Calcium hydroxide dressings using different preparation and application modes: density and dissolution by simulated tissue pressure

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

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

Micro-computed tomography analysis of calcium hydroxide delivery efficacy in C-shaped canal system of mandibular second molars

BACKGROUND

Calcium hydroxide [Ca(OH)2] is widely accepted as a biocompatible interappointment intracanal medicament. This study aimed to analyze the efficacy of Ca(OH)2 placement into the C-shaped canal system of mandibular second molars using the syringe method with and without lentulo spiral utilizing micro-computed tomography (micro-CT).

METHODS

Twenty-four extracted mandibular second molars were instrumented and classified into C-shaped floors (n = 12) and non-C-shaped floors (n = 12). Both groups were placed with Ca(OH)2 using the syringe system, then all teeth were scanned and cleaned, and placed with Ca(OH)2 again but with the syringe system followed by lentulo spiral and rescanned. The specimens were scanned using micro-CT to analyze the volume, volume percentage, uncontacted surface area, and uncontacted surface area percentage of Ca(OH)2 with the two delivery methods in the entire canal and at the apical 4 mm of the canal. Mann-Whitney test and Wilcoxon signed-rank test were used to determine the statistical differences among the groups.

RESULTS

Syringe administration used in conjunction with lentulo spiral presented lower uncontacted surface area, a lower percentage of uncontacted surface area, larger volume, and a higher percentage of volume than syringe without lentulo spiral (P < 0.05). There was no significant difference between the C-shaped floor group and the non-C-shaped floor group (P > 0.05) in the Ca(OH)2 uncontacted surface area, volume, and percentages at different regions of canals and among different delivery techniques groups.

CONCLUSIONS

The lentulo spiral and syringe technique combination can increase the volume and contacted surface area of Ca(OH)2 in the C-shaped canal system of mandibular second molars.

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

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

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

Aim and objective

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

Materials and methods

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

Results

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

Conclusion

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

How to cite this article

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

The double-edged sword of calcium hydroxide in endodontics: Precautions and preventive strategies for extrusion injuries into neurovascular anatomy

BACKGROUND

Nowhere in the consideration of dental care involving endodontics does a patient become more vulnerable to potentially life-changing injuries than during a root canal procedure on the mandibular dentition that may invade and injure the neurovascular anatomy.

CASE DESCRIPTION

The authors present a series of 5 cases wherein using calcium hydroxide as a disinfection strategy in endodontics caused serious neurologic injury to the treated patients. The mechanism in all cases was the inappropriate use of needle applications resulting in significant overfill into the inferior alveolar nerve space. Although calcium hydroxide has been recognized and used as a meaningful disinfectant in endodontic therapy for many years, the dangers and risks associated with a needle delivery technique are discussed and analyzed with recommendations based on current research to minimize risk.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

A literature search revealed that the 5 cases are not solitary cases; indeed, consequences of calcium hydroxide overfills have been described before. Therefore, a clinician initiating root canal therapy on a mandibular posterior tooth should always be mindful of the vital neurovascular anatomy, which commonly approximates the ends of these roots. Preoperative cone-beam computed tomographic imaging and the thoughtful delivery of medicaments in treatment can help the clinician manage close proximity to neural anatomy and avoid potential injuries.

Comparative Evaluation of Three Obturating Techniques in Primary Molars: An in Vivo Study

Objectives: The purpose of this study was to evaluate and compare the quality of obturation between the two tested methods for root canal filling with a newer system in primary teeth. Study design: A total of 104 canals were prepared and obturated using zinc oxide eugenol paste. The three delivery systems compared were: Rotary lentulospiral and Navitip^® withNavitip^® Double Sideport. Radiographs were used to evaluate the canals for length of obturation and presence of voids. Results: The data were analyzed using chi-square tests. Significant differences was seen between the three groups for the presence of voids (p value =0.042) with less voids in Navitip^® Double Sideport. There were no difference between the three groups for the extent of filling (p value=0.170). Conclusion- Navitip^® Double Sideport showed the better results in terms of extent of obturation and absence of voids when compared to the Rotary lentulospiral and Navitip^®.

Evaluation of Root Canal Filling in Primary Teeth by Volumetric Analysis: In Vitro Study

Purpose

This study was conducted to evaluate the efficacy of various techniques to fill root canals of primary teeth by volumetric analysis using cone beam computed tomography (CBCT) to assess percentage of obturated volume (POV), percentage volume of voids (PVV), and depth-of-fill.

Methodology

Root canals in 40 extracted deciduous maxillary incisors were instrumented with H-files to size 35 and volume of the canal measured using CBCT under “On Demand 3D AppTM Software” (Cybermed Inc. Medical 3D imaging software). The teeth were divided into four groups of 10 samples each and root filled by Lentulo spiral mounted on slow-speed hand-piece, NaviTip System, Bi-directional spiral and Combination method i.e. Lentulo spiral mounted on slow speed hand-piece followed by NaviTip syringe respectively, after that depth-of-fill for each group was checked. Then, the filled canal volume was measured using CBCT under “On Demand 3D AppTM Software”. Further, the (POV), (PVV) was calculated.

Statistical analysis

The data were statistically analysed using one-way ANOVA, Turkey post Hoc test and Pearson’s Chi-square test.

Clinical significance

Adequate adaptation of root canal filling material decreases the chance of microorganism regrowth, reinfection due to voids creation and minimizes the potential drawback of overfilling like foreign body reaction or deflection of the unerupted permanent tooth.

Results

The four groups were comparable in canal volume. The overall percentage of obturated volume was 53%, 59.7%, 40.3% and 75.1%; the overall percentage volume of voids was 48%, 40.3%, 58.6%, 29.5%; optimally filled canals for each group was 80%, 60%, 30% and 90% respectively (p < 0.05).

Conclusion

The greatest percentage of obturated volume and maximum number of optimally filled canals was obtained in method combining both Lentulo spiral in slow speed hand piece along with NaviTip system. Whereas, voids were the constant finding with all root fillings.

How to cite this article: Sijeria P, Bhartia R, Swamy KVN, Kulkarni S, Singla S. Evaluation of Root Canal Filling in Primary Teeth by Volumetric Analysis: In Vitro Study. Int J Clin Pediatr Dent, 2018;11(5):386-392.

Comparative evaluation of three obturation techniques in primary incisors using digital intra-oral receptor and C.B.C.T-an in vitro study

OBJECTIVES

Successful pulpectomy in primary teeth depends on quality of obturation. It can be evaluated using digital intra-oral receptor (D.I.O.R) and cone beam computed tomography (C.B.C.T). The purposes of this study were to compare 3 different obturation techniques such as lentulospiral, insulin syringe, and endodontic plugger in primary incisors and to evaluate its quality of obturation using D.I.O.R and C.B.C.T technique.

MATERIALS AND METHODS

Thirty-three extracted primary incisors were biomechanically prepared and obturated with zinc oxide eugenol cement by 3 different obturation techniques. The obturation was evaluated for length of obturation and voids using D.I.O.R and C.B.C.T methods.

RESULTS

There was a statistically significant difference between all the groups in length of obturation (P = 0.02) in both D.I.O.R and C.B.C.T. Significant differences (P = 0.03) were present in number of voids among 3 obturation techniques in C.B.C.T. Statistically more voids were observed with D.I.O.R in lentulospiral (P = 0.04) group and in insulin syringe (P = 0.02) group.

CONCLUSIONS

Acceptable result was obtained with lentulospiral in length of obturation compared to insulin syringe and endodontic plugger technique. Insulin syringe technique resulted in increased underfilling with least number of voids. More number of voids were seen in middle one-third and least number of voids were observed at apical one third of the root among all the 3 techniques of obturation. The study concluded that void identification is improved with D.I.O.R compared to C.B.C.T.

CLINICAL RELEVANCE

Lentulospiral reported effective length of obturation, while insulin syringe with least number of voids. D.I.O.R (2-Dimensional) is efficient in detecting voids compared to C.B.C.T (3-Dimensional) in obturated primary teeth.

Primary Molar Pulpectomy Using Two Different Obturation Techniques: A Clinical Study

CONTEXT

A major goal in pediatric dentistry is preservation of the integrity of primary teeth and their supporting tissues until physiological process of exfoliation takes place. Pulpectomy serves such a purpose using various materials and techniques to fill the canals of primary teeth. Aims: The aim of this in vivo study was to determine the efficacy of modified disposable syringe technique in root canals of primary molars using digital radiography when obturated with endoflas.

SETTINGS AND DESIGN

A clinical study was undertaken for a period of 6 months.

SUBJECTS AND METHODS

A total of 60 primary maxillary and mandibular molars were selected in the age group of 4-8 years and randomly divided into two groups. The teeth were obturated with handheld lentulospiral and a modified disposable syringe techniques. Postoperative radiographic evaluation was done for quality of fill and voids using digital radiography. Statistical Analysis Used: Results were assessed using Chi-square test and Mann-Whitney U-test. Results: No statistically significant difference between quality of obturation using hand-held lentulospiral and modified disposable syringe (P < 0.05) was observed. Optimal obturation was achieved in both techniques; however, voids in obturation were not significant.

CONCLUSIONS

Both the hand-held lentulospiral and modified disposable syringe technique are effective in the obturation of primary molar root canals in terms of quality of fill.

Antimicrobial Activity and Physicochemical Properties of Calcium Hydroxide Pastes Used as Intracanal Medication

INTRODUCTION

The aim of the present study was to evaluate the pH, calcium release, solubility, and antimicrobial action against biofilms of calcium hydroxide + saline solution, Calen (SS White Artigos Dentários Ltd, Rio de Janeiro, Brazil) (CH/P), Calen camphorated paramonochlorophenol (CMCP) (CH/CMPC), and calcium hydroxide + chlorhexidine (CH/CHX) pastes.

METHODS

The pH of the pastes was determined with a calibrated pH meter placed in direct contact with each paste. The root canals of acrylic teeth (N = 10) were filled with the previously mentioned intracanal dressings and immersed in ultrapure water to measure hydroxyl (pH meter) and calcium ion release (atomic absorption spectrophotometer) at time intervals of 3, 7, 15, and 30 days. To assess solubility, the root canals of acrylic teeth (N = 10) were filled with the previously mentioned pastes and scanned by micro-computed tomographic imaging before (initial) and after 7, 15, and 30 days of immersion in ultrapure water. The solubility of each specimen was the difference between the initial and final volume scanning. For antimicrobial analysis, monospecies and dual-species biofilms were in vitro induced on dentin blocks (N = 20). Afterward, they were treated with the pastes for 7 days. Live/dead dye and a confocal microscope were used to measure the percentage of living cells. Data were statistically compared (P < .05).

RESULTS

The highest OH^- ion release values were found in 3 and 30 days. Ca²⁺ releases were greater in CH/CMCP. CH/P and CH/CMCP showed a higher percentage of volume loss values. CH/CHX presented the greatest antimicrobial action.

CONCLUSIONS

CH/P and CH/CMPC showed higher solubility values in the period analyzed. Seven days of contact may be insufficient for calcium hydroxide + saline solution, CH/P, and CH/CMCP pastes to kill bacterial cells in the biofilms studied. Chlorhexidine added to CH favored greater effectiveness against the previously mentioned bacterial biofilms.

Comparative evaluation of endodontic pressure syringe, insulin syringe, jiffy tube, and local anesthetic syringe in obturation of primary teeth: An in vitro study

PURPOSE

The purpose of this in vitro study was to compare four methods of root canal obturation in primary teeth using conventional radiography.

MATERIALS AND METHODS

A total of 96 root canals of primary molars were prepared and obturated with zinc oxide eugenol. Obturation methods compared were endodontic pressure syringe, insulin syringe, jiffy tube, and local anesthetic syringe. The root canal obturations were evaluated by conventional radiography for the length of obturation and presence of voids. The obtained data were analyzed using Chi-square test.

RESULTS

The results showed significant differences between the four groups for the length of obturation (P < 0.05). The endodontic pressure syringe showed the best results (98.5% optimal fillings) and jiffy tube showed the poor results (37.5% optimal fillings) for the length of obturation. The insulin syringe (79.2% optimal fillings) and local anesthetic syringe (66.7% optimal fillings) showed acceptable results for the length of root canal obturation. However, minor voids were present in all the four techniques used.

CONCLUSIONS

Endodontic pressure syringe produced the best results in terms of length of obturation and controlling paste extrusion from the apical foramen. However, insulin syringe and local anesthetic syringe can be used as effective alternative methods.

Intracanal placement of calcium hydroxide: a comparison of specially designed paste carrier technique with other techniques

Background

This study compared the effectiveness of a Specially Designed Paste Carrier technique with the Syringe-Spreader technique and the Syringe-Lentulo spiral technique in the intracanal placement of calcium hydroxide.

Methods

Three groups, each containing 15 single-rooted human anterior teeth were prepared using standardized Mtwo rotary instruments to a master apical file size 40 with 0.04 taper. Each group was filled with calcium hydroxide paste using: Syringe and #25 finger spreader (Group 1); Syringe and #4 rotary Lentulo spiral (Group 2), Specially Designed Paste Carrier (Group 3). Using pre-filling and post-filling radiographs in buccolingual and mesiodistal planes, the radiodensities at 1 mm, 3 mm, 5 mm, and 7 mm from the apical foramen were analyzed by ANOVA and Bonferroni post hoc tests.

Results

Overall, The Specially Designed Paste Carrier technique showed a statistically significantly higher mean radiodensity than the two other compared techniques. No significant difference was detected between the Syringe-Lentulo spiral and the Syringe-Spreader techniques.

Conclusion

The Specially Designed Paste Carrier technique was more effective than the Syringe-Spreader technique and the Syringe-Lentulo spiral technique in the intracanal placement of calcium hydroxide.

Definition and endodontic treatment of dilacerated canals: a survey of Diplomates of the American Board of Endodontics

AIM

To gather data from Diplomates of the American Board of Endodontics regarding treatment of dilacerated canals.

MATERIALS AND METHODS

A questionnaire addressing definition, endodontic treatment procedures and prognosis was constructed and distributed via e-mail to 708 Diplomates of the American Board of Endodontics. Data from 150 respondents, a 21% response rate, were collected by using a Web-based interface. For statistical analysis, Chi-square tests were used.

RESULTS

More than 25% of respondents believed that a dilacerated root should have a curvature > 40°. One-visit treatment is the best therapeutic approach and transportation is the most likely complication in preparation of these canals. A crown-down technique, watch-winding motion and a master apical file # 25 are the best choices for preparation of these canals. Any warm obturation technique is preferred over lateral compaction by most respondents.

CONCLUSION

A crown-down technique for root canal preparation and a thermoplastic obturation technique are recommended for canals whose curvature is more than 40°. The prognosis of the treatment of these canals is judged not lower than normal canals.

CLINICAL SIGNIFICANCE

Crown-down technique and thermoplastic obturation are recommended for dilacerated canals.

Fine-tuning of bioactive glass for root canal disinfection

An ideal preparation of 45S5 bioactive glass suspensions/slurries for root canal disinfection should combine high pH induction with capacity for continuing release of alkaline species. The hypothesis of this study was that more material per volume of bioactive glass slurry is obtained with a micrometric material (< 5 microm particle size) or a micrometric/ nanometric hybrid, rather than a solely nanometric counterpart. This should correlate with alkaline capacity and antimicrobial effectiveness. Slurries at the plastic limit were prepared with test and reference materials in physiological saline. Total mass and specific surface area of glass material per volume were determined. Continuous titration with hydrochloric acid was performed, and antimicrobial effectiveness was tested in extracted human premolars mono-infected with E. faecalis ATTC 29212 (N = 12 per material). While the nanometric slurry had a 12-fold higher specific surface area than the micrometric counterpart, the latter had a considerably higher alkaline capacity and disinfected significantly better (Fisher's exact test, P < 0.05). The hybrid slurry behaved similarly to the micrometric preparation.

Stimulatory Effects of Hydroxyl Radical Generation by Ga-Al-As Laser Irradiation on Mineralization Ability of Human Dental Pulp Cells

The present study was conducted to investigate the effects of Ga-Al-As laser irradiation on the mineralization ability of human dental pulp (HDP) cells. HDP cells in vitro were irradiated once with a Ga-AL-As laser at 0.5 W for 500 s and at 1.0 W for 500 s in order to investigate free radicals as one mechanism for transmission of laser photochemical energy to cells. Production of the hydroxyl radical (*OH) was measured using the ESR spin-trapping method and was found to be increased by laser irradiation. The DMPO-OH was not detected in the presence of dimethyl sulfoxide (DMSO), a *OH scavenger. The formation of calcification nodule was also investigated by von Kossa staining. The number of calcified nodules was increased by 1.0 W-laser irradiation. Alkaline phosphatase (ALP) activity was higher in the 1.0 W-laser irradiation group. Expression of mRNAs for heat shock protein 27, bone morphogenetic proteins (BMPs) and ALP were greater in the 1.0 W-laser irradiation group. Expression of BMPs in the conditioned medium was also higher in the 1.0 W-laser irradiation group. In particular, DMSO decreased the number of calcified nodule produced by 1.0 W-laser irradiation. These results supposed that the mineralization of HDP cells is stimulated by laser irradiation, and that *OH generated by laser irradiation is a trigger for promotion of HDP cell mineralization.

A comparative study on the disinfection potentials of bioactive glass S53P4 and calcium hydroxide in contra-lateral human premolars ex vivo

AIM

To evaluate the effects of bioactive glass S53P4 versus calcium hydroxide when used as dressings in contra-lateral human premolars infected with Enterococcus faecalis ATCC 29212.

METHODOLOGY

Pairs of contra-lateral premolar teeth plus single control premolars were obtained from 23 individuals aged 10-26 years undergoing orthodontic treatment. Root canals of teeth with fully formed apices (nine contra-lateral pairs, seven controls) were instrumented using a size 60 FlexoFiles 2 mm short of canal length. Canals with open apices (six contra-lateral pairs, four controls) were circumferentially instrumented using a FlexoFile. Root canals were rinsed with 1% sodium hypochlorite and 10% citric acid. Teeth were then suspended in tryptic soy broth (TSB) and autoclaved. Positive controls and study teeth were infected with E. faecalis ATCC 29212 for 2 weeks in TSB, while negative controls were kept in sterile TSB. Subsequently, contra-lateral premolars were dressed with bioactive glass S53P4 (BAG) or calcium hydroxide suspensions for 10 days. Dentine samples were obtained from teeth with fully formed apices using ISO-size 70, 80 and 90 FlexoFiles to working length and cultured. Teeth with open apices were fixed, fractured and examined using scanning electron microscopy (SEM).

RESULTS

Calcium hydroxide had a strong antibacterial effect and was significantly more effective than BAG in preventing residual bacterial growth (P < 0.01). SEM analysis revealed apparent substance-specific modes of action.

CONCLUSIONS

Calcium hydroxide was an effective disinfectant in human teeth.