Evaluation of the Impact of Calcium Silicate-Based Sealer Insertion Technique on Root Canal Obturation Quality: A Micro-Computed Tomography Study.

BACKGROUND: Calcium silicate-based sealers have gained in popularity over time due to their physicochemical/biological properties and their possible use with single-cone obturation. The single cone technique is a sealer-based obturation and there is still a knowledge gap regarding the potential impact of the sealer insertion method on the root canal-filling quality. Therefore, the aim of this micro-CT study was to assess the impact of the calcium silicate-based sealer insertion technique on void occurrence and on the sealer extrusion following single-cone obturation. METHODS: Thirty-six single-rooted mandibular premolars with one canal were shaped with Reciproc® R25 (VDW, Munich, Germany) then divided randomly into four groups of nine canals, each depending on the TotalFill® BC Sealer insertion technique used with single cone obturation: injection in the coronal two-thirds (group A); injection in the coronal two-thirds followed by direct sonic activation (group B); injection in the coronal two-thirds followed by indirect ultrasonic activation on tweezers (group C); sealer applied only on the master-cone (control group D). Samples were then scanned using micro-CT for voids and sealer extrusion calculation. Data were statistically analyzed using v.26 IBM; Results: No statistically significant differences were noted between the four groups in terms of voids; nevertheless, sonic activation (group B) followed by ultrasonic activation on the tweezers (group C) showed the best results (p = 0.066). Group D showed significantly less sealer extrusion when compared with group C (p = 0.044), with no statistically significant differences between groups D, A and B (p > 0.05). CONCLUSIONS: Despite no significant differences observed between the different sealer placement techniques, the use of sonic and ultrasonic activation might be promising to reduce void occurrence. Further investigations are needed to demonstrate the potential benefit of calcium silicate-based sealer activation especially in wide and oval root canals in order to improve the quality of the single-cone obturation.

Impact of Final Irrigation Protocol on the Push-Out Bond Strength of Two Types of Endodontic Sealers.

Aim: The aim of this study was to assess the impact of the final irrigation protocol on the push-out bond strength of calcium silicate-based sealers when compared to an epoxy resin-based sealer. Materials and Methods: Eighty-four single-rooted mandibular human premolars were shaped using the R25® instrument (Reciproc, VDW, Munich, Germany) and then divided into three subgroups of 28 roots each depending on the final irrigation protocol: EDTA (ethylene diamine tetra acetic acid) and NaOCl activation, Dual Rinse® HEDP (1-hydroxyethane 1,1-diphosphonate) activation or sodium hypochlorite (NaOCl) activation. Then, each subgroup was divided into two groups (14 each) according to the sealer used (AH Plus Jet® or Total Fill BC Sealer®) for single-cone obturation. Dislodgement resistance using a universal testing machine, samples' push-out bond strength and failure mode under magnification were determined. Results: EDTA/Total Fill BC Sealer® showed significantly greater values of push-out bond strength compared with HEDP/Total Fill BC Sealer® and NaOCl/AH Plus Jet®, with no statistical difference with EDTA/AH Plus Jet®, HEDP/AH Plus Jet® and NaOCl/Total Fill BC Sealer®, whereas HEDP/Total Fill BC Sealer® showed significantly lower values of push-out bond strength. The apical third demonstrated higher means of push-out bond strength compared with middle and apical thirds. The most common failure mode was cohesive but showed no statistical difference compared to other types. Conclusions: Irrigation solution and final irrigation protocol affect the adhesion of calcium silicate-based sealers.

ECHO: An Information System for the Monitoring and Evaluation of Dental Student Activity in a Pre-Doctoral Clinic.

The main goal of dental education is to develop health professionals who will maintain and improve the oral health of patients. This requires the quantitative and qualitative assessment of dental student activity. The aim of this work is to describe the ECHO information system that was developed at Timone Hospital (France) for the monitoring and evaluation of dental student activity and to present the results of a qualitative evaluation of student perceptions of this system. According to the analysis of the UML model of care-related procedures and data, the pre-existing process of student evaluation was characterized by redundancy between administrative and educational data. ECHO was developed in PHP/MySQL and designed to centralize the two types of data in a unified computerized process. The qualitative evaluation of dental student perceptions of ECHO was performed using an anonymous online Google Form questionnaire. Among the respondents (102/254 students), 96% stated that ECHO is easy to use, 86% that it saves time, and 81% that it gives them a better overview of their activity. After several years of use, ECHO has solved many of the difficulties related to the use of internship paper booklets, while also providing a documentary database of the activities of our dental department. The student activity data stored in ECHO are directly accessible by faculty members and can be reused to facilitate departmental management and research and to improve patient follow-up.

Suitability of Reusing Pre-Doctoral Student Activity Data from an Educational Information System for Quality Measures of Caries Risk.

Dental caries management requires individualized follow-up and prophylaxis based on patients' caries risk (PCR). In large pre-doctoral clinics, the use of institutional quality measures (QMs) is essential to control the quality of patient follow-up and to evaluate the need for improvement measures. The aim of this retrospective study was to evaluate the suitability of reusing student activity data for the development of QMs of caries risk. Two approaches for predicting PCR using student activity data were evaluated and compared. The first approach used the procedure codes recommended by the Dental Quality Alliance and the second used these same codes along with three educational codes. The sensitivity, specificity, overall accuracy of the two approaches were evaluated. A Receiver Operating Characteristic (ROC) curve analysis was carried out, and the areas under the ROC curve of the two approaches were compared using Delong's test. A two-tailed P value ≤0.05 was considered statistically significant. While the two approaches were able to correctly predict PCR, the approach using both procedure and educational codes showed better predictive performance. The reuse of student activity data is an easy and robust method for the development of QMs of caries risk that can help improve monitoring and quality of patient care.

Current strategies for conservative endodontic access cavity preparation techniques-systematic review, meta-analysis, and decision-making protocol.

OBJECTIVES: To assess related studies and discuss the clinical implications of endodontic access cavity (AC) designs. MATERIALS AND METHODS: A systematic review of studies comparing the fracture resistance and/or endodontic outcomes between different AC designs was conducted in two electronic search databases (PubMed and Web of Science) following the PRISMA guidelines. Study selection, data extraction, and quality assessment were performed. Meta-analyses were undertaken for fracture resistance and root canal detection, with the level of significance set at 0.05 (P = 0.05). RESULTS: A total of 33 articles were included in this systematic review. The global evaluation of the risk of bias in the included studies was assessed as moderate, and the level of evidence was rated as low. Four types of AC designs were categorized: traditional (TradAC), conservative (ConsAC), ultraconservative (UltraAC), and truss (TrussAC). Their impact on fracture resistance, cleaning/disinfection, procedural errors, root canal detection, treatment time, apical debris extrusion, and root canal filling was discussed. Meta-analysis showed that compared to TradAC, (i) there is a significant higher fracture resistance of teeth with ConsAC, TrussAC, or ConsAC/TrussAC when all marginal ridges are preserved (P < 0.05), (ii) there is no significant effect of the type of AC on the fracture resistance of teeth when one or two marginal ridges are lost (P > 0.05), and (iii) there is a significantly higher risk of undetected canals with ConsAC if not assisted by dental operating microscope and ultrasonic troughing (P < 0.05). CONCLUSIONS: Decreasing the AC extent does not necessarily present mechanical and biological advantages especially when one or more surfaces of the tooth structure are lost. To date, the evidence available does not support the application of TrussAC. UltraAC might be applied in limited occasions. CLINICAL RELEVANCE: Maintaining the extent of AC design as small as practical without jeopardizing the root canal treatment quality remains a pragmatic recommendation. Different criteria can guide the practitioner for the optimal extent of AC outline form which varies from case to case.

Calcium Silicate-Based Root Canal Sealers: A Narrative Review and Clinical Perspectives.

Over the last two decades, calcium silicate-based materials have grown in popularity. As root canal sealers, these formulations have been extensively investigated and compared with conventional sealers, such as zinc oxide-eugenol and epoxy resin-based sealers, in in vitro studies that showed their promising properties, especially their biocompatibility, antimicrobial properties, and certain bioactivity. However, the consequence of their higher solubility is a matter of debate and still needs to be clarified, because it may affect their long-term sealing ability. Unlike conventional sealers, those sealers are hydraulic, and their setting is conditioned by the presence of humidity. Current evidence reveals that the properties of calcium silicate-based sealers vary depending on their formulation. To date, only a few short-term investigations addressed the clinical outcome of calcium silicate-based root canal sealers. Their use has been showed to be mainly based on practitioners' clinical habits rather than manufacturers' recommendations or available evidence. However, their particular behavior implies modifications of the clinical protocol used for conventional sealers. This narrative review aimed to discuss the properties of calcium silicate-based sealers and their clinical implications, and to propose rational indications for these sealers based on the current knowledge.

Microscopic and chemical evaluation of the filling quality of five obturation techniques in oval-shaped root canals.

OBJECTIVES: The aim of this study was to assess the filling quality of five obturation techniques in oval-shaped root canals. MATERIALS AND METHODS: A total of 212 mandibular first molars with one distal oval canal were selected. Distal canals, shaped with WaveOne Gold Primary, were randomly divided in five groups (n = 40) for obturation: continuous wave condensation, GuttaCore, Thermafil, single cone with AH plus, and single cone with BioRoot RCS. The proportions of gutta-percha-filled areas (GPFA), sealer-filled areas (SFA), void areas (VA), and the sealer/gutta tags into dentinal tubules at 4 mm and 2 mm from the apex were analyzed by an optical numeric microscope, SEM, and energy-dispersive X-ray (EDX). Data were then compared by Kruskal-Wallis one-way ANOVA on ranks (α = 0.05). RESULTS: At 4 mm, a statistically significant higher GPFA and lower SFA were observed in the GuttaCore and Thermafil groups compared with the 3 other groups. A statistically significant lower VA was observed in the continuous wave condensation, GuttaCore, and Thermafil groups than in the two single-cone groups. At 2 mm, there were a statistically significant higher GPFA and lower SFA and VA in GuttaCore and Thermafil groups than in the 3 other groups. At the two levels investigated, the presence of gutta-percha tags was clearly demonstrated for GuttaCore and Thermafil groups; no tags were observed in the 3 other groups. CONCLUSIONS: Obturation quality was overall improved in GuttaCore and Thermafil groups. CLINICAL RELEVANCE: Carrier-based techniques may significantly improve the filling quality compared to continuous wave condensation and single-cone technique. The single-cone technique might have inherent limitations especially in oval root canals regardless of the sealer used.

In Vitro Evaluation of Different Irrigation Protocols on Intracanal Smear Layer Removal in Teeth with or without Pre-Endodontic Proximal Wall Restoration.

To investigate the influence of pre-endodontic coronal wall restoration on smear layer removal during different root canal irrigation strategies, single-root premolars were prepared with a mesio-occlusal cavity. Half were left untreated (G1), while the mesial walls of the remaining half were reconstructed using a resin composite (G2). The specimens were divided into control (ctrl) groups, which used the conventional needle irrigation method, and four experimental subgroups according to irrigation strategy: Sonic activation using the Endoactivator, sonic activation using the EQ-S, mechanical activation using the XP-Endo finisher, and ultrasonic activation using the EndoUltra. Smear layer removal was assessed through SEM and the results were statistically analyzed. At the coronal and middle thirds, no significant difference (p > 0.05) was detected for G1 and G2, except for the control subgroups (G1ctrl vs G2 ctrl) at the middle third. At the apical third, the smear layer removal was significantly greater for G2 than G1. In G1, both at the middle and apical level, EQ-S and EndoUltra showed greater smear layer removal (p < 0.05) compared to the others G1 subgroups. In G2, at the apical level, the EQ-S and EndoUltra were the most effective in smear layer removal. Pre-endodontic coronal wall restoration may improve the smear layer removal during root canal irrigation.

Canal Transportation and Centring Ability of Reciproc and Reciproc Blue With or Without Use of Glide Path Instruments: A CBCT Study.

Objective: The objective of this ex vivo study was to evaluate canal transportation and centring ability of Reciproc and Reciproc blue systems in curved root canals with or without prior use of PathFile rotary system (PF) using Cone Beam Computed Tomography (CBCT). Methods: One hundred and twenty curved root canals from maxillary and mandibular premolars were selected. Canals were divided randomly into 4 groups (n=30): Reciproc 25 (R25), (PF+R25), Reciproc Blue 25 (RB25), (PF+RB 25). Specimens were scanned before and after root canal preparation. Using CBCT, root canal transportation and centring ability was assessed by measuring the shortest distance from the edge of uninstrumented canal to the periphery of the root (mesial and distal) before and after preparation. Data were analysed using a one-way analysis of variance and Tukey test. The p value was set at 0.05. Results: Less transportation and better centring ability occurred when PF was used before R25 or RB25 (P<0.0001). There was no significant difference between R25 and RB25 groups. Conclusion: Using PF before R25 and RB25 resulted in less root canal transportation and better centring ability. The specific thermo-mechanical treatment of RB25 did not provide better results when compared to R25.

Influence of Negotiation, Glide Path, and Preflaring Procedures on Root Canal Shaping-Terminology, Basic Concepts, and a Systematic Review.

INTRODUCTION: Negotiation, glide path, and preflaring are essential steps in root canal shaping procedures. This report aimed to discuss the terminology, basic concepts, and clinical considerations of negotiation, glide path, and preflaring procedures and the influence of these steps on root canal shaping. METHODS: This systematic review was undertaken following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The protocol has been registered with the International Prospective Register of Systematic Reviews (number CRD42019127021). A comprehensive literature search was performed by 2 independent reviewers using a selected search strategy in 2 electronic databases (PubMed and Scopus) until January 28, 2019. A further search was performed manually in endodontic journals. Studies investigating or comparing at least 1 shaping property resulting from root canal instrumentation with a glide path or preflaring in human extracted teeth or clinical studies were included. RESULTS: The literature shows that the definition of glide path and preflaring procedures remains controversial, which requires an elaboration in the American Association of Endodontists' Glossary of Endodontic Terms. After the removal of irrelevant and duplicated articles, 98 articles were included. The impact of glide path preparation and preflaring on working length determination, apical file size determination, canal transportation, separation of endodontic files, shaping time, dentinal microcrack formation, and extrusion of debris was discussed. Because of heterogeneity among the included studies, quantitative synthesis was not performed for most of the parameters. CONCLUSIONS: An evidence-based guideline is needed to define and correlate the basic concepts and current applications of each step of contemporary advancements in root canal instruments. Glide path preparation reduces the risk of debris extrusion, has no influence on the incidence of dentinal crack formation, and improves the preservation of the original canal anatomy. The creation of a glide path may have no impact on Reciproc files (VDW, Munich, Germany) in reaching the full working length. Preflaring increases the accuracy of working length determination. Further randomized clinical trials are required to evaluate the effect of a glide path and preflaring on root canal treatment outcomes.

An international survey on the use of calcium silicate-based sealers in non-surgical endodontic treatment.

OBJECTIVES: To gain insight on the current clinical usage of bioceramic root canal sealers (BRCS) by general dental practitioners (GDPs) and endodontic practitioners (EPs) and to determine if BRCS clinical application is in accordance with the best available evidence. MATERIAL AND METHODS: An online questionnaire of 18 questions addressing BRCS was proposed to 2335 dentists via a web-based educational forum. Participants were asked about socio-demographic data, clinical practice with BRCS, and their motivation for using BRCS. Statistical analysis (chi-squared test or Fisher's exact test) was applied, as appropriate, to assess the association between the variable categories (p value < 0.05). RESULTS: The response rate was 28.91%. Among respondents, 94.8% knew BRCS (EPs more than GDPs, p < 0.05) and 51.70% were using BRCS. The primary reason for using BRCS was their belief of its improved properties (87.7%). Among BRCS users, single-cone technique (SCT) was the most employed obturation method (63.3%) which was more applied by GDPs (p < 0.05); EPs utilized more of the thermoplasticized obturation techniques (p < 0.05). A proportion of 38.4% of BRCS users indicated the usage of SCT with BRCS regardless of the root canal anatomy (GDPs more than EPs p < 0.05) and 55.6% considered that BRCS may influence their ability to re-establish apical patency during retreatment (GDPs more than EPs p < 0.05). CONCLUSIONS: This study highlights wide variation in the clinical use of BRCS which is not in accordance with the current literature. CLINICAL RELEVANCE: This inconsistency among EPs and GDPs on BRCS clinical application requires further clarifications to better standardize their use and improve their future evaluation.

A cross-sectional analysis of patient care pathways and profiles in a dental emergency department.

INTRODUCTION: Hospital dental emergency (DE) departments are assumed to improve access to emergency care. Patients use these facilities at night and during weekends, mainly because private care is not available at these times. However, motivation for using hospital care during office hours remain unclear. This study aimed to investigate the characteristics and care pathways of patients consulting a DE department during office hours and to identify the profiles of DE department users. METHODS: A descriptive cross-sectional study was performed in the DE department of La Timone Hospital (Marseille, France). Structured interviews were conducted with 150 patients. The interview guide explored sociodemographic data, dental care behaviour, characteristics of the emergency visit, care pathway and follow-up. Descriptive statistics and a multiple correspondence analysis were used for statistical analysis of the data collected. RESULTS: The main motivation for seeking care was pain (76%), and 59.3% of the patients attended the DE department as a first intention. The main reasons for coming to the hospital were trust in hospital practitioners (42%) and convenience of care accessibility (40.1%). Two contrasting profiles of patients were identified: young patients with a low income (regular users of DE departments, seeking acute pain relief); and elderly patients (infrequent users of DE departments, seeking follow-up care). CONCLUSION: This study highlighted that hospitals can be a primary pathway to DE care even though private care may be available. However, serious limitations regarding the continuity of care in the hospital exist, regardless of patient profile.

Comparison of Antimicrobial Substantivity of Six Root Canal Irrigants against Enterococcus faecalis.

Introduction: The antimicrobial substantivity of Mixture of Doxycycline, Citric acid, and Tween 80 (MTAD), Tetraclean, Tetraclean NA, Q-Mix, 2% Chlorhexidine (CHX) and Octenisept was assessed in human root dentine blocks infected with Enterococcus (E.) faecalis. Methods and Materials: A total of 170 dentine tubes were prepared from human maxillary incisors. After crown and apical third removal, cementum was abraded. The remaining center-holed pieces were cut into 4-mm blocks, infected with E. faecalis in Brain Heart Infusion (BHI) broth for 28 days, then randomly divided into 6 experimental groups (n=25) and 2 controls (n=10). At 0, 7, 14, 21 and 28 days, dentine chips were removed from the canals, with sequential round burs with increasing diameters, and collected into freshly prepared BHI broth. After culturing, growing colonies were counted as colony forming units (CFU). Conventional non-parametric tests (Kruskal-Wallis and Mann-Whitney tests) were used to assess intra-group (at different time frames) and inter-group (at each experimental time) differences (P=0.05). Results: Tetraclean yielded the lowest CFU counts (P<0.001) at each observation time. Tetraclean NA and Q-Mix showed better (P<0.001) substantivity than 2% CHX and MTAD (except for Q-Mix versus MTAD at 14 days, P=0.21). Conclusions: In this in vitro study, Tetraclean NA and Q-Mix displayed the best antimicrobial substantivity against E. faecalis after Tetraclean in infected human root dentine. Considering the findings of our study and potential drawbacks of antibiotic-based irrigants, free-antibiotic irrigants may represent viable alternative for final rinse in root canal treatment.

Dental students' attitudes towards management of pain and anxiety during a dental emergency: educational issues.

INTRODUCTION: High levels of patients' pain and anxiety characterise dental emergencies. The main objective of this study was to examine the self-reported attitudes of dental students towards these parameters in emergency conditions. A secondary objective was to determine if individual parameters (gender, personal experience of dental pain, personal dental anxiety and year of study) might affect their attitudes. METHODS: One-hundred and eighty-seven undergraduate dental students with clinical practice completed a multiple-choice self-administered questionnaire online. The aforesaid individual parameters were collected and the students were asked to rate the frequency of their behaviour towards items representing good management of patients' pain and anxiety. The chi-square test of independence, Fisher's exact test and multiple logistic regression models were used for statistical analysis. RESULTS: Oral assessment of anxiety before treatment was scarce and was significantly associated with the students having personally experienced dental pain (P = 0.007). Pre-, intra- and postoperative pain appeared to be managed unequally by the students. Male students were significantly less likely to inform patients about postoperative pain (P = 0.014). More clinical experience was associated with less systematic consideration for intra-operative pain (P < 0.05). Being dentally anxious showed no significant association with higher frequencies of behaviours towards patients' pain and anxiety. CONCLUSIONS: These findings highlight the need for educational improvement regarding pain and anxiety in emergency conditions, especially concerning the assessment methods and continuity in the control of pain. Emergency dental care appears to be a very suitable field for contextual learning.

Sodium Hypochlorite Accident: A Systematic Review.

INTRODUCTION: Sodium hypochlorite (NaOCl) extrusion beyond the apex, also known as "a hypochlorite accident," is a well-known complication that seldom occurs during root canal therapy. These "accidents" have been the subject of several case reports published over the years. Until now, no publication has addressed the global synthesis of the general and clinical data related to NaOCl extrusion. The main purpose of this article was to conduct a systematic review of previously published case reports to identify, synthesize, and present a critical analysis of the available data. A second purpose was to propose a standardized presentation of reporting data concerning NaOCl extrusions to refine and develop guidelines that should be used in further case report series. METHODS: A review of clinical cases reporting NaOCl accidents was conducted in June 2016 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist; it combined an electronic search of the PubMed database and an extensive manual search. RESULTS: Forty full-text articles corresponding to 52 case reports published between 1974 and 2015 were selected. Four main categories of data were highlighted: general and clinical information, clinical signs and symptoms of NaOCl extrusions, management of NaOCl extrusions, and healing and prognosis. Overall, up to now, clinical cases were reported in a very unsystematic manner, and some relevant information was missing. CONCLUSIONS: A better understanding of the potential causes, management, and prognosis of NaOCl accidents requires a standardization of reported data; this study proposes a template that can fulfill this objective.

Current Assessment of Reciprocation in Endodontic Preparation: A Comprehensive Review-Part I: Historic Perspectives and Current Applications.

INTRODUCTION: During the evolution of mechanical instrumentation in endodontics, an important role has been played by reciprocating stainless steel files using horizontal rotational, vertical translational, or combined movements. These kinds of systems are still in use mainly as an accessory to help in the first phases of the treatment. METHODS: The literature concerning these systems has been analyzed using selected criteria. RESULTS: The latest evolution of horizontal rotational reciprocating movement brought to the development of a different kind of movement in which the angles are asymmetrical and that appears to be ideal in conjunction with modern nickel-titanium (NiTi) files with a greater taper. Initially, this movement was limited to particular handpieces available on the market that was used with existing NiTi files to complete root canal instrumentation. Later on, specific files and proprietary motors were introduced into the market. The differences between reciprocating motion used for NiTi and stainless steel files are described and critically analyzed. CONCLUSIONS: A classification of the different mechanical reciprocating motions used is presented, thus enabling an easier understanding of these systems and anticipated future developments.

Current Assessment of Reciprocation in Endodontic Preparation: A Comprehensive Review--Part II: Properties and Effectiveness.

INTRODUCTION: Many reciprocating file systems (RFs) have recently been introduced. This article reviews the properties, effectiveness, and clinical outcomes of the RFs. METHODS: A PubMed electronic search was conducted by using appropriate key words to identify investigations on RFs. After retrieving the full-text relevant articles, the cross citations were also identified. RESULTS: This review summarizes the mechanical properties, shaping ability, preservation of the root canal anatomy, shaping time, cleaning effectiveness, microcrack formation, bacterial reduction, extrusion of debris, and removal of root canal filling materials of RFs. CONCLUSIONS: The favorable results of RFs indicate their potential application as viable alternatives to rotary file systems, yet no filing system is able to entirely prepare the dentin of canals, totally eliminate sessile and planktonic microorganisms, or remove the filling material completely from the root canal system.

Do cell phones affect establishing electronic working length?

INTRODUCTION: Patients often keep their cell phones on and nearby during root canal therapy. Cell phones release electromagnetic interference, which might disturb electronic working length measurements. The purpose of this ex vivo study was to determine the effect of a cell phone (Apple iPhone 5 [Apple, Cupertino, CA] or KP100 [LG, Seoul, Korea]) placed into direct contact with an electronic apex locator (EAL) (Dentaport Root ZX module [J Morita Corp, Tokyo, Japan] or Propex II [Dentsply Maillefer, Ballaigues, Switzerland]) on working length determination. METHODS: Twenty-six human premolars without fractures or carious lesions were used; previously cleaned; and observed under magnification (×15) in order to check for the presence of only 1 apical foramen, the absence of apical resorption, an "open" apex, and accessory canals. The working length measurement was performed with a #15 K-file in the presence of 2.6% sodium hypochlorite under 4 conditions: (1) visually, under the microscope until the file tip reached the canal terminus; (2) electronically, without the cell phone in proximity; (3) electronically, with the cell phone in standby mode placed in physical contact with the EAL; and (4) electronically, with the cell phone activated by a call in the same position. The experimental model for electronic working length determination was a screw top plastic container filled with a saline solution. The measurements were repeated 3 times per canal under each condition. Scores of 1 to 3 categorized the stability of the readings as follows: (1) good stability; (2) unstable reading with minor difficulties determining the working length; and (3) major difficulties or impossible to determine the working length. A 2-way repeated measures analysis of variance (way 1: cell phone type and way 2: EAL model) was performed, and a second repeated measures analysis of variance was performed to seek a difference among the 4 working length determination conditions. RESULTS: Neither the cell phone type nor the EAL affected the measurements (not significant). The electronic working length measurements gave the same results as the visual examination, and this length was not influenced by direct contact with a cell phone (not significant). It was also possible to determine the electronic working length under all the experimental conditions. CONCLUSIONS: Within the limitations of the present study, it can be concluded that patients can keep their cell phones on during root canal therapy without any adverse effect on electronic working length determination.

Implications of endodontic-related sinus aspergillosis in a patient treated by infliximab: a case report.

INTRODUCTION: Sinus aspergillosis is a potential complication after root canal therapy of antral teeth. Indeed, zinc oxide-eugenol cement overfilling in the sinus may promote fungal infection. Moreover, if sinus aspergillosis triggers chronic sinusitis with aspergilloma, it may also lead to invasive phenomena, especially for immunocompromised patients. METHODS: We reported a sinus aspergillosis case of a patient treated with infliximab (Remicade; Janssen Biologics BV, Leiden, Netherlands). The purpose of this article was to explore the mechanisms of this pathosis, especially the impact of the root canal sealer overextension, which is a contributing factor for fungal infection. The surgical management and the follow-up are also described. RESULTS: Six months after surgery, the patient showed no clinical signs and presented with a healthy and airy right maxillary sinus on the computed tomography scan. CONCLUSIONS: In conclusion, prevention and screening of aspergillosis of maxillary sinus may be considered before starting an anti-tumor necrosis factor alpha therapy.