Micro-CT evaluation of the effectiveness of the combined use of rotary and hand instrumentation in removal of Resilon

Critical analysis of research methods and experimental models to study removal of root filling materials

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.

Micro CT pilot evaluation of removability of two endodontic sealers

PURPOSE

This study compared the removability of AH Plus and EndoSequence BC sealers using in vitro micro-computed tomography.

METHODS

Ten single-canal, extracted human teeth were cleaned and shaped with ProTaper NEXT rotary files to size X5 (50/0.06) (Dentsply-Sirona). Canals were obturated with a single cone gutta-percha and either AH Plus (Dentsply-Sirona) (Group A) or EndoSequence BC (Brasseler) (Group B). ProTaper Universal Retreatment files (Dentsply-Sirona) were used to remove obturation materials after 90 days at 37^oC/100% humidity. Each tooth was scanned using micro-computed tomography (SkyScan 1272; Bruker) at an isotropic resolution of 6 μm from which the percent of material removed was calculated. Two-sample t-tests and one-way ANOVA were used for analysis.

RESULTS

The percent removal of materials in the coronal third was 92.9% ± 7.3% (Group A) and 93.2% ± 6.1% (Group B). Removal in the middle third was 94.9% ± 8.5% (Group A) and 96.5% ± 6.1% (Group B). Apical third removal was 76.2% ± 27.9% (Group A) and 70.1% ± 30.8% (Group B). No statistically significant differences were determined between the two sealers or among the sectional thirds within each group (P > 0.05).

CONCLUSION

AH Plus and EndoSequence BC sealers exhibit the same removability at all canal levels of 70% to 96%, with better removal coronally.

Removal efficacy and cytotoxicity of a calcium hydroxide paste using N-2-methyl-pyrrolidone as a vehicle

Objectives

This study investigated the removal efficacy and cytotoxicity of a newly developed calcium hydroxide paste (cleaniCal, Maruchi) using N-2-methyl-pyrrolidone (NMP) as a vehicle in comparison with ApexCal (Ivoclar Vivadent) and Calcipex II (Nishika), which use different vehicles such as polyethylene glycol and propylene glycol, respectively.

Materials and Methods

Thirty maxillary premolars with oval-shaped canals were divided into 3 groups and the teeth were filled with one of the pastes. After removal of the paste, micro-computed tomographic (μ-CT) imaging was obtained to assess the volume of residual paste in the root canal of each tooth. The teeth were then split longitudinally and the area of the paste-coated surface was evaluated by stereomicroscopy. The cytotoxicity of each product was assessed using an agar overlay assay. The effect of each vehicle on cell viability was evaluated using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. The data were analyzed using one-way analysis of variance and Tukey's tests to detect any significance (p < 0.05).

Results

In the μ-CT and stereomicroscopic analysis, cleaniCal exhibited less remnants of medicament than ApexCal and Calcipex. cleaniCal showed a higher cytotoxicity than the other pastes in the agar overlay assay. Furthermore, NMP exhibited lower cell viability compared to the other vehicles.

Conclusions

cleaniCal showed better removal efficacy compared to the other products. However, clinicians should be aware of the higher cytotoxicity of the NMP-based material and consider its possible adverse effects on periradicular tissue when it is overfilled.

Comparison of the Effectiveness of Different Techniques for Supportive Removal of Root Canal Filling Material

Objective:

To compare the cleanliness of oval cross-sectioned root canals after using different supportive techniques for removal of root canal filling material as part of retreatment process.

Methods:

One hundred mandibular canine teeth with flat oval cross-sectioned canals were instrumented up to #40.06 and obturated using the warm vertical compaction technique. Removal of the gutta-percha and sealer was performed using the D-RaCe nickel-titanium retreatment instruments. The roots were randomly divided into four groups of 25 teeth, and the activation processes were applied: XP-endo Finisher (XP), EndoActivator (EA) and IrrıSafe (IS). Conventional needle irrigation (CI) was used as the control group. The teeth were sectioned, and digital images were captured. The photographs were analysed using AutoCAD software regarding the area of residual root filling. Kruskal–Wallis and post hoc Dunn’s tests were performed for statistical analysis.

Results:

There was significantly less gutta-percha and sealer remnant in the XP group than in the other groups (P<0.05). The CI group contained significantly more gutta-percha and sealer remnant than the other groups (P<0.05). The apical third of the CI group had significantly more residual gutta-percha and sealer when compared to that of the other groups (P<0.05).

Conclusion:

Within the limitations of this study, the amount of gutta-percha and sealer in the XP group was lower than that in the EA, IS, and CI groups.

Comparison of the amount of apical debris extrusion associated with different retreatment systems and supplementary file application during retreatment process

BACKGROUND

The type of instrument affects the amount of debris extruded. The aim of this study was to compare the effect of retreatment systems and supplementary file application on the amount of apical debris extrusion.

MATERIALS AND METHODS

Forty-eight extracted mandibular premolars with a single canal and similar length were selected. The root canals were prepared with the ProTaper Universal system with a torque-controlled engine. The root canals were dried and were obturated using Gutta-percha and sealer. The specimens were randomly divided into four equal groups according to the retreatment procedures (Group 1, Mtwo retreatment files; Group 2, Mtwo retreatment files + Mtwo rotary file #30 supplementary file; Group 3, ProTaper Universal retreatment (PTUR) files; and Group 4, PTUR files + ProTaper F3 supplementary file). The extruded debris during instrumentation were collected into preweighed Eppendorf tubes. The amount of apically extruded debris was calculated by subtracting the initial weight of the tube from the final weight. Three consecutive weights were obtained for each tube.

RESULTS

No statistically significant difference was found in the amount of apically extruded debris between Groups 1 and 3 (P = 0.590). A significant difference was observed between Groups 1 and 2 (P < 0.05), and between Groups 3 and 4 (P < 0.05).

CONCLUSIONS

The use of supplementary file significantly increased the amount of apically extruded debris.

3D micro-CT analysis of void formations and push-out bonding strength of resin cements used for fiber post cementation

PURPOSE

To investigate the void parameters within the resin cements used for fiber post cementation by micro-CT (µCT) and regional push-out bonding strength.

MATERIALS AND METHODS

Twenty-one, single and round shaped roots were enlarged with a low-speed drill following by endodontic treatment. The roots were divided into three groups (n=7) and fiber posts were cemented with Maxcem Elite, Multilink N and Superbond C&B resin cements. Specimens were scanned using µCT scanner at resolution of 13.7 µm. The number, area, and volume of voids between dentin and post were evaluated. A method of analysis based on the post segmentation was used, and coronal, middle and apical thirds considered separately. After the µCT analysis, roots were embedded in epoxy resin and sectioned into 2 mm thick slices (63 sections in total). Push-out testing was performed with universal testing device at 0.5 mm/min cross-head speed. Data were analyzed with Kruskal–Wallis and Mann–Whitney U tests (α=.05).

RESULTS

Overall, significant differences between the resin cements and the post level were observed in the void number, area, and volume (P<.05). Super-Bond C&B showed the most void formation (44.86 ± 22.71). Multilink N showed the least void surface (3.51 ± 2.24 mm²) and volume (0.01 ± 0.01 mm³). Regional push-out bond strength of the cements was not different (P>.05).

CONCLUSION

µCT proved to be a powerful non-destructive 3D analysis tool for visualizing the void parameters. Multilink N had the lowest void parameters. When efficiency of all cements was evaluated, direct relationship between the post region and push-out bonding strength was not observed.

Effectiveness of Sonic, Ultrasonic, and Photon-Induced Photoacoustic Streaming Activation of NaOCl on Filling Material Removal Following Retreatment in Oval Canal Anatomy

OBJECTIVE

This study aimed to assess the effectiveness of sonic, ultrasonic and laser [photon-induced photoacoustic streaming (PIPS)] irrigation activation in removing filling remnants from oval root canals after standard canal retreatment procedures with the ProTaper universal rotary retreatment system.

METHODS

Twenty-eight maxillary first premolars were instrumented with ProTaper NiTi rotary instruments and obturated with gutta-percha and AH Plus sealer using the continuous wave of condensation technique. After storage at 37°C and 100% humidity for 1 week, the specimens were retreated with the ProTaper universal retreatment system for the removal of filling material. Teeth were then randomly assigned into four groups (n = 7): group 1, positive control; group 2, retreated with sonic irrigation; group 3, retreated with ultrasonic irrigation; and group 4, retreated with laser irradiation. The specimens were scanned using micro-CT before instrumentation, after obturation and mechanical retreatment, and after additional activation procedures. The percentage volume of the filling remnants was measured. Specimens were split longitudinally after micro-CT scan, canal walls were examined using scanning electron microscopy (SEM), and the amount of residual filling material was scored.

RESULTS

The filling materials' removal efficacy in the three experimental groups was higher than that of the control group (p < 0.05), whereas filling materials ranging from 1.46 ± 0.30 to 2.21 ± 0.46 mm(3) remained in the canal in all three experimental groups. Additionally, there was a significantly greater reduction in the amount of filling remnants in the PIPS group than in the sonic and ultrasonic groups (both p < 0.05), and significantly greater reduction in the ultrasonic group than the sonic group (p < 0.05).

CONCLUSIONS

Activation of NaOCl with PIPS showed significantly better performance than sonic and ultrasonic techniques in removing the filling remnants following mechanical retreatment of oval root canals. The ultrasonic technique also performed better than the sonic technique. However, none of the additional activation procedures was able to completely eliminate the filling remnants.

The bond strength of adhesive resins to AH plus contaminated dentin cleaned by various gutta-percha solvents

The optimal bonding of adhesives to dentin requires the sealer to be completely removed from dentinal walls. The aim of this study was to investigate the effect of different cleaning procedures using gutta-percha solvents on bond strength of adhesive resins to AH Plus contaminated dentin (APCD). The pulp chamber dentin surfaces were contaminated with AH Plus and cleaned with five different techniques (dry cotton, chloroform, orange oil, eucalyptol, and ethanol). Then, Clearfil SE Bond (CSE) (Kuraray), and Tetric N Bond (TNB) (Ivoclar Vivadent) were applied and filled with a composite resin. The serial sticks (1 × 1 mm) were obtained and tested for microtensile bond strength. Scanning electron microscopy (SEM) was used for analysis of debonded surfaces. Ethanol exhibited the highest bond strength to APCD followed by dry cotton. There was no statistically significant difference between ethanol and dry cotton (p > 0.05). Eucalyptol showed the lowest bond strength to APCD and statistically significant differences (p < 0.05) in comparison with other groups. APCD reduced the bond strength of all adhesive resins. Dry cotton, ethanol, and chloroform were the most suitable techniques when used with CSE together, whereas ethanol was best with TNB.