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PubMed1998

Apical limit of root canal instrumentation and obturation, part 2. A histological study.

The results of an in vivo histological study involving apical and periapical tissues following root canal therapy after different observation periods demonstrated the most favourable histological conditions when the instrumentation and obturation remained at or short of the apical constriction. This was the case in the presence of vital or necrotic pulps, also when bacteria had penetrated the foramen and were present in the periapical tissues. When the sealer and/or the gutta-percha was extruded into the periapical tissue, the lateral canals and the apical ramifications, there was always a severe inflammatory reaction including a foreign body reaction despite a clinical absence of pain.

Adolescent↗
PubMed1993

Experimental apical sealing with a new canal obturation system.

Twenty-seven root canals were obturated by the Thermafil system after conventional preparation. The lateral condensation technique was used as a control in 11 other canals. All specimens were immersed passively in India ink for 3 days at 37 degrees C. After rendering all roots transparent, no statistically significant differences (p < 0.4) were seen in apical leakage as determined stereomicroscopically. Like-wise, no relationship was noted between leakage and the last apical file size used to prepare and clean the canals.

Dental Leakage↗
PubMed2005

21st century endodontics. Part 4.

The prime objective of this series of papers has been to focus the attention of the reader on the biological principles of root canal treatment. Accurate diagnosis, knowledge of the root canal morphology and the principles of modern preparation techniques are all essential so that appropriate chemical cleaning and disinfection of the entire root canal system may be accomplished. This paper will consider two further aspects of root canal treatment. First, whether the root canal system should be prepared and obturated in a single visit, and, if not, which intervisit medication is appropriate. Secondly, the modern concepts and techniques for obturation of the root canal system.

Aluminum Compounds↗
PubMed2004

Evaluation of the influence of smear layer on the apical and coronal sealing ability of two sealers.

The aim of this in vitro study was to determine the effect of the smear layer on apical and coronal leakage in root canals obturated with AH26 or RoekoSeal sealers. A total of 160 maxillary anterior teeth extracted for periodontal reasons were used. The root canals were prepared to a size #7 with ProFile.06 taper Series 29 rotary instruments in a crown-down manner. Eight groups were created by all possible combinations of three factors: smear layer (present/absent), leakage assessment (apical/coronal), and sealer used (AH26/RoekoSeal). All teeth were obturated using lateral condensation technique of gutta-percha. A fluid filtration method was used to test apical or coronal leakage. According to the results of this study, the smear (+) groups displayed higher apical and coronal leakage than those smear (-) groups for both root canal sealers (p < 0.05). There was no statistically significant difference in either apical or coronal leakage between RoekoSeal and AH26, regardless of the presence or absence of the smear layer (p > 0.05). However, apical leakage was significantly higher than coronal leakage for both root canal sealers used in this study (p < 0.05). Under the conditions of this study, the results indicate that removal of the smear layer has a positive effect in reducing apical and coronal leakage for both AH26 and RoekoSeal root canal sealers.

Bismuth↗
PubMed2004

[Comparative study of resosolv and chloroform in retreatment of canal obturated with resinifying agent].

OBJECTIVE: To evaluate the possibility for removal of resinifying agent, time required for removal and the working length loss by Resosolv or Chloroform. METHODS: 40 human teeth (80 root canals) obturated with FR phenolaldehyde agent were divided into four groups, 20 root canals per group. Group A: Resosolv with K file; group B: chloroform with K file; group C: Resosolv with Ultrasonic K file; group D: Chloroform with ultrasonic K file. Calculating the pereentage for removal of resinifying agent, time required for removal and the working length loss. RESULTS: The effectiveness of Resosolv for removing resinifying agent was better than chloroform. 87.5% of canals could be negotiated by Resosolv; 45% of canals be negotiated by chloroform. CONCLUSION: Resosolv is an effective solvent for canals obturated with resinifying agent.

Chloroform↗
PubMed1990

High tech root canal preparation and obturation and new instrumentation.

With the use of the CAVIENDO and the ENDOTEC, and the improved instruments; the calibrated M SERIES PLUGGER/SPREADERS and new ENDO DIAMOND ACCESS BUR, a high-tech biologic approach to endodontic therapy has been developed that allows the operator to perform root canal treatment efficiently, effectively and with ease, achieving the highest degree of success.

Gutta-Percha↗
PubMed2003

Effect of root resection on the apical sealing ability of mineral trioxide aggregate.

OBJECTIVE: The purpose of this in vitro study was to determine the minimum depth of mineral trioxide aggregate (MTA; ProRoot; DENTSPLY/Tulsa Dental, Tulsa, Okla) required to maintain an apical seal following root resection. Study design. In 10 instrumented teeth, MTA was used to obturate the apical 6 mm of the root canal and was allowed to set for 48 hours. Leakage was determined by means of a fluid filtration method at a pressure of 20 cm H(2)O. Leakage was measured before root resection, and after 3, 4, 5, and 6 mm apical resections. Data were analyzed by means of a Kruskal-Wallis one-way analysis of variance with P <.05. RESULTS: Fluid leakage was shown to increase after each resection, but did not reach statistical significance (P <.05) until 4 mm of the apex had been removed. CONCLUSION: The results indicate that root resection did not significantly affect the sealing ability of MTA when at least 3 mm of the MTA remained. Although there was a statistically significant difference in leakage following the 4 mm resection, it is unknown what the biological difference would be between the 3 mm and 4 mm resections.

Aluminum Compounds↗
PubMed2005

Application of biologically-oriented dentin bonding principles to the use of endodontic irrigants.

PURPOSE: To compare the removal of smear layer and the structure of the hybrid layer formed after the use of EDTA or MTAD solutions when used as a final flush. METHODS: Single-rooted extracted premolars (n=18) were collected and treated for root canal therapy using NaOCl irrigation followed by a final rinse of 17% EDTA, Biopure MTAD, or saline (negative control). The roots were obturated with gutta-percha and a hydrophilic HEMA-containing root canal sealer. The TEM specimens were impregnated with 50% silver nitrate to visualize sealing imperfections and nanoleakage. The structure of the coronal, middle and apical parts of root canal walls was examined using transmission electron microscopy. RESULTS: After NaOCl irrigation, a final rinse with BioPure MTAD or 17% EDTA completely removed the 2 microm-thick smear layer on mechanically instrumented root canal walls. The BioPure MTAD hybrid layer was thicker than the 17% EDTA hybrid layer. Both the BioPure MTAD and EDTA caused a collapse of the dentin matrix structure which impeded sealer infiltration and the formation of high quality hybrid layer bonding. The hybrid layers created in smear layer-covered dentin exhibited less potential for nanoleakage than the MTAD or EDTA hybrid layers.

Bicuspid↗
PubMed2004

Digital radiograph registration and subtraction: a useful tool for the evaluation of the progress of chronic apical periodontitis.

The purpose of this study was to evaluate the suitability of a digital radiograph registration and subtraction software for a sensitive and reliable assessment of the progress of chronic apical periodontitis. Ninety cases of teeth with chronic apical periodontitis have been studied. In each case, a preoperative radiograph was taken, root canals were prepared, and a Ca(OH)2 paste was placed in the root canals. Radiographic control and replacement of Ca(OH)2 paste took place at 15-day intervals. The root canals were obturated 1.5 months after the first appointment. Recall radiographs were taken 0.5, 1.5, 3, 6, and 12 months after the obturation. All radiographs were taken for each case under constant conditions by using a direct digital radiography system. In each case, the preoperative, postoperative, and control and recall radiographs were digitally registered and pairwise subtracted. The resulting images were further processed by using contrast enhancement and pseudocoloring methods. Changes to the periapical tissue structure were easily detectable by using the above-mentioned methodology, even during short time intervals.

Calcium Hydroxide↗
PubMed1999

A general dentist's viewpoint of two new endodontic techniques.

Over 3 years ago, two new endodontic techniques were developed. The first was a straightforward, comprehensive approach for root canal instrumentation. The second was a simple and predictable obturation system. The combination of these systems lead to impressive results that were easily attained. The instrumentation method uses existing armamentarium, allowing nearly any canal to be shaped to ideal form to precisely match a tapered gutta percha point. The root canal sealer technique incorporates controlled placement of a modified epoxy-resin cement that allows for a thoroughly sealed, single-cone root canal fill. The results rival other available systems. This article presents a stepwise guide to achieve stress-free, successful case results that general dentists and endodontists desire.

Attitude of Health Personnel↗
PubMed1999

Histological periapical repair after obturation of infected root canals in dogs.

Histological periapical healing of infected roots obturated in one-step or with prior calcium hydroxide (Ca(OH)2) disinfection was compared. Seventy-two roots of vital dog teeth were instrumented to ISO size 45. Sixty roots were infected with dental plaque and closed. Six weeks later, apical periodontitis was radiographically confirmed in the infected roots. The teeth were divided into the following groups: group 1, one-step (n = 24)-roots were irrigated with 10 ml of saline, obturated, and permanently restored; group 2, Ca(OH)2 (n = 24)-roots were treated as in group 1, except that after saline irrigation, Ca(OH)2 dressing was placed in the canal for 1 wk before obturation; group 3, positive control (n = 12)--the roots were irrigated with saline, but the canals were not obturated; and an additional group, group 4, served as a negative control (n = 12)--these teeth that were not infected with plaque were aseptically obturated. The dogs were sacrificed after 6 months. The roots and surrounding apical tissues were prepared and histologically examined by two independent evaluators blinded to the treatment groups. A two-way ANOVA test demonstrated that the four treatment groups were significantly different from one another. The positive control showed the most inflammation, the negative control the least, and the Ca(OH)2 group had significantly less inflammation than the one-step group (p < 0.05). It is concluded that Ca(OH)2 disinfection before obturation of infected root canals results in significantly less periapical inflammation than obturation alone.

Analysis of Variance↗
PubMed1991

Retrograde approaches in endodontic therapy.

The routine use of retrograde fillings during apical surgery, as well as the material of choice for that purpose, have been debated. A retrograde filling is placed so as to seal an infected root canal causing periapical pathosis. Therefore, retrograde root canal fillings should be performed routinely during apical surgery regardless of the apparent technical quality of the root canal obturation, unless orthograde endodontic treatment is performed in conjunction with surgery. When orthograde treatment is not performed, retrograde root canal filling enhances the prognosis of apical surgery. An array of potential retrograde filling materials have been extensively investigated in vitro and in vivo. Once that the biocompatibility of the materials is confirmed a clinical comparison, rather than in vitro sealability studies, is the most valid evaluation method. Some of the difficulties encountered in long term clinical studies in patients may be avoided in animal studies. The review of the relevant literature of the past decade suggests that amalgam used in conjunction with cavity varnish is the retrograde filling material of choice. It must be stressed, however, that retrograde filling is not comparable to debridement and obturation of the entire root canal. Therefore, when the only way to approach the root canal is from the apical direction, rather than placing an apical retrograde filling, a retrograde endodontic treatment of the entire canal should be preferred, if it is feasible.

Apicoectomy↗
PubMedDate not supplied

Comparative evaluation of endodontic management of teeth with unformed apices with mineral trioxide aggregate and calcium hydroxide.

PURPOSE: The purpose of this study was to compare mineral trioxide aggregate (MTA) and calcium hydroxide (Ca(OH)2) for their efficacies and time taken for formation of apical biological calcific barriers and resolution of periapical radiolucencies, if present at baseline, in teeth with unformed apices. METHODS: Twenty nonvital permanent maxillary incisors with unformed apices, stratified according to the size of periapical radiolucencies and stage of root development, were equally allocated to MTA and Ca(OH)2 groups. In group 1 (MTA group), after 7 days of disinfection with Ca(OH)2, MTA was packed into the apical one third of the root canals and obturation with gutta percha (GP) was performed in 90% (9/10) of cases within 15 to 30 days. In group 2 (Ca(OH)2 group), obturation was performed following clinical and radiographic depiction of the apical stop. RESULTS: The mean time taken for apical biological barrier formation was 3 +/- 2.9 months for group 1 and 7 +/- 2.5 months for group 2 (P=.008). The periapical radiolucencies were resolved in 4.6 +/- 1.5 months for group 1 and 4.4 +/- 1.3 months for group 2 (P=.83). The total treatment was completed in 0.75 +/- 0.4859 months and 7 +/- 2.5 months for groups 1 and 2, respectively. CONCLUSION: The 2 materials were found to be equally efficacious in the management of nonvital teeth with unformed apices. Time taken to complete the treatment and the biological barrier formation in group 1 was significantly less than that for group 2. The healing time for periapical radiolucencies was almost identical.

Adolescent↗
PubMed1983

An in vitro study of the comparative effectiveness of obturating curved root canals with gutta-percha cones, silver cones, and stainless steel files.

The quality of apical seal obtained with gutta-percha cones, silver cones, and stainless steel files was assessed in 120 freshly extracted teeth with moderately or severely curved root canals. Teeth were coated with wax, except in the apical foramen area, and immersed in 2 percent methylene blue solution for 48 hours. Apical leakage was quantitated by a linear measurement of the distance that the dye penetrated along the root canal and by a volumetric measurement of the quantity of dye within the root. There was a highly significant (p less than 0.001) correlation between the two measurements. Root canals filled with silver cones showed significantly less apical leakage than those filled with gutta-percha or stainless steel files, regardless of degree of curvature. For both silver cones and stainless steel files, leakage was less in severely curved roots than in moderately curved roots.

Dental Bonding↗