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

Comparative Evaluation of the Quality of Obturation Between Three Obturation Techniques in Primary Canines: An In Vitro Study

Aims This study compares three obturation techniques (rotary lentulo spiral, handheld lentulo spiral, and pressure syringe) for the quality of two filling pastes (zinc oxide eugenol (ZOE) paste and Metapex (Meta Biomed Co., Ltd., Chungcheongbuk-do, Korea). Methods and materials Sixty extracted primary canines were instrumented and obturated by filling materials. The obturation techniques were divided into three groups according to different obturation techniques. Obturation quality was evaluated for length, density, and presence of voids by using digital radiography. Results This study showed that the handheld lentulo spiral technique using Metapex and ZOE exhibited more optimal fillings for obturation length. The highest density obturation was achieved using the syringe injection approach with Metapex and ZOE. The highest incidence of both external and internal voids was observed in the group using ZOE with the handheld lentulo spiral technique Conclusions Based on the findings of this study, for both filling materials, the handheld lentulo spiral technique had the greatest number of optimal lengths but there were also more voids.

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.

Evaluation of the efficacy of the Lentulo spiral filler operated at four different speeds and with two different techniques in cadaveric canine teeth of dogs

This study evaluated the effect of filling technique and rotational speed on the efficacy of sealer cement placement using the Lentulo spiral filler. Cadaveric maxillary and mandibular canine teeth (n = 74) from age and breed matched fresh-frozen adult canine cadaver heads were utilized. Following routine mechano-chemical preparation, teeth were randomly divided into 8 treatment groups with varying rotational speeds [250-2,000 revolutions per minute (RPM)] and fill techniques (backfill technique versus pumping technique). The quality of the sealer cement fill was evaluated radiographically before and after master gutta percha cone placement. Percentage of voids present in the apical, midbody, and coronal portions of the tooth were subjectively scored as: no voids present, voids present in less than 25% of the area, voids present in 25-50% of the area, voids present in greater than 50% of the area. The apex was also scored as underfilled, adequately filled, or overfilled. Operating the Lentulo spiral filler at 2,000 RPM resulted in the best quality fill regardless of filling technique. The pumping technique with placement of the master gutta percha cone had a higher probability of success as compared to the backfill technique, but this finding lacked significance. Regardless of speed or technique, the apical region had the highest quality of fill. The addition of the master gutta percha cone improved the quality of fill. Therefore, we recommend using the Lentulo spiral filler at higher speeds with a pumping technique (followed by addition of a master gutta percha cone) to improve the quality of epoxy resin-based sealer cement placement.

Assessment of Four Obturation Methods in Deciduous Teeth Using Digital Radiography: An In Vivo Study

Aim and objective

This study was carried out to comparatively assess the efficiency of four methods of obturation viz Lentulo spiral, Navi tip syringe, Bi directional spiral, and Past inject carrier in deciduous teeth using vista scan.

Materials and methods

A total sample of 100 primary root canals [4 groups of 25 canals each] with 2/3^rd of root length were selected and randomly allocated into four different obturating techniques, i.e., Group I: Lentulo spiral, Group II: Navi tip syringe, Group III: Bi directional spiral, and Group IV: Past inject carrier. The quality of obturation [Coll and sadrain, 1996] and presence or absence of voids were evaluated by using Vista scan. The recorded data was statistically analyzed.

Results

The highest mean rank value of optimally filled canals was obtained by Group IV [58.00] followed by Group I [50.00] with no significant difference. The highest mean rank value of under filled canals and over filled canals were obtained by Group III and Group II, respectively, and these results were statistically significant. All the four obturation techniques showed presence of voids with no significant difference.

Conclusion

Both Lentulo spiral and Past inject carrier were equally efficient in attaining an optimally filled homogenous obturation in deciduous teeth.

How to cite this article

Raju SS, Reddy RE, Rani TS, et al. Assessment of Four Obturation Methods in Deciduous Teeth Using Digital Radiography: An In Vivo Study. Int J Clin Pediatr Dent 2022;15(S-1):S52-S56.

Comparison of Various Root Canal Filling Materials and Obturation Techniques for Primary Teeth Using Microcomputed Tomography

Aim:

The aim of this study was to compare the effectiveness of different filling materials and obturation techniques for root canal obturation in primary teeth.

Materials and Methods:

Eighty maxillary primary incisors were included in this in vitro study. After biomechanical preparation, all samples were scanned using microcomputed tomography (micro-CT) and root canal volumes were calculated. Samples were grouped according to filling materials and obturation techniques, with ten samples in each group. The samples were filled with zinc oxide eugenol (ZOE) and Vitapex using four different obturation techniques (local anesthesia syringe, lentulo spiral, pastinject, and lentulo spiral–ultrasonic activation). After filling, samples were scanned a second time using micro-CT and root canal volumes were calculated. The statistical analysis was performed using SPSS version 24.0. Data were analyzed by Kruskal–Wallis and Mann–Whitney U tests.

Results:

When the ZOE and Vitapex were compared, it was observed that there were no significant differences between their postobturated volumes, percentage obturated volume (POV), internal void (IV), and percentage of internal void volume (PIV) ( P > .05). The local anesthesia syringe group had a significantly lower postobturated volume and POV, and a significantly higher IV and PIV for both filling materials than that by the other groups ( P < .05). There was no significant difference between the other obturation techniques ( P > .05). For the local anesthesia syringe group, postobturated volume and POV were significantly higher and IV and PIV were significantly lower with Vitapex than with ZOE ( P < .05). There was no significant difference between the other obturation techniques filled either with ZOE or Vitapex ( P > .05).

Conclusion:

Except for the syringe technique, no difference was observed between the ZOE and Vitapex materials. The syringe technique used in the primary root canal filling was less effective than the other techniques, which had similar efficacy, and in this technique, more effective canal filling was achieved with Vitapex.

To evaluate and compare the compressive strength of root dentin exposed to calcium hydroxide, mixed with various vehicles for a period of 30 days – An in vitro study

Background:

Long-term use of intracanal medicaments such as calcium hydroxide (CH) reduces the fracture resistance of dentin.

Aim:

This study aimed to evaluate and compare the compressive strength of root dentin exposed to CH, mixed with various vehicles after 30 days of placement.

Settings and Design:

Sixty single-rooted extracted human permanent premolars were collected, and complete instrumentation was done. Samples were divided into six groups.

Materials and Methods:

In Group I, no medicament was placed. In Group II, Group III, and Group IV, the root canals were filled with CH powder mixed with normal saline, distilled water, and local anesthetic solution. In Group V and Group VI, the root canals were filled with Metapaste and RC-Cal. Access cavities were sealed using IRM and were stored for 30 days. Teeth sectioned to obtain a 5 mm thick dentin cylinder subjected to compressive loading to evaluate the fracture resistance using a universal testing machine.

Statistical Analysis:

Results were analyzed using one-way ANOVA and multiple comparisons using Bonferroni test.

Results:

Highest mean compressive strength was recorded in Group I followed by Group II, Group IV, Group VI, Group III, and Group V.

Conclusions:

CH when used as a root canal dressing material will reduce the compressive strength of the teeth irrespective of the form of CH and vehicle.

Hardened exogenous material after extrusion of calcium hydroxide with barium sulfate: Case study and histopathologic and laboratory analyses

BACKGROUND AND OVERVIEW

Although calcium hydroxide (Ca[OH]₂) paste associated with barium sulfate (BaSO₄) is considered a safe agent, there is a lack of clinical research on its effects on periodontal and submucosal tissues. The aim of the authors was to report the effects of extrusion of Ultracal XS paste (Ultradent Products) in 2 cases. The authors also analyzed the paste constituents and compared them with the proportion reported by the manufacturer and the material extruded.

CASE DESCRIPTION

The authors present 2 cases in which root canals were restored with Ultracal XS paste after cleaning and shaping, and there was unintentional overextension of the paste into periradicular tissues, with a hardened exogenous material observed associated with inflammatory signs and symptoms. A biopsy was performed, and the material was subjected to histopathologic analysis and characterization through scanning electron microscopy, energy dispersive x-ray spectroscopy, Fourier transform infrared spectroscopy, and x-ray diffraction.

CONCLUSIONS

BaSO₄ and calcium carbonate (CaCO₃) were associated with a hardened material after Ultracal XS paste extrusion. The Ca(OH)₂ percentage on the Ultracal XS paste was approximately 2 times greater than the proportion reported by the manufacturer.

PRACTICAL IMPLICATIONS

Ca(OH)₂ with BaSO₄ paste application should be performed carefully, and its extrusion to periradicular and submucosal tissues should not occur. Its extrusion may result in the formation of a persistent exogenous material of hardened consistency associated with inflammatory signs and symptoms.

Comparative evaluation of three obturation systems in primary molars - A randomized clinical trial

OBJECTIVES

The objective of this study is to evaluate and compare the radiographic efficacy of the quality of obturation and to assess the number of voids and the obturation time in primary teeth using Pastinject™, disposable needle, and capillary tips.

MATERIALS AND METHODS

A total of 34 teeth with 103 canals were randomly divided into three groups using chit method, based on used application: Group 1: Pastinject™ (Micro-Mega, Besancon, France); Group 2: Disposable needle (23G short needle BD Discardit™, Becton Dickinson India Pvt. Ltd.), and Group 3: Capillary tips (Meta Biomed^© Co. Ltd., China). All the groups were named based on obturation systems used. To compare the quality of obturation, the Chi-square test was used; to assess the number of voids, Kruskal-Wallis ANOVA test was used; and to evaluate the obturation time, post hoc Scheffe one-way ANOVA test was used. All P values having <0.05 were considered as statistical significant (P < 0.05). Kappa statistics were performed to check interexaminer reliability. Descriptive statistics were used for evaluation using SPSS (version. 21).

RESULTS

Capillary tips resulted in better optimal filled canals and less obturation time, compared to disposable needle and Pastinject (P < 0.001). There was no significant difference evident among three groups in relation to voids (P = 0.111).

CONCLUSION

Capillary tip technique proved to be the most effective, yielding a higher number of optimally filled canals and minimal voids, combined with easier placement of the material into the canals when compared to Pastinject and disposable needle obturation.

Clinical Assessment of Various Obturating Techniques for Primary Teeth: A Comparative Study

INTRODUCTION

Lifelong preservation of tooth in a healthy state is the ultimate goal of dentistry. Premature loss of primary teeth is common due to caries, dental trauma or other causes. As the primary teeth are the best space maintainers, teeth with infected pulps should be retained until exfoliation, whenever possible.

AIM

The purpose of this in vivo study was to evaluate and compare the efficacy of different obturating methods used in primary teeth.

MATERIALS AND METHODS

Forty one patients aged four to nine years with a total of 60 teeth were selected. Out of the 60 teeth, 32 were primary mandibular first molars and 28 were primary mandibular second molars, the sample was randomly divided into three groups. Disposable syringe, lentulo spiral and past inject were used for obturation. Postoperative evaluation was done for; quality of canal obturation, presence of voids using postoperative radiographs following obturation of teeth. The data were analysed to assess the success rate of the three methods used for obturation using Chi-square test.

RESULTS

Among the three groups of the study, past inject exhibited the maximum number of optimally filled canals. Maximum number of underfilled canals was found with lentulospiral, and the maximum number of overfilled canals was seen with disposable syringe. Least number of voids was observed in canals filled with the past inject technique and disposable syringe.

CONCLUSION

The results suggest that the most successful technique for obturation of primary teeth was past inject.

Calcium hydroxide medication in primary molars using different preparations and placement techniques: an in vitro study

AIM

This was to compare the effectiveness of different preparations and delivery techniques of calcium hydroxide paste as an intracanal medicament in primary molar root canals.

METHODS

Extracted lower primary second molars roots (72) were randomly assigned to the four experimental groups. After complete root canal preparation with TF rotary nickel titanium up to .06/30 file, a mix of calcium hydroxide/ distilled water was delivered by lentulo spiral (group 1) or a syringe (group 2). UltraCal(®) XS was placed by lentulo spiral (group 3) and a syringe (group 4). Digital radiographs were taken in both buccal and proximal directions before and after calcium hydroxide placement to evaluate the quality of filling. The mean percentages of filled calcium hydroxide area by subtracted digital radiograph, and the quality assessments between four experimental groups, were compared by using Two-way ANOVA and Fisher's exact test respectively. A p value of less than 0.05 was considered statistical significance.

RESULTS

There was no statistically significant difference in the mean percentages of the filled calcium hydroxide area among different preparations and delivery techniques (p ≥ 0.05). The syringe technique had statistically significant fewer of air inclusions than when using the lentulo spiral with the mix of calcium hydroxide group (p < 0.05). The completeness of obturation and the quality of filling at apical part were not different among groups (p ≥ 0.05).

CONCLUSION

Syringe technique was a simpler handling method that presented similar filling quality but fewer porosities than lentulo spiral technique in primary molar root canals.

Evaluation of hydroxyl ion diffusion in dentin and injectable forms and a simple powder-water calcium hydroxide paste: an in vitro study

Background:

Intra canal medicaments are used to reduce the number of bacteria and reinfection in endodontic procedures. Calcium Hydroxide was introduced to endodontics by Herman as an intracanal antimicrobial agent.

Objectives:

The aim of this study was to present an injectable formulation of calcium hydroxide then compare the final pH of this new formulation with Metapaste and evaluate the effect of a mixture of Calcium Hydroxide powder with water on human extracted teeth.

Patients and Methods:

A total of 49 extracted human single-canal roots without caries and visible microcracks were included in this study. The teeth were decoronated and length of teeth was measured 1 mm anatomic apex. The canals were prepared using step-back technique. A cavity was created in the middle third of the buccal surface of all roots. The teeth were randomly divided into five groups: Group A (n = 15): In this group the root canals were filled with a mixture of calcium hydroxide powder and distilled water. Group B (n = 15): Included roots that were filled with Metapaste. Group C (n = 15): Root canals of this group were filled with new formulation of calcium hydroxide paste. Group D (negative control, n = 2): Included roots that were filled with a mixture of calcium hydroxide powder and distilled water. Group E (positive control, n = 2): Root canals of this group were filled with a mixture of calcium hydroxide powder and distilled water. Each tooth was immersed in a separate closed container with 4 mL saline for 2 weeks, pH of liquids were measured with an electrical pH meter after 7 and 14 days. The SPSS software (version 13) was used for data analysis. Analysis of variance (ANOVA) and Tukey tests were used for the statistical evaluation of results.

Results:

There was no significant difference at 7th day between the groups (P = 0.17) but at 14th day, a significant difference was observed between the groups (P = 0.04).

Conclusions:

The new formulation of calcium hydroxide with methylcellulose base has slower ionic dissolution, more durability and longevity of alkaline properties in comparison to combination of powder with distilled water and is comparable with other commercial products.

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.

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 effect of two different calcium hydroxide combinations on root dentine microhardness

AIM

To evaluate the effect of a calcium hydroxide and glycerine mix and a calcium hydroxide and water mix on the microhardness of human root dentine.

METHODOLOGY

Eleven freshly extracted maxillary canine and central incisor teeth were used. The teeth were sectioned transversally to produce a total of 22 dentine discs from the middle-third of the root. The specimens were divided into two groups of 11 discs each. Dentine samples were treated with either a Ca(OH)2-glycerine combination or a Ca(OH)2-distilled water combination for 1, 3 and 7 days. Dentine microhardness was measured with a Knoop indenter with a load of 100 g for 15 s before and during the experimental period. Each root disc received a series of three indentations around the pulp space, 1 mm from canal wall.

RESULTS

Statistical analysis showed that both combinations significantly decreased dentine microhardness after 3 and 7 days (P < 0.01). The reduction in dentine microhardness following the use of a Ca(OH)2-glycerine combination was significantly greater than that after a Ca(OH)2-distilled water combination after 3 and 7 days (P < 0.01).

CONCLUSION

The use of Ca(OH)2 combinations for intracanal dressing softens dentine.