Does the Mixing Method of AH Plus Jet Affect its Physicochemical and Mechanical Properties?

INTRODUCTION: The purpose of this study was to evaluate whether the mixing method of AH Plus Jet sealer affects its physicochemical and mechanical properties. METHODS: The properties of AH Plus Jet sealer were analyzed when mixed using either the Auto Mix Tip or manual mixing. The evaluated properties included radiopacity (n = 5), initial and final setting times (n = 5), flow (n = 5), and solubility (n = 3), following specifications outlined in ISO 6876/2012 and ADA Nº 57/2000. pH levels were measured at intervals of 3, 24, 72, and 168 hours (n = 10). The push-out bond strength test was conducted using a universal testing machine and using bovine teeth (n = 30). Failure modes were analyzed with stereomicroscopy. Porosity was evaluated under micro-CT (n = 5), and scanning electron microscopy was also performed (n = 5). One-way analysis of variance and Tukey, unpaired t-tests, or Mann-Whitney tests were used with a significance level of 5%. RESULTS: The Auto Mix exhibited a radiopacity value of 12.11 mmAl, whereas manual mixing resulted in 12.55 mmAl (P > .05). For initial and final setting times, Auto Mix showed 901 minutes and 1779 minutes, respectively, while manual mixing recorded values of 631 minutes and 1504 minutes (P < .05). In terms of flow, Auto Mix demonstrated higher values (25.26 mm) than manual mixing (21.71 mm) (P < .05). No statistical differences were observed between the two methods for solubility and pH (P > .05). Manual mixing presented a higher bond strength value (14.52 MPa) than Auto Mix (9.81 MPa) (P < .05). The mixed failure mode was the most frequent outcome for both methods. The highest porosity was observed for Auto Mix (P < .05). Scanning electron microscopy analysis revealed that manual mixing resulted in a smoother surface with fewer pores and smaller, more evenly distributed agglomerates compared to automatic mixing. CONCLUSION: The mixing method employed for AH Plus Jet sealer influences some physicochemical and mechanical properties of the material.

New Ultrasonic Tip for Root Canal Filling of the Mesial Canals of Mandibular Molars with Isthmus: A Laboratory Evaluation Using Computed Microtomography.

INTRODUCTION: The obturation quality of the mandibular molar mesial canals and isthmuses with two thermoplastic techniques, ultrasonic vertical condensation (UVC) and continuous wave of condensation (CWC), was evaluated using computed microtomography (µCT). METHODS: Thirty-six human mandibular molars had been previously scanned and analyzed using µCT for mesial roots with morphologically similar isthmuses for this study. Coronal access and confirmation of foraminal patency were performed, and the actual length of the teeth was established using a clinical microscope (40X magnification). The canals were prepared using ProTaper Gold instruments up to #F3, with 2.5% sodium hypochlorite as the irrigant solution, followed by a passive ultrasonic irrigation protocol. The specimens were randomly divided into the UVC and CWC groups based on the obturation technique to be used. Obturation was performed with #F3 gutta-percha cones cemented using AH Plus Jet sealer. The µCT scans were performed after 15 days, and the images were evaluated by a calibrated examiner blinded to the experimental groups to determine the filling rate of the entire canal area, including the main canal and isthmus. Student's t-test was used for statistical analysis; P values ≤0.05 were considered significant. RESULTS: Neither of the thermoplastic obturation techniques achieved complete filling of the canals (86.3% for UVC and 91.4% for CWC), with a statistically significant difference between them (P = .029). CONCLUSIONS: Under the conditions of the study, it can be concluded that none of the techniques completely filled the canal/isthmus of the mandibular molars; however, the CWC exhibited better performance.

Root canal length changes during mechanical preparation due to different cervical enlargement patterns.

This study aimed to evaluate the root canal real length (RL) changes due to the mechanical instrumentation use with different flaring magnitudes. After access cavity, 60 mesial root canals of mandibular molars were randomly separated in three groups: Hyflex EDM (HF; #25/.12, #10/.05 e #25/~), Reciproc Blue (RB; R25), and MTwo (M2; #10/.04, #15/.05, #20/.06 e #25/.06). The RL was defined as the apical limit, and 2.5% sodium hypochlorite irrigating solution was chosen. After the access cavity (RL 1), cervical flaring (RL 2), and complete chemical-mechanical preparation (RL 3), the RL was evaluated. The RL was evaluated by a blind examiner with the aid of a microscope (16x) placing the endodontic file stop at the coronary reference. When comparing length measurements, the RL was shorter before instrumentation than that after instrumentation. A reduction of 0.65 mm (HF), 0.61 mm (RB), and 0.48 mm (M2) was observed. However, among groups, no statistical differences were found (p > 0.05). Under the conditions tested, it can be inferred that all mechanical systems provoked RL variations, which emphasizes the need for constant verification of the odontometry, mainly before root canal obturation.

Safety of large preparation with different instruments in the buccal canals of maxillary molars.

This study aimed to evaluate the influence of large apical preparations with Reciproc (REC), Hyflex CM (HCM) and Twisted File Adaptive (TFA) systems using micro-computed tomography (MCT). Ninety mesiobuccal (MB) and distobuccal (DB) root canals of maxillary molars (n = 45) were scanned using MCT before and after the shaping procedures. The root canals (n = 15) were prepared until REC 40.06, HCM 40.04 and TFA 35.04. The root canal transportation (RCT), centring ability (CA), change in volume of the root canal and at different levels (VC), remaining dentine thickness (RDT), removal of dentine wall (RDW) and working time (WT) were evaluated. Data were analysed using the Kruskal-Wallis and Dunn tests, and the one-way ANOVA and Tukey tests with a level of significance set at 5%. No significant difference among the instruments was found regarding the RCT, CA, RDT, RDW and WT (P > 0.05), in larger apical preparations in curved MB and straight DB canals of maxillary molars.

Evaluation of type of kinematics on glide path procedures and torsional fatigue resistance after preparation of moderately curved canals.

Sixty moderately curved canals of mandibular molars classified as Vertucci's type IV canal configuration were selected by micro-CT 1174. The teeth were divided into two groups according to the kinematics used, whether reciprocating or rotary motion (n=30, totaling 60 mesial root canals). The instruments used to perform the glide path procedures had identical features (0.15 mm of tip size, 0.04 mm/mm taper, thermal treatment, and square cross-section), but differed in the direction of the cutting blade. The duration of the procedure and the absolute and percentage frequency of the instruments to reach the full working length were recorded. The torsional test (3630-1; 1992) was performed on both used and unused instruments, to evaluate a possible reduction in the torsional resistance when using the glide path procedure. Statistical analysis was performed using the unpaired t-test and the chi-square test, and the level of significance was set at 5%. The type of kinematics used affected the duration of glide path procedures, and the reciprocating motion seemed to induce less torsional stress during glide path procedures.

Influence of Different Coronal Preflaring Protocols on Electronic Foramen Locators Precision.

The aim of this study was to evaluate the influence of different coronal preflaring protocols (absent, conservative and conventional) on the accuracy of Root ZX II, Raypex 6, and RomiApex A-15 electronic foramen locators (EFLs). Twenty mandibular molars with Vertucci's type IV mesial roots were subjected to endodontic exploration and foraminal patency confirmation. Under 16x magnification, its real lengths (RL) were measured and registered (RL1). The canals were then irrigated with 2.5% sodium hypochlorite and electronically measured (EM1) employing the alginate model; all measurements were performed in triplicate by a blind operator using adjusted endodontic hand-files introduced until the apex foramen. Coronal preflaring procedures were sequentially performed with #25/.06 (conservative) and #25/.12 (conventional) instruments; new RLs extents were performed after each coronal preparation protocol (RL2/RL3), as same as electronic measurements (EM2/EM3). The devices error (mm) was evaluated considering the difference between RLs and EMs at each preparation stage; their precision was stablished adopting ±0.5 mm as tolerance margin. The EFLs error significantly reduced after conventional coronal preflaring protocol (p<0.05), which not occur after the conservative one. The best precisions values were noted after conventional preparation as 90% (Root ZX II), 97.5% (Raypex 6), and 92.5% (RomiApex A-15). No significant differences were found in EFLs comparisons, regardless of the coronal protocol tested (p>0.05). Under the conditions tested it can be concluded that the EFLs evaluated were precise. Moreover, the preflaring protocols influences its accuracy's, where the less conservative one produced the best results.

Penetration of bioceramic and epoxy-resin endodontic cements into lateral canals.

The aim of the present study was to assess the penetration capacity of two endodontic cements, Endosequence BC Sealer and AH Plus, in artificial lateral canals. Twenty-six two-rooted, maxillary first premolars were instrumented to size 40.06 using K3 files. In each root, six lateral canals of two diameters (0.06 and 0.10 mm) were created with a working length of 2, 4, and 6 mm. The specimens were randomly divided into two groups according to the endodontic cement to be used (Endosequence BC Sealer and AH Plus) and obturated by the single-cone technique. The specimens were imaged by digital periapical radiography and scores from 0 to 4 were attributed according to the degree of penetration by sealers into the lateral canals. Data were analyzed statistically by Kruskal-Wallis and Student-Newman-Keuls tests, and a significance level of p < 0.05 was adopted. No significant difference was observed between the two endodontic cements used to fill the simulated lateral canals (p > 0.05). The diameter of lateral canals only influenced the capacity of the Endosequence BC Sealer in filling the canals, and presented greater penetration in the lateral canals of diameter 0.10 mm (p < 0.05). We concluded that the bioceramic endodontic cement Endosequence BC Sealer presented similar ability as AH Plus to fill simulated lateral canals.

The influence of ultrasonic activation on the setting time and flow of four endodontic sealers / A influência da ativação ultrassônica no tempo de ajuste e no fluxo de quatro vedadores endodônticos / La influencia de la activación ultrasónica en el tiempo de ajuste y flujo de cuatro selladores endodónticos

The aim of the present study was to evaluate the influence of ultrasonic activation (UA) on the setting time and flow of four endodontic sealers: AH Plus (AH), Sealer Plus (SP), MTA Fillapex (MTAF), and BioRoot RCS (BIO). Properties were evaluated as required by ANSI/ADA Specification N° 57 (2008); only the size of the specimens was modified. UA was applied using a smooth tapered ultrasonic tip coupled to a piezoelectric ultrasonic device (30% power) on the freshly mixed materials in two cycles of 20 seconds. The results were statistically analyzed using the ANOVA and Kruskal-Wallis tests, followed by the Tukey and Dunn posthoc tests, respectively, depending on the normality of the data. The shortest setting times, initial and final, were, 115 (BIO/UA) and 148.6 (BIO/UA) min, whereas the longest were 1215 (AH) and 1928 (AH) min. The MTAF sealer did not set throughout the experimental period (2880 minutes). Significant differences were observed between BIO and MTAF and the other sealers, with or without UA, both in the initial and final setting time (P < 0.05). UA did not change the initial setting times; however, it reduced the final setting of BIO (P < 0.05). The highest and lowest flow values observed were 25.52 mm (AH/UA) and 18.66 mm (BIO/UA), respectively. The AH sealer, regardless of UA, exhibited higher flow values compared to the other sealers (P < 0.05), except for the MTAF/UA group, which was the only sealer in which UA promoted a significant flow increase (P < 0.05). Under the conditions of the study, it can be concluded that the BIO, under UA, presented the lowest setting time; however, it exhibited the lowest flow values. The MTAF sealer did not reach its final setting. Moreover, the SP groups exhibited intermediate results in all analyses. In summary, only the final setting time of the BIO group and the flow values of the MTAF group were influenced by UA.

O objetivo do presente estudo foi avaliar a influência da ativação ultrassônica (UA) no tempo e fluxo de ajuste de quatro selantes endodônticos: AH Plus (AH), Sealer Plus (SP), MTA Fillapex (MTAF) e BioRoot RCS (BIO). As propriedades foram avaliadas conforme exigido pela Especificação N° 57 (2008) da ANSI/ADA; apenas o tamanho dos espécimes foi modificado. O UA foi aplicado usando uma ponta de ultrassom suave cônica acoplada a um dispositivo ultrassônico piezoelétrico (30% de potência) nos materiais recém-misturados em dois ciclos de 20 segundos. Os resultados foram analisados estatisticamente usando os testes ANOVA e Kruskal-Wallis, seguidos pelos testes póstticos de Tukey e Dunn, respectivamente, dependendo da normalidade dos dados. Os tempos de ajuste mais curtos, iniciais e finais, foram 115 (BIO/UA) e 148,6 (BIO/UA) min, enquanto os mais longos foram 1215 (AH) e 1928 (AH) min. O selador da MTAF não foi colocado durante todo o período experimental (2880 minutos). Foram observadas diferenças significativas entre o BIO e o MTAF e os demais seladores, com ou sem UA, tanto no tempo de ajuste inicial quanto final (P < 0,05). A UA não alterou os tempos de ajuste inicial; no entanto, reduziu o ajuste final da BIO (P < 0,05). Os valores de fluxo mais alto e mais baixo observados foram 25,52 mm (AH/UA) e 18,66 mm (BIO/UA), respectivamente. O selador AH, independentemente do UA, apresentou valores de fluxo mais elevados em comparação com os outros seladores (P < 0,05), exceto para o grupo MTAF/UA, que foi o único selador no qual o UA promoveu um aumento significativo do fluxo (P < 0,05). Nas condições do estudo, pode-se concluir que o BIO, sob UA, apresentou o menor tempo de ajuste; no entanto, exibiu os menores valores de fluxo. O selador MTAF não atingiu seu ajuste final. Além disso, os grupos de SP apresentaram resultados intermediários em todas as análises. Em resumo, apenas o tempo de ajuste final do grupo BIO e os valores de fluxo do grupo MTAF foram influenciados pelo UA.

El objetivo del presente estudio fue evaluar la influencia de la activación ultrasónica (AU) sobre el tiempo de ajuste y flujo de cuatro selladores endodónticos: AH Plus (AH), Sealer Plus (SP), MTA Fillapex (MTAF) y BioRoot RCS (BIO). Las propiedades se evaluaron según lo requerido por la especificación ANSI/ADA N° 57 (2008), sólo se modificó el tamaño de los ejemplares. El AU se aplicó utilizando una punta ultrasónica cónica lisa acoplada a un dispositivo piezoeléctrico ultrasónico (30% de potencia) sobre los materiales recién mezclados en dos ciclos de 20 segundos. Los resultados se analizaron estadísticamente mediante las pruebas ANOVA y Kruskal- Wallis, seguidas de las pruebas postcográficas de Tukey y Dunn, respectivamente, dependiendo de la normalidad de los datos. Los tiempos de fraguado más cortos, inicial y final, fueron 115 (BIO/UA) y 148,6 (BIO/UA) min, mientras que los más largos fueron 1215 (AH) y 1928 (AH) min. El sellador MTAF no se ajustó durante todo el período experimental (2880 minutos). Se observaron diferencias significativas entre BIO y MTAF y los demás selladores, con o sin AU, tanto en el tiempo de ajuste inicial como final (P < 0,05). La AU no modificó los tiempos de ajuste inicial, pero redujo el ajuste final de BIO (P < 0,05). Los valores más altos y más bajos de caudal observados fueron 25,52 mm (AH/UA) y 18,66 mm (BIO/UA), respectivamente. El sellador AH, independientemente del AU, presentó valores de caudal más altos en comparación con los demás selladores (P < 0,05), excepto para el grupo MTAF/AU, que fue el único sellador en el que el AU promovió un incremento significativo del caudal (P < 0,05). Bajo las condiciones del estudio, se puede concluir que el BIO, bajo AU, presentó el menor tiempo de fraguado, sin embargo, presentó los menores valores de caudal. El sellador MTAF no alcanzó su ajuste final. Por otra parte, los grupos SP presentaron resultados intermedios en todos los análisis. En resumen, solo el tiempo de ajuste final del grupo BIO y los valores de flujo del grupo MTAF fueron influenciados por el AU.

Debris extrusion and foraminal deformation produced by reciprocating instruments made of thermally treated NiTi wires.

To evaluate the amount of apically extruded debris, percentage of foraminal enlargement and apical foramen (AF) deformation that occurred during root canal preparation with different reciprocation systems: Reciproc, WaveOne (M-Wire), and ProDesign R (Shape Memory Technology Wire) at two different working lengths (WLs): 0.0 and 1.0 mm beyond the AF. The AF of 120 root canals in 60 mesial roots of mandibular molars were photographed with stereomicroscope and randomly assigned into four groups: manual, Reciproc (REC), WaveOne (WO), and ProDesign R (PDR); subsequently, they were further subdivided according to the WL (n=15). Teeth were instrumented, coupled to a dual collecting chamber, and then another photograph of each AF was captured. Extrusion was analysed by determining the weight of extruded debris. Each AF diameter was measured in pre- and post-instrumentation images to determine deformation, which was analysed, and afterwards the final format of AFs was classified (circular/oval/deformed). We found no significant differences when analysing each system at different WLs. When considering each WL, REC and WO showed highest extrusion values (P<.05); for AF enlargement, differences were observed only for WO, when it was used beyond the AF; differences were observed among M-Wire groups beyond the AF (P<.05). AF deformation was observed in all groups; PDR showed the lowest AF deformation values at both WLs; M-Wire groups showed 50% strain beyond the AF. Authors concluded that beyond the apical limit, the alloy and taper are important aspects when considering extrusion and deformation.

Avaliação da influência da agitação ultrassônica na resistência de união de dois materiais reparadores utilizados para selar perfurações na furca / Assessment of the influence of ultrasonic agitation on the joint resistance of two repairing materials used to seal perforations in the burning / Evaluación de la influencia de la agitación ultrasónica en la resistencia de la unión de dos materiales de reparación utilizados para sellar otras perforaciones

Avaliou-se a influência da utilização da agitação ultrassônica na resistência de união à dentina, por meio de push-out, proporcionada pelos cimentos MTA-Angelus branco (MTA) e Biodentine (BD), empregados no selamento de perfurações de furca. Foram utilizados 48 primeiros ou segundos molares inferiores, com raízes não fusionadas, distantes cerca de 2 mm entre si na porção cervical das mesmas. Os dentes foram acessados e, em seguida, as raízes foram seccionadas transversalmente abaixo da junção cemento-esmalte. Os dentes foram montados em blocos de silicona de adição e perfurações de furca realizadas em seus assoalhos paralelamente ao longo eixo dos dentes e perpendiculares aos assoalhos dentais. A amostra foi dividida em quatro grupos (n = 12) em função do material reparador e da utilização ou não da agitação ultrassônica (AU). Quando empregada, a AU foi aplicada em 2 ciclos de 20 segundos por meio de inserto cônico liso acionado por ultrassom piezoelétrico. Concluídos os selamentos eles foram protegidos com cimento de ionômero de vidro e os dentes imersos em PBS. Decorridos 7 dias discos com 1 mm de altura foram retirados dos assoalhos dentais com auxílio de cortadora metalográfica e levados à máquina de ensaio universal. Os resultados expressos em MPa foram submetidos aos testes ANOVA dois fatores e de Bonferroni. Os maiores valores de resistência obtidos foram no grupo Biodentine com ultrassom (29,41 MPa), seguidos em ordem decrescente pelos grupos Biodentine sem ultrassom; MTA com ultrassom e MTA sem ultrassom (3,72 MPa). Nas condições do estudo concluiu-se que o BD apresentou maior resistência de união à dentina radicular; ainda, que a agitação ultrassônica influenciou positivamente na resistência de união do material à dentina.

We evaluated the influence of the use of ultrasonic agitation on the resistance to the dentin, by means of push-out, provided by the white MTA-Angelus (MTA) and Biodentine (BD) cements, used in the sealing of drilling holes. 48 first or second lower molars were used, with unfused roots, about 2 mm apart in the cervical portion of them. The teeth were accessed and then the roots were sectioned transversely below the cementenamel junction. The teeth were mounted in addition silicon blocks and hole drills performed on their floors parallel along the axis of the teeth and perpendicular to the dental floorings. The sample was divided into four groups (n = 12) depending on the repair material and whether ultrasonic agitation (AU) was used. When employed, the AU was applied in 2 20-second cycles by means of a smooth conical insert activated by piezoelectric ultrasound. Once the seals were completed, they were protected with glass ionomer cement and the teeth immersed in PBS. After 7 days, 1 mm high disks were removed from the dental floorboards with the aid of a metallographic cutter and taken to the universal test machine. Results expressed in MPa were submitted to two-factor and Bonferroni ANOVA tests. The highest resistance values obtained were in the group Biodentine with ultrasound (29.41 MPa), followed in descending order by the groups Biodentine without ultrasound; MTA with ultrasound and MTA without ultrasound (3.72 MPa). Under the conditions of the study, it was concluded that BD showed greater resistance to root dentin binding; also, that ultrasonic agitation positively influenced the resistance of the material to dentin binding.

influencia del uso de la agitación ultrasónica sobre la resistencia de la unión a la dentina se evaluó mediante un estiramiento, proporcionado por los cementos blancos (MTA) y biodentinos (BD) MTA-Angelus, empleados en el sello de los taladros. Se utilizaron los primeros o segundos molares inferiores, con raíces sin fundir, a unos 2 mm de distancia en la porción cervical de las raíces. Se accedió a los dientes y luego las raíces se seccionaron transversalmente por debajo de la unión cemento-enamel. Los dientes se ensamblaron además bloques de silicona y agujeros de perforación en sus pisos a lo largo del eje de los dientes y perpendiculares al suelo dental. La muestra se dividió en cuatro grupos (n = 12) según el material de reparación y si se utilizó o no la agitación ultrasónica (AU). Cuando se empleó, la UA se aplicó en 2 ciclos de 20 segundos mediante una inserción cónica suave activada por ultrasonido piezoeléctrico. Una vez concluidos los sellos, se protegieron con cemento ionómero de vidrio y los dientes se sumergieron en PBS. Al cabo de 7 días, los discos de 1 mm de altura se retiraron del suelo de corte metálico y se llevaron a la máquina de ensayo universal. Los resultados expresados como MPa se presentaron a las pruebas de dos factores ANOVA y Bonferroni. Los valores de resistencia más altos obtenidos fueron en el grupo de Biodentina con ultrasonido (29,41 MPa), seguidos en orden descendente por los grupos de Biodentina sin ultrasonido; MTA de ultrasonido y MTA libre de ultrasonido (3,72 MPa). En las condiciones del estudio se concluyó que la DB mostró mayor resistencia de la unión a la dentina raíz; y que la agitación ultrasónica tuvo una influencia positiva en la resistencia del material a la dentina.

Periapical surgery with transsurgical filling of a tooth with extensive periapical lesion: case report / Cirurgia periapical com obturação transcirúrgica de dente com extensa lesão periapical: relato de caso / Cirugía periapical con obturación transquirúrgica de diente con lesión periapical extensa: descripción de un caso

This paper aims to describe a case of endodontic treatment associated with surgical treatment with apical curettage, apicectomy and transsurgical filling of a right upper lateral incisor with extensive periapical lesion. The patient attended the dental office reporting pain, facial swelling and fever. On clinical examination, an increase in extra and intra-oral volume was observed, affecting the bottom of the right upper sulcus; there was a negative response to the sensitivity test on tooth 12. The periapical radiograph showed the presence of an extensive periapical lesion involving the apices of teeth 11 and 12. In light of these findings, conventional endodontic treatment was chosen. The chemical-mechanical preparation was performed with X1-Blue mechanized files associated with 2.5% sodium hypochlorite and, after three changes of intracanal medication with calcium hydroxide, exudation through the canal persisted. Therefore, a periapical surgery was performed with curettage of the lesion, apicectomy and transsurgical obturation associated with AH Plus sealer. After 7 months of follow-up, complete regression of the periapical lesion was observed. In view of the limitations, the success of this case can be attributed to the association of endodontic treatment with the chosen surgical technique, since a repair of the periapical bone radiolucency was observed.

Este trabalho tem como objetivo descrever um caso de tratamento endodôntico associado ao tratamento cirúrgico com curetagem apical, apicetomia e obturação transcirúrgica de um incisivo lateral superior direito com extensa lesão periapical. Paciente compareceu ao consultório odontológico relatando dor, inchaço na face e febre. Ao exame clínico observou-se um aumento de volume extra e intra-oral acometendo o fundo de sulco superior direito; obteve-se resposta negativa ao teste de sensibilidade no dente 12. A radiografia periapical mostrou a presença de extensa lesão periapical envolvendo os ápices dos dentes 11 e 12. Diante dos achados optou-se pelo tratamento endodôntico convencional. O preparo químico-mecânico foi realizado com as limas mecanizadas X1-Blue associado com hipoclorito de sódio a 2,5% e, após três trocas de medicação intracanal com hidróxido de cálcio, a exsudação via canal persistia. Diante disso, foi realizada uma cirurgia periapical com curetagem da lesão, apicetomia e obturação transcirúrgica associada com o cimento AH Plus. Após 7 meses de acompanhamento foi observado a regressão completa da lesão periapical. Diante das limitações, o sucesso desse caso pode ser atribuído à associação do tratamento endodôntico com a técnica cirúrgica escolhida, visto que foi observado um reparo da radiotransparência óssea periapical.

El objetivo de este artículo es describir un caso de tratamiento endodóntico asociado a tratamiento quirúrgico con curetaje apical, apicetomía y obturación transquirúrgica de un incisivo lateral superior derecho con lesión periapical extensa. El paciente acudió a la clínica dental refiriendo dolor, hinchazón en la cara y fiebre. El examen clínico mostró un aumento de volumen extra e intraoral que afectaba al surco superior derecho, con una respuesta negativa a la prueba de sensibilidad en el diente 12. La radiografía periapical mostró la presencia de una extensa lesión periapical que afectaba a los ápices de los dientes 11 y 12. Se optó por un tratamiento endodóntico convencional. La preparación químico-mecánica se realizó con las limas mecanizadas X1-Blue asociadas a hipoclorito sódico al 2,5% y, tras tres cambios de medicación intracanal con hidróxido de calcio, persistía la exudación a través del conducto. Por lo tanto, se realizó una cirugía periapical con curetaje de la lesión, apicetomía y obturación transquirúrgica asociada a cemento AH Plus. Tras 7 meses de seguimiento, se observó una regresión completa de la lesión periapical. Dadas las limitaciones, el éxito de este caso puede atribuirse a la asociación del tratamiento endodóntico con la técnica quirúrgica elegida, ya que se observó una reparación de la radiotransparencia ósea periapical.

Influence of NiTi alloy on the root canal shaping capabilities of the ProTaper Universal and ProTaper Gold rotary instrument systems.

OBJECTIVE: This study aimed to evaluate the influence of the NiTi wire in Conventional NiTi (ProTaper Universal PTU) and Controlled Memory NiTi (ProTaper Gold PTG) instrument systems on the quality of root canal preparation. MATERIAL AND METHODS: Twelve mandibular molars with separate mesial canals were scanned using a high-definition microcomputed tomography system. The PTU and PTG instruments were used to shape twelve mesial canals each. The canals were scanned after preparation with F2 and F3 instruments of the PTU and PTG systems. The analyzed parameters included the remaining dentin thickness at the apical and cervical levels, root canal volume and untouched canal walls. Data was analyzed for statistical significance by the Friedman and Dunn's tests. For the comparison of data between groups, the Mann-Whitney test was used. RESULTS: In the pre-operative analysis, there were no statistically significant differences between the groups in terms of the area and volume of root canals (P>.05). There was also no statistically significant difference between the systems with respect to root canal volume after use of the F2 and F3 instruments. There was no statistical difference in the dentin thickness at the first apical level between, before and after instrumentation for both systems. At the 3 cervical levels, the PTG maintained centralization of the preparation on the transition between the F2 and F3 instruments, which did not occur with the PTU. Conclusion The Conventional NiTi (PTU) and Controlled Memory NiTi (PTG) instruments displayed comparable capabilities for shaping the straight mesial root canals of mandibular molars, although the PTG was better than the PTU at maintaining the centralization of the shape in the cervical portion.

Root canal length changes during mechanical preparation due to different cervical enlargement patterns

Abstract This study aimed to evaluate the root canal real length (RL) changes due to the mechanical instrumentation use with different flaring magnitudes. After access cavity, 60 mesial root canals of mandibular molars were randomly separated in three groups: Hyflex EDM (HF; #25/.12, #10/.05 e #25/~), Reciproc Blue (RB; R25), and MTwo (M2; #10/.04, #15/.05, #20/.06 e #25/.06). The RL was defined as the apical limit, and 2.5% sodium hypochlorite irrigating solution was chosen. After the access cavity (RL 1), cervical flaring (RL 2), and complete chemical-mechanical preparation (RL 3), the RL was evaluated. The RL was evaluated by a blind examiner with the aid of a microscope (16x) placing the endodontic file stop at the coronary reference. When comparing length measurements, the RL was shorter before instrumentation than that after instrumentation. A reduction of 0.65 mm (HF), 0.61 mm (RB), and 0.48 mm (M2) was observed. However, among groups, no statistical differences were found (p > 0.05). Under the conditions tested, it can be inferred that all mechanical systems provoked RL variations, which emphasizes the need for constant verification of the odontometry, mainly before root canal obturation.

Evaluation of type of kinematics on glide path procedures and torsional fatigue resistance after preparation of moderately curved canals

Abstract: Sixty moderately curved canals of mandibular molars classified as Vertucci's type IV canal configuration were selected by micro-CT 1174. The teeth were divided into two groups according to the kinematics used, whether reciprocating or rotary motion (n=30, totaling 60 mesial root canals). The instruments used to perform the glide path procedures had identical features (0.15 mm of tip size, 0.04 mm/mm taper, thermal treatment, and square cross-section), but differed in the direction of the cutting blade. The duration of the procedure and the absolute and percentage frequency of the instruments to reach the full working length were recorded. The torsional test (3630-1; 1992) was performed on both used and unused instruments, to evaluate a possible reduction in the torsional resistance when using the glide path procedure. Statistical analysis was performed using the unpaired t-test and the chi-square test, and the level of significance was set at 5%. The type of kinematics used affected the duration of glide path procedures, and the reciprocating motion seemed to induce less torsional stress during glide path procedures.

Efficacy of Electronic Foramen Locators in Controlling Root Canal Working Length during Rotary Instrumentation.

The present study evaluated the efficacy of electronic foramen locators (EFLs) to control root canal working length during rotary instrumentation and to assess possible reliability variations of different working lengths. Forty-eight human mandibular bicuspids were randomly divided in 2 groups according to the used device, Root ZX II (RZX) and Propex II (PRO). They were further subdivided in 2 subgroups according to the root canal preparation level (0.0 and -1.0). Preparation was performed with the Protaper rotary system using a crown-down technique. RZX was employed on its automatic auto-reverse mode (AAR) and PRO was used with the MPAS-10R contra-angle to monitor the preparation. The last used file (F3) was fixed, and the apical portion of the teeth was worn buccolingually, allowing to measure the extent between the file tip and the apical foramen (AF). The precision values of 0.0 mm and -1.0 mm were 100% and 0.0% for RZX, and 100% and 66.7% for PRO, respectively, with a range of ±0.5 mm. Statistical analysis showed no differences between the groups at 0.0 mm. However, at -1.0 mm, RZX showed the poorest results (0.96±0.11 mm), followed by PRO (0.43±0.23 mm). The difference between RZX and PRO was statistically significant. The EFLs were precise in maintaining the working length during rotary preparation when reaching the AF, but when their penetration was limited, both devices showed decreased precision; the RZX AAR failed in all instances.

Evaluation of the maintenance of the apical limit during instrumentation with hybrid equipment in rotary and reciprocating modes.

INTRODUCTION: The objective of the present study was to evaluate ex vivo the maintenance of the apical limit during instrumentation with the Root ZX (J Morita, Tokyo, Japan) and VDW Gold (VDW GbmH, Munich, Germany) hybrid devices in rotary and reciprocating modes and determine the possible function variations of different preparation levels (0.0 mm and -1.0 mm). METHODS: Seventy-two human uniradicular mandibular premolars, which had their coronal access performed and their apical foramen (AF) standardized (200 µm) were used. After their randomized division, the root canals were chemically mechanically prepared with #F4 ProTaper (Dentsply Maillefer, Ballaigues, Switzerland) and #R40 Reciproc (VDW GbmH) instruments. At the end of the instrumentation, the last instrument was fixed, and 4.0 mm of the apical portion was worn, permitting the measurement of the distance between the instrument tips and the AF. RESULTS: The determined precision values of 0.0 and -1.0 mm were 100% and 33.4% (Root), 100% and 41.6% (VDW Gold with rotary movement) and 100% and 33.3% (VDW Gold with reciprocating movement), respectively, with a margin of ±0.5 mm. No statistical differences were found with respect to the comparisons of every level of preparation. However, significant differences were found when comparing the groups with rotary function at the different levels, with a higher precision for the groups that reached the AF. CONCLUSIONS: It was concluded that both devices, independent of the function used, were more efficient in the maintenance of the apical limit when used until the AF; however, such reliability was compromised when -1.0 mm from the apical limit was established.

Influence of different coronal preflaring protocols on electronic foramen locators precision

Abstract: The aim of this study was to evaluate the influence of different coronal preflaring protocols (absent, conservative and conventional) on the accuracy of Root ZX II, Raypex 6, and RomiApex A-15 electronic foramen locators (EFLs). Twenty mandibular molars with Vertucci's type IV mesial roots were subjected to endodontic exploration and foraminal patency confirmation. Under 16x magnification, its real lengths (RL) were measured and registered (RL1). The canals were then irrigated with 2.5% sodium hypochlorite and electronically measured (EM1) employing the alginate model; all measurements were performed in triplicate by a blind operator using adjusted endodontic hand-files introduced until the apex foramen. Coronal preflaring procedures were sequentially performed with #25/.06 (conservative) and #25/.12 (conventional) instruments; new RLs extents were performed after each coronal preparation protocol (RL2/RL3), as same as electronic measurements (EM2/EM3). The devices error (mm) was evaluated considering the difference between RLs and EMs at each preparation stage; their precision was stablished adopting ±0.5 mm as tolerance margin. The EFLs error significantly reduced after conventional coronal preflaring protocol (p<0.05), which not occur after the conservative one. The best precisions values were noted after conventional preparation as 90% (Root ZX II), 97.5% (Raypex 6), and 92.5% (RomiApex A-15). No significant differences were found in EFLs comparisons, regardless of the coronal protocol tested (p>0.05). Under the conditions tested it can be concluded that the EFLs evaluated were precise. Moreover, the preflaring protocols influences its accuracy's, where the less conservative one produced the best results.

Resumo O objetivo deste estudo foi avaliar a influência de diferentes protocolos de pré-alargamento cervical (ausente, conservador e convencional) na precisão dos localizadores eletrônicos foraminais (LEFs) Root ZX II, Raypex 6 e RomiApex A-15. Vinte molares inferiores com raízes mesiais do tipo IV de Vertucci foram submetidos à exploração endodôntica e confirmação da patência foraminal. Sob ampliação de 16x, seus comprimentos reais (CR) foram medidos e registrados (CR1). Os canais foram então irrigados com hipoclorito de sódio a 2,5% e medidos eletronicamente (ME1) utilizando o modelo em alginato; todas as medidas foram realizadas em triplicata por um operador cego, utilizando limas endodônticas ajustadas introduzidas até o forame apical. Os procedimentos de pré-alargamento cervical foram realizados sequencialmente com os instrumentos #25/.06 (conservador) e #25/.12 (convencional); novas determinações de CRs foram realizadas após cada protocolo de preparação cervical (CR2/CR3), da mesma forma que as medidas eletrônicas (ME2/ME3). O erro dos dispositivos (mm) foi avaliado considerando a diferença entre CRs e MEs em cada estágio de preparação; sua precisão foi estabelecida adotando ± 0,5 mm como margem de tolerância. O erro dos LEFs reduziu significativamente após o protocolo convencional de alargamento cervical (p<0,05), o que não ocorreu após o conservador. Os melhores valores de precisão foram observados após a preparação convencional como 90% (Root ZX II), 97,5% (Raypex 6) e 92,5% (RomiApex A-15). Não foram encontradas diferenças significantes nas comparações entre os LEFs, independentemente do protocolo cervical testado (p>0,05). Sob as condições testadas, pode-se concluir que os LEFs avaliados foram precisos. Além disso, os protocolos de alargamento influenciam sua precisão, onde o menos conservador produziu os melhores resultados.

In vivo accuracy of two electronic foramen locators based on different operation systems.

The aim of this study was to compare in vivo the accuracy of two electronic foramen locators (EFLs) based on different operation systems - Root ZX and Propex II. Ten healthy adult patients needing premolar extractions due to orthodontic reasons participated in the study, providing a sample of 17 noncarious, non-restored, vital teeth (n= 24 canals). After coronal access preparation and cervical preflaring and prior to tooth extraction, the root canal length was measured alternating the two EFLs. All measurements were performed with K-files well fitted to the canal diameter at the level that each EFL indicated the apical foramen in their display (APEX or 0.0). The last K-file were fixed in place with cyanoacrylate, the tooth was extracted, and the apical 4 mm of each root were resected to measure the distance between the file tip and the apical foramen. The mean errors based on the absolute values of discrepancies were 0.30 ± 0.29 mm (Root ZX) and 0.32 ± 0.27 mm (Propex II). Analysis by the Wilcoxon test for paired samples showed no statistically significant differences between the electronic canal measurements performed with the EFLs (p=0.587). The apical foramen was accurately located in 75% (Root ZX) and 66.7% (Propex II) of the cases, considering a ±0.5 mm error margin, with no statistically significant difference by the chi-square test. Despite having different measurement mechanisms, both EFLs were capable of locating the apical foramen with high accuracy in vivo. Under the tested clinical conditions, Root ZX and Propex II displayed similar results.

Penetration of bioceramic and epoxy-resin endodontic cements into lateral canals

Abstract: The aim of the present study was to assess the penetration capacity of two endodontic cements, Endosequence BC Sealer and AH Plus, in artificial lateral canals. Twenty-six two-rooted, maxillary first premolars were instrumented to size 40.06 using K3 files. In each root, six lateral canals of two diameters (0.06 and 0.10 mm) were created with a working length of 2, 4, and 6 mm. The specimens were randomly divided into two groups according to the endodontic cement to be used (Endosequence BC Sealer and AH Plus) and obturated by the single-cone technique. The specimens were imaged by digital periapical radiography and scores from 0 to 4 were attributed according to the degree of penetration by sealers into the lateral canals. Data were analyzed statistically by Kruskal-Wallis and Student-Newman-Keuls tests, and a significance level of p < 0.05 was adopted. No significant difference was observed between the two endodontic cements used to fill the simulated lateral canals (p > 0.05). The diameter of lateral canals only influenced the capacity of the Endosequence BC Sealer in filling the canals, and presented greater penetration in the lateral canals of diameter 0.10 mm (p < 0.05). We concluded that the bioceramic endodontic cement Endosequence BC Sealer presented similar ability as AH Plus to fill simulated lateral canals.

Accuracy of five electronic foramen locators with different operating systems: an ex vivo study.

OBJECTIVE: The aim of this study was to evaluate, ex vivo, the precision of five electronic root canal length measurement devices (ERCLMDs) with different operating systems: the Root ZX, Mini Apex Locator, Propex II, iPex, and RomiApex A-15, and the possible influence of the positioning of the instrument tips short of the apical foramen. MATERIAL AND METHODS: Forty-two mandibular bicuspids had their real canal lengths (RL) previously determined. Electronic measurements were performed 1.0 mm short of the apical foramen (-1.0), followed by measurements at the apical foramen (0.0). The data resulting from the comparison of the ERCLMD measurements and the RL were evaluated by the Wilcoxon and Friedman tests at a significance level of 5%. RESULTS: Considering the measurements performed at 0.0 and -1.0, the precision rates for the ERCLMDs were: 73.5% and 47.1% (Root ZX), 73.5% and 55.9% (Mini Apex Locator), 67.6% and 41.1% (Propex II), 61.7% and 44.1% (iPex), and 79.4% and 44.1% (RomiApex A-15), respectively, considering ±0.5 mm of tolerance. Regarding the mean discrepancies, no differences were observed at 0.0; however, in the measurements at -1.0, the iPex, a multi-frequency ERCLMD, had significantly more discrepant readings short of the apical foramen than the other devices, except for the Propex II, which had intermediate results. When the ERCLMDs measurements at -1.0 were compared with those at 0.0, the Propex II, iPex and RomiApex A-15 presented significantly higher discrepancies in their readings. CONCLUSIONS: Under the conditions of the present study, all the ERCLMDs provided acceptable measurements at the 0.0 position. However, at the -1.0 position, the ERCLMDs had a lower precision, with statistically significant differences for the Propex II, iPex, and RomiApex A-15.