Targeted Endodontic Microsurgery: Computed Tomography-based Guided Stent Approach with Platelet-rich Fibrin Graft: A Report of 2 Cases.

Endodontic microsurgery is a predictable alternative to nonsurgical treatment of persistent and recurrent apical periodontitis. The modern endodontic microsurgical procedure has been evolving in pace with technological advances. The introduction of modern innovations such as cone-beam computed tomographic (CBCT) imaging, 3-dimensional (3D) printing technology, and a 3D surgical guide designed with computer-aided software has allowed for a novel approach to the surgical site. The aim of these case reports was to describe root-end surgery with the use of the implant DDS-Pro planning software (Natrodent Polska, Poland), a 3D-printed surgical guide precisely positioned according to the preoperative CBCT scan measurements (CS 8100; Carestream Dental, Atlanta, GA), and a modified soft tissue access. A hollow trephine bur was used to perform the osteotomy, resection of the root, and enucleation of the lesion. The intact cortical plate was salvaged and used as a graft along with plasma-rich fibrin acquired preoperatively from the patient's blood. The positioning guide allowed the clinicians to precisely achieve targeted tissues and shorten the procedure time. Modified soft tissue management helped achieve a small surgical wound for uneventful healing. A less than 12-month CBCT follow-up of both cases showed complete 3D healing of the surgical site.

Chemical aspect of sodium hypochlorite activation in obtaining favorable outcomes of endodontic treatment: An in-vitro study.

BACKGROUND: Endodontic treatment is one of the most widely performed procedures in a dental office. New techniques for enhancing the effectiveness of irrigants are being introduced into the dental market. It is crucial to choose a proper method to obtain the highest possible long-term success of performed endodontic treatment. Sodium hypochlorite (NaOCl) appears to be one of the most common and profitable solutions for root canal irrigation. The activation of a solution may be analyzed in 2 fields, physical - turbulence of flow, and chemical - disintegration of irrigant molecules into very active radicals that improve its activity. While the physical alternations of irrigant flow with different techniques are widely studied, there are not many attempts to approach the subject in chemical terms. OBJECTIVES: The aim of the study was to compare the chemical effectiveness of 2 methods of NaOCl activation: ultrasonics vs the Self-Adjusting File system (SAF) as an adjunct to increase the efficacy of the irrigant. MATERIAL AND METHODS: The level of activation was evaluated via a reaction of the activated NaOCl samples, with 9-fluorenol as the starting organic material. The model reaction is based on the oxidation of 9-fluorenol to 9-fluorenon. The evaluation was performed using 1H nuclear magnetic resonance (NMR) spectroscopy, comparing the spectra obtained for the examined mixtures. RESULTS: Nuclear magnetic resonance studies show that the use of ultrasonics resulted in increased chemical degradation of NaOCl as compared to the SAF system and non-agitated samples. The prevalence of chemical activation in the ultrasonic group over the SAF group was almost 3 times higher, 3.11 to 1.20, respectively. The Kruskal-Wallis rank sum test revealed there is a statistically significant difference in distributions between the groups. CONCLUSIONS: Both SAF and ultrasonics activate NaOCl. Ultrasonic agitation provided higher chemical activation of NaOCl solution than the SAF. The use of ultrasonic agitation of NaOCl in endodontic treatment will allow us to obtain better long-term clinical results.