A. Damien Walmsley

Incidence of root face alteration after ultrasonic retrograde cavity preparation

PROBLEM Ultrasonic root end preparation is now a recognized clinical procedure. Advantages claimed include improved access to the surgical site (because of reduced root end bevel), and faster more conservative preparation of the root end cavity. However, cracking of the root face has been reported after preparation. OBJECTIVES The aim of this study was to determine the incidence of root end cracking at varying ultrasonic power levels with a replica technique and scanning electron microscopy. STUDY DESIGN The root canals of 55 single-rooted teeth were prepared to size 40 apically and obturated with laterally condensed gutta perch and sealer. Root ends were resected at 90 degrees 3 mm from the apex. Class 1 cavities (n = 5) were prepared with retro tips in a Neosonic handpiece with different power settings. Time of preparation and load applied were constant. Another experimental group (n = 5) was prepared with a no. 1 rotary bur. A replica technique with addition-cured silicone impression material and epoxy resin was used to prevent drying artefacts. Specimens were viewed under scanning electron microscope for alterations of the root face. RESULTS Results showed no root face cracking across the full range of instrument power settings, although chipping of the retrograde cavity margins was observed. No cracking was noted in bur-prepared teeth.

Reciprocating Root Canal Technique Induces Greater Debris Accumulation Than a Continuous Rotary Technique as Assessed by 3-Dimensional Micro–Computed Tomography

INTRODUCTION The ability of single-file, reciprocating instruments to remove inorganic debris is uncertain. By using micro-computed tomography (microCT), this study compared the 3-dimensional distribution, quantity, and density of remaining inorganic debris in the mesial root of mandibular molars after instrumentation. A single reciprocating file was compared with a multifile rotary instrumentation technique. METHODS Teeth were selected for instrumentation using reciprocating or rotary instruments (n = 19). Teeth were scanned using microCT before and after instrumentation. Through shape recognition and superimposition image analysis techniques, remaining inorganic tissue debris was identified, quantified, and visualized 3-dimensionally, mapping debris to its location. The use of a density phantom enabled the debris density to be calculated, giving a measure of compactness. RESULTS After single-file instrumentation, an average of 19.5% debris remained in the canal compared with 10.6% with the multifile technique (P = .01) and at an average density of 1.60 g/m(3) compared with 1.55 g/m(3) for the multifile system (P > .05). Isthmuses, protrusions, and irregularities in the canal wall were repeatedly seen at the locations of debris accumulation. CONCLUSIONS In canals with a high prevalence of isthmuses and protrusions, using multifile rotary systems may be preferred over reciprocating files because it can yield cleaner canals with less debris accumulation.

An analytical Micro CT methodology for quantifying inorganic dentine debris following internal tooth preparation

OBJECTIVES MicroCT allows the complex canal network of teeth to be mapped but does not readily distinguish between structural tissue (dentine) and the debris generated during cleaning. The aim was to introduce a validated approach for identifying debris following routine instrumentation and disinfection. METHODS The mesial canals of 12 mandibular molars were instrumented, and irrigated with EDTA and NaOCl. MicroCT images before and after instrumentation and images were assessed qualitatively and quantitatively. RESULTS Debris in the canal space was identified through morphological image analysis and superimposition of the images before and after instrumentation. This revealed that the removal of debris is prohibited by protrusions and micro-canals within the tooth creating areas which are inaccessible to the irrigant. Although the results arising from the analytical methodology did provide measurements of debris produced, biological differences in the canals resulted in variances. Both irrigants reduced debris compared to the control which decreased with EDTA and further with NaOCl. However, anatomical variation did not allow definitive conclusions on which irrigant was best to use although both reduced debris build up. CONCLUSIONS This work presents a new approach for distinguishing between debris and structural inorganic tissue in root canals of teeth. The application may prove useful in other calcified tissue shape determination. CLINICAL SIGNIFICANCE Remaining debris may contain bacteria and obstruct the flow of irrigating solutions into lateral canal anatomy. This new approach for detecting the amount of remaining debris in canal systems following instrumentation provides a clearer methodology of the identification of such debris.

Mechano-physical and biophysical properties of power-driven scalers: driving the future of powered instrument design and evaluation

This review has highlighted the importance of standardizing future investigations to enable more meaningful interstudy comparisons to be made. This report also makes recommendations for factors that should be considered and incorporated into future investigations, both in vitro and in vivo, in order to achieve more standardization. These recommendations are listed below.

Three-dimensional analyses of ultrasonic scaler oscillations.

BACKGROUND It is stated that the oscillation patterns of dental ultrasonic scalers are dependent upon whether the instrument is of a magnetostrictive or piezoelectric design. These patterns are then linked to differences in root surface debridement in vitro. MATERIAL AND METHODS Piezoelectric (A, P) and magnetostrictive (Slimline, TFI-3) ultrasonic scalers (three of each) were evaluated, loaded (100 g/200 g) and unloaded with a 3D laser vibrometer. Loads were applied to the probe tips via teeth mounted in a load-measuring device. RESULTS Elliptical motion was demonstrated for all probes under loaded and unloaded conditions. Loading flattened the elliptical motion along the length of the probe. Unloaded, Slimline tip 1 was significantly different to tips 2 and 3 (p<0.0001). There were no differences between the A-tips (p>0.207). All TFI-3 tips were different to each other (p<0.0001). P-tips 1 and 2 were different to each other (p=0.046). Loaded, Slimline tips were different to each other (p<0.001). There were no differences between the P probes (p>0.867). Generator power increased all Slimline and P tip vibrations (p<0.0001). CONCLUSIONS Probe oscillation patterns are independent of ultrasound production mechanism and are dependent upon probe shape and generator power. Loaded probes oscillated with an elliptical pattern.

Analyzing Endosonic Root Canal File Oscillations: An In Vitro Evaluation

INTRODUCTION Passive ultrasonic irrigation may be used to improve bacterial reduction within the root canal. The technique relies on a small file being driven to oscillate freely within the canal and activating an irrigant solution through biophysical forces such as microstreaming. There is limited information regarding a files oscillation patterns when operated while surrounded by fluid as is the case within a canal root. METHODS Files of different sizes (#10 and #30, 27 mm and 31 mm) were connected to an ultrasound generator via a 120 degrees file holder. Files were immersed in a water bath, and a laser vibrometer set up with measurement lines superimposed over the files. The laser vibrometer was scanned over the oscillating files. Measurements were repeated 10 times for each file/power setting used. RESULTS File mode shapes are comprised of a series of nodes/antinodes, with thinner, longer files producing more antinodes. The maximum vibration occurred at the free end of the file. Increasing generator power had no significant effect on this maximum amplitude (p > 0.20). Maximum displacement amplitudes were 17 to 22 microm (#10 file, 27 mm), 15 to 21 microm (#10 file, 31 mm), 6 to 9 microm (#30 file, 27 mm), and 5 to 7 microm (#30, 31 mm) for all power settings. Antinodes occurring along the remaining file length were significantly larger at generator power 1 than at powers 2 through 5 (p < 0.03). CONCLUSIONS At higher generator powers, energy delivered to the file is dissipated in unwanted vibration resulting in reduced vibration displacement amplitudes. This may reduce the occurrence of the biophysical forces necessary to maximize the techniques effectiveness.

Cutting characteristics of ultrasonic surgical instruments

OBJECTIVE Ultrasonic surgical devices are becoming increasingly popular and work is required to understand the performance of the cutting tips. This experimental study looks to investigate the way in which ultrasonic bone cutting tools oscillate and how this oscillation is modified when contacted against bone surfaces with varying loads. The defects produced in instrumented bone surfaces were measured and related to the tip motion. METHODS An ultrasonic cutting probe was scanned, unloaded, using a scanning laser vibrometer to determine its free oscillation pattern and amplitude. This probe tip was then contacted against bone under various loads to assess the modification in oscillation characteristics. Cuts were performed over a period of 10 s. The cut bone surfaces were assessed using laser profilometry to determine defect depths. RESULTS The average vibration displacement amplitude at the probe tip, under load, was <12 μm in the longitudinal direction and was greatest for the cortical cutting mode. Elliptical probe motion was successfully mapped out under the range of loads tested. Defect depths of up to 0.36 mm were detected and were greatest when the tip was in contact with the bone with a load of 100 g. CONCLUSIONS This work showed that the nature of the surface being cut may significantly alter the mode shape and magnitude of the probe oscillation. The maximum depth of cut with minimum restraining of tip motion was achieved at 100 g contact load.

Vibration characteristics of dental high-speed turbines and speed-increasing handpieces

OBJECTIVES Vibrations of dental handpieces may contribute to symptoms of hand-arm vibration syndrome in dental personnel and iatrogenic enamel cracking in teeth. However, methods for measuring dental handpiece vibrations have previously been limited and information about vibration characteristics is sparse. This preliminary study aimed to use a novel approach to assess the vibrations of unloaded high-speed handpieces in vitro. METHODS Maximum vibration displacement amplitudes of five air turbines and two speed-increasing handpieces were recorded whilst they were operated with and without a rotary cutting instrument (RCI) using a scanning laser vibrometer (SLV). RESULTS RCI rotation speeds, calculated from frequency peaks, were consistent with expected values. ANOVA statistical analysis indicated significant differences in vibrations between handpiece models (p<0.01), although post hoc tests revealed that differences between most individual models were not significant (p>0.11). Operating handpieces with a RCI resulted in greater vibrations than with no RCI (p<0.01). Points on the head of the handpiece showed greater vibration displacement amplitudes than points along the body (p<0.01). CONCLUSIONS Although no single measurement exceeded 4 microm for the handpieces in the current test setup (implying that these vibrations may be unlikely to cause adverse effects), this study has formed the basis for future work which will include handpiece vibration measurements whilst cutting under clinically representative loads.

Ultrasound Stimulation of Different Dental Stem Cell Populations: Role of Mitogen-activated Protein Kinase Signaling

INTRODUCTION Mesenchymal stem cells (MSCs) from dental tissues may respond to low-intensity pulsed ultrasound (LIPUS) treatment, potentially providing a therapeutic approach to promoting dental tissue regeneration. This work aimed to compare LIPUS effects on the proliferation and MAPK signaling in MSCs from rodent dental pulp stem cells (DPSCs) compared with MSCs from periodontal ligament stem cells (PDLSCs) and bone marrow stem cells (BMSCs). METHODS Isolated MSCs were treated with 1-MHz LIPUS at an intensity of 250 or 750 mW/cm2 for 5 or 20 minutes. Cell proliferation was evaluated by 5-bromo-2-deoxyuridine (BrdU) staining after 24 hours of culture following a single LIPUS treatment. Specific ELISAs were used to determine the total and activated p38, ERK1/2, and JNK MAPK signaling proteins up to 4 hours after treatment. Selective MAPK inhibitors PD98059 (ERK1/2), SB203580 (p38), and SP600125 (JNK) were used to determine the role of activation of the particular MAPK pathways. RESULTS The proliferation of all MSC types was significantly increased after LIPUS treatment. LIPUS at a 750-mW/cm2 dose induced the greatest effects on DPSCs. BMSC proliferation was stimulated in equal measures by both intensities, whereas 250 mW/cm2 LIPUS exposure exerted maximum effects on PDLSCs. ERK1/2 was activated immediately in DPSCs after treatment. Concomitantly, DPSC proliferation was specifically modulated by ERK1/2 inhibition, whereas p38 and JNK inhibition exerted no effects. In BMSCs, JNK MAPK signaling was LIPUS activated, and the increase in proliferation was blocked by specific inhibition of the JNK pathway. In PDLSCs, JNK MAPK signaling was activated immediately after LIPUS, whereas p-p38 MAPK increased significantly in these cells 4 hours after exposure. Correspondingly, JNK and p38 inhibition modulated LIPUS-stimulated PDLSC proliferation. CONCLUSIONS LIPUS promoted MSC proliferation in an intensity and cell-specific dependent manner via activation of distinct MAPK pathways.

High Speed Imaging of Cavitation around Dental Ultrasonic Scaler Tips

Cavitation occurs around dental ultrasonic scalers, which are used clinically for removing dental biofilm and calculus. However it is not known if this contributes to the cleaning process. Characterisation of the cavitation around ultrasonic scalers will assist in assessing its contribution and in developing new clinical devices for removing biofilm with cavitation. The aim is to use high speed camera imaging to quantify cavitation patterns around an ultrasonic scaler. A Satelec ultrasonic scaler operating at 29 kHz with three different shaped tips has been studied at medium and high operating power using high speed imaging at 15,000, 90,000 and 250,000 frames per second. The tip displacement has been recorded using scanning laser vibrometry. Cavitation occurs at the free end of the tip and increases with power while the area and width of the cavitation cloud varies for different shaped tips. The cavitation starts at the antinodes, with little or no cavitation at the node. High speed image sequences combined with scanning laser vibrometry show individual microbubbles imploding and bubble clouds lifting and moving away from the ultrasonic scaler tip, with larger tip displacement causing more cavitation.