An audit of root canal filling quality performed by undergraduate pre-clinical dental students, Yemen.

BACKGROUND: Dental students are future dentists. Continuous assessment and improving of the educational curricula will ensure excellent academic performance of dental students and thus providing the community with the best treatment modalities. The aim of this study was to evaluate the root canal filling quality performed in extracted teeth by preclinical undergraduate Yemeni dental students. METHODS: Root canal treatment was performed by undergraduate preclinical dental students on 331 extracted human teeth including 741 roots. The teeth were then collected and evaluated radiographically based on three criteria of quality (length, density, and taper). Cohen's Kappa test was used to assess the agreement between the examiners and Chi-squared test was used for the association between the study variables. The level of significant was set at α < 0.05. RESULTS: The results of the study revealed that the overall quality of roots canals fillings was poor. However, more than half of the study sample (53.4%) had adequate length, 13.1% had adequate density, and 14.2% had adequate taper. Anterior as well as single-rooted teeth had significantly better quality than posterior and multi-rooted teeth, respectively. The root canal fillings quality mandibular teeth was better than of maxillary teeth with no significant difference (P > 0.05). CONCLUSION: The findings of the study emphasize the need of improving the endodontic course in the preclinical level and more advanced techniques and instruments should be incorporated.

Radiographic Evaluation of Root Canal Fillings Performed by Dental Students

Objectives: To evaluate radiographically the technical quality of root canal fillings performed by dental students at the School of Dentistry, University of the West Indies. Methods: The dental school's database of student clinical activity between the period 2000-2004 was investigated for patients who completed root canal treatment. For each root filled tooth, at least four periapical radiographs were examined: preoperative, working length determination, try in GP point and postoperative. The final sample consisted of 198 patients with 288 root filled teeth and 460 canals. The length, presence of voids, taper, curvature of canal and fractured instruments were recorded and scored. Chi-squared analysis was used to determine statistically significant differences between the technical quality of root fillings and tooth type. Results: Sixty-three percent, 27.6% and 72.2% of root filled canals had adequate length, density and taper respectively. Fractured instruments were found in only 7 of the root canals (1.5%).The acceptability for both length and taper was found in 31.5% of canals. A significantly greater proportion of root fillings of adequate length and taper were observed in straight canals compared to curved canals (P<0.05). However no significant difference was observed for the presence of voids in straight or curved canals. The percentage of root fillings with adequate length was significantly greater in maxillary teeth than in mandibular teeth (P <0.05) and in anterior teeth compared to posterior teeth (P< 0.001).The overall acceptability of root fillings having adequate length and taper, absence of voids and no fractured instruments was found in 10.9% of canals. The mandibular incisors had the greatest level of acceptability for all observed parameters (27.3%). Conclusion: The overall acceptability of root fillings performed by dental undergraduate students was only 10.9%. Changes in teaching methods may be required to improve the quality of root canal treatment among dental students.

Diameter and Taper Variability of Single-file Instrumentation Systems and Their Corresponding Gutta-percha Cones.

INTRODUCTION: Manufacturers offer single-file instrumentation systems with matching gutta-percha (GP) cones to simplify root canal preparation and obturation. The purpose of this study was to determine whether file diameters and tapers match with corresponding cone diameters and tapers (precision) as well as industry standards (accuracy). METHODS: Twenty files and corresponding GP cones from each size of F360 (#25, #35, #45, #55 with .04 taper) and Reciproc (#25, #40, #50 with variable tapers) instruments were examined by using optical microscopy (×32) to determine their diameter and taper. Precision was evaluated by using one-way analysis of variance (α = 0.05) with Scheffé post hoc tests and t tests with Bonferroni correction. Accuracy was calculated by subtracting the nominal values from the measured values of all files and GP cones, and mean diameter and taper differences were compared by using one-way analysis of variance (α = 0.05) and Scheffé post hoc test for pairwise comparison. RESULTS: For F360, the majority of file and cone diameters were within the tolerance levels, but most of the file diameters were significantly larger than GP cone diameters (P < .05), but the majority of all measured values were within the tolerance levels. For Reciproc, file and cone diameters at D1 and D3 mostly approached the nominal values. At the coronal end, file diameters #25 and #50 were significantly smaller than cone diameters (P < .05). For both instrumentation systems, almost all file and cone tapers matched with the preset tolerance ranges. For Reciproc, significant differences between file and GP cone demonstrated either smaller cone or smaller file diameters and tapers, depending on the size. Most of the measured values were within the acceptable range, but diameters at the coronal end exhibited the highest percent difference from the nominal values. CONCLUSIONS: Despite the call for standardization, variability in diameter and taper dimensions between single-file instrumentation systems and their corresponding GP cones can be expected.

Aplicación del MTA en un caso de restauración endodóntica avanzada por vía directa. Presentación de caso / Direct placement of MTA in a case of advanced endodontic restoration. Case presentation

IIntroducción Las lesiones endoperiodontales son aquellas de carácter inflamatorio que comprometen simultáneamente la pulpa dental y las estructuras del periodonto de inserción, donde se obtiene un pronóstico favorable solo cuando el diente está en un ambiente cerrado y protegido, y se alcanza la cronicidad del componente periodontal de la afección. Para lo cual el uso de los biomateriales y el esquema operatorio tienen un carácter crucial. Objetivo: Describir un caso de restauración endodóntica avanzada por vía directa, con el uso de MTA. Presentación del caso:Paciente de 45 años, masculino, quien acude a consulta presentando una lesión endoperiodontal combinada con toma del fulcron en (46). El mismo requirió una radiculectomía, reconstrucción de corona y raíz por vía directa, y estabilización a través del uso del Agregado Trióxido Mineral (MTA). Conclusiones:La aplicación del MTA en la restauración endodóntica avanzada combinada con el composite nano híbrido por vía directa es una alternativa factible de realizar en una sola visita, y garantiza una rápida recuperación de las funciones buco-dentales del paciente(AU)

Introduction: Endoperiodontal lesions are those lesions that have an inflammatory character that simultaneously compromise the dental pulp and periodontal structures of insertion, where favorable prognosis is obtained only when the tooth is in a closed and protected environment, and the chronicity of the periodontal component is achieved. Consequently, the use of biomaterials and the operative scheme have a crucial character. Objective: To describe a case of advanced endodontic restoration by direct placement of MTA. Case presentation: 45 years old patient who comes to the consultation presenting a combined endoperiodontal lesion, reaching the fulcron in (46). The patient required a radiculectomy, a direct reconstruction of the crown and the root, and stability through the use of Mineral Trioxide Aggregate(MTA). Conclusions: The direct placement of MTA in an advanced endodontic restoration, combined with the nano-hybrid material is an alternative that is viable to do in a single visit and guarantees a fast recovery of the buccal-dental functions of the patient(AU)

Evaluation of bond strength in single-cone fillings of canals with different cross-sections.

AIM: To evaluate the effect of root canal cross-sectional shape on single-cone root filling bond strength, as well as to determine the percentage of gutta-percha-filled areas (PGFA) and sealer-filled areas (PSFA), establishing a relationship between these variables. METHODOLOGY: Distal roots of mandibular molars were selected using microcomputed tomography imaging and allocated into three groups (n = 10) according to canal shape: round, oval and long oval. The canals were prepared with an R40 reciprocating instrument and filled with matching single-cone gutta-percha and AH Plus sealer. Two 1-mm-thick dentine slices were obtained from each third of each root. PGFA and PSFA were calculated in digital images (x25 magnification) of each slice. Next, the slices were subjected to a push-out test and the failure modes (adhesive, cohesive or mixed) were assessed. Data were analysed using parametric tests (P < 0.05). RESULTS: In the coronal (2.17 ± 0.56MPa) and middle thirds (1.78 ± 0.45MPa), the round canals were associated with higher bond strength values (P < 0.01), with no difference between the groups for the apical third (P > 0.05). Adhesive and mixed failures predominated in round canals, whilst cohesive failures were more frequent in oval and long oval canals. Round canals had significantly higher PGFA and lower PSFA than all other groups (P = 0.000). The PGFA and PSFA had a positive (r = 0.521, P = 0.000) and a negative (r = -0.523, P = 0.000) correlation with bond strength, respectively. CONCLUSION: Bond strength values of gutta-percha and sealer were affected by canal shape. Higher percentage of gutta-percha-filled area resulted in higher bond strength to dentine.

Micro-CT evaluation of the quality of root fillings when using three root filling systems.

AIM: To evaluate the percentage volumes of filling materials and voids in single-rooted teeth filled with three different filling systems using micro-computed tomography (micro-CT). METHODOLOGY: Thirty single-rooted human teeth were used. After preparation of the root canals, the teeth were randomly divided into three groups (n = 10). The canals were filled with EndoREZ, ActiV GP or AH Plus/gutta-percha. Each specimen was scanned using a micro-CT device at a resolution of 13.68 µm. Percentage volumes of root filling materials and voids were calculated and data were analysed statistically using the Kruskal-Wallis test and the Mann-Whitney U-test with Bonferroni adjustment. Within each group, the Friedman test was performed with the Wilcoxon signed-rank test to detect discrepancies. RESULTS: The percentage volume of filling material was significantly lower in the ActiV GP group than in the other groups (P < 0.05), whilst the percentage volume of voids was significantly higher in the ActiV GP group than in the other groups (P < 0.05). CONCLUSION: None of the systems were associated with void-free root fillings. The ActiV GP system had a significantly higher percentage volume of voids than the other systems.

Análise da qualidade da obturação em raizes mesiais de molares inferiores utilizando dois cimentos endodônticos: EndoSequence e AH Plus / Analysis of the quality of obturation in mesial roots of molars using two endodontic cements: EndoSequence and AH Plus

Objetivo: O objetivo deste estudo foi avaliar, por microtomografia computadorizada (micro-CT), a qualidade da obturação de canais mesiais de molares inferiores utilizando os cimentos EndoSequence BC Sealer e AH Plus. Metodologia: Vinte molares inferiores foram divididos em dois grupos (n=10) de acordo com o cimento utilizado na obturação. O preparo quimico-mecânico foi realizado com as limas rotatórias K3XF. As amostras foram escaneadas por micro-CT antes e depois da intrumentação, e depois da obturação. O volume do sistema de canais radiculares (SCR) após a instrumentação e o volume da obturação foram calculados, assim, o volume percentual da obturação e dos espaços vazios pôde ser obtido. Resultados: Todas as amostras apresentaram volumes de obturação menores do que o volume pós instrumentação do SCR (p < 0,05). Não houve diferença estatística significante entre os grupos quanto ao volume da obturação e o volume de espaços vazios (p >0,05). Conclusões: Os cimentos endodônticos EndoSequence BC Sealer e AH Plus proporcionaram uma qualidade semelhante de obturação em canais mesiais de molares inferiores. Nenhum dos cimentos foi capaz de proporcionar total preenchimento do SCR. (AU)

Aim: The aim of this study was to evaluate, by computadorized microtomography (micro-CT), the root canal filling quality of mesial roots of mandibullar molars using EndoSequence BC Sealer and AH Plus sealers. Methodology: Twenty mandibular molars were divided into two groups (n=10) according to the sealer used in the obturation. Root canals were prepared using K3XF rotary files. The specimens were scanned before and after instrumentation, and after obturation by using micro-CT. The root canal system volume after instrumentation, and the filling volume were calculated, so the percentage volume of the filling, and voids and gaps could be obtained. Results: All the specimens presented the final volume smaller than the inicial volume (P < 0.05). There was no significant difference between groups with regard to the filling volume and voids and gaps volume (P > 0.05). Conclusions: EndoSequence BC Sealer and AH Plus sealer promoted a similar root filling quality in mesial root canals of madibullar molars. None of the sealers was able to fill the entire area of the root canal system. (AU)

Comparação clínica e radiográfica aleatória de materiais obturadores utilizados no tratamento de canais radiculares de dentes decíduos / Clinical and radiographic comparison of materials used in the treatment of primary teeth

Esse estudo objetivou avaliar o desempenho clínico e radiográfico de tratamentos de canais radiculares com remoção da smear layer em dentes decíduos utilizandose dois materiais obturadores distintos: pasta iodoformada e pasta a base de hidróxido de cálcio espessada com óxido de zinco. Foram tratados 27 dentes diagnosticados com necrose pulpar ou pulpite irreversível devido a lesões de cárie ou traumatismo dento-alveolar em 23 crianças (7 meninas e 16 meninos) com idade entre 2 e 7 anos. Os participantes foram selecionados baseados em critérios de inclusão e exclusão específicos e os dentes que necessitavam de tratamento endodôntico foram aleatoriamente alocados em dois grupos G1 - obturados com pasta iodoformada (iodofórmio, paramonoclorofenol canforado e pomada contendo acetato de prednisolona 5,0mg e rifamicina 1,5mg); G2 - obturados com pasta a base de hidróxido de cálcio espessada com óxido de zinco (Calen®/OZ: Ca(OH)2 ­ 26,12% e OZ ­ 39,33%) sendo tratados, no máximo, 2 dentes por criança. Os exames clínicos foram realizados um mês, três meses e seis meses após a realização das pulpectomias. As radiografias de controle foram tomadas ao término da terapia pulpar e no sexto mês de acompanhamento. As avaliações radiográficas foram realizadas por dois operadores treinados, calibrados e cegos para o material obturador utilizado. Os dados foram analisados de forma descritiva. Cem por cento dos tratamentos em ambos os grupos foram classificados como sucesso. Dessa forma, o desempenho das pulpectomias não foi influenciada pelo tipo de material obturador utilizado nem por qualquer outra variável analisada. O cuidado na seleção dos casos e na execução dos tratamentos, bem como no monitoramento dos pacientes no período de acompanhamento podem ter contribuído para as altas frequências de sucesso desse estudo. Os dentes tratados com a pasta Calen®/ZO apresentaram qualidade superior de obturação. Pode-se concluir que todos os dentes tratados tiveram comportamento clínico e radiográfico equivalente independente do material obturador empregado no período de seis meses de acompanhamento. (AU)

This study aims to evaluate the clinical and radiographic outcome of root canal treatment (CT) with smear layer removal performed in primary teeth using two root canal filling materials ­ iodoform based paste and calcium hydroxide/zinc oxide paste. This trial was carried out on 27 primary teeth with necrotic pulps or irreversible pulpitis caused by dental caries or trauma in 23 children (7 girls and 16 boys) aged between 2 and 9 years old. Participants were selected based on specific inclusion and exclusion criteria and the teeth which needed pulpectomy procedure were randomly allocated into 2 groups: Group I (GI) ­ iodoform paste (iodoform + camphorated parachlorophenol + ointment comprising prednisolone acetate 5.0mg and rifamycin 1.5mg ); Group II (GII) ­ calcium hydroxide/zinc oxide paste (Calen®/ZO: Ca(OH)2 ­ 26.12% e OZ ­ 39.33%). It were treated at most two teeth per child. The outcome measures were evaluated clinically at one and three months and both clinically and radiographically at six months according to specific criteria. Two blinded, trained and calibrated evaluators assessed the radiographic outcomes. Descriptive analysis was performed. A hundred percent of the treatments in both groups were successful, hence the pulpectomy performance in both groups were influenced neither by the filling material nor by any other analyzed variable. Strict caution in case selection and in execution of the treatment as well as in monitoring the patients in the follow up period may have contributed to the high success rate of this study. We can conclude that the clinical and radiographic sixmonth outcome of root canal treatment with smear layer removal performed in primary teeth was successful independently of the root filling material used. (AU)

Radiographic Diagnosis of Periapical Status and Quality of Root Canal Fillings in a Saudi Arabian Subpopulation.

PURPOSE: To assess the prevalence of apical periodontitis (AP), as determined by orthopantomograms (OPGs), and its correlation with the quality of root fillings and coronal restorations. MATERIALS AND METHODS: This cross-sectional study evaluated a random sample of 193 patients--112 (58%) females and 81 (42%) males--who presented as new patients at the Division of Endodontics. Digital OPGs were independently examined by two reliability-calibrated endodontists. The total number of teeth present, the location of the root canalfilled teeth, and the presence or absence of AP were recorded for each radiograph. The results were statistically analysed using the chi-square test followed by model building using multiple logistic regression. RESULTS: A total of 324 endodontically treated teeth from the 193 selected radiographs were analysed. The mean number of teeth per patient was 25.5 ± 4.6, with an average of 1.64 root canal treatments per subject. Radiographically detected AP was associated with 190 (58.6%) root canal-treated teeth. The logistic model shows that the quality of endodontic treatment (adjusted odds ratio [ORa] = 1.82; 95% confidence interval [CI]: 1.40-3.17), status of coronal restoration (ORa = 1.77; 95% CI: 1.20-2.61) and the type of material used for coronal restorations (ORa = 1.39; 95% CI: 1.03-1.87) were significantly related to the periapical health of the teeth. CONCLUSIONS: The quality of endodontic treatment, status of coronal restoration and the type of coronal restorative material were found to be the most important factors influencing the health of periradicular tissue.

A microcomputed tomography-based comparison of root canal filling quality following different instrumentation and obturation techniques.

OBJECTIVE: With a microcomputed tomography (microCT) imaging device, we aimed to quantitatively evaluate root canal fillings after commonly used endodontic procedures and also tested the suitability of microCT for this purpose. MATERIALS AND METHODS: Eighty single roots were instrumented and obturated with gutta-percha and Tubli-Seal. They were divided into 4 groups of 20. The Hand groups were instrumented with hand files and filled with thermoplastic (Th) compaction and cold lateral (CL) condensation, i.e. Hand-Th and Hand-CL, respectively. The Rot groups, i.e. Rot-Th and Rot-CL, were instrumented with a rotary ProFile system and filled as above. The roots were scanned and 3-dimensional (3D) visualization was obtained. The number, size, percentage of volume and distribution of voids at the filling/dentine interface (i-voids) and voids surrounded by filling material (s-voids) were measured. RESULTS: Canal fillings differed significantly with regard to the size of both types of voids and the average number of i-voids. All canals presented a low volume of voids. The highest percentage (0.69%) was found for i-voids in the Hand-CL group, while the lowest volume (0.11% for s-voids and 0.14% for i-voids) was in the Hand-Th canals. Apically, in the last 3 mm, i-voids were observed mainly in the Th groups, and s-voids occurred mostly in the coronal part of the canal filling in all cases. CONCLUSION: MicroCT was a useful tool for 3D quantitative evaluations of these root canal fillings. None of the root canal instrumentation and filling methods ensured void-free obturation. CL condensation produced mainly i-voids. With Th compaction, internal s-voids were particularly common, but there were mainly i-voids in the apical part.

Quality of obturation achieved by a non-gutta-percha-based root filling system in single-rooted canals.

INTRODUCTION: The present study examined the quality of obturation in root canals filled by an experimental non-gutta-percha-based (NGP) root filling system using warm vertical or cold lateral compaction. The quality of obturation was evaluated by comparing the volumetric percentage of gaps and voids identified from similar canals obturated with gutta-percha and an epoxy resin-based sealer using the same obturation techniques. METHODS: Forty single-rooted premolars with oval-shaped canals were cleaned, shaped, and obturated with 1 of the 4 material/obturation technique combinations (n = 10). Filled canals were scanned with micro-computed tomographic imaging. Reconstructed images were analyzed for the volumetric percentage of gaps and voids at 3 canal levels (0-4, 4-8, and 8-12 mm from the working length). Roots were sectioned at the 4-mm, 8-mm, and 12-mm levels. Scanning electron microscopic images of negative replicas of root sections were examined to quantify the circumferential percentage of interfacial gaps and the area percentage of intracanal voids. Data were analyzed with parametric or nonparametric statistical methods. RESULTS: A statistically significant difference was found for the volumetric percentage distribution of gaps and voids for "obturation technique" but not for "material." Significantly higher percentages of gaps and voids were identified in canals obturated with the NGP system using cold lateral compaction. Examination of negative replicas ascribed this difference to a higher area percentage of interfacial gaps rather than more intracanal voids. CONCLUSIONS: Using warm vertical compaction, the NGP system fulfils the objective of 3-dimensional obturation of the canal space in a manner comparable with the results achieved with gutta-percha and a root canal sealer.

Quality of obturation achieved by an endodontic core-carrier system with crosslinked gutta-percha carrier in single-rooted canals.

OBJECTIVES: The present study examined the quality of obturation in root canals obturated by GuttaCore, a gutta-percha-based core-carrier system with a cross-linked thermoset gutta-percha carrier, by comparing the incidence of gaps and voids identified from similar canals obturated by cold lateral compaction or warm vertical compaction. METHODS: Thirty single-rooted premolars with oval-shaped canals were shaped and cleaned, and obturated with one of the three obturation techniques (N=10): GuttaCore, warm vertical compaction or cold lateral compaction. Filled canals were scanned with micro-computed tomography (micro-CT); reconstructed images were analysed for the volumetric percentage of gaps and voids at three canal levels (0-4mm, 4-8mm and 8-12mm from working length). The roots were subsequently sectioned at the 4-mm, 8-mm and 12-mm levels for analyses of the percentage of interfacial gaps, and area percentage of interfacial and intracanal voids, using scanning electron microscopy (SEM) to examine negative replicas of root sections. Data were analysed with parametric or non-parametric statistical methods at α=0.05. RESULTS: Both micro-CT and SEM data indicated that canals obturated with GuttaCore core-carriers had the lowest incidence of interfacial gaps and voids, although the results were not significantly different from canals obturated by warm vertical compaction. Both the GuttaCore and the warm vertical compaction groups, in turn, had significantly lower incidences of gaps and voids than the cold lateral compaction group. CONCLUSIONS: Because of the similarity in obturation quality between GuttaCore and warm vertical compaction, practitioners may find the GuttaCore core-carrier technique a valuable alternative for obturation of oval-shaped canals. CLINICAL SIGNIFICANCE: The quality of obturation achieved by GuttaCore in single-rooted canals is not significantly different from that achieved by warm vertical compaction.

Push-out bond strength of self-adhesive methacrylate resin-based sealers to root dentin.

This study examined the adhesive strength of two self-adhesive methacrylate resin-based sealers (MetaSEAL and RealSeal SE) to root dentin and compared them with RealSeal and AH Plus in properties. A total of 48 extracted human single-rooted teeth were used to prepare the 0.9-mm thick longitudinal tooth slice (each per tooth). Standardized simulated canal spaces of uniform dimensions were prepared in the middle of radicular dentin. After treated with 5.25% sodium hypochlorite (NaOCl) and 17% EDTA, tooth slices were allocated randomly to four groups (n=12) in terms of different sealers used: MetaSEAL, RealSeal SE, RealSeal, and AH plus groups. The simulated canal spaces were obturated with different sealers in each group. There were 10 slabs with 20 simulated canal spaces (n=20) used in each group for push-out testing. The failure modes and the ultrastructures of fractured sealer-dentin interfaces were examined. The remaining 2 slabs in each group underwent partial demineralization for observation of the ultrastructure of resin tags. The results showed that the push-out bond strength was 12.01±4.66 MPa in MetaSEAL group, significantly higher than that in the other three groups (P<0.05). Moreover, no statistically significant differences were noted in the push-out bond strength between RealSeal SE (5.43±3.68 MPa) and AH Plus (7.34±2.83 MPa) groups and between RealSeal SE and RealSeal (2.93±1.76 MPa) groups (P>0.05). Mixed failures were predominant in the fractured sealer-dentin interfaces in MetaSEAL and AH Plus groups, while adhesive failures were frequently seen in RealSeal SE and RealSeal groups. In conclusion, after complete removal of the smear layer, MetaSEAL showed superior bond ability to root dentin. The RealSeal SE is applicable in clinical practice, with its adhesive strength similar to that of AH Plus. The self-adhesive methacrylate resin-based sealer holds promise for use in endodontic treatment.

Quality of different gutta-percha techniques when filling experimental internal resorptive cavities: a micro-computed tomography study.

The purpose of this ex vivo study was to determine the quality of root fillings in experimental internal resorptive cavities filled using cold lateral condensation (CLC), vertical condensation and Thermafil techniques. Forty-five extracted maxillary canine teeth were selected. After root canal instrumentation, the roots were sectioned horizontally and experimental internal resorption cavities were prepared. The root sections were re-approximated with a luting agent and randomly assigned to three groups (n = 15) to be filled using CLC, vertical condensation and Thermafil, respectively. Assessment of obturation quality in the internal resorptive cavity was performed using a desktop X-ray micro focus computed tomography scanner, and the percentage of gutta-percha (GP), sealer and voiding was calculated for each specimen. Data were statistically analysed using non-parametric tests, with P < 0.05 denoting a statistically significant difference. Vertical condensation filled 96.25 ± 8.31% of the total artificial cavity, and was superior to CLC (63.20 ± 16.87%) and Thermafil (59.26 ± 18.47%). The mean percentage of voids was 3.75 ± 8.31% in the vertical condensation group, 37.09 ± 17.13% in the CLC group and 41.06 ± 18.60% in the Thermafil group. We conclude that obturation of experimental resorption cavities is significantly better when using vertical condensation than when using other GP-based techniques.

Carrier-based root canal filling materials: a literature review.

A review of the literature on the use of carrier based obturation materials focusing on Thermafil and Resilon based obturator (RealSeal 1) are presented in this article. The review addressed the history, apical leakage, coronal leakage, biocompatibility, sealing ability and clinical success of Thermafil and RealSeal 1. Based on the studies gathered, this review concluded that both treatment techniques (Thermafil and RealSeal 1) did not provide excellent apical sealing ability. More research should be done to try to overcome their main drawback, its sealing ability.

Periapical status and quality of root fillings in a selected adult Riga population.

AIM: The aim of the study was to assess the prevalence of apical periodontitis and quality of root canal fillings in an adult Riga subpopulation. MATERIALS AND METHODS: Panoramic radiographs of Latvian adults 35-44 year old attending a private dental clinic for the first time during the period of 2004-2008 were included in the study. Totally, 312 out of 1248 panoramic radiographs were randomly selected and examined for periapical conditions and endodontic treatment quality. The technical quality of root fillings was evaluated in terms of length in relation to the root apex and lateral adaptation to the canal wall. The periapical status was assessed using the PAI index. The data were analyzed using SPSS 14 computer software program. Statistical significance was assessed by the chi-squared (Pearson's) test. RESULTS: Out of the 312 individuals examined 224 (72%) had one or more teeth with apical periodontitis (PAI 3-5) and 272 individuals (87%) had one or more endodontically treated teeth. Amongst 7065 teeth evaluated 1255 (18%) were endodontically treated. Only 285 teeth (23%) of the root canal treated teeth were with complete root canal fillings. There was a statistically significant relationship between quality of root canal fillings and apical periodontitis (p<0.0001). In teeth with complete fillings only 15% were with apical periodontitis, but apical periodontitis were detected in 342 teeth (35%) with incomplete root fillings. CONCLUSION: The results from this study indicates a high prevalence of apical periodontitis and low quality of root fillings in a selected adult Riga population.

Can audit improve patient care and treatment outcomes in endodontics?

Clinical audit is part of the NHS clinical governance framework for dentistry and is recommended as a quality improvement process for patient care, yet there is very mixed evidence supporting audit's ability to produce change in practice. Findings show evidence of changes following audit which improved patient care and practice efficiency. However, there is a general lack of dissemination of audit results, little useful feedback provided to participants, limited use of formal re-auditing of a particular topic and little reported on whether audit improves outcomes for patients. As part of its clinical governance responsibility, the Community Dental Service (CDS) is committed to ensuring that its clinical audit is robust, strategic and measures patient outcomes in its evaluation. The aim of this paper is to present a complete endodontic audit cycle; its recommendations and effects on the process and on outcomes of clinical patient endodontic care; and to evaluate if audit was a useful tool in this case.

Assessment of the sealing abilities of several root canal sealers and filling methods.

OBJECTIVE: To evaluate the sealing abilities of two root canal sealers (epoxy resin-based AH Plus(®) and polydimethylsiloxane-based GuttaFlow(®)) and of five root filling techniques (lateral condensation, matched taper single gutta-percha point, laterally condensed-matched taper gutta-percha point, Thermafil(®) and continuous wave of condensation), using a bacterial leakage model. MATERIALS AND METHODS: One hundred and seventy-four single-rooted human teeth were randomly divided into 10 test groups (n = 15) and two control groups (n = 12). The roots that were filled with the test material, using the different root filling techniques, were mounted in a two-chamber bacterial leakage model and Enterococcus faecalis was added to the upper chambers. The lower chambers of all of the specimens were checked every day during the test period (100 days). The day of turbidity was recorded for each sample. Statistical analysis was performed using the Kaplan-Meier and log-rank tests. RESULTS: There was no significant difference between the epoxy resin-based and the polydimethylsiloxane-based sealers, irrespective of the filling techniques used (p > 0.05). The continuous wave of condensation technique was found to be superior to the other techniques (p < 0.05). The difference between the other groups was insignificant (p > 0.05). CONCLUSIONS: AH Plus and GuttaFlow sealers showed similar levels of sealing ability. The continuous wave of condensation technique had the best sealing capability when compared to the other techniques.

Physicochemical properties of endodontic sealers of different bases.

OBJECTIVE: To assess the setting time (ST), flow (FL), radiopacity (RD), solubility (SB) and dimensional change following setting (DC) of different sealers (AH Plus®, Polifil, Apexit Plus®, Sealapex®, Endométhasone® and Endofill®) according to American National Standards Institute/American Dental Association (ANSI/ADA) Specification 57. MATERIAL AND METHODS: Five samples of each material were used for each test. For ST, cast rings were filled with sealers and tested with a Gilmore needle. For FL, the sealer was placed on a glass plate. After 180 s, another plate with 20 g and a load of 100 g were applied on the material, and the diameters of the discs formed were measured. In RD, circular molds were filled with the sealers, radiographed and analyzed using Digora software. For SB, circular molds were filled with the sealers, a nylon thread was placed inside the material and another glass plate was positioned on the set, pressed and stored at 37°C. Samples were weighed, placed in water, dried and reweighed. The water used for SB was analyzed by atomic absorption spectrometry. For DC, circular molds were filled with the sealers, covered by glass plates and stored at 37°C. Samples were measured and stored in water for 30 days. After this period, they were dryed and measured again. RESULTS: Regarding ST, AH Plus®, Apexit® and Endofil® sealers are in accordance with ANSI/ADA standards. Endométhasone's manufacturer did not mention the ST; Polifil is an experimental sealer and Sealapex® did not set. Considering RD, SB and DC, all sealers were in accordance with ANSI/ADA. The spectrometric analysis showed that a significant amount of K+ and Zn2+ ions was released from Apexit Plus® and Endofill®, respectively. CONCLUSION: Except for DC, all other physicochemical properties of the tested sealers conformed to ANSI/ADA requirements.