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Ginjeira A, Neto F, Behdad S, Farinha I, Gonçalves N, Martins JNR, Pires M, Rito Pereira M, Vasconcelos I, Duarte I. Influence of root shape on canal complexity at the mandibular molar apical surgical resection level: A micro-CT study. Arch Oral Biol 2024; 164:105983. [PMID: 38718467 DOI: 10.1016/j.archoralbio.2024.105983] [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: 10/03/2023] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 06/06/2024]
Abstract
OBJECTIVES This study aimed to investigate the relationship between the aspect ratios of mandibular molar roots at the apical 3-mm level and their root canal complexity. DESIGN This study used micro-CT imaging to analyze 163 two-rooted mandibular molars. The aspect ratios of the roots at the apical 3-mm level were categorized as "< 2.75" or "≥ 2.75" (mesial) and "< 1.75" or "≥ 1.75" (distal). A two-dimensional (2D) analysis focused on four apical axial cross-section levels to determine the presence of main and accessory canals and isthmus. Additionally, a three-dimensional (3D) assessment of the apical 4-mm of both roots examined main and accessory canals, apical foramina, apical deltas, and middle mesial canals. RESULTS Mesial roots with aspect ratios ≥ 2.75 showed a higher number of main canals at all levels compared to those with aspect ratios < 2.75 at the 3-mm level. Additionally, the ≥ 2.75 group exhibited more accessory canals and a higher average number of accessory canals. The 3D assessment confirmed significantly more accessory canals and apical foramina in the ≥ 2.75 group. The prevalence of roots with apical deltas was nearly double in the ≥ 2.75 group, and middle mesial canals were exclusively found in this group. In the distal root, the ≥ 1.75 group showed a significantly higher number of main canals at all axial levels. No significant differences were observed between groups in terms of accessory canals, apical foramina, or deltas. CONCLUSIONS A higher root aspect ratio is related to higher anatomical complexity.
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Affiliation(s)
- António Ginjeira
- Faculdade de Medicina Dentária, Universidade de Lisboa, Rua Professora Teresa Ambrósio, 1600-277 Lisboa, Portugal; Grupo de Investigação em Bioquimica e Biologia Oral, Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), Faculdade de Medicina Dentária, Universidade de Lisboa, Rua Professora Teresa Ambrósio, 1600-277 Lisboa, Portugal
| | - Filipa Neto
- Faculdade de Medicina Dentária, Universidade de Lisboa, Rua Professora Teresa Ambrósio, 1600-277 Lisboa, Portugal
| | - Shirin Behdad
- Faculdade de Medicina Dentária, Universidade de Lisboa, Rua Professora Teresa Ambrósio, 1600-277 Lisboa, Portugal
| | - Inês Farinha
- Faculdade de Medicina Dentária, Universidade de Lisboa, Rua Professora Teresa Ambrósio, 1600-277 Lisboa, Portugal
| | - Nuno Gonçalves
- Faculdade de Medicina Dentária, Universidade de Lisboa, Rua Professora Teresa Ambrósio, 1600-277 Lisboa, Portugal
| | - Jorge N R Martins
- Faculdade de Medicina Dentária, Universidade de Lisboa, Rua Professora Teresa Ambrósio, 1600-277 Lisboa, Portugal; Grupo de Investigação em Bioquimica e Biologia Oral, Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), Faculdade de Medicina Dentária, Universidade de Lisboa, Rua Professora Teresa Ambrósio, 1600-277 Lisboa, Portugal; Centro de Estudo de Medicina Dentária Baseada na Evidência (CEMDBE) - Cochrane Portugal, Faculdade de Medicina Dentária, Universidade de Lisboa, Rua Professora Teresa Ambrósio, 1600-277 Lisboa, Portugal; LIBPhys-FCT UID/FIS/04559/2013 (https://doi.org/10.54499/UIDB/04559/2020), Faculdade de Medicina Dentária, Universidade de Lisboa, Rua Professora Teresa Ambrósio, 1600-277 Lisboa, Portugal
| | - Mariana Pires
- Faculdade de Medicina Dentária, Universidade de Lisboa, Rua Professora Teresa Ambrósio, 1600-277 Lisboa, Portugal.
| | - Mário Rito Pereira
- Faculdade de Medicina Dentária, Universidade de Lisboa, Rua Professora Teresa Ambrósio, 1600-277 Lisboa, Portugal
| | - Isabel Vasconcelos
- Faculdade de Medicina Dentária, Universidade de Lisboa, Rua Professora Teresa Ambrósio, 1600-277 Lisboa, Portugal; Center for Rapid and Sustainable Product Development, Polytechnic Institute of Leiria, Rua de Portugal, 2430-028 Marinha Grande, Portugal
| | - Isabel Duarte
- TEMA - Centre for Mechanical Technology and Automation, Department of Mechanical Engineering, University of Aveiro, 3810-193 Aveiro, Portugal; LASI - Intelligent Systems Associate Laboratory, Guimarães, Portugal
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Wagih M, Hassanien E, Nagy M. Sealing Ability and Adaptability of Nano Mineral Trioxide Aggregate as a Root-End Filling Material. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.10080] [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: Comparison between Nano MTA & MTA as a root-end filling materials regarding adaptability and sealing ability.
Materials and Methods: Forty extracted human maxillary incisors with straight roots were used. After root canals preparation and obturation, the apical 3 mm of each root was resected perpendicular to the long axis of the tooth. Root end cavities were prepared to a depth of 3mm parallel to the long axis of the tooth. The teeth were randomly divided into two main equal groups of 20 samples each according to the root-end filling material used either MTA or Nano MTA. Ten samples from each group were sectioned longitudinally into two equal halves to measure the sealing ability and another ten samples from each group were sectioned transversally to obtain 1 mm thick section to measure the adaptability of both materials. All samples were photographed under the SEM at three different magnifications (×1000). The gap thickness between the root end filling material and the retro cavity dentine walls were measured at seven selected points at the material-dentine interface in micrometers (µm).
Results: Nano MTA and MTA showed no statistically significant difference in the gap thickness between dentin-material interface in both longitudinal and transverse sections. Regarding the sealing ability, the mean value in MTA was (3.27±0.77), while the mean in Nano-MTA was (3.15±0.71). Regarding the adaptability, the mean value in MTA was (2.46±0.60), while the mean in Nano-MTA was (2.05±0.712). Both materials showed good sealing ability and good adaptation to the dentinal wall.
Conclusion: Nano MTA revealed good sealing ability and adaptability comparable to MTA when used as a retrograde filling material.
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Setzer FC, Kratchman SI. Present Status and Future Directions - Surgical Endodontics. Int Endod J 2022; 55 Suppl 4:1020-1058. [PMID: 35670053 DOI: 10.1111/iej.13783] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022]
Abstract
Endodontic surgery encompasses several procedures for the treatment of teeth with a history of failed root canal treatment, such as root-end surgery, crown- and root resections, surgical perforation repair, and intentional replantation. Endodontic microsurgery is the evolution of the traditional apicoectomy techniques and incorporates high magnification, ultrasonic root-end preparation and root-end filling with biocompatible filling materials. Modern endodontic surgery uses the dental operating microscope, incorporates cone-beam computed tomography (CBCT) for preoperative diagnosis and treatment planning, and has adopted piezoelectric approaches to osteotomy and root manipulation. Crown- and root resection techniques have benefitted from the same technological advances. This review focuses on the current state of root-end surgery by comparing the techniques and materials applied during endodontic microsurgery to the most widely used earlier methods and materials. The most recent additions to the clinical protocol and technical improvements are discussed, and an outlook on future directions is given. While non-surgical retreatment remains the first choice to address most cases with a history of endodontic failure, modern endodontic microsurgery has become a predictable and minimally invasive alternative for the retention of natural teeth.
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Affiliation(s)
- F C Setzer
- Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - S I Kratchman
- Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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Ekici Ö, Aslantaş K, Kanık Ö, Keles A. Temperature and time variations during apical resection. Acta Odontol Scand 2021; 79:156-160. [PMID: 33245674 DOI: 10.1080/00016357.2020.1850855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this study was to investigate temperature and time variations during root-end resection. MATERIAL AND METHODS Sixty human premolars were selected. The root canals were enlarged up to ProTaper X3 rotary instrument. A thermocouple was placed into the root canal 1 mm behind the resection line. The teeth were randomly divided into six groups according to the apical resection method: steel bur, tungsten carbide bur, Lindeman bur, diamond bur, laser and ultrasonic surgical piezo with a diamond tip. The root ends were resected 3 mm away from the root apex. The temperature of the root dentine during resection was recorded as maximum temperature, mean temperature and temperature change. The time required for apicectomy was recorded for each group. The Kruskal-Wallis method was used to analyse the differences between temperature changes during apical resections. The significance level was set at 5%. RESULTS There was no significant difference between bur groups in terms of temperature increase. The maximum temperature in piezo surgery was significantly higher than the Lindeman, tungsten and steel burs (p < .001). In addition, the maximum temperature in laser surgery was higher than the Lindeman bur (p < .05). An increase in the temperature was mostly seen in piezo surgery and the least temperature change occurred in the Lindeman bur. Mean time stayed under 1 min in each group. CONCLUSIONS Although piezo caused the highest temperature increase, the measured temperature increase was within physiological limits in all tested techniques.
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Affiliation(s)
- Ömer Ekici
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Kubilay Aslantaş
- Department of Mechanical Engineering, Faculty of Technology, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Özgür Kanık
- Department of Restorative Dentistry, Faculty of Dentistry, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Ali Keles
- Department of Endodontics, Faculty of Dentistry, Ondokuz Mayıs University, Samsun, Turkey
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Keleş A, Keskin C, Alqawasmi R, Versiani MA. Micro-computed tomographic analysis of the mesial root of mandibular first molars with bifid apex. Arch Oral Biol 2020; 117:104792. [DOI: 10.1016/j.archoralbio.2020.104792] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 06/01/2020] [Accepted: 06/01/2020] [Indexed: 12/16/2022]
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Nepal M, Shubham S, Tripathi R, Khadka J, Kunwar D, Gautam V, Gautam N. Spectrophotometric analysis evaluating apical microleakage in retrograde filling using GIC, MTA and biodentine: an in-vitro study. BMC Oral Health 2020; 20:37. [PMID: 32013975 PMCID: PMC6998061 DOI: 10.1186/s12903-020-1025-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 01/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The present study compares the apical microleakage of three different root-end filling materials in which the retrograde cavity is prepared by two different burs. METHODS Eighty extracted single rooted maxillary and mandibular premolars were taken. Root canal treatment was completed. Apical 3 mm of all the teeth were resected with diamond disk. The tooth were divided into four groups with two subgroups for each group containing 10 tooth (N = 10) as: Group IA (Negative Control and IB (Positive Control); Group IIA and IIB: Prepared with round carbide bur and round diamond bur respectively, filled with GIC; Group IIIA and IIIB: Prepared with round carbide bur and round diamond bur respectively, filled with MTA; Group IVA and IVB: Prepared with round carbide bur and round diamond bur, filled with Biodentine. After applying two coats of nail varnish leaving apical 3 mm (except for negative control group) all teeth were immersed in 2% methylene blue for 3 days and again in 65% nitric acid for next 3 days for extraction of dye. The obtained solution was then transferred to eppendorf tube and centrifuged in microcentrifuges at 14,000 revolution per minutes (RPM) for 5 min. Optical density or absorbance of the supernatant solution was measured with UV spectrophotometer at 550 nm. RESULTS The absorbance of the supernatant solution after dye extraction is decreasing in the order of positive control> GIC > MTA > Biodentine> negative control group. The significant difference was observed between GIC and MTA (p = 0.0001) and GIC and Biodentine (p = 0.0001) with two different burs but statistically non-significant difference was observed between MTA and Biodentine with Carbide bur (p = 0.127) and Diamond bur (p = 0.496) respectively. CONCLUSIONS Within the limitations of the present study, it can be concluded that Biodentine and MTA showed less microleakage as compared to GIC. There is no significant difference between mean microleakage of MTA and Biodentine. However, the mean OD of the Biodentine was least of all evaluated materials. Preparation of the root-end using round carbide bur as well as round diamond burs showed comparable microleakage for all three filling materials.
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Affiliation(s)
- Manisha Nepal
- Department of Conservative Dentistry and Endodontics, Universal College of Medical Sciences, Bhairahawa, Nepal.
| | - Snigdha Shubham
- Department of Conservative Dentistry and Endodontics, Universal College of Medical Sciences, Bhairahawa, Nepal
| | - Rupam Tripathi
- Department of Conservative Dentistry and Endodontics, Universal College of Medical Sciences, Bhairahawa, Nepal
| | - Jwolan Khadka
- Department of Conservative Dentistry and Endodontics, KIST Medical College, Lalitpur, Nepal
| | - Deepa Kunwar
- Department of Conservative Dentistry and Endodontics, Gandaki Medical College, Pokhara, Nepal
| | - Vanita Gautam
- Department of Conservative Dentistry and Endodontics, Universal College of Medical Sciences, Bhairahawa, Nepal
| | - Narayan Gautam
- Department of Biochemistry, Universal College of Medical Sciences, Bhairahawa, Nepal
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Ordinola-Zapata R, Martins JNR, Niemczyk S, Bramante CM. Apical root canal anatomy in the mesiobuccal root of maxillary first molars: influence of root apical shape and prevalence of apical foramina - a micro-CT study. Int Endod J 2019; 52:1218-1227. [PMID: 30849181 DOI: 10.1111/iej.13109] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 03/05/2019] [Indexed: 11/28/2022]
Abstract
AIM To determine whether a relationship exists between the apical shape of roots and root canal system complexity by performing a micro-computed tomography analysis. METHODOLOGY One hundred extracted permanent maxillary first molars were scanned using a micro-computed tomography device at 19.6 μm voxel size. Two groups of mesiobuccal roots were formed according to the root aspect ratio value in the apical 3-mm cross-sectional level ('<2 and ≥ 2.00'). Data were recorded regarding the number and presence of accessory canals and their location, isthmus, presence of the mesiobuccal canal and dentine thickness. Depending on the analysed variable, Mann-Whitney U test and Z-test for proportions were used to compare groups. The significant level was set at 5%. RESULTS Mesiobuccal roots with an aspect ratio ≥ 2.00 at the apical 3-mm cross-sectional level had higher percentages of accessory canals, apical foramina and MB2 root canals in the apical 3 mm. The vertical average distance from the accessory foramina and origin from the anatomic apex was 1.40 and 2.19 mm, respectively. Overall, 21.8% of the accessory canals had their origin coronal to a 3-mm root resection line. There was no difference between the groups regarding dentine thickness. CONCLUSION The shape of the apical 3 mm of maxillary first molar mesiobuccal roots was a predictive factor for the presence of complex root canal systems. Roots with a lower aspect ratio had less complex apical anatomy.
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Affiliation(s)
- R Ordinola-Zapata
- Department of Endodontics, Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil.,Division of Endodontics, University of Minnesota School of Dentistry, Minneapolis, MN, USA
| | - J N R Martins
- Department of Endodontics, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal
| | - S Niemczyk
- Bender Division of Endodontics, Albert Einstein Medical Center, Philadelphia, PA, USA
| | - C M Bramante
- Department of Endodontics, Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil
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Abstract
A better understanding of endodontic disease and the causes of treatment failure has refined the role of surgery in endodontics. The advent of newer materials, advances in surgical armamentarium and techniques have also led to an improved endodontic surgical outcome. The aim of this article is to provide a contemporary and up-to-date overview of endodontic surgery. It will focus primarily on the procedures most commonly performed in endodontic surgery.
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Affiliation(s)
- B S Chong
- Professor/Honorary Consultant in Restorative Dentistry, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London
| | - J S Rhodes
- Specialist in Endodontics, Poole, Dorset
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Yadav SS, Shah N, Naseem A, Roy TS, Sood S. Effect of “Apical Clearing” and “Apical Foramen Widening” on Apical Ramifications and Bacterial Load in Root Canals. THE BULLETIN OF TOKYO DENTAL COLLEGE 2014; 55:67-75. [DOI: 10.2209/tdcpublication.55.67] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Özkurt Z, Baybora Kayahan M, Kazazoğlu E. In vitro comparison of fracture strength of experimental hollow and solid design zirconia dowels. J Prosthodont 2012; 21:385-8. [PMID: 22469214 DOI: 10.1111/j.1532-849x.2012.00846.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the fracture strength of experimental hollow and solid design zirconia dowels. MATERIALS AND METHODS Three types of dowels (fiber-reinforced composite [FRC], hollow design, and solid design zirconia dowels) were tested in the study (n = 10). A three-point bending method was conducted, and a load was applied until fracture. The values were recorded as Newtons (N) and then converted to megapascals (MPa) according to the diameter of the dowels. Statistical analyses were performed using one-way ANOVA and Tukey HSD tests. The significance was set at p < 0.05. RESULTS The mean fracture strength of the hollow design zirconia dowels was significantly higher (960.72 MPa) than solid zirconia dowels (741.78 MPa) and FRC dowels (687.64 MPa) (p < 0.05). CONCLUSIONS The hollow design zirconia dowel seems to have sufficient fracture strength for anterior restorations. This design may be beneficial to access the apical region when retreatment is necessary, without any dowel-removing procedure.
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Affiliation(s)
- Zeynep Özkurt
- Department of Prosthodontics, Yeditepe University Faculty of Dentistry, Istanbul, Turkey.
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Kontakiotis EG, Palamidakis FD, Farmakis ETR, Tzanetakis GN. Comparison of isthmus detection methods in the apical third of mesial roots of maxillary and mandibular first molars: macroscopic observation versus operating microscope. Braz Dent J 2011; 21:428-31. [PMID: 21180799 DOI: 10.1590/s0103-64402010000500009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The aims of this study were to assess the presence and the frequency of isthmuses in the mesial roots of the maxillary and mandibular first molars (at two resection levels from the apex), and to compare the findings obtained by macroscopic observation (MO) and operating microscope (OM). Forty maxillary and 40 mandibular mesial roots were observed at 3 and 5 mm from the apex initially macroscopically and then with the use of an OM. The presence of an isthmus and the number of root canals detected were recorded. Data were analyzed statistically by Fisher's exact test for isthmus evaluation and Wilcoxon signed rank-test for number of root canals at a confidence interval of 95%. Comparison between MO and OM regarding the number of roots with isthmuses provided the following results: Mandibular group: At 3 mm level: MO 19 ?s. OM 27; at 5 mm level: MO 31 ?s. OM 32. Maxillary group: At 3 mm level: MO 9 ?s. OM 14; at 5 mm level: MO 19 ?s. OM 21. Significant differences (p<0.05) were found concerning the accuracy of the isthmus detection methods at both resection levels (3 and 5 mm) and both types of roots, as well as for the number of the canals inspected under the OM between the two resection levels of the mesial roots of the maxillary first molars. Under the tested conditions, OM increased the diagnostic accuracy of isthmus detection at both resection levels and root types.
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Fabiani C, Franco V, Covello F, Brambilla E, Gagliani MM. Removal of surgical smear layer. J Endod 2011; 37:836-8. [PMID: 21787500 DOI: 10.1016/j.joen.2011.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2010] [Revised: 02/28/2011] [Accepted: 03/03/2011] [Indexed: 11/30/2022]
Abstract
INTRODUCTION During apicoectomy and retrograde cavity preparation, a smear layer, which contains microorganisms and necrotic pulpal tissues, is formed on the dentinal surfaces cut by the instruments. Bacteria can survive and proliferate inside or below the smear layer. The purpose of this study was to evaluate in vitro two different procedures for the removal of the smear layer in retrocavities prepared with ultrasonic retrotips. METHODS Twenty-eight single-rooted teeth were cleaned, shaped, and obturated with gutta-percha and sealer. The apical 3 mm of each root were cut with a carbide bur, and retrograde cavities were prepared with ProUltra ultrasonic retrotips (Maillefer Dentsply, Baillagues, Switzerland) at a depth of 3 mm. Teeth in group A were treated with a gel of 35% orthophosphoric acid for 15 seconds, and teeth in group B were treated with a gel of 24% EDTA at a neutral pH for 2 minutes. The samples were prepared for scanning electron microscopic observation and scored for the presence of the smear layer on the retrocavity walls. RESULTS Eighty percent of the teeth in group A showed an optimal degree of cleanliness of the walls, with dentinal tubules completely open. The majority of analyzed samples coming from group B showed dentinal tubules covered with the smear layer. CONCLUSIONS The analysis of the samples showed that orthophosphoric acid is more effective than EDTA in removing surgical smear layer even with less time of action.
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Bhuva B, Barnes JJ, Patel S. The use of limited cone beam computed tomography in the diagnosis and management of a case of perforating internal root resorption. Int Endod J 2011; 44:777-86. [DOI: 10.1111/j.1365-2591.2011.01870.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Affiliation(s)
- Bill Kahler
- University of Queensland Dental School, Brisbane, Queensland, Australia.
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