The impact of minimally invasive root canal preparation strategies on the ability to shape root canals of mandibular molars

Efficacy of root filling removal from aged, minimally instrumented mandibular molars using a retreatment system combination

OBJECTIVE

This study evaluated the efficacy of the ProTaper Universal Retreatment system (PTUR) and XP-endo Finisher R instrument (XPFR) in removing 64-month-old root filling material from minimally-instrumented mandibular molar canals.

METHODS

Forty-eight root canals with Vertucci type II or IV configurations from 30 mandibular molars were instrumented to size 20/0.04 taper using Vortex Blue NiTi rotary instruments and irrigated with the GentleWave system. The canals were divided into three groups based on the root filling method: single-cone with AH Plus sealer (SA), single-cone with GuttaFlow 2 sealer (SG), and GuttaCore with AH Plus sealer (GA). Specimens were stored at 100 % humidity and 37 °C for 64 months. Retreatment consisted of PTUR instrumentation, followed by XPFR for canals with residual filling material. Micro-computed tomography was used to evaluate the volume of root filling material in the canals after 64 months of obturation, post-PTUR instrumentation, and after the supplementary XPFR approach.

RESULTS

No significant differences were observed in the volume of root filling material among the SA, SG, and GA groups (p > 0.05). After PTUR retreatment, the percentage of filling material removal, or remaining volume, did not significantly differ among the three groups (p > 0.05). However, supplementary XPFR instrumentation significantly reduced the remaining filling material in all groups. The PTUR and XPFR combination was the most effective in the SA and GA groups, followed by the SG group (p < 0.05).

CONCLUSION

The PTUR and XPFR retreatment system combination was more effective in removing root filling material from minimally-instrumented mandibular molars.

CLINICAL SIGNIFICANCE

The combined use of retreatment file systems improves efficacy of retreating minimally-instrumented mandibular molars by reducing residual filling material and enhancing canal cleanliness, with the potential to improve retreatment outcomes.

Shaping ability of three instrumentation system in moderately curved canals: A micro-CT study

This study aims to compare the shaping ability of three systems using micro-computed tomography (micro-CT). Moderately-curved mesial canals of 36 mandibular molars were assigned to three groups (n = 24); Protaper Next (PTN, 0.25, 0.06), WaveOne Gold (WOG, 0.25, 0.07), TruNatomy (TRN, 0.25, 0.04), and instrumentation was performed. Pre- and post-micro-CT scans were obtained. Canal volume and surface, structure model index (SMI), centroid shift, canal transportation, and untouched canal were analyzed. One-way ANOVA and Student's t-test were used for statistics. There was no difference in SMI, centroid shift, and centering ability between the study groups (p > .05). Removed dentin and canal surface changes were lower in TRN, while untouched dentin walls were higher (p < .05). Cross-sections became more rounded (p < .05), but not significant between groups (p > .05). Considering the removed dentin by TRN, it can be used in critical dentin thickness, such as the danger zone (DZ). PTN, WOG, and WOG kept the original canal course similarly. Untouched dentin by TRN (41%) was wider than PTN and WOG, consequently, meticulous irrigation is recommended. TRN, which provides a controlled increase in canal volume, can be used in thin dentin such as the DZ, however, its use should be supported by copious irrigation and brushing considering the rate of untouched dentin walls. RESEARCH HIGHLIGHTS: TRN presented a higher untouched dentin wall compared to PTN and WOG. Canal volume and surface changes were the lowest in the TRN group. The centering abilities were similar in PTN, WOG, and TRN.

Postoperative pain of minimally invasive root canal treatment:a randomized clinical trial

This randomized clinical trial compared postoperative pain between a minimally invasive (MP) and conventional root canal treatment protocol (CP). A total of 170 mature permanent teeth (either with vital or necrotic pulp), were randomly assigned into two groups. In the CP group, ProTaper Gold (Dentsply Sirona, Ballaigues, Switzerland) and a continuous wave of condensation technique were used, whereas, in the MP group, TruNatomy (Dentsply Sirona), ultrasonic-assisted irrigation (UI), calcium hydroxide, and a sealer-based obturation technique were used. Patients recorded preoperative and postoperative pain using a 0-10 numerical rating scale (NRS) at 4 h, 1, 2, 3, 4, 5, 6, and 7 days after instrumentation and 1 day after canal obturation, respectively. There were no significant differences in pain intensity at any time points assessed between the two groups (p > 0.05). The occurrence of moderate/intense pain after instrumentation was significantly associated with preoperative periapical index (PAI) (p = 0.017) and NRS scores (p < 0.001). Preoperative pulp status (p = 0.009) and NRS score (p = 0.006) were identified as significant factors in the occurrence of moderate/intense pain after obturation. Instrumentation unequivocally reduced pain severity for both groups. The post-endodontic pain associated with the use of MP, combined with UI, Ca(OH)2, and calcium-silicate cement, did not differ from that of CP. Preoperative pain score, PAI, and preoperative pulp status were determined to be prognostic factors for postoperative pain.

Debridement ability of the WaveOne Gold and TruNatomy systems in the apical third of root canals: ex vivo assessment

Cleaning and shaping the root canal system are essential steps for performing successful endodontic therapy, and are challenging procedures in the apical region. This study aimed to conduct an ex vivo assessment of the debridement ability of the WaveOne Gold (Medium 35/.06) and TruNatomy (Medium 36/.03) systems in the apical third of round root canals of mandibular premolars. Forty-eight teeth, extracted for orthodontic or periodontal reasons, were divided into three groups (n=16), as follows: Group C, control (without instrumentation or irrigation); Group WOG, instrumentation with WaveOne Gold; Group TN, instrumentation with TruNatomy. A total of 40 mL of 2.5% sodium hypochlorite and 5 mL of 17% ethylenediamine tetraacetic acid were used per root canal in all the groups. Ten 0.5-μm serial cross-sections per specimen were obtained every 0.2 mm from a 2-mm segment of the apical region, extending from 1 to 3 mm short of the root apex. The sections were stained with hematoxylin-eosin and analyzed under a digital microscope (100x). The percentages of unprepared walls and remaining debris were quantified using ImageJ software. Generalized linear models were used to analyze the results (α=5%). Groups WOG and TN had significantly lower percentages of unprepared walls and remaining debris than Group C (p<0.05). There was no significant difference between groups WOG and TN for either of the variables studied (p>0.05). Instrumentation with the WaveOne Gold Medium and TruNatomy Medium instruments was associated with equivalent percentages of unprepared walls and remaining debris in the apical third of round canals of mandibular premolars.

Shaping Efficiency of Rotary and Reciprocating Kinematics of Engine-driven Nickel-Titanium Instruments in Moderate and Severely curved Root Canals Using Microcomputed Tomography: A Systematic Review of Ex Vivo Studies

INTRODUCTION

This systematic review aimed to compare reciprocating with continuous rotary instrumentation kinematics, by means of microcomputed tomography evaluations, in extracted human permanent teeth with moderate and severe canal curvatures.

METHODS

The research protocol was registered in the International Prospective Register of Systematic Reviews and given the reference number CRD42023404035. An electronic search was undertaken in MEDLINE (PubMed), EBSCO, Scopus, Web of Science databases until December 2021. Manual screening of issues in endodontic journals and references of relevant articles were assessed individually. The risk of bias (RoB) of the included articles was evaluated with the QUIN tool (Quality Assessment Tool for In Vitro Studies).

RESULTS

Among 1640 retrieved articles, 49 were included in the qualitative synthesis. Fifteen articles had low RoB, 33 articles had medium RoB, and only 1 study was at high RoB. Continuous rotary systems had better centering ability in both moderate and severe canal curvatures and resulted in less apical transportation in severely curved root canals. None of the kinematic systems was capable of instrumenting the entire canal surface area. Reciprocating kinematics systems tended to provide higher increase in surface area of severely curved canals and produced fewer dentinal microcracks in moderately curved canals.

CONCLUSIONS

The evidence presented in this review suggests that continuous rotary system seems to be better than reciprocating system in solving the major issues encountered during root canal instrumentation of extracted teeth with moderate and severe curvatures.

The effect of root canal preparation tapers on planktonic bacteria and biofilm reduction in the apical third: A correlative microtomography and microbiological laboratory study

AIM

To evaluate the influence of different preparation tapers on the reduction in planktonic bacteria and biofilms of Enterococcus faecalis and Candida albicans in the apical third (4 mm) of the mesial roots of mandibular molars, correlating decontamination with canal shape.

METHODOLOGY

After microtomography analysis for morphological standardization of the canals, 48 mandibular molar roots, each containing two canals (96 canals), were contaminated with E. faecalis and C. albicans and divided into four groups (n = 11) for canal instrumentation using ProDesign Logic 2 files with different tapers G (.03): # 25.03; G (.04): # 25.04; G (.05): # 25.05; and G (.06): # 25.06 and irrigation with 2.5% sodium hypochlorite. Four roots were examined under a scanning electron microscope (SEM) to qualitatively assess biofilm formation. Eight roots were used as the negative control group (samples were not contaminated). Bacteriological samples were taken exclusively from the apical third of the roots before and after chemical-mechanical preparation and bacterial counts were determined (CFU/mL). The final micro-CT scan was used to quantify the volume variation and unprepared canal area in the apical third. Statistical analysis was performed using the Kruskal-Wallis, Student-Newman-Keuls and Wilcoxon tests for analysis of microbiological data. anova and the Tukey or Games-Howell test were used for analysis of micro-CT data and Spearman's test for correlations (α = 5%).

RESULTS

All groups showed a significant reduction in bacteria (p < .05), with no statistically significant difference between groups. There was no significant difference in per cent volume increase between groups. The unprepared area (Δ%) was affected by the file used (p = .026) and was significantly lower for G (.06) compared to G (.03). There was no statistically significant correlation among bacterial reduction, volume and unprepared area (p > .05).

CONCLUSION

The different preparation tapers influenced root canal shaping in the apical third but did not improve decontamination in this region.

Comparative Evaluation of the Canal Shaping Ability, Pericervical Dentin Preservation, and Smear Layer Removal of TruNatomy, WaveOne Gold, and ProTaper Ultimate-An Ex Vivo Study in Human Teeth

INTRODUCTION

Innovative file systems have been recently introduced, claiming improved effectiveness and superior ability to preserve the tooth structure, still allowing an efficient preparation and disinfection up to the apical region. Regardless, few data are available on the comparative effectiveness of the most recently developed systems. Thus, this ex vivo study aimed to comparatively evaluate, for the first time, the functionality of WaveOne Gold (WOG), TruNatomy (TN), and ProTaper Ultimate (PU) file systems regarding canal shaping, dentin preservation, and smear layer removal ability.

METHODS

Human maxillary incisors were randomly divided for instrumentation with one of the assayed systems. Canal shaping ability and pericervical dentin preservation were characterized through microtomographic evaluation and morphometric assessment (n = 15). Smear layer removal ability was evaluated by scanning electron microscopy (SEM) (n = 6).

RESULTS

TN and PU presented the lowest canal volume variation upon instrumentation, found to be significantly lower than that attained with WOG (P < .05). Pericervical dentin was reduced in all groups upon instrumentation, with TN evidencing the highest preservation, quantitatively similar to PU, and significantly higher than that attained with WOG (P < .05). SEM imaging revealed the presence of scattered remnants of the smear layer and partially opened dentinal tubules at the apical portion, with no significant differences between systems.

CONCLUSIONS

TN and PU allowed for the highest tissue preservation, reporting the lowest volume variation and the highest preservation of the pericervical dentin. None of the assessed systems provided a complete removal of the smear layer in the apical region.

Does minimally invasive canal preparation provide higher fracture resistance of endodontically treated teeth? A systematic review of in vitro studies

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.

Shaping ability of Procodile and R6 Reziflow nickel-titanium reciprocating instruments in curved mesial root canals of mandibular molars: A MicroCT study

To compare the shaping ability of Procodile and R6 Reziflow instruments used in reciprocating motion in severely curved root canals, assessed with micro-computed tomography (μCT). Fourteen extracted human mandibular first molars were randomly assigned to two instrumentation techniques (n = 14 mesial root canals): Procodile or R6 Reziflow. For both groups, root canals were prepared to the working length up to a size 25, .06 taper. Molars were virtually divided into apical, middle and coronal thirds and μCT was used to scan all samples pre- and post-root canal. Canal transportation, centring ability, volume, surface area and unprepared area were evaluated. Geometrical parameter changes were compared with preoperative values (one-way analyses of variance and Tukey multiple comparison post-hoc test) between groups and Student t-test within groups (α = 0.05) Significantly less transportation was observed associated with the Procodile technique in the molar's coronal third compared to the R6 Reziflow technique (p < .05). No significant differences in root canal centring ability, volume, surface area and unprepared area were observed. Procodile showed a lower percentage increase of surface area compared to R6 Reziflow (p < .05). The Procodile and R6 Reziflow techniques applied to first molar root canal performed similarly except for the less transportation observed in the coronal third using Procodile. RESEARCH HIGHLIGHTS: MicroCT analysis of canal geometry before and after instrumentation revealed that Procodile and R6 Reziflow showed a similar shaping ability to shape curved root canals without substantially modifications of the original tooth anatomy.

Novel technologies to improve the treatment of endodontic microbial infections: Inputs from a drug delivery perspective

Endodontic microbial infections are still a challenge for an effective treatment for being biofilm-mediated and very refractory to conventional therapies. Biomechanical preparation and chemical irrigants cannot fully eradicate biofilms due to the anatomic structure of the root canal system. Instruments employed in biomechanical preparation and irrigants solution cannot reach the narrow and deepest portion of root canals, especially the apical thirds. In addition, aside from the dentin surface, biofilms can also infiltrate dentine tubules and periapical tissues, compromising treatment success. Therefore, different technologies have been investigated to achieve a more effective outcome in the control of endodontic infections. However, these technologies continue to face great difficulties in reaching the apical region and eradicating biofilms to avoid the recurrence of infection. Here, we present an overview of the fundamentals of endodontics infections and review technologies currently available for root canal treatment. We discuss them from a drug delivery perspective, highlighting each technology's strength to envision the best use of these technologies.

Taper 0.06 Versus Taper 0.04: The Impact on the Danger Zone

INTRODUCTION

This study aimed to evaluate the effects of root canal enlargement on the danger zone (DZ) of mandibular molars.

METHODS

Thirty mesial roots of mandibular first molars were scanned in micro-computed tomography (S1). Canals were sequentially enlarged with rotary instruments up to sizes 30/0.04 (S2) and 30/0.06 (S3). The dentin thickness was measured at 0.1-mm intervals after each preparation step (n = 2964 slices). Root level and position of the DZ were also recorded. Data were compared using analysis of variance with Bonferroni pairwise comparison, Cochran's Q method, and Pearson's test (α = 5%).

RESULTS

Comparing the specimens before (S1) and after (S2 and S3) preparations showed a significant reduction in the thickness of the DZ (P < .05), as well as between S2 and S3 steps (P < .05). At S1, the DZ was mostly located in the middle third of the root, but after preparation, it shifted toward the coronal direction (P < .05). Both S2 (P = .004, r = 0.508) and S3 (P = .004, r = 0.506) preparation steps showed a positive correlation between canal length and the root level of the DZ. At S1, the DZ was positioned toward the distal and mesial in 73.4% (n = 22) and 26.6% (n = 8) of the specimens, respectively. After S3, the number of specimens with DZ positioned toward the mesial aspect of the root significantly reduced to 3.3% (n = 1), whereas none of the specimens with DZ positioned toward the distal changed its position after root canal enlargements (P > .05).

CONCLUSION

Overall, the enlargement of mesial canals of mandibular first molars with final instruments sizes 30/0.04 and 30/0.06 affected the thickness, root level, and position of the DZ.

Incidence of Post-Operative Pain following a Single-Visit Pulpectomy in Primary Molars Employing Adaptive, Rotary, and Manual Instrumentation: A Randomized Clinical Trial

Background and Objectives. To differentiate the intensity of postoperative pain after primary molar pulpectomy employing manual instrumentation versus two single-file systems with different kinetics (the XP-Endo shaper file with adaptive instrumentation vs. the Kedo-SG blue file with continuous rotation instrumentation). Materials and Methods. This three-arm, single-blind, randomized clinical trial included assessing 75 healthy children between 4 to 9 years who required pulpectomy for primary molars (mandibular first and second). The three groups each had an equal number of children. Children in Group 1 had their teeth instrumented with the XP-endo Shaper, children in Group 2 had their teeth instrumented with the Kedo-SG Blue file, and children in Group 3 had their teeth instrumented manually using K-files. The degree of postoperative pain was measured using a four-point pain scale at 6-, 12-, 24-, 48-, and 72-h following therapy. Each participant's parent received five flashcards with four faces and a word characterizing each face. The data were analyzed using Kruskal-Wallis and chi-square tests. The level of significance was set to 5%. Results. During the follow-up period, there was a significant difference in postoperative pain intensity between the three groups. The XP-endo shaper was associated with considerably decreased post operative at the 6- and 12-h interval followed by Kedo-SG. The highest post-operative discomfort across the groups was related to the patients who underwent manual instrumentation. Conclusion. In comparison to rotary and manual instrumentation, postoperative pain severity was reduced with adaptive instrumentation.

Root canal irrigation system using remotely generated high-power ultrasound

Root canal treatment is performed to remove the bacteria proliferating in the root canals of a tooth. Many conventional root canal irrigation methods use an instrument inserted into the root canals. However, bacteria removal is often incomplete in the apical region of the root canal, and the treatment carries clinical risks, such as instrument fracture and extrusion of irrigation liquid through the canal apex. We here suggest a novel, remotely generated high-intensity ultrasound irrigation system that exhibits better irrigation performance and a reduced clinical risk. Our device employs powerful ultrasonic waves generated by a transducer placed outside a target tooth. The generated ultrasonic waves are guided to travel into the root canals. In the root canals of the target tooth, acoustic cavitation occurs, and vapor bubbles are created. The dynamic motions of vapor bubbles create remarkable cleaning effects. Using root canal models, we tested the cleaning performance of the proposed system and compared it with other conventional irrigation methods. The results revealed that biofilm in the apical region of the root canal models can be removed exclusively using the proposed system, thus demonstrating an improvement in cleaning performance. We also measured pressure at the apex of the root canals of an extracted tooth while operating the proposed system. Our system exhibited a smaller pressure compared to the syringe irrigation method, thus suggesting a reduced risk of apical extrusion of the irrigation liquid. Since the proposed system operates without inserting instruments into the root canal, it can clean multiple root canals in a tooth simultaneously with a single treatment. The proposed device would be a breakthrough in root canal treatment in terms of irrigation performance, clinical safety, and ease of treatment.

The impact of TruNatomy and ProTaper Gold instruments on the preservation of the periradicular dentin and on the enlargement of the apical canal of mandibular molars

INTRODUCTION

This study aimed to evaluate the preservation of the periradicular dentin and the enlargement of the apical canal of mandibular molars with TruNatomy and ProTaper Gold instruments.

METHODS

Twenty mandibular molars were scanned in a micro-CT device, anatomically paired, and distributed into 2 groups (n=10). In the ProTaper Gold group, mesial and distal canals were prepared up to F2 (25/.08v) and F3 (30/.09v) instruments, while in the TruNatomy group, mesial and distal canals were enlarged until Prime (26/.04v) and Medium (36/.03v) instruments, respectively. After a new scan, surface area, volume, unprepared areas, transportation, percentage of dentin removal, and dentin thickness parameters were calculated. Data were compared between groups using Mann-Whitney, Student t-test, and the non-metric multidimensional scaling test with alpha set at 5%.

RESULTS

No difference was found between groups regarding unprepared canal areas and reduction of dentin thickness (P > 0.05). Transportation was lower than 0.1 mm in all groups and statistical differences were observed only at the apical third of the mesiobuccal canal with lower values in the TruNatomy group. ProTaper Gold removed more dentin than TruNatomy at the coronal level of mesial roots (1.8% and 1.0%, respectively) (P < 0.05).

CONCLUSIONS

TruNatomy and ProTaper Gold were efficient for performing canal preparation in mandibular molars. The tested systems were similar in terms of untouched canal walls and remaining dentin thickness, and slightly different in the apical transportation of mesial canals and percentage of dentin removal at the coronal third, but without clinically significant errors.

Present status and future directions - Minimal endodontic access cavities

In the last decades, the move of Medicine towards minimally invasive treatments is notorious and scientifically grounded. As Dentistry naturally follows its footsteps, minimal access preparation also became a trend topic in the endodontic field. This procedure aims to maximize preservation of dentine tissue, backed up by the idea that this is an effective way to reduce the incidence of post-treatment tooth fracture. However, with the assessment of the body of evidence on this topic, it is possible to observe some key-points (a) the demand for nomenclature standardization, (b) the requirement of specific tools such as ultra-flexible instruments, visual magnification, superior illumination, and three-dimensional imaging technology, (c) minimally invasive treatment does not seem to affect orifice location and mechanical preparation when using adequate armamentarium, but it (d) may impair adequate canal cleaning, disinfection, and filling procedures, and also (e) it displays contradictory results regarding the ability to increase the tooth strengthen compared to the traditional access cavity. In spite of that, it is undeniable that methodological flaws of some benchtop studies using extracted teeth may be responsible for the conflicting data, thus triggering the need for more sophisticated devices/facilities and specifically designed research in an attempt to make it clear the role of the access size/design on long-term teeth survival. Moreover, it is inevitable that a clinical approach like minimal endodontic access cavities that demands complex tools and skilled and experienced operators bring to the fore doubts on its educational impact mainly when confronted with the conflicting scientific output, ultimately provoking a cost-benefit analysis of its implementation as a routine technique. In addition, this review discusses the ongoing scientific and clinical status of minimally invasive access cavities aiming to input an in-depth and unbiased view over the rationale behind them, uncovering not only the related conceptual and scientific flaws, but also outlining future directions for research and clinical practices. The conclusions attempt to skip from passionate disputes highlighting the current body of evidence as weak and incomplete to guide decision making, demanding the development of a close-to-in-situ laboratory model or a large and well-controlled clinical trial to solve this matter.

Impact of several NiTi-thermally treated instrumentation systems on biomechanical preparation of curved root canals in extracted mandibular molars

AIM

To evaluate the shaping ability of several heat-treated nickel-titanium systems used to prepare root canals with moderate and severe curvature, in extracted mandibular molars, by micro-computed tomography, considering their variation in kinematics and design.

METHODOLOGY

Curved-mesial roots of mandibular molars were randomly selected and assigned into 4 balanced experimental groups (n = 10), established by determining homogeneous 3D parameters of volume and surface area: R-Motion (RM) size 30, 0.04 taper (RM; FKG Dentaire), Reciproc Blue (RCB) size 25, 0.08 taper (RCB; VDW GmbH), HyFlex CM (HFX) size 30, 0.04 taper (HFX; Coltène Whaledent) and XP-endo Shaper size (XPS) 30, 0.01 taper (XPS; FKG Dentaire). The volume of irrigation was established at 10 ml of 2.5% NaOCl. Throughout the entire root canal preparation procedures, the samples were fixed in a vice submerged in a container with water monitored at 37°C. Dimensional cross-sectional measures of area, perimeter, roundness, major/minor diameters and 3-dimensional (volume, surface area, structure model index - SMI) parameters as well as the smallest dentine thickness along the cervical and middle root thirds were evaluated by micro-CT. Data were analysed using analysis of variance and post hoc Tukey tests (α = 5%).

RESULTS

Reciproc Blue and XPS had significantly greater mean increases in cross-sectional area measurements, only in the middle third, when compared with RM and HFX (p < .05). RM, RCB and XPS had a similar increase in measurements of length and width of perimeter (p > .05), and HFX had significantly lower mean increases in perimeter values only when compared with XPS (p < .05). RCB and XPS had significantly greater mean increases in volume when compared with RM and HFX (p < .05). RM had a significantly lower difference in SMI after preparation, compared with RCB, HFX and XPS (p < .05). The smallest dentine thickness was observed after the use of RCB (p < .05), in the danger and safety zones.

CONCLUSIONS

XP-endo Shaper and RM had a shaping ability similar to that of instruments with larger tapers, achieved with less dentine removal in danger and safe zones in curved-mesial canals of extracted molar teeth treated on a laboratory benchtop.

Antimicrobial and cytotoxic activity of electrosprayed chitosan nanoparticles against endodontic pathogens and Balb/c 3T3 fibroblast cells

The aims of this study were to synthesize highly positively charged chitosan nanoparticles (Ch-Np) using the electrospraying technique, and to test their antimicrobial activity against endodontic pathogens, and cytotoxicity against fibroblast cells. Ch-Np were synthesized from low molecular weight chitosan (LMW-Ch) using the electrospraying technique, and characterized. The antimicrobial activity was evaluated against Streptococcus mutans, Enterococcus faecalis, and Candida albicans in their planktonic state using a Time-Kill Test performed by using broth micro-dilution technique, and against biofilm biomass using a microtiter plate biofilm assay. The cytotoxicity was evaluated using Balb/c 3T3 fibroblast cells with the standard MTT assay. Electrospraying of LMW-Ch produced Ch-Np with an average size of 200 nm, and a surface charge of 51.7 mV. Ch-Np completely eradicated S. mutans and E. faecalis in the planktonic state and showed fungistatic activity against C. albicans. Furthermore, it significantly reduced the biofilm biomass for all the tested microbial species [S. mutans (p = 0.006), E. faecalis (p < 0.0001), and C. albicans (p = 0.004)]. When tested for cytotoxicity using 3T3 cells, Ch-Np showed no cytotoxicity. In conclusion, the highly positively charged, colloidal dispersion of Ch-Np are effective as a biocompatible endodontic antimicrobial agent.

Shaping ability of four single-file systems in the instrumentation of second mesiobuccal canals of three-dimensional printed maxillary first molars

Background

This study evaluated and compared the shaping ability of four advanced single-file nickel-titanium (NiTi) systems during the preparation of curved second mesiobuccal (MB2) canals in maxillary first molar replicas fabricated by three-dimensional (3D) printing via micro-computed tomography (Micro-CT) imaging.

Methods

A total of 60 3D-printed maxillary first molar replicas were constructed from one extracted tooth, with an angle of curvature ranging from 15° to 25°. The MB2 canals from these 60 replicas were divided into 4 groups of 15 replicas according to the canal instrumentation system used, namely, Waveone gold (WOG), Reciproc blue (RCB), XP-endo shaper (XPS) and M3-L. The specimens were scanned before and after preparation using Micro-CT. The pre- and post-instrumentation images of each specimen were superimposed, and the amount of resin removed, the change in surface area, the canal transportation, and centering ability were assessed using the Mimics software. Instrumentation time was also recorded. One-way analysis of variance and least significant difference (LSD) tests were used to statistically compare the groups. The significance level was set at 5%.

Results

Instrumentation time with M3-L was significantly longer than the other systems (P<0.05). The amount of resin removed and the change in surface area generated by the 4 systems were different at the apical, middle, and coronal thirds, and the total canal (P<0.05). Overall, WOG and XPS resulted in the less change than RCB and M3-L. There was no significant difference among the groups at the middle third regarding canal transportation and centering ability (P>0.05). However, a significant difference was found at the apical level (P<0.05), where RCB showed the poorest centering ability and the highest canal transportation (P<0.05). In addition, XPS resulted in the least canal transportation (P<0.05) at the coronal level, while there was no significant difference between the four groups in terms of centering ability.

Conclusions

The M3-L instrument required more time to prepare the curved MB2 canals compared with the other systems. Overall, WOG and XPS showed the least resin removal and surface area change. M3-L, XPS, and WOG instruments respected the original canal curvature better than RCB files.

Analysis of Instrumentation Protocols Regarding the Quality of Mesial Canal Preparation in Mandibular Molars: A Micro-computed Tomographic Study

INTRODUCTION

This study aimed to use micro-computed tomographic imaging to analyze the quality of the endodontic preparation of mesial canals in mandibular molars provided by 3 instrumentation protocols.

METHODS

Forty-five extracted mandibular molars with 2 independent mesial canals were selected, and the initial micro-computed tomographic imaging was performed. The initial volume values of the canals were submitted to statistical analysis for paired division. The groups were determined according to the final enlargement of the canal and the working length adopted (ie, G25.06/+1 mm, G35.05/foramen, and G50.01/-1 mm). At the end of each instrumentation sequence, the root canals were scanned and analyzed with regard to the increase in the total and apical volume, centralization, and preparation transportation and the percentage of the total and apical uninstrumented walls.

RESULTS

For the intragroup comparison, the Wilcoxon test was used, and for the intergroup analysis, the Kruskal-Wallis and Dunn tests were used (P < .05). In the analysis of the canal total volume, a statistical difference was found between G25.06/+1 mm and the remaining groups (P < .05). In the apical third, a statistical difference was observed between G25.06/+1 mm and G50.01/-1 mm (P < .05). No statistical difference was found between the groups in terms of centralization and transportation of the preparation or in terms of the percentage of the total or apical uninstrumented walls.

CONCLUSIONS

The preparation of the mesial canals of mandibular molars up to larger tip files but with a lower taper at 1 mm before the foramen resulted in a larger volume of apical preparation, kept the preparation centralized, and provided safe apical dentin wear without excessive cervical wear.

Influence of ultraconservative access cavities on instrumentation efficacy with XP-endo Shaper and Reciproc, filling ability and load capacity of mandibular molars subjected to thermomechanical cycling

AIM

To evaluate the influence of ultraconservative access cavities (UltraAC) on canal shaping and filling ability and load capacity of mandibular molars after root canal preparation with XP-endo Shaper (XP) or Reciproc (RC), under simulated clinical conditions. Traditional access cavities (TradAC) were used for comparison.

METHODOLOGY

Forty extracted mandibular molars were scanned by micro-computed tomographic and, based on similar anatomical features, were divided into four groups (n = 10), according to the type of access cavity and canal instrumentation protocol: TradAC/RC, TradAC/XP, UltraAC/RC and UltraAC/XP. All root canal procedures were performed with the teeth placed in a dental mannequin. Teeth were scanned after root canal instrumentation and filling. Unprepared canal area, dentine removed, accumulated hard tissue debris (AHTD), canal transportation, presence of voids and filling material remnants within the pulp chamber were analysed. After restorative procedures, the teeth were subjected to thermomechanical cycling and to a load capacity test. Statistical analyses were performed using two-way anova test, considering the randomized blocks design (P < 0.05).

RESULTS

The percentage of unprepared canal area was significantly lower in TradAC groups when compared to UltraAC groups (P < 0.05), regardless of the instrument used. The UltraAC/XP group had significantly lower percentage of root dentine removed when compared to other groups (P < 0.05). UltraAC/XP and TradAC/XP groups had significantly lower percentages of AHTD than UltraAC/RC and TradAC/RC groups (P < 0.05). Regarding canal transportation, in the MB root canals, the TradAC/XP group had significantly lower values than other groups (P < 0.05). In general, in ML and distal root canals, TradAC/XP and UltraAC/XP groups had significantly lower values of canal transportation when compared to other groups (P < 0.05). Moreover, the UltraAC/RC had the greatest canal transportation values in MB and distal canals. The UltraAC groups had significantly greater percentages of voids and volume of remaining root filling material within the pulp chamber after cleaning procedures than TradAC groups (P < 0.05). There was no difference in the load capacity amongst groups (P < 0.05).

CONCLUSION

The UltraAC/XP and UltraAC/RC groups had significantly greater areas of unprepared canal walls, significantly more voids and volume of root filling material remnants within the pulp chamber after canal filling. UltraAC/XP was associated with significantly less root dentine removal and significantly more AHTD whilst TradAC/XP had overall significantly less canal transportation. No differences were observed in the load capacity amongst groups.