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PubMed2000

Effectiveness of ProFile .04 taper rotary instruments in endodontic retreatment.

This study investigated the retreatment effectiveness of .04 Taper nickel-titanium rotary ProFiles. Thirty extracted single-rooted anterior teeth were instrumented and obturated with gutta-percha/Roth's Sealer using lateral condensation. They were distributed into three groups of 10 each. Retreatment for group A was done using Profile alone, group B using Profile and chloroform, and group C using hand files with chloroform. The teeth were then split longitudinally into halves. The remaining gutta-percha/sealer on the root canal wall in the cervical, middle, apical thirds, and the whole canals were visually scored with the aid of light microscopes. The results showed that the mean scores in groups A and B were generally lower (better) than group C. Mean scores of the apical thirds tended to be higher (worse) than the middle and the cervical thirds, except in group A. ProFile with or without chloroform seemed to be a viable alternative retreatment method.

Analysis of Variance↗
PubMed2000

Effect of using electronic apex locators on selected endodontic treatment parameters.

The purpose of this study was to determine the effect of using electronic apex locators on the number of radiographs taken and the adequacy in length of the final obturation. Patients in an undergraduate student endodontics clinic participated in the study. The working length (WL) was estimated by the authors for all cases (36 teeth; 58 canals), using both a preoperative standardized radiograph and an electronic measurement. The students were then asked to place WL files to one of the estimates (electronic or radiographic; chosen by random assignment) and take a WL radiograph. Neither the students nor their instructors knew which method was chosen for the estimates. Once treatment was completed, the total number of working radiographs was counted. The number of cases with acceptable (0 to 2 mm short of the apex) or unacceptable obturation was also blindly registered. An electronic estimate of the WL improved length quality of the final obturation, compared with a radiographic estimate. The number of working radiographs taken was less in the electronic apex locator group in anterior and premolar teeth, but not in molars.

Adult↗
PubMed1998

Rubber latex allergy and the endodontic patient.

Increasingly, patients with rubber latex allergy are being seen in dental offices. Health care workers, persons allergic to certain foods and those with certain medical histories are potentially latex-sensitive. This article presents the case of a patient with a history of severe rubber latex allergy and the associated management of an endodontically involved tooth. The possibility of the latex allergic patient being sensitive to gutta-percha obturation material is also raised.

Adult↗
PubMed2003

Endodontic infection: some biologic and treatment factors associated with outcome.

OBJECTIVE: We sought to investigate the simultaneous effect of apical periodontitis, instrumentation level, and density of root canal filling on endodontic treatment outcome. METHODS: For this study, 200 endodontically treated teeth with 441 roots were used. A follow-up examination was conducted 4 +/- 0.5 years postoperatively. Data were subjected to univariate and multivariate analysis. RESULTS: Periapical pathosis had the strongest effect on treatment outcome (P <.0001). The instrumentation level (mean +/- SEM of the working length) for successfully treated teeth/roots with normal preoperative pulp and periapex was farther away from the radiographic apex (1.23 +/- 0.13 mm) than for teeth/roots with an unsuccessful outcome (0.20 +/- 0.09 mm; P <.005). However, successfully treated teeth/roots with pulp necrosis and apical periodontitis had working length levels closer to the radiographic apex (0.55 +/- 0.12 mm) than did teeth/roots with unsuccessful outcomes (1.73 +/- 0.30 mm; P<.001). In teeth/roots with apical periodontitis, a millimeter loss in working length increased the chance of treatment failure by 14%. The risk of failure was higher for a fair/poor density of obturation than for a good density for all diagnoses of periradicular status. CONCLUSION: Diseased periapex, level of working length relative to the radiographic apex, and fair/poor density all affect the outcome of endodontic treatment.

Analysis of Variance↗
PubMed2001

Analysis of the endogrammes developed during obturations on extracted teeth using system B.

The ability of an obturation technique to fill the root canal system tridimensionally depends partially on the timing and intensity of force applications. The aim of this study was to use the Endographe to analyze the forces and wedging effects developed in the root canal using a new obturation technique: System B. This system uses a heat plugger that simultaneously heats and pushes gutta-percha. The plugger was used to soften and move the gutta-percha apically during the down-pack stage. Two different methods, however, were used to withdraw the plugger from the compacted gutta-percha. One used the burst heat method, and the other was cold withdrawal. Five endodontists performed 50 obturations of prepared extracted teeth and 50 obturations of the "wedging effect" holder of the Endographe. The practitioner-obturation assignment was randomized. For each obturation the biggest plugger possible in relationship to the shape of the canal was chosen. For the obturation of the special holder the same tip was chosen. Endogrammes showed the force application and wedging effect sequences. The mean values for the vertical and horizontal forces and the wedging effect were, respectively, 16 +/- 2 N, 5 +/- 1 N, and 9 +/- 1 N. These results suggest that System B is one of the best techniques in terms of the developed vertical forces (low values) and the resulting wedging effect (high values) in relationship to the plasticity of the gutta-percha. The Endogrammes provide a new approach to the analysis of obturation techniques and a means to demonstrate correct and optimal manipulation of the new System B plugger.

Analysis of Variance↗
PubMed2000

The effect of root canal preparation on microleakage within endodontically treated teeth: an in vitro study.

AIM: The purpose of this study was to evaluate the effects of smear layer and canal instrumentation on leakage in root-filled teeth. METHODOLOGY: Six groups (n = 12) of freshly extracted human canines and premolars with closed apices and single roots were used. Groups A, B, C, and D were instrumented with engine-driven rotary nickel-titanium MCXIM files and Groups E and F were instrumented with conventional stainless steel hand files. Groups A, C, and E were flushed with 3.0 mL of 17.0% REDTA to remove the smear layer prior to obturation. All teeth were flushed with 5.25% NaOCl, then obturated with AH-26 sealer and either the lateral condensation (Groups C-E) or thermomechanical compaction technique (Groups A and B). Copper wire was placed coronally in contact with the gutta-percha in each tooth and, after immersion in 0.9% NaCl solution, a 10 volt dc voltage was connected between each tooth and a stainless steel electrode. The current flow in the circuit was observed for 45 days. One way ANOVA and Duncan's Multiple Range Test were used to compare Groups A-F at time intervals of 10, 20, 30 and 45 days and identify statistically significant differences. RESULTS: Significantly less microleakage occurred when the smear layer was removed and when the canals were obturated with thermoplasticized gutta-percha. Canals instrumented with engine-driven NiTi files exhibited less leakage than hand-instrumented canals irrespective of obturation method. CONCLUSIONS: Smear layer removal is beneficial to root canal sealing. Obturation with thermoplasticized gutta-percha provides a superior seal whilst canal instrumentation with engine-driven NiTi files reduces the extent of microleakage in root canals.

Analysis of Variance↗
PubMed2004

Apical extrusion of thermoplasticized obturating material in canals instrumented with Profile 0.06 or Profile GT.

The purpose of this in vitro study was to compare the extrusion of thermoplacticized gutta-percha in teeth instrumented with Profile 0.06 or Profile GT, and obturated with Thermafil Plus and Thermafil GT, respectively. A total of 120, extracted, human maxillary central incisors were divided into four equal groups. Group 1 was instrumented with Profile 0.06 and obturated with Thermafil Plus. Group 2 was instrumented with Profile 0.06 and obturated using warm vertical condensation (negative control). Group 3 was instrumented with Profile GT and obturated with Thermafil GT. Group 4 was instrumented with Profile GT and obturated like Group 2 (negative control). Extrusion was graded as present or absent. Results found 9 of 30 extruded for group 1, 1 of 30 for group 2, 15 of 30 for group 3, and 2 of 30 for group 4. The results suggest that, in vitro, Thermafil GT may be more prone to extruding gutta-percha past the apical foramen than Thermafil Plus.

Chi-Square Distribution↗
PubMedDate not supplied

Cross-sectional assessment of apical dye penetration following clinical simulation of various endodontic techniques.

This study compared apical leakage in mesial roots of mandibular molars that resulted from three different instrumentation/obturation techniques performed in a simulated clinical setting: hand instrumentation by nickel-titanium files followed by cold lateral condensation of gutta-percha/sealer; rotary instrumentation followed by the Microseal system of obturation with softened gutta-percha; and rotary instrumentation followed by obturation with the Thermafil system. Lateral condensation generally was measured superior to the Thermafil method for preventing apical dye penetration while no consistent statistical differences were seen between the lateral condensation and Microseal groups.

Analysis of Variance↗
PubMed2006

Comparison of clinical outcomes using a nickel titanium rotary or stainless steel hand file instrumentation technique.

The purpose of this study was to evaluate the concept that novice clinicians could perform clinical endodontics better and more efficiently if the stainless steel hand file technique is replaced with a nickel titanium rotary file technique. In phase 1 of the study, every endodontic case performed by 2 groups was evaluated for total treatment time. In phase 2, the mesial roots of mandibular molars were evaluated for radiographic quality of completed obturation. The authors found that when the rotary file technique was substituted for the hand file technique, appointment time for case completion was significantly decreased (P<.001) and overall radiographic quality of mandibular molar mesial root obturation was significantly increased (P=.0009). These results support the hypothesis that novice clinicians can perform endodontic therapy more efficiently when using a nickel titanium rotary file technique. In addition, no differences were noted in the incidence of file fracture when using rotary instruments.

Chi-Square Distribution↗
PubMed2002

An in vitro study of coronal microleakage around bonded amalgam coronal-radicular cores in endodontically treated molar teeth.

OBJECTIVE: The aim of this study was to compare the coronal microleakage of conventional and bonded amalgam coronal-radicular (Nayyar) restorations on endodontically treated molar teeth, because coronal seal is a major factor in the long-term success of endodontic treatment. METHOD AND MATERIALS: Forty extracted human molar teeth were root-filled and prepared for coronal-radicular amalgam restorations. Four groups of 10 teeth were restored with Tytin amalgam and Vitrebond, Superbond D Liner II, Panavia 21, or no adhesive agent. The teeth were placed in India ink for 1 week, and then demineralized and rendered transparent. The ink penetration was assessed with a coded scoring system. RESULTS: The bonded amalgam groups produced significantly less leakage than did the nonbonded group. No statistically significant differences in leakage were detected among the bonded amalgam groups. CONCLUSION: To prevent the reinfection of the endodontically treated molar, it may be preferable to restore the tooth immediately after obturation by employing a bonded amalgam coronal-radicular technique.

Boron Compounds↗
PubMed2002

Comparison of the apical seal obtained by a dual-cure resin based cement or an epoxy resin sealer with or without the use of an acidic primer.

This study compared the apical leakage of roots obturated with gutta-percha using either a dual-cure resin based cement (Panavia F) or an epoxy-resin sealer (Thermaseal plus) with or without the application of an acidic primer (ED Primer). Eighty-six single rooted canine teeth were decoronated, cleaned, and shaped by using hand and rotary instruments, randomly divided into four groups, and obturated as follows: group A (n = 20): ED Primer applied followed by thermoplastized obturation with gutta-percha and Thermaseal Plus sealer; group B (n = 20): thermoplastized obturation with gutta-percha and Thermaseal Plus; group C (n = 20): ED primer applied followed by thermoplastized obturation with gutta-percha and Panavia F; group D (n = 20): thermoplastized obturation with gutta-percha and Panavia F. Both a negative control (n = 3; entire root coated with wax) and a positive control (n = 3; obturated with only a fitted master cone) were included in the study. Groups A, B, C, D, and the controls were immersed in molten sticky wax, leaving the apical 2-mm exposed, and quickly chilled. All teeth were immersed in 1% methylene blue dye solution for 10 days, rinsed, and sectioned longitudinally. Apical dye penetration was measured stereomicroscopically at 10-fold magnification. The analysis of variance and Duncan Multiple Range were used for result analysis. The specimens obturated with gutta-percha and an epoxy-resin sealer (with or without an acidic primer) demonstrated significantly less linear dye penetration than specimens obturated with gutta-percha and the dual-cure, resin-based cement (with or without an acidic primer).

Analysis of Variance↗
PubMed1991

In vitro evaluation of four methods of sealer placement.

Sealer is required during root canal obturation, although no studies have shown which method of sealer placement provides the best coverage. This study evaluated and compared four methods of sealer placement: file, lentulo spiral, ultrasonic files, and master gutta-percha cone. Forty mandibular incisors were prepared by a step-back technique. AH26 (0.04 ml) was applied to the placement device, the sealer was placed in the canal, and the canal was obturated with lateral condensation of gutta-percha. The specimens were cleared and evaluated for the presence of the sealer in the apical, middle, and coronal thirds of the canal. The results showed no statistically significant differences among the four groups. The greatest variation in sealer coverage was found in the apical level. Sealer coverage in the coronal and middle thirds was nearly identical regardless of sealer placement technique.

Bismuth↗
PubMed2000

Radiation dose reduction during endodontic therapy: a new technique combining an apex locator (Root ZX) and a digital imaging system (RadioVisioGraphy).

This study was undertaken on 14 teeth in order to evaluate a new technique for radiation dose reduction during endodontic therapy. After examination of the preoperative film, usually available in the patient file, an apex locator (Root ZX) was used to measure the working length. Complete chemomechanical debridement was then performed, and the master cone was evaluated by a digital imaging system (RadioVisioGraphy (RVG)). Obturation was performed when measurements of the electronic device and RVG were comparable. A postoperative image was made by the RVG system to evaluate the final obturation. A clinical and radiographic follow-up examination (follow-up period: 6 to 8 months) revealed satisfactory apical healing. These results indicated that a successful obturation technique can be performed by a single radiation exposure, using the RVG unit for master cone evaluation. This technique may be useful in medically compromised patients who need not to be exposed to excessive or repeated radiation during endodontic therapy.

Bismuth↗
PubMed2002

Microscopic removal of dens invaginatus.

Endodontic treatment for teeth that exhibit the dental anomaly, dens invaginatus, can be difficult due to the bizarre anatomy and relative inaccessibility of the diseased pulp tissue. Surgical intervention or extraction are common approaches to dealing with this condition. This article reports the treatment of an extreme form of dens invaginatus, employing the dental-operating microscope and the ultrasonic instrument. Removal of the entire anomalous structure and pulp tissue was possible, and conventional orthograde obturation was accomplished. Two and 4-yr follow-up radiographs show that healing has occurred. The article demonstrates that the anomalous structure of dens invaginatus is a separate entity from the rest of the tooth. This implies that in many instances it may be entirely removed to facilitate conventional endodontic therapy.

Child↗
PubMed2002

Relationship between crown placement and the survival of endodontically treated teeth.

STATEMENT OF PROBLEM: Crowns have been considered the restoration of choice for endodontically treated teeth, but their selection has been based primarily on anecdotal evidence. PURPOSE: This study tested the hypothesis that crown placement (coronal coverage) is associated with improved survival of endodontically treated teeth when preaccess, endodontic, and restorative factors are controlled. MATERIAL AND METHODS: A University of Iowa College of Dentistry treatment database was used to identify permanent teeth that had undergone initial obturation between July 1, 1985, and December 31, 1987. Study patients were restricted to persons with at least 1 dental visit in each 2-year interval from 1985 to 1996; a simple random sample of 280 patients (n = 400 teeth) was selected. Dental charts, radiographs, and computerized databases were examined to ascertain variables of interest and to verify study inclusion criteria. Kaplan-Meier survival estimates were generated for the 203 teeth that satisfied study inclusion criteria. Multivariate Cox proportional hazards regression models were developed, with standard errors adjusted to account for clustering of teeth within patients. RESULTS: When tooth type and radiographic evidence of caries at access were controlled, the final Cox model showed that endodontically treated teeth not crowned after obturation were lost at a 6.0 times greater rate than teeth crowned after obturation (95% confidence interval: 3.2 to 11.3). CONCLUSION: Within the limitations of this study, a strong association between crown placement and the survival of endodontically treated teeth was observed. These results may impact treatment planning if long-term tooth retention is the primary goal.

Aged↗
PubMed2001

Effect of ultrasonic vibration and various sealer and cement combinations on titanium post removal.

The purpose of this study was to determine the effect of ultrasonic vibration on the force required to remove prefabricated posts. Ninety-six extracted human canines were divided into eight groups, which were prepared and obturated with gutta-percha and either a eugenol-containing (Roth's 801 Elite) or eugenol-free (AH26) sealer. Titanium #6 Parapost XH posts were cemented with either zinc phosphate or Panavia 21 resin cement. One half of the sample was subjected to ultrasonic vibration for 16 min at the post-dentin interface, whereas the other half received no vibration (controls). Each combination of sealer, cement, and vibration status was subjected to tensile load to failure using an Instron testing machine. Posts cemented in teeth obturated with gutta-percha and AH26 sealer demonstrated significantly greater resistance to dislodgement, compared with teeth obturated with gutta-percha and Roth's 801 Elite sealer. There was no statistical difference in retention of posts cemented with either zinc phosphate or Panavia 21, regardless of the sealer used. Additionally ultrasonic vibration increased post retention for both cements.

Analysis of Variance↗
PubMed2001

Comparison of laterally condensed .06 and .02 tapered Gutta-Percha and sealer in vitro.

The purpose of this in vitro study was to compare the quality of the seal in canals prepared in a standardized manner and obturated with a .06 or a .02 tapered gutta-percha master cone using lateral condensation. Forty-four extracted human anterior teeth with single, straight canals were divided into two experimental groups of 20 teeth each and two control groups of 2 teeth each. The teeth were instrumented with Series 29 Profile .06 tapered rotary nickel-titanium files to a master apical file of 0.46 mm. Teeth in group 1 were obturated with a .02 tapered master gutta-percha cone and Roth 801 sealer using lateral condensation. Teeth in group 2 were obturated similarly, except a .06 tapered master gutta-percha cone was used. The depth of spreader penetration was recorded in millimeters. Positive control teeth were instrumented but not filled. Negative control teeth were instrumented, obturated, and externally sealed. The teeth were placed into a coronal leakage apparatus that contained an upper and lower reservoir of trypticase soy broth separated by the tooth. A 24-h growth of Proteus vulgaris in 0.25 ml of trypticase soy broth was placed in the coronal reservoir every 7 days for 70 days and incubated at 37 degrees C. Student's t test was used to determine whether there was a difference in spreader penetration between the groups, and a Fisher's exact test was used to determine whether there was a difference in bacterial leakage. The positive and negative controls validated the testing model. When a .02 tapered master cone was used, the spreader penetrated significantly closer to working length than when a .06 tapered master cone was used (p < 0.05). The difference between the groups in the number of samples that demonstrated complete bacterial penetration was not significant (p > 0.05).

Chi-Square Distribution↗
PubMed1994

Apical seal of teeth obturated by the laterally condensed gutta-percha, the Thermafil plastic and Thermafil metal obturator techniques after post space preparation.

This in vitro study was conducted to determine the effect of post space preparation on teeth obturated with the Thermafil technique, both plastic and metal carriers, and the lateral condensation method. Three groups of 30 teeth each were obturated using the lateral condensation technique and the Thermafil plastic and metal techniques. Post space preparations were accomplished on the obturated groups. All specimens were submerged in India ink under a vacuum for 15 min and then soaked for an additional hour at atmospheric pressure. The teeth were decalcified and cleared to permit visualization and measurement of the extent of dye penetration. There was approximately three times more dye penetration in group 2 (plastic carrier) when compared with group 1 (lateral condensation) and group 3 (metal carrier). This was statistically significant at the 99% confidence level.

Analysis of Variance↗