Apical Dimension of Root Canal Clinically Assessed with and without Periapical Lesions

Ex vivo evaluation of the accuracy of four electronic foraminal locators

Background

To evaluate the accuracy of four different Electronic Foraminal Locators (EFLs): Root ZX II (J. Morita, Tokyo, Japan), Romiapex A15 (Romidan, Kiryat-Ono, Israel), FinePex (Schuster, Porto Alegre, Brazil), and VDW Gold (VDW, Munich, Germany), in determining root canal length.

Material and Methods

Twenty-seven human single-rooted teeth had their crowns sectioned at the cementoenamel junction, and the actual length of the tooth was obtained by visualizing with an operative microscope a #15 file placed adjacent to the apical foramen. The teeth were instrumented with R25 and R40 files, and at the end of each instrumentation, measurements of the lengths of the root canals were made with #25 and #40 files. The data were statistically analyzed by ANOVA and chi-square tests and were considered significant when P<0.05. All devices showed a tendency to underestimate measurements by 0.25 mm diameter.

Results

The mean accuracy of the Root ZX II appliance was statistically lower than the other EFLs (P<0.001). For the 0.40 mm diameter, the mean accuracy of the Romiapex A15 appliance was statistically higher than the other LEFs (P<0.001). However, when the diameter was 0.40 mm, only the Romiapex A15 device tended to overmeasure. Regarding the acceptable limits of variation, it was observed that the devices showed similar efficiency in determining odontometry (P>0.05), both with diameters of 0.25 mm and 0.40 mm.

Conclusions

It was concluded that the devices presented similar and adequate efficacy when observing the limits of acceptable measurements. It was observed that increasing the apical diameter did not influence the accuracy of EFLs in determining root canal lengths. Key words:Endodontics, working length, electronic foraminal locators, endodontic treatment.

Clinical determination of anatomical diameter in different dental groups correlating them with gender, age, tooth/canal and pulpoperiradicular diagnosis: an observational clinical study

The aim of this observational clinical study (OCS) was to determine the clinical anatomical diameter (CAD) in several dental groups, thus correlating them with gender, age, tooth/canal and pulpoperiradicular diagnosis. Three-hundred fifty-nine teeth/584 vital or necrotic root canals from patients of both genders and different ages composed the sample. After performing the necessary previous procedures, K-Flexofiles were used to determine the CAD. Then, the gender and age of the patients, as well as the pulpoperiradicular diagnosis of the teeth were tabulated to conduct the statistical analysis (p < 0.05). Of the 359 teeth/584 root canals evaluated, 208/342 were from women (mean age 38.85 ± 13.42 years) and 151/242 were from men (mean age 45.41 ± 14.90 years). Statistically significant differences between the CAD means of root canals from women and men were not identified (p = 0.411). The analysis of the correlation between the CAD and age also showed a total independence (p = 0.271). Teeth with pulp necrosis and asymptomatic apical periodontitis diagnosed radiographically (TPNAAPDR) had a significantly larger CAD mean than teeth with pulp necrosis and no asymptomatic apical periodontitis diagnosed radiographically (TPNNAAPDR) and teeth with vital pulp and normal apical tissues (TVPNAT) (p = 0.0297); and the last two did not differ statistically (p > 0.05). The largest CAD mean was observed in single canals of maxillary central incisors. The lowest values of this variable were identified in the mesiobuccal and mesial canals of maxillary and mandibular first molars, respectively. The CAD of the root canals was influenced only by the root canal/tooth and pulpoperiradicular diagnosis.

Clinical study of antimicrobial efficacy of laser ablation therapy with indocyanine green in root canal treatment

INTRODUCTION

Laser ablation (LA) therapy is used as an adjunct to endodontic treatment to improve microbial reduction. However, studies evaluating the impact of LA with Indocyanine Green (ICG) are scarce. This study aimed to evaluate the antimicrobial efficacy of LA therapy with ICG in root canal treatment.

METHODS

Sixty patients with periapical lesions in teeth with a single canal, absence of pain, edema, and previous treatment were selected. Patients were randomly allocated into 3 groups according to apical sizes used (n = 20): 25/04; 30/04 and 35/04 were the final sizes used. In half the patients of each group, 2.5% sodium hypochlorite was used as an irrigating solution; and in the other half, saline solution was used. After instrumentation, all patients received LA therapy with ICG. Root canal sampling was performed prior to (S1) and after (S2) root canal instrumentation, and immediately after LA therapy with ICG (S3). Colony-forming units (CFU) were counted and statistical tests were applied (p <0.05).

RESULTS

There was a significant reduction in CFU from S1 to S2 in all treatment protocols (p<0.05). 2.5% sodium hypochlorite as an irrigating solution showed a greater microbial reduction compared to saline solution (p<0.05). LA therapy with ICG further reduced the microbial counts significantly (S2 to S3, S1 to S3) whether sodium hypochlorite or saline was used (p<0.05).

CONCLUSIONS

LA therapy with ICG significantly increased microbial reduction in root canals, regardless of instrumentation sizes or irrigation solution used.

Effectiveness of a reciprocating single file, single cone endodontic treatment approach: a randomized controlled pragmatic clinical trial

OBJECTIVES

To compare the root filling quality, the sealer extrusion, and the healing rates of apical lesions addressed via two endodontic treatment approaches. The hypothesis tested was that both techniques present similar apical periodontitis healing results.

MATERIALS AND METHODS

This study was a parallel-design, pragmatic, and randomized clinical trial. One hundred twenty anterior teeth with necrotic pulps and apical periodontitis were randomly allocated to be either instrumented with hand files and obturated with the lateral compaction technique or instrumented with a single file in a reciprocating movement and obturated with a single-cone technique. The root canal filling quality, the occurrence of sealer extrusion, and apical periodontitis healing were the outcomes of interest. Data were analyzed through chi-square analysis, and the odds ratio for healing was adjusted using a logistic regression model (α = 0.05).

RESULTS

No significant differences were observed between the endodontic techniques regarding the root filling quality or sealer extrusion. Six months after treatment, both endodontic techniques presented equivalent results regarding apical periodontitis healing. The healing rate was affected only by the periapical status at baseline.

CONCLUSIONS

The obturation of the root canal of the anterior teeth using reciprocating file-matched single cones presented a similar quality to that obtained with manual instrumentation followed by the lateral condensation technique. Similar healing rates of apical lesions were also observed.

CLINICAL RELEVANCE

For treating anterior teeth with apical periodontitis, a reciprocating single-file, single-treatment protocol was as effective as a traditional protocol combining hand instrumentation and the lateral compaction obturation technique.

Root ZX Electronic Foramen Locator: An Ex Vivo Study of Its Three Models' Precision and Reproducibility

Although Root ZX is considered the gold standard electronic foramen locator (EFL), two variations of this device were launched, however without different operating mechanisms. This investigation aims to evaluate the precision of Root ZX (RZX), Root ZX II (RII), and Root ZX Mini (RM) EFLs. After access cavity preparation, 32 mandibular single rooted human premolars had their real length measured with the aid of a #15 K-type manual file under magnification (25x). Electronic measurements were performed by the devices in an alternate order until the apical foramen was reached (0.0). Each measurement was performed with adjusted file to the real length of the teeth and verified with a digital caliper. The accuracy of the EFLs was 68.8% (RZX), 65.8% (RII), and 68.8% (RM), considering ±0.5 mm as a margin of tolerance. The mean errors of the devices were 0.37 ± 0.25 mm (RZX), 0.41 ± 0.34 mm (RII), and 0.32 ± 0.28 mm (RM). ANOVA and Tukey test were applied to analyze the obtained data, which showed that there were no statistically significant differences among the locators (P > .05). It can be concluded that the three tested devices demonstrated precise measurements of the real length of the canal without performance differences among them.