A spectrophotometric analysis of dentinal leakage in the resected root

Dentin penetrability evaluation of three different dyes in root-end cavities filled with mineral trioxide aggregate (MTA)

The purpose of this study was to evaluate the penetration of three dyes in MTA root-end fillings. In 30 single-rooted teeth, cavities for retrofilling were prepared with an ultrasound appliance and filled with MTA. The specimens were randomly assigned to three groups (n = 10) and immersed in the following solutions: 2% methylene blue (MET), 50% silver nitrate (NIT) and 0.2% rhodamine B (ROD). Two transversal slices (1 mm) of the retrofilling region were obtained and evaluated using the Image Tool 3.0 software to obtain a quantitative evaluation (in mm²) of the dye penetration around the retrofillings. Data were submitted to statistical analysis using Student’s t-test. The lowest degree of dye penetration was observed for the NIT group, in both slices (p < 0.05). Dye penetration was significantly larger in the ROD group when compared to the NIT group, in both slices (p < 0.05), and to the MET group, only in slice 1 (p < 0.05). Within the limitations of this study, it was concluded that the choice of dye could influence the penetration evaluation in root-end filling studies, and that the NIT had the lowest penetration capacity in the apical dentine.

In vitro sealing ability of dentin bonding agents and cavity varnish with amalgam as retrofills

The aim of this study was to test the effect on the seal produced by an amalgam retrofill of two dentin bonding agents (Amalgambond and All-Bond) and a cavity varnish (Copalite). The three materials were tested when placed before the retrofill (group I) and before and after the retrofill (group II). Ninety teeth distributed into three groups were prepared for the retrofilling. Each group was divided into subgroups of I and II. Linear apical leakage was measured by a stereomicroscope after 1 month in dye. All materials permitted dye leakage around the retrofill, regardless of the application type. No statistical difference was found between the Amalgambond subgroups or between the All-Bond subgroups. There was less leakage in varnish group I than group II. Amalgambond group I leaked significantly less than All-Bond group I.

Ultrasonic root-end preparation: influence of cutting angle on the apical seal

Apical resection is fundamental in obtaining a correct apical seal. The purpose of this study was to evaluate how the apical root resection angle and the cavity made by ultrasonic retrotips may influence the apical seal. A total of 48 extracted teeth were endodontically treated and sealed by guttapercha vertical compaction: 24 were resected with a 45 degrees angle and 24 with a 90 degrees one. An ultrasound source (P.M. 400 EMS) and a CT5 Scaler were used to make the retrograde cavity that was filled afterwards with EBA-zinc oxide-eugenol alumina-added cement. Apical leakage was determined using fuchsin and assessed after the roots were sectioned longitudinally. Linear dye penetration in dentin and at the interface between dentin and cement was measured with a stereomicroscope (x 12 magnification), and the results were statistically analyzed. Results showed that there was less infiltration both in dentin and in the space between the filling and the dentinal wall in the group with the 90 degrees angle, but this difference was statistically significant (p < 0.0001) only for the dentin. None of the samples showed leakage greater than the depth of the preparation. An apical cavity of 3 mm or more along the vertical axis can produce a safe and effective seal.

Microleakage of Diaket and amalgam in root-end cavities prepared using MicroMega sonic retro-prep tips

The in vitro sealing ability of the root-canal sealer Diaket when used as a root-end filling material was compared with that of amalgam using linear micro-leakage of Indian ink. Eight groups of 20 extracted teeth each were formed, plus 12 control teeth as follows: 1) root-end resection of 45 degrees bevel, root-end cavity preparation with an 008 round bur, amalgam root-end filling; 2) 45 degrees bevel, bur, Diaket; 3) 45 degrees bevel, using a sonic retro-prep tip, amalgam; 4) 45 degrees bevel, sonic, Diaket; 5) no bevel, bur, amalgam; 6) no bevel, bur, Diaket; 7) no bevel, sonic, amalgam; 8) no bevel, sonic, Diaket. Root-end cavity depths of 3 mm were prepared. Specimens were immersed in Indian ink for 2 weeks. The teeth were demineralized, rendered transparent and linear dye penetration recorded. Results showed that Diaket provided a superior seal to amalgam irrespective of the root-end preparation. The degree of bevel of the resected root-end did not influence leakage. Sonic instrumentation resulted in a larger root-end cavity than with burs.

Root-end cavity preparation using the MicroMega Sonic Retro-prep Tip. SEM analysis

The objective of this laboratory study was to compare root-end cavities prepared with sonic Retro-prep tips in a MM1500 Sonic Air handpiece with those created by burs in a conventional handpiece. A total of 80 single-rooted extracted human teeth with mature apices and straight canals were included in the study. Four groups of 20 extracted teeth were prepared as follows: I, a 3-4 mm root-end resection perpendicular to the long axis of the root, with a size 40 sonic Retro-prep tip creating an apical cavity 3 mm into root canal system; II, a 45 degrees bevel of the root-face removing a 3-4 mm root segment and root-end preparation as per group I; III, root-end resection as per group I, with an apical cavity prepared using a size 010 inverted cone bur 3 mm down the long axis of the root; IV, resection as per group II, followed by an apical cavity preparation with a size 010 inverted cone bur 3 mm into the root canal system. The apical root portion and root-end cavities were replicated and prepared for SEM analysis at x 20 and x 80 magnification. The degree of chipping associated with the margin of the root-end cavities, as evaluated with a standard grading system, and the incidence of root-face cracks were noted. Marginal chipping of root-end cavities prepared using sonic instrumentation was significantly worse than that produced by burs (P < 0.001). Perpendicular root-end resections showed significantly better scores than bevelled root-end resections (P < 0.005). The incidence of root-face cracking was low with no significant difference between the experimental groups.

Reliability of reduced air pressure methods used to assess the apical seal

The reliability of two commonly used methods of sealability testing, dye leakage under normal atmospheric pressure and dye leakage in a partial vacuum, was tested using a repeated studies design. Forty extracted teeth were instrumented and obturated using lateral condensation of gutta-percha and Sealapex sealer. One-half of the teeth were placed in India ink under normal atmospheric pressure and the other half underwent air evacuation before immersion in the ink. After 24 h the teeth were removed from the ink and rendered transparent for linear leakage analysis. A second study, repeated within the exact parameters of the first, was performed approximately 1 month later. Mann-Whitney U tests indicated that there was no significant difference (P>0.05) between the air and vacuum groups or within each group (air or vacuum) between trials, indicating that the methodology is repeatable and that application of reduced air pressure did not enhance reliability. A large majority of the teeth placed under partial vacuum showed evidence of vacuum-induced artefacts that may negate the value of vacuum as a research tool.

Management of the resected root end: a clinical review

Careful management of the resected root end during endodontic surgery is critical to the overall success of the case. After resection, the root structure presents with multiple anatomical variations and considerations at both a macroscopic and microscopic level. These include root outline, canal anatomy, dentinal tubule configuration, presence of a smear layer and root canal filling material. Proper assessment of these variables will dictate the best methods for root-end management, along with the attainment of an anatomically compatible root face for optimal healing of the periradicular tissues.

Effect of smear layer removal on the diffusion of calcium hydroxide through radicular dentin

Forty single-rooted teeth were sectioned transversely through the cementoenamel junction and instrumented to a size #50 K-Flex file at the working length by saline irrigation. Each root was placed in a dilution vial containing 10 ml of normal saline, and the pH and Ca2+ levels were recorded after 24 h. The roots in group 1 then received a final irrigation with 20 ml of normal saline. Group 2 received a final irrigation with 10 ml of 17% ethylenediaminetetraacetic acid followed by 10 ml of 5.25% NaOCl to remove the smear layer. Group 3 was irrigated in the same manner as group 2, but calcium hydroxide (CH) was placed into the root canal. Group 4 was irrigated with 20 ml of NaOCl, and CH was placed into the root canal. The pH and Ca2+ levels were recorded at 1, 3, 5, and 7 days. After 7 days a 3- x 3- x 1-mm external defect was created in the coronal one third of the root surface. The pH and Ca2+ levels were subsequently recorded at 1, 3, and 7 days. Groups 3 and 4 demonstrated significantly higher H+ and Ca2+ levels than did groups 1 and 2 three days after CH placement and at all subsequent intervals. Group 3 demonstrated significantly higher H+ and Ca2+ readings at some but not all intervals. The results demonstrated that CH diffuses from the root canal to the exterior surface of the root and that the removal of the smear layer may facilitate this diffusion.