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da Rosa AF, Fischer BV, Dias-Junior LCDL, Serique AVC, Bortoluzzi EA, Teixeira CDS, da Fonseca Roberti Garcia L. Effectiveness of different supplementary protocols for remaining filling material removal in endodontic reintervention: an integrative review. Odontology 2024; 112:51-73. [PMID: 37561273 DOI: 10.1007/s10266-023-00845-6] [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: 05/02/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023]
Abstract
The aim of this study was to perform an integrative review to identify the most effective supplementary protocols used after filling material (FM) removal and root canal reinstrumentation, during endodontic reintervention. The literature search was performed on the electronic databases PubMed and Latin American and Caribbean Health Sciences Literature (LILACS), using a combination of specific scientific descriptors. Selection criteria accepted articles published in English, Spanish and Portuguese languages, up to August 2021, involving in vitro and ex vivo studies. After applying the eligibility criteria, 46 articles were included for qualitative analysis. The tool for qualitative analysis of quasi-experimental studies of the Joanna Briggs Institute was used to determine the risk of bias of the included articles. The selected articles provided important data regarding the following supplementary protocols: sonic and ultrasonic activation of the irrigating solution; the use of ultrasonic inserts, XP-endo system instruments, and photon-induced photoacoustic streaming for mechanical debridement; and new devices as GentleWave system, and the self-adjusting file. Overall, all supplementary protocols demonstrated efficacy in removing the remaining FM. The implementation of various supplementary protocols can effectively remove the remaining FM from the root canal walls, although complete removal is not always achieved. However, it was not possible to determine the most effective protocol. Conversely, their association can enhance remaining FM removal. Remaining FM attached to root canal walls hinders proper chemical-mechanical preparation during endodontic reintervention. Supplementary protocols optimize the remaining FM removal, enhancing cleaning and disinfection of root canal.
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Affiliation(s)
- Amanda Freitas da Rosa
- Department of Dentistry - Endodontics Division, Health Sciences Centre, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, CEP, Florianópolis, Santa Catarina, 88040-900, Brazil
| | - Bruna Venzke Fischer
- Department of Dentistry - Endodontics Division, Health Sciences Centre, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, CEP, Florianópolis, Santa Catarina, 88040-900, Brazil
| | - Luiz Carlos de Lima Dias-Junior
- Department of Dentistry - Endodontics Division, Health Sciences Centre, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, CEP, Florianópolis, Santa Catarina, 88040-900, Brazil
| | - Anna Victoria Costa Serique
- Department of Dentistry - Endodontics Division, Health Sciences Centre, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, CEP, Florianópolis, Santa Catarina, 88040-900, Brazil
| | - Eduardo Antunes Bortoluzzi
- Department of Diagnosis & Oral Health, Endodontics Division, University of Louisville, Louisville, KY, USA
| | - Cleonice da Silveira Teixeira
- Department of Dentistry - Endodontics Division, Health Sciences Centre, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, CEP, Florianópolis, Santa Catarina, 88040-900, Brazil
| | - Lucas da Fonseca Roberti Garcia
- Department of Dentistry - Endodontics Division, Health Sciences Centre, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, CEP, Florianópolis, Santa Catarina, 88040-900, Brazil.
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Abdelnaby P, Ibrahim M, ElBackly R. In vitro evaluation of filling material removal and apical debris extrusion after retreatment using Reciproc blue, Hyflex EDM and ProTaper retreatment files. BMC Oral Health 2023; 23:902. [PMID: 37990209 PMCID: PMC10664678 DOI: 10.1186/s12903-023-03579-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 10/25/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVES To evaluate the amount of remaining filing material and apical debris extrusion after retreatment using Reciproc Blue, Hyflex EDM and ProTaper Retreatment Files. MATERIALS AND METHODS Thirty-six extracted permanent mandibular first molars with moderately curved mesial roots were selected. Mesiobuccal canals were prepared using the ProTaper Next system up to size X2 and filled using gutta-percha and Adseal sealer via cold lateral compaction. Teeth were randomly divided into three equal groups (n = 12): Group 1: Reciproc Blue (RB)(VDW, Germany), Group 2: Hyflex EDM (HEDM)(Coltene/Whaledent, Switzerland), Group 3: ProTaper Universal Retreatment file system + ProTaper Next file system (PTUR + PTN)( Dentsply Maillefer, Switzerland). Eppendorf tubes were used to collect the apically extruded debris. Cone-beam computed tomographic scans were taken prior to and after retreatment and the volume of remaining filling material was assessed at the coronal, middle and apical levels. Statistical analysis was performed using the Kruskal-Wallis test, Friedman's test and Wilcoxon Sign Rank test. Significance level was set at p value 0.05. RESULTS There were no statistically significant differences among the three groups in the reduction of the volume of the filling material or in the amount of apically extruded debris. CONCLUSION All the tested filing systems showed similar efficacy in removing the filling material, however, none of them could achieve its complete removal. Apical extrusion of debris occurred with all the systems used with no significant difference between the three groups.
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Affiliation(s)
- Passent Abdelnaby
- Conservative Dentistry Department, MS Student, Endodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Mohamed Ibrahim
- Conservative Dentistry Department, Endodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Rania ElBackly
- Conservative Dentistry Department, Endodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
- Tissue Engineering Laboratories, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
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Madarati AA, Sammani AMN, Alnazzawi AA, Alrahlah A. Efficiency of the new reciprocating and rotary systems with or without ultrasonics in removing root-canals filling with calcium silicate-based sealer (MTA). BMC Oral Health 2023; 23:5. [PMID: 36597070 PMCID: PMC9811723 DOI: 10.1186/s12903-022-02684-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 12/21/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND To compare the efficiency of endodontic rotary and reciprocating systems in removing calcium silicate-sealer based fillings and to investigate the impact of passive ultrasonic irrigation (PUI) on their efficiency. MATERIALS AND METHODS 160 root-canals were instrumented, filled with gutta-percha and calcium silicate based-sealer and divided into 10 equal groups. Five groups in which the reciprocating systems (WaveOne-Gold, Reciproc-Blue and R-Motion) and rotary systems (Fanta-AF-One and Tango-Endo) were used to remove root-canals' fillings. In the other five groups the fillings were removed by the same systems then additionally with PUI. The times to complete retreatments procedures were recorded. Micro-computed tomography's analysis of the root-canals fillings' volume before and after retreatments was used to determine the remaining filling materials (RFMs) volumes. RESULTS The RFMs after using rotary systems (10.1%) was greater than after using reciprocating systems (3.8%) (P < 0.001). The RFMs after using WOG (2%) and RB systems (2.6%) were less than those in the RM (6.8%), TE (9.5%) and FAFO (10.7%) systems [P < 0.05]. The times required to remove the filling materials using the TE (3.7 min), FAFO (4.1 min) and RM (4.1 min) systems were shorter than those required by the RB (5.4 min) and WOG (4.9 min) systems [P < 0.05]. Using PUI resulted in less RFMs (1.44%) when compared to using only rotary or reciprocating systems (6.27%) [P < 0.001]. CONCLUSIONS Endodontic reciprocation systems were more effective, but needed longer times than rotary systems in removing calcium silicate based- sealers fillings. The PUI significantly improved removal of the root-canals' filling materials. CLINICAL RELEVANCE Reciprocating systems and PUI are recommended whenever root-canals retreatment is considered regardless of using calcium silicate-based sealers.
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Affiliation(s)
- Ahmad A. Madarati
- grid.412892.40000 0004 1754 9358Restorative Dental Sciences Department, College of Dentistry, Taibah University, Madina, Kingdom of Saudi Arabia ,Riyadh, 13311 Kingdom of Saudi Arabia
| | - Aya M. N. Sammani
- grid.412892.40000 0004 1754 9358Department of Substitutive Dental Sciences, College of Dentistry, Taibah University, Madina, Kingdom of Saudi Arabia
| | - Ahmad A. Alnazzawi
- grid.412892.40000 0004 1754 9358Department of Substitutive Dental Sciences, College of Dentistry, Taibah University, Madina, Kingdom of Saudi Arabia
| | - Ali Alrahlah
- grid.56302.320000 0004 1773 5396Restorative Dental Sciences Department, Engineer Abdullah Bugshan Research Chair for Dental and Oral Rehabilitation, College of Dentistry, King Saud University, Riyadh, Kingdom of Saudi Arabia
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Simões LP, Dos Reis-Prado AH, Bueno CRE, Viana ACD, Duarte MAH, Cintra LTA, Lemos CAA, Benetti F. Effectiveness and safety of rotary and reciprocating kinematics for retreatment of curved root canals: a systematic review of in vitro studies. Restor Dent Endod 2022; 47:e22. [PMID: 35692221 PMCID: PMC9160764 DOI: 10.5395/rde.2022.47.e22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/07/2021] [Accepted: 10/17/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives This systematic review (register-osf.io/wg7ba) compared the efficacy and safety of rotary and reciprocating kinematics in the removal of filling material from curved root canals. Materials and Methods Only in vitro studies evaluating both kinematics during retreatment were included. A systematic search (PubMed/MEDLINE, Scopus, and other databases, until January 2021), data extraction, and risk of bias analysis (Joanna Briggs Institute checklist) were performed. Efficacy in filling removal was the primary outcome. Results The search resulted in 2,795 studies, of which 15 were included. Efficacy was measured in terms of the remaining filling material and the time required for this. Nine studies evaluated filling material removal, of which 7 found no significant differences between rotary and reciprocating kinematics. Regarding the time for filling removal, 5 studies showed no difference between both kinematics, 2 studies showed faster results with rotary systems, and other 2 showed the opposite. No significant differences were found in apical transportation, centering ability, instrument failure, dentin removed and extruded debris. A low risk of bias was observed. Conclusions This review suggests that the choice of rotary or reciprocating kinematics does not influence the efficacy of filling removal from curved root canals. Further studies are needed to compare the kinematics safety in curved root canals.
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Affiliation(s)
- Lucas Pinho Simões
- Department of Restorative Dentistry, Universidade Federal de Minas Gerais (UFMG), School of Dentistry, Belo Horizonte, MG, Brazil
| | | | | | - Ana Cecília Diniz Viana
- Department of Restorative Dentistry, Universidade Federal de Minas Gerais (UFMG), School of Dentistry, Belo Horizonte, MG, Brazil
| | - Marco Antônio Húngaro Duarte
- Department of Dentistry, Endodontics and Dental Materials, University of São Paulo (USP), School of Dentistry, Bauru, SP, Brazil
| | | | - Cleidiel Aparecido Araújo Lemos
- Department of Dentistry, Federal University of Juiz de Fora, Campus GV (UFJF-GV), School of Dentistry, Governador Valadares, MG, Brazil
| | - Francine Benetti
- Department of Restorative Dentistry, Universidade Federal de Minas Gerais (UFMG), School of Dentistry, Belo Horizonte, MG, Brazil
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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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de Souza DS, S Silva AS, Ormiga F, Lopes RT, Gusman H. The effectiveness of passive ultrasonic irrigation and the easy-clean instrument for removing remnants of filling material. J Conserv Dent 2021; 24:57-62. [PMID: 34475681 PMCID: PMC8378483 DOI: 10.4103/jcd.jcd_590_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/12/2021] [Accepted: 01/18/2021] [Indexed: 02/03/2023] Open
Abstract
Objective This study aimed to evaluate the efficacy of passive ultrasonic irrigation (PUI) and the easy clean instrument by micro-computed tomography (CT) for removing remnant filling materials during endodontic retreatment. Materials and Methods Forty mesial roots of mandibular molars were divided into four groups (n = 10) according to the agitation system and sealer used: Group 1: PUI/AH Plus; Group 2: PUI/TotalFill; Group 3: Easy Clean/AH Plus; and Group 4: Easy Clean/TotalFill. The groups were compared by micro-CT analysis according to the volumes of the obturation and the remaining material before and after the agitation systems were used. Results There was no difference between the groups for total filling volume and initial and final remaining filling volume (P > 0.05). Conclusions Both the PUI and easy-clean instrument are effective for removing remnants of filling material with no difference between the groups.
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Affiliation(s)
| | - Aline S S Silva
- Department of Nuclear Instrumentation, Center of Technology, Federal University of Rio de Janeiro, Brazil
| | - Fabiola Ormiga
- Department of Dental Clinic, Center of Technology, Federal University of Rio de Janeiro, Brazil
| | - Ricardo T Lopes
- Department of Nuclear Instrumentation, Center of Technology, Federal University of Rio de Janeiro, Brazil
| | - Heloisa Gusman
- Department of Dental Clinic, Center of Technology, Federal University of Rio de Janeiro, Brazil
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Comparison of the efficacy of laser-activated and ultrasonic-activated techniques for the removal of tricalcium silicate-based sealers and gutta-percha in root canal retreatment: a microtomography and scanning electron microscopy study. BMC Oral Health 2021; 21:275. [PMID: 34022868 PMCID: PMC8141189 DOI: 10.1186/s12903-021-01638-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 05/18/2021] [Indexed: 12/02/2022] Open
Abstract
Tricalcium silicate-based sealers have been usually indicated for the single-cone technique and result in more residual filling materials in root canal retreatment. Passive ultrasonic irrigation and photon-initiated photoacoustic streaming have been reported to improve the removal efficacy of root canal filling materials. However, the abilities of both techniques combined with NiTi re-instrumentation to remove residual tricalcium silicate-based sealer and gutta-percha have not been compared. The aim of this study was to evaluate the efficacy of laser-activated and ultrasonic-activated techniques in vitro for the removal of the tricalcium silicate-based sealer iRoot SP and gutta-percha after standard canal retreatment procedures with the use of nickel-titanium (NiTi) rotary instruments.
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Kaloustian MK, Nehme W, El Hachem C, Zogheib C, Ghosn N, Mallet JP, Diemer F, Naaman A. Evaluation of two shaping systems and two sonic irrigation devices in removing root canal filling material from distal roots of mandibular molars assessed by micro CT. Int Endod J 2019; 52:1635-1644. [PMID: 31127955 DOI: 10.1111/iej.13163] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/22/2019] [Indexed: 01/11/2023]
Abstract
AIM To compare two preparation systems and two sonic irrigation devices during the removal of root filling material from oval distal canals of extracted mandibular molars. METHODOLOGY The distal canals in 40 extracted mandibular molars were shaped using the ProTaper Next system (Dentslpy Sirona, Ballaigues, Switzerland), filled with Gutta Percha X2 (Dentsply Sirona), along with AH Plus sealer (Dentsply De Trey, Konstanz, Germany) and randomly divided into two groups (n = 20) according to volume of initial filling, preparation diameter and working length. One group was retreated using the Reciproc system (VDW, Munich, Germany), and the other using the 2Shape system (Micro-Mega, Besançon, France). A micro-CT scan was taken after the initial root filling and after retreatment to evaluate the volume of filling material remnants. The teeth were divided into four groups to test the supplementary effect of two sonic irrigation devices on removing filling material: Eddy (VDW) and MM1500 (Micro-Mega). In the first and second groups, 2Shape was followed subsequently by MM1500 and Eddy; in the third and fourth groups, Reciproc was followed by MM1500 and Eddy. A third micro-CT was taken to compare the remaining root filling material in all groups. Wilcoxon's signed rank tests, Mann-Whitney and Kruskal-Wallis tests were used for statistical analysis. RESULTS No significant difference was found for the volume of filling material removed between the Reciproc and 2Shape in the entire canal (P = 0.355). The volume dropped significantly from its initial value after removing the bulk of the root filling by 95.8% (from 4.71 to 0.22 mm3 ) with the 2Shape (P < 0.001) and by 94.0% (from 5.05 to 0.33 mm3 ) with the Reciproc (P < 0.001). Sonic activation significantly decreased the residual volume of filling material remnants by 3.21% (P = 0.013) in the first group, 1.38% (P = 0.012) in the second group, 1.83% (P = 0.008) in the third group and 1.83% (P = 0.012) in the fourth group. At the end, the percentage of residual material was not significantly different among the groups in the entire canal (P = 0.163). CONCLUSION In the distal oval canals of extracted mandibular molar teeth, there was no significant difference between the 2Shape and Reciproc systems in removing gutta-percha/sealer. Sonic activation with MM1500 and Eddy significantly improved filling material removal.
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Affiliation(s)
- M K Kaloustian
- Department of Endodontics, Faculty of Dentistry, Saint Joseph University, Beirut, Lebanon
| | - W Nehme
- Department of Endodontics, Faculty of Dentistry, Saint Joseph University, Beirut, Lebanon
| | - C El Hachem
- Department of Pediatric Dentistry, Faculty of Dentistry, Saint Joseph University, Beirut, Lebanon
| | - C Zogheib
- Department of Endodontics, Faculty of Dentistry, Saint Joseph University, Beirut, Lebanon
| | - N Ghosn
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Saint Joseph University, Beirut, Lebanon
| | - J P Mallet
- Faculté de Chirurgie Dentaire, CHU de Toulouse - Institut Clément Ader (laboratoire), Toulouse, France
| | - F Diemer
- Faculté de Chirurgie Dentaire, CHU de Toulouse - Institut Clément Ader (laboratoire), Toulouse, France
| | - A Naaman
- Department of Endodontics, Faculty of Dentistry, Saint Joseph University, Beirut, Lebanon
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