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Objective: Minor constriction which is the narrowest diameter is considered to be the appropriate apical limit of endodontic treatment. Apex locators provide greater precision, fewer procedural errors, less discomfort to the patient during measurement of working length. The aim of this article is to compare the accuracy of four electronic apex locators in detecting the apical constriction using histological sections as the gold standard. 80Materials and Methods: extracted single-rooted permanent teeth were selected and coronally flattened for stable reference point. Access cavity was prepared and canal patency was checked. Samples were embedded in alginate upto cemento-enamel junction. Working length was determined with the apex locators. A 15 K file adjusted to that reading was placed in the root canal and stabilized with flowable composite. Apical 4 mm of root was longitudinally sectioned and the position of the file in relation to the minor constriction was recorded for each tooth under stereomicroscope at 40X magnification. Chi-square test was carried out to test the difference in accuracy at various levels from the minor foramen. Kruskal Wallis Test was carried out to compare the differences between the study groups for the distance from the tip of the file relative to the minor foramen (P<0.05). Measurements of mean working lengths within ±0.5 mm of minor diameter were 85%Results: acceptable for CanalPro followed by Root ZX Mini (80%) and Propex Pixi (80%) and the least by DPEX V (65%). Conclusion: Accuracy of these instruments for detecting the minor diameter is acceptable for clinical practice
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BACKGROUND: In orthodontic treatment, there will be different degrees of external apical resorption. Severe root resorption will reduce the root/shoot ratio, reduce the stability of teeth, and even cause teeth to loosen and fall out. OBJECTIVE: To compare the difference of external apical root resorption between high torque self-locking bracket and traditional straight wire bracket in orthodontic treatment of bimaxillary protrusion patients. METHODS: Forty-nine patients with bimaxillary protrusion, aged 13-16 years, who were treated in the Hospital of Stomatology of Southwest Medical University from January 2016 to December 2019, were enrolled in this study. The patients were divided into the high torque self-locking bracket group (n=24) and the traditional straight wire bracket group (n=25). Cone beam CT was taken before and after orthodontic treatment. The root morphology and length of maxillary central incisors and lateral incisors were observed by CS 3D Imaging Software. The amount of external apical root resorption between maxillary incisor and lateral incisor was calculated. This study was approved by the Medical Ethics Committee of Hospital of Stomatology of Southwest Medical University. RESULTS AND CONCLUSION: (1) The two groups after orthodontic treatment had achieved a good correction effect. The course of treatment was shorter in the high torque self-locking bracket group than that in the traditional straight wire bracket group (P 0.05). In the same appliance group, the amount of external apical root resorption of the maxillary central incisors was less than the lateral incisors (P < 0.05). (4) Results indicate that compared with the traditional straight wire bracket, the high torque self-locking bracket may have the advantages of short treatment course and low risk of apical absorption in the orthodontic treatment of bimaxillary protrusion.
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Treatment of immature teeth with necrotic pulp is a difficult procedure because of difficulty in obtaining fluid tight seal with normal root canal treatment. Revascularization may be considered as a treatment option in such teeth because of the stem cells present inside may help in closure of open apex by differentiating into cells required for root formation. Methods: 35 patients with history of trauma to upper front teeth were included in the study. For pulp regeneration procedure, bleeding was induced in canal and was allowed to clot over 15 min period to a level 3mm below CEJ coronally and was sealed off with MTA. Patients were followed up for period of 09 months to observe changes in pulp sensibility, increase in root length and increase in dentinal wall thickness. The obtained data was statistically analyzed. Results: There was significant increase in root length and dentinal wall thickness after the procedure. Conclusion: The results conclude that pulp regeneration procedure may be considered as a treatment option for patients with immature apices following trauma.
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Los dientes permanentes presentan desarrollo y formación radicular incompleta al momento de su erupción, el tejido pulpar es el encargado de culminar el proceso de formación radicular por intermedio de los odontoblastos que producen dentina, si la misma se ve afectada por traumatismo, lesión cariosa, resorción intracoronal pre eruptiva (PEIR por sus siglas en inglés) y/o fractura, se altera la vitalidad e incluso puede llegar a producirse necrosis pulpar, lo que ocasionará una interrupción de la formación radicular normal. Para el tratamiento de dientes permanentes jóvenes e inmaduros que han sufrido algún tipo de lesión, pero que aún mantienen la vitalidad pulpar, el procedimiento de apicogénesis con agregado de trióxido mineral (MTA) puede ser considerado como una opción viable, debido a la biocompatibilidad y capacidad de inducir la formación de tejidos duros. En el presente reporte de caso se presenta una pieza dental con antecedente de PEIR, tratada mediante apicogénesis con MTA, lográndose resultados favorables en cuanto al engrosamiento de paredes dentinales, desarrollo radicular y mantenimiento de la vitalidad pulpar.
The permanent teeth have an incomplete development and root formation at the time of its eruption, the pulp tissue is responsible for completing the process of root formation by means of odontoblasts that produce dentin, if it is affected by trauma, carious lesion, Pre-eruptive intracoronal resorption (PEIR) and / or fracture, pulp vitality is altered and pulp necrosis may even occur, which will cause an interruption of the normal radicular formation. For the treatment of immature permanent teeth that have suffered some type of injury, but still maintain pulp vitality, the procedure of apexogenesis with added mineral trioxide (MTA) can be considered as a viable option, due to the biocompatibility and capacity of induce the formation of hard tissues. In this case report we present a tooth with a history of PEIR, treated by apexogenesis with MTA, achieving favorable results in terms of thickening of dentinal walls, root development and maintenance of pulpal vitality.
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SUMMARY: The purpose of this study was to determine the shape and diameter of the physiological foramen in maxillary premolars of a Chilean population. The sample consisted of 125 extracted maxillary premolars, in which the apical three to five millimeters were cut and observed under magnification of 40x, photographed (Motic Cam), and analyzed using Motic Images Plus 2.0 ML in order to obtain measurements of the minor and major diameter of each physiological foramen. The average minor and major diameter in maxillary premolars was 0.270 and 0.413 mm, respectively. In terms of shape, 72.19 % had oval shaped physiological foramen; 18.93 % were irregularly shaped and 8.88 % were round. Oval and irregular canals are significantly more difficult to shape and require special attention in order to obtain a thoroughly disinfected root canal system.
RESUMEN: El objetivo del estudio fue determinar la forma y el diámetro del foramen fisiológico de premolares maxilares en una población Chilena. La muestra consistió en 125 premolares maxilares extraídos, a los que se cortó de 3 a 5 milímetros apicales, fueron observados bajo magnificación de 40x, fotografiado (Motic Cam) y analizados utilizando Motic Images Plus 2.0 ML para obtener las mediciones de el diámetro menor y mayor de cada foramen fisiológico. El promedio del diámetro menor y mayor en premolares maxilares fue de 0,270 y 0,413 mm respectivamente. En cuanto a la forma 72,19 % tenía el foramen fisiológico de forma oval; 18,93 % tenía forma irregular y 8,88 % fue redondo. Canales ovales e irregulares son significativamente más difíciles de conformar y requieren especial atención para obtener una adecuada desinfección del sistema de canales radiculares.
Subject(s)
Humans , Male , Female , Adult , Bicuspid/anatomy & histology , Tooth Apex/anatomy & histology , Chile , MaxillaABSTRACT
Objective@# To evaluate the spatiotemporal relationship between the root apex of mandibular molars and the inferior alveolar nerve canal (IANC) in adults. @*Methods@#Cone-beam computed tomography (CBCT) images were collected in 236 patients, and the distances from the root apexes of mandibular molars to the IANC were measured in NNT 4.6 software. The relationship between distance and gender was evaluated. @*Results@#In two-rooted mandibular first molars, the distances from the mesial root and distal root to the IANC were 7.34 ± 2.07 mm and 6.69 ± 2.08 mm, respectively, in males and 6.47 ± 2.22 mm and 5.94 ± 2.11 mm in females. In three-rooted mandibular first molars, the distances from the mesial root, distobuccal root, and distolingual to the IANC were 7.29 ± 1.30 mm, 7.40 ± 2.33 mm, and 9.97 ± 2.19 mm, respectively, in males and 6.08 ± 2.57 mm, 6.35 ± 2.40 mm, and 9.01 ± 2.90 mm, respectively, in females. In one-rooted mandibular second molars, the distance from the root to the IANC was 4.09 ± 1.64 mm in males and 3.89 ± 1.76 mm in females. In two-rooted mandibular second molars, the distances from the mesial root and distal root to the IANC were 5.14 ± 2.08 mm and 4.39 ± 1.85 mm, respectively, in males and 3.78 ± 1.69 mm and 3.24 ± 1.72 mm, respectively, in females. There were no significant with in-gender differences between the left and right side in the distances from the root apexes to the IANC (P>0.05). The distances from the mandibular first molar were greater in males than in females. The longest average distance was from the distolingual root apexes of three-rooted mandibular first molars to the IANC, and the distances were longer from the distobuccal root apexes of three-rooted mandibular first molars to the IANC than from the distal root apexes of two-rooted mandibular first molars to the IANC (P<0.05). There was no within-gender difference in the distances from the root apexes of single-rooted mandibular second molars to the IANC (P>0.05), but the distances in two-rooted mandibular second molars were larger in males than in females (P<0.05). The distances from the root apexes to the IANC were smaller in mandibular second molars than in mandibular first molars (P<0.05). @*Conclusion @#There are significant differences between adult males and females in the distance from the root apex to the IANC for mandibular first molars and two-rooted mandibular second molars. The distances from the root apexes to the IANC were smaller in mandibular second molars than in mandibular first molars.
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OBJECTIVES: The purpose of this study was to evaluate the proximity of the mandibular molar apex to the buccal bone surface in order to provide anatomic information for apical surgery. MATERIALS AND METHODS: Cone-beam computed tomography (CBCT) images of 127 mandibular first molars and 153 mandibular second molars were analyzed from 160 patients' records. The distance was measured from the buccal bone surface to the root apex and the apical 3.0 mm on the cross-sectional view of CBCT. RESULTS: The second molar apex and apical 3 mm were located significantly deeper relative to the buccal bone surface compared with the first molar (p < 0.01). For the mandibular second molars, the distance from the buccal bone surface to the root apex was significantly shorter in patients over 70 years of age (p < 0.05). Furthermore, this distance was significantly shorter when the first molar was missing compared to nonmissing cases (p < 0.05). For the mandibular first molars, the distance to the distal root apex of one distal-rooted tooth was significantly greater than the distance to the disto-buccal root apex (p < 0.01). In mandibular second molar, the distance to the apex of C-shaped roots was significantly greater than the distance to the mesial root apex of non-C-shaped roots (p < 0.01). CONCLUSIONS: For apical surgery in mandibular molars, the distance from the buccal bone surface to the apex and apical 3 mm is significantly affected by the location, patient age, an adjacent missing anterior tooth, and root configuration.
Subject(s)
Humans , Apicoectomy , Cone-Beam Computed Tomography , Molar , ToothABSTRACT
Information regarding the anatomy of the physiological apical foramen is limited. Knowing its diameter and shapes contributes to clinical work, specifically to the cleaning and shaping of the apical third. The aim of this ex vivo study was to determine the minimum and maximum diameters and shape of the physiological apical foramen in the roots of maxillary and mandibular first molars. A descriptive study was conducted on 89 recently extracted first molars. Roots 3-5 mm from the apex were sectioned and prepared for analysis at 40x magnification. The minimum and maximum diameters of each physiological foramen were measured using the program Motic Images plus 2.0 ML. The shape of the foramina, classified as round, oval or irregular, was determined by the difference between the maximum and minimum diameters. A total of 174 physiological foramina were analyzed. The average of the minimum and maximum diameters was between 0.24-0.33 mm in maxillary first molars and between 0.25-0.33 mm in mandibular first molars. In maxillary molars, the most common shape of the foramen was oval (50%), then irregular (32%), then round (18%). In mandibular molars, the oval shape was also the most frequent (59%), followed by irregular (23%) and round (18%). The findings of this study regarding the morphology of physiological apical foramina in first molars make it easier for the operator to choose the appropriately-sized instruments to perform endodontic therapy successfully.
La información relacionada a la anatomía del foramen fisiológico apical es limitada. Conocer su diámetro y forma contribuye al trabajo clínico, específicamente en los procedimientos de limpieza y conformación del tercio apical. El objetivo de este estudio ex vivo fue determinar los diámetros menor, mayor y la forma del foramen fisiológico apical en las raíces de primeros molares maxilares y mandibulares. Se realizó un estudio descriptivo sobre 89 primeros molares recientemente extraídos. Se seccionaron las raíces a 35 mm del ápice y fueron preparadas para su análisis bajo magnificación de 40X. Se midieron los diámetros mayor y menor de cada foramen fisiológico mediante el programa Motic Images plus 2.0 ML. La forma de los forámenes fue determinada de acuerdo a la diferencia entre diámetro mayor y menor, clasificándose como redondo, oval o irregular. Un total de 174 forámenes fisiológicos fueron analizados. El promedio del diámetro menor y mayor fue entre 0,240,33 mm en primeros molares maxilares y entre 0,250,33 mm en primeros molares mandibulares. En molares maxilares, la forma del foramen más común fue la oval (50%), luego irregular (32%) y redonda (18%). En molares mandibulares, la forma oval también fue la más frecuente (59%), seguida por la irregular (23%) y redonda (18%). Los hallazgos de este estudio en relación a morfología de los forámenes fisiológicos apicales en primeros molares, permite al operador facilitar la elección de instrumentos del calibre adecuado para realizar con éxito la terapia endodóntica.
Subject(s)
Humans , Tooth Apex/anatomy & histology , Molar/anatomy & histology , Mandible , MaxillaABSTRACT
Introduction: Electronic apex locators have been widely used for foraminal identification and for working length determination. The establishment of a correct apical limit is essential for a good prognosis in cases of pulp vitality or pulp infection. Objective and Case reports: The aim of the study is to report two cases where the use of electronic apex locators was crucial due to the inability to visualize the root apex due to a post-surgical retaining plate (case 1) and during orthodontic treatment with a maxillary expander (case 2). Conclusion: In this light we could confirm the effectiveness of these devices for the determination of the working length when it is impossible to perform it by radiographic techniques.
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This aim of this study was to evaluate the root apex of mandibular premolars regarding the presence of main and accessory foramina. The root apexes from fifty extracted mandibular single-rooted premolars were examined by scanning electron microscopy (SEM). The apical openings had their diameter measured and were identified as main or accessory foramina. Double blinded and calibrated examiners analyzed the SEM photographs and classified the premolar roots into three types, based on the presence and size of the apical openings. Type I: roots with a single main apical foramen and no accessory foramina; type II: roots with a main foramen and one or more accessory foramina; type III: roots with accessory foramina only. For the first premolar, 16 roots were classified as type I (48.48%), 4 as type II (12.12%) and 13 as type III (39.40%). For the second premolars, 10 roots were classified as type I (58.83%), 3 as type II (17.65%) and 4 as type III (23.52%). The high incidence of roots with accessory foramina only (type III), mainly in the first premolar, warns of the need for caution during working length determination and apical debridement.
O objetivo deste estudo foi avaliar o apice radicular de premolares inferiores com relacao a presenca de forames ou foraminas. O apice radicular de cinquenta pre-molares unirradiculados humanos extraidos foram examinados pela microscopia eletronica de varredura (MEV). As aberturas apicais tiveram seus diametros medidos e foram identificados como forames ou foraminas. Dois examinadores calibrados e cegos quanto aos grupos analisaram as micrografias em MEV e classificaram as raizes dos pre-molares em tres tipos, baseadas na presenca e tamanho das aberturas apicais. Tipo I: raizes com um unico forame e nenhuma foramina; tipo II: raizes com um forame e uma ou mais foraminas; Tipo III: raizes somente com foramina. Para o primeiro pre-molar, 16 raizes foram classificadas como Tipo I (48.48%), 4 como tipo II (12.12%) e 13 como tipo III (39.40%). Para o segundo pre-molar, 10 raizes foram classificadas como tipo I (58.83%), 3 como tipo II (17.65%) e 4 como tipo III (23.52%). A alta incidencia de raizes do Tipo III, principalmente no primeiro pre-molar, alerta para a necessidade de cuidados na determinacao do comprimento de trabalho e exploracao foraminal.
Subject(s)
Humans , Bicuspid/ultrastructure , Tooth Apex/ultrastructure , Microscopy, Electron, Scanning , MandibleABSTRACT
The present study is aimed at evaluating the anatomic concurrence between foramen openings and root apexes of 247 upper and lower permanent human molar canals, the distance between these structures, the instrument that best fits into the root canal, as well as the direction of foramen deviation. Sixty-four of the canals were partially impenetrable and were discarded. The findings showed that 39.9% ofthe root canals studied had their apical foramen concurrent with their root apexes and 60.1% did not. Clinicians must be made aware of this important anatomical detail, which could be indispensable for successful endodontic treatment.
O objetivo da presente pesquisa foi avaliar a coincidência anatômica entre as aberturas foraminais e os ápices radiculares de 247 canais de molares humanos permanentes superiores e inferiores, a distância entre essas estruturas, a direção para a qual ocorreu o desvio do forame, bem como a lima que melhor se ajustou ao canal. Sessenta e quatro canais encontravam-se parcialmente impenetráveis, sendo descartados do estudo. Os resultados demonstraram que 39,9% dos canais radiculares estudados tiveram seus forames apicais coincidentes com os ápices radiculares, e 60,1% não. Os dados encontrados alertam para esse importante detalhe anatômico, que pode ser fundamental para o sucesso do tratamento endodôntico.
Subject(s)
Endodontics , Root Canal Therapy , Tooth ApexABSTRACT
O objetivo da presente pesquisa foi avaliar a coincidência anatômica entre as aberturas foraminais e os ápices radiculares de 247 canais de molares humanos permanentes superiores e inferiores, a distância entre essas estruturas, a direção para a qual ocorreu o desvio do forame, bem como a lima que melhor se ajustou ao canal. Sessenta e quatro canais encontravam-se parcialmente impenetráveis, sendo descartados do estudo. Os resultados demonstraram que 39,9% dos canais radiculares estudados tiveram seus forames apicais coincidentes com os ápices radiculares, e 60,1% não. Os dados encontrados alertam para esse importante detalhe anatômico, que pode ser fundamental para o sucesso do tratamento endodôntico
The present study is aimed at evaluating the anatomic concurrence between foramen openings and root apexes of 247 upper and lower permanent human molar canals, the distance between these structures, the instrument that best fits into the root canal, as well as the direction of foramen deviation. Sixty-four of the canals were partially impenetrable and were discarded. The findings showed that 39.9% of the root canals studied had their apical foramen concurrent with their root apexes and 60.1% did not. Clinicians must be made aware of this important anatomical detail, which could be indispensable for successful endodontic treatment