Effects of Access Cavity Design and Placement Techniques on Mineral Trioxide Aggregate Obturation Quality in Simulated Immature Teeth: A Micro-Computed Tomography Study.

Background and Objectives: In teeth with open apices, performing single session apexification is a challenging treatment due to the difficulty in handling mineral trioxide aggregate (MTA). Minimally invasive approaches in dentistry have also influenced the cavity designs in endodontics. Until now, different techniques have not been investigated in addition to manual condensation during the process of placing MTA in traditional (TradACs) or conservative (ConsACs) endodontic access cavities. The aim of this in vitro study was to compare and evaluate the obturation quality of MTA apical plugs placed with different techniques in TradACs or ConsACs. Materials and Methods: Sixty upper central teeth were divided into two main groups based on cavity design, and then each main group was further divided into three subgroups according to MTA placement techniques (n = 10): TradAC-manual, TradAC-manual + indirect ultrasonic activation, TradAC-manual + XP-endo Shaper (XPS), ConsAC-manual, ConsAC-manual + indirect ultrasonic activation, and ConsAC-manual + XPS. Subsequently, the porosity percentages in the MTA apical plug were analyzed using micro-computed tomography. The statistical analysis was performed using the Kruskal-Wallis H test and Mann-Whitney U test. Statistical significance was set at p < 0.05. Results: There were differences in volume of porosity percentages (%) according to cavity designs and MTA application techniques (p < 0.05). Except for the XPS group, more porosity was observed in ConsACs compared to TradACs. In TradACs, the significantly lowest open and total porosity was observed in the manual, ultrasonic, and XPS techniques, respectively. In ConsACs, the significantly lowest porosity was observed in the manual, XPS, and ultrasonic techniques, respectively (p < 0.05). Conclusions: In MTA obturation, cavity designs and application techniques had an impact on the MTA porosity. Creating an apical plug in ConsACs may result in more porosity compared to TradACs, especially when manual or indirect ultrasonic activation is preferred. Opting for the manual technique alone may be considered sufficient for controlling porosity for both TradACs and ConsACs.

Influence of Cone-Beam Computed Tomography Voxel Sizes in the Detection of Chemically Induced External Root Resorptions.

BACKGROUND External root resorption usually does not present a clinical sign or symptom, and, therefore, diagnosis is mainly based on radiographic examination. Many studies confirmed the advantage and accuracy of cone-beam computed tomography (CBCT) in evaluating root resorptions. We aimed to evaluate the diagnostic accuracy of CBCT images of chemically induced external root resorptions on extracted human teeth taken in different voxel sizes. MATERIAL AND METHODS In this in vitro study, 36 maxillary and 36 mandibular human incisor teeth, extracted owing to periodontal disease, were used. External resorption cavities were created on the buccal and proximal surfaces by using 10% hydrochloric acid with different application periods of 10, 30, and 60 min. Resorption cavities in different depths were induced to simulate different levels of external resorption. CBCT images were taken with Planmeca Promax 3D Max CBCT (Planmeca, Helsinki, Finland) in 4 different voxel sizes: 400, 200, 150, and 100 µm. RESULTS There was no statistically significant difference between interobserver and intraobserver reliability. Higher observer agreement was obtained for 100-µm and 150-µm voxel sizes. For detection of external root resorption defects, interobserver agreement was highest for the 100-µm voxel size and when defects were located on the proximal side of the samples. The highest k values were obtained for samples kept in hydrochloric acid for 60 min. CONCLUSIONS Chemically induced resorption cavities should be used for experimental studies to better imitate clinical conditions. CBCT requirement is still ambiguous for detection of external resorptions, and more experimental and clinical studies are needed.

Micro-CT evaluation of 'danger zone' and microcrack formation in mesial root canals of primary teeth with single-file rotary and reciprocating systems.

BACKGROUND: Although single-file rotary systems are accepted in the field of paediatric dentistry in terms of providing time advantage, research works continue due to the variable anatomical structure of the root canal. AIM: This study aimed to evaluate rotary systems in different kinematics in terms of microcracks and the shaping of the danger zone in primary molars by micro-CT. DESIGN: The mesial canals of primary molars (n = 30) were used. Root canals in each group (n = 10) were prepared with single-file rotary systems (One Shape®, OS; XP-endo® Shaper, XP-ES; WaveOne Gold, WOG). The images were evaluated for dentin thickness in the danger zone and microcrack formation. RESULTS: WOG caused the highest dentin reduction in the danger zone area. OS led to significantly less dentin reduction than XP-ES and WOG (P < .05). The XP-ES showed the highest number of microcracks (P < .05). No statistically significant difference was found between WOG and OS (P > .05). In all systems, more microcracks were observed in the middle third than coronal and apical. CONCLUSION: Within the limitations of this study, the rotary systems were superior to reciprocating in terms of shaping ability in the danger zone. It is thought that further studies with different systems should be designed considering the anatomical variations and chemical composition of primary teeth.

Comparative evaluation of cone beam CT and micro-CT on blooming artifacts in human teeth filled with bioceramic sealers.

AIM: To assess blooming artifacts caused by root canal sealers in CBCT images compared with those that appeared in micro-CT scan images used as references. MATERIALS AND METHOD: Thirty freshly extracted human mandibular central incisors were used. Root canals were prepared with nickel titanium files with an ISO size 40/0.06 taper and filled with a single cone (40/0.06 taper) and three different sealers. The samples were divided into the following three groups with 10 roots each: (I) AH Plus sealer; (II) Sure Seal Root; and (III) Total BC sealer. Teeth were scanned with the same voxel sizes (0.2 mm) in different CBCT devices and the micro-CT images were acquired as reference images. RESULTS: Significantly different results in terms of blooming artifacts were detected between CBCT and micro-CT images, as well as among the CBCTs images. The canals filled with AH Plus sealer showed more blooming artifacts than those filled with bioceramic sealers (p < 0.05). Additionally, the worst blooming artifact was observed when the images were acquired with lower kilovoltage peak. CONCLUSION: The appearance of blooming artifacts is dependent on sealer and CBCT, and their effects are significantly worse than they are in micro-CT images. The differential effect of different sealers and distinct CBCT protocols should be further investigated to enable the use of bioceramic sealers without a significant impact on post-treatment imaging. CLINICAL RELEVANCE: Root canal sealers showed a different extent of blooming artifact in CBCT images. Hence, researchers and clinicians should be aware of these artifacts before conducting endodontic evaluations using CBCT images.

Cone beam CT evaluation of mandibular molar root canal morphology in a Turkish Cypriot population.

OBJECTIVES: Microorganisms in untreated or overlooked root canals can cause endodontic failure or infection and inflammation. Therefore, clinicians should familiarize themselves with patient's root canal anatomy and morphology. The objective of this retrospective study was to analyze and characterize mandibular root canal morphology using cone beam computed tomography (CBCT) in a Turkish Cypriot population. MATERIALS AND METHODS: This cross-sectional study consisted of retrospective evaluation of CBCT scans from 272 adult patients (aged 16-80 years). The number of roots and canals and the canal configuration in each root were evaluated using Vertucci's classification. The incidence of additional roots and of C-shaped canals in the mandibular first and second molars was also noted. Pearson chi-square tests were performed to analyze canal configurations, laterality, and gender (p ≤ 0.05). RESULTS: For the female and male patients, 94.5 and 94.4 % of the mandibular first and 96.7 and 97.2 % of the mandibular second molars had two roots, respectively. In females, 4.4 % of mandibular first molars had three roots versus 2.7 % of mandibular first molars in male patients. Type IV was the most prevalent canal configuration regardless of the gender (female 61.3 % and male 64.2 %) in the mesial roots. No statistically significant differences according to gender or laterality were found in the incidence of additional canals for either maxillary first or second molars. CONCLUSIONS: Type IV was the most prevalent canal configuration of both the mandibular first and second molar teeth. There was a low prevalence of three-rooted mandibular molars in this particular population. CLINICAL RELEVANCE: The current study is the first of its kind to include a Turkish Cypriot population and, thus, provides baseline data for these patients regarding appropriate root canal treatments.

Comparative evaluation of shaping ability of two nickel-titanium rotary systems using cone beam computed tomography.

BACKGROUND: We evaluated and compared the effects of different NiTi rotary systems--ProTaper Next and New One Shape--on the volume of dentin removed, canal transportation, and canal curvature in extracted human teeth using CBCT scanning with different voxel sizes. METHODS: Fifty extracted human maxillary first molars with mesiobuccal canal curvature (25-35°) were used. Specimens were instrumented with the ProTaper Next or New One Shape. Pre- and post-instrumentation scans were performed to compare transportation at the levels of 2, 5, and 8 mm and volumes with two different voxel sizes (0.125-and 0.100-mm(3)) using 3D CBCT images. This study evaluated and compare the volume of dentin removed, canal transportation, and canal curvature. Differences according to instrumentation and voxel sizes were assessed using the Mann-Whitney U-test and the Wilcoxon signed-rank test. RESULTS: Significant differences were found between apical and coronal levels for both systems (p < 0.05) in canal transportation. In comparing the systems, similar values were found at each level, without significant difference (p > 0.05) in terms of canal curvature and volume. Voxel sizes did not affect the measurements on canal volume, curvature or transportation; no significant difference was found between the 0.100- and 0.125-mm(3) voxel sizes (p > 0.05). CONCLUSIONS: Both instrumentation systems produced similar canal transportation and volume changes. The two voxel resolutions also showed similar results, however a 0.125-mm(3) voxel size can be recommend for a flat panel CBCT scanner with lower exposure dose.

Metastasis of prostate carcinoma in the mandible manifesting as numb chin syndrome.

BACKGROUND: Numb chin syndrome is an uncommon but well-recognized symptom in medical oncology. This condition can be related to metastatic neurological manifestation of malignancy, often with no clinically visible pathology. About 1% of oral cancers, which are located in the soft tissues and jaws, are metastases of primary tumors located elsewhere in the body. The posterior mandible is the most common site of metastasis of the oral region because of its rich blood supply in active areas of hematopoiesis. This article describes prostate carcinoma metastasis located in the mandible and temporomandibular joint of a 78-year-old male. CASE PRESENTATION: A 78-year-old male patient presented to our outpatient clinic with a complaint of numbness and pain on the left site of the mandible. The patient stated that he had been suffering from this numbness for 1 to 2 months. In the medical anamnesis, it was discovered that patient had prostate carcinoma (CA) 5 years previous, and since then, he had visited his doctor periodically for an annual examination. In these examinations and on the basis of tests carried out at the hospital 1 year previous, it was stated that no CA relapse traces were detected. The patient had visited his dentist 2 months previous for pain and numbness of the left molar region. CONCLUSIONS: We report numb chin syndrome, which is an uncommon neurological manifestation of metastatic malignancy. The clinical course and rapid deterioration after the initial presentation of this syndrome is discussed. This clinical situation illustrates the importance of good medical history review prior to all procedures by the medical professions dealing with oncology patients. An awareness of this condition is crucial, especially in symptoms with unexplained facial pain and numbness.

Porosity analysis of four bioceramic materials used for the repair of furcation perforations via micro-computed tomography.

BACKGROUND: Porosity is a crucial parameter that affects the solubility, sealing and mechanical strength of a material. It plays a significant role in determining the success of treatment. OBJECTIVES: The present study aimed to evaluate and compare the porosity of different bioceramic-based materials, using micro-computed tomography (micro-CT). MATERIAL AND METHODS: In the study, 76 permanent lower first or second molars that had been extracted for periodontal reasons and were free of calcification, resorption, root cavities, fractures, or cracks, with discrete roots and complete root apex development were selected. In each of the 4 experimental groups, perforations were made in the furcation areas of 19 molars. Mineral trioxide aggregate (MTA) Angelus®, EndoSequence® Root Repair Material (ERRM), Biodentine™, and BioAggregate were placed on the perforated areas of the samples and scanned with a micro-CT to evaluate porosity. The pore volume and the pore percentage with regard to the closed, open and total porosity of these repair materials were calculated individually in each sample. RESULTS: While no statistically significant differences were found between group I (MTA), group III (Biodentine) and group IV (BioAggregate) when evaluating the total pore percentage (p > 0.05), the parameter in group II (ERRM) was found to be significantly lower as compared to other groups (p > 0.05). CONCLUSIONS: In comparison with the other materials used in this study, the use of ERRM may be more suitable for perforation repair.

Antibacterial efficacy of silver nanoparticles, sodium hypochlorite, chlorhexidine, and hypochlorous acid on dentinal surfaces infected with Enterococcus faecalis.

The purpose of this study was to evaluate the antibacterial effect of silver nanoparticles (AgNPs) against Enterococcus faecalis and compare it with different irrigation solutions. This study was performed using 64 dentin blocks. E. faecalis suspension was dispensed to each sample and incubated under anaerobic conditions at 37°C throughout 21 days. After the inoculation period, the following solutions were added to each group and kept for 5 min: Group 1, 5.25% sodium hypochlorite (NaOCl); Group 2, 2.5% NaOCl; Group 3, 1% NaOCl; Group 4, 2% chlorhexidine (CHX); Group 5, 200 ppm hypochlorous acid (HOCl); and Group 6, AgNPs. The samples of positive control were treated with sterile saline. Biofilm viability assay was performed using the LIVE/DEAD BacLight Bacterial Viability Kit. Samples were examined using confocal laser scanning microscopy, respectively. There was no significant difference between the 5.25% NaOCl, 2.5% NaOCl, and 1%NaOCl groups (p > .05). However, these groups showed statistically higher antibacterial activity than the 2% CHX, 200 ppm HOCl, and AgNP groups. Also, 2% CHX showed greater percentage of dead cells compared with the AgNP and HOCl groups. While AgNPs group showed lower dead cell rate than all NaOCl groups and 2% CHX, it caused higher dead cells than 200 ppm HOCl group. The 200 ppm HOCl group showed the lowest percentage of dead cells (p < .05) Although the antibacterial effect of AgNPs is not as high as NaOCl and CHX, it has considerable bactericidal activity against E. faecalis and can be improved by further studies. RESEARCH HIGHLIGHTS: New antimicrobial approaches for root canal irrigation. Antimicrobial effect of silver nanoparticles against E. faecalis. Elimination of the biofilm layer for the success of endodontic treatment.

Micro-CT comparative evaluation of porosity and dentin adaptation of root end filling materials applied with incremental, bulk, and ultrasonic activation techniques.

The purpose of this study is to investigate the effect of different application methods on the adaptation to dentin and porosity properties of calcium silicate based materials. This study included 72 maxillary canine teeth that had been extracted for various reasons. Following the root canal treatment, root, end resections were performed on the specimens. After the apicectomy, 3 mm deep cavities were created. All materials were mixed according to the manufacturer's instructions. Retrograde cavities were filled with RetroMTA [Group 1a-1c], Biodentine [Group 2a-2c] and BioAggregate [Group 3a-3c]. Placement techniques were applied for each material by using incremental, bulk technique and ultrasonic activation, respectively. The samples were scanned with the SkyScan 1272 µCT system. Porosity values were higher in bulk fill and incremental placement techniques than ultrasonic technique when using MTA and BioAggregate (p < 0.05), but Biodentine showed no statistically significant difference (p > 0.05) on using different placement techniques. The ultrasonic activation technique is beneficial to improve the condensation quality of MTA and BioAggregate. Biodentine showed better results regardless of different application techniques.

Effects of chitosan-containing silver nanoparticles or chlorhexidine as the final irrigant on the bond strength of resin-based root canal sealers.

Background. This study evaluated the combined effects of silver nanoparticles (AgNPs) and chitosan on the dentin bond strength of resin-based root canal sealers using the push-out test and scanning electron microscopy (SEM). Methods. This in vitro study was conducted on 72 extracted mandibular premolar teeth. All the teeth were decoronated perpendicular to the long axis to leave a 13-mm root length. The root canals were prepared, and the samples were randomly divided into seven experimental groups and one control group based on final irrigation solutions. All the final irrigation procedures were performed for one minute. The root canals were dried using paper points and filled with a resin-based sealer and gutta-percha points using a lateral condensation technique. Sections measuring 2 mm in thickness were taken from the apical, middle, and coronal thirds of each root using a cutting machine. The push-out test was performed using a universal testing machine. Results. The solution of AgNPs combined with 0.4% chitosan showed higher bond strength in the coronal region than a combination with 0.2% chitosan. Samples treated with 0.4% chitosan solution exhibited a higher bond strength than the 0.2% chitosan group. There were no significant differences between chlorhexidine (CHX) solution alone and in combination with 0.2% or 0.4% chitosan solution. Conclusion. The combination of chitosan and AgNPs was as effective as CHX in improving the bond strength of resin-based sealers.

Comparative evaluation of the antifungal efficacy of sodium hypochlorite, chlorhexidine, and silver nanoparticles against Candida albicans.

Candida albicans is a microorganism that causes root canal infections. However, it cannot be eliminated with conventional irrigation solutions. Recently, silver nanoparticles (AgNPs) have become popular for their superior antimicrobial effects. The purpose of this study was to evaluate the antifungal effect of AgNPs to C. albicans comparing with 5.25% sodium hypochlorite (NaOCl) and 2% chlorhexidine (CHX). Silver nanoparticles were synthesized by chemical reduction method. Minimum inhibitory concentration and minimum fungicidal concentration of AgNPs against C. albicans strain were determined according to microdilution method reported by Clinical Laboratory Standards Institute. C. albicans biofilm layer was formed on the dentin blocks for 10 days. The biofilm structure was observed by scanning electron microscopy. Statistical analysis was performed with one way analysis of variance analysis and group comparisons were performed with Tukey test. AgNPs showed the highest antifungal effect among the groups. 5.25% NaOCl showed the lowest antifungal effect among the groups. While the 2% CHX solution had a statistically lower antifungal effect than AgNPs, it was found to have a higher effect than NaOCl (p < .016). Nanoparticles present a wide research field as an alternative irrigation solution in root canal treatment. The antifungal effect of AgNPs against C. albicans was confirmed in this study. Further in vivo studies should evaluate the conditions of use and long-term prognosis of AgNPs.

Silver nanoparticles in endodontics: recent developments and applications.

The elimination of endodontic biofilms and the maintenance of a leak-proof canal filling are key aspects of successful root canal treatment. Several materials have been introduced to treat endodontic disease, although treatment success is limited by the features of the biomaterials used. Silver nanoparticles (AgNPs) have been increasingly considered in dental applications, especially endodontics, due to their high antimicrobial activity. For the present study, an electronic search was conducted using MEDLINE (PubMed), the Cochrane Central Register of Controlled Trials (CENTRAL), Google Scholar, and EMBASE. This review provides insights into the unique characteristics of AgNPs, including their chemical, physical, and antimicrobial properties; limitations; and potential uses. Various studies involving different application methods of AgNPs were carefully examined. Based on previous clinical studies, the synthesis, means of obtaining, usage conditions, and potential cytotoxicity of AgNPs were evaluated. The findings indicate that AgNPs are effective antimicrobial agents for the elimination of endodontic biofilms.

Comparative evaluation of dentin volume removal and centralization of the root canal after shaping with the ProTaper Universal, ProTaper Gold, and One-Curve instruments using micro-CT.

Background. The main goal of our study was to assess the volume of dentin removed and transportation in root canals using ProTaper Universal (PTU), ProTaper Gold (PTG) and One-Curve (OC). Ni-Ti rotary instruments in extracted human teeth using by micro-CT. Methods: Thirty human upper 1st premolar teeth with two separate root canals and sturdy, mature root tips were used in the present study. Specimens were decoronated and root length was standardized for micro CT scanning before root canal preparation done. The teeth were randomly separated into three categories (n = 10) according to the rotary NiTi system used for canal instrumentation, i.e., PTU (Dentsply, Maillefer), PTG (Dentsply, Maillefer), and OC (Micro-Mega SA). After root canal preparation, samples were scanned again on micro-CT by the same scanning parameters. Surface area, canal volume, structure model index (SMI), percentage of uninstrumented area and transportation parameters were obtained for each sample before and after micro-CT analyse. Results: No significant differences between the PTG and PTU in terms of the total volume of removed dentin, surface area and percentage of uninstrumented areas were found. However, regarding to parameters above, OC showed a lower efficacy than PTG and PTU in coronal section. Regarding canal transportation, PTG and OC showed lower mean transportation values at all levels. Conclusion: This paper demonstrated the root canal shaping abilities of the PTU, PTG, and OC NiTi file systems. The PTG and OC systems were associated less canal transportation and a better ability to preserve dentinal walls than PTU. There was no significance different between all rotary file systems for SMI values however, PTU and PTG showed greater canal volume and surface area change than OC file systems in coronal section.

Micro-computed tomographic assessment of the shaping ability of the One Curve, One Shape, and ProTaper Next nickel-titanium rotary systems.

OBJECTIVES: This micro-computed tomographic (CT) study aimed to compare the shaping abilities of ProTaper Next (PTN), One Shape (OS), and One Curve (OC) files in 3-dimensionally (3D)-printed mandibular molars. MATERIALS AND METHODS: In order to ensure standardization, 3D-printed mandibular molars with a consistent mesiobuccal canal curvature (45°) were used in the present study (n = 18). Specimens were instrumented with the OC, OS, or PTN files. The teeth were scanned pre- and post-instrumentation using micro-CT to detect changes of the canal volume and surface area, as well as to quantify transportation of the canals after instrumentation. Two-way analysis of variance was used for statistical comparisons. RESULTS: No statistically significant differences were found between the OC and OS groups in the changes of the canal volume and surface area before and after instrumentation (p > 0.05). The OC files showed significantly less transportation than the OS or PTN systems for the apical section (p < 0.05). In a comparison of the systems, similar values were found at the coronal and middle levels, without any significant differences (p > 0.05). CONCLUSIONS: These 3 instrumentation systems showed similar shaping abilities, although the OC file achieved a lesser extent of transportation in the apical zone than the OS and PTN files. All 3 file systems were confirmed to be safe for use in mandibular mesial canals.

Observer preference for a dedicated medical display vs a standard screen in the detection of dental radioanatomic features.

OBJECTIVE: The aim of this study was to assess observers' preference for a dentomaxillofacial dedicated medical display (MD) vs a general-purpose standard screen (SS) for in vitro and in vivo observation of normal radioanatomic features. STUDY DESIGN: The in vitro sample consisted of 2-dimensional (2-D) intraoral (n = 15), panoramic (n = 2), cephalometric (n = 2), and 3-dimensional (3-D) cone beam computed tomography (CBCT) (n = 9) data sets, acquired by utilizing commercially available skull and head-and-neck phantoms. The in vivo sample consisted of 80 radiographs (intraoral = 20; panoramic = 20; cephalometric = 20; and CBCT = 20). In vitro and in vivo data sets were both acquired by using Minray, Promax2-D, and Vistapano Ceph for 2-D images and Accuitomo, NewTom VGi evo, and Promax3-D for CBCT images. Five observers entered screen preferences when evaluating the appearance of radioanatomic structures on MD and SS. RESULTS: Both in vitro and in vivo assessments showed good interobserver and excellent intraobserver agreement. In vitro data suggested a significant preference for MD over SS for viewing radioanatomic features on panoramic and CBCT images, whereas MD was significantly preferred for in vivo images of all imaging modalities (P < .001). CONCLUSIONS: Overall, observers preferred MD over SS for both in vitro and in vivo observation of normal radioanatomic features irrespective of the imaging modality.

Evaluation of the sealing ability of different root canal sealers: a combined SEM and micro-CT study.

OBJECTIVE: The purpose of this study was to analyze the ability of multiple compounds to seal the dental tubules using scanning electron microscopy (SEM) and micro-computed tomogra-phy (micro-CT). MATERIAL AND METHODS: Twenty-four single-root human mandibular premolars were selected and instrumented with nickel-titanium rotary file and the final file size was #40/06. They were then randomly allocated into 2 groups, and all samples were filled with single cone gutta-percha (#40/06) and one of the tested sealers (AH Plus and EndoSequence BC sealers). All specimens were scanned using micro-CT and then three from each group were randomly selected for SEM analysis. RESULTS: According to SEM, both root canal sealers showed sufficient adaptation to dentin along the whole length of the root canal, though the coronal sections presented superior sealing than the apical sections. Micro porosity analyses revealed that the volume of closed pores and the surface of closed pores had the largest values in the coronal sections, followed by the middle and the apical sections for both sealants (p<0.05). However, no significant difference was observed for those two parameters between AH Plus and EndoSequence BC sealers in any of the three sections (p>0.05), whereas they were larger in the apical section when the AH Plus sealer was used. CONCLUSIONS: By using the single cone technique, neither EndoSequence or AH Plus pro-vides a porosity-free root canal filling. The EndoSequence BC sealer may have similar sealing abilities regarding the whole root canal as the AH Plus sealer. A better sealing effect could be obtained in the coronal and middle sections of a root canal than the apical part by using the tested sealers.

Evaluation of Threshold Values for Root Canal Filling Voids in Micro-CT and Nano-CT Images.

While several materials and techniques have been used to assess the quality of root canal fillings in micro-CT images, the lack of standardization in scanning protocols has produced conflicting results. Hence, the aim of this study was to determine a cutoff voxel size value for the assessment of root canal filling voids in micro-CT and nano-CT images. Twenty freshly extracted mandibular central incisors were used. Root canals were prepared with nickel titanium files to an ISO size 40/0.06 taper and then filled with a single cone (40/0.06 taper) and AH Plus sealer. The teeth were scanned with different voxel sizes with either micro-CT (5.2, 8.1, 11.2, and 16.73 µm) or nano-CT (1.5 and 5.0 µm) equipment. Images were reconstructed and analyzed with the NRecon and CTAn software. Void proportion and void volume were calculated for each tooth in the apical, middle, and coronal thirds of the root canal. Kruskal-Wallis and post hoc Mann-Whitney U tests were performed with a significance level of 5%. In micro-CT images, significantly different results were detected among the tested voxel sizes for void proportion and void volume, whereas no such differences were found in nano-CT images (p > 0.05). Micro-CT images showed higher void numbers over the entire root length, with statistically significant differences between the voxel size of 16.73 µm and the other sizes (p < 0.05). The values of the different nano-CT voxel sizes did not significantly differ from those of the micro-CT (5.2, 8.1, and 11.2 µm), except for the voxel size of 16.73 µm (p < 0.05). All tested voxel sizes enabled the detection of root canal filling voids except for the voxel size of 16.73 µm. Bearing in mind the limitations of this study, it seems that a voxel size of 11.2 µm can be used as a reliable cutoff value for the assessment of root canal filling voids in micro-CT imaging.

Endodontic management of taurodontism with a complex root canal anatomy in mandibular posterior teeth.

One of the biggest challenges in endodontic treatment is to comprehensively understand the variation of tooth root canal anatomy. To a large degree, the anatomy and furcation distribution of teeth, which vary from nationality and ethnic groups, will influence the clinical diagnosis, treatment plan and even prognosis. Taurodontism, as one of anatomic variation in tooth structures, is relatively hard to be seen in dental clinics. Two special cases of taurodontism with varied root canal anatomies in mandibular second premolar and first molar are reported in this paper.

Assessment of Volumetric Distortion Artifact in Filled Root Canals Using Different Cone-beam Computed Tomographic Devices.

INTRODUCTION: Artifacts in cone-beam computed tomographic (CBCT) imaging may compromise radiodiagnosis. Obturation materials for endodontic treatment may present with variable material density and thus also cause distinct artifact expression. The aim of this study was to assess the volume distortion artifact of root canal sealers using CBCT devices and micro-CT imaging as a reference. METHODS: Thirty single-root mandibular central incisors were used for this study. Teeth were prepared with EndoSequence rotary nickel-titanium files (Brasseler USA, Savannah, GA) and divided into 3 groups. Canals were obturated with gutta-percha and AH Plus root canal sealer (Dentsply Maillefer, Ballaigues, Switzerland) using single-cone filling techniques. Each tooth was scanned with different CBCT devices (ie, Promax 3D Max [Planmeca Inc, Roselle, IL], NewTom VGi evo [NewTom, Verona, Italy], and 3D Accuitomo 170 [J Morita, Kyoto, Japan]) with the same voxel size (0.2 mm3) and compared with micro-CT imaging as a reference standard. RESULTS: The results showed a significant difference in terms of volume distortion between micro-CT and CBCT images (P < .05). There were also significant differences among CBCT devices. Promax 3D Max measurements showed significantly larger root canal volumes than the other CBCT machines (P < .05). However, NewTom VGi evo and 3D Accuitomo 170 showed similar results without any significant difference (P > .05). CONCLUSIONS: CBCT devices showed more volumetric distortion artifact than micro-CT imaging. The volume was variable for different CBCT devices while scanning at the same voxel size. However, to assess the effect of sealer materials on CBCT imaging, further studies should be conducted for different sealers.