[Treatment and obturation of root canals with necrotic pulp].
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Dental Materials↗
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[Possibilities of root canal filling with gutta-percha. A critical investigation of different techniques].
92 root canal fillings were performed using single guttapercha point with sealer (chloropercha) and lateral condensation of gutta-percha. Neither with single point nor with lateral condensation methods it is possible to achieve advantages in clinical or radiographic success. Nevertheless, the lateral condensation of gutta-percha is a suitable method for beginners to learn the complicated technique of root canal obturation.
Female↗
Management of diffuse tissue argyria subsequent to endodontic therapy: report of a case.
A case of severe mucogingival argyria secondary to leakage around and corrosion of silver cone root canal obturations and apical amalgam restorations is presented. Following removal of the silver points and re-treatment of the root canals, periradicular surgery was performed to remove the amalgam root-end restorations and reduce the amount of dispersed metallic particles in the subcutaneous tissues. Subsequent free gingival grafting created an esthetically pleasing and biologically acceptable result.
Adult↗
The effect of insertion rates on fill length and adaptation of a thermoplasticized gutta-percha technique.
The purpose of this in vivo study was to determine the effect of the insertion rate of a thermoplasticized gutta-percha obturation technique (Thermafil Plus) on the quality of the root canal obturation. A calibrated practitioner obturated the tooth in each of three groups with insertion rates of 18, 6, and 3 mm/s, respectively. The quality of the obturation was assessed by measuring the length of fill and the replication of induced canal irregularities, consisting of dimples and grooves. All measurements were made on a single tooth, with a working length of 18 mm from the canal orifice, embedded in a split mold, with 20 measurements for each insertion rate. Measurements were made under a low-power microscope, with the images recorded on videotape. The length of fill decreased with decreasing the insertion rate, from a mean overextension of +0.88 mm (SD 1.12 mm) for the 18 mm/s rate to a mean underfill of -0.13 mm (SD 1.03 mm) for the 3 mm/s rate. A trend of decreasing fill with decreasing insertion rate was observed, with the difference between the insertion rates of 18 mm/s and 3 mm/s being statistically significant at p < 0.05 using a single comparison test. Replication of dimples decreased with decreasing the insertion rate from a mean reproduction of 99% for the 18 mm/s rate to a mean reproduction of 90% for the 3 mm/s rate. The replication of grooves also decreased with decreasing the insertion rate from a mean reproduction of 100% for the 18 mm/s rate to a mean reproduction of 88% for the 12 mm/s rate. Statistical analysis of the data for both the dimples and the grooves using a paired comparison post hoc Scheffe test found these differences are significant at p < 0.05.
Gutta-Percha↗
Comparison of a warm gutta-percha obturation technique and lateral condensation.
This study was designed to compare a warm gutta-percha obturation technique, Thermafil Plus (Tulsa Dental, Tulsa OK), with lateral condensation for the ability to adapt gutta-percha to the walls of a root canal system. An extracted sectioned and mounted maxillary central incisor had canal irregularities created and was subsequently subjected to multiple obturations using both techniques. Length of fill, replication to working length, number of artificial depressions replicated, quality of replications, number of voids, and general appearance of obturation were all evaluated using standardized criteria. Data evaluation consisted of a one way analysis of variance on the same type defects between obturation groups followed by a Scheffé post-hoc test. A statistically significant difference was found between the groups in each category of evaluation. Gutta-percha using Thermafil was better able to flow into lateral spaces, had fewer voids, and replicated the surface of the root better. It also, however, was extruded out the apical foramen more than in the lateral condensation group.
Analysis of Variance↗
An in vitro study of the coronal leakage of two root canal sealers using an obligate anaerobe microbial marker.
The aim of this in vitro study was to investigate the coronal leakage of obligate anaerobes into root canals obturated with lateral condensation of cold gutta-percha with two root canal sealers. Sixty extracted human teeth with straight, single root canals were prepared using the modified double-flared technique with balanced force under copious irrigation until the master apical file was size 40. The teeth were divided randomly into experimental groups (40 teeth) and control groups (20 teeth). In the experimental groups, 20 teeth were obturated with lateral condensation of cold gutta-percha and AH26 sealer and 20 teeth were obturated with the same technique using TubliSeal EWT sealer. In the control groups, 10 teeth were obturated with the same technique either with AH26 or TubliSeal EWT sealer. These teeth were completely sealed to serve as negative controls. The remaining 10 teeth were not obturated and served as positive controls. The root surface of each tooth was sealed with nail varnish except the apical 2 mm. The coronal part of each root canal was sealed with the cut end of polypropylene tube and placed in a glass bottle containing sterile Fastidious Anaerobe Broth (FAB). Aliquots of 0.5 mL of FAB were injected into the polypropylene tube and the model system was centrifuged at 168 g. An inoculum of Fusobacterium nucleatum in FAB was placed in each coronal chamber at 7-day intervals and daily observations were made for bacterial growth in the apical reservoir for 12 weeks. All positive control teeth showed bacterial leakage within a week, while the negative control teeth remained uncontaminated throughout the test period. All the experimental teeth exhibited leakage of bacterial metabolites within 12 weeks, ranging from 1 to 12 weeks. The mean time for complete leakage in the AH26 and the TubliSeal EWT groups was 8.4 and 8.2 weeks respectively. There was no statistically significant difference (P > 0.05) in leakage between the AH26 and the TubliSeal EWT groups.
Bismuth↗
Sonic and ultrasonic methods in endodontics: a clinical point of view.
The cleanliness of the root canal space depends more upon the root canal morphology than on the technique used for preparation. Sonic and ultrasonic devices can be useful systems to help facilitate several steps in endodontic therapy. These are: instrumentation of the coronal and middle thirds, instrumentation of ribbon-shaped canals, removal of foreign obstructions and obturation of the root canal space.
Foreign Bodies↗
[Long term evaluation of results of endodontic treatments of dental pulp necrosis (74 cases obturated by the monoconal technique].
Various factors may affect the outcome of root canal therapy. In this study 74 endodontocally treated pulpless teeth were evaluated: (43 with periapical radiolucency and 31 without periapical lesions). These 74 non surgical treatment were performed in 60 patients (26 men and 34 women) by undergraduated students. The overall success rate was 71.62%; the rate of success for cases with no periapical radiolucency exceeded 80% whereas only 62.8% of the cases with perapical radiolucency had undergone partial resolution or complete resolution. Only 17.1% of lesions demonstrated complete radiographic resolution 12 to 16 months after the endodontic treatment. Reasons that may explain the low success rate are lake of asepty, root canal preparation and root canal filling technique.
Dental Pulp Necrosis↗
Apical limit of root canal instrumentation and obturation, part 1. Literature review.
One of the major controversies in root canal therapy concerns the apical limit of instrumentation and obturation. The results of longitudinal prognostic studies, basic anatomical knowledge of the apical third of the root canal, and the histological pulp reaction to caries progression demonstrated the presence of a vital apical pulp remnant, even in the presence of a periapical lesion. Finally necrosis and bacteria establish themselves in the periapical lesion. All valid prognosis studies confirm the practice of staying short of the apex with a homogeneous obturation to obtain the highest success rate of 90-94% (when done by or under supervision of specialists; results in the general population had a failure rate greater than 50%). The location of the apical foramen(ina) related to root canal treatment most frequently ends short of the apex, often by several millimetres.
Dental Pulp↗
[Techniques of obturation: critical analysis].
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Humans↗
The effect of variation in thermomechanical compaction techniques upon the quality of the apical seal.
The purpose of the present study was to assess the effect of compactor design, alterations in rotational speed and modification to the basic technique of thermomechanical compaction on the quality of the apical seal produced by gutta-percha and sealer cement. The integrity of the apical seal achieved using two different configurations of compactor, rotational speeds of 8000 and 16,000 rev/minute and a hybrid technique which combined thermomechanical compaction with lateral condensation were compared with conventional lateral condensation. The same brand of gutta-percha and type of sealer were used throughout the investigation. A cleared tooth technique that allowed the three-dimensional assessment of Indian ink leakage was employed. Instrument fracture, a problem experienced in some other investigations, did not occur with either design of compactor used. Apical dye leakage was found to be a relatively frequent occurrence with each variation in obturation technique studied, including that of lateral condensation of cold gutta-percha and sealer. The results showed no significant difference in the mean degree of leakage for each of the groups or in the proportion of specimens that showed leakage (P greater than 0.1). The advantages of the hybrid method of root canal obturation were discussed.
Equipment Design↗
Dentin wall adaptation of multiphase versus temperature thermoplasticized gutta-percha. A scanning electron microscopic study.
An in-vitro study was designed to compare dentin wall adaptation of Multiphase gutta-percha root canal obturation technique versus high temperature thermoplasticized gutta-percha (Obtura) in the presence and absence of smear layer. Forty single rooted teeth with straight canals were used. After decapitation roots were divided into two equal groups. Group (I) received final irrigation with EDTA and Sodium hypochlorite (NaOCI) to remove the smear layer, while roots in Group (II) were irrigated with NaOCI alone. Each group was then subdivided into two subgroups to represent the two filling techniques. Teeth were sectioned longitudinally and viewed under scanning electron microscope. Multiphase gutta-percha showed excellent adaptation to canal wall, specially in the absence of smear layer and displayed a homogeneous mass with little amount of voids than the Obtura system.
Dental Marginal Adaptation↗
Surface debris of canal walls after post space preparation in endodontically treated teeth: a scanning electron microscopic study.
PURPOSE: To evaluate surface cleanliness of root canal walls along post space after endodontic treatment using 2 different irrigant regimens, obturation techniques, and post space preparation for adhesive bonding. STUDY DESIGN: Forty teeth, divided into 4 groups, were instrumented, using Ni-Ti rotary files, irrigated with NaOCl or NaOCl+EDTA and obturated with cold lateral condensation (CLC) or warm vertical condensation (WVC) of gutta-percha. After post space preparation, etching, and washing procedure, canal walls were observed using a scanning electron microscope (SEM). Amount of debris, smear layer, sealer/gutta-percha remnants, and visibility of open tubules were rated. RESULTS: Higher amounts of rough debris, large sealer/gutta-percha remnants, thick smear layer, and no visibility of tubule orifices were recorded in all the groups at apical level of post space. At middle and coronal levels areas of clean dentin, alternating with areas covered by thin smear layer, smaller debris, gutta-percha remnants, and orifices of tubules partially or totally occluded by plugs were frequently observed. CONCLUSIONS: After endodontic treatment, obturation, and post space preparation SEM analysis of canal walls along post space shows large areas (covered by smear layer, debris, and sealer/gutta-percha remnants) not available for adhesive bonding and resin cementation of fiber posts.
Acid Etching, Dental↗
The effect of immediate versus delayed cementation on the retention of different types of fiber post in canals obturated using a eugenol sealer.
Post can be placed immediately after the completion of the endodontic procedure or at a later stage after setting of the sealer. In this in vitro study, post space preparation and post cementation were performed immediately (group 1), 24 h (group 2), and 7 days (group 3) after root filling. A control group with no root canal obturation was included (group 4). Each group was further divided into three subgroups, according to the post type and to the materials used for luting the post. A push-out test was performed to evaluate post-root canal dentin interfacial strength. Differences among experimental groups were analyzed with two-way ANOVA and the Tukey test. Significant differences (p < 0.05) in interfacial strengths were observed for the factors post cementation interval and post type. Clinicians should be careful in performing immediate cementation of fiber posts, as delayed cementation shows higher post-dentin interfacial strengths irrespective of the post type.
Analysis of Variance↗
Lateral condensation in canals prepared with nickel titanium rotary instruments: an evaluation of the use of three different master cones.
Forty-five single-rooted teeth were instrumented with ProFile ISO .06 nickel-titanium rotary instruments and obturated with lateral condensation using three different master cones: an ISO-standardized gutta-percha cone (group A), a Dia-ISO(GT).06 gutta-percha cone (group B), and a size medium gutta-percha cone (group C). Obturation efficiency in each group was evaluated by recording the number of accessory cones utilized. To evaluate obturation quality in the three groups, a cross-sectional observation of the ability of the gutta-percha in each group to obliterate the prepared canal space was carried out. Results showed that obturation efficiency was significantly greater in groups B and C than in group A. There was no significant difference in obturation quality between any of the three groups.
Analysis of Variance↗
Calibrated latex microspheres percolation: a possible route to model endodontic bacterial leakage.
Endodontic therapy is conducted to effectively seal the root canal system. In vitro methods are used to estimate the quality of the seal, generally by measuring any microleakage that allows the tracers to penetrate along the obturated root canal. The use of bacteria as tracers seems to give the most clinically relevant demonstration of microleakage associated with a root canal system. Many bacterial strains have been used to evaluate marginal leakage, but results are sometimes contradictory, probably because they may depend on the bacterial strain used. In the studies described in this article, the percolation of both calibrated latex microspheres equivalent in diameter (0.4-9.5 microm) to bacteria and three bacterial strains (Actinomyces odontolyticus, Lactobacillus acidophilus, and Pseudomonas fluorescens) was compared in teeth filled using noncompressive and compressive techniques. The depth (d) to which the microspheres and bacteria penetrated varied over the time (t) of contamination according to a logarithmic relation. The slope (S) and the intercept (I, corresponding to penetration after 1 month) of the d = f(In t) plots can serve to quantify penetration over time. Statistical analysis of I by the Newman-Keuls procedure, which couples the tracers and filling techniques, showed that A. odontolyticus and L. acidophilus behave like 4.8-microm particles and P. fluorescens like 2.2-microm particles (corresponding approximately to their size in length) and that noncompressive techniques are less hermetic than compressive techniques. S and I are in direct relation and this relation is independent of the filling technique. Moreover, for the calibrated particles, both I and S varied linearly with the inverse of the square root of the particle diameter, indicating that their displacements are governed solely by Brownian movements and the penetration over time is caused by diffusion phenomena. The size of the tracer is the predominant factor governing its penetration. Inert particles mimic bacterial percolation into the marginal hiatus and can thus be used to model this percolation and establish a relative scale of the behavior of different bacteria during percolation.
Actinomyces↗
A study of endodontic treatment carried out in dental practice within the UK.
AIM: The purpose of this study was to gather both qualitative and quantitative information on the nature of root canal treatment carried out by a group of dentists working within the United Kingdom. METHODOLOGY: A two-part questionnaire was posted to 720 dentists who graduated from the Dental School, Cardiff, Wales, UK. The first part requested basic information regarding age, year of qualification, field of practice, etc. The second part consisted of 15 questions on endodontic practice and root canal treatment. RESULTS: The response rate was 41.5%. Two hundred and ninety-nine questionnaires contained useful information. The majority of practitioners did not use rubber dam during root canal treatment. The vast majority (89%) exposed a radiograph with an instrument of known length in situ to gauge the 'working length', a small number relied upon tactile sensation. Most practitioners used local anaesthetic solution as an irrigant during instrumentation of the root canal. A wide variety of instruments were used for root canal treatment; a stepback technique was preferred by almost half the practitioners. Antiseptic solution was preferred as an interappointment dressing. More than half of the respondents used laterally condensed gutta-percha to obturate root canals in anterior teeth but only one-third used the same technique in posterior teeth. Less than half the respondents exposed a radiograph to check the fit of the master point prior to obturation. Two-thirds of practitioners used a zinc oxide based material as their root canal sealer. Three-quarters of the practitioners exposed a post obturation radiograph. CONCLUSIONS: The results of this study suggest that although some dentists are using the techniques taught during their undergraduate careers, a large percentage now use techniques with no evidence of clinical effectiveness.
Adult↗
Influence of smear layer on the coronal leakage of Thermafil and laterally condensed gutta-percha root fillings with a glass ionomer sealer.
The effect that two methods of root canal obturation, combined with removal of the smear layer, had on coronal leakage was studied in vitro. Single-rooted teeth with mature apices were prepared chemomechanically and divided into two groups of 72 teeth each. One of the groups was treated with 40% citric acid and 2% sodium hypochlorite to remove the smear layer. The teeth were then subdivided and obturated using the glass ionomer sealer, Ketac Endo and either lateral condensation or Thermafil. After storage for 7 days or 4 months, the specimens were evaluated for coronal leakage using Indian ink. After 90 h, each root was split longitudinally and the maximum extent of leakage was measured using a stereomicroscope at x6 magnification. After 7 days, there was significantly less leakage in those teeth obturated with Thermafil without smear layer compared with the other groups (p < 0.05). After 4 months, there was no significant difference in leakage between the groups (p > 0.05).
Dental Leakage↗