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Ajina MA, Shah PK, Chong BS. Critical analysis of research methods and experimental models to study removal of root filling materials. Int Endod J 2021; 55 Suppl 1:119-152. [PMID: 34674279 DOI: 10.1111/iej.13650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 12/14/2022]
Abstract
Despite enjoying high favourable outcome rates, root canal treatment is not always successful. Root canal retreatment is a widely practised option for managing a non-healing root treated tooth. A basic distinction between retreatment and initial treatment is the requirement to remove the existing root filling material occupying the root canal space. Only then, can the technical deficiencies and possible causes of failure be addressed. Hence, the successful removal of the root filling material is critical to achieving the objectives of retreatment. Many different materials and techniques have been used for root canal filling, which have been documented in a plethora of studies; these are mainly laboratory studies investigating the removal of root filling materials. To help guide future research, which may then better inform clinical practice in relation to retreatment procedures, the focus of this narrative review is on the research methods and experimental models employed to study the removal of root filling materials. The current available literature demonstrates great variation in the research methodologies used to study the removal of root filling material, including direct visualization by splitting tooth samples or clearing, three-dimensional radiographic imaging including using microcomputed tomography or cone-beam computed tomography, and a combination of these techniques. Depending on the research method employed, variation also exists in quantification of root filling material removal; these include measurements of surface area, volume or weight, and criteria-based (semi-quantitative) assessment. Experimental models, using human teeth or resin models, differ with respect to standardization techniques and replication of the clinical scenario including initial sample preparation, canal filling, allocation and technical aspects of retreatment procedures. Future models should replicate, as closely as possible, the clinical scenario. Currently, microcomputed tomography provides a highly detailed, non-invasive and non-destructive method of objectively assessing and quantifying root filling removal.
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Affiliation(s)
- Mahdi A Ajina
- Institute of Dentistry, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Pratik K Shah
- Institute of Dentistry, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Bun San Chong
- Institute of Dentistry, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
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Accuracy and Reliability of Intraoral Radiographs in Determining the Cleanliness of Root Canals after Endodontic Retreatment. Eur Endod J 2021; 2:1-5. [PMID: 33403328 PMCID: PMC7757945 DOI: 10.14744/eej.2017.17014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/05/2017] [Accepted: 05/30/2017] [Indexed: 11/20/2022] Open
Abstract
Objective: This study aimed to evaluate the accuracy and reliability of periapical radiographs obtained with two different projections in determining the cleanliness of root canals in endodontic retreatment using the sectioned roots as a gold standard. Methods: The amount of residual root-filling material after endodontic retreatment procedures in 42 roots was assessed in radiographs and in microscopic photographs of the sectioned roots by five observers. Furthermore, the cleanliness of 80 roots was assessed based on orthogonal and mesio-angulated radiographs. Four parameters were used for the evaluation of cleanliness. Wilcoxon signed-rank tests and percentage agreement calculations were used for comparisons between the radiographs and the gold-standard observations and between the orthogonal and mesio-angulated radiographs, respectively. Intra- and interobserver reproducibility was tested using Kappa statistics and intra-class correlation tests. The statistically significance level was 0.05. Results: In general, significantly more residual root-filling material was detected in the photographs of the split roots (gold standard) than in the radiographs. Comparing orthogonal and eccentric projections, only slight differences in cleanliness were found. The intraobserver reproducibility was fair to almost perfect for radiographs and microscopic photographs. For all parameters, the reproducibility was better for the radiographs than for the microscopic photographs. The interobserver variability ranged from fair to almost perfect agreement for the radiographs. Conclusion: The accuracy of periapical radiographs was poor in determining the cleanliness of root canals after endodontic retreatment, whereas the reliability of the radiographs was fair. A mesio-angulated projection did not contribute essentially to the detection of residual root-filling materials.
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Peroba Rezende Ramos AT, Fagundes Jordão-Basso KC, Porto TS, Kuga MC. Effect of irrigation protocol during post space preparation on the dentin adhesive interface: An in vitro study. J Prosthet Dent 2020; 125:324.e1-324.e9. [PMID: 33213888 DOI: 10.1016/j.prosdent.2020.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 01/04/2023]
Abstract
STATEMENT OF PROBLEM The post space must be prepared with techniques that do not interfere with the bond strength. These techniques are related to the availability of opened dentinal tubules and incidence of residue among the dentin, the adhesive, and the cement. Nevertheless, the effect of different irrigants during endodontic instrumentation is unclear. PURPOSE The purpose of this in vitro study was to assess the incidence of residue, the number of opened dentinal tubules, and the bond strength of the cementation system to root dentin of post space after 3 different irrigation protocols. MATERIAL AND METHODS The roots of bovine incisors were obturated, prepared to receive a fiber post, and divided into 3 groups as per the irrigation protocol: without irrigation, with alternating irrigation, and with continuous irrigation. Thirty roots (n=10) were evaluated by using scanning electron microscopy to assess the incidence of residue (×100 magnification) and the number of opened dentinal tubules (×2000 magnification). The fiber posts were cemented, and the remaining specimens (n=10) were subjected to pushout testing and failure mode evaluation. RESULTS All protocols presented a similar incidence of residue, regardless of the post space third (P>.05). The irrigation protocol without irrigation had the lowest number of opened dentinal tubules in the cervical and middle thirds (P<.05). The number of opened dentinal tubules was similar in all protocols in the apical third of the post space (P>.05). The irrigation protocol without irrigation had the lowest bond strength values in the cervical and middle thirds (P<.05). The irrigation protocol with continuous irrigation had the highest bond strength values in the apical third (P<.05). CONCLUSIONS Post space preparation without irrigation negatively affected the bond strength of the resin cementation system to root dentin.
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Affiliation(s)
| | | | - Thiago Soares Porto
- Assistant professor, Division of Restorative and Prosthetic Dentistry, College of Dentistry, The Ohio State University, Columbus, Ohio
| | - Milton Carlos Kuga
- Professor, Department of Restorative Dentistry, São Paulo State University (UNESP), Araraquara, Brazil
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CASTRO RFD, MELO JDSS, DIAS JUNIOR LCDL, SILVA EJNL, BRANDÃO JMDS. Evaluation of the efficacy of filling material removal and re-filling after different retreatment procedures. Braz Oral Res 2018; 32:e94. [PMID: 30231174 DOI: 10.1590/1807-3107bor-2018.vol32.0094] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 07/25/2018] [Indexed: 11/22/2022] Open
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Kok D, Da Rosa RA, Barreto MS, Busanello FH, Santini MF, Pereira JR, Só MVR. Penetrability of AH plus and MTA fillapex after endodontic treatment and retreatment: A confocal laser scanning microscopy study. Microsc Res Tech 2014; 77:467-71. [DOI: 10.1002/jemt.22371] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 03/31/2014] [Accepted: 04/04/2014] [Indexed: 11/10/2022]
Affiliation(s)
| | - Ricardo Abreu Da Rosa
- Conservative Dentistry Department; Federal University of Rio Grande do Sul; Porto Alegre RS Brazil
| | | | | | - Manuela Favarin Santini
- Conservative Dentistry Department; Federal University of Rio Grande do Sul; Porto Alegre RS Brazil
| | | | - Marcus ViníCius Reis Só
- Conservative Dentistry Department; Federal University of Rio Grande do Sul; Porto Alegre RS Brazil
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ASHEIBI F, QUALTROUGH AJ, MELLOR A, WITHERS PJ, LOWE T. Micro-CT evaluation of the effectiveness of the combined use of rotary and hand instrumentation in removal of Resilon. Dent Mater J 2014; 33:1-6. [DOI: 10.4012/dmj.2013-149] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Muller GG, Schonhofen AP, Mora PMPK, Grecca FS, So MVR, Bodanezi A. Efficacy of an Organic Solvent and Ultrasound for Filling Material Removal. Braz Dent J 2013; 24:585-90. [DOI: 10.1590/0103-6440201302252] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 10/17/2013] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to investigate whether a final rinse with Endosolv R® solvent and ultrasound resulted in cleaner root canal walls during endodontic retreatment. A total of 56 extracted premolar teeth were manually instrumented using a step-back flare technique and filled with gutta-percha and AH Plus sealer. After 9 months, the canals were retreated by removing the gutta-percha and sealer with ProTaper Universal Retreatment and rotary preparation with ProTaper Universal System up to an F5 file. As a final step, the teeth were randomly divided in 4 groups (n=14) and were subjected to passive ultrasonic irrigation (PUI) with either Endosolv R or distilled water. In the control groups, the irrigants were left undisturbed. Roots were cleaved and examined under scanning electron microscopy (SEM), and the amount of filling remnants on the canal walls was assessed by two calibrated examiners in a blinded fashion. Data were analyzed by the Kruskal-Wallis test and the Student-Newman-Keuls post hoc test (α=0.05). All groups presented filling debris in the three root canal thirds after retreatment. There were no significant differences between the groups or among the root canal thirds within each group (p>0.05). PUI with Endosolv R was not effective in the removal of filling debris from root canal walls.
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Vale MSD, Moreno MDS, Silva PMFD, Botelho TCF. Endodontic filling removal procedure: an ex vivo comparative study between two rotary techniques. Braz Oral Res 2013; 27:478-83. [DOI: 10.1590/s1806-83242013000600006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 07/31/2013] [Indexed: 11/21/2022] Open
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Rached-Junior FJA, Sousa-Neto MD, Souza-Gabriel AE, Duarte MAH, Silva-Sousa YTC. Impact of remaining zinc oxide-eugenol-based sealer on the bond strength of a resinous sealer to dentine after root canal retreatment. Int Endod J 2013; 47:463-9. [DOI: 10.1111/iej.12170] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 07/09/2013] [Indexed: 11/30/2022]
Affiliation(s)
| | - M. D. Sousa-Neto
- School of Dentistry of Ribeirão Preto; University of São Paulo; Ribeirão Preto Brazil
| | | | - M. A. H. Duarte
- School of Dentistry of Bauru; University of São Paulo; Bauru Brazil
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Rached-Júnior FA, Sousa-Neto MD, Bruniera JFB, Duarte MAH, Silva-Sousa YTC. Confocal microscopy assessment of filling material remaining on root canal walls after retreatment. Int Endod J 2013; 47:264-70. [PMID: 23895052 DOI: 10.1111/iej.12142] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 05/19/2013] [Indexed: 11/29/2022]
Abstract
AIM The percentage of Endofill remaining on canal walls after retreatment with different techniques was evaluated using confocal microscopy and qualitative analysis of the interface between the filling material/dentine. METHODOLOGY Sixty-four root canals of incisors were prepared with ProTaper, filled with gutta-percha and Endofill mixed with 0.1% rhodamine B. The roots were thermocycled and distributed into groups according to the method of evaluation: GI - direct viewing (DV) and GII - operating microscope (OM) and according to the removal technique: A) ProTaper retreatment (PR), B) PR/xylol, C) ultrasound and D) ultrasound/xylol. The root canals were then refilled with gutta-percha and AH Plus with 0.1% fluorescein and sectioned at 2, 4 and 6 mm from the apex. The percentage of remaining Endofill was analysed by confocal microscopy. Additionally, 16 roots were prepared with a ProTaper F5 instrument and were filled with Endofill + 0.1% rhodamine B/gutta-percha (negative control group) (n = 8), and the positive control group (n = 8) were filled with AH Plus with 0.1% fluorescein/gutta-percha. RESULTS Three-way anova demonstrated differences in the method of evaluation, removal techniques and their interaction (P < 0.05). OM (26.15 ± 12.16%) had a smaller percentage of remaining sealer than DV (32.77 ± 14.47%). The Tukey's test revealed that ultrasound/xylol (15.77 ± 7.15%) led to lower percentages of remaining sealer, significantly different from the PR group (35.25 ± 13.63%), PR/xylol (33.03 ± 11.64%) and ultrasound (33.79 ± 11.71%), which were similar (P > 0.05). Qualitative analysis detected that ultrasound had lower remaining Endofill than PR, particularly when combined with xylol. Operating microscope resulted in lower residual sealer, regardless of the removal technique. CONCLUSIONS None of the protocols was associated with complete removal of the filling material; however, the use of ultrasound/xylol under an OM provided better results.
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Affiliation(s)
- F A Rached-Júnior
- School of Dentistry, University of Ribeirão Preto, UNAERP Ribeirão Preto, SP, Brazil
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Kaptan F, Karapinar-Kazandag M, Kayahan MB, Bora T, Bayirli G. Potential of an Er:YAG Laser in the Removal of Calcium Hydroxide from Root Canals. Photomed Laser Surg 2012; 30:250-4. [DOI: 10.1089/pho.2011.3093] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Figen Kaptan
- Department of Endodontics, Faculty of Dentistry, Yeditepe University, Istanbul, Turkey
| | | | | | - Toygan Bora
- Private practice limited to endodontics, Istanbul, Turkey
| | - Gunduz Bayirli
- Department of Endodontics, Faculty of Dentistry, Yeditepe University, Istanbul, Turkey
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Só MVR, De Figueiredo JAP, Fachin EVF, Duarte MAH, Pereira JR, Kuga MC, Da Rosa RA. Clinical microscopic analysis of protaper retreatment system efficacy considering root canal thirds using three endodontic sealers. Microsc Res Tech 2012; 75:1233-6. [DOI: 10.1002/jemt.22054] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 03/15/2012] [Indexed: 11/07/2022]
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Marques da Silva B, Baratto-Filho F, Leonardi DP, Henrique Borges A, Volpato L, Branco Barletta F. Effectiveness of ProTaper, D-RaCe, and Mtwo retreatment files with and without supplementary instruments in the removal of root canal filling material. Int Endod J 2012; 45:927-32. [DOI: 10.1111/j.1365-2591.2012.02051.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Removal of gutta-percha/zinc-oxide-eugenol sealer or gutta-percha/epoxy resin sealer from severely curved canals: an in vitro study. Int J Dent 2011; 2011:541831. [PMID: 22145001 PMCID: PMC3227471 DOI: 10.1155/2011/541831] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2011] [Revised: 08/25/2011] [Accepted: 08/25/2011] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to compare the cleanliness of root canal walls after retreatment using two rotary retreatment files to hand instruments in severely curved canals obturated with gutta-percha and two different sealers. Single rooted mandibular premolars (n = 90) with root curvatures were instrumented and obturated with gutta-percha and an epoxy resin (Group 1, n = 45) or zinc oxide eugenol sealer (Group 2, n = 45). Following retreatment of the specimens (n = 15 ProTaper Universal Retreatment Files (Subgroup B) or R-Endo retreatment files (Subgroup C) after 1 month, split specimens were examined under a stereomicroscope and the percentage of remaining root filling material was statistically compared using one way ANOVA with Bonferroni adjustment for multiple comparisons (P = 0.05). The R-Endo system performed significantly better than the other two file systems (P < 0.05). None of the systems used in this study cleaned root canals thoroughly. The R-Endo system did provide cleaner walls when compared to the other instruments used. The type of root filling materials had an impact on the outcomes with all techniques.
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Fariniuk LF, Westphalen VPD, Silva-Neto UXD, Carneiro E, Baratto Filho F, Fidel SR, Fidel RAS. Efficacy of five rotary systems versus manual instrumentation during endodontic retreatment. Braz Dent J 2011; 22:294-8. [DOI: 10.1590/s0103-64402011000400006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Accepted: 03/28/2011] [Indexed: 11/22/2022] Open
Abstract
The purpose of this study was to evaluate the efficiency of ProFile, GT, ProTaper, Race and K3 rotary instruments compared with hand K-files for removal of gutta-percha during retreatment. Sixty mandibular premolars were instrumented with GT rotary files and filled by thermomechanical compaction of gutta-percha and AH Plus sealer. The teeth are randomly divided into 6 groups of 10 specimens each. The roots were split longitudinally, digital images were created using a flatbed scanner, and the areas with remaining filling material were demarcated using Image Tool 1.21 software. The results indicate that GT left significantly less (p<0.05) remaining filling material (1.18 ± 1.47) than hand (3.70 ± 3.16) and Hero instruments (2.99 ± 2.58). There was no statistically significant difference (p<0.05) among the others techniques: ProFile (1.99 ± 2.66), ProTaper (2.00 ± 1.99) and K3 (2.71 ± 2.87) when compared with GT. In conclusion, GT, ProFile, ProTaper and K3 were more effective in removing gutta-percha than manual and Hero instruments.
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