Measurements of the root surface temperature during thermo-mechanical root canal filling in vitro

External Root Surface Temperature Control with 1,1,1,2-Tetrafluoroethane Intracanal Cryotherapy during Thermoplastic Obturation: An In Vitro Study

AIM

The aim of this in vitro study was to determine the effectiveness of 1,1,1,2-tetrafluoroethane (TFE) intracanal cryotherapy for external root surface temperature control during thermoplastic obturation.

MATERIALS AND METHODS

Thirty extracted adult single-rooted mandibular incisors were selected for this study. Endodontic shaping was performed until size X3 Protaper Next Rotary endodontic file. The teeth were divided into three groups: Group I-Control group wherein conventional irrigation was done using physiologic saline stored at room temperature, Group II-Irrigational Cryotherapy group using physiologic saline at 2.5°C, and Group III-Intracanal TFE cryotherapy group with intracanal refrigerant TFE application. Temperatures were recorded in the apical 3 mm before and after completion of each intervention and post thermoplastic obturation using a noncontact digital laser infrared thermometer.

RESULTS

Intracanal cryotherapy with TFE resulted in a mean decrease of 9.27°C compared with conventional irrigation that exhibited in a mean decrease of 2.13°C. Also, in intracanal cryotherapy group with TFE application, compared with the baseline (24.50°C), no significant differences were observed post obturation (24.61°C) with high-temperature-injectable gutta percha technique indicating good control of temperature rise on the external root surface.

CONCLUSION

Intracanal cryotherapy with refrigerant TFE was highly effective in controlling temperature rise on the external root surface during injectable thermoplastic obturation technique.

CLINICAL SIGNIFICANCE

Minimizing deleterious effects due to high temperatures generated during the thermoplastic obturation is critical. Clinically feasible measures to reduce the transmission of heat generated during thermoplastic obturation have been searched since long. In this regard, intracanal cryotherapy with TFE can be effectively used to control the rise of temperature on the external root surface when employing thermoplastic obturation technique.

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.

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.

The investigation of gutta-percha temperature and compaction force change when using the vertical compaction of warm gutta-percha technique

The naturally occurring isoprene rubber component of gutta-percha has been used in dental root canal filling treatments for almost a hundred years owing to its stability and plasticity as a root canal filling material. The traditional warm gutta-percha vertical compaction technique is the major technique for warm gutta-percha root canal obturation. However, the relation between compaction force and temperature change in this technique is still unclear. The purposes of this study were to determine the ideal gutta-percha molding temperature for compaction and to evaluate single and double heating and compaction in the warm vertical compaction procedures using infrared thermography. Gutta-percha was placed in a digital dry bath incubator at temperatures ranging from 25°C to 62°C in order to analyze compaction forces using an Instron universal testing machine. Both single and double heating and compaction procedures were examined using an infrared thermograph model to monitor temperature change when performing the warm gutta-percha vertical compaction procedure. Our results demonstrate that 44–58°C is the ideal temperature to soften gutta-percha for excellent compaction. Heating and compacting gutta-percha twice at 3 mm from the apex can mold the gutta-percha completely.

Temperature increase during orthodontic bonding with different curing units using an infrared camera

AIM

To evaluate the effects of different curing units and light-tip tooth surface distances on the temperature increase generated during orthodontic bonding, using an infrared camera (IR) and artificial neural networks (ANN).

MATERIALS AND METHODS

Fifty-two freshly extracted human premolar teeth were used. Metallic orthodontic brackets were bonded to the buccal surfaces of the teeth and thermal records were taken using an IR camera and ANN. Brackets were cured with a light-emitting diode (LED) and high intensity halogen (HQTH). Teeth were divided into four groups according to the curing units (LED and HQTH) and curing distances (from tooth surface and 10 mm away from tooth surface). The results were analyzed with analysis of variance (ANOVA) and the Tukey HSD test.

RESULTS

The ANOVA and Tukey HSD tests revealed that temperature changes were influenced by the type of light source and exposure times. All groups revealed significant differences between each other (p < 0.001). The highest surface temperature increase was gained from curing with a LED unit from the tooth surface (11.35°C ± 0.91°C). The lowest surface temperature increase was gained from curing with a HQTH unit 10 mm away from the tooth surface (2.57°C ± 0.6°C).

CONCLUSION

The LED unit induced significantly higher temperature changes than did the HQTH. The temperature increase during orthodontic bonding was increased with long exposure time. A shorter light-tip tooth surface distance leads to greater increases in temperature.

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.

System B, Endo-Twinn and E-Fill. True temperatures inside the canal

Background:

The aim of this study is to verify the variations of the temperature inside the root canal with three different gutta-percha heating systems.

Materials and Methods:

A split-tooth model was built with a lateral groove at 3.5-mm from working length (WL) in order to insert a Chromel-Alumel K-type thermocouple placed in contact with gutta-percha. The thermocouple was connected to a digital thermometer. Sixty obturations were made with medium gutta-percha points. For 20 specimens the System B was used with the Buchanan fine plugger and the temperature was set at 200°C; for other 20 specimens the Endo-Twinn with a fine plugger was used and for the last 20 specimens we used the E-Fill with a 40.04 plugger. All pluggers were pushed to 3.5 mm from WL so that the tips were in contact to the probe.

Results:

The analysis of 60 samples showed the highest temperature average using the System B after 10 seconds (86.85°C), after 15 seconds (94.9°C), after 20 seconds (100.4°C) and after 25 seconds (104.5°C). The Endo-Twinn average values are similar to System-B ones. The E-Fill average values are lower (69.9°C) than the other two systems evaluated only after 10 seconds due to limited working time. The temperatures average obtained using different systems of warm vertical compaction are lower than what was declared by the producing companies.

Conclusion:

Time is one the most important parameters to consider using these systems. Temperatures reached from the System B and Endo-Twinn after 25 seconds; however, seem to be sufficient to ensure an optimal adaptation of the gutta-percha in the anatomical complexity of root canals. The temperatures obtained from the E-Fill, only after 10 seconds, instead seems to be insufficient to assure the rheological characteristics of gutta-percha.

Finite element analysis of the effects of thermal obturation in maxillary canine teeth

OBJECTIVE

The purpose of the present study was to determine the distribution and level of temperature, in a model of a maxillary canine, the surrounding periodontal tissues, and the bones, during a System B heat obturation technique simulation.

STUDY DESIGN

The temperature distribution was determined by using a three-dimensional finite element analysis. The tooth was assumed to have undergone an endodontic treatment before the application. Heat applications of 200 degrees C and 100 degrees C were considered.

RESULTS

By using the virtual model and the simulation technique, the maximum temperature in the periodontal ligament was found to be 43.5 degrees C.

CONCLUSIONS

Within the assumptions and the limitations of the study, it was determined that the simulation of System B technique created no potentially harmful levels of temperature throughout the maxillary canine model.

The Effect of Ultrasonic Post Instrumentation on Root Surface Temperature

This study measured root surface temperature changes when ultrasonic vibration, with and without irrigation, was applied to cemented endodontic posts. Twenty-six, extracted, single-rooted premolars were randomly divided into two groups. Root lengths were standardized, canals instrumented, obturated, and posts cemented into prepared spaces. Thermocouples were positioned at two locations on the proximal root surfaces. Samples were embedded in plaster and brought to 37 degrees C in a water bath. Posts were ultrasonically vibrated for 4 minutes while continuously measuring temperature. Two-way ANOVA compared effects of water coolant and thermocouple location on temperature change. Root surface temperatures were significantly higher (p < 0.001) when posts were instrumented dry. A trend for higher temperatures was observed at coronal thermocouples of nonirrigated teeth and at apical thermocouples of irrigated teeth (p = 0.057). Irrigation during post removal with ultrasonics had a significant impact on the temperature measured at the external root surface.

Evaluation of canal filling after using two warm vertical gutta-percha compaction techniques in vivo: a preliminary study

AIM

To evaluate the quality of root canal filling when comparing two warm gutta-percha filling techniques in vivo.

METHODOLOGY

Human teeth were randomly divided into two equal groups, with 30 canals each. The root canals were shaped by hand and ProFile 0.04 rotary instruments to size 20-40 at the end-point and then filled with gutta-percha cones and AH-Plus. In group A, a traditional warm vertical compaction technique was performed using the Touch'n Heat, and back-filling with the Obtura II. In group B, a modified warm vertical compaction technique was used: small amounts of gutta-percha were removed, and the remaining most apical 3 mm were compacted with a 1 mm movement; then thermomechanical back-filling was performed. The teeth were extracted, stored in dye, cleared, and the distance between the apex and apical limit of the filling, linear dye penetration, and voids were measured from the buccal, lingual, mesial and distal perspective. The homogeneity of variance and means was verified using Levene's test and t-test. ANOVA and Dunnett post hoc test were used to establish the significance and to analyse the effects through multiple comparisons.

RESULTS

Compared with the specimens of group A, the specimens of group B exhibited less mean linear dye penetration (P < 0.05), smaller void length (P < or = 0.05) and maximal width (P < or = 0.05) when examined in all four views, and a more precise filling when viewed from the buccal aspect (P < 0.05).

CONCLUSIONS

The modified warm vertical compaction technique with apical back-filling produced a more effective and precise three-dimensional filling.

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.

Removal of Two Types of Root Canal Filling Material Using Pulsed Nd:YAG Laser Irradiation

OBJECTIVE

The aim of this study was to examine the usefulness of a pulsed Nd:YAG laser in removing two types of endodontic obturation material from the root canal in vitro.

BACKGROUND DATA

Recently, a fine flexible glass fiber made of quartz has been developed to transmit the laser beam more effectively and permit its concentration in a specific area. This has increased the potential usefulness of the Nd:YAG laser in root canal treatment.

METHODS

The time required for removing the root canal obturation material (Gutta-percha cones and, Sealapex or AH26) by means of either Nd:YAG laser irradiation or a conventional method (Gates Glidden drills and K files) was measured. Contact microradiography was used to assess the radiopacity of the root canals before and after the removal of obturation material. The surfaces of the root canal after removal of the obturation materials were also observed by scanning electron microscopy.

RESULTS

Although none of the methods used in this study resulted in complete removal of debris from the root canal wall, the time required for the removal of any of the root canal obturation materials using laser ablation was significantly shorter than that required using the conventional method (p < 0.05). It appeared that some orifices of the dentinal tubules were blocked with melted dentin following laser irradiation.

CONCLUSIONS

Nd:YAG laser irradiation is an effective tool for the removal of root canal obturation materials, and may offer advantages over the conventional method.

Evaluation of Apical Filling After Warm Vertical Gutta-Percha Compaction Using Different Procedures

The aim of the present study was to evaluate the quality of endodontic sealing in the apical 4 mm of narrow and curved canals using different filling techniques. Human teeth were selected and assigned to four different techniques: group A, Schilder's warm vertical condensation; group B, Schilder's technique modified by using an electric heater; group C, Schilder's technique modified by compaction of the apical tract at body temperature; and group D, a modified vertical compaction with apical back-filling. A dye penetration test was performed, and specimens of group D showed increased apical sealing and reduced extension of voids. The use of the vertical compaction with apical back-filling technique allowed the creation of an effective apical plug and an excellent adaptation of back-filling to apical gutta-percha and to root canal walls.

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.

In vitro evaluation of the thermal alterations on the root surface during preparation with different Ni-Ti rotary instruments

The present study evaluated, in vitro, the temperature alterations on the external root surface during instrumentation with four different rotary systems. A total of 20 extracted human maxillary lateral incisors were instrumented using either the ProFile, MicroMega, Quantec or K³ systems and the thermal alterations on the root surface were recorded by means of three thermocouples attached to the coronal, middle and apical portions of the root. Mean temperature increases no higher than 0.4ºC ± 1.0ºC (ProFile system) were recorded, which indicates that these instruments are safe for the surrounding periodontal tissues.

The effect of using an inverted master cone in a lateral compaction technique on the density of the gutta-percha fill

OBJECTIVE

We sought to measure and calculate the percentage of the gutta-percha-filled area in the apical root canal after the use of a standardized or inverted master cone in cold lateral compaction.Study design Two groups of extracted mandibular premolars with a single canal were instrumented with instruments of the same size; furthermore, they were obturated with laterally compacted gutta-percha cones with AH26 used as a sealer. In the first group, a standardized master cone was used with its narrow end in an apical position, whereas in the other group, an inverted master cone was used with its wide end in an apical position. The 2 master cones had the same apical diameter and fit in the apical canal. After lateral compaction, horizontal sections were cut at a level 3 and 5 mm from the apex of each filled tooth. Photographs of the sections were taken by using a microscope equipped with a digital camera; the photos were then scanned as tagged-image file format images. The cross-sectional area of the canal and the gutta-percha were measured by using an image-analysis program. The percentage of gutta-percha-filled area was calculated.

RESULTS

At both levels, the inverted master cone produced a significantly higher percentage, statistically, of gutta-percha-filled area than did the standardized master cone (P =.001 at 3 mm; P =.012 at 5 mm).

CONCLUSION

The use of an inverted master cone in cold lateral compaction may facilitate the apical placement of accessory cones, significantly increasing the volume of gutta-percha while reducing the volume of sealer in the apical root canal.

Temperature change within gutta-percha induced by the System-B Heat Source

AIM

This study evaluated the temperature change within gutta-percha during the vertical compaction technique performed with a System-B Heat Source.

METHODOLOGY

Extracted human teeth were prepared and divided in two equal groups depending on the apex diameter (group 1: 0.20-0.25 mm and group 2: 0.30-0.35 mm). Teeth were root treated with a combination of step-back and coronal flaring instrumentation using Gates Glidden burs and hand stainless steel K- and H-files. Two thermocouples were connected to the outer surface of the root: the first one was placed 2 mm apically from cement-enamel junction (CEJ) (point C); and the second one 1.5 mm from the apex (point A). The instrumented canals were filled with size F gutta-percha cones. All teeth were then immersed in a thermostatic bath at a constant temperature of 37 degrees C and warm vertical compaction was performed using a System-B Heat Source. delta T values were recorded by means of a digital thermometer connected to the thermocouples.

RESULTS

Increments of temperature (delta T) recorded in point A revealed a mean value of 0.5 +/- 0.5 degree C for group 1 and 0.9 +/- 1.1 degrees C for group 2; delta T values recorded at point C gave a mean value of 4.1 +/- 1.7 degrees C for group 1 and 3.9 +/- 1.81 degrees C in group 2. No statistical difference was found between the groups, whilst a difference was present between the measurements at points A and C (P < 0.01).

CONCLUSIONS

The use of the System-B Heat Source on root canals maintained at a constant body temperature by a thermostatic bath revealed that the increase of temperature of the gutta-percha at the apical third of the canal was negligible and that the compaction of the mass of the gutta-percha close to the apex was performed at body temperature. Minor changes in temperature of the outer surface of the root canals occurred, suggesting no danger for the periradicular tissues.

Radicular temperatures associated with thermoplasticized gutta-percha

Thermoplasticized gutta-percha has been used to obturate root canals. The continuous wave of condensation technique uses the System B Heat Source with the choice of different-sized pluggers. The purpose of this study was to measure the temperatures within the root canal and on the root surface at different radicular levels while using the System B Heat Source. Fine, Fine-Medium, and Medium pluggers were evaluated at temperature settings of 200 degrees C, 250 degrees C, and 300 degrees C. The Obtura II gutta-percha delivery system following the manufacturer's instructions and ultrasonically thermoplasticized gutta-percha were used for comparative purposes. The highest mean temperature change on the internal root surface was 74.19 degrees C with the system B at the 6 mm level (6 mm coronal to working length) when the Fine-Medium plugger was set at 300 degrees C. The lowest mean temperature change on the internal root surface was 2.09 degrees C at the 0 mm level (at working length) when the F plugger was set at 200 degrees C. With the Obtura II, the lowest mean internal temperature change was 5.22 degrees C at the 0 mm level, whereas the highest mean internal temperature change was 26.63 degrees C at the 6 mm level. With ultrasonic lateral compaction the lowest mean internal temperature change was 5.01 degrees C at the 0 mm level, whereas the highest mean internal temperature change was 28.95 degrees C at the 6 mm level. At no time did the System B, the Obtura II, or ultrasonic delivery of warm gutta-percha exceed an increase of 10 degrees C at any thermocouple level on the external root surface.

A comparison of thermocouple and infrared thermographic analysis of temperature rise on the root surface during the continuous wave of condensation technique

AIM

This study was designed to use two methods of temperature measurement to analyse and quantify the in vitro root surface temperature changes during the initial stage of the continuous wave technique of obturation of 17 single-rooted premolar teeth with standard canal preparations.

METHODOLOGY

A model was designed to allow simultaneous temperature measurement with both thermocouples and an infrared thermal imaging system. Two thermocouples were placed on the root surface, one coronally and the other near the root apex. A series of thermal images were recorded by an infrared thermal imaging camera during the downpack procedure.

RESULTS

The mean temperature rises on the root surface, as measured by the two thermocouples, averaged 13.9 degrees C over the period of study, whilst the infrared thermal imaging system measured an average rise of 28.4 degrees C at the same sites. Temperatures at the more apical point were higher than those measured coronally. After the first wave of condensation, the second activation of the plugger in the canal prior to its removal always resulted in a secondary rise in temperature. The thermal imaging system detected areas of greater temperature change distant from the two selected thermocouple sites.

CONCLUSIONS

The continuous wave technique of obturation may result in high temperatures on the external root surface. Infrared thermography is a useful device for mapping patterns of temperature change over a large area.

Changes in root surface temperatures with in vitro use of the system B HeatSource

The purpose of this study was to measure root surface temperatures while using the System B HeatSource at various temperature settings. A split-tooth model of a human maxillary central incisor was prepared with 10 thermocouples to record root surface temperatures at 1-mm increments from the root apex. A System B HeatSource model 1005 was used to warm and compact gutta-percha to within 3 mm of the working length using the Buchanan technique. Twenty obturations were recorded at each of the following temperature settings: 250 degrees, 300 degrees, 350 degrees, 400 degrees, 450 degrees, 500 degrees, 550 degrees, and 600 degrees C. Examination of the mean temperatures recorded for each position and at each temperature setting revealed that the thermocouple 5 mm from the apex (T5) detected the highest increases in root surface temperatures. Only this site exceeded the 10 degrees C rise in temperature for one full minute that could cause damage to the supporting structures. The range of instantaneous temperatures at this site was 8.85 to 12.06 degrees C, with a mean of 10.62 +/- 0.93 degrees C. The results of this in vitro study indicate that any temperature setting of the System B HeatSource at or above 250 degrees C has the potential to cause the root surface temperature to rise 10 degrees C. Whether this occurs in vivo or if it does is maintained long enough to cause any tissue damage remains to be determined.

Comparison of two vertical condensation obturation techniques: Touch 'n Heat modified and System B

AIM

The aims of this study were firstly to compare the area of canal occupied by gutta-percha, sealer or voids using the System B heating device with that obtained by a modified vertical condensation technique using the Touch 'n Heat: and secondly to compare the temperature changes at the root canal wall and external root surface during obturation with the above techniques.

METHODOLOGY

Forty-five resin blocks, each with a standardized, simulated, prepared main root canal and five lateral canals, were assigned to three equal experimental groups. The canals were obturated using either the System B technique at two different temperature settings, or vertical condensation with a Touch 'n Heat instrument as the heat source. A heat transfer model was used to simultaneously record internal and external root surface temperature elevations during obturation by the three techniques. Data were analysed using unpaired Student's t-test and Mann-Whitney U-test.

RESULTS

Both obturation techniques produced root fillings consisting of over 90% gutta-percha at most levels, although the percentages of sealer and voids 2-3 mm from the working length following System B obturation were higher than those found following modified vertical condensation. Modified vertical condensation resulted in more gutta-percha in lateral canals. Obturation was accomplished more quickly using the System B, and temperature elevations produced during obturation with the System B were significantly less (P < 0.001) than with vertical condensation. An elevation of external root surface temperature by more than 10 degrees C occurred during vertical condensation.

CONCLUSIONS

The results suggest that the System B may produce an acceptable obturation and that the use of a Touch 'n Heat source during vertical condensation may result in damage to the periodontium.

A comparison of root surface temperatures using different obturation heat sources

This study compared root surface temperatures produced during warm vertical obturation using the System B Heat Source (SB), the Touch 'n Heat device (TH), and a flame-heated carrier (FH). The root canals of 30 maxillary incisor, premolar, and mandibular incisor teeth were prepared; divided into three groups; and obturated using each heat source. A thermocouple placed 2 mm below the cementoenamel junction transferred the temperature rise on the external root surface to a digital thermometer. SB surface temperature rise was < 10 degrees C for all experimental teeth. TH temperature rise in maxillary incisors and premolars was < 10 degrees C; however, > 10 degrees C was observed for mandibular incisors. FH produced a > 10 degrees C surface temperature rise in all experimental teeth. The critical level of root surface heat required to produce irreversible bone damage is believed to be > 10 degrees C. The findings of this study suggest that warm vertical condensation with the SB should not damage supporting periradicular tissues. However, caution should be used with TH and FH on mandibular incisors.

Warm vertical compaction sequences in relation to gutta-percha temperature

The aim of this study was to analyze warm vertical compaction sequences in relation to the temperature variations of gutta-percha. Twenty-four maxillary incisors were obturated according to two different instrumentation techniques: Compaction and heating were performed with either the monomanual classical or bimanual method. To evaluate gutta-percha temperature, thermocouples (TC) were introduced into channels bored through the dentin into the root canal system or fixed on the root surface at 8 (TC8), 4 (TC4), 2 (TC2), and 0 mm (TC0) from the apex. Maximal temperature was 118 degrees C for TC8, 52 degrees C for TC4, and 44 degrees C for TC2 and TC0. At TC0, the temperature remained above 42.9 degrees C for 10 +/- 5 s. These results show the importance of heating down to a distance of 7 mm to ensure a significant increase in apical gutta-percha temperature. They further indicate that the last compaction should last more than 15 s to avoid detrimental cooling and dimensional variations. The principal differences between the monomanual and bimanual methods were the compaction time (5.07 +/- 0.2 min vs 4.02 +/- 0.3 min) and the number of compactions (8 +/- 1 vs 12 +/- 2).

Thermographic assessment of root canal obturation using thermomechanical compaction

The temperature changes on the root surface of 30 extracted human premolar teeth during thermomechanical root canal obturation with gutta-percha were determined using an infrared thermal imaging camera. Three handpiece rotational speeds of 8, 12 and 16 x 10(3) r.p.m. were used, in conjunction with a Gutta Condensor. On completion of the procedure, the quality of tooth canal obturation was examined radiographically. Under the conditions of this experiment, surface root temperature rises of > 97 degrees C were recorded during all three speed settings. The radiographic quality of obturation between the groups appeared not to be significantly different. The clinical relevance of these findings is uncertain, but the temperatures reported are of a magnitude to be of biological importance.

Effect of power settings on temperature change at the root surface when using a Holmium YAG laser in enlarging the root canal

The aim of this study was to determine the maximum amount of power, in watts, that a Holmium YAG laser could deliver via a 245-micron fiberoptic to the canal surface and still not raise the temperature (delta T) of the cementum by > 5 degrees C. Sixty single-rooted teeth were divided into three groups according to power selection (0.50, 0.75, and 1.00 W). The three main outcome variables were: change in apical temperature, change in coronal temperature, and maximum size of an endodontic file that could fit into the canal after lasing. The group means for apical delta T were: 1.00 W = 2.2 degrees C, 0.75 W = 2.68 degrees C, and 0.50 W = 1.58 degrees C. The group means for coronal delta T were: 1.00 W = 1.15 degrees C, 0.75 W = 0.99 degree C, and 0.50 W = 0.56 degree C. The group means for file size were: 1.00 W = 41.25, 0.75 W = 38.75, and 0.50 W = 40.75. The canal size was increased from a size 25 file up to approximately a size 40 file with all power groups. There were no significant differences between the groups for change in apical temperature (p = 0.32), coronal temperature (p = 0.17), or maximum file size (p = 0.86) when adjustments were made for tooth dimensions. In all groups studied, the delta T was < 5 degrees C. This represents a safe and predictable laser procedure.

Permeability, morphologic and temperature changes of canal dentine walls induced by Nd: YAG, CO2 and argon lasers

The permeability, temperature and morphologic changes of the wall of the root canal induced by Nd:YAG, CO2 and argon lasers were studied. The changes were evaluated according to the presence or absence of a smear layer. Root canals of 140 human single-rooted teeth were enlarged using a step-back technique. Permeability was evaluated by the extent of methylene blue dye penetration into the tubules. Temperature changes were measured using a thermovision system, and morphological changes were evaluated by scanning electron microscopy. Laser energy was delivered into the canal by means of a flexible optical fibre or metal tip. There were statistically significant differences in permeability between lased groups with and without a smear layer in the cervical third of the root canal following lasing. In the middle third of the root canal, all three laser types induced permeability increases in groups with a smear layer. In the apical third, statistically significantly decreases in permeability were observed among CO2 laser and Nd:YAG compared with control group (P < 0.01). Rises in temperature ranged from a minimum of +10.1 degrees C (CO2 laser) to a maximum of +54.8 degrees C (argon laser). All three laser devices appeared capable of producing a glazed-like surface and craters.

Dentinal heat transmission induced by a laser-softened gutta-percha obturation technique

In this study, intracanal laser-softened gutta-percha, Ultrafil, and intracanal laser-cured composite resin techniques were compared with respect to the temperature elevation induced on the outer root surface. The temperature at the root surface of 50 single-rooted teeth was measured using a thermovision camera. Argon laser produced a rise in temperature of +12.9 degrees C (gutta-percha) and +13.3 degrees C (composite resin), respectively. The CO2 laser produced +10.3 degrees C and Nd:YAG laser produced the highest temperature elevation of +14.4 degrees C. Low-temperature gutta-percha obturation technique did not produce a measurable temperature change on the external root surfaces.

Comparison of concentric condensation technique with laterally condensed gutta-percha

Sixty mandibular premolars with large, straight canals and 60 nonjoining narrow, curved canals from mesial mandibular molar roots were obturated with gutta-percha via 1 of 3 methods: lateral condensation with sealer, or concentric condensation without sealer. The sealer used was a zinc oxide-eugenol without radiopacifiers. The premolar teeth were radiographed next to a step wedge, both before and after obturation. All teeth were exposed to India ink as a test for linear dye leakage, then cleared, and the leakage recorded. The pre- and postobturation radiographs were scanned at 2 and 6 mm from the apex using a Joyce-Loebel microdensitometer to establish the radiographic density of the obturation material, and a density ratio for the obturation was calculated using the cross-sectional diameter of the obturating material. The incidence of gutta-percha extrusion and Micro-Flow Compactor breakage was recorded. Two-way analysis of variance for linear dye leakage revealed no significant differences between the lateral and concentric condensation groups when sealer was used (p > 0.05). The concentric condensation without sealer groups exhibited significantly greater leakage (p < 0.00001) than the other groups, showing the importance of using sealers. One-way analysis of variance found no significant differences in radiographic density ratios between groups at 2 mm (p > 0.05) or 6 mm from the apex (p > 0.05). The incidence of extrusion was not significant, but a high rate of #30 condensor breakage was found.

In vitro radicular temperatures produced by injectable thermoplasticized gutta-percha

In vitro temperatures produced in the root canal and on the root surface were measured simultaneously as heated gutta-percha was injected into the prepared canal. The canals were obturated with the Obtura II heated gutta-percha system with temperature settings of 160, 185, and 200 degrees C. The mean intracanal temperatures ranged from 40.21 to 57.24 degrees C, whereas the mean root surface temperatures were recorded from 37.22 to 41.90 degrees C for all three temperatures tested. The rise in temperature on the root surface was below the critical level of 10 degrees C and should not cause damage to the periodontal ligament.

In vitro intracanal temperatures produced during warm lateral condensation of Gutta-percha

In vitro intracanal temperatures produced during the war lateral condensation of gutta-percha were measured using a computerized recording system that allowed repeated obturations of a root canal model. The obturations were performed using a Touch 'n Heat unit. Temperatures were recorded to an accuracy of a hundredth degree centigrade by 16 intracanal themocouples connected to the computerized measurement system. The highest intracanal temperature recorded was 114.51 degrees C at a power setting of 6, while the mean intracanal temperature increase above the average room temperature ranged from 8.18 to 65.05 degrees C. In addition, the spreader was not uniformly heated to the same temperature throughout its entire length. The hottest point on the spreader was located 5 mm from the tip.

A new model system for measuring intracanal temperatures

A new model system was developed which allows intracanal temperature measurements to be recorded during repeated obturations of a human tooth root canal. A human central incisor was embedded in clear orthodontic resin and sectioned longitudinally. Sixteen thermocouples were secured at 2-mm intervals along two surfaces of the root canal. The thermocouples were connected to a computerized temperature recording system to measure intracanal temperatures produced by high-temperature thermoplasticized injectable gutta-percha. The system was capable of recording 16 simultaneous temperatures every second with an accuracy of a hundredth degree centigrade. There was a linear increase in the recorded temperatures in the root canal. However, the actual temperatures were lower than expected.

In vivo findings associated with heat generation during thermomechanical compaction of gutta-percha. 2. Histological response to temperature elevation on the external surface of the root

An in vivo investigation is described and a histological evaluation made of the effect of canal obturation by thermomechanical compaction of gutta-percha and sealer on the cementum on the lateral surface of the root and adjacent periodontal membrane and alveolar bone of the ferret canine after time intervals of 24 hours, 20 days and 40 days. These tissue reactions were compared with those in the roots of control teeth filled by lateral condensation of cold gutta-percha and sealer. Iatrogenic damage was apparent in a minority of the experimental specimens 20 and 40 days after obturation.

In vivo findings associated with heat generation during thermomechanical compaction of gutta-percha. 1. Temperature levels at the external surface of the root

Temperature elevations of 10 degrees C above body temperature, of duration greater than 1 minute, may be sufficient to cause bone tissue injury. Temperature rises on the root surface in excess of 10 degrees C have been shown in studies in vitro of thermoplasticized gutta-percha root filling techniques. To determine whether results in vitro at room temperature could be extrapolated to conditions in vivo, temperature elevations were recorded at the mid-point on the root surface of the canine tooth in the ferret during thermomechanical compaction of gutta-percha. The time taken for the temperature to return to normal was also measured. There was no statistically significant difference between temperature elevations recorded in vitro and those measured in vivo. A linear extrapolation may therefore be made from results recorded at room temperature. Temperature elevations dissipated more rapidly in vivo than in vitro; this may be due to the cooling effect of the microvasculature of the periodontal membrane.

Temperature changes in thermoplasticized gutta-percha: a comparison of two ultrasonic units

With the use of an extracted human tooth as in vitro model, this study measured temperature changes in the surface of gutta-percha while it was being ultrasonically thermoplasticized. Two sources of ultrasonic oscillation were used: a Cavitron 2001 ultrasonic unit with a file in a PR-30 insert and an ENAC ultrasonic unit with a plugger or file. Temperature elevation in the apical third of the tooth was minimal with either instrument (1.66 degrees C to 3.74 degrees C). The temperature rise in the middle third was higher with the ENAC unit, although probably still within clinically acceptable limits (range, 6.35 degrees C to 19.10 degrees C). The time taken for each unit to thermoplasticize the gutta-percha and reach a predetermined distance in the experimental model was recorded and defined as instrument efficiency. The Cavitron unit that had the PR-30 insert with a No. 25 file required 0.48 sec/mm, whereas the ENAC unit with a No. 25 file required 10.83 sec/mm and the ENAC unit with a plugger required 8.38 sec/mm. It appears that the Cavitron unit with a PR-30 insert was more than 22 times as efficient as the ENAC unit for thermoplasticizing gutta-percha under the experimental conditions used in this study.

The heat generated on the external root surface during post space preparation

The heat generated on the external root surface of human premolar teeth during post space preparation was measured in vitro. The rise in temperature was recorded at a point 6 mm from the apex of the tooth using a thermocouple attached to a chart recorder. The temperature rise was greatest when the removal of gutta-percha was combined with post channel preparation. Temperature rises of up to 31 degrees C were recorded. Instruments that only removed gutta-percha did not generate the same amount of heat. The results from this study suggest that the use of engine-driven drills to prepare post channels in teeth may generate temperature rises that may cause periradicular tissue damage, and caution should be exercised during their use.