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Vertical root fracture resistance and dentinal crack formation of root canal-treated teeth instrumented with different nickel-titanium rotary systems: an in-vitro study

Lin GSS, Singbal KP, Noorani TY, Penukonda R

Odontology, 2022 Jan;110(1):106-112.
PMID: 34269933 DOI: 10.1007/s10266-021-00643-y

To compare the vertical root fracture (VRF) resistance of root canal-treated teeth instrumented with four different nickel-titanium (NiTi) rotary file systems and examine the dentinal crack pattern and direction using a new classification. Eighty mature mandibular premolars were selected and decoronated, leaving 13 mm of the root. The root samples were mounted in acrylic resin and divided randomly into five groups of different NiTi file systems: Group 1-control, Group 2-T-Pro, Group 3-HyFlex CM, Group 4-TG6 and lastly Group 5-ZenFlex. Samples in Group 2 and Group 3 were instrumented up to size 25/0.04, whereas Group 4 and Group 5 were instrumented up to size 25/0.06. Obturation was performed with AH Plus sealer and gutta-percha using single cone technique. Subsequently, all samples were subjected to occlusal compressive force until they were fractured. The force (N) needed to cause root fracture was recorded. The crack patterns and directions were also inspected under magnification and classified using a new and simple classification. The highest (VRF) resistance was noted in the control group (453.15 ± 92.23 N), followed by T-Pro (387.43 ± 76.81 N), HyFlex CM (381.88 ± 52.73 N), ZenFlex (369.15 ± 89.41 N) and finally TG6 (346.05 ± 72.08 N), but there was no significant difference between T-Pro and HyFlex (P = 0.438). A significantly higher prevalence (P = 0.001) of Type 1 crack pattern was observed, especially in samples instrumented with TG6. Majority of the cracks ran buccolingually except in some samples instrumented with ZenFlex (P = 0.898). Smaller file taper increased the VRF resistance of root canal-treated teeth. Majority of the dentinal crack exhibited Type 1 pattern and ran buccolingually.

Matched MeSH terms: Root Canal Preparation
Gaining access through a calcified pulp chamber: a clinical challenge

Ngeow WC, Thong YL

Int Endod J, 1998 Sep;31(5):367-71.
PMID: 9823142

Dental pulp is prone to dystrophic mineralization; this mineralization can be so extensive that the entire root canal system is obliterated. As a result, root canal treatment can become a difficult if not impossible task. This article presents the endodontic management of a tooth with an obliterated pulp chamber and associated with a discharging sinus in a teenage patient. The role of a calcium hydroxide lining to induce mineralization and cause the obliteration of the pulpal space is also discussed.

Matched MeSH terms: Root Canal Preparation/methods*
Fulltext Comparative evaluation of Sapindus Mukorossi extract with 17% EDTA on smear layer removal in various parts of the tooth root

Farooq A, Bilgrami A, Faraz SA, Qazi FUR, Maqsood A, Altamash S, et al.

J Appl Biomater Funct Mater, 2023;21:22808000231166210.
PMID: 37029505 DOI: 10.1177/22808000231166210

OBJECTIVES: This study aimed to compare the effectiveness of an experimental root canal irrigant and 17% Ethylene-di-amine tetra acetic acid for removal of the smear layer in the coronal, middle and apical portions of the root canal.
MATERIALS AND METHODS: Ninety human single rooted maxillary and mandibular teeth were selected for this study. The teeth were randomly divided into two experimental groups and one control group as follows: Group A (Ethanolic extract of Sapindus Mukorossi), Group B (17% EDTA), and Group C (Distilled water). The root canals of all three groups were prepared with stainless steel K-files by means of the standard step-back technique and irrigated with 5.25% sodium hypo chloride. The teeth were decoronated, following the irrigation and divided longitudinally into two-halves and visualized using scanning electron microscope (SEM) for the amount of smear layer present utilizing the three-point score system. The observations were noted both before and after the treatment. Nonparametric tests were applied for the comparison and p-value ⩽ 0.05 was considered as statistically significant.
RESULTS: It was evident from that smear layer was completely removed in coronal portion of 27 out of 30 teeth in-group A. For middle and apical areas of group A, 24 and 19 teeth showed complete smear layer removal. In-group B it was found that there were 24, 21, and 3 teeth at coronal, middle and apical, areas respectively where smear layer were completely absent. Intra group comparison showed a significant difference (p = 0.002) in smear layer removal was found for group A at coronal, middle and apical thirds. Similarly, a significant difference (p = 0.001) was also found for group B; however heavy smear layer was found among the three parts of the canal for group C.
CONCLUSIONS: Ethanolic extract of Sapindus Mukorossi have higher effectiveness in removing the smear layer from the root canal in comparison to 17% EDTA.

Matched MeSH terms: Root Canal Preparation/methods
Multidisciplinary treatment approach to restore deep horizontally fractured maxillary central incisor

Patil PG, Nimbalkar-Patil SP, Karandikar AB

J Contemp Dent Pract, 2014 Jan 1;15(1):112-5.
PMID: 24939276

This case report demonstrates sequential periodontic, orthodontic and prosthodontic treatment modalities to save and restore deep horizontally fractured maxillary central incisor. The location of fracture was deep in the mucosa which reveals less than 2 mm of tooth structure to receive the crown. The procedures like surgical crown lengthening, endodontic post placement, orthodontic forced eruption, core build-up and metal-ceramic crown restoration were sequentially performed to conserve the fractured tooth. Forced eruption is preferred to surgical removal of supporting alveolar bone, since forced eruption preserves the biologic width, maintains esthetics, and at the same time exposes sound tooth structure for the placement of restorative margins.

Matched MeSH terms: Root Canal Preparation/methods
A computational simulation study on the acoustic pressure generated by a dental endosonic file: effects of intensity, file shape and volume

Tiong TJ, Price GJ, Kanagasingam S

Ultrason Sonochem, 2014 Sep;21(5):1858-65.
PMID: 24735986 DOI: 10.1016/j.ultsonch.2014.03.024

One of the uses of ultrasound in dentistry is in the field of endodontics (i.e. root canal treatment) in order to enhance cleaning efficiency during the treatment. The acoustic pressures generated by the oscillation of files in narrow channels has been calculated using the COMSOL simulation package. Acoustic pressures in excess of the cavitation threshold can be generated and higher values were found in narrower channels. This parallels experimental observations of sonochemiluminescence. The effect of varying the channel width and length and the dimensions and shape of the file are reported. As well as explaining experimental observations, the work provides a basis for the further development and optimisation of the design of endosonic files.

Matched MeSH terms: Root Canal Preparation
Fulltext Accessory roots in maxillary molar teeth: a review and endodontic considerations

Ahmed HM, Abbott PV

Aust Dent J, 2012 Jun;57(2):123-31; quiz 248.
PMID: 22624750 DOI: 10.1111/j.1834-7819.2012.01678.x

Maxillary molar teeth may have accessory roots. The aim of this paper is to review and discuss the endodontic implications of this anatomical variation. A review of the literature was undertaken to identify studies and reported cases where accessory roots have been recorded in maxillary molar teeth. The results show that although the prevalence of accessory roots in maxillary molar teeth is low, they can exist in all three types of maxillary molar teeth, and they may be located palatally, buccally, mesially or distally. Hence, it is essential that dentists undertaking root canal treatment thoroughly assess all teeth to determine how many roots are present in order to provide the best possible outcome of treatment for the patient.

Matched MeSH terms: Root Canal Preparation
Fulltext The antibacterial activity of sodium hypochlorite and chlorhexidine against Enterococcus faecalis: A review on agar diffusion and direct contact methods

Luddin N, Ahmed HM

J Conserv Dent, 2013 Jan;16(1):9-16.
PMID: 23349569 DOI: 10.4103/0972-0707.105291

Complete debridement and disinfection of the root canal system are fundamental requirements for successful endodontic treatment. Despite the morphological challenges of the internal root anatomy, root canal irrigants play an important role in the optimization of the root canal preparation, which is essentially a chemo-mechanical procedure. Enterococcus faecalis is one of the most resistant microorganisms that dominants the microbial ecosystem of persistent periradicular lesions in retreatment cases. For that reason, many in vitro and in vivo studies evaluated and compared the antibacterial activity of sodium hypochlorite and chlorhexidine at varying concentrations using different experimental models against this microorganism. However, many controversies with regard to the ideal irrigant and concentration do in fact exist. Hence, this review aims to discuss the antibacterial activity of these two main root canal irrigants against Enterococcus faecalis using the agar diffusion and direct contact methods and the possible modulating factors responsible for inconsistent findings among different studies. In addition, the disinfection potential of both chemical agents on gutta percha and Resilon cones are also discussed. The source of this review was conducted through an electronic literature search using PubMed database from December 1997 until December 2011, which analyze the related laboratory investigations of both irrigants, published in major endodontic journals.

Matched MeSH terms: Root Canal Preparation
Fulltext Effect of Nd:YAG, Er,Cr:YSGG Laser Irradiation, and Adjunctive Photodynamic Therapy on Push-Out Bond Strength of Zirconia Posts to Radicular Dentin

Alshammary F, Karobari MI, Assiry AA, Marya A, Shaikh GM, Siddiqui AA, et al.

Biomed Res Int, 2021;2021:5523242.
PMID: 34036099 DOI: 10.1155/2021/5523242

This study is aimed at assessing the influence of Nd:YAG, Er,Cr:YSGG laser irradiation, and adjunctive photodynamic therapy (aPDT) on the bond strength of zirconia posts to radicular dentin. Eighty extracted anterior teeth were randomly categorized into 4 groups (n = 20) based on varying laser irradiation treatments, i.e., conventional cleaning and shaping (CCS), Nd:YAG, Er,Cr:YSGG, and aPDT group, respectively. Using a cutting machine, the samples were prepared for push-out bond strength analysis; 4 sections (2 on each apical and cervical) of around 1 mm thickness were sectioned for all roots at a right angle to the long axis of the post. After making the space for the post, they were incorporated into the root system and were subjected to different laser treatments. The universal testing machine was utilized to assess the push-out bond strength, which had a defined 1 mm/minute crosshead speed until the failure was encountered. Specimens in the aPDT group (8.20 ± 2.14 MPa) demonstrated the highest mean push-out bond strength, whereas the lowest was shown by samples in the CCS group (7.08 ± 1.11 MPa). According to the independent t-test, the mean push-out bond strength scores of the cervical segments were higher as compared to the apical segments in research groups (p < 0.05). Overall, the adhesive type was the most frequently encountered failure mode in all of the experimental groups, with the least number of failures observed in aPDT treated teeth samples. In conclusion, the push-out bond strength to radicular dentin was not much influenced by Nd:YAG, Er,Cr:YSGG laser, and aPDT in comparison with CCS. Although statistically not significant, however, the application of aPDT provided better outcomes as compared to other research groups.

Matched MeSH terms: Root Canal Preparation
Fulltext Students perception and satisfactory level in preclinical fixed prosthodontic teaching: post and core

Marlynda Ahmad, Natasya Ahmad Tarib

Malaysian Dental Journal, 2008;29(2):128-134.
MyJurnal

Introduction: Preclinical teaching using simulation is very beneficial in training dental graduates. The use of laboratory simulation for its undergraduate training during the preclinical years has been used in dental education. Purpose: The aim of this study was to evaluate student’s perception, self evaluation and satisfactory level in preparing duralay burn-out post and core in preclinical fixed prosthodontics sessions.

Materials and Methods: The participants comprised of 104 fourth year dental undergraduates in the Faculty of Dentistry Universiti Kebangsaan Malaysia. The students had undergone preclinical session for endodontics during the 3rd year and had already completed root canal treatment on single rooted tooth. The same tooth was used for preclinical post and core preparation. The gutta percha was partially removed and the root canal was prepared. They then proceeded with the preparation of duralay build-up/pattern based on the lecture, video demonstration and manual given. Once completed and satisfied with their work, students were asked to answer the questionnaires in the simulation manual.

Results: Student response rate was 88.46% (92/104). Majority of the students were satisfied with their canal preparation, with about 5mm gutta percha left apically, appropriately shaped canal with sufficient retention and resistance form. They also thought that the surface of the duralay was good with no voids. With regards to the coronal preparation, majority of them incorporated ferrule effect and prepared preliminary crown preparation. More than half of the students claimed the level of difficulty of this procedure was moderate. Furthermore, majority of them said that the lecture and the preclinical manual were sufficient and helpful. The help from the supervisors was also benefit in preparing duralay burnout post and core.

Conclusions: From this study, majority of fourth year dental students could perform appropriate canal preparation as well as duralay pattern post and core. Only one student did not feel competent and confident in doing canal preparation and duralay pattern post and core. Our teaching methods and aids were proven to help them in preparing these tasks.

Matched MeSH terms: Root Canal Preparation
Sealing ability of various restorative materials as coronal barriers between endodontic appointments

Tapsir Z, Aly Ahmed HM, Luddin N, Husein A

J Contemp Dent Pract, 2013 Jan 1;14(1):47-50.
PMID: 23579892

To evaluate and compare the microleakage of various restorative materials used as coronal barriers between endodontic appointments.

Matched MeSH terms: Root Canal Preparation/methods
Apical microleakage evaluation of system B compared with cold lateral technique: In vitro study

Farea M, Masudi S, Wan Bakar WZ

Aust Endod J, 2010 Aug;36(2):48-53.
PMID: 20666748 DOI: 10.1111/j.1747-4477.2009.00187.x

The aim of this study was to evaluate in vitro the apical sealing ability of cold lateral and system B root filling techniques using dye penetration. Eighty-six extracted single-rooted human teeth were prepared and randomly divided into two experimental groups to be obturated by cold lateral condensation (n = 33) and system B (n = 33). The remaining 20 teeth served as positive and negative controls. The roots were embedded for 72 h in methylene blue dye solution and sectioned transversely for dye penetration evaluation using stereomicroscope. The results of this study showed that cold lateral condensation leaked significantly more (P < 0.001) than system B technique.

Matched MeSH terms: Root Canal Preparation/instrumentation; Root Canal Preparation/methods
Intracanal bisphosphonate does not inhibit replacement resorption associated with delayed replantation of monkey incisors

Thong YL, Messer HH, Zain RB, Saw LH, Yoong LT

Dent Traumatol, 2009 Aug;25(4):386-93.
PMID: 19459923 DOI: 10.1111/j.1600-9657.2008.00631.x

Progressive replacement resorption following delayed replantation of avulsed teeth has proved to be an intractable clinical problem. A wide variety of therapeutic approaches have failed to result in the predictable arrest of resorption, with a good long-term prognosis for tooth survival. Bisphosphonates are used in the medical management of a range of bone disorders and topically applied bisphosphonate has been reported to inhibit root resorption in dogs. This study evaluated the effectiveness of a bisphosphonate (etidronate disodium) as an intracanal medicament in the root canals of avulsed monkey teeth, placed before replantation after 1 h of extraoral dry storage. Incisors of six Macaca fascicularis monkeys were extracted and stored dry for 1 h. Teeth were then replanted after canal contamination with dental plaque (negative control) or after root canal debridement and placement of etidronate sealed in the canal space. A positive control of calcium hydroxide placed 8-9 days after replantation was also included. All monkeys were sacrificed 8 weeks later and block sections were prepared for histomorphometric assessment of root resorption and periodontal ligament status. Untreated teeth showed the greatest extent of root resorption (46% of the root surface), which was predominantly inflammatory in nature. Calcium hydroxide treated teeth showed the lowest overall level of resorption (<30% of the root surface), while the bisphosphonate-treated group was intermediate (39%). Ankylosis, defined as the extent of the root surface demonstrating direct bony union to both intact and resorbed root surface, was the lowest in the untreated control group (15% of the root surface), intermediate in the calcium hydroxide group (27%) and the highest in the bisphosphonate group (41%). Bony attachment to the tooth root was divided approximately equally between attachment to intact cementum and to previously resorbed dentin. Overall, bisphosphonate resulted in a worse outcome than calcium hydroxide in terms of both root resorption and ankylosis.

Matched MeSH terms: Root Canal Preparation/instrumentation; Root Canal Preparation/methods
Remaining tooth structure associated with various preparation designs for the endodontically treated maxillary second premolar

Seow LL, Toh CG, Wilson NH

Eur J Prosthodont Restor Dent, 2005 Jun;13(2):57-64.
PMID: 16011232

Existing literature suggests a relationship between the amount of remaining tooth structure and the fracture resistance of the restored endodontically treated tooth. This study investigated the amount of tooth structure remaining following various tooth preparations used in the restoration of the endodontically treated maxillary second premolar. Illustrations of the maxillary second premolar in buccopalatal, mesiodistal and occlusal sections were drawn to scale. Outlines of various intra- and extracoronal preparations were superim-posed on the illustrations to reveal the amount of tooth tissue remaining in each case. Preparations for a ceramic inlay, inlay with palatal cusp coverage and onlay left 2.0-2.5mm of tooth structure buccally and palatally. Following preparation for a metal-ceramic crown, approximately 1.0mm of tooth structure remained buccally, and between 1.6mm-1.8mm palatally. Preparation for an all-ceramic crown was observed to leave 1.0mm-1.2mm of tooth structure surrounding what remained of the endodontic access cavity. It was concluded that decisions as to the type of definitive restoration to restore the endodontically treated maxillary second premolar may be influenced, amongst other factors, by information on the amount of tooth tissue remaining following preparation.

Matched MeSH terms: Root Canal Preparation

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