Root canal curvature influences uncontrolled removal of dentin and cleaning efficacy after ultrasonic activation

Abstract This study evaluated the correlation between root canal curvature and the effects of ultrasonic irrigation in the following parameters: volume of uncontrolled dentin removal (UDRVol), maximum depth of dentin defects, removal of accumulated hard tissue debris (AHTD), and canal transportation in prepared curved root canals. Twenty-four human permanent mandibular molars were divided into two groups according to root canal curvature: moderate curvature (MC: mean 25°); and severe curvature (SC: mean 48°). The specimens were scanned using an X-ray microcomputed scanner (Skyscan 1172) before and after cleaning and shaping and after the final irrigation protocol with ultrasonic irrigation. There was a moderate correlation between the degree of root canal curvature and the volume of remaining AHTD (p<0.05) and between the degree of root canal curvature and maximum depth of defects due to uncontrolled removal of dentin (p<0.05). The teeth in the SC group had a greater maximum depth of defects on the dentin wall in the apical third than the teeth in the MC group (p <0.05). Both groups had a significant reduction of AHTD in all canal thirds, but the amount of remaining AHTD in the middle and apical thirds and the whole canal was significantly greater in the SC than in the MC group (p <0.05). Canal transportation was not influenced by the canal curvature in all thirds (p >0.05). This study concluded that root canal curvature affects significantly the uncontrolled removal of dentin and remaining AHTD volume after the final irrigation protocol with ultrasonic irrigation.

Resumo Este estudo avaliou a correlação entre a curvatura do canal radicular e os efeitos da irrigação ultrassônica nos seguintes parâmetros: volume de remoção não controlada de dentina (UDRVol), profundidade máxima do desgaste de dentina, remoção de debris de tecido duro acumulado (AHTD) e transporte em canais radiculares curvos. Vinte e quatro molares inferiores humanos permanentes foram divididos em dois grupos de acordo com a curvatura do canal radicular: curvatura moderada (MC: média de 25°); e curvatura acentuada (SC: média de 48°). Os espécimes foram digitalizados usando um scanner microcomputador de raios X (Skyscan 1172) antes e depois da limpeza e modelagem e após a irrigação ultrassônica. Houve uma correlação moderada entre o grau de curvatura do canal radicular e o volume de AHTD remanescente (p<0,05) e entre o grau de curvatura do canal radicular e a profundidade máxima de defeitos devido à remoção descontrolada de dentina (p<0,05). Os dentes do grupo SC apresentaram maior profundidade máxima de defeitos na parede dentinária no terço apical do que os dentes do grupo MC (p<0,05). Ambos os grupos tiveram uma redução significativa de AHTD em todos os terços do canal, mas a quantidade de AHTD remanescente nos terços médio e apical e em todo o canal foi significativamente maior no grupo SC do que no grupo MC (p <0,05). O transporte do canal não foi influenciado pela curvatura do canal em todos os terços (p > 0,05). Este estudo concluiu que a curvatura do canal radicular afeta significativamente a remoção descontrolada de dentina e o volume remanescente de AHTD após a irrigação ultrassônica.

Using manual versus mechanized glide path instruments and ProTaper Gold versus ProTaper Next systems in curved canals: micro-CT study

Abstract The aim of this study was to evaluate the root canal shaping effect of ProTaper Gold (PTG) versus ProTaper Next (PTN) instrumentation systems, and of a manual #15 K-type file (K15) versus the ProGlider (PG) mechanized instrument for glide path creation, in severely curved mesial canals. Twenty-four mandibular molars with two separate mesial canals were anatomically matched using computed tomographic scanning, and then divided into two groups (n=12) according to the glide path instrument used, either K15 or PG. In all teeth, the PTG system was used to prepare the mesiobuccal canal, and the PTN, the mesiolingual canal. The teeth were scanned by computed microtomography, before and after root canal preparation, and the values of the initial volume, final volume, volumetric variation, untouched walls, and canal transportation variables were determined. The data were analyzed using the two-way ANOVA test, and the Tukey test for multiple comparisons. There was no significant difference among the study groups regarding volumetric variation or root canal transportation, either in the cervical, middle or apical thirds, or in the entire root canal (p>0.05). In the apical third, the percentage of untouched walls was significantly higher in groups using K15 than in those using PG (p<0.05), namely 33.144% and 23.285%, respectively, irrespective of the instrumentation system. In the other regions, there was no difference between K15 and PG regarding this variable. It was concluded that PG was associated with a lower rate of untouched walls in the apical region than K15.

Remoção de obturações endodônticas de Endosequence BC/CPoint em canais radiculares curvos usando instrumentos rotatórios ou reciprocantes / Removal of Endosequence BC/CPoint endodontic fillings in curved root canals using rotary or reciprocating instruments

Objetivo: O presente estudo usou micro-CT para avaliar a quantidade de material obturador remanescente em canais radiculares curvos que tinham sido obturados com cimento Endosequence BC/Cpoint ou com cimento AH/ guta-percha, depois do retratamento utilizando instrumentos rotatórios ou reciprocantes. Métodos: Sessenta canais mesiovestibulares de molares superiores foram instrumentados até MTwo #35.04. As amostras foram randomicamente alocadas em quatro grupos (n=15): os canais do G1 e G2 foram obturados com AH/guta-percha, e os canais do G3 e G4 foram obturados com BC/Cpoint. O material obturador foi removido usando instrumentos rotatórios ou reciprocantes ­ G1 e G3: R25 Reciproc + reinstrumentação com R40; e G2 e G4: Sistema ProTaper Universal Retratamento + reinstrumentação com MTwo 40.06. Micro-CTs foram usadas para medir a quantidade de material obturador remanescente (mm3 ) para o canal inteiro e para cada terço, em dois momentos: 1) após a remoção do material obturador; e 2) após a reinstrumentação. Resultados: Após a remoção do material obturador, BC/CPoint permaneceu mais dentro do canal do que AH/guta-percha quando o canal inteiro (29,92% x 19,25%, p=0,0290) e o terço apical foram analisados. Após a reinstrumentação, BC/CPoint permaneceu mais do que AH/guta-percha somente no terço apical. Protocolos de tratamento com instrumentos rotatórios ou reciprocantes removeram material obturador sem diferença para AH/guta-percha (G1 e G2: p> 0,05) e BC/CPoint (G3 e G4: p> 0,05). Conclusões: BC/Cpoint é mais difícil de ser removido de canais radiculares curvos do que AH/guta-percha. Instrumentos rotatórios e reciprocantes têm habilidade similar na remoção de material obturador (AU).

Objective: This study used micro-CT to evaluate the amount of remaining filling material in curved root canals obturated with Endosequence BC Sealer/Cpoint or AH/gutta-percha after a rotary or reciprocating retreatment. Methods: Sixty mesiobuccal canals of maxillary molars were instrumented up to MTwo #35.04. Samples were randomly assigned to four groups (n=15): canals from G1 and G2 were filled with AH/gutta-percha, and canals from G3 and G4 were filled with BC/Cpoint. Filling material was removed using rotary or reciprocating instruments: G1 and G3: R25 Reciproc + re-shaping with R40; and G2 and G4: ProTaper Universal Retreatment system + re-shaping with MTwo 40.06. Micro-CT was used to measure the remaining amount of filling material (mm3 ), for the whole canal, and for each third, in two moments: 1) after filling removal and 2) after canal re-shaping. Results: After filling removal, BC/CPoint remained more into the canal than AH/Gutta-percha when the whole canal (29.92% x 19.25%, p = 0.0290) and the apical third were analyzed. After re-shaping, BC/CPoint remained more than AH/Gutta-percha only in the apical third. Rotary or reciprocating retreatment protocols removed filling material without difference for AH/gutta-percha (G1 and G2: p > 0.05) and BC/CPoint (G3 and G4: p > 0.05). Conclusion: BC/Cpoint is more difficult to be removed from curved root canals than AH/gutta-percha. Reciprocating and rotary instruments have similar ability to remove filling material (AU).

Avaliação da qualidade dos agregados leucoplaquetários / Evaluation of the quality of the leuco platelet aggregates

Objetivo ­ Avaliar a qualidade do plasma rico em plaquetas (PRP) e da fibrina rica em plaquetas (PRF) obtidos através de alguns tipos de protocolos de obtenção por meio da contagem de plaquetas e leucócitos nos materiais. Métodos ­ Foram coletadas amostras de sangue de voluntários mediante aprovação do Comitê de Ética em Pesquisa (CEP). As amostras foram centrifugadas em diferentes rotações e tempos (1300 RPM por 5 minutos, 550 RPM por 5 minutos e 550 RPM por 3 minutos). As concentrações de plaquetas e leucócitos foram avaliadas no Coulter LH 750 analyzer. Os resultados foram submetidos a análise estatística (Graph Pad Prism). Resultados ­ As dosagens de plaquetas foram significativamente maiores (p<0.0001) no protocolo de PRF centrifugado a 1300 rpm em comparação com os outros materiais, e as dosagens de leucócitos foram maiores no PRF centrifugado a 550 rpm (p<0.05). Conclusão ­ Os resultados desse trabalho sugerem que a velocidade de centrifugação, o uso de anticoagulante e o tempo de centrifugação são alguns interferentes que afetam a qualidade do material obtido impactando na diminuição do número de células presentes no material. Os resultados também apontam que o PRF apresenta maiores concentrações celulares, principalmente próximo à camada de leucócitos

Objective ­ To evaluate the quality of platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) obtained through some types of protocols for obtaining platelet and leukocyte counts in the materials. Methods ­ Blood samples were collected from volunteers with the approval of the Research Ethics Committee (CEP). The samples were centrifuged at different speeds and times (1300 RPM for 5 minutes, 550 RPM for 5 minutes and 550 RPM for 3 minutes). Platelet and leukocyte concentrations were evaluated on the Coulter LH 750 analyzer. The results were subjected to statistical analysis (Graph Pad Prism). Results ­ Platelet dosages were significantly higher (p <0.0001) in the PRF protocol centrifuged at 1300 rpm compared to other materials, and leukocyte dosages were higher in PRF centrifuged at 550 rpm (p <0.05). Conclusion ­ The results of this work suggest that the centrifugation speed, the use of anticoagulant and the centrifugation time are some interferents that affect the quality of the material obtained impacting on the decrease of the number of cells present in the material. The results also point out that PRF presents higher cellular concentrations, mainly near the leukocyte layer

Internal configuration of maxillary molars in a subpopulation of Brazil's Northeast region: A CBCT analysis

Abstract The present study aimed to evaluate the internal configuration of the maxillary molars of a population from the Northeast region of Brazil. Cone-beam computed tomography (CBCT) exams from 512 patients (1501 teeth) were evaluated regarding the anatomical configuration of the root canal system, according to Vertucci's classification. The images were obtained using a Prexion 3D scanner operating at 90 kVp and 4 mA. The voxel size was 0.125 mm and the cut thickness was 1 mm. The images were then analyzed in the Prexion 3D Viewer software. The data were analyzed statistically by Pearson's chi-square test, with 5% of significance. The first and second molars presented three roots in 99.14% and 87.27% of the cases, respectively. In relation to the number of canals, the first and second molars had a significantly higher frequency of three and four root canals respectively, presenting a higher prevalence of types I and II (p < 0.001). The second mesiobuccal canal (MB2) was observed in 48.21% and 22.72% of the first and second molars, respectively (p < 0.001). The identification of the MB2 canal was greater in young and adult patients (p < 0.001), presenting a higher prevalence in male patients (p < 0.001). The internal configuration of the MB root was influenced by gender and by age, presenting a higher prevalence of the MB2 in male patients younger than 50 years of age.

Avaliação qualitativa e quantitativa da instrumentação e obturação de canais radiculares achatados utilizando-se microtomografia computadorizada / Qualitative and quantitative evaluation of instrumentation and obturation of flat root canals using computed microtomography

Na Endodontia, a microtomografia (CT) tem sido amplamente utilizada como método de análise tridimensional. Atualmente, três movimentos mecanizados para o preparo do canal radicular tem sido introduzidos na rotina endodôntica, oscilatório, rotatório e recíproco. Existem diferentes sistemas de limas acionadas por motores capazes de realizar esses movimentos. Sendo assim, os objetivos deste trabalho são utilizar a CT para avaliar, em canais mesiais achatados de molares inferiores, a qualidade e modelagem final de preparo do canal radicular, utilizando-se sistemas oscilatório, recíproco e rotatório e avaliar a obturação do canal radicular com cone único ou ondas contínuas de condensação, no que diz respeito ao volume de material obturador e de espaços vazios. Os resultados não mostraram diferença estatísitica significativa no volume de desgaste entre os grupos testados. Para a porcentagem de superfície não tratada os grupos oscilatório e rotatório tocaram mais paredes nos terços cervical e médio do que o grupo recíproco. A técnica de ondas contínuas de condensação e cone único apresentaram preenchimento de obturação semelhantes nos terços médio e apical, sendo que no terço cervical a técnica de ondas contínuas deixou menor porcentagem de espaços vazios...

Endodontics in the microtomography (CT) has been widely used as a method for three-dimensional analysis. Currently, three mechanized movements for root canal preparation has been introduced in endodontic, oscillatory, rotational and reciprocal routine. There are different files systems driven by motors capable of these movements. Thus, the objectives of this work are using CT to evaluate, in flattened mesial canals of mandibular molars, the quality and final modeling of root canal preparation, using oscillatory, reciprocal and rotational systems and evaluate the root canal filling with single cone or continuous waves of condensation, with respect to the volume of filling material and voids. The results showed no significant difference in estatísitica wear volume between the tested groups. For the percentage of untreated surface and the oscillating rotating groups played more walls in the cervical and middle thirds of the reciprocal group. The technique of continuous wave of condensation and single cone showed similar fillings fill in the middle and apical thirds, and in the cervical third of the technique of continuous wave left lower percentage of voids...