The effect of cone beam computerized tomography voxel size and the presence of root filling on the assessment of middle mesial canals in mandibular molar teeth.

INTRODUCTION: The study aims to compare the detection of the middle mesial canal (MMC) in mandibular molar teeth using cone beam computed tomography (CBCT) with different voxel sizes when the mesiobuccal (MB) and mesiolingual (ML) canals have three distinct phases (unpreparation, preparation and obturation and the removal of the obturation and repreparation). METHODS: Two hundred forty-two extracted human mandibular molars were collected and kept in a physiological saline solution prior to use. 0.2-, 0.28- and 0.35-mm voxel sizes CBCT (n = 242) were performed in three phases (Ph): Ph1, no MB and ML canal preparation or obturation; Ph2, after MB and ML canals preparation and obturation; and Ph3, after the removal of the obturation of MB and ML canals and canals repreparation. Images were analyzed using OnDemand3D® software. After the CBCT acquisition in Ph3, all the samples were clarified to visualize the presence of the MMC directly. A blinded, previously calibrated examiner analyzed all the images. RESULTS: The MMC was detected in 15 of the 242 teeth after the clearing technique. The lowest MMC detection rate was observed at 0.35-mm voxel size regardless of the ML and MB canal condition, while the highest was observed at 0.2-mm voxel size (P < 0.05). There is no statistically significant difference between 0.2-mm and 0.28-mm voxel sizes (P > 0.05). In all voxel sizes, the highest rate of detectability of the MMC was seen in Phase 1, while the lowest was in Phase 2. CONCLUSIONS: It may be appropriate to take a 0.20-mm voxel size CBCT image, especially after the removal of root canal filling. CLINICAL RELEVANCE: An appropriate CBCT voxel size and the absence of root canal filling in the root canal system help to detect the missing MMC.

Effect of different final irrigation agitation techniques on root canal dentin tubule penetration of nanoparticle calcium hydroxide dressing.

This study is aimed to assess the efficacy of different final irrigation agitation techniques on dentin tubule penetration of nanoparticle calcium hydroxide (NCH) dressing. Ninety-six extracted upper incisors were shaped up to #40file. Then, Four experimental groups were formed according to the final irrigation procedure: conventional needle irrigation (CNI), manual dynamic agitation (MDA), sonic agitation (SA) and ultrasonic irrigant agitation (UIA). According to the intracanal drug used, these groups were divided into two subgroups: calcium hydroxide (CH) and NCH. Prepared CH preparations were labelled with Rhodamine B, and CH or NCH were placed in root canals. In the UIA group, both CH and NCH had the highest penetration depth and percentage compared to the other groups (p < 0.05). The penetration depth and percentage of NCH in the UIA and SA groups were significantly higher than in the CH groups (p < 0.05). UIA is more effective than other groups in increasing dentinal tubule penetration of CH and NCH.

Efficacy of different irrigation agitation systems in the removal of root canal sealers from artificial standardised grooves.

The present study aims to assess the efficacy of different irrigation agitation systems in removing calcium silicate-based sealers from artificial standardised apical grooves. After the root canal instrumentation of 96 teeth, artificial apical grooves were created in half of each root. The samples were divided into two main groups according to the sealer type (AH Plus Jet [APJ] and Sure-Seal Root™ [SSR]) (n = 48). The root halves were then reassembled and divided into four experimental groups based on the final irrigation technique used: Conventional Syringe Irrigation (CSI), Ultrasonic Irrigant Agitation (UIA), Sonic Agitation (SA) and Manual Dynamic Agitation (MDA). The roots were then dissembled to assess the amount of root canal sealer. UIA significantly removed more of SSR sealer than CSI, MDA and SA while there was no statistical difference between CSI, MDA, SA and UIA groups in the APJ group. None of the irrigation agitation systems used had completely removed the APJ and SSR sealers. However, UIA was more effective in removing SSR sealer from the standardised apical groove than were CSI, MDA and SA.

Evaluation of apically extruded debris during the canal preparation using new heat-treated nickel-titanium files in curved canals.

This study compared the amount of apically extruded debris associated with different heat-treated Ni-Ti rotary systems during the preparation of curved root canals of mandibular molars. Sixty extracted human mandibular molars were selected. EdgeFile, K3XF, OneCurve (OC) and ROTATE files were used to prepare both mesial canals of teeth. The initial weight of each Eppendorf tube to be used was calculated using an analytical balance prior to instrumentation. After instrumentation, the tubes were then stored for 5 days in an incubator at 70°C. Each tube was reweighed, and the weight of the dry extruded debris was established by subtracting the pre-instrumentation and post-instrumentation weight of the Eppendorf tubes for each group. All files caused apical extrusion of debris. There was no statistical difference between the ROTATE, EdgeFile, OC and K3XF systems (P > 0.05). All the heat-treated Ni-Ti rotary systems led to similar apical debris extrusion during the canal preparation.

Cyclic fatigue resistance of new reciprocating files (Reciproc Blue, WaveOne Gold, and SmartTrack) in two different curved canals.

AIM: In the present study, we compared the cyclic fatigue resistance (CFR) of Reciproc Blue, WaveOne Gold, and SmartTrack files in curved artificial canals. METHODS: Ninety new Reciproc Blue R25, WaveOne Gold Primary, and SmartTrack X1 files were tested in artificial canals with 45° and 60° angles of curvature. CFR was determined by recording the time to fracture in the artificial canals. Two-way analysis of variance was used to analyze the data. RESULTS: In the canal with a 45° angle of curvature, no significant differences were observed amongst Reciproc Blue, WaveOne Gold, and SmartTrack (P > .05). In the canal with a 60° angle of curvature, Reciproc Blue and SmartTrack had a greater CFR than WaveOne Gold (P < .05); there was no significant difference between the Reciproc Blue and SmartTrack files (P > .05). CONCLUSION: The results of the present study showed that Reciproc Blue and SmartTrack files exhibited greater CFR than WaveOne Gold only in canals with a 60° angle of curvature.

Effectiveness of conventional syringe irrigation, vibringe, and passive ultrasonic irrigation performed with different irrigation regimes in removing triple antibiotic paste from simulated root canal irregularities.

BACKGROUND: This study evaluated the efficacy of a sonic device (Vibringe), passive ultrasonic irrigation (PUI), and conventional syringe irrigation (CSI) in the removal of triple antibiotic paste (TAP) from artificial standardized grooves in the apical and coronal thirds of a root canal. MATERIALS AND METHODS: One-hundred eighteen root canals were prepared using the ProTaper system. The roots were split longitudinally, and a standardized groove was prepared in the apical and coronal parts of one segment. The grooves were filled with TAP, and the roots were reassembled. The roots were randomly divided into nine experimental groups and two control groups, according to the following irrigation methods: (1) CSI with sodium hypochlorite (NaOCl) + ethylenediaminetetraacetic acid (EDTA), (2) CSI/EDTA, (3) CSI/NaOCl, (4) PUI/NaOCl + EDTA, (5) PUI/EDTA, (6) PUI/NaOCl, (7) Vibringe/NaOCl + EDTA, (8) Vibringe/EDTA, and (9) Vibringe/NaOCl. The amount of remaining medicament was evaluated under a stereomicroscope. RESULTS: In the apical third, Vibringe/NaOCl + EDTA and PUI/NaOCl + EDTA were superior to the other groups (P < 0.05); there was no significant difference between the other experimental groups (P > 0.05). In the coronal third, there was no significant difference between the experimental groups (P > 0.05). CONCLUSIONS: The use of the NaOCl/EDTA combination together with sonic or ultrasonic agitation improved the removal of TAP from the apical third.

In Vitro Comparison of Cyclic Fatigue Resistance of ProTaper Next, HyFlex CM, OneShape, and ProTaper Universal Instruments in a Canal with a Double Curvature.

INTRODUCTION: The aim of this study was to compare the resistance to cyclic fatigue of ProTaper Next X2 (PTN X2; size 25, 0.06 taper), Hyflex CM (HCM; size 25, 0.06 taper), OneShape (OS; size 25, 0.06 taper), and ProTaper Universal F2 (PTU F2; size 25, 0.08 taper) nickel-titanium files in an artificial root canal with a double (S-shaped) curvature. METHODS: A total of 160 new PTN X2, OS, HCM, and PTU F2 files were tested in an artificial stainless steel canal with a double curvature. Forty files from each system were rotated until fracture to calculate the number of cycles to failure. The length of each fractured fragment was recorded. Data were analyzed by using one-way analysis of variance and Tukey post hoc tests. RESULTS: The resistance to cyclic fatigue of the PTN X2 and HCM instruments was significantly greater than the OS and PTU F2 instruments in the apical curvature (P < .05). There was no statistical difference in the cyclic fatigue resistance of the PTN X2 and HCM instruments in the apical curvature (P > .05). In addition, there was no statistical difference between the OS and PTU F2 instruments in the apical curvature (P > .05). PTN X2, OS, HCM, and PTU F2 instruments showed similar cyclic fatigue resistance values in the coronal curvature (P > .05). CONCLUSIONS: This study showed that PTN X2 and HCM instruments exhibit greater resistance to cyclic fatigue than OS and PTU F2 instruments in the apical curvature of an artificial canal with a double curvature.

Effect of glide path and apical preparation size on the incidence of apical crack during the canal preparation using Reciproc, WaveOne, and ProTaper Next systems in curved root canals: A stereomicroscope study.

This study evaluated the effect of creating a glide path and apical preparation size on the incidence of apical cracks during canal preparation in mandibular molar teeth with curved canals. One hundred and forty extracted teeth were used. The teeth were randomly assigned to one control group or six experimental groups (n = 20 per group) for canal preparation. No preparation was performed on teeth in the control group. In three of the six experimental groups, a glide path was not created; a glide path was created on the curved mesial canals of all teeth in the remaining three experimental groups. All teeth in experimental groups were then instrumented with the following systems: Reciproc, WaveOne (WO), and ProTaper Next (PTN). Digital images of the apical root surfaces of these teeth were recorded before preparation, after instrumentation with size 25 files, and after instrumentation with size 40 files. The images were then inspected for the presence of any new apical cracks and propagation. There was no significant difference between the experimental groups during canal preparation using size 25 files (p > 0.05). Reciproc and WO caused more new apical cracks than did PTN during canal preparation using size 40 files (p < 0.05). However, canal preparation using size 40 files did not cause propagation of existing cracks (p > 0.05). Performing a glide path prior to canal preparation did not change the incidence of apical crack during preparation. Additionally, increasing apical preparation size may increase the incidence of apical crack during canal preparation. SCANNING 38:585-590, 2016. © 2016 Wiley Periodicals, Inc.

Cyclic fatigue resistance of D-RaCe, ProTaper, and Mtwo nickel-titanium retreatment instruments after immersion in sodium hypochlorite.

OBJECTIVES: The aim of this study was to investigate the effect of immersion in sodium hypochlorite (NaOCl) on cyclic fatigue resistance of three different rotary nickel-titanium (NiTi) retreatment files. MATERIAL AND METHODS: A total of 90 new ProTaper, D-RaCe, and Mtwo retreatment files were tested. Thirty files of the same brand were randomly assigned to two groups (n = 15). Group 1 was no immersion (control group) and 16 mm of group 2 instruments were immersed in 5 % NaOCl at 37 °C for 5 min. All instruments were then tested for cyclic fatigue. Resistance to cyclic fatigue was determined by counting the numbers of cycles to failure in a 60° curve with a 5-mm radius, recording the time in seconds to fracture. Data were analyzed by two-way analysis of variance. RESULTS: Resistance to cyclic fatigue decreased significantly for D-RaCe retreatment files after immersion in NaOCl. ProTaper and Mtwo retreatment files were not affected from immersion to NaOCl. D-RaCe retreatment instruments showed better cyclic fatigue resistance than ProTaper and Mtwo retreatment instruments, and the difference was statistically significant (p < 0.05). There was no significant difference between ProTaper and Mtwo retreatment instrument groups (p > 0.05). CONCLUSIONS: D-RaCe retreatment instruments had the highest cyclic fatigue resistance among retreatment files tested in this study, but immersion to NaOCl decreased the cyclic fatigue resistance of D-RaCe retreatment instrument. CLINICAL RELEVANCE: It should be considered that cyclic fatigue resistance of D-RaCe can decrease in contact with NaOCl during the removal of canal filling material.

Effectiveness of different irrigation procedures for removal of dentin debris from a simulated internal resorption cavity.

PURPOSE: The aim of this study was to compare the efficiency of different final irrigation techniques to remove artificially placed dentinal debris from a simulated internal root resorption (IRR) cavity. METHODS: Seventy teeth were prepared using the ProTaper system. The roots were then split longitudinally into two halves, in each of which standardized IRR cavities were prepared. Five teeth were set aside to serve as negative control group. Each cavity of the remaining 65 teeth was filled with dentin debris mixed with 2.5% NaOCl. Another 5 teeth (positive control) were not subjected to the debris removal procedure. Sixty teeth were randomly divided into four experimental groups (n = 15), according to the final irrigation technique used: conventional syringe irrigation (CSI), the Self-Adjusting File (SAF), passive ultrasonic irrigation (PUI), and the EndoActivator (EA). Ten milliliters of 2.5% NaOCl was used during the debris removal procedure. The root halves were disassembled, and the amount of remaining debris was evaluated under a stereomicroscope at 30× magnification. RESULTS: SAF and PUI removed debris significantly better than CSI and EA (P<.05). CSI was the least effective in debris removal (p<0.05). CONCLUSIONS: None of the irrigation techniques used was able to completely remove debris from simulated IRR cavities.

The effect of various backfilling techniques on the fracture resistance of simulated immature teeth performed apical plug with Biodentine.

AIM: To evaluate the fracture resistance of simulated immature teeth that had been backfilled using different materials after using Biodentine as the apical plug material. DESIGN: Seventy-five single-rooted teeth were divided into five groups (n = 15). The 15 teeth in group 1 served as a negative control group and received no treatment. The remaining 60 teeth were instrumented to a #6 Peeso reamer to obtain a standard internal diameter of 1.5 mm. The apical 4 mm of 60 teeth was filled with Biodentine. The backfilling was then performed on each group as follows: group 2--no backfilling (positive control), group 3--gutta-percha, group 4--fiber post, and group 5--Biodentine. Specimens were then subjected to fracture testing. The force required to fracture each specimen was recorded, and the data were statistically analyzed. RESULTS: The mean fracture values of groups 1 and 4 were significantly higher than groups 2, 3, and 5 (P < 0.05). The values of groups 3 and 5 were significantly higher than group 2 (P < 0.05). CONCLUSIONS: The backfilling with fiber post after an apical Biodentine plug provided the highest fracture resistance among all experimental groups.

Evaluation of debris extruded apically during the removal of root canal filling material using ProTaper, D-RaCe, and R-Endo rotary nickel-titanium retreatment instruments and hand files.

INTRODUCTION: The aim of this study was to evaluate the amount of debris extruded apically during the removal of root canal filling material using ProTaper (Dentsply Maillefer, Ballaigues, Switzerland), D-RaCe (FKG Dentaire, La Chaux-de-Fonds, Switzerland), and R-Endo (Micro-Mega, Besançon, France) nickel-titanium (NiTi) rotary retreatment instruments and hand files. METHODS: Sixty extracted single-rooted mandibular premolar teeth were prepared with K-files and filled with gutta-percha and AH Plus sealer (Dentsply DeTrey, Konstanz, Germany). The teeth were then randomly assigned to 4 groups (n = 15 for each group) for retreatment. The removal of canal filling material was performed as follows: hand files, ProTaper, D-RaCe, and R-Endo retreatment instruments. Debris extruded apically during the removal of canal filling material was collected into preweighed Eppendorf tubes. The tubes were then stored in an incubator at 70°C for 5 days. The weight of the dry extruded debris was established by subtracting the preretreatment and postretreatment weight of the Eppendorf tubes for each group. The data obtained were analyzed using 1-way analysis of variance and Tukey post hoc tests. RESULTS: All retreatment techniques caused the apical extrusion of debris. Hand files produced significantly more debris when compared with ProTaper, D-RaCe, and R-Endo rotary systems (P < .05). There was no statistical difference between the ProTaper, D-RaCe, and R-Endo retreatment systems (P > .05). CONCLUSIONS: The findings showed that during the removal of root canal filling material, rotary NiTi retreatment instruments used in this study caused less apical extrusion of debris compared with hand files.

Incidence of apical crack initiation and propagation during the removal of root canal filling material with ProTaper and Mtwo rotary nickel-titanium retreatment instruments and hand files.

INTRODUCTION: The aim of this study was to determine the incidence of crack initiation and propagation in apical root dentin after retreatment procedures performed by using 2 rotary retreatment systems and hand files with additional instrumentation. METHODS: Eighty extracted mandibular premolars with single canals were selected. One millimeter from the apex of each tooth was ground perpendicular to the long axis of the tooth, and the apical surface was polished. Twenty teeth served as the control group, and no preparation was performed. The remaining 60 teeth were prepared to size 35 with rotary files and filled with gutta-percha and AH Plus sealer. Specimens were then divided into 3 groups (n = 20), and retreatment procedures were performed with the following devices and techniques: ProTaper Universal retreatment files, Mtwo retreatment files, and hand files. After retreatment, the additional instrumentation was performed by using size 40 ProTaper, Mtwo, and hand files. Digital images of the apical root surface were recorded before preparation, after instrumentation, after filling, after retreatment, and after additional instrumentation. The images were then inspected for the presence of any new apical cracks and propagation. Data were analyzed with the logistic regression and Fisher exact tests. RESULTS: All experimental groups caused crack initiation and propagation after use of retreatment instruments. The ProTaper and Mtwo retreatment groups caused greater crack initiation and propagation than the hand instrument group (P < .05) after retreatment. Additional instrumentation with ProTaper and Mtwo instruments after the use of retreatment instruments caused crack initiation and propagation, whereas hand files caused neither crack initiation nor propagation (P < .05). CONCLUSIONS: This study showed that retreatment procedures and additional instrumentation after the use of retreatment files may cause crack initiation and propagation in apical dentin.