Comparison of centring ability and transportation between four nickel titanium instrumentation techniques by micro-computed tomography.

AIM: To compare the centring ability and transportation of ProTaper Next (PTN), ProTaper Universal (PTU), Race 123 and RevoS using micro-computed tomography (µCT). METHODOLOGY: Sixty mesial root canals of thirty mandibular molars were divided virtually into coronal, middle and apical thirds, and two reproducible reference points were marked on the external surface of the roots creating 360 measurement points. Samples were randomly allocated to four NiTi instrumentation techniques. Group 1: PTU up to F2 (n = 16), group 2: PTN up to X2 (n = 18), group 3: Race 123 up to T2 (n = 12) and group 4: RevoS up to SU (n = 14). To reproduce a clinical situation, samples were prepared on a phantom head using a surgical operating microscope. Samples were scanned pre- and postoperatively using µCT to compare and calculate the transportation and centring ratio. The data were analysed using parametric statistics. RESULTS: In the coronal and middle third of the root canals, there were significant differences in centring between PTN and PTU (coronal P < 0.001), PTN and RevoS (coronal P < 0.001), Race and PTU (coronal P < 0.01), Race and RevoS (coronal P < 0.01), PTN and RevoS (middle P < 0.01) and Race and RevoS (P < 0.05). Furthermore, there were significant differences in centring between PTN root canal preparations and other instruments in the apical third (PTN and PTU P < 0.01, PTN and Race P < 0.001, PTN and RevoS P < 0.001). In terms of transportation, in the coronal third, there was a significant difference between PTN and PTU (P < 0.05). However, there were no significant differences between the other instruments. In the middle third, significant differences were observed between PTN and PTU (P < 0.05), PTN and RevoS (P < 0.05), Race and PTU (P < 0.05) and Race and RevoS (P < 0.05). However, there were no significant differences between other systems. There was no significant difference in terms of transportation between the four systems in the apical third. CONCLUSIONS: ProTaper Next prepared more centred root canal shapes when compared with Race, PTU and RevoS. In the coronal and middle third of the root canals, the differences in centring between PTN and PTU/RevoS were significant. PTN root canal preparations were more centred than those achieved with all other instruments in the apical third.

Shaping ability of two nickel-titanium instruments activated by continuous rotation or adaptive motion: a micro-computed tomography study.

OBJECTIVES: The objective of the study was to evaluate the shaping ability of curved root canals using Twisted File Adaptive (TFA) files (SybronEndo, Orange, CA) and Mtwo (Sweden & Martina, Padova, Italy) activated by continuous rotation or adaptive motion. MATERIALS AND METHODS: Thirty-two mandibular molars with two separate mesial canals and severe angles of curvature were selected. Each canal was randomly assigned to one of the four experimental groups (n = 16): TFA and Mtwo files used in continuous rotation (groups 1 and 3) or in adaptive motion (groups 2 and 4). Root canals before and after preparation were assessed by micro-computed tomography. Volume, surface area, canal transportation, and centering ability were recorded and analyzed using two-way analyses of variance. RESULTS: Volume and surface area increased less with TFA files in continuous rotation than in other groups (P < 0.001 and P < 0.01, respectively, for each comparison) that were not different (P > 0.05). TFA files had significantly less transportation and higher centering ability than Mtwo both in continuous and adaptive motion (P < 0.0001). Centering ratio, but not canal transportation, was improved by adaptive motion compared with continuous rotation for both instruments (P < 0.01). However, no differences were found in canal transportation and centering ability in the apical third for both instruments and motions (P > 0.05). CONCLUSIONS: No difference between the devices and kinematics was found in the apical third; TFA performed significantly better in the middle and coronal parts of the root canal. CLINICAL RELEVANCE: The use of NiTi files made by heat-treated alloy and/or adaptive motion could improve the qualities of root canal shaping rather than the use of conventional NiTi instruments and/or continuous rotation in the coronal and middle thirds of the root canals, but not in the apical one. Moreover, these findings encourage the use of adaptive motion with conventional NiTi files to improve centering ability without affecting other preparation qualities of root canals.

The detection of periapical pathoses using digital periapical radiography and cone beam computed tomography in endodontically retreated teeth - part 2: a 1 year post-treatment follow-up.

AIM: Part 2 of this prospective clinical study aimed to compare the 1-year outcome of root canal retreatments, when individual roots and teeth were assessed by periapical radiographs and cone beam computed tomography (CBCT). METHODOLOGY: Subjects participating in this study had been referred for management of an endodontic problem associated with one or more root filled teeth. Root canal retreatment was performed by Specialists or postgraduate students under the direct supervision of Specialist endodontic staff. A total of 98 teeth (84 patients) were reassessed clinically and radiographically 1 year after completion of root canal retreatment. The postoperative periapical radiographs and CBCT scans were compared with their respective pre-treatment (diagnostic) periapical radiographs and CBCT scans. The increase or decrease in size of existing periapical radiolucencies and development of new radiolucencies were assessed by a consensus panel consisting of two calibrated examiners. They also determined an appropriate management plan for each case based on the radiographical findings. Comparison of the outcome diagnosis of individual roots and teeth and case management, when assessed by periapical radiographs and CBCT scans, was performed using chi-squared and McNemar's tests. RESULTS: An overall favourable result of 93% success for teeth (96% roots) was recorded when the assessment was undertaken by periapicals compared with 77% success for teeth (87% roots) when assessed by CBCT. A significant difference in outcome diagnosis of single paired roots (P < 0.0001) and teeth (P = 0.0001) was observed when comparing periapicals to CBCT for the cohort of teeth as a whole. When comparing the future management plan on the basis of radiographic information alone, there was a significant difference between periapicals and CBCT-based management (P = 0.01). CONCLUSION: Diagnosis using CBCT revealed a significantly lower number of favourable outcomes than periapicals in root canal retreatment. This significantly affected the future management of cases attending for a review.

Changes in centring and shaping ability using three nickel­titanium instrumentation techniques analysed by micro-computed tomography (µCT).

AIM: To compare the centring ability and the shaping ability of ProTaper (PT) files used in reciprocating motion and PT and Twisted Files (TF) used in continuous rotary motion, and to compare the volume changes obtained with the different instrumentation techniques using micro-computed tomography. Methodology Sixty mesial canals of thirty mandibular molars were randomly assigned to three instrumentation techniques: group 1, canals prepared with the PT series (up to F2) (n = 20); group 2, canals prepared with the F2 PT in reciprocating motion (n = 20); group 3 canals prepared with the TF series (size 25) (n = 20). Teeth were scanned pre- and postoperatively using micro-computed tomography to measure volume and shaping changes, and the obtained results were statistically analysed using parametric tests. Results The increase in canal volume obtained with the three instrumentation techniques was not significantly different. Canals were transported mostly towards the mesial aspect in the apical- and mid-third of the roots, and towards the furcal aspect coronally. No difference in the transportation and centring ratio was found between the techniques. There was no significant difference between the times of instrumentation (TF: 62.5 ± 5.4 s; PT: 60.6 ± 3.9 s; and F2 PT file in reciprocating motion: 51.0 ± 3.3 s). Conclusions ProTaper files used in reciprocating motion and PT and TF used in continuous rotary motion were capable of producing centred preparations with no substantial procedural errors.

Hand and nickel-titanium root canal instrumentation performed by dental students: a micro-computed tomographic study.

The aim of this study was to evaluate root canals instrumented by dental students using the modified double-flared technique, nickel-titanium (NiTi) rotary System GT files and NiTi rotary ProTaper files by micro-computed tomography (MCT). A total of 36 root canals from 18 mesial roots of mandibular molar teeth were prepared; 12 canals were prepared with the modified double-flared technique, using K-flexofiles and Gates-Glidden burs; 12 canals were prepared using System GT and 12 using ProTaper rotary files. Each root was scanned using MCT preoperatively and postoperatively. At the coronal and mid-root sections, System GT and ProTaper files produced significantly less enlarged canal cross-sectional area, volume and perimeter than the modified double-flared technique (P < 0.05). In the mid-root sections there was significantly less thinning of the root structure towards the furcation with System GT and ProTaper (P < 0.05). The rotary techniques were both three times faster than the modified double-flared technique (P < 0.05). Qualitative evaluation of the preparations showed that both ProTaper and System GT were able to prepare root canals with little or no procedural error compared with the modified double-flared technique. Under the conditions of this study, inexperienced dental students were able to prepare curved root canals with rotary files with greater preservation of tooth structure, low risk of procedural errors and much quicker than with hand instruments.

Bonding to root canal: structural characteristics of the substrate.

PURPOSE: To evaluate in vitro the dentin morphology in root canals in terms of tubule orientation, density and increase in surface area after etching. MATERIALS AND METHODS: Thirty anterior teeth were divided in 3 groups at random: the samples of Group 1 were used to study tubular morphology in SEM. Groups 2 and 3 samples were etched with 32% phosphoric acid. The teeth in Group 2 were examined by SEM without further treatment. The samples in Group 3 were treated with a bonding system and fiber posts were luted into the canal. These teeth were then processed for evaluation of hybrid layer formation and resin tags in dentin tubules. The observations were made according to location in the root dentin, tubule density was estimated, and the increase in area available for bonding after etching was calculated. RESULTS: The observations revealed variability in tubule density and orientation within different areas of any one sample. Statistically significant differences in the density of tubules were found depending on location. The dentin surface area available for bonding increased by 202% after etching in the cervical third, 156% in the middle third, and 113% in the apical third of the root dentin. Group 3 samples showed that the thickness of the hybrid layer depended on the density of tubules. In the sectors with a low density of tubules, the hybrid layer was significantly thinner than in areas with a higher density of tubules. The increase in dentin surface area might be responsible for the enhanced bond strength after acid etching, but not all areas exhibited equal responses to etching.

Sealing ability of two "compomers" applied with and without phosphoric acid treatment for Class V restorations in vivo.

STATEMENT OF PROBLEM: "Compomers" are being used with increasing frequency in Europe and North America. PURPOSE: This study evaluated the marginal seal of two compomers in vivo. MATERIAL AND METHODS: Periodontally involved teeth, scheduled for extraction, were selected. Four groups of a combination of materials were used (Dyract with Dyract-PSA primer, group 1; Dyract with Prime and Bond 2.0, group 2; Compoglass with SCA primer, group 3; and Compoglass with Syntac Single Component, group 4). The restorations were made in a standardized shaped cavity, across the cementoenamel junction, and the teeth were extracted after 2 to 3 months of clinical service. The specimens were kept in a solution of 2% methylene blue for 24 hours. After being embedded in epoxy resin, sections were made with a low speed saw along the longitudinal axis of the teeth. The examination of dye penetration was made with a microscope at a magnification of x20 and scoring was done at both coronal and apical sites. Kruskal-Wallis statistical analysis was performed at 5% significance level. RESULTS: Groups 2 and 4 scored significantly less than groups 1 and 3 and for groups 2 and 4, 30% of the restorations exhibited leakage. CONCLUSION: These restoration systems did not completely prevent leakage either at the incisal or the cervical margins. Therefore the use of an enamel-dentin bonding system in combination with the proprietary compomer is recommended.