Root Canal Filling Quality Comparison of a Premixed Calcium Silicate Endodontic Sealer and Different Carrier-Based Obturation Systems.

BACKGROUND: The number of voids within the root canal obturation is a relevant parameter to describe the quality of the technique, as well as to predict long-term prognosis. The aim of this study was to evaluate the quality of root canal obturation in curved root canals filled with Thermafil, GuttaCore, GuttaFusion and lateral compaction with AH Plus and EndoSequence BC sealer, by means of percentage of gutta-percha and sealer filled area. METHODS: 200 curved canals of mandibular molars were divided in five groups (n = 40). Each specimen was evaluated at 3, 6 and 9 mm from the apex. A total of 600 samples were analyzed. Obturation was performed with either Thermafil (TH), GuttaCore (GC), GuttaFusion (GF) or lateral compaction (LC), using AH Plus as sealer. In another group EndoSequence BC sealer (BC) was used. Subgroups (n = 20) were made depending on the use of sonic activation during the placement of the sealer. The percentage of total obturation material was analyzed as an indirect measurement of percentage of voids. RESULTS: GF showed a better performance at the apical level, while GC showed the higher percentage of total obturation at the coronal area. No differences were observed for the activation of sealers in any of the groups. Statistical analysis was performed by using two-way ANOVA. Statistical significance was set at CI: 95% (p < 0.05). CONCLUSIONS: Sonic activation of sealers did not show any benefit to avoid the presence of voids within obturation of curved canals. Following the manufacturer recommendations, we found that TH did not show benefits when applied to curved canals.

Ensayo aleatorizado in vitro sobre la capacidad de obturación de sistemas con vástago en conductos curvos / In vitro randomized-trial on the sealing ability of carrier-based systems in curved root canals

Objetivo: Comparar el porcentaje de área de gutapercha, cemento y huecos en conductos curvos obturados con sistemas con vástago y evaluar la influencia de la activación del cemento durante su colocación. Metodología: 120 conductos curvos de molares mandibulares fueron preparados a un diámetro apical ProFile 30, 0.04. Se obturaron con los sistemas GuttaCore, GuttaFusion o condensación lateral y AHplus (n = 40). Se subdividieron los grupos (n = 20) y se colocó el cemento con activación sónica o no. El cemento se mezcló con Rodamina B para permitir el análisis mediante microscopía confocal. Se calculó el área de gutapercha, cemento y huecos a 3, 6 y 9 mm del ápice. Se realizó el análisis estadístico utilizando ANOVA de dos vías. Para la comparación por pares se realizó el test de Sidak. Resultados: Cuando se comparan los sistemas de gutapercha a 3 mm, GF mostró un mejor comportamiento. CL obtuvo los peores resultados. No se encontró influencia entre los sistemas de obturación y la activación del cemento. Cuando se comparó el porcentaje de huecos entre todos los grupos, los perores resultados fueron para CL a 6 y 9 mm. Conclusiones: Bajo las condiciones de este estudio, el área de gutepercha, cemento y huecos depende del sistema de obturación utilizado. El uso de activación del cemento no influye en la calidad de la obturación

Aim: To compare the percentage of gutta-percha, sealer and voids in curved root canals filled with different gutta-percha carrier-based systems and to assess the influence of activation of the cement during its placement. Methodology: 120 curved canals of mandibular molars were prepared to an apical size ProFile 30, 0.04. They were filled with either GuttaCore, GuttaFusion or lateral condensation and AHplus (n=40). Groups were subdivided (n=20) and sonic activation or not during the placement of the cement was carried out. Cements were labelled with Rhodamine-B dye to allow analysis under confocal microscopy. Percentage of gutta-percha, sealer and voids area were calculated at 3, 6 and 9 mm from the apex. Statistical analysis was performed using two-way ANOVA test. To compare between the obturation systems Sidak correction for multiple comparisons was applied. Results: When comparing the gutta-percha systems at the 3 mm level, GF revealed a better performance. At 6 and 9mm, LC obtained the worst results. An influence between the obturation systems and the activation of the cement was not found. When comparing the percentage of voids among all the groups, worst results were found for LC at 6 and 9 mm. Conclusions: Under the conditions of this study, gutta-percha, sealer area and voids were dependent on the obturation system. The use of activation of the cement do not influence the quality of root filling

Estudio in vitro aleatorizado de la capacidad de obturación de guttacore y thermafil plusmediante cortes transversales / In vitro randomized study of the sealing ability of Guttacore and Thermafil plususing cross sections

El éxito del tratamiento de conductos radica en una adecuada limpieza, conformación y obturación de los mismos. Objetivo: Comparar el PGFA (porcentaje del área rellena por gutapercha) de la obturación de conductos entre el sistema Guttacore(TM) y el sistema Thermafil Plus(R) mediante cortes histológicos. Metodología: Se realizó estudio in vitro aleatorizado sobre 23 conductos cuya curvaturase comprendía entre 21-40º. Los conductos se instrumentaron hasta un calibre apical de 30.04. Tras realizar irrigación final ultrasónica pasiva, se obturaron los conductos con los es realizaron cortes histológicos a 2, 5 y 8 mm del extremo apical. Se fotografió la superficie de los cortes a 2,5x aumentos. Calculamos el PGFA de las muestras. Resultados: Todos los conductos obtuvieron medias superiores al 95% en PGFA (Guttacore: 98,16% a 2 mm, 96,77% a 5 mm y 98,46% a 8 mm; Thermafil: 98,73% a 2 mm, 98,89% a 5 mm y 100% a 8 mm). Existieron diferencias significativas entre ambos grupos en el corte a 8 mm (p=0,011). Conclusiones:1) Thermafil Plus(TM) obtiene significativamente mayor PGFA en corte a 8mm. 2) No existen diferencias significativas a 2 y 5 mm. 3) Se necesitan nuevos estudios comparativos de Guttacore(TM) con otros sistemas de obturación

The success of the root canal treatment takes of in a suitable cleaning, shaping and obturation of the root canal system. Aim: To compare the PGFA (percentage of gutta-percha-filled area) obtained by Guttacore and Thermafil Plus obturation systems using histologic sections. Metodology: a randomized in vitro trial was done on 23 canals in which the angle of curvature was between 21-40º. The instrumentation was done untill a 30.04 file reach the working lenght. After the final irrigation activated with ultrasound, canals were obturated with Thermafil Plus and Guttacore obturation systems. horizontal sections were cut 2, 5 and 8 mm from the apical foramen of each tooth. The crosssectional area of the samples were taken under phtographs to 2.5x increases. The PGFA was calculated. Results: All the canals obtained more than 95% in average of PGFA (Guttacore: 98,16%at 2 mm, 96,77% at 5 mm and 98,46% at 8mm; Thermafil: 98,73% at 2 mm, 98,89% at5 mm and 100% at 8 mm). Significant differences were found between the grups in the cross-sectional area at 8 mm (p=0,011). Conclusions: 1) Thermafil plus gets significantly higher values of PGFA in the cross-sectional area at 8 mm. 2) No significant difference was found between 2 and 5 mm 3) Other studies about comparation of Gutta-core are needed

Revisión crítica actualizada sobre la obturación con el Sistema Thermafil y su sucesor: GuttaCore / Updated critical review of the obturation with the Thermafil System and its successor: GuttaCore

El sistema de obturación Thermafil se basa en un vástago de plástico recubierto de gutapercha. Su evolución, GuttaCore, consta de un núcleo de gutapercha entrelazada con el objetivo de facilitar la remoción de éste manteniendo a la vez las buenas propiedades ofrecidas por la gutapercha termoplástica. El objetivo de este trabajo es describir ambos sistemas y analizar algunos de los aspectos más importantes de la obturación endodóntica como la capacidad desellado, la facilidad de retratamiento y la filtración apical. Para ello se ha efectuado un búsqueda bibliográfica a través de Medline utilizando publicaciones posteriores al año2002, exceptuando la inclusión de artículos más antiguos dada su relevancia. Como resultado, hemos observado que el sistema Thermafil consigue obturaciones herméticas y tridimensionales en todo tipo de conductos a excepción de reabsorciones internas o ausencia de constricción apical. Su curva de aprendizaje es rápida, así como su tiempo de ejecución. Los inconvenientes de esteción de su vástago y las frecuentes sobre obturaciones. El sistema GuttaCore parece facilitar el tiempo de retratamiento pero faltan estudios acerca su comportamiento a largo plazo. Dado que la mayoría de los estudios sobre el comportamiento de Thermafil se han realizado ex vivo, los resultados no pueden extrapolarse directamente a la práctica clínica

The root filling system Thermafil is based on a plastic carrier covered by gutta-percha. Its successor, GuttaCore, consists of a cross linked gutta-percha core with the purpose offacilitate its removal keeping the good properties offered by the thermoplastic gutta-percha. The aim of this review is to describe both based - in - carrier root filling systems Thermafil and GuttaCore and analyze some of the most important aspects of the endodontic obturation such as the sealing ability, the easiness of retreatment and the apical leakage. For this we have carried out a literature search through Medline using publications after the year2002, except for the inclusion of older articles because of its importance. As a result, we found that Thermafil System achieves hermetic and tridimensional obturations in all kinds of root canals except in resorptivecavities and in the absence of the apical constriction. Its learning curve is fast as well as the time of its performance. The disadvantages of this system are the longer time for the removal of the carrier and the often overextended obturations. The GuttaCore system seems to facilitate the retreatment's time but there are no studies about its longterm outcome. Giben that most of the studies on Thermafil's behavior has been performed ex vivo, The results cannot be directly extrapolated to the clinical practice

Actualización en microbiología endodóntica / Update in endodontic microbiology

Los agentes microbiológicos son esenciales en la progresión y perpetuación de la patología inflamatoria perirradicular. Dentro de éstos, las bacterias constituyen la flora más prevalente. Para que un conducto se infecte, la pulpa debe estar necrótica y los microorganismos deben adherirse a los tejidos y multiplicarse en cantidad suficiente, siendo por tanto importante la interacción entre el hospedador y la dosis de infección. Las asociaciones específicas que están implicadas en la patogénesis de la enfermedad perirradicular aún son desconocidas, pero se acepta que las especies aisladas más frecuentemente deben tener una mayor contribución en el grado de patogenicidad. Las diferentes formas de enfermedad perirradicular pueden tener etiologías microbianas distintas. Los tipos de infección endodóntica (primaria, secundaria y persistente) se asocian con diferentes condiciones clínicas. Las infecciones extrarradiculares pueden catalogarse como cualquiera de las anteriores, y están cobrando mucha importancia, por la resistencia que presentan al (..) (AU)

Microbiological agents are essential in the progression and perpetuation of periradicular inflammatory pathologies. Within these, bacteria constitute the most prevalent flora. For a canal to become infected, the pulp must be necrotic and the microorganisms must adhere to the tissues and multiply insufficient quantity, with the interaction being important, therefore, between the host and the infectious dose. The specific associations that are implied in the pathogenesis of the periradicular disease are still unknown, but it is accepted that the most frequently isolated species should have a greater contribution in the degree of pathogenicity. The different forms of periradicular disease maybe classified as different microbial aetiologies. The types of endodontic infections (..) (AU)