Micro-CT Evaluation of Root and Canal Morphology of Mandibular First Premolars with Radicular Grooves

Abstract The aim of this study was to evaluate morphological features of 70 single-rooted mandibular first premolars with radicular grooves (RG) using micro-CT technology. Teeth were scanned and evaluated regarding the morphology of the roots and root canals as well as length, depth and percentage frequency location of the RG. Volume, surface area and Structure Model Index (SMI) of the canals were measured for the full root length. Two-dimensional parameters and frequency of canal orifices were evaluated at 1, 2, and 3 mm levels from the apical foramen. The number of accessory canals, the dentinal thickness, and cross-sectional appearance of the canal at different root levels were also recorded. Expression of deep grooves was observed in 21.42% of the sample. Mean lengths of root and RG were 13.43 mm and 8.5 mm, respectively, while depth of the RG ranged from 0.75 to 1.13 mm. Mean canal volume, surface area and SMI were 10.78 mm3, 58.51 mm2, and 2.84, respectively. Apical delta was present in 4.35% of the sample and accessory canals were observed mostly at the middle and apical thirds. Two-dimensional parameters indicated an oval-shaped cross-sectional appearance of the root canal with a high percentage frequency of canal divisions (87.15%). Canal configuration type V (58.57%) was the most prevalent. C-shaped configuration was observed in 13 premolars (18.57%), whereas dentinal thickness ranged from 1.0 to 1.31 mm. Radicular grooves in mandibular first premolars was associated with the occurrence of several anatomical complexities, including C-shaped canals and divisions of the main root canal.

Resumo O objetivo deste estudo foi avaliar a morfologia de 70 pré-molares inferiores com depressões radiculares (DR) usando a microtomografia. Os dentes foram escaneados e avaliados quanto à morfologia das raízes e canais radiculares, bem como o comprimento, profundidade, frequência e localização das DR. O volume, a área de superfície e o Structure Model Index (SMI) dos canais foram mensurados no comprimento total da raiz. Parâmetros bidimensionais e orifícios do canal foram avaliados a 1, 2 e 3 mm do forame apical. O número de canais acessórios, a espessura dentinária e a aparência transversal do canal em diferentes níveis de raiz também foram registrados. A expressão de sulcos profundos foi observada em 21,42% da amostra. Os comprimentos médios de raiz e DR foram de 13,43 mm e 8,5 mm, respectivamente, enquanto a profundidade das DR variou de 0,75 a 1,13 mm. O volume médio do canal, a área superficial e o SMI foram de 10,78 mm3, 58,51 mm2 e 2,84, respectivamente. O delta apical estava presente em 4,35% da amostra e os canais acessórios foram observados principalmente nos terços médio e apical. Os parâmetros bidimensionais indicaram canais radiculares com secção oval e alta frequência de divisões canal principal (87,15%). A configuração Tipo V do canal radicular foi a mais prevalente (58,57%). A presença de canais em forma de C foi observada em 13 pré-molares (18,57%), enquanto a espessura dentinária variou de 1,0 a 1,31 mm. Os sulcos radiculares nos primeiros pré-molares inferiores foram associados à ocorrência de várias complexidades anatômicas, incluindo canais em forma de C e múltiplas divisões do canal principal.

On the Causality Between Dentinal Defects and Root Canal Preparation: A Micro-CT Assessment

Abstract This study aimed to evaluate the cause-effect relationship between canal preparation with ProTaper Universal (PTU) system and dentinal defects formation using micro-computed tomography (micro-CT) analysis. Forty mesial canals of mandibular molars with a type II Vertucci's canal configuration were scanned at an isotropic resolution of 14.16 µm. The sample was assigned to an experimental (n = 30) and a control (n = 10) groups, and the mesial canals were prepared with PTU system up to F2 instrument. The specimens from the experimental group were scanned and the cross-section images of the mesial roots, before and after preparation, were screened to identify the presence of dentinal defects. In the control group, the specimens were sectioned perpendicularly to the long axis of the root into 1-mm-thick slices (n = 80) and examined under optical microscope. Once a dentinal defect was detected, the slice was scanned through micro-CT. In the experimental group, dentinal micro-cracks were observed in 4,828 slices (24.04%). In all cross-section images, dentinal defects identified in the postoperative images were already present in the corresponding preoperative image. In the control group, 13 out of 80 slices (16.25%) had at least one dentinal defect visualized under stereomicroscopy, which was identified after a further micro-CT scanning. Micro-CT showed reliability as similar as optical microscopy in detecting dentinal defects, adding the possibility of tracking the dentinal tissue, before and after canal preparation, and providing a clear visualization of micro-cracks. Root canal preparation with PTU system did not induce the formation of new dentinal defects.

Resumo O objetivo deste estudo foi avaliar a relação de causa-efeito entre o preparo do canal radicular com o sistema ProTaper Universal (PTU) e a formação de defeitos dentinários usando a análise por micro-tomografia computadorizada (micro-CT). Quarenta raízes mesiais de molares inferiores com a configuração tipo II de Vertucci foram escaneadas com resolução isotrópica de 14.16 μm. A amostra foi distribuída em um grupo experimental (n = 30) e um grupo controle (n = 10), e os canais mesiais foram preparados com o sistema PTU até a lima F2. As amostras do grupo experimental foram escaneadas e as imagens de secção transversal das raízes mesiais, antes e após o preparo, foram analisadas ​​para identificar a presença de defeitos dentinários. No grupo controle, os dentes foram seccionados perpendicularmente em relação ao longo eixo da raiz em fatias de 1 mm de espessura (n = 80) e examinados ao microscópio óptico. Uma vez detectado um defeito dentinário, a fatia foi escaneada através da micro-CT. No grupo experimental, defeitos dentinários foram observados em 4.828 secções transversais (24,04%). Em todas as imagens de secção transversal, os defeitos dentinários após os procedimentos experimentais já estavam presentes na secção pré-operatória correspondente. No grupo controle, 13 das 80 fatias (16,25%) apresentaram pelo menos um defeito dentinário visualizado através do microscópio, o qual foi identificado em um escaneamento posterior. A micro-CT mostrou confiabilidade com a microscopia óptica para detecção e visualização dos defeitos dentinários, permitindo acompanhar o tecido dentinário antes e depois do preparo do canal. O preparo do canal radicular com o sistema PTU não induziu a formação de novos defeitos dentinários.

Unusual Deviation of the Main Foramen from the Root Apex

Abstract The relationship of the main foramen to the anatomic root apex has been the subject of several studies. Although they are anatomically close, they rarely coincide, and their distance can vary according to age or tooth type, ranging from 0.2 to 3.0 mm. The aim of this short communication was to evaluate the distance between the main foramen of independent middle mesial canals (MMCs) and the anatomical mesial root apex of mandibular first molars using the micro-computed tomography. Twenty-five mandibular first molars with MMCs were scanned (resolution of 9.9 µm), and the distance from its main foramen to the anatomical apex was evaluated. Overall, the distance ranged from 0.2 to 2.4 mm; however, in 3 specimens the distance was greater than 3 mm. This report demonstrates that the exit of the main foramen of the MMC varies considerably and could approach a substantial distance from the anatomical apex greater than previously reported in the literature.

Resumo A relação do forame principal com o ápice anatômico da raiz tem sido objeto de vários estudos. Embora estejam anatomicamente próximos, eles raramente coincidem, e a sua distância pode variar de acordo com a idade ou o tipo de dente, oscilando entre 0,2 e 3,0 mm. O objetivo deste artigo é relatar que a saída foraminal do canal mediano (MMC), presente na raiz mesial de molares inferiores, pode apresentar variações significativas, atingindo distâncias acima de 3 mm do ápice anatômico. Vinte e cinco primeiros molares inferiores com MMC foram escaneados (resolução de 9,9 mm) e a distância do forame principal ao ápice anatômico avaliada. Em geral, a distância mostrou variações consideráveis; no entanto, em 3 espécimes esta distância ficou acima de 3 mm. Este estudo teve como objetivo relatar que a saída do forame principal de canais medianos de primeiros molares inferiores pode apresentar variações consideráveis, podendo atingir distâncias maiores do que as relatadas previamente na literatura.

Micro-CT Evaluation of Non-instrumented Canal Areas with Different Enlargements Performed by NiTi Systems

The aim of this study was to compare the percentage of non-instrumented area of root canals prepared with different enlargements using single-file reciprocating systems (Reciproc and WaveOne) and a conventional multi-file rotary (BioRaCe) system by micro-computed tomographic analysis. Thirty mesial roots of mandibular molars with moderate curvature (10° to 20°) presenting a type II Vertucci canal configuration and similar internal volume were chosen and scanned at an isotropic resolution of 14.16 µm. The sample was assigned to 3 groups (n=10) according to the system used for root canal preparation: Reciproc, WaveOne, and BioRaCe groups. Second and third scans were taken after the canals were prepared with instruments sizes 25 and 40, respectively. The recorded images of the surface area voxels of the canals, before and after preparation were examined from the furcation level to the apex to quantify the non-instrumented surface. Statistical data were compared using GLM for repeated-measures with a significance level set at 5%. Instrumentation systems did not influence the percentage of untouched root canal surfaces (p=0.690) whilst a significant reduction in the percentage of static voxels was observed after the enlargement of the root canal (p=0.010) in all groups (p=0.507). None of the systems was able to prepare the entire surface area of the mesial root canal of mandibular molars. The increased final apical size resulted in a significant positive effect on the shaping ability of the tested systems.

Resumo O objetivo deste estudo foi comparar a porcentagem de área não-instrumentada de canais radiculares preparados com diferentes ampliações utilizando sistemas reciprocantes de lima única (Reciproc e WaveOne) e um sistema rotatório convencional de múltiplas limas (BioRaCe) usando a análise da micro tomografia computadorizada. Trinta raízes mesiais de molares inferiores com curvatura moderada (10º a 20º) apresentando a configuração classe II de Vertucci e semelhança de volume do canal foram selecionadas e escaneadas em uma resolução isotrópica de 14,16 µm. A amostra foi dividida em 3 grupos (n=10) de acordo com o sistema utilizado para a preparação do canal radicular: grupo Reciproc, grupo WaveOne e grupo BioRaCe. Segundo e terceiro escaneamentos foram realizados após os canais serem preparados com instrumentos tamanhos 25 e 40, respectivamente. As imagens registradas de voxels da área de superfície dos canais, antes e após o preparo, foram examinadas desde o nível da furca até o ápice para quantificar a superfície não instrumentada. Os dados foram comparados estatisticamente através de GLM para medidas repetidas com um nível de significância de 5%. Os sistemas de instrumentação não influenciaram o percentual de superfícies não tocadas dos canais radiculares (p=0,690), enquanto que uma redução significativa no percentual de voxels estáticos foi observada após o alargamento do canal radicular (p=0,010) em todos os grupos (p=0,507). Nenhum dos sistemas foi capaz de preparar toda a área de superfície do canal mesial dos molares inferiores. O aumento do tamanho final apical resultou num efeito positivo significativo sobre a capacidade de modelar dos sistemas testados.

Accumulated hard tissue debris produced during reciprocating and rotary nickel-titanium canal preparation.

INTRODUCTION: This study compared the amount of hard tissue debris produced after different apical enlargement with single-file reciprocating systems (WaveOne [Dentsply Maillefer, Baillaigues, Switzerland] and Reciproc [VDW, Munich, Germany]) and a conventional multifile rotary system (BioRaCe [FKG Dentaire, La-Chaux-de-Fonds, Switzerland]) using micro-computed tomographic imaging. METHODS: Thirty moderately curved mesial roots of mandibular molars presenting 2 independent root canals were selected and scanned at an isotropic resolution of 14.16 µm. The sample was assigned to 3 groups (n = 10) with respect to the root length and degree of curvature of the mesial root according to the system used for the root canal preparation: Reciproc, WaveOne, and BioRaCe. Second and third scans were taken after the root canals were prepared up to ISO sizes 25 and 40, respectively. The matched images of the mesial canals, before and after preparation, were examined from the furcation level to the apex to evaluate the amount of hard tissue debris (%). Data were statistically compared using a general linear model for repeated-measures with a significance level set at 5%. RESULTS: Instrumentation systems per se did not influence the amount of hard tissue accumulation (P > .05), whereas a significant reduction in the percentage of hard tissue debris was observed after sequential enlargement in all groups (P < .05). CONCLUSIONS: None of the systems yielded root canals completely free from packed hard tissue debris. The increased final apical size resulted in significantly less debris accumulation for both reciprocating and rotary systems.

Computed tomography evaluation of rotary systems on the root canal transportation and centering ability

Abstract: The endodontic preparation of curved and narrow root canals is challenging, with a tendency for the prepared canal to deviate away from its natural axis. The aim of this study was to evaluate, by cone-beam computed tomography, the transportation and centering ability of curved mesiobuccal canals in maxillary molars after biomechanical preparation with different nickel-titanium (NiTi) rotary systems. Forty teeth with angles of curvature ranging from 20° to 40° and radii between 5.0 mm and 10.0 mm were selected and assigned into four groups (n = 10), according to the biomechanical preparative system used: Hero 642 (HR), Liberator (LB), ProTaper (PT), and Twisted File (TF). The specimens were inserted into an acrylic device and scanned with computed tomography prior to, and following, instrumentation at 3, 6 and 9 mm from the root apex. The canal degree of transportation and centering ability were calculated and analyzed using one-way ANOVA and Tukey’s tests (α = 0.05). The results demonstrated no significant difference (p> 0.05) in shaping ability among the rotary systems. The mean canal transportation was: -0.049 ± 0.083 mm (HR); -0.004 ± 0.044 mm (LB); -0.003 ± 0.064 mm (PT); -0.021 ± 0.064 mm (TF). The mean canal centering ability was: -0.093 ± 0.147 mm (HR); -0.001 ± 0.100 mm (LB); -0.002 ± 0.134 mm (PT); -0.033 ± 0.133 mm (TF). Also, there was no significant difference among the root segments (p> 0.05). It was concluded that the Hero 642, Liberator, ProTaper, and Twisted File rotary systems could be safely used in curved canal instrumentation, resulting in satisfactory preservation of the original canal shape.

Shaping ability of Reciproc and TF Adaptive systems in severely curved canals of rapid microCT-based prototyping molar replicas

Objective: To evaluate the shaping ability of Reciproc and Twisted-File Adaptive systems in rapid prototyping replicas. Material and Methods: Two mandibular molars showing S-shaped and 62-degree curvatures in the mesial root were scanned by using a microcomputed tomography (μCT) system. The data were exported in the stereolitograhic format and 20 samples of each molar were printed at 16 µm resolution. The mesial canals of 10 replicas of each specimen were prepared with each system. Transportation was measured by overlapping radiographs taken before and after preparation and resin thickness after instrumentation was measured by μCT. Results: Both systems maintained the original shape of the apical third in both anatomies (P>0.05). Overall, considering the resin thickness in the 62-degree replicas, no statistical difference was found between the systems (P>0.05). In the S-shaped curvature replica, Reciproc significantly decreased the thickness of the resin walls in comparison with TF Adaptive. Conclusions: The evaluated systems were able to maintain the original shape at the apical third of severely curved mesial canals of molar replicas. .

An ex vivo comparison of working length determination by 3 electronic apex locators.

OBJECTIVE: To compare the accuracy of 3 different electronic apex locators (EALs) in establishing the working length in recently extracted teeth. STUDY DESIGN: Sixty teeth (100 canals) were soaked in an alginate model and electronically measured with 3 EALs (Dentaport ZX, Raypex 5, and Elements Diagnostic Unit and Apex Locator). The real working length was calculated as 1.0 mm short of the real length of the canal. The electronic measurements were taken following the manufacturers' orientations within +/-0.05 mm and +/-1.0 mm using a #15 K-file attached to the holder, after canal irrigation with 1% NaOCl. Data were analyzed with Friedman test and Wilcoxon signed rank test, at a significance level of 5%. RESULTS: Within +/-0.5 mm and +/-1.0 mm, the accuracy was 39% and 90% (Dentaport ZX), 31% and 82% (Raypex 5), and 37% and 73% (Elements Diagnostic Unit and Apex Locator), respectively, with statistically significant differences between Elements Diagnostic Unit and Apex Locator and the other EALs. CONCLUSION: None of the EALs yielded an accuracy of 100%. Within the limitations of the present study. Elements Diagnostic Unit and Apex Locator proved to be less reliable than Dentaport ZX and Raypex 5 in the determination of the real working length.

Ex vivo comparison of the accuracy of Root ZX II in detecting apical constriction using different meter's reading.

The purpose of this study was to compare the accuracy of Root ZX II to locate the apical constriction with the display meter set at "0.5" and "1'"reading. Seventy single-rooted teeth were soaked in an alginate model and randomly distributed in 2 groups (n = 35). Measurements were taken following canal irrigation with 1% NaOCl. The length was established using a #20 K-file attached to the holder when the display indicator reached the marks "0.5" (group I) or "1" (group II), after the meter read "Apex." Then, the file was fixed in position and the teeth removed from the alginate. The apical portion of the root was shaved until the tip of the file could be seen, the distance to the apical constriction verified by means of a stereomicroscope and the measurements compared. Statistical analysis was performed by using Student t test with the null hypothesis set as 5%. The mean positions of the file tip relative to the apical constriction were -0.23 +/- 0.39 mm and -0.42 +/- 0.45 for groups I and II, respectively, with no statistical difference (P > .05). The accuracy was 90.5% and 83.78% for the Root ZX II "0.5" and "1" readings, respectively. It was concluded that the meter reading "1" of Root ZX II reduced the risk of working length overestimation.

Influence of shaft design on the shaping ability of 3 nickel-titanium rotary systems by means of spiral computerized tomography.

OBJECTIVE: To evaluate the influence of shaft design on the shaping ability of 3 rotary nickel-titanium (NiTi) systems. STUDY DESIGN: Sixty curved mesial canals of mandibular molars were used. Specimens were scanned by spiral tomography before and after canal preparation using ProTaper, ProFile, and ProSystem GT rotary instruments. One-millimeter-thick slices were scanned from the apical end point to the pulp chamber. The cross-sectional images from the slices taken earlier and after canal preparation at the apical, coronal, and midroot levels were compared. RESULTS: The mean working time was 137.22 +/- 5.15 s. Mean transportation, mean centering ratio, and percentage of area increase were 0.022 +/- 0.131 mm, 0.21 +/- 0.11, and 76.90 +/- 42.27%, respectively, with no statistical differences (P> .05). CONCLUSIONS: All instruments were able to shape curved mesial canals in mandibular molars to size 30 without significant errors. The differences in shaft designs seemed not to affect their shaping capabilities.

Assessment of the biocompatibility of Epiphany root canal sealer in rat subcutaneous tissues.

OBJECTIVE: The aim of this study was to evaluate the biocompatibility of the root canal sealer Epiphany in rat subcutaneous tissues. STUDY DESIGN: Polyethylene tubes were filled with the sealer (I: Epiphany; II: photoactivated Epiphany; III: Epiphany associated with self-etch primer; IV: photoactivated Epiphany associated with primer; and V: control group) and later implanted into 4 different regions of the dorsum of 15 adult male rats (Rattus novergicus, Albinus Wistar). After 7, 21, and 42 days, 5 animals were killed, obtaining 4 samples per group, in addition to the control group, at each analyzed time. RESULTS: In all periods, Epiphany induced a mild inflammatory reaction. However, in group II, in which the primer was not used, extensive necrosis and a moderate to intense inflammatory reaction were observed, mainly after 7 and 21 days. CONCLUSION: Epiphany sealer appears biocompatible when tested on rat subcutaneous tissues.

Clinical management and subsequent healing of teeth with horizontal root fractures.

Horizontal root fractures are uncommon, mainly occurring on the cervical and middle third of the root of permanent upper incisors. The diagnosis is essentially radiographic and requires different healing patterns, depending on some pre- and postinjury factors. The aim of this article was to report the clinical management and different healing types in three cases of horizontal root fractures on permanent dentition. In case 1, the pulp tissue was vital and no treatment was necessary. In case 2, a root canal treatment of the cervical fragment was necessary and in case 3, pulpal necrosis was verified and an apical surgery was performed.

In vivo comparison of the biocompatibility of two root canal sealers implanted into the subcutaneous connective tissue of rats.

OBJECTIVE: To evaluate the subcutaneous biocompatibility of 2 root canal sealers. STUDY DESIGN: The subcutaneous implant technique recommended by the Fédération Dentaire International (FDI) was used to test Endométhasone and EndoREZ root canal sealers. These materials were placed in Teflon tubes, 1 mm in diameter and 10 mm in length, and implanted into 2 pockets created in the back of 40 Calomys callosus rodents, 20 for each material. Tissue biopsies were collected and histologically examined 15, 30, 60, and 90 days after the implantation procedure. The overall level of the inflammatory tissue response was graded as none, slight, moderate, or severe on the sealer-connective tissue interface at the opening ends of the tubes. The connective tissue response along the lateral wall outside of each tube served as a negative control. RESULTS: The tissue reaction to the Endométhasone diminished with time. The EndoREZ sealer was highly toxic during all experimental periods. CONCLUSION: Endométhasone root canal sealer presented biocompatibility within the analyzed periods, whereas EndoREZ showed no biocompatible behavior and caused late hypersensitive reaction.

O paradigma do limite apical de instrumentação - estudo in vivo / The paradigm of the apical limit of instrumentation - in vivo study

O proposíto deste estudo foi comparar in vivo a capacidade do método radiográfico e do método eletrônico, com o localizador apical eletrônico Just II, de determinar o limite apical de instrumetação e obturação, considerando a clássica referência de 1mm aquém do ápice radiográfico. Foram aferidos 56 dentes in vivo em um total de 128 canais. O comprimento de trabalho dos canais radiculares foi determinado pela colocação de uma lima endodôntica na posição da constrição apical, determinada pelo localizador apical e, em seguida, feita uma tomada radiográfica na qual se mediu a distância da ponta da lima ao ápice radiográfico. A compatibilidade entre a referência radiográfica de 1mm do ápice radiográfico e a medição eletrônica foi de 94,7 porcento nos dentes unirradiculares e em 51,5 porcento nos molares. Considerando o total de canais avaliados, os dois métodos foram coincidentes em apenas 67,96 porcento. Conclui-se que, apesar de ser indubitavelmente um recurso importante nos procedimentos de odontometria, os atuais localizadores apicais não suprimem por completo a necessidade da tomada radiográfica para confirmação do comprimenmto de trabalho