Determining the internal morphology of root canals.
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Dental Pulp Cavity↗
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Root canal morphology of maxillary permanent first molar teeth at various ages.
The root canal anatomy and pulp chamber morphology of 216 maxillary permanent first molar teeth of known age was examined using a radiographic technique after infusion of the root canal system with a radiopaque sodium iothalomate gel. This technique proved to be a rapid and effective method for the examination of root canal morphology and is recommended when root canal anatomy needs to be examined before further investigations are carried out. Over 95% of palatal and disto-buccal roots contained a single root canal. The mesio-buccal root was more complex. All types of configurations were seen. Only 26% of mesio-buccal roots showed a single canal. The pulp canal in all roots appeared to narrow at an early age. In the mesio-buccal root, a definite two-directional calcification pattern was apparent in most teeth by the age of 10. The rate of progress of root formation was very variable. There was no apparent relationship between the type of canal system in the mesio-buccal root and the type of canal orifice present. The transverse cross-sectional shape of the pulp chamber was trapezoidal in 81% of teeth.
Adolescent↗
The use of E-speed film for root canal length determination.
This study compared the use of D-speed and E-speed dental X-ray film for assessing the working length of root canals. Root canal files of varying size (ISO 06, 08, 10 and 15) were placed in the root canals of a maxillary molar and a mandibular molar in a dried skull and mandible. Files were set at various lengths relative to the radiographic apex. The X-ray projections were kept constant. Exposure settings for the two film types that gave comparable radiographic density were selected. Films were developed manually under standardized conditions. A total of 48 films of each type were examined at various magnifications by four trained examiners for the estimation of distance between the file tip and radiographic apex. There were no differences between examiners in estimating working length. The effect of file size, root and magnification were also not significant. The differences between the film types were not significant (P > 0.05). It is concluded that clinicians should use E-speed film instead of D-speed film for root canal length measurement, because the exposure time was reduced by over 40% but the quality of the radiographic image was not significantly different.
Dental Pulp Cavity↗
Comparison of radiovisiography with radiographic film in root length determination.
Radiovisiography is a digital intraoral radiographic imaging system requiring a substantial reduction of radiation dosage to the patient over film. For Radiovisiography to replace film, it must be shown to be as efficacious. In this study, a technique of obtaining Radiovisiography and D-speed film images from the same X-ray beam was developed with the use of rare-earth filters. The quality of the resultant radiovisiographic images was verified in vitro with pure radiovisiographic images of teeth in a dried mandible with soft tissue simulation. Two examiners compared Radiovisiography with D-speed film for 20 root length estimations using the same in-vitro model. A clinical study was then carried out on mandibular molars of patients undergoing endodontic treatment, where 35 root lengths were obtained. The results of both in vitro and clinical studies showed no statistical differences in the estimated root lengths using the two imaging systems. The measuring grid available in the Radiovisiography unit produced similarly accurate results. Furthermore, the clinical study demonstrated the effective use of Radiovisiography during root canal treatment, with instant images.
Analysis of Variance↗
Assessing the shape of root canals: an in vitro method using microradiography.
The aim of this paper is to describe an in vitro method which provides clear and accurate details of root canal shape. The method utilizes the technique of contact microradiography to produce high resolution, two-dimensional, real-size images of canals in a longitudinal plane. Specimens can be accurately rotated through 90 degrees allowing images to be produced in a bucco-lingual and mesio-distal direction. The method is simple, relatively rapid and can process large numbers of teeth without the need for complicated and expensive mounting blocks or film holders. The technique can be used to produce pre- and post-operative images of canal shape which can be superimposed to delineate the dentine removed during canal preparation. The method is thus suitable for the evaluation of the shaping ability of endodontic instruments and preparation techniques.
Dental Pulp Cavity↗
An in vitro comparison of 10 radiographic methods for working length estimation.
The aim of this in vitro study was to assess the efficacy of 10 currently available methods of producing radiographic images, two conventional and eight rapid, in working length estimation. Thirty extracted teeth comprising 42 root canals were mounted in blocks of poly(methylmethacrylate) and access cavities prepared. A size 15 Hedstrom file was inserted into each root canal and sealed into position. Each tooth was imaged by 10 methods: combinations of conventional (D- and E- speed) film processed with conventional manual chemistry of two proprietary brands of rapid processing chemistry (Westone Rapid Dental and Kodak 'Rapid Access'), Super X30 packet processed film, Hanshin Hi-Fi and Nix NF45-100 films processed using their respective manufacturers' monobath solutions, and the Sens-A-Ray digital X-ray system. Comparisons of length of file visible were made between the D-speed films (conventionally processed using Kodak chemistry) and the nine other radiographic methods. No significant differences in percentage length of file seen were found between D-speed film processed with conventional chemistry and E-speed film processed with the same chemistry or between D-speed film processed with with conventional chemistry and six of the rapid imaging systems studied. The percentage length of the file visible was significantly less for Sens-A-Ray (P=0.02) and for Nix NF45-100 film (P<0.005) when compared with D-speed film processed with conventional chemistry. This difference in file length is probably not of clinical importance for the Sens-A-Ray images but may be so for the Nix images.
Dental Pulp Cavity↗
A computerized method for the evaluation of root canal morphology.
The objective of this research was to develop a technique that would allow three-dimensional imaging of root canals utilizing computer image processing. Ten single-rooted permanent human teeth with mature apices were analysed. The teeth were decoronated and fixed on boards with the long axis of the root perpendicular to the board. The cross-sectioning started at the root apex and continued in the coronal direction, roughly perpendicular to the long axis of the ++root. The samples were divided into two groups. The first five samples were sectioned 15 times, each section being 0.5-mm thick, in order to obtain the three-dimensional reconstruction of the root and the root canal. The root apex of each sample was cross-sectioned 19 times and each section was 0.2-mm thick. After each section, the root canal contour was defined utilizing the calibrated net with coordinate system in the ocular of the stereomicroscope. The coordinates of the root canal cross-section contour thus determined, together with the value of the thickness of each cut, were relevant input data for the reconstruction of the root canal cross-sections, longitudinal sections and for the final three-dimensional rebuild of the root and the root canal model. this technique appears to be highly accurate in determining the anatomy of the root canal system and may also be applied in other fields of dental research.
Computer Simulation↗
Electronic length measurement using small and large files in enlarged canals.
Electronic apex locators are frequently used attached to a small size endodontic file; however, the effect on the measurement of the relative diameters of the file and the root canal has not been clarified. In this study, the length of enlarged canals was measured using small size files and files matching the canal diameter to observe a possible discrepancy. The accuracy of electronic length control during canal preparation with rotary files was also assessed. The root canals in 21 extracted, single rooted teeth were accessed, and their actual length (AL) established by passing a size 10 file just through the minor apical foramen. The teeth were then embedded in an alginate mold. The initial canal length (IL) was measured with the Root ZX apex locator by negotiating a size 10 file to the apical constriction. The canal was enlarged to size 60 with rotary files while the length was continuously controlled with the apex locator. Then, the final length measurements were obtained with a size 10 file and a size 60 file (FL-10 and FL-60, respectively). The average values of IL, FL-10 and FL-60 were calculated and compared using Repeated Measures Analysis of Variance followed by Tukey's Studentized Range test (P < 0.05). Using composite resin, the size 60 files were secured at the FL-60 length, the teeth were removed from the alginate mold, stained with Picroformal DI Buoin stain and the position of the file tip was observed histomorphometrically after the apical 4 mm of the canal was exposed by grinding the buccal aspect of the root. The IL was 0.45 mm shorter than AL (P < 0.05). The differences between FL-10, FL-60 and IL were not statistically significant. Histomorphometrically, the apical constriction was absent in all the teeth, but the file tips were confined within the root. This study concluded that the Root ZX indicated the location of an apical constriction even when the anatomic constriction was eliminated. In the enlarged canals, length measurements obtained with small and large size files were comparable.
Analysis of Variance↗
Electronic apex locators.
Prior to root canal treatment at least one undistorted radiograph is required to assess canal morphology. The apical extent of instrumentation and the final root filling have a role in treatment success, and are primarily determined radiographically. Electronic apex locators reduce the number of radiographs required and assist where radiographic methods create difficulty. They may also indicate cases where the apical foramen is some distance from the radiographic apex. Other roles include the detection of root canal perforation. A review of the literature focussed first on the subject of electronic apex location. A second review used the names of apex location devices. From the combined searches, 113 pertinent articles in English were found. This paper reviews the development, action, use and types of electronic apex locators.
Dental Instruments↗
Investigation of the root canal configurations of mandibular permanent teeth in the Turkish population.
AIM: To investigate the root and canal morphology of mandibular permanent teeth collected from an indigenous Turkish population. METHODOLOGY: A total of 1400 extracted mandibular permanent teeth were evaluated. The teeth were divided into seven groups as central incisors, lateral incisors, canines, first premolars, second premolars, first molars and second molars in order to evaluate their root canal configurations. Access cavities were prepared and pulp tissue removed using 5.25% sodium hypochlorite solution. The teeth were stored in 5% nitric acid solution for 5 days, then rinsed under running water for 4 h and placed in increasing concentrations of ethyl alcohol. The teeth were rendered transparent by immersion in xylene solution for 3 days until complete transparency was achieved. Following this procedure, India ink was injected in the root canal systems and their configurations were examined and compared with the classification of Vertucci. The following observations were made: (i) root canal classification of mandibular teeth; (ii) morphology of the mandibular permanent teeth. The classification of Vertucci was taken as a reference during the evaluation; however additional canal morphological types were evaluated as separate groups. RESULTS: The presence of a second canal was detected in 68% of mandibular central incisors and 63% of lateral incisors. Lateral canals were found in 6.5% of mandibular central incisors and in 13% of lateral incisors. Overall, 62% of mandibular first premolar teeth had a single canal whereas 71% of second premolars had a single canal. The mandibular first and second molar teeth exhibited similar root canal configurations except for a group of second molar teeth that had a single root and canal. CONCLUSIONS: The morphological characteristics of teeth in this Turkish population were consistent with those of other studies performed on different populations using similar methodology.
Dental Pulp Cavity↗
Shaping ability of ProTaper nickel-titanium files in simulated resin root canals.
AIM: To determine the shaping ability of ProTaper instruments in simulated root canals. METHODOLOGY: Forty canals with four different shapes in terms of angle (20 degrees and 40 degrees) and position of curvature (straight section before curve: 8 and 12 mm) were enlarged according to the recommendations of the manufacturer with the finishing files F1, F2 and F3 to full working length. Preoperative and postoperative pictures, recorded using a digital camera, were superimposed and aberrations recorded. Measurements were carried out at five different points: at the canal orifice (O); half-way to the orifice in the straight section (HO); beginning of the curve (BC); apex of the curve (AC); end-point (EP). RESULTS: Ten instruments deformed (nine F3 and one S1, all in canals with straight section of 8 mm), one instrument fractured. There were significant differences between the various canal shapes for the amount of resin removed from the inner curve at all points (O: P < 0.05; HO: P = 0.001; BC, AC and EP: P < 0.001); and for the resin removed on the outer curve at points HO, AC and EP (P < 0.001). Mean transportation was towards the inner aspect of the curve in all canal types at points BC, towards the outer aspect at the end-point of preparation (EP) in all canals with 12 mm straight section. In 8 mm straight section canals, four danger zones were found; in 12 mm straight section canals three zips were present. The canal aberrations were produced following the use of the F2 and F3 instruments. There were no aberrations following the use of the F1 instrument. CONCLUSIONS: Under the conditions of this study, ProTaper instruments performed acceptable tapered preparations in all canal types. When using F2 and F3 in curved canals, care should be taken to avoid excessive removal at the inner curve, leading to danger zones. In addition, care should also be taken to avoid deformation of the F3 instrument.
Dental Alloys↗
Difference in root canal length between Asians and Caucasians.
AIM: To investigate whether there is a racial difference in canal length between the Asians and Caucasians. METHODOLOGY: Five hundred and fifteen Asian patients who had received root canal treatment at the Yonsei University Hospital, Korea between 1995 and May 2001 and 324 Caucasoid patients who had received root canal treatment at the Graduate Endodontic Clinic at the University of Pennsylvania, US were selected. The clinical endodontic procedures at both clinics were similar. An electronic apex locator (Root-ZX; J. Morita Co., Kyoto, Japan) was used to measure the initial working lengths and this was verified by conventional radiography. The measurements from both Asian and Caucasian teeth were compared using a Student's t-test and a Mann-Whitney test. RESULTS: The mean difference in canal length of pooled teeth between the Asian and Caucasian teeth was 1.2 mm, with a range from 0 to 2.5 mm. The greatest difference was in the distobuccal canal (2.5 mm) of maxillary first molar teeth followed by the mesiolingual canal (2.3 mm) of mandibular second molar, the buccal canal (2.1 mm) of the maxillary second premolar, the maxillary first molar and the mandibular second molar. CONCLUSION: Tooth lengths in Asians were shorter than Caucasians.
Asian People↗
A comparison between two electronic apex locators: an in vivo investigation.
AIM: To compare in vivo the Apex Finder and Root ZX electronic apex locators (EALs) at five different stages during root canal instrumentation. METHODOLOGY: The Apex Finder and Root ZX were used in 64 teeth with either vital or necrotic pulps. Informed consent was obtained by each patient under a study protocol approved by an ethical committee from the University of Trieste. Measurements were made: (stage 1) before instrumentation and irrigation; (stage 2) after brief filing, irrigation with 70% isopropyl alcohol and partial drying; (stage 3) after canal lubrication with EDTA gel (RC-Prep); (stage 4) after complete instrumentation and irrigation with NaOCl 5%; (stage 5) after drying of the final instrumented canal. Stages 2, 3 and 5 were considered low canal conductivity conditions and stage 4 as high. Teeth were then extracted and a size 15 K-file was inserted until its tip was observed under stereomicroscope to reach the foramen and the corresponding length was recorded to an accuracy of 0.25 mm and compared with values derived from the EALs. RESULTS: The data revealed 133 unstable measurements (out of 640): some (68) related to low canal conductivity conditions (more frequently for Root ZX, 67; P < 0.05), and others (63) related to NaOCl presence in the canal (more frequently for Apex Finder, 58; P < 0.05). Accuracy was calculated only on stable measurements. The Root ZX showed significantly (P < 0.05) more precise measurements overall (-0.03 +/- 0.39 mm) compared with the Apex Finder (-0.31 +/- 0.46 mm). Under dry canal conditions the Apex Finder provided the greatest accuracy (-0.0 +/- 0.21) compared with the Root ZX (-0.05 +/- 0.32) (significance P < 0.05). CONCLUSIONS: Under the five different clinical situations both EALs revealed accurate measurements. Apex Finder was negatively influenced by NaOCl in the root canal. The Root ZX was more frequently unable to reveal stable measurements in low conductivity canals.
Analysis of Variance↗
Influence of cervical preflaring on apical file size determination.
AIM: To investigate the influence of cervical preflaring with different instruments (Gates-Glidden drills, Quantec Flare series instruments and LA Axxess burs) on the first file that binds at working length (WL) in maxillary central incisors. METHODOLOGY: Forty human maxillary central incisors with complete root formation were used. After standard access cavities, a size 06 K-file was inserted into each canal until the apical foramen was reached. The WL was set 1 mm short of the apical foramen. Group 1 received the initial apical instrument without previous preflaring of the cervical and middle thirds of the root canal. Group 2 had the cervical and middle portion of the root canals enlarged with Gates-Glidden drills sizes 90, 110 and 130. Group 3 had the cervical and middle thirds of the root canals enlarged with nickel-titanium Quantec Flare series instruments. Titanium-nitrite treated, stainless steel LA Axxess burs were used for preflaring the cervical and middle portions of root canals from group 4. Each canal was sized using manual K-files, starting with size 08 files with passive movements until the WL was reached. File sizes were increased until a binding sensation was felt at the WL, and the instrument size was recorded for each tooth. The apical region was then observed under a stereoscopic magnifier, images were recorded digitally and the differences between root canal and maximum file diameters were evaluated for each sample. RESULTS: Significant differences were found between experimental groups regarding anatomical diameter at the WL and the first file to bind in the canal (P < 0.01, 95% confidence interval). The major discrepancy was found when no preflaring was performed (0.151 mm average). The LA Axxess burs produced the smallest differences between anatomical diameter and first file to bind (0.016 mm average). Gates-Glidden drills and Flare instruments were ranked in an intermediary position, with no statistically significant differences between them (0.093 mm average). CONCLUSIONS: The instrument binding technique for determining anatomical diameter at WL is not precise. Preflaring of the cervical and middle thirds of the root canal improved anatomical diameter determination; the instrument used for preflaring played a major role in determining the anatomical diameter at the WL. Canals preflared with LA Axxess burs created a more accurate relationship between file size and anatomical diameter.
Analysis of Variance↗
Electronic apex locators.
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Dental Instruments↗
Root canal preparation with Endo-Eze AET: changes in root canal shape assessed by micro-computed tomography.
AIM: To evaluate the relative performance of Endo-Eze Anatomic Endodontic Technology (AET) stainless steel instruments when shaping maxillary molar root canals in vitro. Methodology Extracted human maxillary molars were scanned, before and after root canal shaping with Endo-Eze AET, employing micro-computed tomography (muCT) at an isotropic resolution of 34 microm. Three-dimensional root canal models were reconstructed and evaluated for volume, surface area, 'thickness' (diameter), canal transportation and prepared surface. Preparation errors such as apical zips, perforations and fractured instruments were visually determined from those models. Means were contrasted using anova and Scheffé post-hoc tests. RESULTS: Volume and surface area increased significantly and similarly in mesiobuccal (mb), distobuccal (db) and palatal (p) canals and gross preparation errors (n = 17) were found. Mean root canal diameters, 5 mm coronal to the apex, increased from 0.31 to 0.52, 0.35 to 0.50 and 0.50 to 0.70 mm for mb, db and p canals, respectively. Mean canal transportation ranged from 0.15 to 0.29, 0.15 to 0.27 and 0.21 to 0.33 mm for apical, middle and coronal root canal levels, respectively, with highest values found for mb canals (P < 0.003). Root canals were significantly straightened during preparation (P < 0.002). CONCLUSIONS: In summary, Endo-Eze AET instruments shaped root canals in maxillary molars with substantial canal transportation, particularly in mesiobuccal root canals. Preparation with this instrument removed high volumes of dentine, even though apical preparation was size 30. Based on the current results, Endo-Eze AET cannot be recommended for the preparation of teeth with curved root canals.
Analysis of Variance↗
Ex vivo comparison of two electronic apex locators with different scales and frequencies.
AIM: To compare ex vivo the accuracy of two impedance quotient apex locators with different scales and frequencies of the measuring circuit. METHODOLOGY: In each root of 193 extracted human teeth, electronic working length determination (ELD) was carried out with a newly constructed measuring unit. In all cases, ELD was performed using the apex locators Justy II (Hager & Werken, Duisburg, Germany) and Raypex (VDW, Munich, Germany) on the scale points (sp) 0/0.5/1 of each device. A Miller Needle reaching working length was fixed with composite. The corresponding sp and the differences to the other sp were recorded. After histological preparation of the apical region, the teeth were examined under a light microscope. The distances of the Miller Needle tips to the target intervals 'minor foramen-major foramen' and 'apical canal constriction' (apical constriction) were determined for each sp for both devices. The data were statistically analysed by a chi-square test. RESULTS: Precise determination of the target interval 'minor foramen-major foramen' was successful with Raypex 4 in 94.8% (sp 1), 90.7% (sp 0.5) and 72.5% (sp 0) of cases and with Justy II in 59.6% (sp 1), 92.2% (sp 0.5) and 68% (sp 0) of cases. No measurement carried out by Raypex 4 and by Justy II on sp 1 was beyond the major apical foramen. However, on sp 0.5, there were eight measurements for Raypex 4 and four measurements for Justy II beyond the major apical foramen. Overinstrumentation was also recorded for sp 0 in 49 specimens (Raypex 4) and 59 specimens (JustyII). The major apical constriction was met exactly by Raypex 4 in 50.7% (sp 1), 14% (sp 0.5) and 5.2% (sp 0) of cases and by Justy II in 32.1% (sp 1), 23.8% (sp 0.5) and 4.1% (sp 0) of cases. The differences between the determination made with the sp suggested by the manufacturers for Raypex 4 (sp 1) and Justy II (sp 0.5) were not significant (P > 0.05) for the target interval 'minor foramen-major foramen' and significant (P <or= 0.05) for the apical constriction. The differences between the sp of each device were significant (P <or= 0.05) for both target intervals. CONCLUSIONS: It is possible to determine the region between the minor and major apical foramen with electronic apex locators ex vivo. The best results were obtained using the sp advised by the manufacturers. Raypex 4 gave the best results on sp one without any measurement beyond the apical foramen. Use of ELD does not result in precise determination of the apical constriction.
Dental Pulp Cavity↗
Ex vivo evaluation of the capacity of the Tri Auto ZX to locate the apical foramen during root canal retreatment.
AIM: To evaluate ex vivo the capacity of the Tri Auto ZX to locate the apical foramen during root canal retreatment. METHODOLOGY: The root canals of 62 maxillary and mandibular canines were prepared to a length 1 mm short of the apical foramen, to an apical size 35 using 1% sodium hypochlorite as an irrigant. Once prepared, the length of each tooth was measured directly using a size 15 K-Flexofile introduced in the canal until the tip was visible at the apical foramen. After the file was removed, its length was recorded to a precision of 0.01 mm using a calliper. These direct lengths (DL) became the 'gold standard' for comparison with the electronic lengths (EL) derived from the Tri Auto ZX. After direct measurement, the tooth was measured electronically (EL1) and the canals were filled using lateral condensation of gutta-percha cones and sealer. Seven days later the root filling was removed using solvent, Gates-Glidden burs, and K-files, and new electronic lengths determined (EL2). The electronic lengths (EL1 and EL2) were compared with the DL, and the differences were analysed statistically using the proportions test and Student's t-test. RESULTS: At a tolerance limit of +/-0.5 mm, EL1 coincided with the DL in 76% of cases. Lengths obtained in the presence of remnant of filling material (EL2) coincided in 81% of cases. The proportions test used to compare these percentages showed no statistically significant difference between EL1 and EL2 (P > 0.05). The Student's t-test revealed a statistically significant difference (P < 0.05) between the means of the differences between DL/EL1 (-0.36 mm) and DL/EL2 (-0.04 mm). CONCLUSION: The Tri Auto ZX was accurate to +/-0.5 mm in more than 80% of teeth following removal of root fillings.
Cuspid↗