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Mon A, Kim ME, Kum KY, Kwon HB. 3D finite element analysis of stress distribution on the shape of resected root-end or with/without bone graft of a maxillary premolar during endodontic microsurgery. J Dent Sci 2024; 19:837-845. [PMID: 38618133 PMCID: PMC11010716 DOI: 10.1016/j.jds.2023.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/29/2023] [Indexed: 04/16/2024] Open
Abstract
Background/purpose Apical root resection pattern affects the stress distribution behavior in the apical region of the resected tooth. The purpose of the study was to compare the biomechanical responses of resected teeth between endodontic microsurgery (horizontal resection) and targeted endodontic microsurgery (round resection). Materials and methods Five different models were developed. The basic model without resection (NR) was regarded as the control model, and the others involved: horizontal resection without bone grafting (HN), horizontal resection with bone grafting (HG), round resection without bone grafting (RN), and round resection with bone grafting (RG) models. A static load of 100 N was applied to the buccal and palatal cusps of all the teeth in a 30° oblique direction. The maximum von-Mises stress and tooth displacement values were analyzed and compared. Results Both the HN and RN models exhibited lower stress distribution values on bone compared with the NR (control) model. Regarding maximum stress distribution at the root apex, the stress value of the RN model was slightly higher compared to the HN model, whereas the RG model displayed a slightly lower stress value in comparison with the HG model. For maximum tooth displacement value, there were no significant differences between the HN and RN models, as well as the HG and RG models. Conclusion The round resection pattern had comparable stress distribution behaviors at the root apex and tooth displacement values with the horizontal resection pattern. Targeted endodontic microsurgery might provide better biomechanical response of the resected tooth after root-end resection.
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Affiliation(s)
- Aein Mon
- Dental Research Institute and Department of Prosthodontics, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Mi-El Kim
- Dental Research Institute and Department of Oral Anatomy, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Kee-Yeon Kum
- Dental Research Institute and Department of Conservative Dentistry, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Ho-Beom Kwon
- Dental Research Institute and Department of Prosthodontics, School of Dentistry, Seoul National University, Seoul, Republic of Korea
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Damor PR, Sharma S, Kumar V, Chawla A, Logani A. Topography of root-end surface after freehand and three-dimensional-guided apicoectomy procedure: A scanning electron microscope study. JOURNAL OF CONSERVATIVE DENTISTRY AND ENDODONTICS 2024; 27:424-428. [PMID: 38779202 PMCID: PMC11108421 DOI: 10.4103/jcde.jcde_77_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/03/2024] [Accepted: 03/06/2024] [Indexed: 05/25/2024]
Abstract
Background Dentinal microcracks formed during apical resection may lead to increased susceptibility to root fracture and improper sealing of apical preparation that may negatively influence the outcome of endodontic microsurgery. Aims This study was performed to analyze the root-end surface for dentinal microcracks using a scanning electron microscope (SEM) after resection with high-speed bur and trephine drill. Materials and Methods Thirty extracted single-rooted maxillary premolar teeth were selected and randomly distributed into two groups (n = 15). Working length was established using a #15 K-type file. Canals were prepared with a rotary Ni-Ti system to size 30/0.06 using endomotor, irrigated with 3% sodium hypochlorite, dried with paper points, and obturated with gutta-percha cones using a single-cone technique. All samples were mounted on preformed molds and poured using a mixture of sawdust and gypsum. In Group A; tungsten carbide bur was used to perform a freehand apicoectomy. In Group B; a trephine drill was used with a three-dimensional guide to perform 3 mm of root resection. Apicoectomy was performed in both groups under a dental operating microscope. Resected root ends were inspected for microcracks using SEM. The Shapiro-Wilk and Mann-Whitney U-test were used for statistical analysis. Results Microcracks were observed in all samples in both study groups. Trephine drill produced more microcracks on the resected root surface compared to the use of high-speed tungsten carbide bur with a statistically significant difference (P < 0.05). Conclusions The trephine drill used during targeted endodontic microsurgery produced more microcracks on the resected root dentine surface compared to the high-speed tungsten carbide bur used during freehand apicoectomy.
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Affiliation(s)
- Pradipkumar R. Damor
- Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Sidhartha Sharma
- Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Kumar
- Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Amrita Chawla
- Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Logani
- Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
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Yoo YJ, Perinpanayagam H, Kim M, Zhu Q, Baek SH, Kwon HB, Kum KY. Stress Distribution on Trephine-Resected Root-end in Targeted Endodontic Microsurgery: A Finite Element Analysis. J Endod 2022; 48:1517-1525.e1. [DOI: 10.1016/j.joen.2022.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/11/2022] [Accepted: 10/11/2022] [Indexed: 11/05/2022]
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Ran SJ, Yang X, Sun Z, Zhang Y, Chen JX, Wang DM, Liu B. Effect of length of apical root resection on the biomechanical response of a maxillary central incisor in various occlusal relationships. Int Endod J 2019; 53:111-121. [PMID: 31454089 DOI: 10.1111/iej.13211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/22/2019] [Indexed: 11/27/2022]
Abstract
AIM To investigate the stress distribution and tooth displacement of a maxillary central incisor with various apical root resection lengths and occlusal relationships using finite element (FE) analysis. METHODOLOGY A maxillary central incisor was scanned by micro-CT. First, the FE intact incisor model with dentine, enamel, pulp and root surrounded by alveolar bone and periodontal ligament was designed based on the micro-CT image data. Then, six FE models with varying lengths of apical root resection were established to simulate the clinical treatment and reveal the clinically applicable limit of apical root resection during endodontic microsurgery. For each model under different loading conditions, the maximum von Mises stress (σ max) at the root apex, root cervix, alveolar bone and periodontal ligament and the maximum tooth displacement (ΔR max) were calculated and compared. RESULTS In a normal occlusion, more than 6 mm of root resection resulted in a marked increase in the ΔR max values (>10%) and σ max values of alveolar bone (>50%); the stress levels at the root apex increased dramatically when the apical root was resected more than 7 mm. With increased overjet, apical root resection did not change the stress level markedly until it reached 8 mm, but the ΔR max increased markedly (>10%) if the root was resected more than 5 mm. With deep overbites, the σ max increased significantly (>50%) when the root was resected more than 4 mm whilst the ΔR max decreased. With increased overjet and deep overbite, more than 6 mm of resection resulted in a substantial σ max increase (>50%) of alveolar bone and the ΔR max increased markedly (>10%) when the root was resected 8 mm. Additionally, the σ max and the ΔR max values were greater with increased overjet and lower with deep overbites. CONCLUSIONS Using FE analysis, apical root resection of more than 6 mm resulted in a marked increase of stress distribution and tooth displacement in normal and increased overjet with deep overbite occlusal relationships. In increased overjets or deep overbites, more than 5 mm or 4 mm, respectively, stress distribution and tooth displacement increased markedly.
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Affiliation(s)
- S J Ran
- Department of Endodontics and Operative Dentistry, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China.,National Clinical Research Center of Stomatology, Shanghai, China
| | - X Yang
- School of Mechanical and Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Z Sun
- Department of Endodontics and Operative Dentistry, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China.,National Clinical Research Center of Stomatology, Shanghai, China
| | - Y Zhang
- Department of Endodontics and Operative Dentistry, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China.,National Clinical Research Center of Stomatology, Shanghai, China
| | - J X Chen
- Department of Endodontics and Operative Dentistry, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China.,National Clinical Research Center of Stomatology, Shanghai, China
| | - D M Wang
- School of Mechanical and Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - B Liu
- Department of Endodontics and Operative Dentistry, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China.,National Clinical Research Center of Stomatology, Shanghai, China
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Gümrükçü Z, Kurt S, Köse S. Effect of Root Resection Length and Graft Type Used After Apical Resection: A Finite Element Study. J Oral Maxillofac Surg 2019; 77:1770.e1-1770.e8. [PMID: 31153936 DOI: 10.1016/j.joms.2019.04.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 04/23/2019] [Accepted: 04/23/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE Apical resection is a surgical technique that involves removing a tooth's root tip and sealing the apical extent of the root canal system. However, evidence-based information on the biomechanical effects of apically resected tooth determinants is lacking. The aim of the present study was to examine the biomechanical effects of using different graft materials and the effect of different resection quantities on the tooth radix. MATERIALS AND METHODS Thirty finite element models of mandibular central incisors with 1-cm defects in their apical regions were constructed using SolidWorks software (SolidWorks, Waltham, MA). Resections of 0, 1, 2, 3, 4, and 5 mm were created at the root tips, and tissue regeneration was simulated in the empty cavity models using the material properties of healed bone, an allograft, a xenograft, and hydroxyapatite to the grafts used to fill the apical sites. A 100-N force was applied to the various groups of teeth in the oblique (45°) direction, and the maximal von Mises stress and displacement values were determined using Ansys, version 16, software (ANSYS, Inc, Canonsburg, PA). RESULTS The highest of these values was observed in the 5-mm resected and empty model. Increasing the resection amount caused the stress and displacement to increase. The lowest stress and deformation values were seen in the hydroxyapatite group, followed by the xenograft group and the allograft group. CONCLUSIONS The results of the present study have shown that grafting into the apical defect provides biomechanical support for resection of the root structure.
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Affiliation(s)
- Zeynep Gümrükçü
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Recep Tayyip Erdoğan University, Rize, Turkey.
| | - Sevda Kurt
- Assistant Professor, Department of Periodontology, Faculty of Dentistry, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Sinan Köse
- Trabzon Chamber of Commerce and Industry, Trabzon, Turkey
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Angerame D, De Biasi M, Lenhardt M, Bevilacqua L, Franco V. Survival study on teeth after successful endodontic surgical retreatment: influence of crown height, root length, crown-to-root ratio and tooth type. GIORNALE ITALIANO DI ENDODONZIA 2018. [DOI: 10.1016/j.gien.2018.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Monteiro JB, Dal Piva AMDO, Tribst JPM, Borges ALS, Tango RN. The Effect of Resection Angle on Stress Distribution after Root-End Surgery. IRANIAN ENDODONTIC JOURNAL 2018; 13:188-194. [PMID: 29707013 PMCID: PMC5911292 DOI: 10.22037/iej.v13i2.19089] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Introduction: This study aimed to investigate the influence of the resection angle on the stress distribution of retrograde endodontic treated maxillary incisors under oblique-load application. Methods and Materials: A maxillary central incisor which was endodontically treated and restored with a fiber glass post was obtained in a 3-dimensional numerical model and distributed into three groups according to type of resection: control; restored with fiber post without retrograde obturation, R45 and R90 with 45º and 90º resection from tooth axial axis, respectively and restored with Fuji II LC (GC America). The numerical models received a 45º occlusal load of 200 N/cm2 on the middle of lingual surface. All materials and structures were considered linear elastic, homogeneous and isotropic. Numerical models were plotted and meshed with isoparametric elements, and the results were analyzed using maximum principal stress (MPS). Results: MPS showed greater stress values in the bone tissue for control group than the other groups. Groups with apicectomy showed acceptable stress distribution on the fiber post, cement layer and root dentin, presenting more improved values than control group. Conclusion: Apicectomy at 90º promotes more homogeneity on stress distribution on the fiber post, cement layer and root dentin, which suggests less probability of failure. However, due to its facility and stress distribution also being better than control group, apicectomy at 45° could be a good choice for clinicians.
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Affiliation(s)
- Jaiane Bandoli Monteiro
- Department of Dental Materials and Prosthodontics, São Paulo State University (Unesp), Institute of Science and Technology, São José dos Campos, SP, Brazil
| | - Amanda Maria de Oliveira Dal Piva
- Department of Dental Materials and Prosthodontics, São Paulo State University (Unesp), Institute of Science and Technology, São José dos Campos, SP, Brazil
| | - João Paulo Mendes Tribst
- Department of Dental Materials and Prosthodontics, São Paulo State University (Unesp), Institute of Science and Technology, São José dos Campos, SP, Brazil
| | - Alexandre Luiz Souto Borges
- Department of Dental Materials and Prosthodontics, São Paulo State University (Unesp), Institute of Science and Technology, São José dos Campos, SP, Brazil
| | - Rubens Nisie Tango
- Department of Dental Materials and Prosthodontics, São Paulo State University (Unesp), Institute of Science and Technology, São José dos Campos, SP, Brazil
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Influence of Apical Root Resection on the Biomechanical Response of a Single-rooted Tooth—Part 2: Apical Root Resection Combined with Periodontal Bone Loss. J Endod 2015; 41:412-6. [DOI: 10.1016/j.joen.2014.11.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 11/03/2014] [Accepted: 11/08/2014] [Indexed: 11/18/2022]
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Mandava P, Bolla N, Thumu J, Vemuri S, Chukka S. Microleakage evaluation around retrograde filling materials prepared using conventional and ultrasonic techniques. J Clin Diagn Res 2015; 9:ZC43-6. [PMID: 25859524 DOI: 10.7860/jcdr/2015/11071.5595] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 01/01/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The importance of the retrograde cavity preparation and the material used to restore is of utmost importance to achieve successful surgical endodontics. AIM The aim of the present study is to evaluate the apical micro-leakage of root end cavities filled with Mineral trioxide aggregate, Biodentine and light cure GIC using two different cavity preparation techniques that is conventional bur preparation and ultrasonic tip preparation. MATERIALS AND METHODS Eighty extracted single rooted human teeth (except mandibular incisors) with one canal, fully developed apices and without any major carious lesion are collected for the study. The teeth were sectioned at CEJ to standardize the length. Roots are instrumented upto master apical file 40 K size and obturated with gutta percha and AH plus sealer in lateral condensation technique. The teeth were then resected apically at 90° angle axis to the long axis of the root removing 3 mm of the apex. The teeth were divided in to four groups of 20 each- • Group I- samples restored with MTA. • Group II- samples restored with Biodentine. • Group III- (Positive control group)- samples restored with Light activated GIC. • Group IV - (negative control group)- no filling material. Each group is divided into two subgroups (a, b) of ten teeth each 1. Retropreparation done with ultrasonic retrotip. 2. Retropreparation done with conventional bur. The teeth were then immersed in 0.5% Rhodamine B dye for 48 h. The teeth were split longitudinally and the interface between the restored material and the canal wall is observed under Confocal laser scanning microscope. Depth of dye penetration was examined under stereomicroscope. RESULTS The statistical analysis was performed by One way ANOVA, t test. Pair wise comparision was done by Newman - Keuls multiple post hoc test. The mean values of Dye penetration for Group Ia (321.23), Group Ib (490.11), Group IIa (1065.14), Group IIb (1170.96), Group IIIa (1888.90), Group IIIb (2025.35). The samples prepared with ultrasonic retrotip showed less microleakage but it is statistically not significant. CONCLUSION MTA showed significantly less microleakage when compared to Biodentine and light cure GIC and there is no statistical difference between the ultrasonic retrotip preparation and conventional bur preparation.
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Affiliation(s)
- Pragna Mandava
- Senior Lecturer, Department of Conservative Dentistry and Endodontics, SIBAR Institute of Dental Sciences , Guntur, Andhra Pradesh, India
| | - Nagesh Bolla
- Professor and HOD, Department of Conservative Dentistry and Endodontics, SIBAR Institute of Dental Sciences , Guntur, Andhra Pradesh, India
| | - Jayaprakash Thumu
- Professor and HOD, Department of Conservative Dentistry and Endodontics, St. Joseph Dental College , Eluru, Andhra Pradesh, India
| | - Sayesh Vemuri
- Professor, Department of Conservative Dentistry and Endodontics, SIBAR Institute of Dental Sciences , Guntur, Andhra Pradesh, India
| | - Sunil Chukka
- Professor, Department of Conservative Dentistry and Endodontics, SIBAR Institute of Dental Sciences , Guntur, Andhra Pradesh, India
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Jang Y, Hong HT, Roh BD, Chun HJ. Influence of Apical Root Resection on the Biomechanical Response of a Single-rooted Tooth: A 3-dimensional Finite Element Analysis. J Endod 2014; 40:1489-93. [DOI: 10.1016/j.joen.2014.03.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 02/25/2014] [Accepted: 03/07/2014] [Indexed: 11/26/2022]
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Soares JA, Silveira FF, Nunes E. Apical surgery with calcium hydroxide capping of the exposed dentine: a case report. J Oral Sci 2007; 49:79-83. [PMID: 17429187 DOI: 10.2334/josnusd.49.79] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Among a variety of biomaterials that have been reported to be ideal for dental repair, calcium hydroxide has been shown to have excellent long-term biocompatibility in the pulp and periapical areas. Here we report an alternative method employing calcium hydroxide for periapical surgery in a patient who developed internal apical resorption after traumatic injury, which negatively affected the quality of the cleaning, shaping and filling of the root canal. Obturation of the root canal as far as the middle third was followed by apicoectomy and ultrasonic retropreparation, and then retrograde root filling with resin cement sealer (Sealer 26) and zinc oxide powder. Calcium hydroxide paste was applied over the exposed dentinal surface, forming a barrier over the root apex. Radiographic follow-up after 24 months showed absence of apical resorption and complete periapical bone repair associated with a continuous apical lamina dura.
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Affiliation(s)
- Janir A Soares
- Federal University of the Valleys of Jequitinhonha and Mucuri, Diamantina, MG, Brazil
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