Evaluation of heat transfer during root canal obturation with thermoplasticized gutta-percha. Part II. In vivo response to heat levels generated

External Root Surface Temperature Control with 1,1,1,2-Tetrafluoroethane Intracanal Cryotherapy during Thermoplastic Obturation: An In Vitro Study

AIM

The aim of this in vitro study was to determine the effectiveness of 1,1,1,2-tetrafluoroethane (TFE) intracanal cryotherapy for external root surface temperature control during thermoplastic obturation.

MATERIALS AND METHODS

Thirty extracted adult single-rooted mandibular incisors were selected for this study. Endodontic shaping was performed until size X3 Protaper Next Rotary endodontic file. The teeth were divided into three groups: Group I-Control group wherein conventional irrigation was done using physiologic saline stored at room temperature, Group II-Irrigational Cryotherapy group using physiologic saline at 2.5°C, and Group III-Intracanal TFE cryotherapy group with intracanal refrigerant TFE application. Temperatures were recorded in the apical 3 mm before and after completion of each intervention and post thermoplastic obturation using a noncontact digital laser infrared thermometer.

RESULTS

Intracanal cryotherapy with TFE resulted in a mean decrease of 9.27°C compared with conventional irrigation that exhibited in a mean decrease of 2.13°C. Also, in intracanal cryotherapy group with TFE application, compared with the baseline (24.50°C), no significant differences were observed post obturation (24.61°C) with high-temperature-injectable gutta percha technique indicating good control of temperature rise on the external root surface.

CONCLUSION

Intracanal cryotherapy with refrigerant TFE was highly effective in controlling temperature rise on the external root surface during injectable thermoplastic obturation technique.

CLINICAL SIGNIFICANCE

Minimizing deleterious effects due to high temperatures generated during the thermoplastic obturation is critical. Clinically feasible measures to reduce the transmission of heat generated during thermoplastic obturation have been searched since long. In this regard, intracanal cryotherapy with TFE can be effectively used to control the rise of temperature on the external root surface when employing thermoplastic obturation technique.

Thermal and volumetric assessment of endodontic filling techniques using infrared thermography and micro-CT

PURPOSE

To assess root temperature during filling techniques and quantify the volume of endodontic filling materials using infrared thermography (IT) and micro-computed tomography (micro-CT).

METHODS

Ninety premolars were divided into three groups: lateral condensation (LC), single cone (SC) and thermomechanical compaction (TMC). For thermal analysis, 45 teeth were assessed using a FLIR T650sc IT camera during filling techniques and 45 teeth were scanned using a Nikon micro-CT to assess gutta-percha, cement, and void volumes. Descriptive and inferential statistical analyses were performed (non-parametric Mann-Whitney test, Kruskal-Wallis test, and Friedman test with Tukey's bidirectional analysis of variance).

RESULTS

TMC showed the highest temperature increase at 15 s after the procedure and a significant temperature decrease at 45 s after its completion. TMC showed the largest volume of gutta-percha and LC the highest void volume.

CONCLUSION

The temperature increase generated by gutta-percha endodontic filling techniques is within acceptable limits. A greater volume of endodontic cement was observed for the SL and LC filling techniques.

Temperature increase during orthodontic bonding with different curing units using an infrared camera

AIM

To evaluate the effects of different curing units and light-tip tooth surface distances on the temperature increase generated during orthodontic bonding, using an infrared camera (IR) and artificial neural networks (ANN).

MATERIALS AND METHODS

Fifty-two freshly extracted human premolar teeth were used. Metallic orthodontic brackets were bonded to the buccal surfaces of the teeth and thermal records were taken using an IR camera and ANN. Brackets were cured with a light-emitting diode (LED) and high intensity halogen (HQTH). Teeth were divided into four groups according to the curing units (LED and HQTH) and curing distances (from tooth surface and 10 mm away from tooth surface). The results were analyzed with analysis of variance (ANOVA) and the Tukey HSD test.

RESULTS

The ANOVA and Tukey HSD tests revealed that temperature changes were influenced by the type of light source and exposure times. All groups revealed significant differences between each other (p < 0.001). The highest surface temperature increase was gained from curing with a LED unit from the tooth surface (11.35°C ± 0.91°C). The lowest surface temperature increase was gained from curing with a HQTH unit 10 mm away from the tooth surface (2.57°C ± 0.6°C).

CONCLUSION

The LED unit induced significantly higher temperature changes than did the HQTH. The temperature increase during orthodontic bonding was increased with long exposure time. A shorter light-tip tooth surface distance leads to greater increases in temperature.

Heat conductive properties of set root canal sealers

OBJECTIVE

The aim of this study was to examine the thermal conductivity of five different root canal sealers in vitro.

MATERIALS AND METHODS

Sealapex, AH Plus, AH 26, Endomethasone and RoekoSeal root canal sealers were examined. These materials were prepared in accordance with the manufacturer's instructions and applied to standard molds. Three samples of each material were prepared. The samples were kept for 5 days under 37°C conditions. Measurements were taken using a heat conduction unit (P.A. Hilton Ltd. Stockbridge, Hants, UK). The thermal conductivity coefficient was calculated for each sample using the Fourier equation. Coefficients were analyzed statistically by the Kruskal-Wallis test.

RESULTS

Significant differences were found for thermal conductivity between some materials (p < 0.05). The conductivity coefficient of AH Plus was found to be higher than those of the other materials (p < 0.05). No statistically significant differences were found between AH 26 and RoekoSeal (p > 0.05) and the conductivity coefficients of these sealers were found to be lower than those of the other materials (p < 0.05). No statistically significant differences were found between Sealapex and Endomethasone (p > 0.05) and the conductivity coefficients of these sealers were found to be lower than that of AH Plus but higher than those of RoekoSeal and AH26 (p < 0.05).

CONCLUSIONS

The results showed that root canal sealers functioned as thermal insulators and had different heat-conductive properties that depended on their composition.

Thermal irritation of teeth during dental treatment procedures

While it is reasonably well known that certain dental procedures increase the temperature of the tooth's surface, of greater interest is their potential damaging effect on the pulp and tooth-supporting tissues. Previous studies have investigated the responses of the pulp, periodontal ligament, and alveolar bone to thermal irritation and the temperature at which thermal damage is initiated. There are also many in vitro studies that have measured the temperature increase of the pulp and tooth-supporting tissues during restorative and endodontic procedures. This review article provides an overview of studies measuring temperature increases in tooth structures during several restorative and endodontic procedures, and proposes clinical guidelines for reducing potential thermal hazards to the pulp and supporting tissues.

System B, Endo-Twinn and E-Fill. True temperatures inside the canal

Background:

The aim of this study is to verify the variations of the temperature inside the root canal with three different gutta-percha heating systems.

Materials and Methods:

A split-tooth model was built with a lateral groove at 3.5-mm from working length (WL) in order to insert a Chromel-Alumel K-type thermocouple placed in contact with gutta-percha. The thermocouple was connected to a digital thermometer. Sixty obturations were made with medium gutta-percha points. For 20 specimens the System B was used with the Buchanan fine plugger and the temperature was set at 200°C; for other 20 specimens the Endo-Twinn with a fine plugger was used and for the last 20 specimens we used the E-Fill with a 40.04 plugger. All pluggers were pushed to 3.5 mm from WL so that the tips were in contact to the probe.

Results:

The analysis of 60 samples showed the highest temperature average using the System B after 10 seconds (86.85°C), after 15 seconds (94.9°C), after 20 seconds (100.4°C) and after 25 seconds (104.5°C). The Endo-Twinn average values are similar to System-B ones. The E-Fill average values are lower (69.9°C) than the other two systems evaluated only after 10 seconds due to limited working time. The temperatures average obtained using different systems of warm vertical compaction are lower than what was declared by the producing companies.

Conclusion:

Time is one the most important parameters to consider using these systems. Temperatures reached from the System B and Endo-Twinn after 25 seconds; however, seem to be sufficient to ensure an optimal adaptation of the gutta-percha in the anatomical complexity of root canals. The temperatures obtained from the E-Fill, only after 10 seconds, instead seems to be insufficient to assure the rheological characteristics of gutta-percha.

Finite element analysis of the effects of thermal obturation in maxillary canine teeth

OBJECTIVE

The purpose of the present study was to determine the distribution and level of temperature, in a model of a maxillary canine, the surrounding periodontal tissues, and the bones, during a System B heat obturation technique simulation.

STUDY DESIGN

The temperature distribution was determined by using a three-dimensional finite element analysis. The tooth was assumed to have undergone an endodontic treatment before the application. Heat applications of 200 degrees C and 100 degrees C were considered.

RESULTS

By using the virtual model and the simulation technique, the maximum temperature in the periodontal ligament was found to be 43.5 degrees C.

CONCLUSIONS

Within the assumptions and the limitations of the study, it was determined that the simulation of System B technique created no potentially harmful levels of temperature throughout the maxillary canine model.

In Vitro Infrared Thermographic Assessment of Root Surface Temperatures Generated by High-Temperature Thermoplasticized Injectable Gutta-Percha Obturation Technique

The aim of this in vitro study was to measure the temperature rises on the outer surface of roots produced by high-temperature thermoplasticized injectable gutta-percha technique. Thirty extracted human teeth with a single canal (15 maxillary central incisors and 15 mandibular central incisors) were used in this study. After root canal cleaning and shaping, the teeth were obturated with the injected gutta-percha heated to 160 degrees C (Obtura II). Temperature changes on the whole mesial outer surface of the roots was measured using an infrared thermal imaging camera. It showed that the use of gutta-percha heated to 160 degrees C to fill the maxillary central incisors and mandibular central incisors resulted in the rises of the root surface temperature by 8.5 degrees C and 22.1 degrees C, respectively. In conclusion, the injection of the gutta-percha heated to 160 degrees C into the root canal of maxillary central incisors produces temperature on the outer root surfaces below the theoretical critical level and, therefore, should not cause damage to supporting periradicular tissues. The injection of gutta-percha into the root canal space of the mandibular central incisors in vitro, resulted in an elevation of the root surface temperature by more than 10 degrees C.

Biocompatibility of dental materials used in contemporary endodontic therapy: a review. Part 2. Root-canal-filling materials

Root-canal-filling materials are either placed directly onto vital periapical tissues or may leach through dentine. The tissue response to these materials therefore becomes important and may influence the outcome of endodontic treatment. This paper is a review of the biocompatibility of contemporary orthograde and retrograde root-canal-filling materials.

Temperature change within gutta-percha induced by the System-B Heat Source

AIM

This study evaluated the temperature change within gutta-percha during the vertical compaction technique performed with a System-B Heat Source.

METHODOLOGY

Extracted human teeth were prepared and divided in two equal groups depending on the apex diameter (group 1: 0.20-0.25 mm and group 2: 0.30-0.35 mm). Teeth were root treated with a combination of step-back and coronal flaring instrumentation using Gates Glidden burs and hand stainless steel K- and H-files. Two thermocouples were connected to the outer surface of the root: the first one was placed 2 mm apically from cement-enamel junction (CEJ) (point C); and the second one 1.5 mm from the apex (point A). The instrumented canals were filled with size F gutta-percha cones. All teeth were then immersed in a thermostatic bath at a constant temperature of 37 degrees C and warm vertical compaction was performed using a System-B Heat Source. delta T values were recorded by means of a digital thermometer connected to the thermocouples.

RESULTS

Increments of temperature (delta T) recorded in point A revealed a mean value of 0.5 +/- 0.5 degree C for group 1 and 0.9 +/- 1.1 degrees C for group 2; delta T values recorded at point C gave a mean value of 4.1 +/- 1.7 degrees C for group 1 and 3.9 +/- 1.81 degrees C in group 2. No statistical difference was found between the groups, whilst a difference was present between the measurements at points A and C (P < 0.01).

CONCLUSIONS

The use of the System-B Heat Source on root canals maintained at a constant body temperature by a thermostatic bath revealed that the increase of temperature of the gutta-percha at the apical third of the canal was negligible and that the compaction of the mass of the gutta-percha close to the apex was performed at body temperature. Minor changes in temperature of the outer surface of the root canals occurred, suggesting no danger for the periradicular tissues.

Radicular temperatures associated with thermoplasticized gutta-percha

Thermoplasticized gutta-percha has been used to obturate root canals. The continuous wave of condensation technique uses the System B Heat Source with the choice of different-sized pluggers. The purpose of this study was to measure the temperatures within the root canal and on the root surface at different radicular levels while using the System B Heat Source. Fine, Fine-Medium, and Medium pluggers were evaluated at temperature settings of 200 degrees C, 250 degrees C, and 300 degrees C. The Obtura II gutta-percha delivery system following the manufacturer's instructions and ultrasonically thermoplasticized gutta-percha were used for comparative purposes. The highest mean temperature change on the internal root surface was 74.19 degrees C with the system B at the 6 mm level (6 mm coronal to working length) when the Fine-Medium plugger was set at 300 degrees C. The lowest mean temperature change on the internal root surface was 2.09 degrees C at the 0 mm level (at working length) when the F plugger was set at 200 degrees C. With the Obtura II, the lowest mean internal temperature change was 5.22 degrees C at the 0 mm level, whereas the highest mean internal temperature change was 26.63 degrees C at the 6 mm level. With ultrasonic lateral compaction the lowest mean internal temperature change was 5.01 degrees C at the 0 mm level, whereas the highest mean internal temperature change was 28.95 degrees C at the 6 mm level. At no time did the System B, the Obtura II, or ultrasonic delivery of warm gutta-percha exceed an increase of 10 degrees C at any thermocouple level on the external root surface.

In vitro infrared thermographic assessment of root surface temperatures generated by the thermafil plus system

The purpose of this in vitro study was to investigate root surface temperatures generated by the Thermafil Plus system using infrared thermography. A total of 60 extracted human maxillary central incisors and maxillary first molars were biomechanically instrumented using ProFile 0.04 Taper Series 29 rotary instruments. The root canals were obturated using the Thermafil Plus system. An infrared thermography camera was used to measure the external root surface temperatures during and after the completion of obturation. The mean temperature rise of the external root surface from the ambient temperature was 4.26 degrees C for the mesial buccal roots, 4.58 degrees C for the distobuccal roots, 4.76 degrees C for the palatal roots, and 4.87 degrees C for the anterior roots. These temperatures were well below the critical level of 10 degrees C needed to cause damage to the attachment apparatus. From this in vitro experiment, no evidence was discovered which would indicate that the Thermafil Plus obturation system would result in damage to the periodontal ligament and the surrounding attachment apparatus as a consequence of temperature rise on the external root surface.

Comparison of two vertical condensation obturation techniques: Touch 'n Heat modified and System B

AIM

The aims of this study were firstly to compare the area of canal occupied by gutta-percha, sealer or voids using the System B heating device with that obtained by a modified vertical condensation technique using the Touch 'n Heat: and secondly to compare the temperature changes at the root canal wall and external root surface during obturation with the above techniques.

METHODOLOGY

Forty-five resin blocks, each with a standardized, simulated, prepared main root canal and five lateral canals, were assigned to three equal experimental groups. The canals were obturated using either the System B technique at two different temperature settings, or vertical condensation with a Touch 'n Heat instrument as the heat source. A heat transfer model was used to simultaneously record internal and external root surface temperature elevations during obturation by the three techniques. Data were analysed using unpaired Student's t-test and Mann-Whitney U-test.

RESULTS

Both obturation techniques produced root fillings consisting of over 90% gutta-percha at most levels, although the percentages of sealer and voids 2-3 mm from the working length following System B obturation were higher than those found following modified vertical condensation. Modified vertical condensation resulted in more gutta-percha in lateral canals. Obturation was accomplished more quickly using the System B, and temperature elevations produced during obturation with the System B were significantly less (P < 0.001) than with vertical condensation. An elevation of external root surface temperature by more than 10 degrees C occurred during vertical condensation.

CONCLUSIONS

The results suggest that the System B may produce an acceptable obturation and that the use of a Touch 'n Heat source during vertical condensation may result in damage to the periodontium.

Clinical experience of root canal filling by ultrasonic condensation of gutta-percha

Ninety human teeth with a total of 181 prepared root canals were filled with the use of ultrasonically energized spreaders as an aid for lateral condensation of gutta-percha cones. The results were evaluated on the basis of clinical and radiographic criteria. Adequate fillings were found in 93% of the canals and the overall success rate was 93%. All of the recalled patients were clinically comfortable.

A comparison of root surface temperatures using different obturation heat sources

This study compared root surface temperatures produced during warm vertical obturation using the System B Heat Source (SB), the Touch 'n Heat device (TH), and a flame-heated carrier (FH). The root canals of 30 maxillary incisor, premolar, and mandibular incisor teeth were prepared; divided into three groups; and obturated using each heat source. A thermocouple placed 2 mm below the cementoenamel junction transferred the temperature rise on the external root surface to a digital thermometer. SB surface temperature rise was < 10 degrees C for all experimental teeth. TH temperature rise in maxillary incisors and premolars was < 10 degrees C; however, > 10 degrees C was observed for mandibular incisors. FH produced a > 10 degrees C surface temperature rise in all experimental teeth. The critical level of root surface heat required to produce irreversible bone damage is believed to be > 10 degrees C. The findings of this study suggest that warm vertical condensation with the SB should not damage supporting periradicular tissues. However, caution should be used with TH and FH on mandibular incisors.

Effect of power settings on temperature change at the root surface when using a Holmium YAG laser in enlarging the root canal

The aim of this study was to determine the maximum amount of power, in watts, that a Holmium YAG laser could deliver via a 245-micron fiberoptic to the canal surface and still not raise the temperature (delta T) of the cementum by > 5 degrees C. Sixty single-rooted teeth were divided into three groups according to power selection (0.50, 0.75, and 1.00 W). The three main outcome variables were: change in apical temperature, change in coronal temperature, and maximum size of an endodontic file that could fit into the canal after lasing. The group means for apical delta T were: 1.00 W = 2.2 degrees C, 0.75 W = 2.68 degrees C, and 0.50 W = 1.58 degrees C. The group means for coronal delta T were: 1.00 W = 1.15 degrees C, 0.75 W = 0.99 degree C, and 0.50 W = 0.56 degree C. The group means for file size were: 1.00 W = 41.25, 0.75 W = 38.75, and 0.50 W = 40.75. The canal size was increased from a size 25 file up to approximately a size 40 file with all power groups. There were no significant differences between the groups for change in apical temperature (p = 0.32), coronal temperature (p = 0.17), or maximum file size (p = 0.86) when adjustments were made for tooth dimensions. In all groups studied, the delta T was < 5 degrees C. This represents a safe and predictable laser procedure.

In vitro evaluation of apical leakage of root canal fillings after in situ obturation with thermoplasticized and laterally condensed gutta percha

The purpose of this investigation was to compare in vitro the sealing ability of root canal treatments performed in situ with injected thermoplasticized gutta-percha compared with the lateral condensation technique. Thirty single-rooted teeth with straight canals, due for extraction for orthodontic or periodontal reasons were prepared using a step-back technique. Teeth were then divided randomly into groups A and B and obturated, respectively, with the sectional injection thermoplasticized gutta-percha and the lateral condensation techniques. Teeth were extracted after 15 days, immersed in India ink for 3 days and the leakage was determined using area-metric analysis. The roots were ground transversally and the root portion was incrementaly removed with successive steps of 250 microns each, up to the coronal level of the dye penetration. Every section was photographed with a stereoscopic microscope under the same magnification (x20); 310 photographs were taken. Measurements of the area covered by ink as well as the whole cross-sectional area of the canal were made from each photograph with the aid of a digitizing computer. The measurements were subjected to non-parametric statistical analysis. No significant difference was found (P > 0.05). The technique of lateral condensation proved to be better in the first five sections (1.2 mm from the foramen) while thermoplasticized gutta-percha technique was superior in the rest of the root canal.

Sealing ability of sectional injection thermoplasticized gutta-percha technique with varying distance between needle tip and apical foramen

The purpose of this investigation was to evaluate the influence of the distance of the needle tip from the apical foramen on the apical seal and the length control of the root filling material when thermoplasticized gutta-percha is injected using a sectional injection technique. Ninety-nine human single-rooted mandibular incisors and permanent premolars with straight canals were divided into three equal Groups A, B and C. In Group A the teeth had relatively the wider root canal, in Group C the narrowest, while in Group B root canal size was intermediate. The root canals of all teeth were prepared with a step-back technique. Roots of Group A were instrumented to a Size 70 4 mm short of the working length, while roots of Groups B and C to a Size 70 6 mm and 8 mm short of the working length, respectively. The teeth of all groups were covered with aluminium foil and embedded in acrylic blocks. After the placement of sealer (Roth 811) the root canals of all teeth were obturated with injection-molded thermoplasticized gutta-percha using a three-stage sectional technique. The roots remained in India ink for three days and then cleared by successive immersion in nitric acid, ascending grades of alcohol and finally in xylene. The linear dye penetration and the linear apical underextentionion of the root canal filling were measured by two independent examiners under a stereo microscope. There was no significant difference in the linear dye leakage between the groups.(ABSTRACT TRUNCATED AT 250 WORDS)

A new model system for measuring intracanal temperatures

A new model system was developed which allows intracanal temperature measurements to be recorded during repeated obturations of a human tooth root canal. A human central incisor was embedded in clear orthodontic resin and sectioned longitudinally. Sixteen thermocouples were secured at 2-mm intervals along two surfaces of the root canal. The thermocouples were connected to a computerized temperature recording system to measure intracanal temperatures produced by high-temperature thermoplasticized injectable gutta-percha. The system was capable of recording 16 simultaneous temperatures every second with an accuracy of a hundredth degree centigrade. There was a linear increase in the recorded temperatures in the root canal. However, the actual temperatures were lower than expected.

Clinical experience in root canal obturation by an injection thermoplasticized gutta-percha technique

Forty-one human teeth with a total of 71 root canals were obturated with the high-temperature injected thermoplasticized technique (Obtura). Patients were recalled 6 to 36 months postoperatively. Cases were evaluated on the basis of clinical and X-ray findings. The success rate was 93.1%.

In vivo findings associated with heat generation during thermomechanical compaction of gutta-percha. 2. Histological response to temperature elevation on the external surface of the root

An in vivo investigation is described and a histological evaluation made of the effect of canal obturation by thermomechanical compaction of gutta-percha and sealer on the cementum on the lateral surface of the root and adjacent periodontal membrane and alveolar bone of the ferret canine after time intervals of 24 hours, 20 days and 40 days. These tissue reactions were compared with those in the roots of control teeth filled by lateral condensation of cold gutta-percha and sealer. Iatrogenic damage was apparent in a minority of the experimental specimens 20 and 40 days after obturation.

Apical placement of needle tip with an injection-thermoplasticized gutta-percha technique for root canal obturation

It is recommended that when injection-thermoplasticized gutta-percha is used as the obturation technique, the root canal space should be prepared in such a way that the 23-gauge injection needle tip can be placed at a distance 3 to 5 mm short of the working length. In this study the apical seal and extent of gutta-percha were evaluated when the 23-gauge tip was placed at a distance 4 mm, 6 mm, and 8 mm short of the working length. Ninety-nine human single-rooted mandibular incisors and premolars divided into 3 equal groups were used. Their crowns were separated at the cementoenamel junction and their roots were stored in sodium hypochlorite for 1 week. The roots were then instrumented from size 20 at the working length to size 70:4 mm short of the working length in group A, 6 mm in group B, and 8 mm in group C. Following instrumentation, 3 randomly selected roots of each group were used as control. The remaining 30 roots of each group were covered with aluminium foil and embedded in acrylic blocks. The root canals were then dried, coated with sealer (Roth 811) and obturated by injection of thermoplasticized gutta-percha using the single-phase technique. Vertical condensation followed. The roots were immersed in dye for 3 days and then demineralized, dehydrated and cleared in xylene. Measurements of linear dye penetration for the apical seal and for underextension were done by 2 independent examiners under a stereomicroscope. The results of this study showed no statistically significant difference in leakage between the groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Temperature changes in thermoplasticized gutta-percha: a comparison of two ultrasonic units

With the use of an extracted human tooth as in vitro model, this study measured temperature changes in the surface of gutta-percha while it was being ultrasonically thermoplasticized. Two sources of ultrasonic oscillation were used: a Cavitron 2001 ultrasonic unit with a file in a PR-30 insert and an ENAC ultrasonic unit with a plugger or file. Temperature elevation in the apical third of the tooth was minimal with either instrument (1.66 degrees C to 3.74 degrees C). The temperature rise in the middle third was higher with the ENAC unit, although probably still within clinically acceptable limits (range, 6.35 degrees C to 19.10 degrees C). The time taken for each unit to thermoplasticize the gutta-percha and reach a predetermined distance in the experimental model was recorded and defined as instrument efficiency. The Cavitron unit that had the PR-30 insert with a No. 25 file required 0.48 sec/mm, whereas the ENAC unit with a No. 25 file required 10.83 sec/mm and the ENAC unit with a plugger required 8.38 sec/mm. It appears that the Cavitron unit with a PR-30 insert was more than 22 times as efficient as the ENAC unit for thermoplasticizing gutta-percha under the experimental conditions used in this study.

Sealing ability of thermoplasticized gutta-percha in root canal obturation using a sectional vs. a single-phase technique

Properly prepared straight root canals of freshly extracted maxillary canines and central incisors were used to evaluate the sealing ability of the sectional thermoplasticized gutta-percha obturation technique, with or without sealer and the single-phase thermoplasticized gutta-percha filling technique. The teeth were divided into 3 groups (A, B, C) of 20 teeth and were obturated using the 3 thermoplasticized gutta-percha techniques. Group A: single phase with sealer; group B: sectional technique without sealer; and group C: sectional technique with sealer. The obturated teeth were immersed in India ink for 3 days followed by clearing procedures. The teeth were then examined under a stereo microscope and the linear leakage was recorded. Statistical unpaired Student's t-tests showed significantly less dye penetration in teeth obturated using the sectional technique with sealer (group C) than in teeth obturated with the single-phase technique with sealer (group A) or the sectional technique without sealer (group B).

Periodontal tissue reactions following root canal obturation with an injection-thermoplasticized gutta-percha technique

The thermoplasticized gutta-percha obturation technique is a relatively recent development in endodontics. In this study we evaluated the possible effects of heat transmitted to the periodontal tissues when the Obtura root canal filling device was used in dog teeth. Two 8-month-old beagle dogs were used; 56 root canals of 36 teeth (maxillary incisors and first, second and third premolars of both jaws) were divided into two groups. In Group A 26 root canals were obturated with the lateral condensation technique, while in Group B 30 root canals were obturated using the Obtura device, without sealer. Observation periods were 1, 3, 7, 28 and 56 days. After routine laboratory procedures, hematoxylin-eosin stained sections were examined under a light microscope. In this experimental model the thermoplasticized gutta-percha obturation technique caused a periapical inflammatory reaction at all observation periods. Inflammatory reaction and destruction of collagen fibers were localized in the area around the apical delta, while the alveolar founding bone, the roots of the teeth and the periodontal ligament at the side of the root surfaces remained normal.