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).

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.

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.

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.

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.

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.

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.

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.

Outcome assessment of apical surgery: A study of 234 teeth.

BACKGROUND/PURPOSE: Apical surgery is an option for management of endodontically-treated tooth with persistent periapical lesions or symptom and sign. The objective of this study was to investigate the correlation between the demography, preoperative, postoperative factors and healed rate of apical surgery. METHODS: Subjects were retrospectively collected from patients who received apical surgery/apicoectomy at the Endodontic Department, National Taiwan University Hospital from January 2013 to June 2015. The standard apical surgery procedures were performed. The demography, preoperative clinical and radiographic examination data as well as postoperative variables were collected. The outcome assessment was carried out after surgery. Statistical analysis was performed by chi square test to evaluate the potential outcome predictors. RESULTS: Total 187 patients and 234 teeth receiving apical surgery were included. 53 male and 134 female patients were collected. The age was ranged between 17 and 89 years old and the mean age was 43.64 years old. Better healed rate with significant differences were observed in female patient (p < 0.05), age ≤60 years old (p < 0.01), preoperative root canal filling material >2 mm short of apex (p < 0.01), lesion size from ≤2 mm to ≤12 mm (p < 0.05) and follow-up period â‰§12 months (p < 0.01) groups. CONCLUSION: Gender, age, preoperative root canal filling material extent, lesion size and follow-up period may affect the outcome of apical surgery. Tooth type, post, prosthesis, and lesion area showed no marked effect on apical healing. These results provide more detailed information for the clinical practitioners to make treatment plans and are important for clinical endodontic practices.

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.

Prevalence of vertical root fractures in teeth planned for apical surgery. A retrospective cohort study.

AIM: To evaluate retrospectively the prevalence of vertical root fractures (VRFs) in a cohort of patients during apical surgery and the factors possibly associated with VRF. METHODOLOGY: The sample consisted of 944 root filled teeth belonging to 768 patients (49.3% males and 50.7% females; mean age 43.5 ± 11.2 years, range 22-68 years), consecutively referred for endodontic surgery over a six-year period. All patients underwent a clinical assessment of their signs and symptoms. Periapical radiographs of teeth that were candidates for endodontic surgery were taken. Sixty-eight teeth with VRF were identified. Vertical root fractures were identified in pre-surgical screenings in 32 cases (47.1%), and these did not undergo surgery. Another 36 cases of VRF were noted during the intervention for root-end resection. The influence of posts, post type, tooth type, periodontal probing defects, spontaneous pain, sinus tract and follow-up duration was assessed using a logistic regression analysis. RESULTS: Vertical root fractures occurred significantly more frequently (P < 0.001) when a post was present (61 VRF out of 377 teeth with post, prevalence 16.2%) than in teeth without a post (1.2%). Threaded posts and cast posts were significantly more involved in VRF than fibre, silica or carbide posts (P < 0.001). Most fractures (80.9%) occurred 1-5 years after root canal treatment. Sinus tracts, probing defects and spontaneous pain were significantly more associated with VRF cases than with nonfractured teeth. CONCLUSIONS: In the present group of teeth, the major risk for VRF was represented by posts retained by actively engaging the canal via mechanical design (thread) or by frictional fit (cast).

The Root Membrane Technique: A Retrospective Clinical Study With Up to 10 Years of Follow-Up.

PURPOSE: Immediate implant placement in conjunction with intentional root retention is a recently introduced technique, but the majority of existing documentation is limited to short-term reports with low level of evidence. Hence, the aim of this study was to document the long-term clinical and radiographic results of the root membrane technique. METHODS: This retrospective study reports on clinical results of the root membrane technique for periodontal ligament-mediated immediate implant placement with up to 10 years of follow-up from 3 private dental practices. Anterior implants placed with immediate loading from January 2006 to December 2016 were assessed. Kaplan-Meier estimators were computed for reporting of implant success and survival. RESULTS: A sample of 182 patients (82 men and 100 women, age range: 18-83 years) received 250 immediate implants (230 maxilla, 20 mandible) after the root membrane concept and followed-up for a mean of 49.94 months (±32.5). Overall, 5 implant failures were recorded for a 10-year cumulative patient-level implant survival rate of 96.5%. Considering mechanical and biological complications, the 10-year cumulative implant success rate was 87.9%. CONCLUSIONS: Within the limits of the retrospective design, the root membrane technique showed long-term success rates comparable to those of conventional immediate implants.

Utilizing the GentleWave® System for Debridement of Undetected Apical Anatomy.

AIM AND BACKGROUND: Debriding and disinfecting complex anatomies within the root canal system pose a major challenge during root canal therapy. Even with current chemomechanical techniques, debris and bacterial remnants are commonly left behind, which are generally believed to increase the risk of endodontic failure. This case details the use of a new technique to debride complex apical anatomy in a maxillary molar. CASE REPORT: A 48-year-old female presented to the clinic with a chief complaint of increasing pain in her tooth. Clinical examination of the right first maxillary molar (#3) revealed moderate sensitivity to percussion and mild sensitivity to palpation. A pulpal diagnosis of symptomatic irreversible pulpitis and a periapi-cal diagnosis of symptomatic apical periodontitis were made. Mechanical instrumentation was performed using rotary file size #25/.04 for the mesiobuccal and distobuccal canals and size #25/.06 for the palatal canal to create a fluid path and enable obturation of the root canal system following the GentleWave® Procedure. The GentleWave Procedure was completed using Multisonic Ultracleaning™ for complete debridement and disinfection of the root canal system. The tooth was obturated using a warm vertical continuous wave obturation technique. Postoperative radiographs revealed complex anatomy within the apical third that was undetected both during pre-operative radiography and mechanical instrumentation. The palatal canal exhibited a complex apical delta with multiple points of exit, and the mesiobuccal canal revealed an undetected lateral canal within the apical third that had a separate and distinct egress. Conclusion and clinical significance: It is important for the clinician to debride and disinfect complex anatomy within the root canal system to reduce the risk of endodontic failure. This case report highlights the clinical significance of utilizing the GentleWave Procedure for detecting complex apical anatomy during endodontic therapy.

[Effects of different techniques on removal of vapor lock in the apical region of curved canals: a cone-beam computed tomography study].

OBJECTIVE: To compare the effect of four different techniques on removal of vapor lock in the apical region of curved root canals. METHODS: Forty simulated resin root canals with 45° curvature were prepared using WaveOne Primary, then the apical foramen were sealed with soft wax. The teeth were divided randomly into 4 groups thereafter (n=10). Contract solution was injected into the canals using a 30 G side-vented needle and scanned with cone-beam CT (CBCT) to identify the volume of the vapor lock. Four different techniques including photon-induced photoacoustic streaming (PIPS) laser-activated irrigation, gutta-percha cone technique, ultrasonic irrigation, and sonic irrigation were used to remove the vapor locks in the root canals. The residual volume of the vapor lock was identified again using CBCT scanning data. Accordingly, the reduction rates of the vapor lock were calculated. Furthermore, the initial and residual vapor lock length was calculated. The data were analyzed by using the One-way ANOVA analysis and Kruskal-Wallis H test at a significance level of P<0.05. RESULTS: There was no significant difference in the initial vapor lock volume (P>0.05). Residual volume of the vapor lock for PIPS laser-activated irrigation was 0 mm(3), and that for gutta-percha cone technique was (0.02±0.07) mm3, significantly lower than those of ultrasonic and sonic irrigation, the values being (0.20±0.09) mm(3) and (0.23±0.06) mm(3) (P<0.001), respectively. The reduction rates of the vapor lock of PIPS laser-activated irrigation and gutta-percha cone technique were 100.00% (100.00%, 100.00%) and 100.00% (77.66%, 100.00%), respectively, significantly higher than those of ultrasonic irrigation [70.37% (56.41%, 91.43%)] and sonic irrigation [63.54% (51.47%, 74.00%), P<0.001]. The length of the residual vapor lock for PIPS laser-activated irrigation was 0 mm, and that for gutta-percha cone technique was (0.15±0.47) mm, significantly lower than those of ultrasonic and sonic irrigation, values being (2.21±0.09) mm and (2.34±0.08) mm (P<0.001), respectively. The length of the residual vapor locks in the ultrasonic and sonic group remained approximately the same as the distance between the working tip and the apical foramen. CONCLUSION: PIPS laser activated irrigation and gutta-percha cone technique could remove the vapor lock from the apical region of curved canals effectively.

Apically extruded debris during root canal preparation using Vortex Blue, K3XF, ProTaper Next and Reciproc instruments.

AIM: To assess the amount of debris extruded apically during root canal preparation using various nickel-titanium instrumentation systems. METHODOLOGY: Sixty extracted single-rooted mandibular premolar human teeth were randomly assigned to four groups (n = 15 teeth for each group). The canals were then instrumented with the following instrument systems: Vortex Blue (VB; Dentsply Tulsa Dental, Tulsa, OK, USA), K3XF (SybronEndo, Orange, CA, USA), Reciproc (VDW, Munich, Germany) and ProTaper Next (PTN; Dentsply Maillefer, Ballaigues, Switzerland). Apically extruded debris during instrumentation was collected into pre-weighed Eppendorf tubes. The Eppendorf tubes were then stored in an incubator at 70 °C for 5 days. The weight of the dry extruded debris was established by subtracting the pre-instrumentation and post-instrumentation weight of the Eppendorf tubes for each group. The data were analysed using one-way analysis of variance (anova) and Tukey's post hoc tests. RESULTS: Vortex Blue and PTN files were associated with significantly less apically extruded debris than the K3XF and Reciproc files (P < 0.05), but there was no significant difference between the VB and PTN files or between the K3XF and Reciproc files (P > 0.05). CONCLUSIONS: All instruments were associated with apical extrusion of debris. VB and PTN files were associated with less debris extrusion compared to the other systems.

Comparison of apically extruded debris after large apical preparations by full-sequence rotary and single-file reciprocating systems.

AIM: To evaluate the amount of apically extruded debris produced by ProTaper Universal (PTU), ProTaper Next (PTN), WaveOne (WO) and Reciproc (R) systems after large apical preparations. METHODOLOGY: Sixty mandibular premolars with a single canal were selected and randomly assigned into 4 groups (n = 15) according to the system used for root canal preparation: PTU, PTN, WO and R groups. Canal preparations were performed up to size 40 in each group. Distilled water was used as an irrigant, and the apically extruded debris from each tooth was collected in pre-weighted glass vials and dried. The average weight of debris was assessed using a microbalance, and the data were analysed statistically using one-way analysis of variance and the post hoc Tukey multiple comparison test (α = 0.05). RESULTS: The PTU system was associated with significantly more debris than the other systems (P < 0.05). No significant differences were found between PTN, WO and R systems (P > 0.05). CONCLUSIONS: All systems were associated with apical debris extrusion when canals were prepared to a large apical size. The PTU system was associated with more debris extrusion.

Influence of a glide path on apical extrusion of debris during canal preparation using single-file systems in curved canals.

AIM: To evaluate the effect of a glide path on the amount of apically extruded debris during canal preparation using single-file systems in curved canals. METHODOLOGY: Ninety extracted mandibular molar teeth were randomly assigned to six groups (n = 15 for each group) for canal instrumentation. Endodontic access cavities were prepared in each tooth. In three of the six groups, a glide path was not created whereas a glide path was created using PathFile instruments on the mesial canals of all teeth in the remaining three groups. The mesial canals of the teeth were then instrumented with the following single-file instrument systems: WaveOne, Reciproc and OneShape. Debris extruded apically during instrumentation was collected into pre-weighed Eppendorf tubes. The tubes were then stored in an incubator at 70 °C for 5 days. The weight of the dry extruded debris was established by subtracting the pre-instrumentation and post-instrumentation weight of the Eppendorf tubes for each group. The data obtained were analysed using one-way analysis of variance (anova) and Tukey's post hoc tests. RESULTS: The OneShape file was associated with less debris extrusion than the Reciproc and WaveOne files when canal instrumentation was performed without a glide path (P < 0.05). However, no significant difference was found between the Reciproc and WaveOne files (P > 0.05). There was no significant difference amongst the OneShape, Reciproc and WaveOne files when a glide path was created before canal preparation in curved root canals (P > 0.05). All systems extruded significantly less debris in groups with a glide path than in groups without a glide path (P < 0.05). CONCLUSIONS: All instruments were associated with apical extrusion of debris. Creating a glide path prior to canal instrumentation reduced the amount of apically extruded debris in curved canals.

Pain following foraminal enlargement in mandibular molars with necrosis and apical periodontitis: A randomized controlled trial.

AIM: This randomized controlled trial was conducted to evaluate the effect of foraminal enlargement during chemomechanical root canal preparation on postoperative pain. METHODOLOGY: Seventy mandibular first molars with asymptomatic pulp necrosis and chronic apical periodontitis were randomized into two groups - foraminal enlargement (FE) and conventional nonforaminal enlargement (NFE). Canals were prepared according to the respective protocols, and the teeth were restored temporarily. Postoperatively, the patients were prescribed ibuprofen 400 mg, to be taken if required. Pain experience and analgesic intake were recorded for 7 days following chemomechanical preparation. The data were analysed using Mann-Whitney U-test and chi-square tests. RESULTS: Pain experience was higher with foraminal enlargement than when using a conventional technique. A significant difference was observed in postoperative pain during the first 4 days and the sixth day (P < 0.05), with greater pain in the FE as compared to the NFE group. There was no significant difference in prevalence of analgesic intake and number of doses between the experimental groups (P > 0.05). CONCLUSION: Enlargement of the apical foramen during root canal treatment increased the incidence and intensity of postoperative pain.

The detection of periapical pathoses using digital periapical radiography and cone beam computed tomography in endodontically retreated teeth - part 2: a 1 year post-treatment follow-up.

AIM: Part 2 of this prospective clinical study aimed to compare the 1-year outcome of root canal retreatments, when individual roots and teeth were assessed by periapical radiographs and cone beam computed tomography (CBCT). METHODOLOGY: Subjects participating in this study had been referred for management of an endodontic problem associated with one or more root filled teeth. Root canal retreatment was performed by Specialists or postgraduate students under the direct supervision of Specialist endodontic staff. A total of 98 teeth (84 patients) were reassessed clinically and radiographically 1 year after completion of root canal retreatment. The postoperative periapical radiographs and CBCT scans were compared with their respective pre-treatment (diagnostic) periapical radiographs and CBCT scans. The increase or decrease in size of existing periapical radiolucencies and development of new radiolucencies were assessed by a consensus panel consisting of two calibrated examiners. They also determined an appropriate management plan for each case based on the radiographical findings. Comparison of the outcome diagnosis of individual roots and teeth and case management, when assessed by periapical radiographs and CBCT scans, was performed using chi-squared and McNemar's tests. RESULTS: An overall favourable result of 93% success for teeth (96% roots) was recorded when the assessment was undertaken by periapicals compared with 77% success for teeth (87% roots) when assessed by CBCT. A significant difference in outcome diagnosis of single paired roots (P < 0.0001) and teeth (P = 0.0001) was observed when comparing periapicals to CBCT for the cohort of teeth as a whole. When comparing the future management plan on the basis of radiographic information alone, there was a significant difference between periapicals and CBCT-based management (P = 0.01). CONCLUSION: Diagnosis using CBCT revealed a significantly lower number of favourable outcomes than periapicals in root canal retreatment. This significantly affected the future management of cases attending for a review.