PubMed · 4980509
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F I Mitsis. [Endodontic surgery].. https://pubmed.ncbi.nlm.nih.gov/4980509/
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AIM: This study compared the appearance of root-end cavity preparations and the time required to prepare them using prototype ultrasonic diamond-coated (DC) and stainless-steel (SS) retrotips. METHODOLOGY: In 12 maxillary and 12 mandibular molar teeth 48 root-end cavities were prepared ultrasonically in the palatal, mesio-buccal, distal and mesial root-ends using DC and SS retrotips, alternately. Replicas of the resected root tips and the root-end cavities were examined under a scanning electron microscope (SEM), recording (i) incidence and extent of dentine cracks (ii) minimum remaining thickness of the dentine walls and (iii) surface quality of the resected root-ends. The time taken to complete the preparation was also recorded. Means of these parameters were compared for both types of retrotips using nonparametric tests. RESULTS: No resected root-ends had cracks before preparation. However, after preparation one root-end cavity shaped by an SS retrotip had a microcrack visible at 23x magnification. Four and seven other root-ends had crazed surfaces in the DC and SS groups, respectively (P > 0.05). Remaining minimum dentine thickness was 0.56 +/- 0.28 mm and 0.71 +/- 0.24 for the DC and SS groups, respectively, and this difference was significant (P < 0.05). A root-end cavity in one specimen in the DC group was perforated. Preparation times ranged from 25 s to 361 s and were significantly lower for DC tips (P < 0.01) than the SS tips. The time required to prepare root-end cavities also differed between roots; root-end preparation in mandibular molars was more time consuming. CONCLUSIONS: A better quality surface was produced by the prototype diamond-coated retrotips, in less time than the SS retrotips, which in turn caused fewer cracks than previously reported. DC retrotips removed more dentine than SS retrotips and should therefore be used with care to avoid overpreparation or perforation.
OBJECTIVES: In an attempt to increase the successful rate of endodontic surgical procedures this study proposes the use of an association of three lasers in apicectomy: Er:YAG laser, (wavelength 2.94 microm pulse mode), Nd:YAG laser (wavelength 1.064 microm, pulse mode), and Ga-Al-As laser, (wavelength of 790 nm, continuous wave). BACKGROUND DATA: Previous studies have shown the low success rate of apicectomy by conventional methods due to the presence of remaining bacteria in the surgical site. METHODS: The Er:YAG laser was used to perform osteotomy and root resection without vibration, discomfort, less contamination of the surgical site, and no smear-layer on the dentine surface. The Nd:YAG laser irradiation through a fiber performed sealing of the dentinal tubules and bacterial reduction of the cavity bone. In addition, the improvement of healing and better post-operative achieved with the Ga-Al-As laser encourages the use of those lasers in periapical surgeries. RESULTS: Three years follow-up examination of the clinical case showed radiographically significant decrease of the radiolucent periapical area and no clinical signs and symptoms. CONCLUSION: The outcome of this clinical case indicates that the use of those lasers could be considered an alternative, suitable, and useful method to perform an apicectomy.
The purpose of this in vitro and in vivo study was to compare the quality of retrograde cavities and retrofilling using various retrograde techniques (microhead, ultrasonic). The quality was evaluated on the basis of dye penetration, macroscopic control, and both light microscopic and scanning electron microscopic examination. A total of 40 extracted teeth with a single canal were analyzed. The clinical result was evaluated in 25 patients with root-filled teeth and the indication of apicoectomy. Statistical analysis indicated that the seal was significantly better with ultrasonically prepared cavities than with microhead preparation. Retrofillings prepared ultrasonically also showed significantly fewer peripheral fissures. The scanning electron microscopic examination, however, demonstrated peripheral fissures in all filled teeth. Furthermore, the cavities prepared ultrasonically had a smoother surface and a lower smear layer. This preparation produced a more pleasing final result. The advantages of better accessibility during the preparation, namely, more precise preparation of the retrofilling and only minor substance loss were confirmed clinically. Using the ultrasonic equipment, absolutely sterile working conditions are present.