Retrospective radiographic study comparing unintentional extrusion of gutta-percha versus sealer on teeth with periapical radiolucency.

OBJECTIVES: The purpose of the present study was the radiographic evaluation of endodontically treated teeth presenting periapical radiolucency and unintentional overfilling with gutta-percha or sealer on treatment outcome and persistence of the extruded materials. METHOD AND MATERIALS: After assessment using periapical index (PAI), 202 roots filled with gutta-percha and zinc oxide eugenol sealer (Roth 811, Roth International), exhibiting unintentional overfilling and periapical radiolucency were selected. All cases had at least 1 year follow-up. Type of extruded material, periapical status, and removal/persistence of the extruded material were evaluated by two independent observers. Data were statistically analyzed using logistic and linear regression analysis. RESULTS: Tooth location (P <.001), follow-up period (P <.001), and type of extruded material (P =.004) significantly influenced treatment outcomes. Specifically, posterior roots exhibited better outcomes compared to anterior, and cases with overfilling of sealer showed superior healing potential compared to those with gutta-percha overfilling. Additionally, longer recall periods were associated with improved treatment success. It is also seen that the type of extruded material (P <.001) and follow-up period (P <.001) have significantly affected the presence of extruded material in the follow-up radiograph. The persistence of extruded material was greater when gutta-percha was extruded as well as extruded materials were less detected when the follow-up period was longer. CONCLUSION: Teeth with periapical radiolucency and unintentional overfilling require longer follow-up intervals for effective monitoring of healing. Treatment outcome was associated with the type of extruded materials used in the present study. The persistence of those materials in the periapex did not affect healing.

Understanding root fenestration: A systematic scoping review of prevalence and clinical factors.

The aim of this systematic scoping review is to explore the literature on root fenestration prevalence and its possible etiologic, aggravating and predisposing clinical factors. A systematic search was conducted in 5 electronic databases, by two independent reviewers, without any language and date restrictions. Forty-six full-text records were included in the study, out of which 27 were used for prevalence analysis and 42 for clinical factor analysis. The results suggest that the literature is heterogenous, with major differences in the study protocols and results' presentation, providing limited information regarding root fenestration prevalence and possible racial distribution patterns. Further documentation is also required regarding clinical parameters that may affect root fenestration's presence and severity. Despite their few limitations, retrospective cone beam computed tomography studies with high-resolution protocols, as well as open flap studies for direct observation of possible root fenestration sites, seem the most reliable methods to better comprehend its presence and possible distribution patterns.

Frequency of root fenestration in a Greek subpopulation: A cone beam computed tomography clinical study.

This cone beam computed tomography (CBCT) study aimed to assess the root fenestration (RF) frequency in healthy, intact teeth and analyse their features in a Greek subpopulation. 432 CBCT scans were examined. 5486 teeth were evaluated for RF prevalence. RF prevalence and distribution were recorded for each jaw, tooth group, as well as patient age and sex. RF symmetry, distribution to the affected root surface and the effects of age and sex were evaluated. The prevalence of RF ranged from 0.57% (central incisors) to 7.18% (first premolars) and from 0.48% (second premolars) to 10.79% (lateral incisors) for the maxilla and the mandible, respectively. No symmetrical occurrence of RF was detected. Most RF patients presented one or two defects in both jaws. Types I and IV were the most prevalent in the maxilla, while Types III, II and V were the most prevalent in the mandible. No statistical difference was detected between different sexes and age groups (P > 0.05).

Temperature Rise on the Plugger Surface of 2 Commercially Available Gutta-percha Heating Devices.

INTRODUCTION: The objective of this study was to examine the temperature rise on the plugger surface of 2 commercially available gutta-percha heating devices: the System B (Kerr Dental, Amersfoort, The Netherlands) and the System B Cordless Pack Unit (Kerr Dental). METHODS: Temperature changes were recorded by a Thermocouple Data Logger device (Pico Technology Ltd, St Neots, UK) and 2 thermocouples: the first to record the temperature on the plugger surface in an isolated polytetrafluoroethylene system and the second to record the base temperature of the environment. The gutta-percha heating devices studied were System B with F, FM, M, and ML pluggers set at the "use" position, "touch" mode, temperature of 200°C, and a power setting of 10 and the System B Cordless Pack Unit with the FM plugger set at low power. Two variables were extracted from the collected temperature data: the temperature on the plugger surface 10 seconds after activating each gutta-percha heating device (θ10) and the time required to reach 60°C (t60). The differences between the pluggers over those 2 variables were investigated using analysis of variance and the Tukey B test for post hoc comparisons (P < .05). RESULTS: The mean θ10 for all pluggers ranged between 73°C and 87°C. The mean t60 for all pluggers ranged between 1.3 and 3.3 seconds. No clinically significant differences between the pluggers were observed. CONCLUSIONS: The gutta-percha heating devices tested achieve maximum temperatures lower than 94°C and are capable of gutta-percha phase transformation within approximately 4 seconds of activation.

Evaluation of Antimicrobial Photodynamic Therapy Using Indocyanine Green and Near-Infrared Diode Laser Against Enterococcus faecalis in Infected Human Root Canals.

OBJECTIVE: Photodynamic therapy (PDT) is considered a promising adjunct to the currently available endodontic disinfection techniques leading to more effective reduction of intracanal bacteria. The present ex vivo study aimed to assess the antimicrobial effect of PDT using indocyanine green (ICG) as photosensitizer and a near-infrared (NIR) diode laser in root canals of human teeth infected with Enterococcus faecalis. MATERIALS AND METHODS: Ninety single-rooted teeth after chemomechanical preparation and sterilization were contaminated with an E. faecalis strain. The specimens were divided, randomly, into eight experimental groups: (1) PDT with ICG and laser (0.5 W output power-medium-energy fluence), (2) PDT with ICG and laser (1 W output power-high-energy fluence), (3) only laser emission, (4) only ICG, (5) 2.5% sodium hypochlorite (NaOCl) as irrigant, (6) 2.5% NaOCl and PDT with ICG and laser, (7) no treatment (positive control), and (8) no bacterial biofilm growth (negative control). The root canal contents were sampled by flushing and the collected washings were plated on an appropriate culture medium, which was incubated for 48 h at 35°C ± 2.0. The colony-forming units (CFUs) were determined to assess the bactericidal effect of the tested experimental combinations. RESULTS: The microbiological tests revealed that PDT groups, regardless of the overall power, showed significant lower mean log10 CFU levels, than groups 3 and 4 (p < 0.001) and similar reduction of viable counts with group 5. The combination treatment (group 6) achieved adequate reduction of log10 CFU levels in the viable counts. However, no significant difference (p > 0.05) was observed between groups 1, 2, 5, and 6 and significant difference was noticed between groups 3, 4, and 5 (p < 0.001). CONCLUSIONS: ICG-mediated PDT activated by an NIR diode laser provided increased disinfection of the root canal system, but the overall benefit in total bacterial elimination should be further investigated.

Effect of Er,Cr:YSGG laser irradiation on apical sealing ability of calcium silicatecontaining endodontic materials in root-end cavities.

The aim of this research was to evaluate the apical sealing abilities of 60 root-end cavities filled with mineral trioxide aggregate (MTA) and iRoot BP cements after treated with either 17% EDTA solution or Er,Cr:YSGG laser irradiation. After the filling procedure, apical leakage quantity was measured at 4 weeks using a fluid filtration method. One root from each group was processed for scanning electron microscopy and energy dispersive X-ray spectroscopy analyses. Both EDTA/MTA and laser irradiation/MTA combinations showed significantly lower microleakage than EDTA/iRoot BP and laser irradiation/iRoot BP combinations (p<0.05). Between groups of the same filling material, there were no significant differences among specimens treated with EDTA or laser (p>0.05). Both MTA and iRoot-BP demonstrated tag-like structures within the dentinal tubules when used in conjunction with EDTA.

Periradicular Tissue Responses to Biologically Active Molecules or MTA When Applied in Furcal Perforation of Dogs' Teeth.

The aim of this study was the comparative evaluation of inflammatory reactions and tissue responses to four growth factors, or mineral trioxide aggregate (MTA), or a zinc-oxide-eugenol-based cement (IRM) as controls, when used for the repair of furcal perforations in dogs' teeth. Results showed significantly higher inflammatory cell response in the transforming growth factorß1 (TGFß1) and zinc-oxide-eugenol-based cement (IRM) groups and higher rates of epithelial proliferation in the TGFß1, basic fibroblast growth factor (bFGF), and insulin growth factor-I (IGF-I) groups compared to the MTA. Significantly higher rates of bone formation were found in the control groups compared to the osteogenic protein-1 (OP-1). Significantly higher rates of cementum formation were observed in the IGF-I and bFGF groups compared to the IRM. None of the biologically active molecules can be suggested for repairing furcal perforations, despite the fact that growth factors exerted a clear stimulatory effect on cementum formation and inhibited collagen capsule formation. MTA exhibited better results than the growth factors.

Accidental extrusion of sodium hypochlorite into the maxillary sinus.

An unusual case is reported of accidental extrusion of sodium hypochlorite solution into the maxillary sinus during instrumentation in the course of root canal treatment of a maxillary premolar. This caused a burning sensation accompanied by nasal bleeding, swallowing of blood, and interrupted breathing. The case was managed by irrigating with sterile saline, arresting nasal bleeding, and administering antibiotics, anti-inflammatory drugs, and decongestants.

Cross-sectional study of the radiographic appearance of radiopaque lesions of the jawbones in a sample of Greek dental patients.

OBJECTIVES: The aim of the study was to assess the prevalence of radiopacities in the jaws of a Greek population sample. STUDY DESIGN: Panoramic radiographs of 3,513 patients retrieved from 10 practices in Northern Greece were examined for the presence of radiopacities without the knowledge of the medical histories. Of the initial sample size, 47 radiographs were excluded owing to technical errors. Descriptive characteristics of radiopacities including shape, size, and location, as well as information concerning the tooth involved and the adjacent and opposing teeth, were recorded. All analyses were performed using SPSS software. The Pearson chi-squared test was used to examine the distributions of gender, shape, size, and location. RESULTS: A total of 72 radiopacities were identified in 69 patients (1.96% of the total sample of panoramic radiographs), showing a greater predilection in the mandibular premolar-molar region (78.3% of radiopacities observed); 44.9% of the radiopacities were associated with intact teeth or teeth with shallow filling/caries, whereas 26.1% were associated with heavily decayed/filled teeth. One-half of the radiopacities identified were circular, and the diameter varied from 1 to 2 cm. CONCLUSION: The results indicate the rarity of radiopacities (1.96%) in the Greek population sample that was examined and the predilection for their occurrence in the jaws.

Spreader load required for vertical root fracture during lateral compaction ex vivo: evaluation of periodontal simulation and fracture load information.

OBJECTIVE: To evaluate the biomechanical influence of the periodontium on spreader load measuring required for vertical root fracture (VRF). STUDY DESIGN: Fully developed permanent incisors (n = 32) from 4 fresh goat mandibles were used. All teeth were subjected to standardized root canal instrumentation and divided into 2 groups: Teeth of group A were tested within natural sockets, and teeth of group B were mounted in artificial sockets and then tested. Spreader was driven to standard depth repeatedly, and insertion load was recorded constantly until intentional VRF. RESULTS: Fracture load in group A varied from 5.9 kg to 25.1 kg, and in group B from 4.3 kg to 26.9 kg. No statistical difference was found between the 2 groups in terms of fracture load or plane of fracture (P > .05). CONCLUSIONS: Periodontal simulation by acrylic resin and elastomeric impression material was deemed to be reliable. The inability of fracture load to reveal information about crucial events of the phenomenon was evident.

An in vitro comparison of the sealing ability of three endodontic sealers used in canals with iatrogenic enlargement of the apical constriction.

In cases of disrupted apical constriction effort is made to create an apical stop and subsequently instrument and obturate the canal up to this point. The aim of this study was to in vitro evaluate the sealing ability of three root canal sealers used with the lateral compaction technique in teeth with enlarged constriction. Thirty-six single rooted premolars with straight canals were instrumented up to the apical constriction using a step-back technique. The constriction was enlarged and root canal instrumentation 1.5 mm short of the original working length was performed, to create a new apical stop. Teeth were obturated using lateral compaction technique with either Topseal, Roth 811, or Apexit. Teeth were subjected to area-metric analysis of dye penetration in transverse root sections, up to the most coronal extend of the dye. Sections were studied under the stereomicroscope, digital images were processed and leakage area was estimated. Statistical analysis was performed using Student's t test and Wilcoxon matched-pairs signed-rank test. No gutta-percha was extruded into the space between the apical constriction and the new iatrogenically created constriction. Topseal showed statistical significant less leakage. No significant difference was found between Apexit and Roth 811 (t = 0.99; p = 0.75).

A comparative study of crack development in stainless-steel hedstrom files used with step-back or crown-down techniques.

The purpose of this study was to evaluate the effect of step-back (SB) and crown-down (CD) techniques on crack development of stainless-steel Hedstrom files (H-files). Ninety-seven mesial root canals of freshly extracted human mandibular molars were selected. Six sets of H-files (#15, #20, and #25 ISO size each) were used with SB and CD techniques for the chemomechanical preparation of 8, 16, and 24 root canals using 2.5% NaOCl as an irrigant and EDTA gel as a chelating agent. Files were sterilized in an autoclave between successive uses. A seventh unused set served as control. After macroscopic examination all files were embedded in epoxy resin, ground, polished, and studied under a metallographic microscope. The maximum crack size of each file was measured by means of standard image-analysis procedures. Macroscopically the files presented no signs of plastic deformation, apart from a file #15, used with SB technique, which fractured after 16 root-canal preparations. The microscopic examination showed no cracks: on control files, on files used with the CD technique for 8 and 16 cycles, on file #20 used with the SB technique for 8 and 16 cycles, as well as on file 25 used with the SB technique for 8 cycles. Cracks were found on H-file #15 used with the SB technique for 8 and 16 cycles, on file 25 used with the SB technique for 16 cycles, and on all files used for 24 cycles with both SB and CD techniques. Under the conditions of this study it was concluded that the instrumentation technique is deeply implicated in the crack development. Crack propagation was accelerated when SB technique was used.