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PubMed1993

The relationship between the root canal filling and post space preparation.

The restoration of root treated teeth often requires the use of posts. Their use may affect the quality of the seal of the root canal filling. The various aspects of the relationship between root canal filling and post space preparation are discussed in this review. It is recommended that the use of posts should be avoided whenever possible. Where the preparation of post space is required, immediate removal of gutta-percha using heated instruments and small Gates Glidden drills is the method of choice.

Dental Cavity Preparation↗
PubMed2003

Diagnosis and root canal treatment of a mandibular second premolar with three root canals.

AIM: To present a case of a mandibular second premolar with three root canals. SUMMARY: An accurate diagnosis of the morphology of the root canal system is a prerequisite for successful root canal treatment. A review of the literature reveals a low incidence of all types of premolars with three root canals. Diagnostic means such as preoperative radiographs and examination of the pulp chamber floor aid the location of root canal orifices. The diagnostic and therapeutic problems concerning premolars with unusual anatomy are described on the basis of a clinical example. A case report describes the successful treatment of a mandibular second premolar with three root canals. KEY LEARNING POINTS: Clinicians should be aware of unusual root canal anatomy in mandibular premolars. Radiographs exposed at two different horizontal angles and their careful interpretation facilitate the search of additional root canals. The use of magnification and additional lighting are recommended for the clinical examination of the pulpal floor.

Adult↗
PubMed2005

The adoption of new endodontic technology amongst Danish general dental practitioners.

AIM: To assess the adoption of new endodontic technology in a population of Danish practitioners. METHODOLOGY: Members of the Copenhagen Dental Association (n = 1156) were approached with a questionnaire concerning the frequency of various endodontic procedures. Three options were available: often, occasionally and never. Responses were anonymous. The statistical analyses were performed as studies of association in two- or three-way contingency tables, and with Goodman-Kruskal's gamma-coefficient as the basic tool chosen. RESULTS: Only data from general practitioners (GPs) in private practice were analysed (n = 956). The response rate was 72%. NiTi hand instruments were often used to negotiate canals by 18%, whilst 10% often used NiTi rotary systems. Electronic apex locators were often employed by 15%. Nineteen per cent reported that warm gutta-percha was often used. A majority (53%) often spend two sessions to instrument a molar, and 20% often needed three or more sessions to finish the shaping phase. To complete a treatment of a nonvital case most practitioners reported to use at least three appointments. Only 4% frequently applied rubber dam. CONCLUSIONS: The adoption of new endodontic technology is at an early stage amongst Danish GPs. A new revised remuneration system might influence the rate of adoption, allowing the practitioners to act more rationally and produce a higher frequency of good-quality root fillings. Progress towards high quality endodontics might be hindered by the nonuse of rubber dam.

Denmark↗
PubMed2005

Calcium hydroxide dressings using different preparation and application modes: density and dissolution by simulated tissue pressure.

AIM: To study the effect of different apical shapes in prepared simulated root canals on the application of a commercially prepared calcium hydroxide paste by a syringe or lentulo spiral. METHODOLOGY: Three different types of root canal preparation were performed in 90 simulated canals: group A to an apical size 20 and a 0.10 taper using hand and rotary instruments, group B to an apical size 30 and a 0.08 taper using GT rotary instruments and group C to an apical size 40 and a 0.04 taper using ProFile 0.04 instruments. The insertion of calcium hydroxide [Ca(OH)2] paste was accomplished using either a lentulo spiral or a syringe. After 1 week of simulated fluid pressure applied to the apical end of the canal using physiological saline solution, the solution was evaluated for released Ca(OH)2. The specimens were weighed initially, after preparation, after insertion of Ca(OH)2 paste, after temporization with Cavit and after 1 week of simulated fluid pressure. Digital radiographs of the filled canals were taken and canal areas in mm2, gray values of the Ca(OH)2 dressings, total area of voids in mm2, as well as location of voids in the apical, middle or coronal thirds of the root canals were measured. Analyses of variance, with Scheffe's post-hoc tests, as well as chi-square tests were performed. RESULTS: Canals in group C had significantly fewer (P < 0.01) radiographic voids than canals in groups A and B. Using a lentulo spiral resulted in significantly (P < 0.05) fewer voids compared with the injection technique. More voids were detected coronally compared with middle and apical root canal thirds (P < 0.05). CONCLUSIONS: Canal shape and method of application had an impact on the amount and radiodensity of calcium hydroxide dressings in simulated root canals. Canals prepared to an apical size 40 and a taper of 0.04 had the least number of voids; Ca(OH)2 was placed with significantly fewer voids using a lentulo spiral compared with the injection technique.

Calcium Hydroxide↗
PubMed2006

A laboratory analysis of gutta-percha-filled area obtained using Thermafil, System B and lateral condensation.

AIM: To determine the percentage of gutta-percha-filled area (PGFA) in the apical third of root canals when filled with either Thermafil, System B or lateral condensation. METHODOLOGY: Sixty extracted human maxillary central incisor teeth were root filled as following: G1: lateral condensation (n = 20), G2: System B (n = 20) and G3: Thermafil system (n = 20). A horizontal section was cut 2 and 4 mm from the apical foramen of each tooth. The samples were prepared for microscopic analysis and photomicrographs of each apical surface were taken at a magnification of 50x. Through digital image analysis, the cross-sectional area of the canal and the gutta-percha was measured. The PGFA was calculated. The PGFA data obtained in the three groups were analysed using a nonparametric Friedman and Wilcoxon signed-rank tests. RESULTS: Significant differences in PGFA were found between the Thermafil System (G3) and both System B (G2) and lateral condensation (G1) (P < 0.01). The greatest PGFA occurred in the Thermafil group. No significant statistical difference was found between System B and lateral condensation (P > 0.05). CONCLUSIONS: The coated carrier gutta-percha system Thermafil produced significantly higher PGFAs than lateral condensation and System B techniques.

Anatomy, Cross-Sectional↗
PubMed2006

Retreatment efficacy of hand versus automated instrumentation in oval-shaped root canals: an ex vivo study.

AIM: To compare the efficacy of hand versus automated instrumentation when retreating oval-shaped root canals. METHODOLOGY: Sixty human premolars with single oval canals were instrumented and filled with gutta-percha and sealer and divided into three groups (n = 20)--group 1: ProFile .04 taper rotary instruments; group 2: Anatomic Endodontic Technology (AET), and group 3: manual instrumentation with Hedström files. The teeth were split longitudinally and gutta-percha/sealer remnants in the coronal, middle and apical thirds were assessed with light microscopy. The mean percentage of gutta-percha/sealer remnants for each group was calculated and statistically analysed for significance using an ANOVA repeated measures (P < 0.001) and Tukey's multiple comparison test. The time required for retreatment was analysed using a one-way ANOVA and Tukey's test (P < 0.001). RESULTS: Overall, 10-18% of the canal walls were covered with gutta-percha/sealer remnants after preparation using any technique. Statistical analysis demonstrated that the mean values for remnants of filling material in the ProFile group were significantly higher than for the other groups (P < 0.001), except in the apical third where no significant difference occurred. In all groups, the mean values in the middle third were higher than the coronal and apical thirds. The retreatment time for ProFile and AET was significantly shorter compared to manual instrumentation with Hedström files (P < 0.001). CONCLUSIONS: Under the experimental conditions, AET instruments and manual instrumentation with Hedström files resulted in cleaner canals. However, completely clean root canal walls were not produced with any of the techniques investigated.

Bicuspid↗
PubMed2006

Evaluation of canal filling after using two warm vertical gutta-percha compaction techniques in vivo: a preliminary study.

AIM: To evaluate the quality of root canal filling when comparing two warm gutta-percha filling techniques in vivo. METHODOLOGY: Human teeth were randomly divided into two equal groups, with 30 canals each. The root canals were shaped by hand and ProFile 0.04 rotary instruments to size 20-40 at the end-point and then filled with gutta-percha cones and AH-Plus. In group A, a traditional warm vertical compaction technique was performed using the Touch'n Heat, and back-filling with the Obtura II. In group B, a modified warm vertical compaction technique was used: small amounts of gutta-percha were removed, and the remaining most apical 3 mm were compacted with a 1 mm movement; then thermomechanical back-filling was performed. The teeth were extracted, stored in dye, cleared, and the distance between the apex and apical limit of the filling, linear dye penetration, and voids were measured from the buccal, lingual, mesial and distal perspective. The homogeneity of variance and means was verified using Levene's test and t-test. ANOVA and Dunnett post hoc test were used to establish the significance and to analyse the effects through multiple comparisons. RESULTS: Compared with the specimens of group A, the specimens of group B exhibited less mean linear dye penetration (P < 0.05), smaller void length (P < or = 0.05) and maximal width (P < or = 0.05) when examined in all four views, and a more precise filling when viewed from the buccal aspect (P < 0.05). CONCLUSIONS: The modified warm vertical compaction technique with apical back-filling produced a more effective and precise three-dimensional filling.

Cermet Cements↗
PubMed2006

The percentage of gutta-percha-filled area in simulated curved canals when filled using Endo Twinn, a new heat device source.

AIM: To compare the percentage of gutta-percha-filled area (PGP) in simulated root canals when varying the penetration depth and function of the pluggers (heat versus heat plus vibration) using Endo Twinn. METHODOLOGY: Sixty-four resin blocks with simulated 34-35 degrees curved canals were randomly divided into two groups in order to obtain two canal shapes: group A with 0.8 taper and group B with 0.4 taper. The apical portion of each canal was prepared to a size 20 K-file. The canals were filled with gutta-percha in combination with a root canal sealer. In each group 16 canals were filled using the Endo Twinn heat function and 16 canals by means of both the heat and the vibration function. All samples were sectioned horizontally at three levels (1.25, 2.5 and 4.0 mm from the working length) and the PGP was measured. Data were analysed using ANOVA test. RESULTS: At the 1.25 mm level PGP was significantly greater using the vibration function (P = 0.0329) and in 0.8 taper canals (P < 0.0001). At the 2.5 mm level the PGP was greater in the canals with 0.8 taper compared with a 0.4 taper with or without vibration (vibration, P = 0.0056; interaction taper-vibration, P = 0.0020). In 0.4 taper canals the PGP was greater when the vibration function was activated. At the 4 mm level in 0.8 taper canals there was no significant difference in PGP with or without the vibration (P = 0.6742). CONCLUSIONS: 0.8 taper canals had significantly greater PGP than 0.4 taper canals. At the 1.25 mm level there was significantly greater PGP when the vibration function was activated.

Dental Pulp Cavity↗
PubMed1995

Apical leakage following root canal dressing with calcium hydroxide.

The purpose of this study was to analyse the apical leakage in teeth filled by the lateral condensation technique following medication with calcium hydroxide. One hundred and twenty extracted human teeth were biomechanically prepared by using exclusively reaming motion with files up to #40. Half of the teeth received a calcium hydroxide dressing for 3 days. The medication was removed by irrigation and reaming motion with files #40 up to #70. The teeth were divided in 6 experimental groups, according to the dimension of the utilized instrument. The root canals were filled and posteriorly the teeth were placed into a 2% methylene blue dye solution inside a flask, which was attached to a vacuum pump. Leakage was measured linearly, and the results showed significantly (p<0.01) less leakage in the experimental groups that received calcium hydroxide dressings than in the control groups. The results persisted even after the removal of 300 micrometers of dentin from the root canal dentinal walls.

Analysis of Variance↗