Effect of different apical actions of new integrated endodontic motors on apical debris extrusion: An in vitro study.

The new generation endodontic motors can perform different kinematics when they reach a certain predetermined level thanks to the integrated apex locator system. These actions consist of apical reverse, apical slow down and apical stop. The aim of this study is to compare this action's effect on apical debris extrusion. Sixty extracted human lower premolars were selected. Teeth are divided into four random groups (n = 15). Groups are prepared accordance to their group names as continuous rotation, apical slow down, apical reverse and apical stop. Extruded debris is collected into preweighted Eppendorf tubes and then calculated. One-way ANOVA test showed no statistically significant result between experimental groups. Similar debris extrusion values of all motion modes of the integrated endodontic motor can be interpreted that there will be similar debris extrusion and consequently similar postoperative pain on clinical setting. More in vitro and in vivo research is needed to make a conclusion.

Effect of Recombinant Human Platelet-Derived Growth Factor on Healing of Chronic Periapical Tissue Pathosis Following Apical Surgery in a Canine Model: A Histomorphometric and Microcomputed Tomography Analysis.

This canine in vivo study assessed the effect of recombinant human platelet-derived growth factor (rhPDGF) on the healing of periapical tissues following apical surgery. From a total of 96 premolar teeth, 64 teeth from six beagle dogs (2 years old) were classified as experimental and were randomly assigned to four experimental groups (16 teeth per group). After having the pulp extirpated, leaving teeth open to the oral cavity for 1 week, and sealing with an immediate restorative material for 8 weeks, nonsurgical endodontic treatment was performed. A split-mouth design was used, and intra-animal randomization of treatment sides was applied to the groups as follows: apical curettage + 1.5-mm root-end resection (Group 1); apicoectomy + mineral trioxide aggregate (MTA) root-end filling (Group 2); apicoectomy + MTA root-end filling + rhPDGF (Group 3); and apical curettage + rhPDGF (Group 4). The animals were sacrificed 24 months after apical surgery, and histologic and µCT analyses were performed for bone volume loss (BVL). Group 1 showed partial resolution of the periapical lesions without signs of tissue regeneration (BVL: 49.09 ± 10.97 mm3). Group 2 had minimal bone regeneration and showed cementum reformation in 9 teeth, with no direct attachment to the MTA (BVL: 35.34 ± 10.97 mm3). Group 3 showed regeneration of all damaged apical tissues without direct contact between the cementum and MTA (BLV: 4.51 ± 1.55 mm3). Group 4 showed regeneration of PDL, bone, and cementum and attachment of functional cementum fibers (BVL: 2.82 ± 2.3 mm3). The difference in BVL was statistically significant only for Groups 1 and 2 (P < .05). rhPDGF may help regenerate apical tissue structures following apical surgery.

Apical extrusion of debris when using OneCurve, ProTaper Next and TruNatomy in curved canals.

BACKGROUND: The extrusion of apical debris is related to various factors, and may be affected by variations in technique or instrumentation system. Although the extrusion cannot be completely prevented, it is crucial to minimize the amount of extruded material. OBJECTIVES: The present study aimed to compare apical debris extrusion by the novel TruNatomy (TRN), OneCurve (OC) and ProTaper Next (PTN) instruments in curved root canals. MATERIAL AND METHODS: A total of 60 multi-rooted human mandibular molar teeth with moderate and severe curvature were selected and randomly divided into 3 groups. The root canals were prepared with the OC, TRN and PTN files. For collecting the debris extruded through the apical foramen, Eppendorf tubes were used. After the vaporizing period, the tubes were re-weighed, and the amount of the extruded debris was calculated by subtracting the initial weight from the final weight. Statistical analysis was performed with the Shapiro-Wilk and Kruskal-Wallis tests. The statistical significance level was set at p < 0.05. RESULTS: The least amount of debris was extruded with TRN and the greatest with PTN, but the difference between the groups was not significant (p = 0.257). CONCLUSIONS: All instrumentation systems were associated with debris extrusion. The tested file systems presented similar results in terms of apical debris extrusion in curved canals. The novel TRN system demonstrated promising results, comparable to OC and PTN.

Comparative Evaluation of Apically Extruded Debris During Root Canal Preparation Using Three Different File Systems Applied Under 2.5% Sodium Hypochlorite or 2% CHX Irrigation.

The chemomechanical cleaning of the root canal system is performed using manual and rotary files. This study aimed to compare the effect of ProTaper, Reciproc and HyFlex rotary files considering 2.5% sodium hypochlorite and 2% chlorhexidine (CHX) as irrigating solutions on apical extrusion of intracanal debris. Single-canal mandibular premolars (N=165) were evaluated. The teeth were divided into 6 experimental groups (N=25) for root canal instrumentation using 3 file systems, (Reciproc, HyFlex and ProTaper) and two irrigation solutions, namely 2.5% sodium hypochlorite or 2% CHX. Fifteen teeth were also assigned into three control groups (n=5) with saline as irrigation solution. Eppendorf tubes were weighed and the teeth were placed inside. The canals were instrumented and the tubes weighed to determine the dry weight of extruded debris. Data were analyzed using one-way ANOVA and Bonferroni test (α=0.05). The mean amount of extruded debris using the sodium hypochlorite solution was significantly higher than other irrigating solutions (p⟨0.001). The mean amount of extruded debris using the Reciproc file system was significantly higher compared to ProTaper and HyFlex (p⟨0.001). The use of the sodium hypochlorite solution, single-file systems and reciprocal movement are associated with higher debris extrusion and might be associated with higher risk of postoperative pain.

Are electronic apex locators accurate in determining working length in primary teeth pulpectomies? A systematic review and meta-analysis of clinical studies.

BACKGROUND: The lack of a well-defined apical constriction in primary teeth raises concerns regarding the accuracy of electronic apex locators (EALs) for measuring working length. OBJECTIVES: To evaluate the accuracy of EALs in determining working length in primary teeth pulpectomies. METHODS: Two reviewers searched ten databases up to September 2021. Clinical studies evaluating the accuracy of the electronic measurement of working length in primary teeth pulpectomies were included. Studies without a comparison group, with samples smaller than ten root canals, and that did not use a multiple frequency EAL were excluded. A meta-analysis was conducted to assess the paired differences in mean lengths between measurements obtained by electronic and comparative methods. In addition, a meta-analysis of proportion was applied according to the level of difference between the measures. The risk of bias and applicability of the studies were assessed using the QUADAS-2 tool. The certainty of evidence was assessed with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. RESULTS: Twenty-nine studies were included in the qualitative analysis and twenty-three in the quantitative analysis. The methods of comparison for the electronic measurement were the radiographic method, radiovisiographic, scanning electron microscopy, and direct visualization. The meta-analysis showed that the electronic measurement tends to be shorter than radiographic measurement, while the other methods showed no difference. The proportion analysis showed a higher pooled proportion of difference values between electronic and comparative measurements within -0.5 to +0.5 mm (69.31%). The certainty of the evidence suggested very low confidence in estimating the outcome. DISCUSSION: The results of this review denote a good performance of the EALs in determining working length in primary teeth pulpectomies. However, these results are based on clinical studies with low methodological quality and high heterogeneity, which require careful interpretation for clinical practice. CONCLUSIONS: Although the results suggest acceptable accuracy of EALs in determining working length in primary teeth pulpectomies, the low quality of the included studies and the very low certainty of the evidence require clinicians to interpret these results with caution. More robust evidence is required to support that these devices are accurate for primary teeth. REGISTRATION: CRD42021277414 (PROSPERO).

Introduction of nickel titanium rotary instruments to undergraduate students: afour-yearclinical experience / Introdução de instrumentos rotários de níquel titânio para alunos de graduação: quatro anos de experiência clínica

Many studies address the quality of root canal treatments, but few refer to endodontics usingrotatory techniques performed by noviceoperators. This study evaluatedthe performance of undergraduates in their first contact with rotary root canal instrumentation concerningthe findings of the final periapical radiograph, and thepostendodontic treatment pain.A longitudinal observational studywas performed on periapical radiographs of 491teethfrom 450 patientssubmitted toroot canal treatmentby undergraduate students from 2015 to 2018. The analysis of the length of root canal filling followed the criteria: (i) acceptable, ifperiapical radiograph presentsroot filling ending 0 -1 mm short of radiographic apex; (ii) over, if periapical radiograph presentsroot filling ending beyond the radiographic apex; and (iii) under, ifperiapical radiograph presentsroot filling ending > 1 mm short of radiographic apex. Evaluation of postendodontic treatment painwas categorized into either absence or presenceof pain. Adequate length root canal filling was observed in 65.9% of the cases (324 teeth). Periapical lesions presenceand dimensions did not interfere to the obturation quality.Statistical relation was found between the pulp condition and postendodontic treatment pain. Thepresence of pain was observed in 4.7% of the vital teeth and 0.3% of non-vital teeth. The presence of periapical lesion did not influence postoperative pain.AdequatelengthrootcanalfillingwasobservedinmostcasesandNitTi rotary instrumentation hadapplicability in undergraduate programs, even with novice operators. Besides that, pulp condition had an effect on post endodontic pain (AU).

Muitos estudos abordam a qualidade dos tratamentos de canal radicular, mas poucos se referem à endodontia por meio de técnicas rotatórias realizada por operadores novatos. Este estudo avaliou o desempenho de graduandos no primeiro contato com a instrumentação endodôntica em relação aos achados da radiografia periapical final e à dor pós-tratamento endodôntico. Um estudo observacional longitudinal foi realizado em radiografias periapicais de 491 dentes de 450pacientes submetidos a tratamento endodôntico por estudantes de graduação no período de 2015 a 2018. A análise do comprimento da obturação de canais radiculares obedeceu aos critérios: (i) aceitável, se a radiografia periapical apresentasse término de obturação 0 -1 mm aquém do ápice radiográfico; (ii) acima, se a radiografia periapical apresentasse obturação que termina além do ápice radiográfico; e (iii) abaixo, se a radiografia periapicalapresentasse obturação, terminando > 1 mm aquém do ápice radiográfico. A avaliação da dor pós-operatória foi categorizada em ausência ou presença de dor. A obturação de canais radiculares de comprimento adequado foi observada em 65,9% dos casos (324 dentes). A presença e as dimensões das lesões periapicais não interferiram na qualidade da obturação. Foi encontrada relação estatística entre a condição pulpar e a dor pós-tratamento endodôntico. Presença de dor foi observada em 4,7% dos dentes vitais e 0,3% dos não vitais. A presença de lesão periapical não influenciou na dor pós-operatória. O comprimento de trabalho adequado foi observado na maioria dos casos e a instrumentação rotatória NitTi teve aplicabilidade em programas de graduação, mesmo com operadores iniciantes. Além disso, a condição pulpar afetou a dor pós-operatória (AU).

Assessment of Apical Extrusion of Debris during Root Canal Preparation with Different Ni-Ti File Systems: An In Vitro Study.

AIM AND OBJECTIVE: The aim of this study was to evaluate the apical extrusion of debris during root canal preparation with the use of different Nickel-Titanium (Ni-Ti) file systems. MATERIALS AND METHODS: Totally 60 single-rooted human mandibular premolar teeth with fully formed roots were chosen for the study. The coronal access cavity and all other preparations were done with the use of an access cavity kit and then 60 samples were randomly separated into three investigational groups (n = 20); group I: self-adjusting file, group II: WaveOne Gold, and group III: Mtwo rotary system. After instrumentation, the teeth were taken out from the tube and the root surface-adherent debris was collected by washing off the apical area of the tooth with distilled water (1 ml) into a centrifuge tube. The centrifuge tube was kept for 5 days in an incubator at 70°C to permit evaporation of the moisture prior to weighing the dry debris with the aid of an electrical analytical balance. RESULTS: The highest quantity of debris extruded was by the Mtwo rotary system (0.0394 ± 0.880) followed by WaveOne Gold (0.0247 ± 1.030) and self-adjusting file (0.0198 ± 0.102). A statistically significant difference (p < 0.001) was found between the various file systems. CONCLUSION: After considering the drawbacks of this study, apical debris extrusion could be found with all three groups. However, the self-adjusting file demonstrated a significantly reduced quantity of apical debris extrusion compared to the Mtwo rotary system and WaveOne Gold. CLINICAL SIGNIFICANCE: The chief step during the procedure of root canal treatment is the preparation of the infected root canals biomechanically. This preparation may lead to forcing the apical debris into the periapical space through the apical foramen, resulting in host-initiated immunological response which leads to postoperative discomfort and pain. This consequently leads to selection of a specific rotary system for endodontic treatment.

Root canal curvature as a prognostic factor influencing the diagnostic accuracy of radiographic working length determination and postoperative canal axis modification: an in vitro comparative study.

BACKGROUND: Radiographic analysis of tooth morphology is mandatory for accurate calibration of the degree of canal curvature angle and radiographic working length to its real dimensions in case difficulty assessment protocols. This study aimed to determine the impact of the degree of root canal curvature angle on maintaining the real working length and the original canal axis of prepared root canals using a reciprocating rotary instrumentation technique. METHODS: Radiographic image analysis was performed on 60 extracted single-rooted human premolar teeth with a moderate canal curvature (10°-25°) and severe canal curvature (26°-70°). Working length and longitudinal canal axis were determined using cone-beam computed tomography (CBCT) and digital periapical radiography. The real canal length was determined by subtracting 0.5 mm from the actual canal length. Root canals were prepared using the WaveOne Gold reciprocating file (Dentsply Maillefer, Ballaigues, Switzerland). RESULTS: There was no significant relation of the degree of canal curvature angle to the accuracy of radiographic working length estimated on CBCT and digital periapical radiographic techniques (P > 0.05). Postinstrumentation changes in the original canal axis between moderate and severe canal curvature angles, assessed on CBCT and periapical digital radiographic images were statistically non-significant (P > 0.05). CONCLUSIONS: A standardized digital periapical radiographic method performed similarly to the CBCT technique near to its true working length. No significant interaction exists between the diagnostic working length estimation, postoperative root canal axis modification, and the degree of canal curvature angle, using reciprocating rotary instrumentation technique.

Radiographic and Clinical Findings of Single-Visit Root Canal Treatments with Apical Enlargement in Necrotic Teeth: A Retrospective Cohort Study.

This study evaluated the long-term clinical outcomes of single-visit root canal treatments with apical enlargement on patients with necrotic pulp tissue retrospectively. A total of 137 teeth with necrotic pulp tissue which underwent single-visit root canal treatments were included. The root canals were shaped up until the apical constriction, which was determined by an apex locator. The outcomes were evaluated by two independent and calibrated endodontists clinically and radiographically. Teeth were dichotomized into healed (PAI ≤ 2, no signs or symptoms) and nonhealed (PAI > 2, with/without signs or symptoms) groups. Each patients' preoperative PAI and lesion size were recorded to evaluate the preoperative periapical status as well as several other prognostic factors. Statistical analyses were performed (p = 0.05) on ninety teeth. The mean observation time was 60 months. Out of ninety teeth, 87 (96.7%) were healed and 3 (3.3%) were nonhealed. No correlations were found between the prognostic factors and the outcomes (p > 0.05). Cohen's kappa and Gwet's agreement coefficient scores between the preoperative PAI scores and preoperative lesion sizes showed good agreements, with values of 0.834 and 0.898, respectively. Apical enlargement is a viable treatment option for single-visit root canal treatments.

Evaluation of healing by Cone Beam Computed Tomography (CBCT) using Platelet-Rich Plasma (PRP) + ß -Tricalcium Phosphate (ß -TCP) and Platelet Rich Fibrin (PRF) + ß -Tricalcium Phosphate (ß - TCP) in periapical lesions: Case report.

When teeth have responded poorly to conventional endodontic treatment or when they cannot be treated adequately by nonsurgical means, surgical endodontics remains the treatment of choice. Healing of apical lesions occurs by repair, most of the time. "Repair is the healing of a wound by tissue that does not fully restore the architecture or function of the affected unit". Since this is not ideal, newer regenerative procedures that aim to restore lost tissue have been introduced. ß -Tricalcium phosphate is an alloplastic bone graft material that forms a scaffold for closing the bony defect. It is osteoconductive. Platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) are platelet concentrates, rich in growth factors and they promote regeneration by osteoinduction. This article describes cases of bone augmentation with a combination of PRP + ß -TCP and PRF + ß -TCP for treatment of the chronic periapical lesion. The cases were followed for six months and one year and healing was evaluated quantitatively using cone beam computed tomography.

Outcome of revascularization therapy in traumatized immature incisors.

BACKGROUND: The aim of this retrospective analysis was to evaluate the clinical and radiological outcome of revascularization therapy in traumatized permanent incisors to determine whether this approach could be implemented into clinical routine. METHODS: A total of 16 traumatized incisors (either avulsion or severe luxation/intrusion) with open apices (> 1 mm) that underwent revascularization following a standardized protocol were analyzed with a mean follow-up of 22 months. Radiographs and clinical parameters (such as root length, pulp space, dentin wall width, apical foramen, alveolar bone loss, ankylosis/mobility, supra-/infraposition, discoloration, probing depth) were compared pre- and postoperatively and statistically analyzed. RESULTS: Over the follow-up period, 81.3% of the teeth survived revascularization and regained sensitivity, while 18.7% failed, as they had to be extracted due to serious root resorption. Regarding radiographic outcomes a significant difference could only be found in the decrease of apical foramina (p = 0.04). The other parameters showed no significant difference between pre- and postoperative measurements. More than half of the teeth (56.3%) developed root resorptions and 31.3% displayed signs of ankylosis and 92.9% developed discolorations during follow-up. However, 85.7% of the teeth maintained the bone level and outcomes of mobility showed a significant solidification. CONCLUSIONS: Revascularization is a promising approach for the treatment of immature incisors to regain sensitivity and to enhance apical closure and at least to maintain alveolar bone in terms of a socket preservation. Further studies have to be performed to determine ideal conditions (type of trauma, age, width of apical foramen) for a revascularization.

The effect of cervical preflaring on the apical debris extrusion of single or multiple rotary Ni-Ti files.

BACKGROUND: There were no comparing data about the effect of recently developed file system OneCurve on apical debris extrusion. AIM: The aim of this in vitro study was to compare the influence of the rotary nickel-titanium (Ni-Ti) files on apical debris extrusion after cervical preflaring. MATERIALS AND METHODS: Sixty-six lower incisor teeth with a single root canal were used in this study. After the determination of working length, the specimens were divided into six experimental groups according to root canal preparation. G1: ProTaper-Next, G2: EndoFlare + ProTaper-Next, G3: 2Shape, G4: EndoFlare + 2Shape, G5: OneCurve, and G6: EndoFlare + OneCurve. Each specimen was inserted into separate preweighed Eppendorf tubes to collect apically extruded debris. A total of 8 mL of distilled water was used for each specimen for irrigation. After the completion of root canal preparation, the Eppendorf tubes were weighed again after evaporation to calculate the amount of extruded debris. The data were statistically analyzed with one-way analysis of variance (P > 0.05). RESULTS: There was no statistically significant difference between the experimental groups. The amount of apically extruded debris was similar after preparing root canals with ProTaper-Next, 2Shape, and OneCurve with and without cervical preflaring. CONCLUSION: Under the conditions of this in vitro study, ProTaper-Next, 2Shape, and OneCurve files had similar apical debris extrusion values. Cervical preflaring of root canals did not affect the amount of apically extruded debris.

Accuracy of working length measurement with endo motor having built-in apex locator and comparison with periapical radiographs.

OBJECTIVE: To determine the accuracy of working length measurement with endomotor having builtin apex locator by comparing it with periapical radiographs. METHODS: The cross-sectional study was conducted at the Department of Operative Dentistry, Dr Ishrat-ul-Ibad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, from January to June 2014, and comprised permanent maxillary anterior teeth with mature apices. A preoperative radiograph was taken by using standardised paralleling technique. The access cavity was prepared by a high speed water-cooled diamond bur. After doing initial filing and drying the canal, the working length was taken with an endomotor with built-in apex locator in dual mode using the Protaper Rotary File S1. The length was measured using a millimeter scale. After attaining tentative working length from the pre-operative radiograph, 1mm was subtracted from the radiographic apex. A stainless steel K-file was placed in the canal at this length and a radiograph was taken by paralleling technique using intraoral film holder. The electronic and radiographic findings were noted. Accuracy was considered positive if the endomotor reading was 0-2mm short of the radiographic working length. Data was analysed using SPSS 16. RESULTS: Of the 96 cases, working length with X-Smart Dual was acceptable in 85(88.5%) cases, and unacceptable in 11(11.5%) cases. CONCLUSIONS: Accuracy of working length measurement with endomotor having built-in apex locator was found to be a better measuring tool compared to the conventional periapical radiographs.

Apical extrusion of debris after canal shaping with three single-file systems.

OBJECTIVES: The aim of this study was to evaluate the quantity of apically extruded debris after canal shaping with three single-file systems. MATERIALS AND METHODS: Sixty mesiobuccal canals of mandibular molars were divided into three experimental groups according to the used file systems-WaveOne Gold, RECIPROC Blue, and HyFlex EDM One file. Debris extruded during canal shaping were collected in preweighed vials. Each canal was irrigated with 5 mL of distilled water via a 30 G side-vented needle. The amount of the debris extruded from each canal was calculated by subtracting the preinstrumentation from postinstrumentation measurement. The preparation times were recorded. Data were analyzed using analysis of variance (ANOVA) and posthoc Tukey tests with α = 0.05. RESULTS: WaveOne Gold extruded the least amount of debris. Results between WaveOne Gold and HyFlex EDM were significantly different. No significant differences in canal shaping time were detected among the three groups (P > 0.05). CONCLUSION: WaveOne Gold showed the best results regarding apical debris extrusion. Difference between WaveOne Gold and HyFlex EDM suggests that file design and motion kinematics affect the quantity of debris extrusion.

Traumatismo em dente com rizogênese incompleta: caso clínico / Traumatism in tooth with incomplete rizogenesis: clinical case

O traumatismo dentário acontece de maneira frequente, tendo maior prevalência em incisivos centrais, podendo ocorrer de várias formas, acometendo o tecido duro e o tecido de sustentação do dente. A severidade do trauma pode ocasionar um processo degenerativo ou uma lesão irreversível até a mortificação da polpa, por isso deve-se observar o estágio de desenvolvimento do dente para correta terapêutica diante de uma rizogênese completa ou incompleta. A necrose pulpar em um dente com ápice incompleto paralisa o seu processo de desenvolvimento o que torna necessário a realização da apicificação. O objetivo desse presente trabalho é relatar um caso clínico de traumatismo em um dente com rizogênese incompleta e a conduta terapêutica instituída para promover a apicificação do mesmo. Entretanto, Durante o tratamento foi um grande desafio promover o fechamento do ápice que fora paralisado após o trauma. Portanto, foi preciso realizar várias sessões de medicação intracanal com hidróxido de cálcio que é o material mais indicado para induzir a formação de barreira calcificada para fechamento completo do ápice(AU)

The dental trauma occurs frequently, having a higher prevalence in central incisors, and can occur in several ways, affecting the hard tissue and the tooth support tissue. The severity of the trauma can cause a degenerative process or an irreversible lesion until the mortification of the pulp, so the stage of development of the tooth must be observed for correct therapy in the presence of complete or incomplete rhizogenesis. Pulp necrosis in a tooth with an incomplete apex paralyzes its development process, which makes it necessary to perform the inoculation. The objective of this present work is to report a clinical case of trauma in a tooth with incomplete rhizogenesis and the therapeutic conduct instituted to promote the apicification of the same. However, during the treatment it was a great challenge to promote the closure of the apex that had been paralyzed after the trauma. Therefore, it was necessary to perform several intracanal medication sessions with calcium hydroxide, which is the most suitable material to induce the formation of a calcified barrier for complete closure of the apex(AU)

The use of enamel matrix derivative for the treatment of the apically involved tooth: A case report.

INTRODUCTION: The aim of this report is to present a case of an apically involved tooth with successful regeneration by only applying enamel matrix derivative. The root of the tooth was planed and the defect area was well debrided using various instruments, including curettes and an ultrasonic scaler, and the root surface of the tooth and the defect area were loaded with enamel matrix derivative. PATIENT CONCERNS: A 32-year-old man visited the clinic due to a referral for the evaluation of his mandibular left first molar. DIAGNOSIS: The clinical and radiographic assessment displayed the loss of the periodontium around the tested tooth with apical involvement of the mesial root. Bleeding upon probing was noted at the mandibular first molar, with the deepest periodontal probing depth of 15 mm. INTERVENTIONS: A nonsurgical approach was firstly performed on the tooth, and the deepest probing depth was reduced to 12 mm. After re-evaluation, elevation of a full-thickness flap was done, the root of the tooth was planed, and the defect area was well debrided using various instruments, including curettes and an ultrasonic scaler. The defect area on the mandibular left first molar was grafted with enamel matrix derivative. OUTCOMES: The 7-month postoperative clinical and radiographic evaluation showed healthy gingiva and an increase in radiopacity. The final 1-year and 9-month postoperative evaluation showed that regeneration of bony defect was well maintained up to the final evaluation with reduction of probing depth. CONCLUSION: In conclusion, a case of apically involved tooth can be treated only with enamel matrix derivative after meticulous debridement with curettes and an ultrasonic scaler.

Radiographic Assessment of Bone Healing Using Cone-beam Computed Tomographic Scans 1 and 5 Years after Apical Surgery.

INTRODUCTION: The objective of this long-term study was to evaluate radiographic healing in cone-beam computed tomographic (CBCT) scans taken 1 and 5 years after apical surgery. METHODS: In the context of a prospective clinical study, postsurgical CBCT scans were taken 1 and 5 years after apical surgery. Three calibrated observers independently assessed buccolingual CBCT images oriented along the longitudinal axis of the treated roots. Radiographic periapical healing was categorized as "fully, partially, or not healed" for each of the following study parameters: the resection plane, the cortical plate, the apical area, and the overall bone healing. The analysis included the interobserver agreement (Fleiss kappa values), the comparison of 5- and 1-year ratings, and the changes of healing categories from 1-5 years (McNemar-Bowker tests). Data were analyzed statistically for the detection of significant differences. RESULTS: CBCT images of 41 teeth (in 41 patients) with 47 treated roots were evaluated. At 5 years, all studied parameters had higher rates of fully healed cases compared with the rate at 1 year. The resection plane and apical area parameters each were judged in 72.3% as fully healed at 5 years, whereas the cortical plate and overall bone healing parameters showed clearly lower fully healed rates (42.6% and 38.3%, respectively). Fully healed cases at 1 year remained so at 5 years in 87.5%-100% depending on the study parameter. CONCLUSIONS: This 5-year CBCT follow-up study of apical surgery showed a marked improvement of radiographic healing from 1-5 years but to a varying degree regarding the different study parameters. Although new hard tissue formation at the resection plane and within the former apical defect was advanced in most cases at 5 years, the reestablishment of the cortical bone plate clearly lagged behind.

A 10-year Follow-up Study of 119 Teeth Treated with Apical Surgery and Root-end Filling with Mineral Trioxide Aggregate.

INTRODUCTION: The objective of this clinical study was to assess the long-term outcome (clinical signs/symptoms and radiographic healing) of teeth treated with apical surgery and mineral trioxide aggregate (MTA) for root-end filling. METHODS: One hundred ninety-five patients were recalled 1, 5, and 10 years after apical surgery for clinical and radiographic examinations. Three calibrated observers evaluated the periapical radiographs independently. The evolution of the cases over time was analyzed. Healing classification of teeth was divided into "healed" versus "not healed" teeth using well-established clinical and radiographic healing criteria. The potential influence of sex, age, type of treated tooth, type of MTA, and first-time versus repeat surgery on healing outcome was statistically analyzed. RESULTS: The inception cohort included 195 teeth. The dropout rate after 10 years amounted to 39% (n = 76). Of the 119 teeth available for the 10-year analysis, 97 teeth were classified as healed (81.5%). No significant differences were found with regard to the rate of healed cases for the subcategories of the parameters of age, sex, type of MTA, and first-time or repeat surgery. Concerning the type of treated tooth, the rate of healed maxillary molars (95.2%) differed significantly (P = .035) from the rate of healed maxillary premolars (66.7%). The predictive value of the cases classified as healed at 1 year and remaining so over the 10-year observation period was 86.8%. CONCLUSIONS: This 10-year follow-up study of teeth treated with apical surgery and MTA as root-end filling material showed an acceptable rate of healed cases. Many of the lost teeth had been extracted because of longitudinal root fractures during the observation period.

The evaluation of apicectomy without retrograde filling in terms of lesion size localization and approximation to the anatomic structures.

BACKGROUND: The purpose of this study was to evaluate of the patients who underwent apical resection. Besides assess the classification of resection side, localization, lesion size, approximation of anatomic structures and the purpose of the apical surgery retrospectively. MATERIAL AND METHODS: In this stutdy 782 patients and 1191 apical resection applied tooth evaluated. 504 of the patients were famale and 278 were male. Patients age was between 13 and 76 years old and operated between January 2016 and January 2017. The study includes incisor, canine and premolar teeth which had the apical resection as the first time. Operation side evaluated from orthopantomograph and periapical radiographs. RESULTS: There were 1191 teeth operated and 966 of them in maxilla and 225 of them in mandible. The number of the incisor teeth were 871, 177 were canine, 129 were premolar and one of them was molar. The total amount of 468 patients had operated by just 1 tooth, 454 of the operated teeth had cyst on the operation side. Premolar and molar side 21 of the 93 lesion had approximation with maxillar sinus. On the other hand in maxilla 39 of 569 lesion had approximation with nasal cavity. In mandibula 1 of the 15 lesion, which involved mandibular premolar teeth, had approximation with mental foramen. CONCLUSIONS: Apical resection operation mostly done for one tooth, and the lesion size was less than 10 milimeters. Furthermore apical resection mostly done for incisors cause of odontogenic cyst.

Influence and safety of electronic apex locators in patients with cardiovascular implantable electronic devices: a systematic review.

The widespread use of cardiovascular implantable electronic devices has increased concerns regarding using electronic apex locators in patients with these devices. This systematic review investigated the effects and safety of using electronic apex locators in patients with cardiovascular implantable electronic devices. METHODS: An electronic search in the Cochrane Library, PubMed (MEDLINE), ScienceDirect, and Scientific Electronic Library Online (Scielo) databases for relevant articles published between December 2000 and December 2018 was performed. The search strategy centered on terms related to electronic apex locators use during root canal treatment in patients with cardiovascular implantable electronic devices. RESULTS: Seven studies (five in vitro and two in vivo) fulfilled the inclusion criteria for this review. It was found that electronic apex locators can be used safely in patients with cardiovascular implantable electronic devices, when general precautions are followed. CONCLUSIONS: Although the present review suggests that electronic apex locators can be used safely in patients with implantable cardioverter defibrillators, consultation with patients' cardiologists remains advisable.