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An assessment of the plastic Thermafil obturation technique. Part 2. Material adaptation and sealability.

The short- and long-term apical seal of root canals obturated with softened alpha-phase gutta-percha on plastic core-carriers, Thermafil, was compared to that of laterally condensed, cold gutta-percha. Fifty-one roots from mandibular molars with separate canals, patent canal orifices and curvatures greater than 15 degrees were cleaned and shaped with K-files and 2.5% sodium hypochlorite to a size 30 at the apex, and flared with Hedstrom files to create a continuously tapering funnel preparation. Canals were randomly obturated with Sealapex root canal sealer and either alpha-phase gutta-percha on a plastic Thermafil carrier, or standard beta-phase gutta-percha with lateral condensation. Teeth were separated into three groups of 17 each and placed in black India ink for 24 h, 7 days or after 5 months storage in water. The teeth were demineralized, rendered transparent, and apical microleakage determined by the linear measurement of dye penetration. Significant differences in microleakage were noted between the 24 h and 5-month Thermafil groups (P < 0.05), 24-h and 7-day lateral condensation groups (P < 0.05), and 24-h and 5-month lateral condensation groups (P < 0.05). There were no significant differences between the two techniques at each time interval. It was concluded that both techniques demonstrated a significant increase in apical microleakage over a 5-month period.

Dental Leakage↗

Comparison of procedural errors resulting during root canal preparations completed by senior dental students in patients using an '8-step method' versus 'serial step-back technique'.

OBJECTIVE: To compare procedural errors that occur in patients during root canal preparation by senior dental students using a new '8-step method' versus the traditional 'serial step-back technique.' STUDY DESIGN: Senior dental students treated 221 root canals of maxillary and mandibular teeth. Instrumentation included coronal flaring with Gates-Glidden reamers and standardized stainless steel K-files in all teeth. A new 8-step method was used to prepare 67 canals using standardized stainless steel hand instruments (8-step SS) and 69 canals using the rotary Nickel Titanium instruments (8-step NiTi). The traditional serial step-back technique (step-back) was used for 85 root canals. In the apical third, reaming or filing motions were used up to sizes 25 and only reaming motion in sizes larger than 25 with the new 8-step method. A filing motion was used in the step-back for all sizes. Root canals of all groups were obturated with gutta-percha points and AH26 using a lateral condensation technique. Pre- and postoperative radiographs were taken of each tooth. Procedural errors were recorded and statistically analyzed using a binomic test for comparison of proportion. RESULTS: Procedural errors detected consisted of 2 canals with transportation (3%) with the 8-step SS, and 3 canals (4%) with transportation with 8-step NiTi. There were no canal obstructions or instrument separations. With the step-back, 20 canals were transported (24%), 7 canals had obstructions (8%), and in 1 canal instrument was separated (1%). CONCLUSIONS: The new 8-step method resulted in fewer procedural errors than the traditional serial step-back technique when senior students prepared root canals in patients either by hand with standardized K-files or by rotary NiTi instrumentation.

Bismuth↗

A new non-instrumental technique for cleaning and filling root canals.

The aim of this in vitro study was to test the ability of a novel non-instrumental technique to prepare and obturate root canals. Cleaning of the root canal system was achieved with a device which was able to develop, under reduced pressure, controlled cavitation. The same device was used for proper drying and subsequent obturation of the root canal system. A total of 55 freshly extracted molars with 120 canals were treated either by the step-back technique and lateral condensation of gutta-percha and AH26 as a sealer or by the new device. The teeth were then sectioned horizontal to the long axis of the root canal and examined by light microscopy. The cross-sectional area, area with residual pulpal tissue and voids were assessed morphometrically. Overall, the treatment with the new device resulted in similar cleanliness and obturation quality when compared with the control group. Total treatment time using the new non-instrumental technique, however, was less than half of that using hand instrumentation.

Analysis of Variance↗

In vitro infrared thermographic assessment of root surface temperatures generated by the thermafil plus system.

The purpose of this in vitro study was to investigate root surface temperatures generated by the Thermafil Plus system using infrared thermography. A total of 60 extracted human maxillary central incisors and maxillary first molars were biomechanically instrumented using ProFile 0.04 Taper Series 29 rotary instruments. The root canals were obturated using the Thermafil Plus system. An infrared thermography camera was used to measure the external root surface temperatures during and after the completion of obturation. The mean temperature rise of the external root surface from the ambient temperature was 4.26 degrees C for the mesial buccal roots, 4.58 degrees C for the distobuccal roots, 4.76 degrees C for the palatal roots, and 4.87 degrees C for the anterior roots. These temperatures were well below the critical level of 10 degrees C needed to cause damage to the attachment apparatus. From this in vitro experiment, no evidence was discovered which would indicate that the Thermafil Plus obturation system would result in damage to the periodontal ligament and the surrounding attachment apparatus as a consequence of temperature rise on the external root surface.

Body Temperature↗

[Iatrogenic risks during the obturation of the root canal system].

A hermetic seal is the main goal of obturation of the root canal system. For that purpose guttapercha still remains the filling material of choice. Most filling techniques use plasticized guttapercha and a condensation technique to fulfil the requirements of hermetic seal. The heat to plasticize and the forces applied to condense that material may have an influence on the periodontal ligament and/or the remaining tooth structure. Furthermore can overfilling of guttapercha and more likely the sealer, affect the periodontal tissue. Although rare, mandibular nerve damage and adverse effects on the sinus maxillaris can be the result of inadequate treatment.

Dental Bonding↗

A one-stage calcific barrier technique in a root-fractured incisor tooth: a case report.

This paper describes the use of calcium hydroxide powder as an immediate plug before root canal obturation in the case of a root-fractured upper central incisor that had been unresponsive to 18 months of treatment to create a calcific barrier. The calcium hydroxide plug allowed both good condensation of the filling material and prevention of extrusion of the root filling material which could have been detrimental to continued healing of the fracture.

Calcium Hydroxide↗

[Root canal preparation for obturation using nickel-titanium mechanical devices].

Engine-driven ProFile instruments manufactured by Maillefer (Switzerland) and Tulsa Dental Products (USA) have been used for cleaning and shaping root canals. Both of them are nickel titanium, U-shaped instruments designed for a controlled slow speed (250 rpm) rotary handpiece. In contrast to the Maillefer instruments ProFile Series 29 files (Tulsa Dental) show a constant 29% increase between tip diameters. As these more tapered instruments (ProFile 0.04; 0.06) are rotated, they produce a "crown-down" preparation, resulting in a tunnelform taper from orifice to apex. According to our experiences ProFile instruments are useful alternative tools for root canal preparation quickly and efficiently.

Dental Instruments↗