1
|
Pujari MD, Das M, Das A, Kamath DG, Henry J, Shyam A, Alhaleis DM. Assessment of Smear Layer Removal and Penetration Depth of Root Canal Irrigant Using Different Irrigation Activation Systems: A Comparative Study. J Contemp Dent Pract 2024; 25:331-334. [PMID: 38956847 DOI: 10.5005/jp-journals-10024-3626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
AIM The aim of the current study was to evaluate the penetration depth and smear layer removal of root canal irrigant using various irrigation activation techniques. MATERIALS AND METHODS In this investigation, sixty single-rooted premolars extracted for orthodontic purposes were chosen. Diamond burs were used to create an access cavity, and #10 K-file was used to determine the patency. About sixty samples were divided into the following three groups (20 samples in each group), group I: Irrigation with conventional needle, group II: Activation of EndoVac system, group III: Passive ultrasonic irrigation (PUI). The efficacy of the smear layer was assessed using a scanning electron microscopy at a ×2000 magnification. One-way ANOVA was used to record and analyze the data. All statistical analyses were performed with a significance level of p < 0.05. RESULTS At coronal third, the maximum smear layer was removed in group II (1.26 ± 0.02) followed by group III (1.84 ± 0.16) and group I (2.89 ± 0.21). At middle third, smear layer removal was maximum in group I (1.18 ± 0.10) followed by group III (1.72 ± 0.09) and group I (2.66 ± 0.18). At apical third, the more smear layer was removed in group II (1.02 ± 0.01) followed by group III (1.58 ± 0.08) and group I (2.38 ± 0.06). There was a highly significant difference found between the three different irrigation systems at all three levels (p < 0.001). CONCLUSION In conclusion, every irrigation device that was evaluated was successful in removing the smear layer from the root canal. However, the EndoVac system group removed a greater amount of smear layer compared with PUI and conventional needle group. CLINICAL SIGNIFICANCE With the goal of promoting cleaning that is beyond the ability of mechanical devices, irrigation is a crucial part of root canal therapy. If an efficient irrigation delivery system is used, the irrigants can reach the working length (WL). This type of distribution system needs to provide a suitable amount of irrigants up to the WL, as well as have enough flow and be effective at debriding the entire canal system. How to cite this article: Pujari MD, Das M, Das A, et al. Assessment of Smear Layer Removal and Penetration Depth of Root Canal Irrigant Using Different Irrigation Activation Systems: A Comparative Study. J Contemp Dent Pract 2024;25(4):331-334.
Collapse
Affiliation(s)
- Mohan D Pujari
- Department of Conservative Dentistry and Endodontics, Aditya Dental College, Beed (MUHS Nashik), Maharashtra, India, Phone: +91 8149238157, e-mail:
| | - Maneesha Das
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha 'O' Anusandhan University, Bhubaneswar, Odisha, India
| | - Asutosh Das
- Department of Oral and Maxillofacial Surgery, Kalinga Institute of Dental Sciences, KIIT Deemed to be University, Bhubaneswar, Odisha, India
| | - Dinesh G Kamath
- Department of Conservative Dentistry and Endodontics, Indira Gandhi Institute of Dental Sciences, Kothamangalam, Ernakulam, Kerala, India
| | - Junu Henry
- Department of Prosthodontics, Al-azhar Dental College, Thodupuzha, Kerala, India
| | - Arun Shyam
- Department of Conservative Dentistry and Endodontics, Mahe Institute of Dental Sciences & Hospital, Chalakkara, U.T. of Puducherry, India
| | - Doaa M Alhaleis
- Department of Operative and Restorative Dentistry, Dentistry Program, Batterjee Medical College, Jeddah, Saudi Arabia
| |
Collapse
|
2
|
Chan CW, Romeo VR, Lee A, Zhang C, Neelakantan P, Pedullà E. Accumulated Hard Tissue Debris and Root Canal Shaping Profiles Following Instrumentation with Gentlefile, One Curve, and Reciproc Blue. J Endod 2023; 49:1344-1351. [PMID: 37516238 DOI: 10.1016/j.joen.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 07/31/2023]
Abstract
INTRODUCTION This laboratory study aimed to evaluate the accumulated hard tissue debris (AHTD) and shaping performance following root canal instrumentation with a novel stainless steel rotary system (Gentlefile; MedicNRG, Kibbutz Afikim, Israel) compared with two single-file nickel-titanium instruments of different kinematics through micro-computed tomography (micro-CT) analysis. METHODS Thirty isthmus-containing mesial roots of human mandibular molars with a curvature of 15°-35° were scanned with micro-CT at an isotropic resolution of 12 μm and randomly assigned to three groups (n = 10) according to the instruments used for canal preparation: Gentlefile (GF; #23/.04), One Curve (OC; #25/.06; Micro-Mega, Besancon, France), and Reciproc Blue R25 (RB; #25/.08; VDW, Munich, Germany). The AHTD, unprepared canal surface area, volume changes, surface area changes, and transportation were evaluated by comparing preoperative and postoperative micro-CT images. In addition, the time required for canal preparation was recorded. Data were statistically analyzed using the one-way analysis of variance (ANOVA) test or the Kruskal-Wallis test at a significance level of 5%. RESULTS No significant differences were observed in the percentage of AHTD or in the unprepared canal surface area between the three groups (P > .05). The RB group demonstrated a significantly greater percentage increase in volume and surface area than the GF group (P < .05). The GF and OC groups showed significantly less transportation at 3 mm from the apex than the RB group (P < .001). The OC group required significantly less time for instrumentation than the RB and GF groups (P < .05). CONCLUSIONS Instrumentation with GF (#23/.04), OC, and RB yielded similar levels of AHTD and unprepared surface area in isthmus-containing curved canals. GF achieved this with less dentin removal and apical transportation, at the expense of a longer preparation time.
Collapse
Affiliation(s)
- Chi Wai Chan
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Virginia Rosy Romeo
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Angeline Lee
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Chengfei Zhang
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.
| | - Prasanna Neelakantan
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China; Department of Endodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, CA.
| | - Eugenio Pedullà
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| |
Collapse
|
3
|
Wigler R, Herteanu M, Wilchfort Y, Kfir A. Efficacy of Different Irrigant Activation Systems on Debris and Smear Layer Removal: A Scanning Electron Microscopy Evaluation. Int J Dent 2023; 2023:9933524. [PMID: 37771362 PMCID: PMC10533223 DOI: 10.1155/2023/9933524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 08/19/2023] [Accepted: 09/02/2023] [Indexed: 09/30/2023] Open
Abstract
Background Irrigation is an essential component of root canal treatment to enable cleaning beyond the reach of mechanical instruments. The study aimed to assess and compare the efficacy of different final irrigation protocols, including sonic- and ultrasonic-powered irrigant-activation systems, on debris and smear layer removal in the coronal, middle, and apical thirds of straight oval root canals. Materials and Methods Straight oval root canals of 60 human mandibular incisors were prepared to size 40.04 and divided into four groups (n = 15) according to the final irrigation protocols: (a) Eddy sonic activation (b) endosonic passive ultrasonic irrigation (PUI), (c) irrisafe PUI, and (d) manual syringe and needle irrigation with no additional activation, which served as control. After the treatment procedures, the roots were split and observed using scanning electron microscopy. The presence of remaining debris and smear layer at the coronal, mid-root, and apical thirds of the canals were evaluated using a score system and statistically analyzed using multinominal models with significance level set at p < 0.05. Results None of the final irrigation protocols completely removed all debris and smear layer from all root canals. When the syringe and needle were used without activation, more debris and smear layer were found in the apical third of the canals. Activation of the final irrigant with each of the three devices significantly reduced the presence of debris in the apical third, compared to the syringe and needle final irrigation, with no difference among the three activation devices. Eddy and irrisafe activation also significantly reduced the residual smear layer in the apical third, compared to syringe and needle alone, while the reduction in the remaining smear layer by endosonic activation did not reach the significance level. Conclusions Removal of debris and smear layer from the apical part of the root canal by syringe and needle irrigation alone may be significantly improved by using sonic or ultrasonic activation of the final irrigant. Endosonic activation was less effective in removal of smear layer from the apical part of the canals compared to the other two activation systems.
Collapse
Affiliation(s)
- Ronald Wigler
- Department of Endodontology, The Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moran Herteanu
- The Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yuval Wilchfort
- The Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anda Kfir
- Department of Endodontology, The Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
4
|
Rödig T, Westbomke V, Haupt F, Münster M, Baxter S. Effect of preparation size on the removal of accumulated hard-tissue debris from the mesial root canal system of mandibular molars using SWEEPS technology. Clin Oral Investig 2023; 27:2787-2796. [PMID: 36642725 PMCID: PMC10264281 DOI: 10.1007/s00784-023-04862-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 01/06/2023] [Indexed: 01/17/2023]
Abstract
OBJECTIVES This study assessed the influence of preparation size on the efficacy of shock wave-enhanced emission photoacoustic streaming (SWEEPS) and conventional irrigation (CI) on removal of accumulated hard tissue debris (AHTD) from isthmus-containing mandibular molars using micro-computed tomographic analysis. MATERIALS AND METHODS Sixty extracted mandibular molars with two mesial canals connected by an isthmus were selected. Canals were shaped with Mtwo instruments (VDW, Munich, Germany) up to sizes 25/.06, 40/.04 or 40/.06 (n = 20), and specimens were distributed into 2 final irrigation groups (n = 10): SWEEPS and CI. Roots were scanned at a resolution of 10.5 µm before and after preparation and final irrigation. Data sets were co-registered, and the percentage reduction of AHTD calculated for each specimen was statistically compared using analysis of variance with a of 5% significance level. RESULTS The preparation size did not significantly influence the percentage reduction of AHTD (p < 0.05), whereas the final irrigation technique had a significant effect on debris removal (p < 0.05). A significant reduction of AHTD was achieved after final irrigation in all groups (p < 0.05); however, SWEEPS was associated with a significantly greater percentage reduction of debris than CI (p < 0.05). None of the specimens presented a completely clean isthmus. CONCLUSIONS Removal of AHTD was not significantly affected by the preparation size. SWEEPS was associated with significantly less debris than CI. CLINICAL RELEVANCE SWEEPS performed significantly better than CI regarding the removal of AHTD from isthmus-containing mandibular molars irrespective of the preparation size.
Collapse
Affiliation(s)
- Tina Rödig
- Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
| | - Valerie Westbomke
- Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Franziska Haupt
- Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Marc Münster
- Endopur, Clinic for Endodontology, Frankfurt, Germany
| | - Steffi Baxter
- Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| |
Collapse
|
5
|
Evaluation of the band-shaped isthmuses in the mesiobuccal root canal system using micro-computed tomography. Clin Oral Investig 2022; 26:5909-5914. [PMID: 35578113 DOI: 10.1007/s00784-022-04548-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 05/08/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES This micro-computed tomography (micro-CT) study analyzed band-shaped isthmuses having their floor at the apical third of the mesiobuccal roots of maxillary molars in terms of 2D and 3D morphological parameters. MATERIALS AND METHODS A total of 199 maxillary first molars were scanned with micro-CT. Twenty-seven specimens, confirmed to have a band-shaped isthmus, were further examined in terms of the isthmus length, volume, structure model index (SMI), and surface area. The distance of apical foramina of mesial canals from the isthmus floor and major-minor diameters, roundness, perimeter, and area of the isthmus roof and floor were compared. Statistical analyses were performed with descriptive statistics and t-test with a 5% significance threshold. RESULTS The band-shaped isthmus frequency was 13.5% and its length reached up to 5.5 mm. The distances of the apical foramina of mesiobuccal canals (MB1 and MB2) from the isthmus floor were similar (p > .05). Isthmus roof and floor showed significant differences in terms of their major diameter and area (p < .05), whereas their minor diameter, roundness, and perimeter values were similar (p > .05). CONCLUSION The band-shaped isthmuses are not rare and can reach through the half of the root length with oval cross-sections in the floor and roof anatomy. The distance between the isthmus floor and apical foramina did not differ between MB1 and MB2. CLINICAL RELEVANCE The band-shaped isthmus morphology contributes to the complexity of the apical anatomy of maxillary first molar teeth with various lengths and diameters.
Collapse
|
6
|
Al-rujaib BA, Zaghloul MH, Reda A, Badr AE. Efficacy of Different Endodontic Irrigant Activation Systems on Smear Layer Removal and Canal Cleanliness: Comparative Scanning Electron Microscopic Study. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM: This study assessed the effectiveness of 5 different irrigant activation systems on canal cleanliness and removal of smear layer from root canals.
METHODS: A total of 110 mandibular premolars with straight root canal were assigned to five groups (n = 20): conventional needle irrigation, passive ultrasonic activation, sonic activation with EndoActivator, negative apical pressure EndoVac (EV), or EDDY system, besides a control group (n = 10). All teeth were prepared to size 40, and irrigated with NaOCl (5.25%) according to the respective technique. Roots were split longitudinally and subjected to scanning electron microscopic analysis. The presence of smear layer and debris was evaluated using 5-grade scoring systems with ×1000 and ×400 magnification, respectively. Data were analyzed at 5%.
RESULTS: Regarding the smear layer, activation with EV and ED was significantly more effective than other activation groups (p < 0.05). Activation of the irrigant significantly improved removal of debris (p < 0.05).
CONCLUSION: No activation technique was able to eliminate smear layer and debris completely from root canals, nevertheless, EDDY is significantly better in removing debris and smear layer from the apical third of the canal.
Collapse
|
7
|
Removal of Accumulated Hard Tissue Debris (AHTD) from Root Canals with an Electric Current Device: A MicroCT Preliminary Report. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12041969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In modern endodontics, removal of accumulated hard tissue debris (AHTD) from root canals is requested. In the last decade, different irrigating solutions and activation methods have been successfully tested. Sonic activation has been shown to be effective in the removal of AHTD. Electric current has been tested before in restorative dentistry, but not in endodontics. An experimental electric current delivering device was compared in the removal of AHTD, using microCT analyses. Fifteen single-rooted teeth were shaped with TruNatomy system endodontic files and divided into three groups: negative control group: specimens underwent no activation; EA group: specimens were activated with EndoActivator (EA); EB group: specimens were activated with ElectroBond (EB). The 2D images, 3D images and morphometric analysis from the microCT showed a statistically significant increased AHTD removal when EB was used. Results of the present preliminary study showed that the irrigant activation with ElectroBond is encouraging when compared to EndoActivator along the entire root canal system. The AHTD was significantly statistically reduced, validating the clinical use of electric fields in endodontics.
Collapse
|
8
|
Biocompatibility and Antibacterial Action of Salvadora persica Extract as Intracanal Medication (In Vitro and Ex Vivo Experiment). MATERIALS 2022; 15:ma15041373. [PMID: 35207914 PMCID: PMC8878108 DOI: 10.3390/ma15041373] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/28/2022] [Accepted: 02/08/2022] [Indexed: 02/01/2023]
Abstract
This study aimed to test the biocompatibility and antibacterial properties of Salvadora persica (S. persica) extract, a natural product, as an intracanal medication in comparison with calcium hydroxide (Metapaste, META BIOMED, Cheongju, Korea). The pH values of both materials were tested. The biocompatibility of S. persica extract and Metapaste was determined using light microscopy and MTT assays. The antibacterial action was tested using the zone of bacterial inhibition on four common bacterial species. In addition, intracanal medication was administered using 68 extracted single-rooted teeth contaminated with Enterococcus faecalis (E. faecalis), and the percentage reduction in colony count (% RCC) at 1, 3, and 7 days was measured. The extension of activity for both materials was assessed using histological sections and scanning electron microscopy. S. persica was found to be acidic in nature. Both materials showed significantly lower cell viability than the positive control cells on days 1 and 3 but not on day 7. S. persica showed better antibacterial effects against E. faecalis and S. mutans. S. persica extract showed 97.6%, 98.9%, and 99.3% RCC values at 1, 3, and 7 days, respectively, which are comparable to those of Metapaste. S. persica herbal extract is a promising material that can be utilized as an intracanal medication, but its use requires further research.
Collapse
|
9
|
Pawar AM, Kfir A, Metzger Z, Bhardwaj A, Yohana Y, Wahjuningrun DA, Luke AM, Pawar BA. Can Type of Instrumentation and Activation of the Final Irrigant Improve the Obturation Quality in Oval Root Canals? A Push-Out Bond Strength Study. BIOLOGY 2022; 11:biology11010059. [PMID: 35053055 PMCID: PMC8773160 DOI: 10.3390/biology11010059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 12/21/2021] [Accepted: 12/21/2021] [Indexed: 11/25/2022]
Abstract
Simple Summary The complete instrumentation of oval root canals remains practically unattainable. The majority of studies show that shaping oval, flat, and irregularly shaped canals is challenging, with more than half of the root canal area remaining unaltered. Furthermore, both rotary and reciprocating files compact hard tissue debris into the isthmus areas and buccal and/or lingual recesses of oval canals, impairing debridement and filling. In addition, one of the most essential variables in assessing the success of endodontic therapy is the adhesion of root canal filling material to dentin. Abstract To appraise the outcome of file systems and activation of the final irrigant on the push-out bond strength of root fillings in oval canals. Single-rooted mandibular premolars (n = 180) with oval canals were divided into three groups (n = 60) for instrumentation: ProTaper Next (PTN), WaveOne (WO), and Self-adjusting File (SAF). The specimens were further divided into subgroups (n = 20) and subjected to final irrigation with activation by EndoActivator or passive ultrasonic irrigation or without activation. Then, the specimens were again subdivided (n = 10) and obturated with gutta-percha and AH Plus (GP-AH) or C-Point with EndoSequence bioceramic sealer (C-EBC). One-millimeter-thick horizontal slices were cut from the apical third of the root, 5 mm from the apex, and subjected to push-out bond strength (BS) testing. Specimens for which SAF was used exhibited higher BS values than those for which PTN or WO was used (p < 0.05). Activation of the final irrigation did not affect the BS of the root fillings. Root fillings made of C-EBC presented a higher BS than those made of GP-AH (p < 0.05). Adhesive failure was more common with specimens instrumented using PTN and WO. Root canals instrumented with SAF, showed the highest bond strength values for both root filling materials. The C-EBC produced significantly higher bond strength values than those of the GP-AH.
Collapse
Affiliation(s)
- Ajinkya M. Pawar
- Department of Conservative Dentistry and Enododntics, Nair Hospital Dental College, Mumbai 400008, India
- Correspondence: (A.M.P.); (D.A.W.); (A.M.L.)
| | - Anda Kfir
- Department of Endodontology, The Goldschleger School of Dental Medicine, Tel Aviv 69978, Israel; (A.K.); (Z.M.)
| | - Zvi Metzger
- Department of Endodontology, The Goldschleger School of Dental Medicine, Tel Aviv 69978, Israel; (A.K.); (Z.M.)
| | - Anuj Bhardwaj
- Department of Conservative Dentistry and Endodontics, College of Dental Sciences & Hospital, Indore 453331, India;
| | - Yeyen Yohana
- Department of Conservative Dentistry, Faculty of Dental Medicine, Universitas Airlingga, Surabaya 60132, East Java, Indonesia;
| | - Dian Agustin Wahjuningrun
- Department of Conservative Dentistry, Faculty of Dental Medicine, Universitas Airlingga, Surabaya 60132, East Java, Indonesia;
- Correspondence: (A.M.P.); (D.A.W.); (A.M.L.)
| | - Alexander Maniangat Luke
- Department of Clinical Science, College of Dentistry, Ajman University, Al-Jurf, Ajman 346, United Arab Emirates
- Center of Medical and Bio-allied Health Sciences Research, Ajman University, Al-Jurf, Ajman 346, United Arab Emirates
- Correspondence: (A.M.P.); (D.A.W.); (A.M.L.)
| | - Bhaggyashri A. Pawar
- Division of District Early Intervention Centre, Department of Dentistry, Thane Civil Hospital, Thane 400601, India;
| |
Collapse
|
10
|
Barbosa AFA, Lima COD, Sassone LM, Fares RD, Fidalgo TKDS, Silva EJNL. Effect of passive ultrasonic irrigation on hard tissue debris removal: a systematic review and meta-analysis. Braz Oral Res 2021; 35:e123. [PMID: 34878078 DOI: 10.1590/1807-3107bor-2021.vol35.0123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 03/15/2021] [Indexed: 12/22/2022] Open
Abstract
Accumulated hard tissue debris (AHTD) in root canal irregularities may negatively impact adequate root canal disinfection. In light of this, the efficacy of passive ultrasonic irrigation (PUI) to reduce AHTD has been largely studied in in vitro studies, which have adopted different analytic methods of varying accuracy to determine the extent of AHTD more correctly. Therefore, the aim of this study was to compare how well PUI and non-activated irrigation (NAI) systems perform in reducing AHTD during final irrigation protocols, based exclusively on studies whose analyses used microCT scanning. A systematic search of the studies published up to April 2020 was performed using MeSH terms and free terms, in the following databases: PubMed, Scopus, Web of Science, BVS (Lilacs and BBO) and Embase. The inclusion criteria consisted of laboratory studies that evaluated the amount of AHTD, and compared PUI with NAI protocols using microCT analysis. The risk of bias in the selected studies was assessed critically by two reviewers. A meta-analysis was performed using the RevMan software program (P<0.05), and included studies providing the standardized mean difference (SMD), using a fixed effect model, and adopting a confidence interval of 95%. In all, 3495 studies were identified, three of which met the inclusion criteria. All three were considered as having a low risk of bias. The meta-analysis comparing the ability of PUI and NAI protocols to remove hard tissue debris showed a higher percentage of AHTD reduction (P<0.01) for PUI, with a confidence interval of 1.41 [0.79, 2.02]. The heterogeneity among the studies was 82% (I2). Considering the limitations of the present study, this systematic review and meta-analysis showed that PUI was more effective than NAI in removing hard tissue debris, based exclusively on studies that used microCT scanning to provide a more precise analysis of the two techniques used. The findings presented in the present study reinforce the concept that PUI can increase residue removal and improve the cleanliness of the root canal in endodontic treatments.
Collapse
Affiliation(s)
- Ana Flávia Almeida Barbosa
- Universidade do Estado do Rio de Janeiro - UERJ, School of Dentistry, Department of Endodontics, Rio de Janeiro, RJ, Brazil
| | - Carolina Oliveira de Lima
- Universidade do Estado do Rio de Janeiro - UERJ, School of Dentistry, Department of Endodontics, Rio de Janeiro, RJ, Brazil
| | - Luciana Moura Sassone
- Universidade do Estado do Rio de Janeiro - UERJ, School of Dentistry, Department of Endodontics, Rio de Janeiro, RJ, Brazil
| | - Raissa Dias Fares
- Universidade do Estado do Rio de Janeiro - UERJ, School of Dentistry, Department of Preventive and Community Dentistry, Rio de Janeiro, RJ, Brazil
| | - Tatiana Kelly da Silva Fidalgo
- Universidade do Estado do Rio de Janeiro - UERJ, School of Dentistry, Department of Preventive and Community Dentistry, Rio de Janeiro, RJ, Brazil
| | | |
Collapse
|
11
|
Natanasabapathy V, Arul B, Srinivasan V, Santosh SS, Vasudevan A, Arockiam S, Namasivayam A, Deivanayagam K, Srinivasan MR. Removal of accumulated hard tissue debris from mesial root of mandibular molars evaluated using micro-CT - a systematic review and network meta-analysis. Evid Based Dent 2021:10.1038/s41432-021-0207-x. [PMID: 34795397 DOI: 10.1038/s41432-021-0207-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/21/2021] [Indexed: 11/09/2022]
Abstract
Aim The aim of this systematic review and network meta-analysis was to identify the best irrigant activation technique (IAT) for the removal of accumulated hard tissue debris (AHTD) from the mesial root of mandibular molars evaluated using micro-CT studies.Methods The research question was based on the PICO format. Four electronic databases - PubMed, Scopus, Embase and Web of Science - were searched for articles up to June 2020. Selected articles were assessed for bias using the Joanna Briggs Institute Critical appraisal tool. The network meta-analysis using a fixed-effects model and SUCRA ranking were performed. The quality of the evidence was assessed using the CINeMA framework.Results Eleven studies were included for qualitative synthesis while seven were included for quantitative synthesis. The risk of bias of all included articles was low. The results based on SUCRA values revealed the IAT shock wave-enhanced emission photoacoustic streaming (100%) resulted in the greatest reduction of the volume of AHTD from mesial roots of mandibular molars. Ranking of the other IATs was as follows: photon-induced photoacoustic streaming (87%), laser-activated irrigation (79.3%), XP EndoFinisher (71.2%), ultrasonically activated irrigation (59.6%), apical negative pressure (42.3%), EasyClean (37.4%), EDDY (26.2%), EndoActivator (24.2%), self-adjusting file (11.6%) and needle irrigation (11.3%).Conclusion None of the IATs rendered the root canals completely free of AHTD. The laser-activated irrigation groups fared better than all other interventions in reducing AHTD from the mesial roots of mandibular molars. The confidence rating ranged from low to high for indirect evidence and moderate to high for mixed evidence. Results must be interpreted with caution due to the laboratory nature of the included studies.
Collapse
Affiliation(s)
- Velmurugan Natanasabapathy
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Ammal Dental College & Hospital, Meenakshi Academy of Higher Education and Research (MAHER), No.1, Alapakkam Main Road, Maduravoyal, Chennai, 600095, Tamil Nadu, India.
| | - Buvaneshwari Arul
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Ammal Dental College & Hospital, Meenakshi Academy of Higher Education and Research (MAHER), No.1, Alapakkam Main Road, Maduravoyal, Chennai, 600095, Tamil Nadu, India
| | - Vignesh Srinivasan
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Ammal Dental College & Hospital, Meenakshi Academy of Higher Education and Research (MAHER), No.1, Alapakkam Main Road, Maduravoyal, Chennai, 600095, Tamil Nadu, India
| | - Sneha Susan Santosh
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Ammal Dental College & Hospital, Meenakshi Academy of Higher Education and Research (MAHER), No.1, Alapakkam Main Road, Maduravoyal, Chennai, 600095, Tamil Nadu, India
| | - Aishwarya Vasudevan
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Ammal Dental College & Hospital, Meenakshi Academy of Higher Education and Research (MAHER), No.1, Alapakkam Main Road, Maduravoyal, Chennai, 600095, Tamil Nadu, India
| | - Selva Arockiam
- Department of Orthodontics, Faculty of Dentistry, Meenakshi Ammal Dental College & Hospital, Meenakshi Academy of Higher Education and Research (MAHER), No.1, Alapakkam Main Road, Maduravoyal, Chennai, 600095, Tamil Nadu, India
| | - Ambalavanan Namasivayam
- Department of Periodontology and Oral implantology, Faculty of Dentistry, Meenakshi Ammal Dental College & Hospital, Meenakshi Academy of Higher Education and Research (MAHER), No.1, Alapakkam Main Road, Maduravoyal, Chennai, 600095, Tamil Nadu, India
| | - Kandaswamy Deivanayagam
- Department of Conservative Dentistry & Endodontics, Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, 600116, Tamil Nadu, India
| | - M R Srinivasan
- Department of Conservative Dentistry and Endodontics, Sri Venkateswara Dental College and Hospital, Chennai, 600130, Tamil Nadu, India
| |
Collapse
|
12
|
Liapis D, De Bruyne MAA, De Moor RJG, Meire MA. Postoperative pain after ultrasonically and laser-activated irrigation during root canal treatment: a randomized clinical trial. Int Endod J 2021; 54:1037-1050. [PMID: 33595920 DOI: 10.1111/iej.13500] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 02/12/2021] [Accepted: 02/15/2021] [Indexed: 12/18/2022]
Abstract
AIM To compare the intensity of postoperative pain after primary root canal treatment of asymptomatic teeth when using ultrasonically (UAI) or laser-activated irrigation (LAI). METHODOLOGY In this superiority randomized clinical trial (ClinicalTrials.gov ID: NCT03981237) with parallel design, fifty-six patients with an asymptomatic tooth in need of primary root canal treatment were enrolled. After chemo-mechanical canal preparation using rotary instruments and NaOCl irrigation, teeth were randomly assigned to two groups and patients were blinded to the final irrigation protocol. In the UAI group (n = 28), 60s activation with an Irrisafe tip was done per canal. In the LAI group (n = 28), NaOCl was activated with a pulsed Er:YAG (2940 nm) laser, equipped with a conical tip, with settings of 50 µs, 20 mJ at 15 Hz for 60 s. Patients recorded their pain intensity 6, 24, 48 and 72 h after treatment on a 100 mm visual analogue scale (VAS), as well as their analgesic consumption. Pain levels and incidence were compared across groups using the Mann-Whitney U-test and chi-square test. RESULTS Overall, mean postoperative pain intensity was low, with the majority of patients having no or minimal pain 24 h postoperatively. At 6 h postoperatively, pain intensity and incidence were significantly higher in the UAI group compared to the LAI group (P < 0.05). For the other time intervals, no significant differences in postoperative pain incidence or intensity were found. The frequency of analgesic intake did not differ significantly between the two groups. Neither of the activation methods resulted in any adverse effects. CONCLUSIONS Ultrasonically and laser-activated irrigation resulted in low and comparable levels of postoperative pain in asymptomatic patients receiving primary root canal treatment.
Collapse
Affiliation(s)
- D Liapis
- Department of Oral Health Sciences, Section of Endodontology, Ghent University, Ghent, Belgium
| | - M A A De Bruyne
- Department of Oral Health Sciences, Section of Endodontology, Ghent University, Ghent, Belgium
| | - R J G De Moor
- Department of Oral Health Sciences, Section of Endodontology, Ghent University, Ghent, Belgium
| | - M A Meire
- Department of Oral Health Sciences, Section of Endodontology, Ghent University, Ghent, Belgium
| |
Collapse
|
13
|
Evaluation of smear layer and debris removal by stepwise intraoperative activation (SIA) of sodium hypochlorite. Clin Oral Investig 2020; 25:237-245. [PMID: 32500405 DOI: 10.1007/s00784-020-03358-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 05/19/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To evaluate the efficacy of a stepwise intraoperative activation (SIA) of irrigants during and after the instrumentation compared with that of a conventional activation (CA) performed only after the instrumentation to remove smear layer and debris using different activation devices. MATERIALS AND METHODS A total of 70 single-rooted teeth were divided into a control group (no activation, n = 10) and two different experimental groups according to the irrigant activation protocol used: group 1 (CA), in which sodium hypochlorite was activated only after the use of the last mechanical file, and group 2 (SIA), in which activation was performed during and after the instrumentation. The two groups were divided into 3 subgroups according to the activation device used (n = 10): passive ultrasonic irrigation (PUI, subgroup a), EndoActivator (EA, subgroup b), and EDDY (subgroup c). The roots were split longitudinally and observed using scanning electron microscopy (SEM) to evaluate the presence of debris and smear layer, and the results were statistically analyzed. RESULTS All activation protocols and devices were more effective than control group in removing smear layer and debris from all root canal thirds (P < 0.05), except for CA-EA (group 1b) in the apical third. In the apical third, SIA was found to be more effective than CA (P < 0.05) to remove smear layer and residual debris when PUI was used, to remove the smear layer when EA was used (P < 0.05), and to remove residual debris when EDDY was used (P < 0.05). PUI and EDDY removed statistically more smear layer and debris than EA in the apical third (P < 0.05). CONCLUSIONS The SIA technique improved the smear layer and debris removal from the apical third and debris removal from the coronal third, and PUI and EDDY were more effective than EA in the apical third. CLINICAL RELEVANCE The stepwise intraoperative activation (SIA) technique may increase smear layer and debris removal.
Collapse
|
14
|
Ng Y, Reddington LP, Berman A, Knowles JC, Nazhat SN, Gulabivala K. Viscoelastic and chemical properties of dentine after different exposure times to sodium hypochlorite, ethylenediaminetetraacetic acid and calcium hydroxide. AUST ENDOD J 2020; 46:234-243. [DOI: 10.1111/aej.12397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Yuan‐Ling Ng
- Unit of Endodontology Division of Restorative Dental Science UCL Eastman Dental Institute University College London London UK
| | - Liam P. Reddington
- Unit of Endodontology Division of Restorative Dental Science UCL Eastman Dental Institute University College London London UK
| | - Antony Berman
- Unit of Endodontology Division of Restorative Dental Science UCL Eastman Dental Institute University College London London UK
| | - Jonathan C. Knowles
- Division of Biomaterials & Tissue Engineering UCL Eastman Dental Institute University College London London UK
- Department of Nanobiomedical Science & Institute for Tissue Regeneration Engineering Dankook University Cheonan Korea
- Discoveries Centre for Regenerative and Precision Medicine UCL Campus London UK
| | - Showan N. Nazhat
- Department of Mining and Materials Engineering McGill University Montreal Quebec Canada
| | - Kishor Gulabivala
- Unit of Endodontology Division of Restorative Dental Science UCL Eastman Dental Institute University College London London UK
| |
Collapse
|
15
|
Lee OYS, Khan K, Li KY, Shetty H, Abiad RS, Cheung GSP, Neelakantan P. Influence of apical preparation size and irrigation technique on root canal debridement: a histological analysis of round and oval root canals. Int Endod J 2019; 52:1366-1376. [DOI: 10.1111/iej.13127] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 04/10/2019] [Indexed: 12/22/2022]
Affiliation(s)
- O. Y. S. Lee
- Faculty of Dentistry The University of Hong Kong Hong Kong
| | - K. Khan
- Faculty of Dentistry The University of Hong Kong Hong Kong
| | - K. Y. Li
- Centralized Research Laboratories Faculty of Dentistry The University of Hong Kong Hong Kong
| | - H. Shetty
- Department of Conservative Dentistry and Endodontics Nair Hospital Dental College Mumbai India
| | - R. S. Abiad
- Endodontic Division Faculty of Dentistry Beirut Arab University Beirut Lebanon
| | | | - P. Neelakantan
- Faculty of Dentistry The University of Hong Kong Hong Kong
| |
Collapse
|
16
|
Zhao Y, Fan W, Xu T, Tay FR, Gutmann JL, Fan B. Evaluation of several instrumentation techniques and irrigation methods on the percentage of untouched canal wall and accumulated dentine debris in C‐shaped canals. Int Endod J 2019; 52:1354-1365. [DOI: 10.1111/iej.13119] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 03/18/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Y. Zhao
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei‐MOST) & Key Laboratory of Oral Biomedicine Ministry of Education School & Hospital of Stomatology Wuhan University Wuhan China
| | - W. Fan
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei‐MOST) & Key Laboratory of Oral Biomedicine Ministry of Education School & Hospital of Stomatology Wuhan University Wuhan China
| | - T. Xu
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei‐MOST) & Key Laboratory of Oral Biomedicine Ministry of Education School & Hospital of Stomatology Wuhan University Wuhan China
| | - F. R. Tay
- Department of Endodontics The Dental College of Georgia Augusta University Augusta GA USA
| | - J. L. Gutmann
- Department of Restorative Science/Endodontics Texas A&M University Baylor College of Dentistry Dallas TX USA
| | - B. Fan
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei‐MOST) & Key Laboratory of Oral Biomedicine Ministry of Education School & Hospital of Stomatology Wuhan University Wuhan China
| |
Collapse
|
17
|
Rödig T, Koberg C, Baxter S, Konietschke F, Wiegand A, Rizk M. Micro-CT evaluation of sonically and ultrasonically activated irrigation on the removal of hard-tissue debris from isthmus-containing mesial root canal systems of mandibular molars. Int Endod J 2019; 52:1173-1181. [PMID: 30773661 DOI: 10.1111/iej.13100] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 02/13/2019] [Indexed: 01/23/2023]
Abstract
AIM To evaluate the efficacy of sonically and ultrasonically activated irrigation on removal of accumulated hard-tissue debris (AHTD) in mesial root canal systems of mandibular molars using micro-computed tomographic (micro-CT) analysis. METHODOLOGY Forty mesial roots of mandibular molars with two independent canals joined apically by an isthmus (Vertucci type II) were selected. The root canals were instrumented using Reciproc R25 instruments, and specimens were scanned at a resolution of 10.5 μm. Subsequently, n = 10 roots were assigned to each of the four final irrigation groups such that the group means and variances were almost identical: sonically activated irrigation with EndoActivator (EA) or EDDY (ED), ultrasonically activated irrigation (UAI) and manual irrigation without activation (MI). The final irrigation procedures were performed using a total of 5 mL 1% NaOCl and 5 mL 15% EDTA per canal over 5 min with activation time of 4 × 20 s. Reconstructed data sets were coregistered, and the mean percentage reduction of AHTD after final irrigation was compared statistically between groups using analysis of variance at a significance level set at 5%. RESULTS A significant reduction of AHTD was achieved after final irrigation in all groups (P < 0.05), ranging from 44.1% to 66.8%. The vol% of debris after irrigation was 3.7 ± 1.9% for EA, 3.3 ± 2.3% for ED, 2.1 ± 1.6% for UAI and 4.4 ± 2.3% for MI, with no significant difference between groups (P > 0.05). CONCLUSIONS None of the final irrigation protocols completely removed AHTD from mesial root canal systems in extracted human mandibular molars. Sonically and ultrasonically activated irrigation performed no better compared to manual irrigation.
Collapse
Affiliation(s)
- T Rödig
- Department for Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Göttingen, Germany
| | - C Koberg
- Department for Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Göttingen, Germany
| | - S Baxter
- Department for Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Göttingen, Germany
| | - F Konietschke
- Institute of Biometry and Clinical Epidemiology, Charité - University Medical Center Berlin, Berlin, Germany
| | - A Wiegand
- Department for Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Göttingen, Germany
| | - M Rizk
- Department for Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Göttingen, Germany
| |
Collapse
|
18
|
Stringheta CP, Bueno CES, Kato AS, Freire LG, Iglecias EF, Santos M, Pelegrine RA. Micro‐computed tomographic evaluation of the shaping ability of four instrumentation systems in curved root canals. Int Endod J 2019; 52:908-916. [DOI: 10.1111/iej.13084] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 01/23/2019] [Indexed: 11/28/2022]
Affiliation(s)
- C. P. Stringheta
- Department of Endodontics São Leopoldo Mandic Dental Research Center CampinasSP Brazil
| | - C. E. S. Bueno
- Department of Endodontics São Leopoldo Mandic Dental Research Center CampinasSP Brazil
| | - A. S. Kato
- Department of Endodontics São Leopoldo Mandic Dental Research Center CampinasSP Brazil
| | - L. G. Freire
- Division of Endodontics Department of Restorative Dentistry School of Dentistry University of São Paulo São Paulo SP Brazil
| | - E. F. Iglecias
- Division of Endodontics Department of Restorative Dentistry School of Dentistry University of São Paulo São Paulo SP Brazil
| | - M. Santos
- Division of Endodontics Department of Restorative Dentistry School of Dentistry University of São Paulo São Paulo SP Brazil
| | - R. A. Pelegrine
- Department of Endodontics São Leopoldo Mandic Dental Research Center CampinasSP Brazil
| |
Collapse
|
19
|
Wang Z, Shen Y, Haapasalo M. Root Canal Wall Dentin Structure in Uninstrumented but Cleaned Human Premolars: A Scanning Electron Microscopic Study. J Endod 2018; 44:842-848. [DOI: 10.1016/j.joen.2018.01.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 01/27/2018] [Accepted: 01/29/2018] [Indexed: 10/17/2022]
|
20
|
Espir CG, Nascimento-Mendes CA, Guerreiro-Tanomaru JM, Freire LG, Gavini G, Tanomaru-Filho M. Counterclockwise or clockwise reciprocating motion for oval root canal preparation: a micro-CT analysis. Int Endod J 2018; 51:541-548. [PMID: 28375575 DOI: 10.1111/iej.12776] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 03/29/2017] [Indexed: 11/28/2022]
Abstract
AIM To evaluate oval root canal preparation using one or two instruments in counterclockwise or clockwise reciprocating motion. METHODOLOGY The radiographic diameter of mandibular human incisors was evaluated, and oval canals were selected (2 ≤ Diameter Ratio ≤ 4). Fifty-seven teeth were assigned to root canal preparation (n = 19): Reciproc 40 (R40) in a counterclockwise reciprocating motion; Mtwo size 40, .06 taper (M 40.06) in a clockwise reciprocating motion or Mtwo size 20, .06 taper and size 40, .06 taper (M 20/40.06) in a clockwise reciprocating motion. Mtwo instruments were coupled to an ENDO DUAL motor, turning 150° clockwise and 30° counterclockwise. Scanning was performed before and after root canal preparation using a SkyScan 1176 micro-computed tomography. Volume, percentage of debris and percentage of uninstrumented surface were analysed in the entire root canal and in each third of the canal. Data were compared using anova and Tukey's tests or Kruskal-Wallis and Dunn tests. RESULTS The Reciproc and Mtwo systems using different kinematics were associated with a similar increase in root canal volume. Additionally, both system had similar percentage of uninstrumented surface (P > 0.05). Mtwo size 20, .06 taper and size 40, .06 taper was associated with significantly lower debris (P < 0.05) in the middle third (0.56%) when compared to R40 (1.31%) and M size 40, .06 taper (1.54%). CONCLUSIONS The conventional reciprocation motion for R40 and the clockwise reciprocation motion for Mtwo resulted in similar root canal preparations. Less remaining debris was present in the middle third when two instruments with different diameters were used.
Collapse
Affiliation(s)
- C G Espir
- Department of Restorative Dentistry, Araraquara Dental School, São Paulo State University, Araraquara, São Paulo, Brazil
| | - C A Nascimento-Mendes
- Department of Restorative Dentistry, Araraquara Dental School, São Paulo State University, Araraquara, São Paulo, Brazil
| | - J M Guerreiro-Tanomaru
- Department of Restorative Dentistry, Araraquara Dental School, São Paulo State University, Araraquara, São Paulo, Brazil
| | - L G Freire
- Department of Dentistry, São Paulo Dental School, University of São Paulo, São Paulo, São Paulo, Brazil
| | - G Gavini
- Department of Dentistry, São Paulo Dental School, University of São Paulo, São Paulo, São Paulo, Brazil
| | - M Tanomaru-Filho
- Department of Restorative Dentistry, Araraquara Dental School, São Paulo State University, Araraquara, São Paulo, Brazil
| |
Collapse
|
21
|
Zhang C, Liu J, Liu L. The influence of ProTaper and WaveOne on apically extruded debris: A systematic review and meta-analysis. J Conserv Dent 2018; 21:474-480. [PMID: 30294105 PMCID: PMC6161523 DOI: 10.4103/jcd.jcd_82_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background: Apically extruded debris produced during root canal preparation can induce postoperative inflammation and subsequent failure of root canal treatment. Therefore, debris production must be reduced to improve the outcome of root canal treatment. Aim: This study aimed to provide a theoretical basis for the improvement of root canal treatment by comparing the difference in the amount of apically extruded debris produced during the root canal preparation of extracted human teeth with ProTaper Universal (PTU), ProTaper Next (PTN), and WaveOne (WO). Materials and Methods: On March 30, 2017, three researchers searched five electronic databases (PubMed/Medline, Cochrane, Science Direct Online, Embase, and Web of Science) with no time limitations. Only articles written in English were retrieved, and 150 articles were obtained. Then, the three researchers independently selected articles in accordance with previously established inclusion and exclusion criteria, and inconsistent results were discussed. Data were analyzed through meta-analysis for standardized mean difference (SMD). Results: Eight studies met the inclusion criteria and were subjected to qualitative analysis. Four articles showed that PTU produced higher amounts of apical debris than WO; two articles showed that PTU produced lower amounts of apical debris than WO; and three articles showed that PTN produced lower amounts of apical debris than WO. Moreover, one article demonstrated that PTU produced higher amounts of apical debris than PTN. A meta-analysis showed that PTU and WO did not produce significantly different amounts of apically extruded debris: SMD = −0.26, Z = 0.50 (P > 0.05). PTU produced lower amounts of apically extruded debris than WO: SMD = −4.98, Z = 2.79 (P < 0.05). However, results were significantly heterogeneous among all the included studies (I2= 97%). No significant difference was found between PTU and WO in the amounts of apically extruded debris: SMD = 0.47, Z = 1.06 (P > 0.05). Conclusion: Currently available evidence shows that PTN can produce lower amounts of apical debris than WO (P < 0.05). Moreover, the amounts of apically extruded debris produced by PTU and WO are not significantly different (P > 0.05). Nevertheless, given the limited number of studies reviewed, a definitive conclusion cannot be reached.
Collapse
Affiliation(s)
- Chen Zhang
- Department of Oral Medical, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Jun Liu
- Department of Orthodontics, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lingshuang Liu
- Department of Endodontics, Affiliated Hospital of Qingdao University, Qingdao, China.,Department of Oral Medical, Qingdao University, Qingdao, China
| |
Collapse
|
22
|
Influence of the internal anatomy on the leakage of root canals filled with thermoplastic technique. Clin Oral Investig 2017; 22:1385-1393. [PMID: 29019080 DOI: 10.1007/s00784-017-2235-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 09/28/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The aim of this paper is to evaluate the influence of the internal anatomy on the leakage of root canals filled with the thermoplastic technique. MATERIALS AND METHODS The upper central incisors (UCI) and mesial roots of the lower molars (MRLM) (n = 12 each) were tested regarding leakage using the gas-enhanced permeation test (GEPT) after root filling. The quality of the root fillings was assessed using micro-computed tomography (μCT) by superimposing scans before and after treatment to calculate unfilled volume. The calculated void volume was compared between the groups and correlated to the measured leakage values. Data were analyzed using t test and Pearson's correlation tests (p < 0.05). RESULTS The mean void volume did not differ between UCI and MRLM (13.7 ± 6.2% vs. 14.2 ± 6.8%, respectively). However, significantly more leakage was evident in the MRLM (p < 0.001). While the leakage correlated highly to the void volume in the MRLM group (R 2 = 0.981, p < 0.001), no correlation was found in UCI (R 2 = 0.467, p = 0.126). CONCLUSION MRLM showed higher leakage values, which correlated to the void volume in the root canal fillings. CLINICAL RELEVANCE Care should always be taken while doing root canal treatments, but attention to teeth with known/expected complex root canal anatomy should be considered.
Collapse
|
23
|
Lopes RMV, Marins FC, Belladonna FG, Souza EM, De-Deus G, Lopes RT, Silva EJNL. Untouched canal areas and debris accumulation after root canal preparation with rotary and adaptive systems. AUST ENDOD J 2017; 44:260-266. [DOI: 10.1111/aej.12237] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Rosa Maria Vianna Lopes
- Department of Endodontics; School of Dentistry; Grande Rio University (UNIGRANRIO); Duque de Caxias Rio de Janeiro Brazil
| | - Fernanda Cunha Marins
- Department of Endodontics; School of Dentistry; Grande Rio University (UNIGRANRIO); Duque de Caxias Rio de Janeiro Brazil
| | | | - Erick Miranda Souza
- Department of Dentistry II; Federal University of Maranhão; São Luis Maranhão Brazil
| | - Gustavo De-Deus
- Department of Endodontics; Fluminense Federal University (UFF); Niterói Rio de Janeiro Brazil
| | - Ricardo Tadeu Lopes
- Nuclear Engineering Program; Federal University of Rio de Janeiro (UFRJ); Rio de Janeiro Rio de Janeiro Brazil
| | | |
Collapse
|
24
|
Azim AA, Piasecki L, da Silva Neto UX, Cruz ATG, Azim KA. XP Shaper, A Novel Adaptive Core Rotary Instrument: Micro–computed Tomographic Analysis of Its Shaping Abilities. J Endod 2017; 43:1532-1538. [DOI: 10.1016/j.joen.2017.04.022] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 04/10/2017] [Accepted: 04/22/2017] [Indexed: 11/26/2022]
|
25
|
Zuolo ML, Zaia AA, Belladonna FG, Silva EJNL, Souza EM, Versiani MA, Lopes RT, De-Deus G. Micro-CT assessment of the shaping ability of four root canal instrumentation systems in oval-shaped canals. Int Endod J 2017; 51:564-571. [DOI: 10.1111/iej.12810] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 06/27/2017] [Indexed: 11/29/2022]
Affiliation(s)
- M. L. Zuolo
- Endodontic Division; Department of Restorative Dentistry; Piracicaba Dental School; State University of Campinas; Piracicaba São Paulo Brazil
| | - A. A. Zaia
- Endodontic Division; Department of Restorative Dentistry; Piracicaba Dental School; State University of Campinas; Piracicaba São Paulo Brazil
| | - F. G. Belladonna
- Department of Endodontics; Fluminense Federal University; Niterói Rio de Janeiro Brazil
| | - E. J. N. L. Silva
- Department of Endodontics; Grande Rio University; Duque de Caxias Rio de Janeiro Brazil
| | - E. M. Souza
- Department of Dentistry II; Federal University of Maranhão; São Luís Maranhão Brazil
| | - M. A. Versiani
- Department of Restorative Dentistry; Dental School of Ribeirão Preto; University of São Paulo; São Paulo São Paulo Brazil
| | - R. T. Lopes
- Nuclear Engineering Program; Federal University of Rio de Janeiro; Rio de Janeiro Brazil
| | - G. De-Deus
- Department of Endodontics; Fluminense Federal University; Niterói Rio de Janeiro Brazil
| |
Collapse
|
26
|
Lloyd A, Navarrete G, Marchesan MA, Clement D. Removal of calcium hydroxide from Weine Type II systems using photon-induced photoacoustic streaming, passive ultrasonic, and needle irrigation: a microcomputed tomography study. J Appl Oral Sci 2017; 24:543-548. [PMID: 28076457 PMCID: PMC5161252 DOI: 10.1590/1678-775720160234] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 08/01/2016] [Indexed: 11/22/2022] Open
Abstract
Objective This study compared the effectiveness of Er:YAG laser-activated irrigation (PIPS), passive ultrasonic irrigation (PUI) with EndoUltra and standard needle irrigation (SNI) in the removal of calcium hydroxide [Ca(OH)2] from the mesial roots of Weine Type II mandibular molars. Material and Methods Thirty mandibular molars were screened by µCT for the presence of mesial roots with complex intra-canal anatomy and a common apical foramen. The teeth were enlarged to a standardized 25/.06 preparation and filled with Ca(OH)2 paste. Specimens were divided into three groups (n=10) according to the technique used for Ca(OH)2 removal: PIPS, at 15 Hz and 20 mJ using a 9 mm long, 600 µm diameter tip; PUI using a 15/.02 tip; and SNI (30 Ga. side-vented needle). Equal volumes of 8.25% NaOCl and 17% EDTA were used in all groups. µCT was used to measure the initial amount of Ca(OH)2 present and to assess the residual volume of Ca(OH)2 following each irrigation protocol. Data were analyzed using Tukey HSD and Kruskal-Wallis tests (α=5%). Results The mean volume of Ca(OH)2 before removal was significantly higher in the coronal third than in the middle and apical third (p<0.001). Ca(OH)2 was similarly removed from the coronal and middle thirds with the three methods used (p>0.05). PIPS (median 0%; IQR: 0-0) showed significant higher Ca(OH)2 removal in the apical third than PUI (median 100%, IQR: 85-100) and SNI (median 47%; IQR: 16-72) (p<0.001). Conclusions PIPS laser-activation was more effective for the removal of Ca(OH)2 from mesial roots of mandibular molars with Weine Type II canal configurations than PUI with EndoUltra and SNI.
Collapse
Affiliation(s)
- Adam Lloyd
- - University of Tennessee Health Science Center, College of Dentistry, Department of Endodontics, Memphis, TN, USA
| | - Geraldine Navarrete
- - University of Tennessee Health Science Center, College of Dentistry, Department of Endodontics, Memphis, TN, USA
| | - Melissa Andreia Marchesan
- - University of Tennessee Health Science Center, College of Dentistry, Department of Endodontics, Memphis, TN, USA
| | - David Clement
- - The University of Oklahoma, College of Dentistry, Oklahoma City, OK, USA
| |
Collapse
|
27
|
Urban K, Donnermeyer D, Schäfer E, Bürklein S. Canal cleanliness using different irrigation activation systems: a SEM evaluation. Clin Oral Investig 2017; 21:2681-2687. [PMID: 28185091 DOI: 10.1007/s00784-017-2070-x] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 02/01/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The purpose of this study was to assess the efficacy of different final irrigation activation methods in removing debris and smear layer in the apical, middle, and coronal portion of straight root canals. MATERIAL AND METHODS Straight root canals of 58 freshly extracted mandibular premolars were used. Root canals were prepared to size 40.06. Irrigation was performed using 3% sodium hypochlorite. Samples were divided into four equal groups (n = 12) according to the irrigation activation techniques: (A) manual irrigation (MI), (B) EndoActivator (EA) (Dentsply Maillefer, Ballaigues, Switzerland), (C) sonic activation EDDY (EDDY; VDW, Munich, Germany), and (D) passive ultrasonic irrigation (PUI). Ten teeth served as negative controls. Roots were split longitudinally, and the canal walls were subjected to scanning electron microscopy. The presence of debris and smear layer at coronal, middle, and apical levels were evaluated using a 5-point scoring system and statistically analyzed using Kruskal-Wallis and chi-square tests. RESULTS Canal cleanliness decreased from coronal to apical (P = 0.035). Significantly more debris was removed with EA, EDDY, and PUI compared to MI (P < 0.001; total values), but no differences were observed in the different portions of the root canals (P > 0.05). Smear layer removal with PUI, EA, and EDDY was not significantly different (P > 0.05), but only EDDY and PUI were superior to MI (P < 0.01). CONCLUSION All activation methods created nearly debris-free canal walls and were superior compared to manual irrigation (P < 0.001). EDDY and PUI also showed significantly better smear layer scores compared to manual irrigation. CLINICAL RELEVANCE The sonic activation system EDDY performed equally as well as PUI, and both methods were significantly superior compared with manual irrigation in straight root canals with regard to debris and smear layer removal.
Collapse
Affiliation(s)
- K Urban
- Department of Operative Dentistry, University of Münster, Münster, Germany
| | - D Donnermeyer
- Department of Operative Dentistry, University of Münster, Münster, Germany
| | - Edgar Schäfer
- Central Interdisciplinary Ambulance in the School of Dentistry, University of Münster, Waldeyerstr. 30, 48149, Münster, Germany.
| | - S Bürklein
- Central Interdisciplinary Ambulance in the School of Dentistry, University of Münster, Waldeyerstr. 30, 48149, Münster, Germany
| |
Collapse
|
28
|
SEREFOGLU B, PİSKİN B. Micro computed tomography evaluation of the Self-adjusting file and ProTaper Universal system on curved mandibular molars. Dent Mater J 2017; 36:606-613. [DOI: 10.4012/dmj.2016-255] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Burcu SEREFOGLU
- Ege University, School of Dentistry, Department of Endodontology
| | - Beyser PİSKİN
- Ege University, School of Dentistry, Department of Endodontology
| |
Collapse
|
29
|
Keleş A, Alçin H, Sousa-Neto MD, Versiani MA. Supplementary Steps for Removing Hard Tissue Debris from Isthmus-containing Canal Systems. J Endod 2016; 42:1677-1682. [DOI: 10.1016/j.joen.2016.07.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 07/29/2016] [Accepted: 07/29/2016] [Indexed: 11/29/2022]
|
30
|
Leoni GB, Versiani MA, Silva-Sousa YT, Bruniera JFB, Pécora JD, Sousa-Neto MD. Ex vivoevaluation of four final irrigation protocols on the removal of hard-tissue debris from the mesial root canal system of mandibular first molars. Int Endod J 2016; 50:398-406. [DOI: 10.1111/iej.12630] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 03/15/2016] [Indexed: 11/29/2022]
Affiliation(s)
- G. B. Leoni
- Department of Restorative Dentistry; Dental School of Ribeirão Preto; University of São Paulo; Ribeirão Preto SP Brazil
| | - M. A. Versiani
- Department of Restorative Dentistry; Dental School of Ribeirão Preto; University of São Paulo; Ribeirão Preto SP Brazil
| | - Y. T. Silva-Sousa
- Department of Endodontics; Faculty of Dentistry; University of Ribeirão Preto; Ribeirão Preto SP Brazil
| | - J. F. B. Bruniera
- Department of Endodontics; Faculty of Dentistry; University of Ribeirão Preto; Ribeirão Preto SP Brazil
| | - J. D. Pécora
- Department of Restorative Dentistry; Dental School of Ribeirão Preto; University of São Paulo; Ribeirão Preto SP Brazil
| | - M. D. Sousa-Neto
- Department of Restorative Dentistry; Dental School of Ribeirão Preto; University of São Paulo; Ribeirão Preto SP Brazil
| |
Collapse
|
31
|
Arias-Moliz MT, Morago A, Ordinola-Zapata R, Ferrer-Luque CM, Ruiz-Linares M, Baca P. Effects of Dentin Debris on the Antimicrobial Properties of Sodium Hypochlorite and Etidronic Acid. J Endod 2016; 42:771-5. [PMID: 26951957 DOI: 10.1016/j.joen.2016.01.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Revised: 12/28/2015] [Accepted: 01/11/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The purpose of this study was to determine the influence of dentin powder on the concentration, pH, and antimicrobial activity of sodium hypochlorite (NaOCl) alone and combined with etidronic acid (HEBP). METHODS Biofilms of Enterococcus faecalis were grown on the surface of dentin blocks for 5 days and then exposed to 1% and 2.5% NaOCl alone or combined with 9% HEBP for 3 minutes in the absence and presence of dentin powder. The biovolumes of the biofilm were measured using confocal microscopy and the live/dead technique. The available chlorine and pH of the solutions were also measured. Nonparametric tests were used to determine statistical differences (P < .05). RESULTS The presence of dentin powder resulted in a reduction of the free available chlorine and pH in all the irrigating solutions; 1% NaOCl lost its antimicrobial activity completely in the presence of dentin powder. The antimicrobial activity was significantly reduced in the 2.5% NaOCl and 1% NaOCl/HEBP groups, and it was not affected in the 2.5% NaOCl/HEBP group. CONCLUSIONS The presence of dentin powder significantly decreased the available chlorine and antimicrobial activity of 1% NaOCl, 2.5% NaOCl, and 1% NaOCl/HEBP irrigating solutions. The antimicrobial activity of 2.5% NaOCl/HEBP was not affected by the dentin powder after a 3-minute contact time against E. faecalis biofilms.
Collapse
Affiliation(s)
| | - Ana Morago
- Department of Microbiology, School of Dentistry, University of Granada, Spain
| | - Ronald Ordinola-Zapata
- Department of Endodontics, Bauru Dental School, University of São Paulo, São Paulo, Brazil
| | | | | | - Pilar Baca
- Department of Stomatology, School of Dentistry, University of Granada, Spain
| |
Collapse
|
32
|
Liu Z, Liu J, Gu L, Liu W, Wei X, Ling J. The shaping and cleaning abilities of self-adjusting files in the preparation of canals with isthmuses after glidepath enlargement with ISO or ProTaper Universal NiTi files. J Dent Sci 2016; 11:83-89. [PMID: 30894951 PMCID: PMC6395177 DOI: 10.1016/j.jds.2015.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 08/31/2015] [Indexed: 11/19/2022] Open
Abstract
Background/purpose This study compared the shaping and cleaning ability of self-adjusting files (SAF) after glidepath enlargement with ISO NiTi files (Group I) or ProTaper Universal (PTU; Group II) for preparing maxillary premolar canals with isthmuses. Materials and methods Twenty-eight teeth containing isthmuses were scanned preoperationally after glidepath enlargement and preparation with SAF (n = 14). Changes in canal and isthmus volume, prepared surface, debris volume, and transportation were determined. Data were compared by t test between groups and paired t test within each group. Results No difference was observed regarding changes in canal volume or prepared surface between the two groups (P > 0.05). Paired t tests showed that the coronal and middle prepared areas of the canal after using SAF in Group I were statistically larger than those using ISO files, whereas the use of an adjuvant preparation with SAF after PTU resulted in a significant increase in the apical prepared area in Group II. ISO and SAF systems deviated less from the center than did PTU and SAF systems at most sections. After the use of SAF, isthmus volumes were significantly increased within each group (P < 0.05). Although less debris resulted from the use of SAF instruments as compared to glidepath instruments, there was no significant difference between both groups (P > 0.05). Conclusion SAF following glidepath enlargement with ISO files could improve preparation of the coronal and middle part of the canals, and adjuvant preparation with SAF after using large-taper instruments increased the apical prepared area.
Collapse
Affiliation(s)
| | | | | | | | - Xi Wei
- Corresponding authors. Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology and Institute of Stomatological Research, Sun Yat-sen University, 56 Ling Yuan Xi Road, Guangzhou 510055, China.
| | - Junqi Ling
- Corresponding authors. Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology and Institute of Stomatological Research, Sun Yat-sen University, 56 Ling Yuan Xi Road, Guangzhou 510055, China.
| |
Collapse
|
33
|
Wolf TG, Paqué F, Zeller M, Willershausen B, Briseño-Marroquín B. Root Canal Morphology and Configuration of 118 Mandibular First Molars by Means of Micro-Computed Tomography: An Ex Vivo Study. J Endod 2016; 42:610-4. [PMID: 26906239 DOI: 10.1016/j.joen.2016.01.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 01/07/2016] [Accepted: 01/12/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The aim of this study was to investigate the root canal system morphology of the mandibular first molar by means of micro-computed tomography. METHODS The root canal configuration, foramina, and accessory canals frequency of 118 mandibular first molars were investigated by means of micro-computed tomography and 3-dimensional software imaging. A 4-digit system describes the root canal configuration from the coronal to apical thirds and the main foramina number. RESULTS The most frequent root canal configurations in mesial root were 2-2-2/2 (31.4%), 2-2-1/1 (15.3%), and 2-2-2/3 (11.9%); another 24 different root canal configurations were observed in this root. A 1-1-1/1 (58.5%), 1-1-1/2 (10.2%), and 16 other root canal configurations were observed in the distal root. The mesiobuccal root canal showed 1-4 foramina in 24.6%, and the mesiolingual showed 1-3 foramina in 28.0%. One connecting canal between the mesial root canals was observed in 30.5% and 2 in 3.4%. The distolingual root canal showed 1-4 foramina in 23.7%, whereas a foramen in the distobuccal root canal was rarely detected (3.4%). The mesiobuccal, mesiolingual, and distolingual root canals showed at least 1 accessory canal (14.3, 10.2, and 4.2%, respectively), but the distobuccal had none. CONCLUSIONS The root canal configuration of mandibular first molars varies strongly. According to our expectations, both the mesial and distal roots showed a high number of morphologic diversifications. The root canal system of the mesial root showed more root canal configuration variations, connecting and accessory canals than the distal root.
Collapse
Affiliation(s)
- Thomas Gerhard Wolf
- Department of Operative Dentistry, Johannes Gutenberg University Medical Center, Mainz, Germany.
| | - Frank Paqué
- Division of Preventive Dentistry, Periodontology, and Cariology, University of Zürich Center of Dental Medicine, Zürich, Switzerland
| | - Maximilian Zeller
- Department of Operative Dentistry, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Brita Willershausen
- Department of Operative Dentistry, Johannes Gutenberg University Medical Center, Mainz, Germany
| | | |
Collapse
|
34
|
Plotino G, Cortese T, Grande NM, Leonardi DP, Di Giorgio G, Testarelli L, Gambarini G. New Technologies to Improve Root Canal Disinfection. Braz Dent J 2016; 27:3-8. [DOI: 10.1590/0103-6440201600726] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 02/22/2016] [Indexed: 11/21/2022] Open
Abstract
Abstract Effective irrigant delivery and agitation are prerequisites to promote root canal disinfection and debris removal and improve successful endodontic treatment. This paper presents an overview of the currently available technologies to improve the cleaning of the endodontic space and their debridement efficacy. A PubMed electronic search was conducted with appropriate key words to identify the relevant literature on this topic. After retrieving the full-text articles, all the articles were reviewed and the most appropriate were included in this review. Several different systems of mechanical activation of irrigants to improve endodontic disinfection were analysed: manual agitation with gutta-percha cones, endodontic instruments or special brushes, vibrating systems activated by low-speed hand-pieces or by sonic or subsonic energy, use of ultrasonic or laser energy to mechanically activate the irrigants and apical negative pressure irrigation systems. Furthermore, this review aims to describe systems designed to improve the intracanal bacterial decontamination by a specific chemical action, such as ozone, direct laser action or light-activated disinfection. The ultrasonic activation of root canal irrigants and of sodium hypochlorite in particular still remains the gold standard to which all other systems of mechanical agitation analyzed in this article were compared. From this overview, it is evident that the use of different irrigation systems can provide several advantages in the clinical endodontic outcome and that integration of new technologies, coupled with enhanced techniques and materials, may help everyday clinical practice.
Collapse
|
35
|
Versiani MA, Alves FRF, Andrade-Junior CV, Marceliano-Alves MF, Provenzano JC, Rôças IN, Sousa-Neto MD, Siqueira JF. Micro-CT evaluation of the efficacy of hard-tissue removal from the root canal and isthmus area by positive and negative pressure irrigation systems. Int Endod J 2015; 49:1079-1087. [DOI: 10.1111/iej.12559] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 10/08/2015] [Indexed: 11/30/2022]
Affiliation(s)
- M. A. Versiani
- Department of Restorative Dentistry; Dental School of Ribeirão Preto; University of São Paulo; Ribeirão Preto SP Brazil
| | - F. R. F. Alves
- Department of Endodontics; Faculty of Dentistry; Estácio de Sá University; Rio de Janeiro RJ Brazil
| | - C. V. Andrade-Junior
- Department of Health; Dentistry Division; Southwest State University of Bahia; Jequié Brazil
| | - M. F. Marceliano-Alves
- Department of Endodontics; Faculty of Dentistry; Estácio de Sá University; Rio de Janeiro RJ Brazil
| | - J. C. Provenzano
- Department of Endodontics; Faculty of Dentistry; Estácio de Sá University; Rio de Janeiro RJ Brazil
| | - I. N. Rôças
- Department of Endodontics; Faculty of Dentistry; Estácio de Sá University; Rio de Janeiro RJ Brazil
| | - M. D. Sousa-Neto
- Department of Restorative Dentistry; Dental School of Ribeirão Preto; University of São Paulo; Ribeirão Preto SP Brazil
| | - J. F. Siqueira
- Department of Endodontics; Faculty of Dentistry; Estácio de Sá University; Rio de Janeiro RJ Brazil
| |
Collapse
|
36
|
Plotino G, Grande N. Nuove tecnologie per il miglioramento della disinfezione canalare. DENTAL CADMOS 2015. [DOI: 10.1016/s0011-8524(15)30079-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
37
|
De-Deus G, Marins J, Silva EJNL, Souza E, Belladonna FG, Reis C, Machado AS, Lopes RT, Versiani MA, Paciornik S, Neves AA. Accumulated Hard Tissue Debris Produced during Reciprocating and Rotary Nickel-Titanium Canal Preparation. J Endod 2015; 41:676-81. [DOI: 10.1016/j.joen.2014.11.028] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 11/28/2014] [Accepted: 11/30/2014] [Indexed: 10/24/2022]
|
38
|
Pawar AM, Pawar S, Kfir A, Pawar M, Kokate S. Push-out bond strength of root fillings made with C-Point and BC sealer versus gutta-percha and AH Plus after the instrumentation of oval canals with the Self-Adjusting File versus WaveOne. Int Endod J 2015; 49:374-81. [DOI: 10.1111/iej.12455] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 03/26/2015] [Indexed: 11/25/2022]
Affiliation(s)
- A. M. Pawar
- Department of Conservative Dentistry and Endodontics; D Y Patil Dental School and Hospital; Pune Maharashtra India
| | - S. Pawar
- Department of Oral and Maxillofacial Surgery; D Y Patil Dental College & Hospital; Navi Mumbai Maharashtra India
| | - A. Kfir
- Department of Endodontology; Tel Aviv University; Tel Aviv Israel
| | - M. Pawar
- Department of Conservative Dentistry and Endodontics; Government Dental College & Hospital; Mumbai Maharashtra India
| | - S. Kokate
- Department of Conservative Dentistry and Endodontics; YMT Dental College & Hospital; Navi Mumbai Maharashtra India
| |
Collapse
|
39
|
Arias-Moliz MT, Ordinola-Zapata R, Baca P, Ruiz-Linares M, Ferrer-Luque CM. Antimicrobial Activity of a Sodium Hypochlorite/Etidronic Acid Irrigant Solution. J Endod 2014; 40:1999-2002. [DOI: 10.1016/j.joen.2014.07.031] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 07/03/2014] [Accepted: 07/20/2014] [Indexed: 10/24/2022]
|
40
|
Neves AA, Silva EJ, Roter JM, Belladona FG, Alves HD, Lopes RT, Paciornik S, De-Deus GA. Exploiting the potential of free software to evaluate root canal biomechanical preparation outcomes through micro-CT images. Int Endod J 2014; 48:1033-42. [PMID: 25353648 DOI: 10.1111/iej.12399] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 10/22/2014] [Indexed: 11/28/2022]
Abstract
AIM To propose an automated image processing routine based on free software to quantify root canal preparation outcomes in pairs of sound and instrumented roots after micro-CT scanning procedures. METHODOLOGY Seven mesial roots of human mandibular molars with different canal configuration systems were studied: (i) Vertucci's type 1, (ii) Vertucci's type 2, (iii) two individual canals, (iv) Vertucci's type 6, canals (v) with and (vi) without debris, and (vii) canal with visible pulp calcification. All teeth were instrumented with the BioRaCe system and scanned in a Skyscan 1173 micro-CT before and after canal preparation. After reconstruction, the instrumented stack of images (IS) was registered against the preoperative sound stack of images (SS). Image processing included contrast equalization and noise filtering. Sound canal volumes were obtained by a minimum threshold. For the IS, a fixed conservative threshold was chosen as the best compromise between instrumented canal and dentine whilst avoiding debris, resulting in instrumented canal plus empty spaces. Arithmetic and logical operations between sound and instrumented stacks were used to identify debris. Noninstrumented dentine was calculated using a minimum threshold in the IS and subtracting from the SS and total debris. Removed dentine volume was obtained by subtracting SS from IS. RESULTS Quantitative data on total debris present in the root canal space after instrumentation, noninstrumented areas and removed dentine volume were obtained for each test case, as well as three-dimensional volume renderings. CONCLUSION After standardization of acquisition, reconstruction and image processing micro-CT images, a quantitative approach for calculation of root canal biomechanical outcomes was achieved using free software.
Collapse
Affiliation(s)
- A A Neves
- Faculdade de Odontologia, Departamento de Odontopediatria e Ortodontia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - E J Silva
- Escola de Ciências da Saúde, Universidade do Grande Rio, Duque de Caxias
| | - J M Roter
- Polícia Militar do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - F G Belladona
- Faculdade de Odontologia, Universidade Federal Fluminense, Niterói, Brazil
| | - H D Alves
- Programa de Engenharia Nuclear, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - R T Lopes
- Programa de Engenharia Nuclear, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - S Paciornik
- Departamento de Engenharia de Materiais, Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, Brazil
| | - G A De-Deus
- Escola de Ciências da Saúde, Universidade do Grande Rio, Duque de Caxias
| |
Collapse
|
41
|
Busquim S, Cunha RS, Freire L, Gavini G, Machado ME, Santos M. A micro-computed tomography evaluation of long-oval canal preparation using reciprocating or rotary systems. Int Endod J 2014; 48:1001-6. [DOI: 10.1111/iej.12398] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 10/10/2014] [Indexed: 11/29/2022]
Affiliation(s)
- S. Busquim
- Postgraduate Program in Endodontics; School of Dentistry; University of Sao Paulo; Sao Paulo Brazil
| | - R. S. Cunha
- Department of Restorative Dentistry; College of Dentistry; University of Manitoba; Winnipeg MB Canada
| | - L. Freire
- Postgraduate Program in Endodontics; School of Dentistry; University of Sao Paulo; Sao Paulo Brazil
| | - G. Gavini
- Division of Endodontics; Department of Restorative Dentistry; School of Dentistry; University of Sao Paulo; Sao Paulo Brazil
| | - M. E. Machado
- Division of Endodontics; Department of Restorative Dentistry; School of Dentistry; University of Sao Paulo; Sao Paulo Brazil
| | - M. Santos
- Division of Endodontics; Department of Restorative Dentistry; School of Dentistry; University of Sao Paulo; Sao Paulo Brazil
| |
Collapse
|
42
|
Metzger Z. The self-adjusting file (SAF) system: An evidence-based update. J Conserv Dent 2014; 17:401-19. [PMID: 25298639 PMCID: PMC4174698 DOI: 10.4103/0972-0707.139820] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 08/01/2014] [Accepted: 08/04/2014] [Indexed: 11/04/2022] Open
Abstract
Current rotary file systems are effective tools. Nevertheless, they have two main shortcomings: They are unable to effectively clean and shape oval canals and depend too much on the irrigant to do the cleaning, which is an unrealistic illusionThey may jeopardize the long-term survival of the tooth via unnecessary, excessive removal of sound dentin and creation of micro-cracks in the remaining root dentin. The new Self-adjusting File (SAF) technology uses a hollow, compressible NiTi file, with no central metal core, through which a continuous flow of irrigant is provided throughout the procedure. The SAF technology allows for effective cleaning of all root canals including oval canals, thus allowing for the effective disinfection and obturation of all canal morphologies. This technology uses a new concept of cleaning and shaping in which a uniform layer of dentin is removed from around the entire perimeter of the root canal, thus avoiding unnecessary excessive removal of sound dentin. Furthermore, the mode of action used by this file system does not apply the machining of all root canals to a circular bore, as do all other rotary file systems, and does not cause micro-cracks in the remaining root dentin. The new SAF technology allows for a new concept in cleaning and shaping root canals: Minimally Invasive 3D Endodontics.
Collapse
Affiliation(s)
- Zvi Metzger
- Department of Endodontology, School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
43
|
Metzger Z, Solomonov M, Kfir A. The role of mechanical instrumentation in the cleaning of root canals. ACTA ACUST UNITED AC 2013. [DOI: 10.1111/etp.12048] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
44
|
Koçak S, Koçak MM, Sağlam BC, Türker SA, Sağsen B, Er Ö. Apical Extrusion of Debris Using Self-Adjusting File, Reciprocating Single-file, and 2 Rotary Instrumentation Systems. J Endod 2013; 39:1278-80. [DOI: 10.1016/j.joen.2013.06.013] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 05/14/2013] [Accepted: 06/29/2013] [Indexed: 10/26/2022]
|
45
|
De-Deus G, Marins J, Neves ADA, Reis C, Fidel S, Versiani MA, Alves H, Lopes RT, Paciornik S. Assessing accumulated hard-tissue debris using micro-computed tomography and free software for image processing and analysis. J Endod 2013; 40:271-6. [PMID: 24461417 DOI: 10.1016/j.joen.2013.07.025] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 07/23/2013] [Accepted: 07/29/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The accumulation of debris occurs after root canal preparation procedures specifically in fins, isthmus, irregularities, and ramifications. The aim of this study was to present a step-by-step description of a new method used to longitudinally identify, measure, and 3-dimensionally map the accumulation of hard-tissue debris inside the root canal after biomechanical preparation using free software for image processing and analysis. METHODS Three mandibular molars presenting the mesial root with a large isthmus width and a type II Vertucci's canal configuration were selected and scanned. The specimens were assigned to 1 of 3 experimental approaches: (1) 5.25% sodium hypochlorite + 17% EDTA, (2) bidistilled water, and (3) no irrigation. After root canal preparation, high-resolution scans of the teeth were accomplished, and free software packages were used to register and quantify the amount of accumulated hard-tissue debris in either canal space or isthmus areas. RESULTS Canal preparation without irrigation resulted in 34.6% of its volume filled with hard-tissue debris, whereas the use of bidistilled water or NaOCl followed by EDTA showed a reduction in the percentage volume of debris to 16% and 11.3%, respectively. The closer the distance to the isthmus area was the larger the amount of accumulated debris regardless of the irrigating protocol used. CONCLUSIONS Through the present method, it was possible to calculate the volume of hard-tissue debris in the isthmuses and in the root canal space. Free-software packages used for image reconstruction, registering, and analysis have shown to be promising for end-user application.
Collapse
Affiliation(s)
- Gustavo De-Deus
- Department of Endodontics, Grande Rio University, Rio de Janeiro State University, Rio de Janeiro, Brazil.
| | - Juliana Marins
- Department of Dental Clinics, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Aline de Almeida Neves
- Department of Endodontics, Grande Rio University, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Claudia Reis
- Department of Dental Clinics, University of Espirito Santo, Espirito Santo, Brazil
| | - Sandra Fidel
- Department of Dental Clinics, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Marco A Versiani
- Department of Restorative Dentistry, Dental School of Ribeirao Preto, University of São Paulo, São Paulo, Brazil
| | - Haimon Alves
- Nuclear Engineering Program, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ricardo Tadeu Lopes
- Nuclear Engineering Program, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | |
Collapse
|
46
|
Elsherief SM, Zayet MK, Hamouda IM. Cone-beam computed tomography analysis of curved root canals after mechanical preparation with three nickel-titanium rotary instruments. J Biomed Res 2013; 27:326-35. [PMID: 23885273 PMCID: PMC3721042 DOI: 10.7555/jbr.27.20130008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 02/24/2013] [Accepted: 03/16/2013] [Indexed: 11/30/2022] Open
Abstract
Cone beam computed tomography is a 3-dimensional high resolution imaging method. The purpose of this study was to compare the effects of 3 different NiTi rotary instruments used to prepare curved root canals on the final shape of the curved canals and total amount of root canal transportation by using cone-beam computed tomography. A total of 81 mesial root canals from 42 extracted human mandibular molars, with a curvature ranging from 15 to 45 degrees, were selected. Canals were randomly divided into 3 groups of 27 each. After preparation with Protaper, Revo-S and Hero Shaper, the amount of transportation and centering ability that occurred were assessed by using cone beam computed tomography. Utilizing pre- and post-instrumentation radiographs, straightening of the canal curvatures was determined with a computer image analysis program. Canals were metrically assessed for changes (surface area, changes in curvature and transportation) during canal preparation by using software SimPlant; instrument failures were also recorded. Mean total widths and outer and inner width measurements were determined on each central canal path and differences were statistically analyzed. The results showed that all instruments maintained the original canal curvature well with no significant differences between the different files (P = 0.226). During preparation there was failure of only one file (the protaper group). In conclusion, under the conditions of this study, all instruments maintained the original canal curvature well and were safe to use. Areas of uninstrumented root canal wall were left in all regions using the various systems.
Collapse
Affiliation(s)
- Samia M. Elsherief
- Department of Endodontics, Faculty of Oral and Dental Medicine, Cairo University, Cairo 65239, Egypt;
- Department of Endodontics, Faculty of Dentistry, Umm Al Qura University, Makkah, Saudi Arabia;
| | - Mohamed K. Zayet
- Lecturer of Radiology, Faculty of Oral and Dental Medicine, Cairo University, Cairo 65239, Egypt;
| | - Ibrahim M. Hamouda
- Department of Dental Biomaterials, Faculty of Dentistry, Mansoura University, Mansoura 35516, Egypt;
- Conservative Dentistry Department, Faculty of Dentistry, Umm Al Qura University, Makkah 715, Saudi Arabia.
| |
Collapse
|
47
|
Self-Adjusting File Cleaning-Shaping-Irrigation System Improves Root-filling Bond Strength. J Endod 2013; 39:254-7. [DOI: 10.1016/j.joen.2012.10.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 10/10/2012] [Accepted: 10/18/2012] [Indexed: 11/20/2022]
|
48
|
De-Deus G, Barino B, Marins J, Magalhães K, Thuanne E, Kfir A. Self-Adjusting File Cleaning-Shaping-Irrigation System Optimizes the Filling of Oval-shaped Canals with Thermoplasticized Gutta-percha. J Endod 2012; 38:846-9. [DOI: 10.1016/j.joen.2012.02.027] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 02/24/2012] [Accepted: 02/24/2012] [Indexed: 11/27/2022]
|
49
|
|