Intracanal placement of Ca(OH)2: a comparison of techniques

Efficacy of different irrigation needles and ultrasonic activation on calcium hydroxide removal: a micro-CT study using 3D-printed endodontic models

INTRODUCTION

The aim of this study was to evaluate the efficacy of different irrigation needles and passive ultrasonic activation in removing Ca(OH)2 from an endodontic model that duplicated a root canal configuration of a human natural tooth.

METHODS

An extracted human maxillary premolar was subjected to root canal preparation and scanned with microcomputed tomography (micro-CT). A 3-dimensional reconstruction model of the natural tooth was printed to endodontic models using a polyjet printer. The root canals of the models were filled with Ca(OH)2 paste and divided into two groups based on the irrigation protocol: conventional syringe-needle irrigation (conventional group) and passive ultrasonic irrigation (PUI group). Each group was subdivided into three groups (n = 10) according to the type of needle: half-cut, side-vented, and TruNatomy irrigation needle. Micro-CT imaging was used to assess the percentage of reduction of Ca(OH)2. Data were analyzed using two-way analysis of variance test (α = .05).

RESULTS

The side-vented and TruNatomy irrigation needles showed significantly higher percentage reductions than the half-cut needle (P < .05) in the conventional irrigation group. The PUI group showed significantly higher percentage reductions of Ca(OH)2 than the conventional group regardless of the type of needle (P < .05). However, no significant difference was found among the needles in the PUI group.

CONCLUSIONS

The type of irrigation needle and the use of PUI influenced the removal efficacy of Ca(OH)2. PUI enhanced the removal of Ca(OH)2 regardless of the type of irrigation needle.

Micro-computed tomography analysis of calcium hydroxide delivery efficacy in C-shaped canal system of mandibular second molars

BACKGROUND

Calcium hydroxide [Ca(OH)2] is widely accepted as a biocompatible interappointment intracanal medicament. This study aimed to analyze the efficacy of Ca(OH)2 placement into the C-shaped canal system of mandibular second molars using the syringe method with and without lentulo spiral utilizing micro-computed tomography (micro-CT).

METHODS

Twenty-four extracted mandibular second molars were instrumented and classified into C-shaped floors (n = 12) and non-C-shaped floors (n = 12). Both groups were placed with Ca(OH)2 using the syringe system, then all teeth were scanned and cleaned, and placed with Ca(OH)2 again but with the syringe system followed by lentulo spiral and rescanned. The specimens were scanned using micro-CT to analyze the volume, volume percentage, uncontacted surface area, and uncontacted surface area percentage of Ca(OH)2 with the two delivery methods in the entire canal and at the apical 4 mm of the canal. Mann-Whitney test and Wilcoxon signed-rank test were used to determine the statistical differences among the groups.

RESULTS

Syringe administration used in conjunction with lentulo spiral presented lower uncontacted surface area, a lower percentage of uncontacted surface area, larger volume, and a higher percentage of volume than syringe without lentulo spiral (P < 0.05). There was no significant difference between the C-shaped floor group and the non-C-shaped floor group (P > 0.05) in the Ca(OH)2 uncontacted surface area, volume, and percentages at different regions of canals and among different delivery techniques groups.

CONCLUSIONS

The lentulo spiral and syringe technique combination can increase the volume and contacted surface area of Ca(OH)2 in the C-shaped canal system of mandibular second molars.

Assessing the efficacy of jet dispenser versus direct syringe injection for calcium hydroxide paste placement in artificial root canals

This study aimed to evaluate the efficacy of a novel jet dispenser (JD) for filling simulated straight and curved canals with calcium hydroxide (Ca(OH)2) paste by comparing the level of intracanal medicament with traditional direct syringe delivery. The Ca(OH)2 paste was delivered into the canals using either a direct syringe with binding tip and unbinding tip or a JD. The analysis of the ratio of the canal filled area (RCFA) in the coronal, middle, and apical thirds was conducted using the Kruskal-Wallis and Mann-Whitney U tests (α = 0.05). The JD resulted in a significantly higher RCFA of 1.00 in the middle and apical thirds in both the straight and curved canals than the direct syringe method (p < 0.001). Voids were frequently observed in the direct syringe group, whereas JD showed no voids within the filled area. In the direct syringe groups, the apical area was more readily filled in both canal types when the tip was bound (p < 0.001). The JD was found to be more effective in filling the entire canal space than the binding and unbinding conditions of the direct injection method, particularly in the apical area.

Advancing Nitinol: From heat treatment to surface functionalization for nickel–titanium (NiTi) instruments in endodontics

Nickel-titanium (NiTi) alloy has been extensively researched in endodontics, particularly in cleaning and shaping the root canal system. Research advances have primarily focused on the design, shape, and geometry of the NiTi files as well as metallurgy and mechanical properties. So far, extensive investigations have been made surrounding surface and thermomechanical treatments, however, limited work has been done in the realm of surface functionalization to augment its performance in endodontics. This review summarizes the unique characteristics, current use, and latest developments in thermomechanically treated NiTi endodontic files. It discusses recent improvements in nano-engineering and the possibility of customizing the NiTi file surface for added functionalization. Whilst clinical translation of this technology has yet to be fully realized, future research direction will lie in the use of nanotechnology.

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Nitinol (Nickel Titanium alloy) is widely used to clean/shape root canal system in endodontics.

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To enhance its performance, various thermo-mechanical and nano-engineering modifications have been performed.

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This comprehensive review summarizes the latest advances and future trends relating to functionalized NiTi endodontic files.

Comparative Evaluation of Efficacy of Obturation Techniques in Deciduous Teeth Using Cone-beam Computed Tomography: An In Vivo Study

Introduction

Pediatric dentistry has evolved from extraction acclimatized practice to prevention and preservation. Successful endodontic treatment is mandated for retention of pulpally involved primary teeth.

Aim and objective

To comparatively evaluate the obturation techniques namely lentulospiral and skini syringe with NaviTip in primary teeth using cone-beam computed tomography (CBCT).

Materials and methods

The study was carried out among children ranging between the ages of 4 years and 8 years of either sex with pulpal involvement of primary molars which were indicated for pulpectomy. The study population was divided into two groups according to the type of obturating technique used. Group I included samples obturated with lentulospirals while group II samples were obturated using skini syringes with NaviTip. Postoperatively, CBCT imaging was used to evaluate the quality of fill of both the obturation techniques by determining the presence of voids in the root canals.

Results

The total number of voids present in group I were 48, in which, 8 were in the coronal third, 16 in the middle third, and 24 in the apical third. On the other hand, the total number of voids present in group II was 21, out of which 7 were in the coronal third, 10 in the middle third, and 4 in the apical third. A statistically significant difference was noted between the two groups in terms of the overall voids present.

Conclusion

Within the limits imposed by the conditions used in the present study, both techniques can be used for obturation in the root canals of primary molars. Voids were observed with both the techniques, but minimum in group II, i.e., skini syringe with NaviTip.

How to cite this article

Nezam S, Mukherjee CG, Shukla JN, et al. Comparative Evaluation of Efficacy of Obturation Techniques in Deciduous Teeth Using Cone-beam Computed Tomography: An In Vivo Study. Int J Clin Pediatr Dent 2021;14(1):75–80.

Primary Molar Pulpectomy Using Two Different Obturation Techniques: A Clinical Study

CONTEXT

A major goal in pediatric dentistry is preservation of the integrity of primary teeth and their supporting tissues until physiological process of exfoliation takes place. Pulpectomy serves such a purpose using various materials and techniques to fill the canals of primary teeth. Aims: The aim of this in vivo study was to determine the efficacy of modified disposable syringe technique in root canals of primary molars using digital radiography when obturated with endoflas.

SETTINGS AND DESIGN

A clinical study was undertaken for a period of 6 months.

SUBJECTS AND METHODS

A total of 60 primary maxillary and mandibular molars were selected in the age group of 4-8 years and randomly divided into two groups. The teeth were obturated with handheld lentulospiral and a modified disposable syringe techniques. Postoperative radiographic evaluation was done for quality of fill and voids using digital radiography. Statistical Analysis Used: Results were assessed using Chi-square test and Mann-Whitney U-test. Results: No statistically significant difference between quality of obturation using hand-held lentulospiral and modified disposable syringe (P < 0.05) was observed. Optimal obturation was achieved in both techniques; however, voids in obturation were not significant.

CONCLUSIONS

Both the hand-held lentulospiral and modified disposable syringe technique are effective in the obturation of primary molar root canals in terms of quality of fill.

An in vitro comparison of three delivery techniques for obturation of root canals in primary molars

AIM

This in vitro study evaluated the efficacy of three different obturation techniques with regards to quality of two filling pastes-Ca(OH)₂/iodoform syringe paste and zinc oxide eugenol paste in primary molars.

METHODS

Root canals of 45 extracted primary molars were prepared and randomly divided into three groups of 15 teeth each. Group A-canals were filled with Ca(OH)₂/iodoform syringe paste, Group B-zinc oxide eugenol paste with handheld lentulo spiral and Group C-zinc oxide eugenol paste with rotary lentulo spiral. The quality of filled root canals was evaluated with conventional radiography in antero-posterior and lateral dimensions.

RESULTS

There were significant differences between all groups in the presence of voids (p = 0.03) and length of filling (p = 0.002). Half of the sampled teeth in handheld lentulo spiral group had voids in the filled canals, while 80% of the teeth filled with Ca(OH)₂/iodoform syringe resulted in overfilling of the paste.

CONCLUSIONS

All three delivery methods for the obturation of primary molars' root canals showed inherent limitations in terms of voids and quality of filling. Voids are inevitable and were present in all the techniques. Overfilling was more frequently seen with the syringe method, while the lentulo spiral technique, both handheld and rotary, showed a better quality of filling.

Comparative evaluation of endodontic pressure syringe, insulin syringe, jiffy tube, and local anesthetic syringe in obturation of primary teeth: An in vitro study

PURPOSE

The purpose of this in vitro study was to compare four methods of root canal obturation in primary teeth using conventional radiography.

MATERIALS AND METHODS

A total of 96 root canals of primary molars were prepared and obturated with zinc oxide eugenol. Obturation methods compared were endodontic pressure syringe, insulin syringe, jiffy tube, and local anesthetic syringe. The root canal obturations were evaluated by conventional radiography for the length of obturation and presence of voids. The obtained data were analyzed using Chi-square test.

RESULTS

The results showed significant differences between the four groups for the length of obturation (P < 0.05). The endodontic pressure syringe showed the best results (98.5% optimal fillings) and jiffy tube showed the poor results (37.5% optimal fillings) for the length of obturation. The insulin syringe (79.2% optimal fillings) and local anesthetic syringe (66.7% optimal fillings) showed acceptable results for the length of root canal obturation. However, minor voids were present in all the four techniques used.

CONCLUSIONS

Endodontic pressure syringe produced the best results in terms of length of obturation and controlling paste extrusion from the apical foramen. However, insulin syringe and local anesthetic syringe can be used as effective alternative methods.

Measurement of pH and calcium ions release from different calcium hydroxide pastes at different intervals of time: Atomic spectrophotometric analysis

AIM

To evaluate the effect of different vehicles on pH and release of calcium ions from calcium hydroxide (CH) paste from apical third of root canals.

METHODS

40 single rooted extracted human mandibular premolars were instrumented with RevoS files (MicroMega) up to ISO size 40. The teeth were divided into 4 groups on the basis of vehicle as follows: Group I - calcium hydroxide mixed with 2% chlorhexidine; Group II - calcium hydroxide mixed with propylene glycol; Group III - calcium hydroxide mixed with glycerine; and Control - calcium hydroxide mixed with double distilled water. Each group had two subgroups (n = 5) on the basis of the calcium hydroxide delivery. Subgroup A - calcium hydroxide paste placed with spiral filler (Lentulospiral) subgroup B - calcium hydroxide paste placed with flat wire filler (Paste Inject). pH and calcium ion release was evaluated at 24 h, 48 h, 7th day, 15th day and 30th day using a pH meter and atomic absorption spectrophotometer respectively.

RESULTS

The calcium release from various groups was highest for CH+glycerine (Group III) followed by CH+chlorhexidine (Group I), CH+propylene glycol (Group II) and CH+double distilled water (control). At all the intervals the differences in calcium ion release among the groups were statistically significant (p < 0.05), except on day 7. Delivery technique did not have a significant effect on calcium ion release. Highest pH values were recorded from CH+glycerine group at day 30 for both the delivery systems, however rise in pH from day 1 to day 30 were non-significant in all groups with both delivery systems.

CONCLUSION

Demonstrable changes in calcium ion release occurred from the calcium hydroxide mixed with various vehicles and CH+glycerine group showed the maximum calcium ion release at all intervals and highest pH day 30.

Comparison of pH changes induced by calcium enriched mixture and those of calcium hydroxide in simulated root resorption defects

INTRODUCTION

External resorption usually occurs after dental trauma and the loss of root cementum. Because it has the ability to induce alkaline pH, calcium hydroxide is used in treatment of external resorption, which is reportedly not free from disadvantages. Driven by such understanding, the aim of this in vitro study was to compare the pH changes induced by calcium enriched mixture (CEM) and those of calcium hydroxide in simulated root resorption defects.

METHODS

Twenty-one paired extracted human premolars were cut to the length of 14 mm. Root canal preparation was performed by using ProTaper rotary system. Cavities of 0.7-mm depth and 1.4-mm diameter were prepared on the external root surface, 5 mm from the apex. Half of the teeth were filled with CEM and the other half with calcium hydroxide. Five premolars were also assigned as the negative control group and filled with normal saline. To be assured of the filling quality, a radiograph was obtained from each tooth. Subsequently, pH of the cavity was measured with a microelectrode at 20-minute, 3-hour, and 1-, 7-, 14-, 21-, and 28-day intervals after filling.

RESULTS

Mean pH in the CEM and in the calcium hydroxide groups were significantly varied during the study period, with pH of the calcium hydroxide group significantly higher than that of CEM in all of the measurements. However, no significant difference was observed between the pH of the calcium hydroxide group and that of the control group at the 7-day and 14-day measurements and between those of the CEM group and the control group at days 7, 21, and 28.

CONCLUSIONS

In comparison with calcium hydroxide, CEM hardly maintained alkaline pH during the first month of use, and so CEM may be an inappropriate material in treatment of external root resorption.

Intracanal placement of calcium hydroxide: a comparison of specially designed paste carrier technique with other techniques

Background

This study compared the effectiveness of a Specially Designed Paste Carrier technique with the Syringe-Spreader technique and the Syringe-Lentulo spiral technique in the intracanal placement of calcium hydroxide.

Methods

Three groups, each containing 15 single-rooted human anterior teeth were prepared using standardized Mtwo rotary instruments to a master apical file size 40 with 0.04 taper. Each group was filled with calcium hydroxide paste using: Syringe and #25 finger spreader (Group 1); Syringe and #4 rotary Lentulo spiral (Group 2), Specially Designed Paste Carrier (Group 3). Using pre-filling and post-filling radiographs in buccolingual and mesiodistal planes, the radiodensities at 1 mm, 3 mm, 5 mm, and 7 mm from the apical foramen were analyzed by ANOVA and Bonferroni post hoc tests.

Results

Overall, The Specially Designed Paste Carrier technique showed a statistically significantly higher mean radiodensity than the two other compared techniques. No significant difference was detected between the Syringe-Lentulo spiral and the Syringe-Spreader techniques.

Conclusion

The Specially Designed Paste Carrier technique was more effective than the Syringe-Spreader technique and the Syringe-Lentulo spiral technique in the intracanal placement of calcium hydroxide.

Definition and endodontic treatment of dilacerated canals: a survey of Diplomates of the American Board of Endodontics

AIM

To gather data from Diplomates of the American Board of Endodontics regarding treatment of dilacerated canals.

MATERIALS AND METHODS

A questionnaire addressing definition, endodontic treatment procedures and prognosis was constructed and distributed via e-mail to 708 Diplomates of the American Board of Endodontics. Data from 150 respondents, a 21% response rate, were collected by using a Web-based interface. For statistical analysis, Chi-square tests were used.

RESULTS

More than 25% of respondents believed that a dilacerated root should have a curvature > 40°. One-visit treatment is the best therapeutic approach and transportation is the most likely complication in preparation of these canals. A crown-down technique, watch-winding motion and a master apical file # 25 are the best choices for preparation of these canals. Any warm obturation technique is preferred over lateral compaction by most respondents.

CONCLUSION

A crown-down technique for root canal preparation and a thermoplastic obturation technique are recommended for canals whose curvature is more than 40°. The prognosis of the treatment of these canals is judged not lower than normal canals.

CLINICAL SIGNIFICANCE

Crown-down technique and thermoplastic obturation are recommended for dilacerated canals.

Bacterial leakage in root canals filled with calcium hydroxide paste associated with different vehicles

This in vitro study evaluated, using a bacterial leakage model, whether intracanal medication with calcium hydroxide [Ca(OH)2]-based pastes prepared with different vehicles, has inhibitory effect on corono-apical leakage of bacteria. Forty instrumented human canines were dressed with Ca(OH)2 p.a. associated with: G1 = distilled water; G2 = polyethylene glycol (PG); G3 = PG + CMCP; and G4 = glycerin. Five teeth with intact crowns served as negative controls and 5 instrumented teeth without temporary dressing served as positive controls. All teeth were mounted in a 2-chamber apparatus and then exposed to human saliva for 63 days. Leakage was recorded when turbidity was observed in the lower chamber. Fifty percent of the samples of G1 and G2, 10% of G3 and 80% of G4 were fully contaminated after 9 weeks. Statistically significant differences were observed with paired comparisons G3 and G4 (p=0.0069), with G3 achieving better seal against bacterial leakage than G4.

Efficacy of spirally filled versus injected non-setting calcium hydroxide dressings

The aim of this study was to evaluate the adequacy of spirally filled vs injected non-setting calcium hydroxide (NS Ca(OH)(2)) in the management of traumatized permanent teeth undergoing endodontic treatment for apexification, control of infection or the management of root resorption. A random selection of patients with traumatized teeth undergoing endodontic procedures was made. A total of 100 cases were assigned for placement of NS Ca(OH)(2) by spiral filling and 50 cases by injection of the dressing directly into the canal. Post-operative radiographs were assessed for complete canal obturation and in particular, the density and length of the dressing within the canal. The results revealed that the injected NS Ca(OH)(2) dressing consistently produced better results than the spirally placed dressings. It also completely removed the chance of instrument fracture and as a result of this trial, the department of child dental health has now adopted the use of this injectable system.

Influence of calcium hydroxide points on the quality of intracanal dressing filling

Purpose

The aim of this study was to evaluate, in vitro, the quality of calcium hydroxide [Ca(OH)₂] paste filling (Ultracal, Ultradent) associated or not with Ca(OH)₂-containing gutta-percha points (Calcium Hydroxide Plus Points™, Roeko) in curved root canals.

Material and Methods

One hundred and twenty roots of extracted human teeth, randomly divided into three curvature ranges (mild - 0 to 14°; moderate - 15° to 29°; severe - >30°) were used. After chemomechanical preparation, the roots were assigned to 4 groups (n=30), according to the technique of intracanal dressing placement: group 1 - Ca(OH)₂ paste was applied with a lentulo spiral; group 2 - Ca(OH)₂ paste was applied with a lentulo spiral and a Ca(OH)₂ point was inserted into the canal; group 3 - Ca(OH)₂ paste was applied with a Navitip™ tip (supplied with Ultracal system); group 4 - Ca(OH)₂ paste was applied with a Navitip™ tip and a Ca(OH)₂ point was inserted into the canal. The roots were cleared and the quality of apical third filling was assessed by a calibrated experienced examiner. The specimens were examined under stereomicroscopy and scored 1 to 4 (i.e., from inadequate to complete root canal filling). The results were analyzed statistically by ANOVA and Duncan's post hoc test at 5% significance level.

Results

There were no statistically significant differences (p>0.05) among the curvature degrees in groups 1, 3 and 4. Severely curved roots in group 2 presented bordering significance (p=0.05). The groups that associated the use of Ca(OH)₂ paste and points (2 and 4) showed better apical filling than the other groups, but this difference was statistically significant (p<0.001) only for roots with severe curvature.

Conclusion

According to the results of this study, the curvature degree did not influence the quality of filling. The techniques that used Ca(OH)₂-containing gutta-percha points yielded better filling of the apical third in roots with severe curvature.

The outlook for implants and endodontics: a review of the tissue engineering strategies to create replacement teeth for patients

Ideally, root canal therapy involves the removal of diseased pulp tissues and permanent replacement with healthy pulp to revitalize teeth. Rather than placing implants, the ideal solution is to grow new replacement teeth. Success rates of implants and endodontic treatments can exceed 90%, which presents a formidable challenge to tissue engineering researchers to ensure that future dental treatments are even more successful. The purpose of this article is to explain how tissue engineering can be used to create replacement teeth. The science of tissue engineering has evolved from growing simple tissues in cell culture incubators to a multistep process. Although the problems of introducing tissue engineering therapies as part of routine dental treatments are substantial, the potential benefits are equally ground breaking.

Delivery of calcium hydroxide: comparison of four filling techniques

This study compared the weight and radiographic appearance of Ca(OH)(2) delivered into standardized, minimally and fully prepared canals using (a) an injection system, (b) an endodontic Flex-O file rotated counter-clockwise, (c) a lentulo spiral, and (d) a .04 rotary NiTi file rotated in reverse. Two extracted human second mandibular premolars with single canals were prepared to an MAF #25 or an MAF #40. A weight measurement and radiograph were made for each filling. Three independent examiners evaluated the radiographs. Regardless of technique, only about 45% of the optimal weight of Ca(OH)(2) was delivered into the minimally prepared canal. Radiographically the filling quality was only 1 to 2 (10 scale). In contrast, all delivery techniques delivered near optimal weight of Ca(OH)(2) in the completely prepared canal with a radiographic filling quality of 8.8 to 9.3. The results indicate that complete instrumentation is needed to obtain near optimal delivery of Ca(OH)(2).

Calcium hydroxide dressings using different preparation and application modes: density and dissolution by simulated tissue pressure

AIM

To study the effect of different apical shapes in prepared simulated root canals on the application of a commercially prepared calcium hydroxide paste by a syringe or lentulo spiral.

METHODOLOGY

Three different types of root canal preparation were performed in 90 simulated canals: group A to an apical size 20 and a 0.10 taper using hand and rotary instruments, group B to an apical size 30 and a 0.08 taper using GT rotary instruments and group C to an apical size 40 and a 0.04 taper using ProFile 0.04 instruments. The insertion of calcium hydroxide [Ca(OH)2] paste was accomplished using either a lentulo spiral or a syringe. After 1 week of simulated fluid pressure applied to the apical end of the canal using physiological saline solution, the solution was evaluated for released Ca(OH)2. The specimens were weighed initially, after preparation, after insertion of Ca(OH)2 paste, after temporization with Cavit and after 1 week of simulated fluid pressure. Digital radiographs of the filled canals were taken and canal areas in mm2, gray values of the Ca(OH)2 dressings, total area of voids in mm2, as well as location of voids in the apical, middle or coronal thirds of the root canals were measured. Analyses of variance, with Scheffe's post-hoc tests, as well as chi-square tests were performed.

RESULTS

Canals in group C had significantly fewer (P < 0.01) radiographic voids than canals in groups A and B. Using a lentulo spiral resulted in significantly (P < 0.05) fewer voids compared with the injection technique. More voids were detected coronally compared with middle and apical root canal thirds (P < 0.05).

CONCLUSIONS

Canal shape and method of application had an impact on the amount and radiodensity of calcium hydroxide dressings in simulated root canals. Canals prepared to an apical size 40 and a taper of 0.04 had the least number of voids; Ca(OH)2 was placed with significantly fewer voids using a lentulo spiral compared with the injection technique.

Calcium hydroxide: a review

Calcium hydroxide is a multipurpose agent, and there have been an increasing number of indications for its use. Some of its indications include direct and indirect pulp capping, apexogenesis, apexification, treatment of; root resorption, iatrogenic root perforations, root fractures, replanted teeth and interappointment intracanal dressing. The purpose of this paper is to review the properties and various indications for the use of calcium hydroxide.

Growth at high pH increases Enterococcus faecalis adhesion to collagen

AIM

To evaluate the effect of growth at pH levels from 7.1 to 9.5 on the adherence of Enterococcus faecalis to bovine serum albumin (BSA) and collagen type I.

METHODOLOGY

Enterococcus faecalis strain A197A was grown in broth of adjusted pHs varying between 7.1 and 9.5. Aliquots of bacterial suspensions were added to wells coated either with BSA or with collagen type I. Bacteria adhering to the surfaces were stained with crystal violet. Spectrophotometric measurements of the dissolved stain were used to assess the number of bacteria adhering to the surfaces. The data obtained were analysed using the Kolmogorov-Smirnov test, Levene's test and Student's t-test, with alpha = 0.05 as the level for statistical significance.

RESULTS

The adhesion of E. faecalis to BSA-coated surfaces decreased inversely with alkalinity of the growth medium. The pH 7.1-grown bacteria bound to BSA significantly more than the other BSA groups. On the contrary, the adhesion to collagen type I-coated surfaces of bacteria grown at pH 8.0 and 8.5 was significantly greater than for those grown at pH 7.1.

CONCLUSIONS

A minor increase in pH up to 8.5, which may be a consequence of insufficient treatment with alkaline medicaments such as calcium hydroxide, increases the collagen-binding ability of E. faecalis, in vitro. This can be a critical mechanism by which E. faecalis predominates in persistent endodontic infections.

Evaluation of the Incidence of Transportation after Placement and Removal of Calcium Hydroxide

The purpose of this in vitro study was to evaluate the incidence of apical transportation after the placement and removal of Ca(OH)2 in straight and curved root canals. Twenty maxillary central incisors (group A) and 20 mesiobuccal canals from mandibular molars (group B) were instrumented at the working length to a #45 file and #30 file, respectively. Postinstrumentation radiographs were taken with the corresponding final file inserted into the canal to the working length. Afterward, the root canals were filled with a Ca(OH)2 paste using Lentulo spirals, and the teeth incubated for 7 days. The Ca(OH)2 paste was then removed up to the working length using a #45 file for group A and a precurved #30 file for group B. Final radiographs were taken with the file inserted into the canal to the working length. Postinstrumentation and final radiographs were superimposed to evaluate the incidence of transportation. As expected, in group A (straight canals) no transportation was detected, whereas in group B (curved canals) 9 of 20 canals showed apical transportation (95% confidence interval, 23.1-68.5% transportation). Statistically significant differences were observed between groups A and B (p < 0.05).

Stem Cell Responses in Tooth Regeneration

Scientific advances in the creation of restorative biomaterials, in vitro cell culture technology, tissue grafting, tissue engineering, molecular biology, and the human genome project provide the basis for the introduction of new technologies into dentistry. This review is intended to facilitate the development of stem cell therapy for use with established therapeutic modalities to restore and regenerate oral tissues. Teeth have been shown to mineralize in response to injury for many decades, but only in recent years has the position of the stem cells been localized around blood vessels. The cells have been identified as myofibroblastoid pericytes. The ability to control the differentiation and proliferation of these cells is being examined to create stem cell therapies that can solve dental problems more effectively than current treatment regimes. Although the problems of introducing these technologies are substantial, the potential benefits to patients and the profession are equally promising - a cure for caries and diseases, a cure for oral cancer, correction of congenital defects, and the regeneration of teeth and tissues to restore oral functions. The purpose of this review is to describe how these new technologies can most usefully be employed in dentistry to enable clinicians to satisfy patient demand for a nondefective dentition.

Intracanal Placement of Calcium Hydroxide: A Comparison of Techniques, Revisited

The goal of this in vitro study was to compare the effectiveness of three different placement techniques of calcium hydroxide paste in a curved canal. An acrylic resin block with a 44-degree curvature was instrumented to a #40 Flex-R file. The canal was filled with radiopaque calcium hydroxide paste using the following techniques: group 1, the paste was injected with an Ultradent tip; group 2, the paste was injected as in group 1 and followed by a size 35 Lentulo to working length; and group 3, the paste was placed with a size 35 Lentulo only, to working length. Each technique was performed 25 times. The radiodensity of the simulated canal was measured at 1, 3, 5, and 7 mm from the canal terminus. At 1 mm, the Lentulo was significantly better than the other two techniques. At 3 mm, the Lentulo technique and the combined technique were better than the Ultradent tip alone.

Ca2+ Diffusion Through Dentin of Ca(OH)2 Associated with Seven Different Vehicles

This investigation measured the diffusion of Ca2+ through dentin by using Ca(OH)2 associated with various vehicles. After mechanical preparation and removal of smear layer, 41 human premolar teeth were stored individually in flasks containing 800 ml of ultra-pure deionized water for 2855 h. The Ca2+ concentration was measured by atomic absorption spectrophotometry as a function of time. These measurements were divided into two phases: dissolution, to check the loss of Ca2+ from the tooth structure itself, for which all canals were kept empty and open in the absence of medication for 1168 h, and diffusion, in which the specimens were divided into 10 groups (3 control groups: group 1 = water control, group 2 = sealing control, and group 3 = open canal dissolution control; 7 experimental groups in which the whose canals were filled with Ca(OH)2 paste associated with the following vehicles: group 4 = saline; group 5 = polyethylene glycol (Calen); group 6 = glycerin and camphorated parachlorophenol group 7 = camphorated paramonochlorophenol; group 8 = glycerin; group 9 = glycerin and tricresol formaldehyde (TCF); and group 10 = anesthetic solution. This phase lasted 1687 h. A total of 1058 measurements of Ca2+ were made. Regression analysis was used for statistical evaluation. We concluded that diffusion occurred differently for each group: the medications used in the root canals interacted with the dentinal structure or among themselves; the medication coated the dentinal tubule, facilitating the diffusion of Ca2+ into the external part of the root.

Influence on pH of vehicle containing glycerin used with calcium hydroxide

- The pH values of the external aqueous medium, relative to the roots of 41 human premolar teeth filled with Ca(OH)2 in to several vehicles, were evaluated in the present study. After root canal biomechanical preparation and smear-layer removal, the teeth were stored individually, immersed in flasks containing 800 ml of ultra-pure deionized water for a period of 118 days. A pH meter was used to analyse the pH values as a function of time. The measurements were divided into phase 1: dissolution, in which all canals remained empty and open in the absence of medicament for 48 days, and phase 2: diffusion, in which the specimens were divided into 10 groups which consisted of three control groups: group 1, water control; group 2, sealing control; and group 3, opened canal dissolution control, and seven experimental groups, with five teeth each, whose canals were filled with Ca(OH)2 paste associated with the following vehicles: group 4, saline solution; group 5, polyethylene glycol (Calen); group 6, glycerin and parachlorophenol (PMCC); group 7, PMCC; group 8, glycerin; group 9, glycerin and formo cresol (FC); and group 10, anesthetic solution. This phase lasted for 70 days. A total of 1058 measurements of the pH values were made. Regression analysis was used for statistical evaluation. The results show that all groups containing polyol in the composition of the paste had a trend to acidification in the interval between filling and 14 days later (therapeutic period) and, at the end of the experiment (1687 h to 70 days after canal filling), the pH was slightly alkaline. We conclude that polyhydroxy alcohol (glycerin and polyethylene glycol, Calen) diffusion enhances acidification of the aqueous medium.

Long-term survival of primary root canal treatment carried out in a dental teaching hospital

AIM

This study aimed to examine clinically and radiographically the survival of primary root canal treatment completed in a dental teaching hospital between 10 and 20 years previously.

METHODOLOGY

A data collection form was used to collate all information obtained from the written patients' records along with the results from clinical and radiographic examination of 608 teeth, out of a total of 986 randomly selected teeth that had been root filled in the Prince Philip Dental Hospital (PPDH), Hong Kong, between 1981 and 1989. The criteria for failure were extractions (except for documented nonendodontic reason), retreatments and presence of a periapical radiolucency. The survival function of the treated teeth was plotted against the calculated date of failure using the Kaplan-Meier (K-M) method. Covariables were examined further by Cox Regression analysis with a backward stepwise method.

RESULTS

A total of 314 teeth (52%) were either documented or deemed to have failed after examination. The median survival time was 111 months. Cox Regression analysis indicated that the survival of root-filled teeth was significantly influenced by the tooth type, preoperative periapical status and the type of coronal restoration. The survival function declined with time, with a rapid drop in the first 18 months or so. The rate at which failures occurred appeared to slow down with a longer observation time.

CONCLUSIONS

There was a nonlinear decline in the cumulative survival probability of primary root canal treatment. Tooth type, preoperative periapical status and type of post and final restoration significantly affected the long-term survival of the treated teeth.

Odontoblast morphology and dental repair

OBJECTIVES

To investigate the changes in morphology and activity of pulp odontoblasts in response to cavity restoration variables and patient factors.

METHODS

Class V non exposed cavities were prepared in the intact 1st or 2nd premolar teeth of 27 patients, aged between 9 and 17 years-old. Following tooth extraction, the area of reactionary dentine and the area of the odontoblasts were measured using computerised histomorphometry.

RESULTS

The cytoplasm to nucleus ratio of the odontoblasts was found to increase beneath cut dentinal tubules, following the secretion of reactionary dentine. However, none of the patient or preparation variables were found to be correlated with changes in the odontoblast cytoplasm to nucleus ratio.

CONCLUSIONS

Morphological changes in human odontoblasts is directly related to their capacity to repair dentine injuries and provide pulp protection. Changes in odontoblast morphology reflect secretory activity.

Intracanal placement of calcium hydroxide: a comparison of two different mixtures and carriers

Objective. The purpose of this study was to compare the placement techniques of Ca(OH)(2). Study Design. Forty simulated curved canals (42 degrees) in transparent resin blocks were used and separated into 4 experimental groups, 10 canals each. A paste of Ca(OH)(2) was mixed with either water or glycerin and placed into canals with Lentulo spiral or Pastinject. Radiographs were taken of each sample. The canal fillings were evaluated by 3 endodontists and scored as to length of placement and completeness of fill. Cohen's kappa test was used to measure agreement between raters, and Kruskal-Wallis analysis of variance test was used to determine statistical differences between the 4 groups. Results. As to length of placement, statistically significant differences were found between Ca(OH)(2) + water pastes filled with Lentulo spiral (group 1) and Ca(OH)(2) + glycerin pastes filled with either Pastinject or Lentulo spiral. The findings of group 1 showed that the paste was short of the apex by more than 2 mm, whereas the other 3 groups were either at the apex or only 1 to 2 mm short. As to middle and coronal completeness of fill, differences were found to be statistically significant between Ca(OH)(2) + water paste filled with Lentulo spiral group and the other groups. Most of the canals in group 1 had greater than one-half void space at apical third, whereas the canals had less than one-fourth void space when Ca(OH)(2) + glycerin pastes were filled with Pastinject. Conclusions. Ca(OH)(2) when mixed with glycerin and placed into the canals, either with a Lentulo spiral or Pastinject, provided satisfactory results. Pastinject showed better fillings with Ca(OH)(2) + water pastes than Lentulo spiral.

Transdentinal stimulation of reactionary dentinogenesis in ferrets by dentine matrix components

OBJECTIVES

Trans-dentinal stimulation of reactionary dentinogenesis may be mediated through cellular signalling by bio-active components released from the dentine matrix during injury. Understanding of these processes will be important to guide dentinal repair activity following restorative surgery. The purpose of this study was to investigate the effects of implanting isolated dentine matrix proteins within cavity preparations on dentinal repair activity and odontoblast survival using a controlled experimental animal model.

METHODS

Forty-five ferret canine teeth each had a standardised non-exposed cylindrical Class V cavity cut into the buccal dentine. Ten cavities were restored with zinc oxide eugenol, as a control. Two different lyophilised preparations of dentine matrix components were implanted on the axial floor of the remaining 35 cavities prior to filling with zinc oxide eugenol. After post-operative periods of 2, 7, 14, 28, and 90 days, the teeth were extracted and examined histomorphometrically and the data analysed statistically by analysis of variance tests.

RESULTS

The odontoblasts beneath the restored cavities responded to the presence of the two dentine matrix preparations by increasing the mean area of reactionary dentine secreted by 433 and 578%, and the numbers of odontoblasts remained stable.

CONCLUSION

Dentine matrix components can stimulate reactionary dentinogenesis in non-exposed cavity preparations. It will now be important to identify how this may be harnessed as a part of routine restorative surgery to optimise treatment outcomes with a biological basis.

Calcium hydroxide retention in wide root canals with flaring apices

Calcium hydroxide (CH) is used to induce apexification in immature, pulpless teeth with wide root canals and flaring apices. Three placement methods of CH were compared in vitro, for their ability to enhance CH retention in the canal. Barium sulfate (BS), added as radiopacifier, was studied for its effects on the radiographic follow up of CH retention, as well as on the ability to detect voids in the CH. Calcium hydroxide filled teeth were kept in phosphate buffered saline-containing tubes in a shaker water bath. Radiographs were taken weekly to follow the retention or loss of the material; they were scanned and stored as digitized images. Quantitative evaluations were done on these images, using a computerized gray scale. Condensed CH was better retained in root canals than either lentulo-placed paste or commercial injected paste. Barium sulfate in the CH paste enabled better detection of voids in the paste filling the canal, however, it obscured the disappearance of CH from the canal, due to a residual radiopacity effect. The results supported (a) condensation of calcium hydroxide as a preferred method that improves its retention in wide root canals, and (b) discontinuing the use of barium sulfate as a radiopacifier in apexification procedures.

The effect of cavity restoration variables on odontoblast cell numbers and dental repair

OBJECTIVES

Dentinal repair following cavity restoration is dependent on several parameters including the numbers of surviving odontoblasts. The purpose of this study was to examine the effects of cavity cutting and restoration treatments on post-operative odontoblast numbers.

METHODS

353 Standardised non-exposed rectangular Class V cavities, were cut into the buccal dentin of intact 1st or 2nd premolar teeth of 165 patients, aged between nine and 25 years of age. Composite cavity restorations with various etching treatments were compared with resin-modified glass ionomer cements, enamel bonding resins, as well as polycarboxylate, calcium hydroxide, and zinc oxide eugenol materials. Following tooth extraction (20-381 days) for orthodontic reasons, the area of the reactionary dentine and the area of the odontoblasts was measured histomorphometrically.

RESULTS

Odontoblast numbers and dentine repair activity were found to be influenced more by cavity restoration variables, than the choice of cavity filling materials or patient factors. The most important cavity preparation variable was the cavity remaining dentine thickness (RDT); below 0.25mm the numbers of odontoblasts decreased by 23%, and minimal reactionary dentine repair was observed.

CONCLUSIONS

Odontoblast injury increased as the cavity RDT decreased. In rank order of maintaining odontoblast numbers beneath restored cavities with a RDT below 0.5mm, and using calcium hydroxide for comparison; calcium hydroxide (100%), polycarboxylate (82.4%), zinc oxide eugenol (81.3%), composite (75.5%), enamel bonding resin (49.5%) and RMGIC (42.8%). The vitality and dentine repair capacity of the pulp is dependent on odontoblast survival. Variations in the extent of odontoblast injury caused during operative procedures, may be the major underlying reason for the success or failure of restorative treatments.

Tooth slice organ culture for cytotoxicity assessment of dental materials

The purpose of this work was to develop a tooth slice organ culture method to assess the response of the cells of the dental pulp to commonly used dental materials and products. Wistar rat tooth slices were grown in culture for two and ten days in the presence of dental materials. After culture, the tooth tissues were processed and the responses of the pulpal cells were analysed histomorphometrically. Cytotoxic cell destruction was observed following the direct application of test materials to tooth slices (n = 298) after 10 days in culture (MANOVA, P = 0.0001), whilst the restoration of prepared deep dentine cavities (n = 30), with test products, did not result in a significant amount of pulpal injury (MANOVA, P = 0.287). In rank order of causing pulpal injury, the test materials from the most to the least cell destructive, was; Salicylic acid. Calcium hydroxide, Kalzinol zinc oxide eugenol, high-mercury Amalgam, Prime & Bond, Dycal, Barium sulphate, Hypocal, Scotchbond, Calasept, Life and One-step. Tooth slice organ culture, provided a cytotoxicity screening method for dental materials, bearing a closer physiological resemblance to the clinical situation than cell culture screening methods. Tooth slice culturing may have the potential to replace some types of in vivo animal experimentation, as there is a clear need to reduce this form of testing.

Human odontoblast cell numbers after dental injury

OBJECTIVES

The purpose of this study was to measure the changes in odontoblast cell numbers in response to cavity restoration variables and patient factors, and the effect these factors have on dental repair by tertiary dentinogenesis. The number of vital odontoblasts is a critical factor for pulpal repair following restorative surgery, and yet little information is available on these cell numbers.

METHODS

Class V non-exposed cavities were prepared in the buccal surface of intact first or second premolar teeth of 27 patients, between 9 and 17 years of age. Following tooth extraction (28-163 days) the area of reactionary dentine and the area of the odontoblasts were measured histomorphometrically.

RESULTS

Patient factors, as well as cavity preparation and restoration variables, had little effect on the numbers of odontoblasts per pulpal unit area. However, the age of the patient did appear to have an effect on the reactionary dentine secretory capacity of odontoblasts per unit area, and on the relative number of odontoblasts beneath cut dentinal tubules.

CONCLUSIONS

Odontoblast cell numbers were maintained following the preparation of cavities cut into dentine with a 0.5mm residual dentine thickness. The repair capacity of the pulp-dentine complex would appear to be age dependent, this may explain differences in the success of various restorative treatments between patients.

Postoperative pulpal and repair responses

BACKGROUND

Each year in the United States, the success of 10 million surgically restored carious lesions depends on a favorable tertiary dentin repair response to preparation, restoration and patient factor variables. The authors investigated the relationship between these variables and dentinal response.

METHODS

Standardized rectangular Class V restoration preparations were cut into the buccal dentin of intact first or second premolars of 27 patients without exposing the pulp and were restored. The patients were between 9 and 17 years of age. The treated teeth were scheduled for extraction for orthodontic reasons. After tooth extraction, the tertiary dentin was analyzed histomorphometrically.

RESULTS

The area of tertiary reactionary dentin was found to be correlated using linear regression analysis of variance with restoration residual dentin thickness (P = .0024), age of the patient (P = .0045), restoration floor surface area (P = .0266) and restoration width (P = .0415). The authors did not find a correlation with the premolar position (P = .0594), sex of the patient (P = .650), pulpal inflammatory reaction (P = .613) or the time elapsed since surgery (P = .531). Restoration with zinc oxide eugenol was found to negatively influence tertiary dentin matrix secretion (post hoc analysis of variance, P = .030).

CONCLUSIONS

The age of a patient at treatment, the choice of restorative material and the size of the restoration preparation are all factors that can positively or negatively affect the pulpal repair response.

CLINICAL IMPLICATIONS

Age of the patient affects dentin repair capacity and may be a factor in treatment planning decisions. Minimizing the cutting of dentin, especially the width and base of the preparation, reduces the probability of recurrent pulpal complications.

Five methods of calcium hydroxide intracanal placement: an in vitro evaluation

OBJECTIVE

The purpose of this study was to evaluate root canal dressing with calcium hydroxide paste using 5 techniques of placement.

STUDY DESIGN

After endodontic preparation, each of 50 single-rooted premolars was filled with calcium hydroxide paste through use of one of the following techniques: Gutta-Condensor, MecaShaper, K-type ultrasonic file, Lentulo, and Pastinject. Radiographs of all 3 third root zones were made after cleaning and shaping and obturation. Density measurements (in pixels) were registered by means of an image analyzer and then compared through use of analysis of variance and Newman-Keuls multiple means tests.

RESULTS

With respect to average filling density, the techniques ranked as follows, in ascending order: Gutta-Condensor, MecaShaper, K-type ultrasonic file, Lentulo, and Pastinject. There was a significant difference (P <.0009) between the Gutta-Condensor and Pastinject techniques, between the MecaShaper and Pastinject techniques, and between the ultrasonic file and Pastinject techniques; all favored the Pastinject. There were no significant differences between the Gutta-Condensor, MecaShaper, ultrasonic file, and Lentulo techniques or between the Lentulo and Pastinject techniques.

CONCLUSIONS

The use of a specially designed paste carrier (the Pastinject) improved calcium hydroxide placement in root canals.

The antimicrobial effect of calcium hydroxide in root canals pretreated with 5% iodine potassium iodide

Calcium hydroxide (CH) is often used as a routine interappointment dressing during the endodontic treatment of teeth with apical periodontitis. However, it fails to consistently produce sterile root canals. The present study was set up to find out whether an antimicrobial strategy including the use of CH could be made more effective if: 1) canals were pretreated with 5% iodine potassium iodide (IPI), and 2) the dressing period was extended up to 2 months. Fifty human teeth, with radiographically verified apical periodontitis, were microbiologically sampled. After chemomechanical preparation the canals were pretreated with IPI for 3-7 days. Teeth where microorganisms persisted were then treated with CH for 2 months. Following instrumentation and dressing with IPI, 43 bacterial strains were recovered in 22 of the teeth. Samples obtained after the CH dressing period disclosed growth of 13 facultative and two strict anaerobic strains in 10 teeth. Enterococcus faecalis was identified in two specimens. In conclusion, the present study gave no evidence for an increased antimicrobial effect of CH if it was left for longer periods in the root canal. Although pretreatment with IPI from a quantitative point of view did not seem to add antimicrobial power, it might reduce the frequency of persisting strains of E. faecalis.

Dentinal tubule penetration of root canal sealers after root canal dressing with calcium hydroxide

The purpose of this study was to evaluate the dentinal tubule penetration of root canal sealers after root canal dressing with calcium hydroxide (Ca(OH)2). Forty-two single-rooted teeth were instrumented to size 60. Six teeth served as the control group, and the remaining teeth were assigned to two groups. Root canals of the first group were filled with the Ca(OH)2 paste; the second group was filled with TempCanal, and all were incubated for 7 days. The samples were either irrigated with only NaOCl or with EDTA, followed by NaOCl to remove Ca(OH)2. All of the teeth were obturated with CRCS, AH26, and Ketac Endo by a lateral condensation technique. The specimens were then kept at the same conditions for another 7 days, and then all of the roots were prepared for scanning electron microscopic evaluation. Scanning electron microscopic examination revealed that Ca(OH)2 was not completely removed from the root canal surfaces, and root canal sealers did not penetrate into the dentinal tubules when only NaOCl was used. EDTA followed by NaOCl irrigation resulted in complete removal of Ca(OH)2 and root canal sealers penetrated into the dentinal tubules.

Histological periapical repair after obturation of infected root canals in dogs

Histological periapical healing of infected roots obturated in one-step or with prior calcium hydroxide (Ca(OH)2) disinfection was compared. Seventy-two roots of vital dog teeth were instrumented to ISO size 45. Sixty roots were infected with dental plaque and closed. Six weeks later, apical periodontitis was radiographically confirmed in the infected roots. The teeth were divided into the following groups: group 1, one-step (n = 24)-roots were irrigated with 10 ml of saline, obturated, and permanently restored; group 2, Ca(OH)2 (n = 24)-roots were treated as in group 1, except that after saline irrigation, Ca(OH)2 dressing was placed in the canal for 1 wk before obturation; group 3, positive control (n = 12)--the roots were irrigated with saline, but the canals were not obturated; and an additional group, group 4, served as a negative control (n = 12)--these teeth that were not infected with plaque were aseptically obturated. The dogs were sacrificed after 6 months. The roots and surrounding apical tissues were prepared and histologically examined by two independent evaluators blinded to the treatment groups. A two-way ANOVA test demonstrated that the four treatment groups were significantly different from one another. The positive control showed the most inflammation, the negative control the least, and the Ca(OH)2 group had significantly less inflammation than the one-step group (p < 0.05). It is concluded that Ca(OH)2 disinfection before obturation of infected root canals results in significantly less periapical inflammation than obturation alone.

Dentin penetration of 2 calcium hydroxide combinations

OBJECTIVE

Calcium hydroxide is a common intracanal medicament. The powder can be mixed with different vehicles for placement in canals. This study examines pH changes in dentin with 2 different calcium hydroxide preparations.

STUDY DESIGN

The combinations used were calcium hydroxide + distilled water and calcium hydroxide + glycerin (1/7 distilled water). One hundred forty extracted teeth with single canals were used. pH changes in dentin after the intracanal placement of these combinations were evaluated at different dentin thicknesses by measuring the pH of the external environment.

RESULTS

For all dentin thicknesses and at all time periods, the calcium hydroxide + glycerin combination showed significantly higher pH values than the calcium hydroxide + distilled water combination.

CONCLUSIONS

Considering pH elevations, we propose the use of a calcium hydroxide + glycerin combination.

Comparative in vitro investigation of different methods for temporary root canal filling with aqueous suspensions of calcium hydroxide

Three methods for temporarily filling root canals with calcium hydroxide pastes were compared. Each of 20 root canals of extracted, human, single-rooted teeth was shaped with hand instruments under standardized conditions up to ISO size 50 and filled using a syringe system, a lentulo spiral or an endodontic reamer. Quality of fillings was assessed radiographically and by inspecting ground preparations. Ridit (relative to an identified distribution) analysis was employed to confirm differences in frequencies of certain quality criteria obtained with various application methods. With regard to degree of obturation and occurrence of porosities, application of temporary fillings with a lentulo spiral or syringe system revealed significantly better results than application with hand instruments (reamer). No differences with regard to degree of obturation were detected when comparing results obtained with syringe or lentulo. Fewer porosities in the apical part of the root canal were seen, both on radiographs and ground sections, with the syringe system compared with the lentulo spiral. In the presence of some contradictory reports found in the literature, the present study suggests that, after straight or slightly curved root canals have been shaped up to at least ISO size 50, high quality temporary root canal fillings may be obtained by application of an aqueous suspension of calcium hydroxide with a syringe system.

Canal debridement: effectiveness of sodium hypochlorite and calcium hydroxide as medicaments

The action of chemicals such as calcium hydroxide (Ca(OH)2) and sodium hypochlorite (NaOCl) that are used as tissue solvents may be enhanced by prolonged contact. The objective of this study was to determine if sealing Ca(OH)2 and NaOCl into the canal space would improve debridement of both the main canal and areas inaccessible to files. Mesial root canals of 75 freshly extracted mandibular molars were step-back hand-instrumented. Another six molars were controls. Either Ca(OH)2, NaOCl, or no medication was sealed in the canals for 1 or 7 days. Canals were finally irrigated with H2O and prepared for histological evaluation. The cleanliness of main canals and inaccessible areas (isthmi and fins) at the apical, middle, and coronal thirds was examined, scored, and compared by nonparametric statistical analysis. Results showed no significant differences among different groups in either the 1-day or 7-day time intervals in either the main canal or inaccessible areas. Instrumentation combined with NaOCl irrigation alone accounted for the removal of tissue in the main canal. In conclusion, in this system, prolonged contact with Ca(OH)2 and NaOCl was similarly ineffective; neither contributed significantly to canal debridement.

An in vitro evaluation of the sealing ability of Super-EBA cement used as a root canal sealer

Forty-six extracted human teeth, 26 maxillary central incisors, and 20 mandibular incisors were instrumented with flared preparations. The maxillary and mandibular incisors were prepared to #50 and #30 master apical file sizes, respectively. Ten maxillary and mandibular teeth were obturated with a single gutta-percha (GP) cone and Super-EBA cement. Ten maxillary and mandibular incisors were obturated with laterally condensed GP and Roth 801 sealer. Six maxillary incisors were used as controls. Apical leakage of India ink was measured using a stereomicroscope after clearing the teeth. Results showed significantly less leakage in the mandibular incisors filled with GP and Super-EBA (p<0.05). There was no significant difference in leakage when comparing the maxillary central incisors (p>0.05). In this in vitro study, root canal obturation with a single GP cone and Super-EBA showed promise as an effective way to eliminate or reduce apical microleakage. Further studies are needed to test the ability to use this obturation method clinically.

Effect of calcium hydroxide paste dressing on uninstrumented root canal wall

Dissolution of soft tissues on the uninstrumented root canal wall by an intracanal dressing of calcium hydroxide paste was examined by scanning electron microscopy (SEM). The roots of human extracted teeth were split longitudinally into halves, and the pulp tissue was removed by forceps. Then, the halves were divided randomly into three groups. Specimens in the control group were given no treatment. Specimens of the 1-wk group were stored for 7 days in calcium hydroxide-saline paste under the condition of 100% humidity and 37 degrees C. Specimens of the 4-wk group were stored for 28 days in the same manner, but washed and replaced into new paste every week. Root canal walls of these specimens were compared under a scanning electron microscope. A layer of odontoblasts was observed in the control group, whereas it had disappeared completely in the 1- and 4-wk groups. However, the predentin remained almost intact in the 1-wk group, and although the surface was eroded, in the 4-wk group. It was found that calcium hydroxide paste dressing could dissolve the odontoblastic cell layer, but had little effect on predentin.

Influence of apical enlargement on bacterial infection during treatment of apical periodontitis

This study sought to evaluate the influence of apical enlargement and 1-wk calcium hydroxide dressing on bacterial infection of root canals. Sixty single-rooted teeth were used. Half of these teeth were prepared to a size 25 file and the other half to a size 40 file. Then the root canals were dressed with calcium hydroxide for 1 wk. Bacterial sampling showed significant reduction of bacterial growth during the treatment. No statistically significant difference was noted between the size 25 and 40 file groups after instrumentation, and after 1-wk calcium hydroxide dressing.