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Usta SN, Silva EJNL, Falakaloğlu S, Gündoğar M. Does minimally invasive canal preparation provide higher fracture resistance of endodontically treated teeth? A systematic review of in vitro studies. Restor Dent Endod 2023; 48:e34. [PMID: 38053776 PMCID: PMC10695733 DOI: 10.5395/rde.2023.48.e34] [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: 07/24/2023] [Revised: 08/17/2023] [Accepted: 08/27/2023] [Indexed: 12/07/2023] Open
Abstract
This systematic review aimed to investigate whether minimally invasive root canal preparation ensures higher fracture resistance compared to conventional root canal preparation in endodontically treated teeth (ETT). A comprehensive search strategy was conducted on the "PubMed, Web of Science, and Scopus" databases, alongside reference and hand searches, with language restrictions applied. Two independent reviews selected pertinent laboratory studies that explored the effect of minimally invasive root canal preparation on fracture resistance, in comparison to larger preparation counterparts. The quality of the studies was assessed, and the risk of bias was categorized as low, moderate, or high. The electronic search yielded a total of 1,767 articles. After applying eligibility criteria, 8 studies were included. Given the low methodological quality of these studies and the large variability of fracture resistance values, the impact of reduced apical size and/or taper on the fracture resistance of the ETT can be considered uncertain. This systematic review could not reveal sufficient evidence regarding the effect of minimally invasive preparation on increasing fracture resistance of ETT, primarily due to the inherent limitations of the studies and the moderate risk of bias.
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Affiliation(s)
- Sıla Nur Usta
- Department of Endodontics, Gulhane Faculty of Dentistry, University of Health Sciences, Ankara, Turkey
| | | | - Seda Falakaloğlu
- Department of Endodontics, Faculty of Dentistry, Istanbul Health and Technology University, Istanbul, Turkey
| | - Mustafa Gündoğar
- Department of Endodontics, Faculty of Dentistry, University of Medipol, İstanbul, Turkey
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Ahmad MZ, Merdad KA, Sadaf D. An overview of systematic reviews on endotoxins in endodontic infections and the effectiveness of root canal therapy in its removal. Evid Based Dent 2022:10.1038/s41432-022-0826-x. [PMID: 36482195 DOI: 10.1038/s41432-022-0826-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 02/16/2022] [Indexed: 06/17/2023]
Abstract
Background The objective of this overview was to synthesise the current evidence on the role of endotoxins in endodontics infections and to evaluate the effectiveness of endodontic procedures in its removal using information from published systematic reviews.Methods Electronic databases Medline, Scopus, Embase, Cochrane Library and Google Scholar were searched for reviews published up to July 2021. Systematic reviews on endotoxins based on clinical and/or observational studies were included. The quality of systematic reviews was assessed with the AMSTAR2 tool.Results A total of five systematic reviews were selected, of which two reviews were of high quality. A significantly higher level of endotoxins were found in teeth with exudation, teeth with a previous episode of pain and pain on percussion. Chemomechanical preparation of root canals significantly reduce endotoxin levels. Calcium hydroxide intracanal medication in symptomatic teeth was significantly effective in endotoxin reduction (standardised mean difference -1.051 [95% confidence interval -2.039 to -0.063]; p <0.05; I2 = 83.3%; certainty of evidence = very low). Multiple session root canal treatment in teeth with symptomatic apical periodontitis was significantly more effective in endotoxins/lipopolysaccharides removal than single-session treatment.Conclusion Limited quality of evidence showed a significant association of endotoxins in infected teeth with clinical symptoms. Conventional chemomechanical preparation of root canals and intracanal medication were unable to eliminate endotoxins from the root canal system. Future evolution of effective disinfection therapies is warranted.
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Affiliation(s)
- Muhammad Z Ahmad
- Restorative Dentistry Department, College of Dentistry in Ar Rass, Qassim University, Alrass, Saudi Arabia
| | - Khalid A Merdad
- Department of Endodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Durre Sadaf
- Department of Microbial Diseases, University College London, Eastman Dental Institute, London, United Kingdom.
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Ajina MA, Shah PK, Chong BS. Critical analysis of research methods and experimental models to study removal of root filling materials. Int Endod J 2021; 55 Suppl 1:119-152. [PMID: 34674279 DOI: 10.1111/iej.13650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 12/14/2022]
Abstract
Despite enjoying high favourable outcome rates, root canal treatment is not always successful. Root canal retreatment is a widely practised option for managing a non-healing root treated tooth. A basic distinction between retreatment and initial treatment is the requirement to remove the existing root filling material occupying the root canal space. Only then, can the technical deficiencies and possible causes of failure be addressed. Hence, the successful removal of the root filling material is critical to achieving the objectives of retreatment. Many different materials and techniques have been used for root canal filling, which have been documented in a plethora of studies; these are mainly laboratory studies investigating the removal of root filling materials. To help guide future research, which may then better inform clinical practice in relation to retreatment procedures, the focus of this narrative review is on the research methods and experimental models employed to study the removal of root filling materials. The current available literature demonstrates great variation in the research methodologies used to study the removal of root filling material, including direct visualization by splitting tooth samples or clearing, three-dimensional radiographic imaging including using microcomputed tomography or cone-beam computed tomography, and a combination of these techniques. Depending on the research method employed, variation also exists in quantification of root filling material removal; these include measurements of surface area, volume or weight, and criteria-based (semi-quantitative) assessment. Experimental models, using human teeth or resin models, differ with respect to standardization techniques and replication of the clinical scenario including initial sample preparation, canal filling, allocation and technical aspects of retreatment procedures. Future models should replicate, as closely as possible, the clinical scenario. Currently, microcomputed tomography provides a highly detailed, non-invasive and non-destructive method of objectively assessing and quantifying root filling removal.
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Affiliation(s)
- Mahdi A Ajina
- Institute of Dentistry, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Pratik K Shah
- Institute of Dentistry, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Bun San Chong
- Institute of Dentistry, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
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Pinto JC, Torres FFE, Santos-Junior AO, Duarte MAH, Guerreiro-Tanomaru JM, Tanomaru-Filho M. Safety and Effectiveness of Additional Apical Preparation using a Rotary Heat-treated Nickel-Titanium file with Larger Diameter and Minimum Taper in Retreatment of Curved Root Canals. Eur J Dent 2021; 15:247-252. [PMID: 33622011 PMCID: PMC8184271 DOI: 10.1055/s-0041-1723065] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate the effect of additional apical preparation using the ProDesign Logic (PDL) 50/.01 rotary heat-treated nickel-titanium (NiTi) file with a larger diameter and minimal taper for retreatment of curved root canals. MATERIALS AND METHODS Mesial curved root canals of 12 mandibular molars were prepared using PDL 25/.06 and filled using the continuous wave of condensation technique and AH Plus sealer. After retreatment using ProDesign S (PDS) 25/.08, PDL 25/.06 and PDL 35/05, a complementary procedure was performed with PDL 50/.01. Microcomputed tomography (micro-CT) scanning was performed before and after retreatment procedures. The cyclic fatigue resistance of unused PDS 25/.08, PDL 25/.06, PDL 35/.05 and PDL 50/.01 instruments (n = 12) was evaluated in a stainless-steel device. STATISTICAL ANALYSIS Data on the volumes of the root canals and the remaining filling materials were submitted to the paired t-test. Cyclic fatigue resistance data was submitted to one-way ANOVA and Tukey's tests (α = 0.05). RESULTS Use of PDL 50/.01 decreased the remaining filling materials in the apical third (p < 0.05). The root canal volume was similar in the cervical and middle thirds before and after preparation using PDL 50/.01 (p > 0.05). PDL 50/.01 presented the highest cyclic fatigue resistance (p < 0.05). CONCLUSIONS Use of the PDL 50/.01 instrument as an additional apical preparation for retreatment of curved root canals improved filling material removal in the apical third, while maintaining the dentin in the cervical and middle thirds. In addition, PDL 50/.01 presented high-flexural resistance.
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Affiliation(s)
- Jader Camilo Pinto
- Department of Restorative Dentistry, School of Dentistry, São Paulo State University, São Paulo, Brazil
| | | | | | - Marco Antonio Hungaro Duarte
- Department of Dentistry, Endodontics and Dental Materials, School of Dentistry, University of São Paulo São Paulo, Brazil
| | | | - Mario Tanomaru-Filho
- Department of Restorative Dentistry, School of Dentistry, São Paulo State University, São Paulo, Brazil
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Doğanay Yıldız E, Arslan H. The effect of blue thermal treatment on endodontic instruments and apical debris extrusion during retreatment procedures. Int Endod J 2019; 52:1629-1634. [PMID: 31131904 DOI: 10.1111/iej.13161] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 05/22/2019] [Indexed: 01/03/2023]
Abstract
AIM To determine the effect of blue thermal treatment on Reciproc (VDW, Munich, Germany) endodontic instruments and the amount of apically extruded debris during retreatment procedures. METHODOLOGY Thirty extracted mandibular molar teeth having mesial roots with a degree of curvature less than 20° and having an initial apical size equivalent to a size 10 K-file were selected. The mesial roots of the teeth were removed from the cementoenamel junction to obtain a 15-mm root length. The mesiobuccal canals were prepared to size F2 using the ProTaper Universal system (Dentsply Sirona, Ballaigues, Switzerland), filled with gutta-percha and 2Seal (VDW) using the lateral compaction technique and then randomly divided into two groups (n = 15). The root fillings were removed with one of the following instruments using a crown-down preparation technique: M-Wire Reciproc or Reciproc Blue (both VDW). Apically extruded debris was collected in pre-weighed Eppendorf tubes. The Eppendorf tubes were then stored in an incubator at 70 °C for five days to evaporate the distilled water. The data were analysed using the Mann-Whitney U test (P = 0.05). RESULTS Reciproc Blue (1.42 ± 0.4491 mg) extruded significantly less debris apically than M-Wire Reciproc (2.56 ± 1.0232 mg) (P < 0.05). CONCLUSIONS Blue thermal treatment of Reciproc instruments was associated with less debris extrusion during retreatment procedures.
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Affiliation(s)
- E Doğanay Yıldız
- Department of Endodontics, Faculty of Dentistry, Kırıkkale University, Kırıkkale, Turkey
| | - H Arslan
- Department of Endodontics, Faculty of Dentistry, Health Sciences University, İstanbul, Turkey
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Neelakantan P, Ahmed HMA, Chang JWW, Nabhan MS, Wei X, Cheung GSP, Gomes BPFA. Effect of instrumentation systems on endotoxin reduction from root canal systems: A systematic review of clinical studies and meta‐analysis. AUST ENDOD J 2018; 45:407-413. [DOI: 10.1111/aej.12333] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Prasanna Neelakantan
- Discipline of Endodontology Faculty of Dentistry The University of Hong Kong Hong Kong Hong Kong
| | - Hany Mohamed Aly Ahmed
- Department of Restorative Dentistry Faculty of Dentistry University of Malaya Kuala Lumpur Malaysia
| | - Jeffrey Wen Wei Chang
- Discipline of Endodontology Faculty of Dentistry The University of Hong Kong Hong Kong Hong Kong
| | - Mohamed Shady Nabhan
- Department of Prosthetic Dentistry Faculty of Dentistry Ain Shams University Cairo Egypt
| | - Xi Wei
- Department of Operative Dentistry and Endodontics Guanghua School of Stomatology, Affiliated Stomatological Hospital Guangdong Provincial Key Laboratory of Stomatology Sun Yat‐sen University Guangzhou China
| | - Gary Shun Pan Cheung
- Discipline of Endodontology Faculty of Dentistry The University of Hong Kong Hong Kong Hong Kong
| | - Brenda P. F. A. Gomes
- Department of Restorative Dentistry Endodontics Division Piracicaba Dental School State University of Campinas ‐ UNICAMP Piracicaba São Paulo Brazil
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De-Deus G, Belladonna FG, Zuolo AS, Simões-Carvalho M, Santos CB, Oliveira DS, Cavalcante DM, Silva EJNL. Effectiveness of Reciproc Blue in removing canal filling material and regaining apical patency. Int Endod J 2018; 52:250-257. [DOI: 10.1111/iej.12991] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 08/05/2018] [Indexed: 12/11/2022]
Affiliation(s)
- G. De-Deus
- Department of Endodontics; Fluminense Federal University; Niterói Brazil
| | - F. G. Belladonna
- Department of Endodontics; Fluminense Federal University; Niterói Brazil
| | - A. S. Zuolo
- Department of Endodontics; Fluminense Federal University; Niterói Brazil
| | - M. Simões-Carvalho
- Department of Endodontics; Fluminense Federal University; Niterói Brazil
| | - C. B. Santos
- Department of Endodontics; Fluminense Federal University; Niterói Brazil
| | - D. S. Oliveira
- Department of Endodontics; Fluminense Federal University; Niterói Brazil
| | - D. M. Cavalcante
- Department of Endodontics; Fluminense Federal University; Niterói Brazil
| | - E. J. N. L. Silva
- Department of Endodontics; Grande Rio University; Duque de Caxias Rio de Janeiro Brazil
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Yammine S, Jabbour E, Diemer F, Majzoub Z. Canal Straightening Following Overinstrumentation with Three Nickel-Titanium Rotary Instruments. J Int Soc Prev Community Dent 2018; 8:245-251. [PMID: 29911063 PMCID: PMC5985682 DOI: 10.4103/jispcd.jispcd_18_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 01/30/2018] [Indexed: 12/22/2022] Open
Abstract
AIM The aim of the present in vitro study to compare canal straightening following shaping of curved canals with three types of new generation nickel-titanium (NiTi) rotary instruments-ProTaper Next (PTN)®, BT RaCe (BTR)®, and WaveOne Gold (WOG)®- and three different levels of protrusion beyond the major apical foramen. MATERIALS AND METHODS Forty-five extracted human maxillary and mandibular molars with at least one curved canal were distributed in three comparable groups of 15 canals each. The canals were instrumented to the major foramen and then overinstrumented with the final file 0.5 mm, 1 mm, and 1.5 mm beyond the foramen using PTN (Group PTN = 15), BTR (Group BTR = 15), and WOG (Group WOG = 15). Standardized pre- and post-instrumentation radiographs of the root canal were obtained for all groups using digital intraoral radiographs coupled with software. Differences in the degree of curvature were regarded as straightening and canal curvature was evaluated based on Schneider technique using the AmScope software for measurements and compared between groups and levels of instrumentation applying Mixed-model ANOVA. Significance was set at 0.05. RESULTS Canal curvature tended to gradually straighten out as the level of instrumentation increased in all three groups without statistically significant difference among the groups (P = 0.826). CONCLUSION Overinstrumentation in curved canals resulted in straightening of the canal curvature.
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Affiliation(s)
- Salwa Yammine
- Department of Endodontics, Faculty of Dental Medicine, Lebanese University, Hadath, Beirut, Lebanon
| | - Edgard Jabbour
- Department of Endodontics, Faculty of Dental Medicine, Lebanese University, Hadath, Beirut, Lebanon
| | - Franck Diemer
- Université Paul Sabatier, Institut Clément Ader, CHU de Toulouse, France
| | - Zeina Majzoub
- Department of Periodontology, Faculty of Dental Medicine, Lebanese University, Hadath, Beirut, Lebanon
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Yammine S, Jabbour E, Nahas P, Majzoub Z. Foramen Changes following Over Instrumentation of Curved Canals with Three Engine-Driven Instruments: An In Vitro Study. IRANIAN ENDODONTIC JOURNAL 2017; 12:454-461. [PMID: 29225641 PMCID: PMC5722120 DOI: 10.22037/iej.v12i4.16268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 08/06/2017] [Accepted: 08/20/2017] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The present in vitro study aimed to evaluate and compare the changes in shape and surface area of the major foramen following shaping of curved canals with three new generation NiTi engine-driven instruments naming ProTaper Next, BT RaCe and WaveOne Gold- with 3 different levels of protrusion beyond the major apical foramen. METHODS AND MATERIALS A total of 45 extracted human molars with at least one curved canal were distributed in 3 comparable groups of 15 that were instrumented using either ProTaper Next (PTN), BT RaCe (BTR) or WaveOne Gold (WOG). The canals were instrumented to the major foramen and then over instrumented with the final file 0.5 mm, 1 mm and 1.5 mm beyond the foramen. Standardized pre- and post-instrumentation photographs of the foramen were obtained for all groups using a stereomicroscope. Foramen shape and surface area were evaluated using the AmScope software for measurements and compared between groups and levels of instrumentation applying binary conditional logistic regression and repeated measures ANOVA. The level of significance was set at 0.05. RESULTS Foramen shape tended to gradually change from circular to oval as the level of instrumentation increased in all groups. The original foramen shape in WOG group remained better than other groups. Foramen surface areas increased in all groups with Group BTR demonstrating significantly greater values than the other 2 groups. CONCLUSION Over instrumentation resulted in apical enlargement and ovalization in all 3 groups but with different patterns. These differences can be attributed to the final file size, design characteristics and kinematics of the 3 systems.
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Affiliation(s)
- Salwa Yammine
- Department of Endodontics, Lebanese University, Campus Rafic Hariri, Hadath, Beirut, Lebanon;
| | - Edgard Jabbour
- Department of Endodontics, Lebanese University, Campus Rafic Hariri, Hadath, Beirut, Lebanon;
| | - Paul Nahas
- Department of Restorative and Esthetic Dentistry, Lebanese University, Campus Rafic Hariri, Hadath, Beirut, Lebanon;
| | - Zeina Majzoub
- Department of Periodontology, Lebanese University, Campus Rafic Hariri, Hadath, Beirut, Lebanon
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