Impacts of Contracted Endodontic Cavities on Primary Root Canal Curvature Parameters in Mandibular Molars.

INTRODUCTION: The purpose of this study was to provide information regarding the debate on contracted endodontic cavities (CECs); their impacts on angle, location, and radius of the primary canal curvature (PCC) were assessed in type IV mesial root canals of mandibular molars at different stages of instrumentation. Impacts on treatment time were also assessed. METHODS: Twenty-four teeth were matched by radiographic and micro-computed tomographic criteria and accessed via CECs (CEC, n = 12) or nonextended traditional endodontic cavities (TECs, n = 12). PCC parameters were radiographically determined using a repositioning apparatus before glide path preparation (PI), after glide path preparation, and after final instrumentation (FI). Instrumentation was performed with PathFiles (13/.02, 16/.02; Dentsply Maillefer, Ballaigues, Switzerland) and ProFile Vortex files (Dentsply Tulsa Dental Specialties, Tulsa, OK) to size 30/.04 at the working length under copious irrigation. Changes in PCC were measured with ImageJ (National Institutes of Health, Bethesda, MD). The instrumentation time was recorded. Data were analyzed with 2-way repeated measures analysis of variance (α < .05) and Tukey honest significant difference tests. RESULTS: A significant (P < .001) decrease in the mean angle and increase in the mean radius were detected at each instrumentation stage for both CECs (angle: PI = 42.57°± 8.00°, FI = 32.61°± 5.17°; radius: PI = 6.48 ± 1.81 mm, FI = 10.55 ± 1.48 mm) and TECs (angle: PI = 38.80°± 7.15°, FI = 30.08°± 6.99°; radius: PI = 6.97 ± 2.31 mm, FI = 11.01 ± 2.20 mm). PCC location shifted apically (P < .001). Changes in PCC parameters did not differ significantly between CECs and TECs (P > .05). The treatment time was significantly (P < .0001) longer for CECs (83.17 ± 6.71 minutes) than for TECs (33.18 ± 9.20 minutes). CONCLUSIONS: Instrumentation of curved mesial canals reduced the severity and abruptness of PCC and shifted the PCC location apically similarly in mandibular molars with CECs and those with nonextended TECs. The extended treatment time with CEC merits consideration when debating CECs versus TECs.

Removal of calcium hydroxide from Weine Type II systems using photon-induced photoacoustic streaming, passive ultrasonic, and needle irrigation: a microcomputed tomography study.

OBJECTIVE: This study compared the effectiveness of Er:YAG laser-activated irrigation (PIPS), passive ultrasonic irrigation (PUI) with EndoUltra and standard needle irrigation (SNI) in the removal of calcium hydroxide [Ca(OH)2] from the mesial roots of Weine Type II mandibular molars. MATERIAL AND METHODS: Thirty mandibular molars were screened by µCT for the presence of mesial roots with complex intra-canal anatomy and a common apical foramen. The teeth were enlarged to a standardized 25/.06 preparation and filled with Ca(OH)2 paste. Specimens were divided into three groups (n=10) according to the technique used for Ca(OH)2 removal: PIPS, at 15 Hz and 20 mJ using a 9 mm long, 600 µm diameter tip; PUI using a 15/.02 tip; and SNI (30 Ga. side-vented needle). Equal volumes of 8.25% NaOCl and 17% EDTA were used in all groups. µCT was used to measure the initial amount of Ca(OH)2 present and to assess the residual volume of Ca(OH)2 following each irrigation protocol. Data were analyzed using Tukey HSD and Kruskal-Wallis tests (α=5%). RESULTS: The mean volume of Ca(OH)2 before removal was significantly higher in the coronal third than in the middle and apical third (p<0.001). Ca(OH)2 was similarly removed from the coronal and middle thirds with the three methods used (p>0.05). PIPS (median 0%; IQR: 0-0) showed significant higher Ca(OH)2 removal in the apical third than PUI (median 100%, IQR: 85-100) and SNI (median 47%; IQR: 16-72) (p<0.001). CONCLUSIONS: PIPS laser-activation was more effective for the removal of Ca(OH)2 from mesial roots of mandibular molars with Weine Type II canal configurations than PUI with EndoUltra and SNI.

Micro-Computed Tomographic Evaluation of the Influence of Root Canal System Landmarks on Access Outline Forms and Canal Curvatures in Mandibular Molars.

INTRODUCTION: This study investigated the influence of anatomic root canal system landmarks on access outline forms of mandibular molars and correlated these to the theoretical distance of orifice relocation and changes in canal primary curvature. METHODS: Thirty relatively calcified human mandibular molars were selected and examined by micro-computed tomographic imaging. Three-dimensional volume reconstructions were made, root canal system landmarks identified, and plotted: canal orifices, canal position at the furcation level, and pulp horn location. Each landmark was separately projected onto the occlusal surface, and 3 access designs were respectively proposed: (1) minimally invasive, (2) straight-line furcation, and (3) straight-line radicular. For each access design, the theoretical distance of orifice relocation and canal primary curvature were determined. Data were submitted to 2-way repeated measures analysis of variance (α < 0.05). RESULTS: The orifice relocation distance required to obtain each type of access outline was greater for radicular-based accesses (0.97 ± 0.32 mm) than for furcation accesses (0.52 ± 0.30 mm, P < .001) and resulted in a greater change in canal primary curvature (P < .001; 15.9° ± 4.6° and 9.4° ± 4.3°, respectively). The canal primary curvature for each access outline type was statistically different from each other (P < .0001), whereas the minimally invasive access showed the highest mean angle (40.1° ± 8.4°) followed by the straight-line furcation (30.7° ± 7.5°) and the straight-line radicular accesses (24.2° ± 8.4°). CONCLUSIONS: The use of different landmarks to establish access outline designs affected the primary angle of curvature in relatively calcified mandibular molars.

Elimination of intracanal tissue and debris through a novel laser-activated system assessed using high-resolution micro-computed tomography: a pilot study.

INTRODUCTION: Laser-activated irrigation to remove organic debris from canal isthmuses was investigated using x-ray microfocus computed tomographic imaging. METHODS: A total of 14 extracted human mandibular molars were used. The mesial canals were prepared using a standardized instrumentation protocol. Two groups (n = 7) underwent final irrigation using either standard needle irrigation (SNI) or photon-induced photoacoustic streaming (PIPS). After enlarging canals to 30/.06, canal volumes were reconstructed from micro-computed tomographic scans before and after irrigation to assess removal of organic tissue and inorganic debris by quantitative analysis of the superimposed volumes. Comparisons of the volumes were made using 2-way analysis of variance and Tukey method, with statistical differences considered significant at the alpha = 0.05 level. RESULTS: Debris removal and an increase in root canal system volume for the laser-activated PIPS group was more significant (P < .001) than for the SNI group (P = .04). Irrigation using PIPS increased the canal volume and eliminated debris from the canal system 2.6 times greater than SNI. CONCLUSIONS: Eliminating debris from complex canal spaces found in mandibular molars was achieved at a significantly greater level using laser-activated PIPS irrigation compared with SNI.

Removal of calcium hydroxide from Weine Type II systems using photon-induced photoacoustic streaming, passive ultrasonic, and needle irrigation: a microcomputed tomography study

ABSTRACT Objective This study compared the effectiveness of Er:YAG laser-activated irrigation (PIPS), passive ultrasonic irrigation (PUI) with EndoUltra and standard needle irrigation (SNI) in the removal of calcium hydroxide [Ca(OH)2] from the mesial roots of Weine Type II mandibular molars. Material and Methods Thirty mandibular molars were screened by µCT for the presence of mesial roots with complex intra-canal anatomy and a common apical foramen. The teeth were enlarged to a standardized 25/.06 preparation and filled with Ca(OH)2 paste. Specimens were divided into three groups (n=10) according to the technique used for Ca(OH)2 removal: PIPS, at 15 Hz and 20 mJ using a 9 mm long, 600 µm diameter tip; PUI using a 15/.02 tip; and SNI (30 Ga. side-vented needle). Equal volumes of 8.25% NaOCl and 17% EDTA were used in all groups. µCT was used to measure the initial amount of Ca(OH)2 present and to assess the residual volume of Ca(OH)2 following each irrigation protocol. Data were analyzed using Tukey HSD and Kruskal-Wallis tests (α=5%). Results The mean volume of Ca(OH)2 before removal was significantly higher in the coronal third than in the middle and apical third (p<0.001). Ca(OH)2 was similarly removed from the coronal and middle thirds with the three methods used (p>0.05). PIPS (median 0%; IQR: 0-0) showed significant higher Ca(OH)2 removal in the apical third than PUI (median 100%, IQR: 85-100) and SNI (median 47%; IQR: 16-72) (p<0.001). Conclusions PIPS laser-activation was more effective for the removal of Ca(OH)2 from mesial roots of mandibular molars with Weine Type II canal configurations than PUI with EndoUltra and SNI.