine. The maximum force prior to fracture was determined for each tooth based on a force vs. deflection curve. The mean maximum force prior to fracture for all teeth was 831 N. No significant difference in mean fracture resistance was identified between the control group and treatment groups or between the different treatment groups themselves. Thus, when faced with a difficult to instrument palatal root, the treatment method chosen should be based on operator preference and experience.
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Affiliation(s)
- Jennifer Matelski
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, United States
| | - Aaron Rendahl
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, United States
| | - Stephanie Goldschmidt
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, United States
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Kostunov J, Rammelsberg P, Klotz AL, Zenthöfer A, Schwindling FS. Minimization of Tooth Substance Removal in Normally Calcified Teeth Using Guided Endodontics: An In Vitro Pilot Study. J Endod 2020; 47:286-290. [PMID: 33245970 DOI: 10.1016/j.joen.2020.10.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/18/2020] [Accepted: 10/26/2020] [Indexed: 11/15/2022]
Abstract
INTRODUCTION This study evaluated the success rate of and tooth substance removal required for computer-guided preparation of endodontic access cavities. METHODS Thirty acrylic typodont teeth with root canals (10 each of tooth numbers 11, 14, and 17) were randomly allocated to a study or control group (15 teeth per group). In the study group, teeth were fixed in acrylic resin and subsequently digitized using a laboratory scanner. A cone-beam computed tomographic scan was then taken. Access cavity preparations were planned virtually, and a template was 3-dimensionally printed. In the control group, access cavities were prepared using the conventional access technique. Tooth substance removal was assessed by weighing teeth before and after preparation. Volume loss was analyzed statistically by use of the Wilcoxon-Mann-Whitney test at a significance level of P < .05. RESULTS Using guided endodontics, 93.3% of root canals were located successfully compared with 100% of root canals using the conventional technique. In the control group, the mean tooth substance removal was 16.1 ± 3.7 mm³ for incisors, 44.2 ± 8.9 mm³ for premolars, and 99.3 ± 3.1 mm³ for molars. In the study group, significantly less tooth substance was removed; substance loss was 10.3 ± 1.1 mm³ for incisors, 29.3 ± 4.2 mm³ for premolars, and 51.8 ± 5.3 mm³ for molars. CONCLUSIONS The use of guided endodontics in normally calcified teeth enables the preservation of a significant amount of tooth substance. However, this advantage must be carefully balanced against a greater radiation burden and risk of perforation, higher costs, and more difficult debridement and visualization of the pulp chamber and root canals.
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Affiliation(s)
- Jana Kostunov
- Department of Prosthetic Dentistry, Heidelberg University Hospital, Heidelberg, Germany.
| | - Peter Rammelsberg
- Department of Prosthetic Dentistry, Heidelberg University Hospital, Heidelberg, Germany
| | - Anna-Luisa Klotz
- Department of Prosthetic Dentistry, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas Zenthöfer
- Department of Prosthetic Dentistry, Heidelberg University Hospital, Heidelberg, Germany
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Chamberless Endodontic Access for Treatment of Calcified Anterior Central Incisors. J Endod 2020; 47:322-326. [PMID: 33129898 DOI: 10.1016/j.joen.2020.10.017] [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: 09/04/2020] [Revised: 10/21/2020] [Accepted: 10/26/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Modern techniques for treating maxillary anterior central incisors with calcified canals emphasize maintaining coronal dentin with small crown access. Alternatively, traditional retrograde surgical procedures are focused on creating an apical seal predominately limited to the remaining resected apical one third of the root canal space. A treatment option for calcified anterior teeth, with avoidance of traditional orthograde access, is presented. Chamberless endodontic access (CEA) to the canal is chosen in this case, leveraging a previous surgical treatment and osseous defect to create straight line canal access. METHODS A tooth presenting with a chronic apical abscess and an apparent previous apical surgery was instrumented and obturated using a CEA avoiding the traditional orthograde approach to the root canal system. Straight line approach was achieved retrograde and canal instrumentation was performed using ultrasonic activated U-files. Canal obturation was accomplished with warm vertical condensation technique followed by placement of an apical retroseal. RESULTS A successful 52-month outcome demonstrated the viability of CEA facilitating retrograde instrumentation and obturation. CONCLUSIONS Use of CEA simultaneously protected the clinical crown and provided a successful clinical outcome. A viable option for treatment of an anterior calcified canal and abscess due to dental trauma, CEA mitigates many of the risks associated with the treatment of calcified root anatomy.
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Tsotsis P, Dunlap C, Scott R, Arias A, Peters OA. A survey of current trends in root canal treatment: access cavity design and cleaning and shaping practices. AUST ENDOD J 2020; 47:27-33. [PMID: 33030288 DOI: 10.1111/aej.12449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 09/16/2020] [Indexed: 01/26/2023]
Abstract
The purpose of this study was to evaluate current trends in access cavity design and cleaning and shaping among endodontists. A survey was e-mailed to active members of the American Association of Endodontists. Data showed that most respondents used traditional (57%) or conservative (43%) access cavities; less than 1% reported using ultraconservative access cavities. A glide path was created by 93% of respondents; NaOCl was used as lubricant by 51% of respondents, while 28% used RC Prep, 9% used liquid EDTA, 7% used Glyde, and 2% did not use any lubricant. Most respondents used NaOCl at 5.25% or higher concentration. Smear layer was removed by 92% of endodontists. Apical gauging was mostly accomplished with hand files. Clinical preferences varied among surveyed endodontists and among different age groups. Currently, very few endodontists use ultraconservative access preparations. There was large variation among the respondents suggesting a possible need for quality guidelines.
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Affiliation(s)
- Polymnia Tsotsis
- Department of Endodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, California, USA
| | - Craig Dunlap
- Department of Endodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, California, USA
| | - Raymond Scott
- Department of Endodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, California, USA
| | - Ana Arias
- Department of Conservative Dentistry, School of Dentistry, Complutense University, Madrid, Spain
| | - Ove A Peters
- Department of Endodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, California, USA.,School of Dentistry, University of Queensland, Herston, Queensland, Australia
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Maqbool M, Noorani TY, Asif JA, Makandar SD, Jamayet NB. Controversies in endodontic access cavity design: A literature review. ACTA ACUST UNITED AC 2020. [DOI: 10.12968/denu.2020.47.9.747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose of this article is to compare and contrast the different types of endodontic access cavity designs based on the current available evidence. Four types of access cavity designs, namely, traditional endodontic access cavity design (TEC), contracted/conservative endodontic access cavity design (CEC), ultra-conservative or ninja endodontic access cavity design (NEC) and truss endodontic access cavity design (TREC) have been suggested, and the latter three are currently in the limelight. Studies in vitro have been performed comparing the TECs, CECs, TRECs and NECs; except for the TECs, the other three types have not undergone clinical trials on patients. The choice of endodontic access cavity design affects fracture strength of the tooth, but remnants of pulpal tissue, due to ineffective instrumentation, can cause root canal treatment failure. CPD/Clinical Relevance: Root canal treatment with new access cavity designs has been proposed. However, there is lack of evidence to support such practices. It is important to consider the potential deleterious effects of such access cavity designs rather than emphasizing the preservation of tooth structure alone.
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Affiliation(s)
| | | | - Jawaad Ahmed Asif
- BDS, MOMS, FRACDS, Senior Lecturer, Oral and Maxillofacial Surgery Unit
| | | | - Nafij Bin Jamayet
- BDS, Grad DipClinSc, MScDent, Senior Lecturer, Prosthodontics Unit, School of Dental Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kota Bharu, Kelantan, Malaysia
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Isufi A, Plotino G, Grande NM, Testarelli L, Gambarini G. Standardization of Endodontic Access Cavities Based on 3-dimensional Quantitative Analysis of Dentin and Enamel Removed. J Endod 2020; 46:1495-1500. [DOI: 10.1016/j.joen.2020.07.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/12/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
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Maske A, Weschenfelder VM, Soares Grecca Vilella F, Burnett Junior LH, Melo TAF. Influence of access cavity design on fracture strength of endodontically treated lower molars. AUST ENDOD J 2020; 47:5-10. [DOI: 10.1111/aej.12446] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Aline Maske
- Dentistry College Universidade Federal do Rio Grande do Sul Porto Alegre Brazil
| | | | - Fabiana Soares Grecca Vilella
- Endodontic Division Department of Conservative Dentistry Universidade Federal do Rio Grande do Sul Porto Alegre Brazil
| | - Luiz Henrique Burnett Junior
- Clinical Department Post‐Graduate Program Dental School Pontifícia Universidade Católica do Rio Grande do Sul Porto Alegre Brazil
| | - Tiago André Fontoura Melo
- Endodontic Division Department of Conservative Dentistry Universidade Federal do Rio Grande do Sul Porto Alegre Brazil
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Augusto CM, Barbosa AFA, Guimarães CC, Lima CO, Ferreira CM, Sassone LM, Silva EJNL. A laboratory study of the impact of ultraconservative access cavities and minimal root canal tapers on the ability to shape canals in extracted mandibular molars and their fracture resistance. Int Endod J 2020; 53:1516-1529. [DOI: 10.1111/iej.13369] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/08/2020] [Accepted: 07/15/2020] [Indexed: 01/15/2023]
Affiliation(s)
- C. M. Augusto
- Department of Endodontics School of Dentistry State University of Rio de Janeiro (UERJ) Rio de Janeiro RJBrazil
| | - A. F. A. Barbosa
- Department of Endodontics School of Dentistry State University of Rio de Janeiro (UERJ) Rio de Janeiro RJBrazil
| | - C. C. Guimarães
- Department of Endodontics School of Dentistry State University of Rio de Janeiro (UERJ) Rio de Janeiro RJBrazil
| | - C. O. Lima
- Department of Endodontics School of Dentistry State University of Rio de Janeiro (UERJ) Rio de Janeiro RJBrazil
| | - C. M. Ferreira
- Department of Endodontics School of Dentistry State University of Rio de Janeiro (UERJ) Rio de Janeiro RJBrazil
| | - L. M. Sassone
- Department of Endodontics School of Dentistry State University of Rio de Janeiro (UERJ) Rio de Janeiro RJBrazil
| | - E. J. N. L. Silva
- Department of Endodontics School of Dentistry State University of Rio de Janeiro (UERJ) Rio de Janeiro RJBrazil
- Department of Endodontics School of Dentistry Grande Rio University (UNIGRANRIO) Rio de Janeiro RJ Brazil
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Silva EJNL, Pinto KP, Ferreira CM, Belladonna FG, De-Deus G, Dummer PMH, Versiani MA. Current status on minimal access cavity preparations: a critical analysis and a proposal for a universal nomenclature. Int Endod J 2020; 53:1618-1635. [PMID: 32854167 DOI: 10.1111/iej.13391] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/17/2020] [Accepted: 08/19/2020] [Indexed: 12/14/2022]
Abstract
In the last decade, several access cavity designs involveing minimal removal of tooth tissue have been described for gaining entry to pulp chambers during root canal treatment. The premise behind this concept assumes that maximum preservation of as much of the pulp chamber roof as possible during access preparation would maintain the fracture resistance of teeth following root canal treatment. However, the smaller the access cavity, the more difficult it may be to visualize and debride the pulp chamber as well as locate, shape, clean and fill the canals. At the same time, a small access cavity may increase the risk of iatrogenic complications as a result of poor visibility, which may have an impact on treatment outcome. This study aimed to critically analyse the literature on minimal access cavity preparations, propose new nomenclature based on self-explanatory abbreviations and highlight the areas in which more research is required. The search was conducted without restrictions using specifics terms and descriptors in four databases. A complementary screening of the references within the selected studies, as well as a manual search in the highest impact journals in endodontics, namely International Endodontic Journal and Journal of Endodontics, was also performed. The initial search retrieved 1831 publications. The titles and abstracts of these papers were reviewed, and the full text of 94 studies was assessed. Finally, a total of 28 studies were identified as evaluating the influence of minimally invasive access cavity designs on the fracture resistance of teeth and on the different stages of root canal treatment (orifice location, canal shaping, canal cleaning, canal filling and retreatment). Overall, the studies had major methodological drawbacks and reported inadequate and/or inconclusive results on the utility of minimally invasive access preparations. Furthermore, they offered limited scientific evidence to support the use of minimally invasive access cavities to improve the outcome of root canal treatment and retreatment; they also provided little evidence that they preserved the fracture resistance of root filled teeth to a greater extent than traditional access cavity preparations. It was concluded that at present, there is a lack of supporting evidence for the introduction of minimally invasive access cavity preparation into routine clinical practice and/or training of undergraduate and postgraduate students.
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Affiliation(s)
- E J N L Silva
- Department of Endodontics, School of Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, RJ, Brazil.,Department of Endodontics, School of Dentistry, Rio de Janeiro State University (UERJ), Rio de Janeiro, RJ, Brazil.,Department of Endodontics, School of Dentistry, Fluminense Federal University (UFF), Niterói, RJ, Brazil
| | - K P Pinto
- Department of Endodontics, School of Dentistry, Rio de Janeiro State University (UERJ), Rio de Janeiro, RJ, Brazil
| | - C M Ferreira
- Department of Endodontics, School of Dentistry, Rio de Janeiro State University (UERJ), Rio de Janeiro, RJ, Brazil
| | - F G Belladonna
- Department of Endodontics, School of Dentistry, Fluminense Federal University (UFF), Niterói, RJ, Brazil
| | - G De-Deus
- Department of Endodontics, School of Dentistry, Fluminense Federal University (UFF), Niterói, RJ, Brazil
| | - P M H Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - M A Versiani
- Department of Endodontics, School of Dentistry, Fluminense Federal University (UFF), Niterói, RJ, Brazil
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48
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Silva EJNL, Oliveira VB, Silva AA, Belladonna FG, Prado M, Antunes HS, De‐Deus G. Effect of access cavity design on gaps and void formation in resin composite restorations following root canal treatment on extracted teeth. Int Endod J 2020; 53:1540-1548. [DOI: 10.1111/iej.13379] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 12/11/2022]
Affiliation(s)
- E. J. N. L. Silva
- Department of Endodontics Grande Rio University Duque de CaxiasBrazil
- Department of Endodontics Fluminense Federal University NiteróiBrazil
| | - V. B. Oliveira
- Department of Endodontics Grande Rio University Duque de CaxiasBrazil
| | - A. A. Silva
- Department of Endodontics Grande Rio University Duque de CaxiasBrazil
| | - F. G. Belladonna
- Department of Endodontics Fluminense Federal University NiteróiBrazil
| | - M. Prado
- Department of Endodontics Veiga de Almeida University Rio de Janeiro Brazil
| | - H. S. Antunes
- Department of Endodontics Grande Rio University Duque de CaxiasBrazil
| | - G. De‐Deus
- Department of Endodontics Fluminense Federal University NiteróiBrazil
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49
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Impacts of contracted endodontic cavities compared to traditional endodontic cavities in premolars. BMC Oral Health 2020; 20:250. [PMID: 32894117 PMCID: PMC7487681 DOI: 10.1186/s12903-020-01237-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 08/27/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND This study aims to compare the percentage of dentin removed, instrumentation efficacy, root canal filling and load at fracture between contracted endodontic cavities, and traditional endodontic cavities on root canal therapy in premolars. METHODS Forty extracted intact human first premolars were imaged with micro-CT and randomly assigned to the contracted endodontic cavity (CEC) or traditional endodontic cavity (TEC) groups. CEC was prepared with the aid of a 3D-printed template, canals were prepared with a 0.04 taper M-Two rotary instrument, and cavities were restored with resin. Specimens were loaded to fracture in an Instron Universal Testing Machine after a fatigue phase. The data were analyzed by the independent samples T test and Mann-Whitney U test, appropriate post hoc tests. RESULTS In the premolars tested in vitro, the percentage of dentin removed in the premolars with two dental roots in the CEC group (3.85% ± 0.42%) was significantly smaller (P < 0.05) than in the TEC group (4.94% ± 0.5%). The untouched canal wall (UCW) after instrumentation for TECs (16.43% ± 6.56%) was significantly lower (P < .05) than the UCW (24.42% ± 9.19%) for CECs in single-rooted premolars. No significant differences were observed in the increased canal volume and surface areas in premolars between the TEC and CEC groups (P > 0.05). CECs conserved coronal dentin in premolars with two dental roots but no impact on the instrument efficacy. There were no differences between the CEC groups and the TEC groups in the percentage of filling material and voids (P > 0.05). In addition, the mean load at failure of premolars did not significantly differ between the CEC and TEC groups and there was no significant difference in the type of fracture (P > 0.05). CONCLUSION The results of this study suggest that CEC could not improve the fracture resistance of the endodontically treated premolars. The instrumentation efficacy and the percentage of filling material did not significantly differ between CECs and TECs in premolars.
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50
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Gambarini G, Galli M, Morese A, Stefanelli LV, Abduljabbar F, Giovarruscio M, Di Nardo D, Seracchiani M, Testarelli L. Precision of Dynamic Navigation to Perform Endodontic Ultraconservative Access Cavities: A Preliminary In Vitro Analysis. J Endod 2020; 46:1286-1290. [DOI: 10.1016/j.joen.2020.05.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/09/2020] [Accepted: 05/31/2020] [Indexed: 12/13/2022]
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