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Effect of Different Electroconductive Root Canal Irrigations on the Accuracy of Different Apex Locators: An In Vitro Comparative Study

Aim

An accurate working length (WL) estimation is fundamental to a successful endodontic therapy. The objective of this comparative in vitro research was to investigate the performance of iPex II and the Root ZX Mini electronic apex locators (EALs) in measuring root canal WL with different irrigant solutions and their relation to the electrical conductivity of irrigation solutions.

Materials and Methods

Seventy sound permanent lower premolar teeth, each with a single root and developed apices, were used. Under an X15 stereomicroscope, the real working length was determined with the aid of a #10 file. After that, teeth were placed into an alginate model, and the iPex II and Root ZX Mini were used for the detection of electronic working length with various irrigants. Seventy teeth were randomly distributed into seven groups, 10 per each group (group I: dry canal; group II: distilled water; group III: ozonated water; group IV: 5% sodium hypochlorite (NaOCl); group V: 2% chlorhexidine, group VI: 17% ethylenediaminetetraacetic acid (EDTA) solution, and group VII: 17% EDTA gel). The difference in WL was calculated by deducting real working length from its electronic working length. The study also evaluates the electrical conductivity of the seven endodontic irrigant solutions. The two-way analysis of variance (ANOVA) test was used for statistical analysis.

Results

Statistically, neither both types of EALs (P = 0.088) nor various irrigating solutions with varying electrical conductivities (P = 0.099) significantly affect the accuracy of EL estimation.

Conclusions

There were no significant differences between the accuracy of the Root ZX Mini and the iPex II. The accuracy of both apex locators is unaffected in the presence of various irrigation solutions with varying electrical conductivities in this research.

Comparative Evaluation of Accuracy of Different Apex Locators: Propex IQ, Raypex 6, Root ZX, and Apex ID with CBCT and Periapical Radiograph-In Vitro Study

OBJECTIVES

This study aimed to validate the accuracy of working length (WL) measurements obtained with the newly introduced Propex IQ apex locator and to compare it with the latest generations of other electronic apex locators, CBCT, and conventional periapical radiographs by using the actual WL measurements obtained by using an endodontics microscope as a reference.

MATERIALS AND METHODS

Thirty-five extracted single-rooted human mandibular first premolars with curvatures from 10° to 20° were selected according to the inclusion and exclusion criteria and cut at the cementoenamel junction to achieve a standard reference point for WL determination. The actual WL was obtained by inserting a size-15 k-file in the root canal until the tip of the file was visible under an endodontic microscope. The definitive WL was measured using Propex IQ (Dentsply Sirona), Raypex 6 (VDW Dental), Root ZX (Morita), and Apex ID (Kerr Dental). In addition, radiographic WL was obtained using periapical radiographs and CBCT. One-way ANOVA was used for comparisons of the WL values, with a p value < 0.05. The percentage of success of each method for determination of the definitive WL was assessed using cross-tabulation and chi-square tests.

RESULTS

CBCT radiographs and Propex IQ apex locator yielded the most accurate WL measurements in comparison with the actual WL measurements (p < 0.05). Raypex 6, Root ZX, and Apex ID yielded more accurate WL measurements than conventional periapical radiographs (p < 0.05). Periapical radiographs yielded the least accurate WL measurements in comparison with the actual WL values (p < 0.05).

CONCLUSIONS

Within the limitations of this study, the Propex IQ apex locator showed higher accuracy than Raypex 6, Root ZX, and Apex ID for WL determination in the root canal. Nevertheless, CBCT radiographs yielded the maximum accuracy for WL measurements.

Calcium Silicate-Based Sealers Do Not Reduce the Risk and Intensity of Postoperative Pain after Root Canal Treatment when Compared with Epoxy Resin-Based Sealers: A Systematic Review and Meta-Analysis

This review aims to evaluate whether root canal obturation with calcium silicate-based (CSB) sealers reduces the risk and intensity of endodontic postoperative pain when compared to epoxy resin-based (ERB) sealers. The review was registered at PROSPERO (CRD42020169255). Two independent reviewers conducted an electronic search in PubMed, Scopus, EMBASE, Web of Science, Cochrane Library and LILACS until November 2020 and included only randomized clinical trials with adult health participants undergoing root canal treatment. After selection, the JBI Critical Appraisal tool was used to assess the risk of bias. A fixed-effect meta-analysis was performed to summarize the results of pain risk and pain intensity at time intervals of 24 and 48 hours. Finally, the certainty of evidence was assessed using the GRADE approach. The search resulted in 1,206 records, of which five studies (n = 421 patients) met the eligibility criteria and presented moderate to low risk of bias. There was no significant difference between groups in the risk of pain in the first 24 hours (relative risk or RR = 0.83, 95% confidence interval or CI: 0.60, 1.16, I 2 =) or 48 hours (RR = 0.56, 95% CI: 0.26, 1.21, I 2 =). Silicate-based sealers led to lower pain intensity only at 48 hours (mean and standard deviation = 0.37, 95% CI: 0.69, 0.05). All analyses revealed low heterogeneity (I 2 < 25%). The evidence presented moderate level of certainty. Currently available evidence has shown that there is no difference between CSB and ERB sealers in the risk or intensity of postoperative pain.

A Review of Medicolegal Considerations of Endodontic Practice for General Dental Practitioners

Treating a live human being to their health has been considered as a noble profession since the ancient times. Doctors are duty bound by their professional ethics to provide the best treatment to their patients. Endodontics is the specialty branch of the dental science of saving natural teeth in the oral cavity. During endodontic procedures, a mishap can occur any time in a day-to-day practice and may be treated as negligence which in turn ends into some legal complications. To prevent and tackle such future medicolegal issues related to endodontic treatment, the knowledge of the legal aspect of such clinical situation is necessary.

Assessment of pain and dissolution of apically extruded sealers and their effect on the periradicular tissues

Aim:

This study aimed to evaluate the intensity of pain after unintentional extrusion of resin-based and calcium hydroxide (Ca[OH]₂)-based endodontic sealers as well as their influence on the periradicular tissues.

Materials and Methods:

A total of 120 single-rooted teeth exhibiting extrusion of sealer in the postoperative radiographs were included in the study. According to the sealers used, the teeth were divided into four groups (n = 30): Group I – AH Plus^®, Group II – Resino Seal, Group III – Sealapex™, and Group IV – Apexit^® Plus. Postoperative pain was assessed at 0–6 h, 6–12 h, 12–24 h, and 24–48 h of obturation using Visual Analog Scale. Radiographs were taken at 3, 6, and ≥9 months to 1-year follow-up and compared with baseline radiographs to assess the dissolution of extruded sealers and healing of periradicular tissues.

Statistical Analysis:

ANOVA, Kruskal–Wallis, and Pearson's Chi-square test were used. Statistical significance level was set at P ≤ 0.05.

Results:

Postoperative pain intensity was higher in case of AH Plus^® sealer followed by Sealapex™ up to 12 h of obturation and was statistically nonsignificant. Apexit^® Plus at all time intervals showed statistically significant less pain intensity than AH Plus^® and Sealapex™ but not from Resino Seal group. At 9-month follow-up, better healing of periradicular tissues was shown by AH Plus^® (48.1%) followed by Apexit^® Plus (44.4%) and Sealapex™ (41.2%) with statistically nonsignificant difference.

Conclusion:

In case of periapical extrusion, both resin-based and Ca(OH)₂-based sealers caused postoperative pain. Both Ca(OH)₂- and resin-based sealers did not influence the treatment outcome.