Radicular temperatures associated with thermoplasticized gutta-percha

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.

Use of micro-CT to examine effects of heat on coronal obturation

PURPOSE

The aim of this study was to categorize the effects of heat on coronal obturation with gutta-percha and sealer using X-ray micro-computed tomography (micro-CT).

METHODS

Ten single-rooted, extracted human teeth were shaped using ProTaper NEXT files to size X5 (#50/Taper 6%) with 2.5% NaOCl irrigation. A single ProTaper NEXT X5 gutta-percha point was then inserted with epoxy resin (AH Plus) or tricalcium silicate (EndoSequence BC) sealer (n = 5/group), and cut at the cemento-enamel junction. The teeth were scanned using micro-CT (SkyScan1272) to obtain 11 sagittal 2-D images. Three calibrated raters categorized the coronal 0.5 mm of the images into four categories: "swirled sealer and/or gutta-percha without voids" (I), "uniform voids and sealer/gutta-percha" (II), "non-uniform voids and sealer/gutta-percha" (III), and "swirled sealer and/or gutta-percha with voids" (IV). Intra-rater and inter-rater reliability were then calculated. Chi-square tests were conducted to determine the significance of differences in each category between sealers.

RESULTS

The intra-class correlation coefficient was 0.55 (same rater/two different times) and Fleiss' kappa (different raters/same image) was 0.34. Categories I, II, III, and IV accounted for 16.4%, 4.2%, 30.3%, and 49.1% for AH Plus, and 6.7%, 4.2%, 27.3%, and 61.8% for EndoSequence BC, respectively.

CONCLUSION

Category IV was most common and Category II the least common. Significant differences were evident between sealers for Category I (P < 0.01).

Obturation of Root Canals By Vertical Condensation of Gutta-Percha – Benefits and Pitfalls

Vertical condensation of gutta-percha is one of the frequently used techniques of hermetic and three-dimensional obturation of root canal system which is one of the primary goals of endodontic tooth treatment. Techniques for filling root canals have been described since ancient Egypt and have undergone dynamic development in recent decades. The aim of the article is to analyze the technique of obturation of root canals using vertical condensation of guttapercha and to point out its benefits and pitfalls.

The poor-quality treatment of the tooth deteriorates its prognosis, function, and long-term survival in the oral cavity; thus, the hermetic obturation of the root canals is one of the most important pillars of the complex tooth treatment. Obturation of the root canals by vertical condensation of warm gutta-percha is nowadays considered in the correct indications as one of the most commonly used techniques in the excellent dental practices. Even though it is quite technologically challenging and time-consuming it enables to reach high level of predictability and clinical success. Currently, the obturation technique based on master gutta-percha cone combined with the calcium-silicate based sealer is emerging. However, long term results of clinical studies and follow-up are needed to make a significant improvement in the area of endodontics.

Effects of heat on seven endodontic sealers

PURPOSE

To examine the microscopic surface features, chemical composition, and thermodynamic profile of seven endodontic sealers (AH Plus, Adseal, MTA-Fillapex, RoekoSeal, GuttaFlow 2, GuttaFlow BioSeal, and EndoRez) exposed to high-temperature changes using an endodontic obturation device.

METHODS

The thermal properties were examined using scanning calorimetry (DSC) and thermogravimetric analysis (TGA). Then, six disc-shaped specimens of each sealer were prepared and divided into two groups - a room temperature group and a heat exposure group - for analysis of surface and chemical changes using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS).

RESULTS

DSC analysis showed that AH Plus had the highest exothermal signal (122.9°C), while TGA analysis showed that MTA-Fillapex was most affected by increased temperature (32.4% mass loss at 230ºC). SEM analysis showed that while AH Plus and GuttaFlow BioSeal maintained their surface integrity after heat exposure, the EDS profiles demonstrated changes in the chemical composition of the sealers after heat exposure for 5 s. High-temperature exposure had a negative impact on the properties of five of the sealers (Adseal, MTA-Fillapex, RoekoSeal, GuttaFlow 2, and EndoRez).

CONCLUSION

AH Plus and GuttaFlow BioSeal showed minimal changes upon high-temperature exposure, suggesting their suitability for thermal endodontic obturation techniques.

Effects of heat in the properties of NaOCl alone and mixed with etidronate and alkaline tetrasodium EDTA

AIM

To assess the free available chlorine concentration (FAC), organic tissue dissolution and smear layer removal capacity of sodium hypochlorite (NaOCl) alone and when mixtured with etidronate (HEDP) and tetrasodium EDTA (Na₄ EDTA), and heated to different temperatures.

METHODOLOGY

Mixtures at 1 : 1 ratio of 5% NaOCl with distilled water (considered NaOCl alone), 18% HEDP or 10% Na₄ EDTA were heated to 25 °C, 37 °C, 48 °C and 60 °C. The FAC in the mixtures was assessed at 5, 10, 20, 30, 60 and 120 min. Samples of bovine muscle tissue (n = 10) were prepared with similar size and weighed before and after 5, 10 and 15 min of immersion in the mixtures heated to the different temperatures to verify organic matter dissolution. The intergroup results were compared statistically using one-way analysis of variance (anova) and intragroup by two-way analysis of variance (anova), both followed by Tukey's multiple-comparison test (α < 0.01). Bovine dentine blocks (n = 10) were analysed by scanning electron microscopy before and after immersion in the mixtures, and the time taken to remove the smear layer from the surfaces of the samples was determined. The Friedman test was used to compare the scores of the same group (α < 0.01), and the Kruskal-Wallis test with Dunn's post hoc was used to compare the different groups (α < 0.01). Saline solution was used as a control in the experiments of tissue dissolution and smear layer removal, RESULTS: Heating NaOCl alone did not affect its FAC. The higher the temperature of the mixtures with the chelators, the lower the FAC. Organic tissue dissolution was improved by increases in temperature of NaOCl alone and its mixture with HEDP (P < 0.01); however, the mixture with Na₄ EDTA had no improvement (P > 0.01). Smear layer removal by NaOCl alone was enhanced by heating resulting in lower scores in some samples and became more rapid in the mixtures with the chelators. The saline solution did not promote tissue dissolution nor smear layer removal (P > 0.01).

CONCLUSION

In this laboratory study, heating NaOCl alone or when mixed with HEDP improved its capacity to dissolve organic matter and remove the smear layer. However, the mixture with HEDP required frequent refreshment to retain these effects when heated. Due to the acceleration in the reaction between the irrigants, very rapid reductions in the free available chlorine in the mixtures with Na₄ EDTA heated to the different temperatures occurred.

Temperature changes affect the rheological properties of a silicone-based and an epoxy resin-based root canal sealers

To evaluate temperature changes on the rheological properties (setting time and complex viscosity (η*)) of GuttaFlow Bioseal (GFB) and AH Plus Jet (AHPJ). Rheological measurements were performed in oscillating mode at the strain amplitude and angular frequency of 0.01% and 10 rad s^-1 , respectively. Each sealer (n = 5) was tested running a temperature ramp (rapid increase to 80°C, 1 min constantly at 80°C, and slower decrease to 37°C). Control groups (n = 5) were tested at a constant temperature of 37°C. Kolmogorov-Smirnov and one-way ANOVA (P < 0.05) statistical tests were performed. The temperature ramp reduced setting time of GFB (24.85 to 4.45 min) (P < 0.05), but did not alter that of AHPJ (P > 0.05). GFB exhibited an increased η*, whereas the AHPJ η* was decreased when heated (P < 0.05). Rheological properties of sealers were negatively affected by temperature changes.

Heat Generation Changes with Electrically Heated Pluggers after Multiple Autoclave Cycles at Different Operating Temperatures

INTRODUCTION

Electrically heated pluggers are the most commonly used instruments during warm obturation techniques. This study aimed to evaluate the effect of sterilization and operating temperature settings on the heat generation of pluggers of various taper sizes.

METHODS

Fifty pluggers were sterilized at 132°C for 25 minutes for a total of 150 cycles. One group (Autoclave200) consisted of 25 pluggers tested at an operating temperature setting of 200°C, whereas another group (Autoclave400) consisted of 25 pluggers tested at 400°C. The heat generation at their tip surface was measured with T-type thermocouples at 0, 50, 100, and 150 autoclave cycles. An unpaired t test was used to compare the time it took the pluggers to reach 60°C and the mean maximum temperature change.

RESULTS

After 50 autoclave cycles, all of the 0.04 taper pluggers in Autoclave200 failed to reach 60°C. After 100 autoclave cycles, one of the 0.10 taper pluggers in Autoclave200 did not reach 60°C, and after 150 autoclave cycles, one of the 0.04 taper pluggers failed to generate any heat. The mean increase in the time to reach 60°C ranged from 1071-4004 milliseconds and 510-2074 milliseconds for Autoclave200 and Autoclave400, respectively. The mean maximum temperature change decreased by 13-29°C and 24-116°C for Autoclave200 and Autoclave400, respectively.

CONCLUSIONS

After multiple autoclave cycles and higher operating temperature use, the electrically heated pluggers transferred less heat to the tip surface, potentially making them less effective.

Thermal analysis and stability of commercially available endodontic obturation materials

OBJECTIVES

The purpose of this study was to evaluate the thermal stability of 23 commercially-available endodontic obturation materials.

MATERIALS AND METHODS

Specimens (n = 10) were sealed in aluminum differential scanning calorimetry (DSC) crucibles and subjected to thermal scan series consisting of a 25 to 70 °C at 5 °C/min followed by a rapid increase to 230 °C, followed by a second scan from 25 to 70 °C at 5 °C/min. The first scan evaluated the materials as-received followed by a worse-case-scenario thermal challenge simulating temperatures involved with warm vertical condensation obturation techniques. The second thermal scan observed any phase changes from the high temperature challenge. This two-scan process was repeated twice to observe changes encountered by repeat high heat exposure during obturation. Mean thermal enthalpies were analyzed with Kruskal-Wallis and Games-Howell post-hoc test. (p = 0.05).

RESULTS

Thermal behavior was material dependent. During the first thermal scan, materials typically demonstrated broad endothermic enthalpy curves suggesting either a gutta-percha phase mixture and/or an alpha crystalline phase. The first high-heat challenge produced definitive alpha/beta thermal phase signatures usually associated with gutta-percha. Changes in beta-phase enthalpies were noted with Therarmafil Plus and UltraFil Firmset while increase in alpha-phases was observed with GuttaCore, K3, Lexicon, and Schein Accessory Points.

CONCLUSIONS

Commercial endodontic gutta-percha obturation materials displayed thermal characteristics that were material dependent. However, all demonstrated stability at temperatures in excess to that experienced during warm vertical condensation techniques.

CLINICAL RELEVANCE

The gutta-percha obturation materials evaluated in this evaluation can be used successfully in warm vertical condensation techniques without fear of degradation.

Temperature Changes on External Root Surfaces with the Use of Several Thermoplastic Filling Techniques

INTRODUCTION

The purpose of this study was to measure the temperature rise on the external root surface of filled root canals using Touch'n Heat (Analytic Endodontics, Orange, CA), the TC System (TC; Tanaka de Castro & Minatel Ltda, Cascavel, PR, Brazil), and the Tagger technique.

METHODS

Forty-five single-canal mandibular premolar human teeth were used in the 3 experimental groups. The root canals were enlarged to accommodate up to an R40 Reciproc file (VDW, Munich, Germany). Next, the specimens were filled according to the technique evaluated. The measurement of the temperature was performed by K chromium-aluminum thermocouples attached to the coronal, middle, and apical root levels.

RESULTS

There was a significant difference among the 3 techniques (P < .001) in relation to the temperature variation between the highest temperature and the initial temperature. The highest temperature change was found with the Tagger technique at the middle third root level (11.8°C), and the lowest variation was in TC at the cervical third (2.05°C).

CONCLUSIONS

There was a rise of temperature on the external root surface for all of the techniques evaluated. TC showed the lowest temperature rise.

Quality of root canal fillings using three gutta-percha obturation techniques

Objectives

The goal of this study was to compare the density of gutta-percha root fillings obturated with the following techniques: cold lateral (CL) compaction, ultrasonic lateral (UL) compaction, and warm vertical (WV) compaction.

Materials and Methods

Thirty-three extracted mandibular first molars, with two separate mesial canals in each, were selected. After instrumentation, the canals were stratified into three groups based on canal length and curvature, and underwent obturation with one of the techniques. No sealer was used in order to avoid masking any voids. The teeth were imaged pre- and post-obturation using micro-computed tomography. The reconstructed three-dimensional images were analyzed volumetrically to determine the amount of gutta-percha present in every 2 mm segment of the canal. P values < 0.05 were considered to indicate statistical significance.

Results

The overall mean volume fraction of gutta-percha was 68.51 ± 6.75% for CL, 86.56 ± 5.00% for UL, and 88.91 ± 5.16% for WV. Significant differences were found between CL and UL and between CL and WV (p < 0.05), but not between UL and WV (p = 0.526). The gutta-percha density of the roots treated with WV and UL increased towards the coronal aspect, but this trend was not noted in the CL group.

Conclusions

WV compaction and UL compaction produced a significantly denser gutta-percha root filling than CL compaction. The density of gutta-percha was observed to increase towards the coronal aspect when the former two techniques were used.

Comparison of the time required to create secondary fracture of separated file fragments by using ultrasonic vibration under various canal conditions

INTRODUCTION

Nickel-titanium files often separate because of mechanical fatigue. The purpose of this study was to determine safe preparation techniques for separated file removal by using ultrasonics.

METHODS

Fifty nickel-titanium file fragments were divided into 5 groups. An ultrasonic tip was activated on a file fragment positioned between dentin blocks simulating several canal conditions: Group 1 consisted of the fragment protruding from a pair of straight dentin blocks. For group 2, the fragment was also positioned between 2 straight dentin blocks except one block was positioned 1 mm more apically than the other block, simulating a troughed area that is often created during file removal attempts. For groups 3-5, the fragment was positioned similarly as group 2 but between blocks with 30°, 45°, and 60° curvatures, respectively. The time it took for secondary fracture to occur was recorded, and the data were statistically analyzed.

RESULTS

Fragments with dentin wall supporting on the opposite side of ultrasonic activation site resisted fracture significantly longer than those without it. Fragments in 30° and 45° curved blocks took significantly longer to fracture than the other groups (Fisher protected least significant difference, P < .05).

CONCLUSIONS

Secondary fracture of separated files appeared to be reduced when the ultrasonic tip was applied to the inner curvature of the canal.

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.

Denaturation temperatures of dentin matrices. I. Effect of demineralization and dehydration

The denaturation temperature (T(d)) of dentin collagen in mineralized versus demineralized teeth was examined as a function of dentin age and the extent of dehydration. Using differential scanning calorimetry, T(d) of mineralized dentin was shown to be between 160 degrees C to 186 degrees C, depending on whether it was from young or old dentin that was hydrated or dehydrated, respectively. Demineralized dentin exhibited a T(d) of 65.6 degrees C that increased with dehydration to 176 degrees C. The presence of apatite crystallites or interpeptide bonding increased the T(d) of demineralized matrices. Interpeptide hydrogen bonding seems to stabilize collagen to thermal challenge. Water breaks interpeptide hydrogen bonds making collagen more susceptible to thermal denaturation. Rises in intracanal temperature are unlikely to cause extensive denaturation of mineralized root dentin walls. However, hydrated or partially dehydrated root canal walls that have been partially demineralized with chelating agents or mild acids may be susceptible to thermal denaturation.

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.

Thermal injury through intraradicular heat transfer using ultrasonic devices

BACKGROUND

The use of ultrasonic energy is a highly efficient method of removing obstructions and cements within the root canal space when re-treatment or rehabilitation of that ultrasonic energy dislodges and removes cemented objects from the bonded interface of the canal wall. When using this method, there is less potential for structural loss or root damage and significantly less operator stress than when using other methods.

CASE DESCRIPTIONS

There is little evidence in published research of the considerable heat transfer that occurs during use of ultrasonic devices to remove posts, pastes and separated instruments in teeth. The authors present three cases of patients who experienced serious burn injuries during application of ultrasonic energy for restorative dentistry. The authors also offer techniques and strategies for safe and effective use of ultrasonic devices.

CLINICAL IMPLICATIONS

On the basis of the best available evidence, the authors recommend strategies to provide safe and effective therapy while using ultrasonic devices in intraradicular obstruction removal. The intent of the suggested protocols is to provide advanced and sophisticated therapies in a safe and regulated manner with patient safety as an overriding priority.

Root Surface Temperature Rises In Vitro During Root Canal Obturation Using Hybrid and Microseal Techniques

The aim of this in vitro study was to measure the temperature rise on the outer surface of roots during filling with hybrid technique and Microseal. Twenty extracted human maxillary and mandibular premolars with a single canal were randomly divided into two groups of 10 teeth each. In the first group, the teeth were filled with hybrid technique (thermomechanical compaction with Engine Plugger used following lateral condensation of the apical part of the canal), the second group was filled using Microseal. After root canal obturation the filling material was removed and the obturation procedure was repeated. A total of 20 obturations in each group were performed. Temperature changes were measured using a thermal imaging camera. The temperature of certain regions of the mesial surface was analyzed and the highest temperature values were recorded. Statistical analysis was performed using the Mann-Whitney U test. The mean increase of temperature during the hybrid technique with Engine Plugger was 23.8 degrees C, while during Microseal it was significantly lower (p = 0.000001) at 5.5 degrees C. The temperature rise generated by Microseal was below the critical level and should not damage supporting structures, however, the hybrid technique generated a relatively high temperature rise that may cause periodontal tissue damage.

Intracanal temperature rise evaluation during the usage of the System B: replication of intracanal anatomy

AIM

To evaluate and determine intracanal temperature rises at 2 and 4 mm from the working length (WL) necessary to obtain proper replication of intracanal anatomy with gutta-percha (GP) using the System B heat source during vertical condensation.

METHODOLOGY

A split-tooth model was prepared and artificial shallow depressions were cut in the buccal canal wall 2 and 4 mm from the WL. At the same level on the palatal wall holes were drilled to adapt two thermocouples. The canal was filled using GP in a vertical condensation technique by placing the System B plugger at 2 and 4 mm from the WL in groups A and B, respectively. Two control groups in which no GP was used were carried out placing the plugger 2 and 4 mm from the WL (groups A.c and B.c, respectively) and activating the heat source. Recording of temperature rise was carried out during the filling procedure for groups A and B and during activation for control groups A.c and B.c; the highest temperatures were recorded. After each filling was completed, 3 min were allowed for the GP to cool and the model divided to reveal the filling. Images of the GP were taken with a CCD camera to evaluate the presence of replication of artificial round depressions. In control groups, the temperature was recorded for 20 s after a 3 s activation of the heat source. The rise in temperature was compared between the groups individually at each level (2 or 4 mm) and statistically analysed using one-way anova and Fisher PLSD tests at 5% of significance level (P < 0.05).

RESULTS

Mean temperature rises of 14 +/- 3 and 12 +/- 2 degrees C at 2 and 4 mm from the WL, respectively, were observed in group A fillings, and 4 +/- 1 and 6 +/- 1 degrees C at 2 and 4 mm, respectively, in group B fillings. Recordings at 2 mm showed significantly (P < 0.05) higher temperature rises with group A.c when compared with groups B and B.c. Replication of intracanal anatomy with GP was always found in group A fillings at both levels but only 4 mm from the WL in group B fillings.

CONCLUSIONS

Positioning the plugger close to WL and a temperature rise of 6 degrees C were necessary to obtain replication of intracanal anatomy. A mean temperature rise of 4 degrees C at 2 mm from WL (group B) resulted in no replication of intracanal anatomy. Further studies simulating clinical conditions are necessary.

Root surface temperature rises during root canal obturation, in vitro, by the continuous wave of condensation technique using System B HeatSource

OBJECTIVES

This in vitro study evaluated increases in root surface temperature during the continuous wave of condensation technique using a System B HeatSource.

STUDY DESIGN

Forty-five extracted human teeth (15 maxillary central incisors, 15 mandibular central incisors, and 15 maxillary canines) were used. After root canal cleaning and shaping, the teeth were filled with the continuous wave of condensation technique using a System B HeatSource. Temperature changes on the whole mesial and vestibular outer surfaces of the roots were measured using an infrared thermal imaging camera.

RESULTS

The results of this in vitro study showed that the use of the continuous wave of condensation technique to fill the maxillary central incisors and maxillary canines produced temperature rises below the critical level. In the mandibular central incisors the use of a System B HeatSource resulted in elevation of the root surface temperature by more than 10 degrees C.

CONCLUSION

The continuous wave of condensation technique using the System B HeatSource produces temperature changes on the outer root surfaces, which, in the case of teeth with relatively thin dentinal walls, can reach relatively high values.

Comparison of the obturation density of cold lateral compaction versus warm vertical compaction using the continuous wave of condensation technique

The purpose of this in vitro study was to compare quantitatively the density of standard cold lateral gutta-percha compaction and warm vertical compaction by using the continuous wave of condensation technique. Forty transparent acrylic blocks with 30-degree, curved root canals were instrumented using Gates Glidden burs and Profile 0.06 taper rotary nickel-titanium files in a crown-down manner. The blocks were weighed and randomly assigned to two evenly distributed groups. Group A was obturated with the cold lateral-compaction technique using medium-fine, gutta-percha accessory points until the canal was completely filled. Group B was obturated with the continuous wave of condensation technique until the canal was completely filled. The blocks were weighed again after obturation. Data were analyzed using a two-sample t test at the 5% significance level. Results demonstrated that the continuous wave of condensation technique resulted in a significantly greater density compared with cold lateral compaction. Warm vertical compaction using the continuous wave of condensation technique in acrylic blocks resulted in a greater gutta-percha fill by weight compared with standard cold lateral compaction.

Nonsurgical retreatment

With all the potential for endodontic success, the fact remains clinicians are confronted with posttreatment endodontic disease. When the elected treatment plan is endodontic nonsurgical retreatment, then the goal is to access the pulp chamber and remove materials from the root canal space and if present, address deficiencies or repair defects that are pathologic or iatrogenic in origin. This article provides a literature review with clinical recommendations for one important group of retreatment issues: the removal of posts and broken instruments.

Root Surface Temperature Rises in Vitro During Root Canal Obturation With Thermoplasticized Gutta-Percha on a Carrier or by Injection

The aim of this in vitro study was to measure the temperature rise on the outer root surfaces of teeth during four different root canal obturation techniques. Sixty extracted human maxillary and mandibular premolars with a single canal were used. After root canal cleaning and shaping, the teeth were randomly divided into four groups of 15 teeth each and obturated with Thermafil obturators or Soft-Core obturators using Ultrafil or Trifecta low-temperature thermoplasticized gutta-percha techniques. Temperature changes on the external mesial root surfaces were measured using a thermal imaging camera. Lower temperature rises were found for Ultrafil and Trifecta techniques (2.14 degrees C and 2.03 degrees C, respectively) than for Thermafil and Soft-Core techniques (3.87 degrees C and 3.67 degrees C, respectively). These findings suggest that solid core gutta-percha combined with low-temperature injectable gutta-percha obturation techniques may impose less risk for thermal damage to the surrounding periradicular tissues.

Effect of different temperatures and penetration depths of a System B plugger in the filling of artificially created oval canals

OBJECTIVES

The purpose of this study was to compare the gutta-percha-filled area in oval canals while varying the temperature and penetration depth of the System B plugger.

STUDY DESIGN

Seventy-five resin blocks, with artificially created oval canals, were obturated by using a continuous wave technique. In groups 1, 2, and 3, the plugger was introduced to a depth of 4 mm from the apex at set temperatures of 100, 200, and 350 degrees C, respectively. In group 4, the plugger was inserted to a depth of 2 mm from the apex at a set temperature of 200 degrees C. Group 5 was obturated in the same way as group 2, and then an additional cold plugging was performed to a depth of 3 mm from the apex. The cross sections of the obturated canals were photographed, and the percentage of the gutta-percha-filled area (PGP) was measured.

RESULTS

No significant differences were found between the 3 different temperature settings (P >.05). At 1 mm from the apex, group 4 showed the highest PGP (95.57% +/- 6.86), followed by group 5 (84.72% +/- 12.19), and group 2 (67.33 +/- 13.03) (P <.05).

CONCLUSION

In artificially created oval canals, plugger temperature within the range used in this study did not affect the PGP. However, the penetration depth of the plugger was significantly related to PGP.

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.

A preliminary analysis of the morphology of lateral canals after root canal filling using a tooth-clearing technique

AIM

This study used a modified tooth-clearing technique to allow observation of accessory canals following filling with a warm gutta-percha technique and one of two endodontic cements.

METHODOLOGY

Ten extracted human maxillary molars with three roots were selected and divided into two equal groups of five teeth. Each group had 15 canals. Root canal preparation was performed with a modified double flared technique; irrigation with 5% NaOCl and lubrication with RC-Prep were used. The canals were then filled with gutta-percha and cement utilizing a warm vertical condensation technique in the apical third followed by thermo-mechanical compaction in the middle and coronal thirds. Pulp Canal Sealer or AH-Plus were used in the experimental groups. The teeth were demineralized with a modified buffered acid solution, cleared in methylsalicylate and examined under a stereomicroscope. Accessory canals were evaluated in the apical, middle and coronal thirds of each root canal and categorized as narrow or wide, following observation on four surfaces. The depth of penetration of gutta-percha and cement into lateral canals was scored using a 5-point system.

RESULTS

Complete transparency of the roots was achieved. Accessory canals were detected in all specimens. In coronal ramifications, gutta-percha filled the empty spaces (coronal thirds, grades 3 and 4: 70.9% in AH-Plus group and 68.8% in Pulp Canal Sealer group). In the apical accessory canals, gutta-percha entered less frequently (apical thirds, grades 3 and 4: 17.9% in the AH-Plus group and 3.2% in the Pulp Canal Sealer group); cement without gutta-percha (grades 1 and 2) was present in 55.5% in the AH-Plus group and 38.7% of the Pulp Canal Sealer group. Analysis showed that AH-Plus cement resulted in significantly greater filling of the apical accessory canals compared to Pulp Canal Sealer.

CONCLUSIONS

The modified tooth-clearing technique allowed observation of fine morphological details in all specimens. Effective gutta-percha filling was evident in most of the wide coronal lateral canals whilst the apical narrow ramifications were often incompletely filled by cement. Overall AH-Plus demonstrated better diffusion into lateral accessory canals compared to Pulp Canal Sealer.