The antimicrobial effect of new and conventional endodontic irrigants on intra-orally infected dentin.

OBJECTIVES: To evaluate if the incorporation of antimicrobial compounds to chelating agents or the use of chelating agents with antimicrobial activity as 7% maleic acid and peracetic acid show similar disinfection ability in comparison to conventional irrigants as sodium hypochlorite or iodine potassium iodide against biofilms developed on dentin. MATERIALS AND METHODS: The total bio-volume of live cells, the ratio of live cells and the substratum coverage of dentin infected intra-orally and treated with the irrigant solutions: MTAD, Qmix, Smear Clear, 7% maleic acid, 2% iodine potassium iodide, 4% peracetic acid, 2.5% and 5.25% sodium hypochlorite was measured by using confocal microscopy and the live/dead technique. Five samples were used for each irrigant solution. RESULTS: Several endodontic irrigants containing antimicrobials as clorhexidine (Qmix), cetrimide (Smear Clear), maleic acid, iodine compounds or antibiotics (MTAD) lacked an effective antibiofilm activity when the dentin was infected intra-orally. The irrigant solutions 4% peracetic acid and 2.5-5.25% sodium hypochlorite decrease significantly the number of live bacteria in biofilms, providing also cleaner dentin surfaces (p < 0.05). CONCLUSIONS: Several chelating agents containing antimicrobials could not remove nor kill significantly biofilms developed on intra-orally infected dentin, with the exception of sodium hypochlorite and 4% peracetic acid. Dissolution ability is mandatory for an appropriate eradication of biofilms attached to dentin.

Propolis as storage media for avulsed teeth: microscopic and morphometric analysis in rats.

The maintenance of the avulsed teeth in appropriate media for preserving the cellular viability has been important for repairing the periodontal ligament and preventing the root resorption after tooth reimplantation. Propolis is a substance capable of preserving cellular viability. This study aimed to analyze the propolis substance as a storage media for maintaining the avulsed teeth, besides to determine the ideal time period for keeping the tooth inside it. Thus, 60 maxillary right central incisors of rats were extracted and divided into five groups. In groups I and II, teeth were kept in propolis for 60 min and 6 h, respectively; in group III, teeth were kept in milk for 6 h; in group IV, teeth were kept dry for 60 min; and in group V, they were immediately reimplanted. All teeth had their root canals filled with calcium hydroxide paste. Following, teeth were reimplanted in their sockets. After 15 and 60 days, animals were killed and the obtained samples were processed in laboratory for microscopic and morphometric analyzing. The results showed that the occurrence of inflammatory resorption, dental ankylosis and the formation of the connective tissue parallel to the root surface were similar among groups. It could be verified a greater occurrence of replacement resorption in group IV when comparing to other groups. In groups I and IV, the presence of periodontal ligament-like connective tissue was substantially smaller than the other groups. Regarding to the cementum amount over the root, it could be observed that this was present in smaller amount in groups I and IV. Group II was similar to groups III and IV. Therefore, according to the results of this study, the use of propolis as a storage media for maintaining avulsed teeth could be highlighted, and the 6-h period was more appropriate than the 60-min period.

Effect of sputter-coating on cracking of root-end surfaces after ultrasonic retrograde preparation--a SEM study of resected root apices and their respective impressions.

The aim of this study was to evaluate in vitro the effect of sputter-coating for SEM analysis on the formation of cracks on root-end surfaces after retrograde cavity preparation with ultrasonic tips. Root-end cavities were prepared with either Satelec S12/90 degrees D diamond-coated or S12/90 degrees non-coated stainless steel retrotips. Impressions were taken before and after retrograde cavity preparation. The resected root apices and their respective impressions were examined using a scanning electron microscope, and the presence, extension and numbers of cracks were recorded after each procedure. The number of cracks observed directly on the ultrasonically prepared root-end surfaces was larger than that observed in their respective impressions taken after root-end cavity preparation, which suggests that cracking was mostly produced by the sputter-coating process required for SEM analysis. Impressions of the root-end cavities prepared with non-coated ultrasonic stainless steel retrotips showed a greater incidence of cracks (3/10 impressions) than those that replicated cavities prepared with diamond-coated retrotips (1/10 impressions). No statistical difference was found between the diamond and stainless steel retrotips.

Biocompatibility evaluation of alendronate paste in rat's subcutaneous tissue.

Alendronate is a known inhibitor of root resorption and the development of alendronate paste would enhance its utilization as intracanal medication. Therefore, this study aimed to investigate the biocompatibility of experimental alendronate paste in subcutaneous tissue of rats, for utilization in teeth susceptible to root resorption. The study was conducted on 15 male rats, weighing approximately 180-200 grams. The rats' dorsal regions were submitted to one incision on the median region and, laterally to the incision, the subcutaneous tissue was raised and gently dissected for introduction of two tubes, in each rat. The tubes were sealed at one end with gutta-percha and taken as control. The tubes were filled with experimental alendronate paste. The animals were killed at 7, 15 and 45 days after surgery and the specimens were processed in laboratory. The histological sections were stained with hematoxylin-eosin and analyzed by light microscopy. Scores were assigned to the inflammatory process and statistically compared by the Tukey test (P < 0.05). Alendronate paste promoted severe inflammation process at 7 days, with statistically significant difference compared to the control (P < 0.05%). However, at 15 days, there was a regression of inflammation and the presence of connective tissue with collagen fibers, fibroblasts and blood vessels was observed. After 45 days, it was observed the presence of well-organized connective tissue, with collagen fibers and fibroblasts, and few inflammatory cells. No statistical difference was observed between the control and experimental paste at 15 and 45 days. The experimental alendronate paste was considered biocompatible with subcutaneous tissue of rat.

CAMPANELLIProgrammed Death 1 (PD-1) and PD-1 Ligand (PD-L1) Expression in Chronic Apical Periodontitis.

OBJECTIVE: This study aimed to examine programmed death protein 1 (PD-1) and programmed death lig-and 1 (PD-L1) expression on leukocytes from chronic apical periodontitis, and to determine the levels of cytokines in the apical periodontitis lesions. METHODS: Leukocytes from healthy gingival tissue (n=16) and chronic apical periodontitis (n=10) were eval-uated using flow cytometry. The PD-1 and PDL-1 expressions were evaluated using flow cytometry. The cy-tokine levels were evaluated by enzyme-linked immunosorbent assay. Data were analyzed using one-way ANOVA. The statistical significance level was set at P<0.05. RESULTS: Results showed that the apical periodontitis lesions are more infiltrated by PD-1+ and PDL1+ lym-phocytes than the control samples. In addition, the PDL-1 expression was detected on macrophages in the apical periodontitis lesions, and was significantly higher compared to leukocytes from healthy gingival tis-sue. The IFN-γ, TGF-ß, IL-10, and TNF-α levels were significantly higher in the apical periodontitis lesions com-pared to control samples. CONCLUSION: The PD-1, PD-L1, and CTLA-4 molecules are evident in apical periodontitis, and can be an impor-tant immune checkpoint in chronic periapical periodontitis.

Mineral Trioxide Aggregate with or without Calcium Chloride in Pulpotomy.

The aim of this study was to evaluate the reaction of the pulp tissue against mineral trioxide aggregate (MTA) with or without 10% calcium chloride (CaCl(2)). Pulpotomies were performed in 4 canines and 8 premolars of two 8-month-old dogs. MTA with or without CaCl(2) was applied on the pulp tissue. The animals were killed after 90 days, and the specimens were processed for the microscopic analysis. Pulp tissue response was similar for MTA with and without CaCl(2). Pulp vitality was present in all specimens, along with pulp repair with formation of mineralized tissue bridging. The addition of CaCl(2) to MTA did not change its biologic properties in formation of mineralized barrier after pulpotomy.

Alveolar mucosa necrosis induced by utilisation of calcium hydroxide as root canal dressing.

This case demonstrates the ability of calcium hydroxide to cause connective tissue necrosis. A patient with a history of trauma exhibited a large area of external inflammatory root resorption affecting the cervical and middle thirds of tooth 12. After root canal cleaning, a calcium hydroxide root canal dressing was applied to control the resorption process. After three days when the patient attended for replacement of the dressing an irregular zone of necrosis was observed on the buccal aspect of the alveolar mucosa. Careful curettage and irrigation was then performed to remove the extruded calcium hydroxide and necrotic tissue. After curettage, the root canal was accessed and irrigated with saline solution for removal of remnants of the dressing. The dressing was than replaced taking care to avoid contact with soft tissue, which might induce further damage, minimising the overflow of material. Improvement in healing was observed at 15-day follow-up, with complete closure of the lesion by soft tissue. At the 120-day follow-up, no scar was detected. At 180-day follow-up, the root canal was filled only with mineral trioxide aggregate (MTA) with aid of K files #20 and #50. At two-year follow-up, there were no symptoms and the resorption process seemed to have ceased. It is important to emphasise the damage that may occur when calcium hydroxide is in close and extended contact with the soft tissues, which could happen when dressing material is extruded through a root resorption.

Analysis of mandibular second molars with fused roots and shallow radicular grooves by using micro-computed tomography.

AIM: This study aimed to describe the morphological and morphometric aspects of fused mandibular second molars with radicular shallow grooves using micro-computed tomography (CT). MATERIALS AND METHODS: Eighty-eight mandibular second molars with fused roots were scanned in a micro-CT scanner at a voxel size of 19.6 µm. After reconstruction, only molars without C-shaped roots and presenting shallow radicular grooves were selected. 30 molars were chosen for further analysis. Canal cross-sections were classified according to Fan's modified classification (C1, C2, C3, and C4) and morphometric parameters at the apical region, examination of accessory foramina and tridimensional configuration were evaluated. RESULTS: Three-dimensional reconstructions indicated a higher prevalence of merging type (n = 22). According to Fan's modified classification, the C4 configuration was predominant in the 3 apical mm. Roundness median values revealed a more round-shaped canals at 3 mm (0.72) than at 2 (0.63) and 1 (0.61) mm from the apex. High values of major and minor diameters were observed in the canals of these evaluated sections. In addition, few accessory apical foramina were observed at 1 and 2 mm from the apex. The average distance between last accessory foramina and the anatomic apex was 1.17 mm. A less complex internal anatomy is found when a mandibular second molar presents fused roots with shallow radicular grooves. The merging type canal was frequently observed. Moreover, the C4 configuration was predominant at a point 3 mm from the apex and presented rounded canals, large apical diameters, and few accessory foramina. The cervical and middle thirds presented C3 and C1 canal configurations most frequently. CONCLUSION: A minor morphological complexity is found when fused mandibular second molars present shallow radicular grooves.

The Influence of Humidity on Intra-tubular Penetration and Bond Strength of AH Plus and MTA Fillapex: An In Vitro Study.

OBJECTIVE: The aim of this study was to evaluate the influence of humidity on the intra-tubular penetration, bond strength and failure mode associated with AH Plus (AH) and MTA Fillapex (MTAF) sealers. METHODS: For this analysis, an apparatus was created to maintain the humidity of the specimens. Sixty bovine single-rooted teeth with similar anatomy were used. The teeth were randomly divided into 4 groups (n=15): G1 - AH/moist, G2 - AH/dry, G3 - MTAF/moist and G4 - MTAF/dry. A laser scanning confocal microscope was used to analyse the penetrability of the sealers into the dentinal tubules. A push-out test was performed to examine the diameter and height of the root canal fillings. The failure mode was analysed under a stereomicroscope at 40× magnification. The data were submitted to non-parametric Kruskal-Wallis and Dunn's tests. The significance level was P<0.05. RESULTS: The MTAF sealer exhibited higher intra-tubular penetration values compared to AH Plus (P<0.05) sealer. AH Plus showed the highest bond strength values. Regarding the type of failure mode, a majority of cohesive failures was identified, irrespective of the moisture conditions, which were not statistically significant among the sealers (P<0.05). CONCLUSION: Humidity conditions did not influence the intra-tubular penetration, bond strength and failure mode of AH Plus and MTAF sealers.

A comparison of the physicochemical properties of AH Plus Jet with samples taken from the beginning, middle and final portions of the automix syringe system

Aim To evaluate physicochemical properties and semi-quantitative elemental analysis of AH Plus Jet with samples from the beginning, middle and final portions of the automix syringe system. Methodology Three experimental groups based on the source of the material used (beginning, middle and final portion) were established for each of the evaluated properties. Setting time, flow and radiopacity were evaluate following ANSI/ADA n. 57 specification. Set specimens was used in the semi-quantitative elemental analysis in an energy-dispersive X ray spectroscopy and scanning-electron microscopy (EDS/SEM). Statistical analysis was performed using one-way ANOVA followed by Tukey test (P<0.05). Results Flow, setting time, solubility and EDS/SEM tests showed no significant differences among the three portions of the automix syringe (P>0.05). Radiopacity test showed significant differences in the beginning of the syringe comparing to the middle and final portions (P<0.05). EDS/SEM analysis identified the presence of C, O, Al, Ca, Zr and W. The element Al, however, was found only in the final portion of the syringe. Conclusions The results of AH Plus Jet suggested an adequate ratio of the components, without segregation between organic and inorganic components, since the results of setting time, flow, solubility and EDS/SEM analysis presented similar values regardless of the portion of the syringe from where the sealer was taken.

Sealing ability of MTA and radiopaque Portland cement with or without calcium chloride for root-end filling.

The aim of this study was to evaluate the influence of calcium chloride (CaCl(2)) on the sealing ability of three Mineral Trioxide Aggregate (MTA) cements, ProRoot MTA, MTA-Angelus, and radiopaque White Portland cement (WPC), for retrograde root filling. Seventy roots of extracted single-rooted teeth were instrumented and obturated. After sectioning the samples at 2 mm from the apex, they received one layer of Araldite and two coats of nail enamel, except for the apical dentinal surface submitted to apicectomy. Standardized retrograde cavities were prepared, filled with one of the materials, and immersed in 0.2% Rhodamine B solution for 72 hours. Dye leakage was analyzed on a light microscope with ocular micrometer. Kruskal-Wallis and Miller tests were used to compare groups arranged in increasing order of leakage, according to mean rank of scores: WPC+CaCl(2), MTA-Angelus+CaCl(2), ProRoot MTA+CaCl(2), MTA-Angelus, ProRoot MTA, and WPC. CaCl(2) improved the sealing ability of all three MTA cements.

Evaluation of the tissue response to MTA and MBPC: Microscopic analysis of implants in alveolar bone of rats.

The aim of this study was to evaluate and compare the quantitative and qualitative inflammatory responses and bone formation potential after implantation of polyethylene tubes filled with a new calcium hydroxide containing sealer (MBPc) and ProRoot mineral trioxide aggregate (MTA). There were 48 Wistar rats divided in three groups: Group I (control group) empty polyethylene tubes were implanted in the extraction site; group II and III, polyethylene tubes were implanted filled with ProRoot mineral trioxide aggregate (MTA) and MBPc, respectively. At 7, 15, and 30 days after tube implantation, the animals were killed, the hemi-maxillas were removed and prepared to light microscopic analyses. The scores obtained were submitted to Kruskal-Wallis statistical test (p < 0.05). Significant differences between the materials were not observed. The results showed that both materials had similar biological response.

Micro-computed Tomographic Analysis of Mandibular Second Molars with C-shaped Root Canals.

INTRODUCTION: The goal of the present study was to evaluate the morphometric aspects of the internal anatomy of the root canal system of mandibular second molars with C-shaped canals. METHODS: Fifty-two extracted second mandibular molars with C-shaped canals, fused roots, and radicular grooves were selected from a Brazilian population. The samples were scanned with a micro-computed tomographic scanner at a voxel size of 19.6 µm. The root canal cross sections were recorded as C1, C2, C3, and C4 root canal configurations according to the modified Melton classification. Morphometric parameters, including the major and minor diameters of the root canals, the aspect ratio, the roundness, and the tridimensional configuration (merging, symmetric, and asymmetric), were evaluated. RESULTS: The 3-dimensional reconstruction images of the teeth indicated an even distribution within the sample. The analysis of the prevalence of the different cross-sectional configurations of the C-shaped molars revealed that these were predominantly of the C4 and C3 configurations (1 mm from the apex) and the C1 and C2 configurations in the cervical third. According to the morphometric parameters, the C1 and the distal aspect of the C2 configurations exhibited the lowest roundness values and higher values for the area, major diameter, and aspect ratio in the apical third. CONCLUSIONS: Mandibular molars with C-shaped root canals exhibited similar distributions of symmetric, asymmetric, and merging type canals. The C1 configuration and the distal aspect of the C2 configuration exhibited the highest area values, low roundness values, and large apical diameters.

Evaluation of pH levels and calcium ion release in various calcium hydroxide endodontic dressings.

OBJECTIVE: The purpose of this study was to evaluate Ca(2+) release and pH of 3 calcium hydroxide-based products used routinely as intracanal dressings, as well as the new gutta-percha points with calcium hydroxide. STUDY DESIGN: The pH and Ca(2+) release were assessed using Calen with camphorated paramonochlorophenol, saline calcium hydroxide paste, LC paste (Lopes and Costa paste-calcium hydroxide with olive oil), and calcium hydroxide containing gutta-percha points. The materials were inserted in polyethylene tubes and immersed in deionized water. The pH variation and Ca(2+) release were monitored periodically for 4 weeks. RESULTS: After 72 hours, materials 1 and 2 raise the pH from 9.6 and 8.2 to 11.4 and 11.3, respectively, while a small change was observed for materials 3 and 4. The calcium concentration released from materials 1, 2, 3, and 4 after 72 hours was 6.54, 4.98, 1.31, and 1.74 mg/dL, respectively. CONCLUSION: Calen plus camphorated paramonochlorophenol and saline calcium hydroxide paste exhibited the highest calcium release and pH levels.

Bilateral fusion of mandibular second molars with supernumerary teeth: case report.

Fusion is a developmental anomaly characterized by the union of two adjacent teeth. In this article we report a rare case of bilateral fusion of permanent mandibular second molars with supernumerary teeth. The rarity with which this entity appears, along with its complex characteristics, often make it difficult to treat. The endodontic management of one tooth is described, as well as the successful treatment of a periradicular lesion.

Antimicrobial activity of calcium hydroxide and chlorhexidine on intratubular Candida albicans.

This study investigated the efficacy of calcium hydroxide and chlorhexidine gel for the elimination of intratubular Candida albicans (C. albicans). Human single-rooted teeth contaminated with C. albicans were treated with calcium hydroxide, 2% chlorhexidine gel, calcium hydroxide plus 2% chlorhexidine gel, or saline (0.9% sodium chloride) as a positive control. The samples obtained at depths of 0-100 and 100-200 µm from the root canal system were analyzed for C. albicans load by counting the number of colony forming units and for the percentage of viable C. albicans using fluorescence microscopy. First, the antimicrobial activity of calcium hydroxide and the 2% chlorhexidine gel was evaluated by counting the number of colony forming units. After 14 days of intracanal medication, there was a significant decrease in the number of C. albicans colony forming units at a depth of 0-100 µm with chlorhexidine treatment either with or without calcium hydroxide compared with the calcium hydroxide only treatment. However, there were no differences in the number of colony forming units at the 100-200 µm depth for any of the medications investigated. C. albicans viability was also evaluated by vital staining techniques and fluorescence microscopy analysis. Antifungal activity against C. albicans significantly increased at both depths in the chlorhexidine groups with and without calcium hydroxide compared with the groups treated with calcium hydroxide only. Treatments with only chlorhexidine or chlorhexidine in combination with calcium hydroxide were effective for elimination of C. albicans.

Repair of rabbit femur defects with organic bovine bone cancellous block or cortical granules.

PURPOSE: To investigate the osseous repair in epiphyseal rabbit femur defects treated with organic bovine bone (OBB) cancellous block or OBB cortical granules. MATERIALS AND METHODS: Forty-eight trephined defects were made bilaterally in 30 rabbits. In 18 animals, the defects were filled with OBB cancellous block (experimental group 1) or OBB cortical granules (experimental group 2), and in 12 animals (control group), the defects on both sides were filled only with blood clot. After 30, 90, and 180 days, the femur epiphyses were collected, fixed, radiographed both digitally and conventionally, and then processed for histologic analyses. The newly formed cortical bone was measured in the histologic sections using a digital image analysis system. RESULTS: Histologically, both experimental groups showed total or partial closure of the defects with woven bone at 30 days, whereas in the control sites, a marked migration of connective tissue into the defect was apparent. At 90 and 180 days, a similar pattern of repair was observed in the experimental groups and the control group. Quantitatively, however, no significant differences between groups (P > .05) were observed throughout the experimental period. A significant reduction in newly formed cortical bone occurred at 90 and 180 days (P < .05) in all groups. Radiographically, no statistically significant differences were seen among the groups (P > .05). CONCLUSIONS: The study showed minor descriptive differences at the first healing period that were not evident at later periods and that were not shown through histomorphometry and radiographic analysis. The only significant results were related to time.

Micro-computed tomography study of the internal anatomy of mesial root canals of mandibular molars.

INTRODUCTION: The aim of this study was to determine the mesiodistal and buccolingual diameter, apical volume, and the presence of isthmuses at the apical level of mesial root canals of mandibular molars. METHODS: Sixty extracted first and second mandibular molars were scanned by using a SkyScan 1076 micro-computed tomography system with a voxel size of 18 µm. The apical thirds of the samples were reconstructed to allow a perpendicular section of the apical third by using the multiplanar reconstruction tool of the OsiriX software. The mesiodistal and the buccolingual distances of root canals were measured between the 1- to 4-mm levels. The type of root canal isthmuses present at these levels was classified by using modified criteria of Hsu and Kim. The volume of the root canal anatomy between the 1- to 3-mm apical levels was obtained by using the CTAN-CTVOL software. RESULTS: The medians of the mesiodistal diameter at the 1-, 2-, 3-, and 4-mm levels in the mesiobuccal and mesiolingual canals were 0.22 and 0.23 mm, 0.27 and 0.27 mm, 0.30 and 0.30 mm, and 0.36 and 0.35 mm, respectively. The buccolingual lengths at the 1-, 2-, 3-, and 4-mm levels were 0.37-0.35 mm, 0.55-0.41 mm, 0.54-0.49 mm, and 0.54 and 0.60 mm, respectively. The presence of isthmuses was more prevalent at the 3- to 4-mm level. However, 27 cases presented complete or incomplete isthmuses at the 1-mm apical level. The mean of the volume of the apical third was 0.83 mm(3), with a minimum value of 0.02 and a maximum value of 2.4 mm(3). CONCLUSIONS: Mesial root canals of mandibular molars do not present a consistent pattern. A high variability of apical diameters exists. The presence of isthmuses at the apical third was not uncommon even at the 1-mm apical level.

The influence of cone-beam computed tomography and periapical radiographic evaluation on the assessment of periapical bone destruction in dog's teeth.

OBJECTIVE: The aim of this study was to determine the influence of periapical radiographs, cone beam computed tomography (CBCT) sections, and cone beam volumetric data on the determination of periapical bone destruction in endodontically treated distal root canals of premolar canine teeth. Nontreated mesial roots were used as controls. STUDY DESIGN: Enterococcus faecalis strain (ATCC 29212) was inoculated into 30 root canals of 2 mongrel dogs to induce apical periodontitis. After 60 days, the root canals of the distal roots of the 11 mandibular and 4 maxillary premolars were endodontically treated (n = 15). The mesial root canals were used as controls (no treatment). The bone destruction was evaluated after 6 months by 5 evaluators using periapical radiographs and by CBCT (coronal and sagittal sections). After the experimental period, the area of the lesions in periapical radiographs and CBCT sections were measured in mm(2) using the ImageTool software. A single evaluator measured the volumetric data using the OsiriX software. The comparison between the diagnosis methods in treated root canals and controls was performed using parametric and nonparametric criteria. The Pearson correlation coefficient was computed between radiographic values and CBCT volumetric data in treated root canals and controls. RESULTS: The results showed the presence of chronic apical periodontitis in every inoculated tooth. After 6 months, periapical radiographs, coronal CBCT sections, and volumetric data showed lower bone destruction in endodontically treated teeth in comparison with the control group (P < .05). The 5 evaluators found no differences between the apical periodontitis area of treated teeth and controls when CBCT sagittal sections were used (P > .05). No correlation was found between x-ray and CBCT volumetric values in treated root canals. CONCLUSIONS: Although selected CBCT sagittal sections showed similar values of bone destruction in endodontically and nontreated root canals, volumetric CBCT data showed that periapical lesions of endodontically treated root canals had half of the volume of periapical lesions in nontreated root canals. No relationship could be found between the periapical values of bone destruction and volumetric data found in CBCT of treated rood canals.

Comparison of GPX with or without solvent and hand files in removing filling materials from root canals--an ex vivo study.

OBJECTIVE: The aim of this study was to compare GPX instruments and hand files for gutta-percha removal. STUDY DESIGN: Fifty maxillary central incisors with a single straight canal were instrumented and filled. The teeth were divided into 5 groups of 10 specimens each, according to the gutta-percha removal techniques: group 1: GPX (21-mm-long teeth); group 2: GPX and xylol as solvent (21-mm-long teeth); group 3: GPX (25-mm-long teeth); group 4: GPX and xylol as solvent (25-mm-long teeth); and group 5: hand files and xylol as solvent. The amount of time for gutta-percha removal and the number of fractured instruments were evaluated. Radiographs were taken, and the teeth were grooved longitudinally and split. The area of residual debris was measured using Sigma Scan software. RESULTS: The time for filling material removal was significantly shorter when GPX was used (P < .05). Overall, hand files and solvent produced fewer remnants of filling materials (P < .05). In the GPX 25 mm-long teeth group, the filling material was not removed in the apical third. CONCLUSIONS: Under the experimental conditions, the GPX instruments proved to be faster than hand instruments in removing root filling materials; however, hand instruments left a smaller amount of residual filling materials on the canal walls. The GPX instruments did not pull the gutta-percha beyond its tip.