Outcome of chairside CAD/CAM ceramic restorations on endodontically treated posterior teeth: a prospective study.

OBJECTIVE: The aim of this study was to evaluate the outcome and risk factors for chairside CAD/CAM full cusp coverage restorations on endodontically treated posterior teeth after 3 years of follow-up. METHODS: A total of 245 endodontically treated posterior teeth of 224 patients were included and restored with CAD/CAM full cusp coverage all-ceramic restorations according to a standardized protocol. Patients were recalled after treatments 1 to 3 years and underwent clinical and radiological examinations. At recall, modified FDI criteria were used to determine treatment outcomes by 2 evaluators. Success was determined when FDI scores were 1-2, and failure was indicated when FDI scores were 5. Logistic regression analysis was performed to evaluate potential risk factors. RESULTS: A total of 183 patients presented at recall, and the clinical outcomes of 201 teeth were analyzed with a recall rate of 82.0% for teeth and 81.7% for patients after 1-3 years of follow-up.185 of 201 teeth were found to have FDI scores of 1-2, and the success rate was 92%. No teeth were extracted during the follow-up period. Fourteen failed cases with an FDI score of 5 presented restoration dislocation, fracture of restoration or/and tooth. Logistic regression analysis revealed that oral parafunction (OR 2.281, 95% CI 2.2 ~ 47.5, P value 0.01) was a risk factor for success rate. CONCLUSION: Chairside CAD/CAM all-ceramic full cusp coverage restoration was (could be) a promising alternative for restoring endodontically treated posterior teeth.

Cost-effectiveness analysis: nonsurgical root canal treatment versus single-tooth implant.

BACKGROUND: Economic evaluation of nonsurgical root canal treatment (NSRCT) and single-tooth implant (STI) provides useful information for medical decision. This retrospective study aimed to evaluate the cost-effectiveness of NSRCT versus single-tooth implant (STI) after 5-year treatment in a university affiliated hospital in Beijing, China. METHODS: 211 patients who underwent NSRCT and 142 patients who had STI were included and recalled after 5-year treatment. The propensity scores were used to match the cases of two treatment modalities. At recall, outcomes were determined based on clinical and radiographical examinations. For endodontically treated cases, absence or reduction of radiolucency were defined as success. Marginal bone loss (MBL) ≤ 4 mm were determined as success for implant cases. Direct and indirect costs were calculated in China Yuan (CNY). Patients' willingness to pay (WTP) for each treatment modality was evaluated by questionnaires. A cost-effectiveness analysis was performed from the societal perspective. RESULTS: 170 patients with 120 NSRCT teeth and 96 STI were available at recall. Based on propensity score matching, 76 endodontically treated teeth were matched to 76 implants. Absence of the radiolucency was observed in 58 of 76 endodontically treated teeth (76%) and reduction of the radiolucency in 9 of 76 teeth (12%) and altogether the success rate was 88%. 100% implants were detected with marginal bone loss (MBL) ≤ 4 mm. The cost advantage of NSRCT (4,751 CNY) over STI (20,298 CNY) was more pronounced. Incremental cost effectiveness ratio (ICER) was 129,563 CNY (STI-NSRCT) per success rate gained. It exceeded the patients' willingness to pay value 7,533 CNY. CONCLUSIONS: Clinical outcomes of NSRCT and STI could be predictable after 5-year treatment. NSRCT may be more cost-effective than STI for managing endodontically diseased teeth.

[Comparison of effectiveness and safety between Twisted File technique and ProTaper Universal rotary full sequence based on micro-computed tomography].

OBJECTIVE: To evaluate the efficacy and security of two type of rotary nickel titanium system (Twisted File and ProTaper Universal) for root canal preparation based on micro-computed tomography(micro-CT). METHODS: Twenty extracted molars (including 62 canals) were divided into two experimental groups and were respectively instrumented using Twisted File rotary nickel titanium system (TF) and ProTaper Universal rotary nickel titanium system (PU) to #25/0.08 following recommended protocol. Time for root canal instrumentation (accumulation of time for every single file) was recorded. The 0-3 mm root surface from apex was observed under an optical stereomicroscope at 25 × magnification. The presence of crack line was noted. The root canals were scanned with micro-CT before and after root canal preparation. Three-dimensional shape images of canals were reconstructed, calculated and evaluated. The amount of canal central transportation of the two groups was calculated and compared. RESULTS: The shorter preparation time [(0.53 ± 0.14) min] was observed in TF group, while the preparation time of PU group was (2.06 ± 0.39) min (P<0.05). In mid-root level, TF group shaping resulted in less canal center transportation than PU group [(0.070 ± 0.056) mm vs. (0.097 ± 0.084) mm, P<0.05]. No instrument separation was observed in both the groups. Cracks were not found in both the groups either based in micro-CT images or observation under an optical stereomicroscope at 25 × magnification. CONCLUSION: Compared with ProTaper Universal, Twisted File took less time in root canal preparation and exhibited better shaping ability, and less canal transportation.

[Real temperature of the continuous-wave pluggers].

OBJECTIVE: To measure the real temperatures on the pluggers of three continuous-wave devices, and to provide theoretical reference to evaluate thermal damage and heat's influence on the filling materials. METHODS: The dual channel K type thermocouple was contacted to various sizes' pluggers in three different continuous-wave devices (BeeFill, Elements, B&L), and the highest temperatures at different points (tip, and 2 mm, 5 mm, 10 mm from the tip) of the pluggers (preset temperature was 200 °C) were recorded. The measurements were performed 5 times. T-test was used to compare the real temperatures at the tips with that set on the display and one-way ANOVA was used to compare the temperatures of the pluggers in different devices, sizes and points. RESULTS: The highest temperature was at the tip of BeeFill 40/0.03 plugger (198.7±7.7) °C, but there was on statistical differences between that and the preset temperature 200 °C. The temperatures of the remaining pluggers were obviously lower than 200 °C (P<0.05). The lowest temperature of the pluggers was detected at 10 mm from the tip of BeeFill 60/0.06 plugger (69.9±4.0) °C. The highest temperature of each plugger was detected at the tip or 2 mm from the tip (112.1 to 198.7 °C,and the median was 140.8 °C). CONCLUSION: The real temperature of most continuous-wave pluggers included in this study is below the set temperature 200 °C.

[Comparison of the incidences of apical root cracks after canal preparation with two nickel-titanium rotary systems: an in vitro study].

OBJECTIVE: To compare the incidences of root cracks after canal instrumentation with HyFlex CM system and the ProTaper Universal system. METHODS: Sixty mandibular incisors were mounted in resin blocks with simulated periodontal ligaments, and the apex was exposed. The control group of 20 teeth was not prepared, and the other 40 teeth were divided into 2 experimental groups (n=20). The 40 root canals of the experimental groups were instrumented using HyFlex CM and ProTaper Universal to the major apical foramen (AF). The horizontal sections 1 mm, 2 mm, and 3 mm from the apex were observed under an optical stereomicroscope at 25×magnification. The presence of cracks was noted. RESULTS: No cracks were found in the control teeth. Cracks were found in 1 of 20 (5%) teeth in HyFlex CM group, and 17 of 20 (85%) teeth in ProTaper Universal group. The difference between the two experimental groups was statistically significant (P<0.01). CONCLUSION: The HyFlex CM files caused fewer root cracks than the ProTaper Universal files during the root canal instrumentation.

The trend of radiographic healing after root canal treatment in teeth with apical periodontitis based on cone-beam computed tomography: A 4-year longitudinal study.

OBJECTIVES: The aim of this study was to observe the radiographic healing of periapical lesions after root canal treatment via volumetric measurements based on cone-beam computed tomography (CBCT) over 4 years. METHODS: In total, 162 single-root teeth from patients with chronic periapical periodontitis who underwent primary root canal treatment were included in this retrospective study. Follow-up visits were scheduled at 1, 2, and 4 years after treatment. The volume of radiolucency at pretreatment and follow-up were measured, and the radiographic outcomes were classified into 4 categories: absence, reduction, uncertain or enlargement. Reduction or enlargement was considered when the volumetric change in radiolucency was 20 % or more. RESULTS: During the 4-year follow-up period, 128 teeth were reviewed at least once, including 3 extracted teeth. Of the remaining 125 teeth, the volume of radiolucency was reduced in 116 teeth (90.6 %), uncertain in 5, and enlarged in 4 teeth during 1 to 4 years after treatment. Among the 43 teeth with reduced radiolucency at 1 year after treatment, 42 (97.7 %) had continuing reduced lesions at 4 years. In the 2 teeth with enlarged radiolucency at 1 year, the volume of radiolucency doubled at 4 years. Cox regression analysis revealed that the preoperative radiolucency size was a risk factor for persistent periapical radiolucency. CONCLUSIONS: The efficacy of root canal treatment for apical periodontitis was predictable. When the radiolucency changed by 20 % or more in volume on CBCT scans at 1 year after treatment, reversal of the radiographic healing tendency was rare. CLINICAL SIGNIFICANCE: The volumetric changes in radiolucency on CBCT could reflect trends in the healing process and may foster early clinical decision-making.

Clinical Outcome and Predictors of Endodontic Microsurgery Using Cone-beam Computed Tomography: A Retrospective Cohort Study.

INTRODUCTION: The aim of this retrospective cohort study was to evaluate the clinical outcomes and identify the prognostic factors of endodontic microsurgery based on cone-beam computed tomographic (CBCT) scans. METHODS: Patients who underwent endodontic microsurgery in teeth with asymptomatic apical periodontitis were included. The clinical outcomes were determined based on clinical and radiographic examinations after surgery 12-48 months. Radiographic healing was assessed on CBCT images by using the modified PENN 3-dimensional criteria and classified into 4 categories: complete, limited, uncertain, and unsatisfactory healing. Multivariate logistic regression was performed to detect outcome risk factors. RESULTS: Of the 204 teeth in 173 invited patients, 148 teeth of 126 patients were examined at review. On CBCT images, 88 teeth (59.5%) showed complete healing, and 42 (28.4%) teeth showed limited healing. All these 130 teeth were asymptomatic and achieved a clinical success rate of 87.8%. Uncertain healing was observed in 9 teeth, one of which was symptomatic. The remaining 9 teeth were unsatisfactory healing on CBCT scans, including 6 teeth with clinical symptoms and 3 free. Lesion type and root-end filling quality were significant outcome predictors (P < .05). The risk of treatment failure for teeth with combined endodontic-periodontal lesions was 8.6 times higher than that for teeth with isolated endodontic lesions. Adequate root-end filling quality improved the probability of success by 5.3 times. CONCLUSIONS: Based on CBCT data, an adequate performed endodontic microsurgery could have predictable success in teeth without periodontal involvement.

Effect of different dentin moisture on the push-out strength of bioceramic root canal sealer.

Background/purpose: Different moisture condition may affect the adhesion between obturation materials and root canal walls, thus further affect the quality of root canal obturation. The aim of this study was to evaluate the influence of dentin moisture conditions after different root canal drying protocols on the push-out strength of bioceramic root canal sealer. Materials and methods: Twenty root canals from extracted human decoronated premolars were prepared in vitro to #30/0.09 taper and assigned to 4 moisture condition groups after using different root canal drying protocols: normal moisture (paper point) group: the canals were blot dried with paper points until the last one appeared dry. Ethanol dry group: the canals were dried with paper points followed by dehydration with 95% ethanol. Isopropanol dry group: the canals were dried with paper points followed by dehydration with 70% isopropanol. Complete dry group: the canals were dried in an air-blowing thermostatic oven for at least 6 h until there was no change in weight at an interval of 1 h. After drying, the canals were obturated with bioceramic sealer iRoot SP. Then, each root was sectioned into eight slices with 1-mm-thick using a diamond saw (40 slices each group). The push-out strength was tested for each slice between the sealer and dentin wall using a universal testing machine at a crosshead speed of 0.5 mm/min, and failure modes were recorded. Two-way analysis of variance and Tukey test were used to analyze the push-out strength. Logarithmic linear regression analysis was used to compare the failure modes. Results: Push-out strength was statistically different in different moisture groups (P < 0.05). After drying using paper point, iRoot SP specimens showed the highest push-out strength (2.04 ± 0.03 MPa), followed by 95% ethanol, 70% isopropanol. The lowest push-out strength (0.68 ± 0.04 MPa) was observed under complete dry. For the failure modes, the majority were cohesive failures in the coronal and middle thirds of the root; while in the apical third, mixed failure was common. Conclusion: Different drying protocols influenced the push-out strength between bioceramic sealer and canal wall.

The association between complete absence of post-treatment periapical lesion and quality of root canal filling.

AIM: The technical quality of a root canal treatment is clinically judged by the apical extension and homogeneity of the filling material imaged by periapical radiographs (PA). The aim of this experiment was to evaluate the association between the technical quality of the root canal filling and treatment outcome. MATERIALS AND METHODS: In 234 teeth (268 roots) that underwent root-canal treatment, the quality of the root canal filling as well as the outcome of the treatment were assessed with both PA and cone-beam computed tomography (CBCT) 2 years after treatment. Satisfactory root filling on PA was defined as 0-2 mm within the radiographic apex without voids; on CBCT scans, the apical end of the canal replaced the radiographic apex. The outcome predictors were analyzed using multivariate logistic regression. RESULTS: At recall, periapical radiolucent areas were absent in 198 (74%) roots on PA and 164 (61%) roots on CBCT scans. The presence of preoperative periapical radiolucency and the quality of root filling and coronal restoration were identified by both PA and CBCT as outcome predictors (p < 0.01). Complete absence of post-treatment periapical radiolucency was observed in CBCT scans in 81% and 49% of satisfactory and unsatisfactory root fillings, respectively, as compared to 87% and 61% revealed by PA. CONCLUSION: Satisfactory root fillings were associated with a favorable outcome, confirmed by both PA and CBCT. CLINICAL RELEVANCE: The outcome of root canal treatment is improved once the filling is 0-2 mm from the apex, and no voids could be detected. Technical skills and performance of root canal filling procedures should be emphasized, and suitable methods should be developed in order to achieve more compacted filling materials without voids and at the correct length.

Fracture resistance of endodontically treated teeth with cervical defects using different restorative treatments.

Background/purpose: The restoration of endodontically treated teeth (ETT) with cervical defects has been a challenge for dentists. The purpose of this study was to evaluate the effect of restorative treatment on the fracture resistance of ETT with cervical defects. Materials and methods: One hundred and twenty freshly extracted human intact straight-single-root maxillary premolars were randomly divided into 6 groups. Group 1 remained untreated. Cervical defects of 4 mm-depth and 3 mm-height were created in groups 2-6. Group 3-6: root canal treatment. Group 4: direct composite resin restoration. Group 5: 2-mm full-cusp-coverage composite resin restoration. Group 6: fiber-post-supported composite resin restoration. A static fracture test was used to determine the fracture resistance of teeth under axial (n = 10) and palatal (30°) (n = 10) loading. Fracture modes were categorized as restorable and unrestorable. Results: Compared with intact teeth, the axial fracture resistance of teeth with cervical defects decreased by approximately 39%, and endodontic procedures resulted in 10% more reduction. When ETT with cervical defects were restored using direct composite resin filling, the axial fracture resistance recovered to 72% of that of intact teeth, but no significant change occurred under oblique loading. After full-cusp-coverage or fiber-post-supported restoration, fracture resistance showed complete recovery to the value of intact teeth (P > 0.05). Sixty percent of fractures were unrestorable for fiber-post-supported teeth, while in the full-cusp-coverage restoration group, 80-90% of fractures were restorable. Conclusion: Full-cusp-coverage restoration or fiber-post-supported restoration could improve the fracture resistance of ETT with cervical defects, whereas unrestorable fractures easily occurred in fiber-post-supported restorations.

Microtensile bond strength to sealer-contaminated dentin after using different cleaning protocols.

BACKGROUND/PURPOSE: Sealer residues on dentin may affect bonding to restorative materials. This study aimed to evaluate the bond strength to sealer-contaminated dentin after using different cleaning protocols. MATERIALS AND METHODS: Freshly extracted bovine incisors were prepared and exposed the buccal pulp chamber dentin, obtaining segments measuring 5 mm × 5 mm with a height of 3 mm. The segments were randomly distributed into 4 groups (n = 7) according to different protocols. Control group: no contamination was performed. In the three experimental groups, the segments were contaminated with epoxy resin-based sealer for 5 min, and different cleaning protocols were performed. Acetone group: acetone-saturated cotton pellets were used to wipe the sealer. Ultrasound group: ultrasonic ET-20D tip cleaning. Acetone combined with ultrasound group: cleaning with acetone-saturated cotton pellets and ultrasonic tip. All segments were bonded using a self-etch adhesive. Two samples in each group were scanned by swept-source optical coherence tomography (SS-OCT) to evaluate sealer residues. A microtensile test was performed on the remaining 5 samples, which were built up with composite resin. RESULTS: Sealer residues were observed in 3 of 14 (21.4%) sections of acetone group by SS-OCT. Compared to the control, ultrasound alone or in combination with acetone preserved the bond strength (P > .05). The ultrasound group exhibited the highest bond strength (39.38 MPa), which differed from that of the acetone group, which provided the lowest bond strength (32.88 MPa) (P < .05). CONCLUSION: Cleaning epoxy resin-based sealer-contaminated dentin surfaces using ultrasound or combined with acetone could preserve the bond strength.

Physicochemical properties of a novel bioceramic silicone-based root canal sealer.

Background/purpose: With introduction into endodontics, bioceramic-based sealers have gained considerable popularity for excellent properties. The aim of this study was to investigate the physicochemical properties of a novel bioceramic silicone-based sealer, GuttaFlow Bioseal, and measure heat flow of setting reactions. Materials and methods: Film thickness, flow, working and setting time of Bioseal were compared with other 4 kinds of sealers: iRoot SP, AH Plus, RoekoSeal and GuttaFlow2. Differential scanning calorimetry test was performed to measure heat flow. Results: Bioseal demonstrated the highest film thickness of 44 µm, double to triple that of the other 4 sealers (P < 0.05). The highest flow was detected in iRoot SP and RoekoSeal, with values of 27.35 and 27.20 mm, while GuttaFlow2 and Bioseal had the lowest of 22.31 and 21.43 mm (P < 0.05). For each sealer, working time at 37 °C was shorter than that at 23 °C (P < 0.05). At 37 °C, Bioseal had the shortest working and setting time of 4.5 and 16.3 min, while iRoot SP showed the longest of 105.0 and 571.7 min (P < 0.05). Differential scanning calorimetry test revealed that setting process of all the tested sealers was exothermic. Bioseal reached an exothermic peak at 14 min, with almost 1.5 times peak intensity of GuttaFlow2 and RoekoSeal. Whereas iRoot SP and AH Plus reached an exothermic peak 5 h after mixing, with intensity 1/2 to 2/3 that of Bioseal. Conclusion: The novel bioceramic silicone-based sealer Bioseal showed intense and fast exothermic reactions with characteristic physicochemical properties.

Distinctive microbiota distribution from healthy oral to post-treatment apical periodontitis.

Post-treatment apical periodontitis (PoAP) occurs when root canal treatment has not adequately eliminated bacterial invasion and infection. Yet little is known about the bacterial composition and changes related to the etiology and pathogenesis of PoAP. In this study, clinical samples classified as root apex (HARD) and periapical granulation tissues (SOFT) were separately collected from 10 patients with PoAP. The microbiota of each sample was characterized by 16S rRNA gene sequencing, and the obtained dataset was coanalyzed with 20 NCBI sequence read archive (SRA) datasets of healthy oral (HO) and primary apical periodontitis (PAP). We observed 2522 operational taxonomic units (OTUs) belonging to 29 phyla, and all samples shared 86.5% of the sequence reads. The OTUs affiliated with Bacteroidetes, Firmicutes, Proteobacteria, Fusobacteria, and Actinobacteria, were identified as core microbiota, which accounted for nearly 90% of 16S rRNA sequences in all samples. However, the principal coordinates analysis (PCoA) of the beta diversity demonstrated that the three periapical statuses have distinct microbial compositions. Compared with HO and PoAP, Actinomyces has a significantly increased abundance in PAP. The microbial diversities in PoAP were significantly lower than those in the HO and PAP (p<0.05). The relative abundance of most bacterial taxa was decreasing, except that Clostridia and Synergistia were increased. Furthermore, we explored the potential metabolic differences of the microbial communities by KEGG pathway prediction. We revealed that the microbiota of PoAP might have a more active metabolic capacity, including carbohydrate metabolism, energy metabolism, and enzyme cofactor/carrier biosynthesis (p<0.05). Our study revealed that invasion of opportunistic pathogens such as Clostridia and Synergistia might play a significant role in PoAP, thus guiding the further study of complex microbial-host interactions and the development of more effective diagnostic and therapeutic methods.

Accuracy of root-end resection using a digital guide in endodontic surgery: An in vitro study.

BACKGROUND/PURPOSE: It is difficult to achieve accurate root-end resection clinically. This in vitro study was conducted to evaluate the operation accuracy of a digital endodontic surgical guide. MATERIALS AND METHODS: 56 extracted maxillary anterior teeth were prepared for endodontic surgical models. The models were randomly divided into 4 groups equally according to the guide (with guide/no guide) and the operator (experienced/inexperienced). Endodontic microsurgeries were performed on models in each group. The deviations in length and angle of the root-end resection were measured based on the optical scanning data of the pre- and postoperative teeth. The general linear model was performed to analyze the effect of a guide on root-end resection deviation. RESULTS: Using a guide, the mean length deviation for experienced/inexperienced operators reduced from 0.99 mm (95% CI [confidence interval, CI], 0.66-1.33 mm)/1.18 mm (95% CI, 0.50-1.86 mm) to 0.31 mm (95% CI, 0.20-0.42 mm)/0.31 mm (95% CI, 0.24-0.37 mm). The mean angle deviation for experienced/inexperienced operators reduced from 16.74° (95% CI, 10.61-22.86°)/15.06° (95% CI, 9.19-20.94°) to 5.04° (95% CI, 3.31-6.77°)/6.79° (95% CI, 4.91-8.67°). The difference was significant between procedures performed with and without a guide (P < 0.01). CONCLUSION: Application of the digital guide in vitro endodontic surgery could improve the accuracy of root-end resection.

Four-year Outcome of Nonsurgical Root Canal Retreatment Using Cone-beam Computed Tomography: A Prospective Cohort Study.

INTRODUCTION: The purpose of this prospective study was to investigate the 4-year outcome and prognostic factors of nonsurgical root canal retreatment determined by measuring the volumetric change of periapical radiolucencies on cone-beam computed tomographic (CBCT) scans. METHODS: Ninety-seven endodontically treated teeth from 80 patients diagnosed as apical periodontitis and indicated for root canal retreatment were included. Retreatment was performed by 7 endodontic specialists using a standardized treatment protocol. The teeth were reexamined clinically and radiographically 48-67 months after retreatment. The volume of preoperative and postoperative periapical radiolucencies on CBCT images was independently measured by 2 examiners. Radiographic outcome is presented in 4 categories: absence, reduction, enlargement, or unchanged. Reduction or enlargement was determined when the volumetric change of radiolucency was 20% or more. Multivariate logistic regression was performed for predictor analysis. RESULTS: Sixty-two teeth (63.9%) from 50 patients returned for follow-up. Fifty-eight teeth were included in the prognostic analysis, all of which were symptom free. The 4 remaining teeth that had been extracted because of fracture were excluded. The total volume of periapical radiolucencies at 4 years postoperatively decreased by 94.6% compared with that preoperatively (P < .001), with an average reduction of 83.4% (95% confidence interval, 69.2%-97.5%). The periapical radiolucencies were determined as absence in 44 teeth (75.9%), reduction in 10 teeth (17.2%), unchanged in 1 tooth (1.7%), and enlargement in 3 teeth (5.2%). Tooth type was identified as an outcome predictor (P < .05). CONCLUSIONS: The 4-year outcome of endodontic retreatment is predictable, with a significant volumetric reduction in periapical radiolucencies.

Fracture Resistance of Roots in Mandibular Premolars Following Root Canal Instrumentation of Different Sizes.

OBJECTIVE: To measure the fracture resistance of mandibular premolar roots following root canal instrumentation with different sizes. METHODS: A total of 100 human permanent mandibular premolars with a straight single canal were decoronated and assigned to 10 groups (n = 10) by block randomisation. In the control group, the roots were uninstrumented, whereas roots in the nine experimental groups were instrumented to different master apical files (MAF) and tapers (MAF/taper): 40/0.05, 45/0.05, 50/0.05, 55/0.05, 60/0.05, 40/0.10, 40/0.15, 45/0.10 and 45/0.15. All roots were subjected to vertical loading until fracture. RESULTS: Fracture load values for instrumented roots were lower than the intact roots of the control group. In 50/0.05, 55/0.05, 60/0.05, 40/0.15 and 45/0.15 groups, the fracture load values were significantly lower than the fracture load value for the control group (P < 0.05) with a 30% decrease. No significant differences in the fracture modes were detected among the 10 groups (P > 0.05). CONCLUSION: Mechanical instrumentation adversely affects the fracture resistance of roots. When the roots of mandibular premolars were instrumented to a MAF equal to or larger than 50 with a taper of 0.05 or to a MAF of 40 or 45 with a taper of 0.15, the fracture load values significantly decreased.

[Cone-beam computed tomography digital for measuring the inclination angle to the long axis of healthy maxillary anterior teeth and morphologically characterizing their labial bone plates].

OBJECTIVE: We aim to determine the thickness of the labial plate, the distance between the cement-enamel junction (CEJ) and alveolar crest, and the inclination angle of the long axis of healthy maxillary anterior teeth by using cone- beam computed tomography (CBCT). METHODS: A total of 345 CBCT volumes obtained by Newtom VGI® CBCT were analyzed by using the NNT software. The digital measurements of the labial bone plate thickness at level 4 mm below the CEJ, the midpoint of tooth root and the radiological tooth apex, the distance between the CEJ and alveolar crest, and the angle between the long axis of the teeth and the long axis of alveolar process were obtained from the mid-sagittal planes of maxillary incisors and canines. Plate thickness 4 mm below the CEJ was measured, and values below ≥1 mm were recorded. RESULTS: In the central incisor, 1) the angle between the long axis of the teeth and alveolar bone was 15.2°±6.2°, the distance between the CEJ and alveolar crest was (1.5±1.0) mm, labial bone plate thick-ness at 4 mm below the CEJ was (0.8±0.4) mm, the midpoint of tooth root was (0.6±0.4) mm, and the radiological tooth apex was (1.3±0.7) mm; in the lateral incisor, 16.2°±8.8°, (1.6±1.0) mm, (0.7±0.5) mm, (0.4±0.6) mm, and (1.1±0.7) mm, respectively; and in the canine, 19.0°±6.2°, (1.8±1.0) mm, (0.9±0.6) mm, (0.4±0.6) mm, and (1.2±0.7) mm, respectively. 2) The frequencies of plate thickness ≥1 mm were 28.3%, 25.8%, and 42.7% in the central incisor, lateral incisor, and canine, respectively. 3) The distance between the CEJ and alveolar crest was positively correlated with age. The correlation coefficients was 0.42 (P<0.01) in the central incisor, 0.50 (P<0.01) in the lateral incisor, and 0.62 (P<0.01) in the canine. CONCLUSIONS: The thickness of labial bone plate is thin, the distance from CEJ to alveolar crest increases with age, and the long axis of the teeth is more inclined than the long axis of alveolar process. Knowledge of these special morphological characteristics can improve the safety and result for many dental procedures.

Outcomes of Endodontic Microsurgery Using a Microscope and Mineral Trioxide Aggregate: A Prospective Cohort Study.

INTRODUCTION: The aim of this study was to investigate the outcome of endodontic microsurgery and analyze the prognostic factors. METHODS: Our prospective cohort study included 98 teeth in 81 patients. An endodontist performed all surgical procedures using endodontic microsurgical approaches. The treated teeth were recalled and examined clinically and radiographically at least 1 year after surgical treatment. The outcome was determined based on clinical and radiographic results. Radiographic healing was classified into 4 categories: complete, incomplete, uncertain, and unsatisfactory healing. An analysis of predictors was performed using multivariate logistic regression. RESULTS: At recall, 74 of the 98 teeth (75.5%) were examined 12 to 30 months after surgery; 71 of the 74 teeth were analyzed clinically and radiographically, and 3 teeth had been extracted. On periapical radiographs, 55 (74.3%) of the 74 teeth showed complete healing, whereas 12 (16.2%) demonstrated incomplete healing. Together the percentage of complete and incomplete healing was 90.5% (67/74), and all 67 teeth were clinically normal. Uncertain healing was observed in 3 teeth (4.1%), one of which was symptomatic with swelling and sinus tract involvement and the other 2 were asymptomatic. The remaining 1 tooth (1.4%) showed unsatisfactory healing and was asymptomatic. The use as an abutment was found to be a negative factor associated with patient outcome (P < .05; odds ratio = 22; confidence interval, 20.47-23.53). CONCLUSIONS: The combined rate of complete and incomplete healing of teeth 12 to 30 months after endodontic microsurgery was 90.5%. The use as an abutment may have a negative effect on treatment outcome.

Influence of Warm Vertical Compaction Technique on Physical Properties of Root Canal Sealers.

INTRODUCTION: The aim of this study was to evaluate the influence of warm vertical compaction on the physical properties of root canal sealers. METHODS: The physical properties of 4 sealers (zinc oxide -eugenol [ZOE], AH Plus [Dentsply International, York, PA], RoekoSeal [Roeko/Coltene/Whaledent, Langenau, Germany], and iRoot SP [Innovative Bioceramix, Vancouver, Canada]) were tested. The setting time and flow of these sealers were measured at standard and high temperatures using ISO 6876 (2012) specifications. The percentage of voids in each sealer after complete setting at 37°C and 140°C was analyzed under a stereoscopic microscope. RESULTS: The setting time of ZOE sealer increased significantly from 144.0 ± 4.1 minutes to 274.2 ± 7.4 minutes when the temperature increased from 37°C to 140°C, whereas there was a significant reduction in the other 3 sealers. At 37°C, the setting time of AH Plus, iRoot SP, and RoekoSeal was 543.8 ± 16.4, 245.8 ± 15.9, and 49.3 ± 1.5 minutes, and at 140°C the setting time decreased significantly to 12.9 ± 0.7, 14.2 ± 0.6, and 2.7 ± 0.4 minutes (P < .05). The flow of AH Plus increased when the temperature changed from 25°C to 140°C (P < .05), whereas the flow reduced for RoekoSeal and iRoot SP (for RoekoSeal from 24.8 ± 0.9 to 12.4 ± 1.3 mm and for iRoot SP from 22.9 ± 0.9 to 13.3 ± 1.5 mm) (P < .05). However, the flow of ZOE sealer was unaffected by the high temperature. ZOE sealer and iRoot SP exhibited a reduction of porosity at a high temperature (P < .05). CONCLUSIONS: Warm vertical compaction influenced some properties (the setting time, flow, and porosity) of 4 sealers. A significant reduction of setting time and flow was found in RoekoSeal and iRoot SP sealers at a high temperature.

Management of Apical Periodontitis: Healing of Post-treatment Periapical Lesions Present 1 Year after Endodontic Treatment.

INTRODUCTION: Post-treatment periapical lesions present 1 year after treatment may heal during the second year or later. The aim of this study was to assess second-year volumetric changes in post-treatment periapical radiolucencies detected 1 year after treatment. METHODS: Post-treatment periapical radiolucencies were detected on cone-beam computed tomographic (CBCT) scans obtained from 93 single-rooted teeth 1 year after endodontic treatment. The outcome of these teeth was evaluated 2 years after treatment. Two examiners independently measured the volume of the radiolucencies on CBCT images twice. A Wilcoxon signed rank test was used to assess the 1- and 2-year post-treatment volumes. RESULTS: The intraclass correlation coefficients for the CBCT volumetric measurements were 0.971 and 0.998 for the 2 examiners, and the interexaminer correlation coefficient was 0.998. Of the 93 teeth with post-treatment radiolucencies at 1 year, 61were examined at the second-year evaluation. The overall size of the radiolucencies significantly decreased during the second year (P = .01); the volume decreased in 38 teeth (63%), remained unchanged in 20 (33%), and increased in 2 (3%). CONCLUSIONS: The volume of post-treatment periapical radiolucencies detected 1 year after treatment was significantly reduced after the second year in 63% of teeth.