Anda Kfir

Diagnosis of Vertical Root Fractures in Endodontically Treated Teeth Based on Clinical and Radiographic Indices: A Systematic Review

INTRODUCTION The diagnosis of vertical root fracture (VRF) is at times complicated for lack of specific signs, symptoms, and/or radiographic features. The purpose of this study was to systematically search and evaluate the literature regarding the diagnostic accuracy of clinical signs and symptoms and radiographic indices for the diagnosis of VRF in endodontically treated teeth by means of a systematic review. METHODS An exhaustive literature search combined with strict inclusion and exclusion criteria was undertaken to identify clinical studies that assessed the diagnosis of VRF. RESULTS There is no substantial evidence regarding the accuracy of the clinical and radiographic indices for the diagnosis of VRF in endodontically treated teeth. CONCLUSIONS Evidence-based data concerning the diagnostic accuracy and clinical effectiveness of clinical and radiographic dental evaluation for the diagnosis of VRF in endodontically treated teeth are lacking. The need for evidence-based research efforts to elucidate the currently unknown situation is of utmost significance.

Outcome of Surgical Endodontic Treatment Performed by a Modern Technique: A Meta-analysis of Literature

INTRODUCTION Numerous studies dealing with the outcome of surgical endodontic treatment have been published. However, study design, treatment protocols, follow-up periods, and inclusion and exclusion criteria are extremely variable. Thus, variable and confusing results have been reported. The aim of the present study was to assess the outcome of surgical endodontic treatment performed with a modern technique and to evaluate factors influencing the outcome by means of a meta-analysis. METHODS An exhaustive literature search combined with strict inclusion and exclusion criteria was undertaken to identify prospective case series or randomized clinical trials that deal with surgical endodontic treatment. RESULTS A successful outcome in a follow-up of more than 1 year postoperatively was 91.6%. Age, gender, tooth type, root-end filling material, and magnification type had no significant effect on the proportion of success. CONCLUSIONS Surgical endodontic treatment done by using a modern technique is a predictable treatment. Additional large-scale prospective clinical studies are needed to evaluate possible predictors of success and failure.

Release of Calcium and Hydroxyl Ions from Set Endodontic Sealers Containing Calcium Hydroxide

Endodontic sealers that contain calcium hydroxide are claimed to possess calcification-promoting properties. Similar liners and hard-setting bases exhibit great variations in their alkalinizing potential and this property has been correlated with their biological effect. The purpose of this study was to investigate the release of calcium and hydroxyl ions from three root canal sealers by extraction with water. Calcium was assessed by EGTA titration and hydroxyl ions by measuring pH. The pattern of release of ions differed in all three sealers. In Sealapex it was similar to that of the control bases, Dycal and Life. Another sealer, Hermetic, rapidly dumped the extractable calcium hydroxide, while release of calcium from CRCS was negligible. The alkalinizing potential was more durable in all three. Disintegration of the pellets of Sealapex indicated that solubility may be the price for increased activity.

The Self-Adjusting File Optimizes Debridement Quality in Oval-shaped Root Canals

INTRODUCTION Oval-shaped canals represent a challenge for rotary nickel-titanium (NiTi) files because buccal and/or lingual recesses are commonly left uninstrumented. The aim of the present study was to evaluate the debridement quality of the Self-Adjusting File (SAF) system in oval canals and compare it with the debridement achieved by a commonly used NiTi rotary system. METHODS A careful specimen selection resulted in two equal groups each consisting of 12 extracted mandibular canines with oval canals that had vital pulps before extraction. All canals had a buccolingual diameter that was at least 2.5 times larger than that of the mesiodistal one as defined from radiographs. One group was subjected to the SAF protocol, whereas the other group underwent conventional protocol; the ProTaper system up to the F2 instrument was used with syringe and open end needle irrigation. Sodium hypochlorite (5.25%) was used as an irrigant for both groups. The roots were then histologically processed and 0.6-μm-thick cross-sections were obtained every 0.5 mm from the 1- to 5-mm apical levels. Morphometric evaluation was performed on cross-sections to determine the amount of remaining pulp tissue as a percent of the root canal area. RESULTS The group-by-location interaction was not significant (P > .05), which means that the group comparisons were not dependent on the cross-sectional level. There was significantly greater residual pulp tissue left after ProTaper system instrumentation versus SAF instrumentation (21.4% vs 9.3%, P < .05). CONCLUSIONS The SAF protocol was significantly more efficient for debridement of oval root canals than the rotary ProTaper protocol.

Comparison of digital with conventional radiography in detection of vertical root fractures in endodontically treated maxillary premolars: an ex vivo study

OBJECTIVE The purpose of the present study was to compare the diagnostic ability of conventional intraoral film radiography and a charged-coupled device (CCD) sensor in detecting vertical root fractures (VRF) in endodontically treated single-rooted extracted human maxillary premolars. STUDY DESIGN The study consisted of 60 extracted single-rooted endodontically treated maxillary premolars: 30 with clinically confirmed VRF (experimental group) and 30 with no VRF (control group). An intraoral CCD sensor and conventional Kodak Insight Film were used. Two observers evaluated the digital and conventional radiographs twice with an interval of 4 weeks. Specificity and sensitivity for each radiographic technique were calculated and subjected to statistical analysis. Kappa values were calculated for intra- and interobserver agreement. Fishers exact test was used to evaluate detection of VRF. The overall differences in sensitivity and specificity between radiographic techniques were evaluated by McNemar test. RESULTS The specificity of the digital system was significantly better (P = .016) for the second observer at the first reading. There were no significant differences in sensitivity and specificity for both observers between the 2 systems for other readings (P > .05). CONCLUSIONS No difference was found between the intraoral CCD sensor and conventional radiography in detecting vertical root fractures for single rooted maxillary premolars ex vivo.

The efficacy of five techniques for removing root filling material: microscopic versus radiographic evaluation.

AIM   To test and compare the efficacy of five methods for the removal of root filling material and to test the hypothesis that radiographs fail to represent the real extent of remaining material on canal walls. METHODOLOGY   Fifty maxillary anterior single-rooted teeth with straight root canals were selected. The coronal third of each root canal was prepared with Gates-Glidden drills to number 3, whilst the apical two-thirds were prepared with manual K-files to size 40. Root fillings were performed using lateral compaction with gutta-percha and AH-26. After full setting, the coronal third of the root filling was removed with Gates-Glidden drills and the teeth divided into five groups (n=10). The remaining root filling material was then removed with either Hedström files and chloroform (25 μL), using size 40 as the last file, SafeSider files, using a NiTi Pleezer reamer with a 0.06 taper followed by size 40 reciprocating file, with or without chloroform, or ProTaper Universal retreatment files (D2, D3) with or without chloroform. Reaching working length with no more gutta-percha on the last file was defined as the endpoint for all procedures. The presence of remaining filling material was first evaluated radiographically and then by the microscopic evaluation of split roots. The time required to accomplish the procedure was also recorded. anova and anova with repeated measures were used for statistical analysis of the results. RESULTS   Overall, 11-26% of the canal wall remained covered with filling material; no significant difference was found between the groups. The mechanized methods were faster than manual removal of filling material (P < 0.01); the use of solvent did not speed up the mechanized procedures. Radiographic evaluation failed to adequately and reliably detect the extent of filling material remaining on the canal walls, which was later observed by microscopic evaluation. CONCLUSIONS   All methods left root canal filling material on the canal walls. Radiographic evaluation failed to detect the extent of remaining root filling material, which could only be detected using microscopy.

Prevalence and Associated Periodontal Status of Teeth with Root Perforation: A Retrospective Study of 2,002 Patients' Medical Records

INTRODUCTION Various procedures along the course of an endodontic treatment may lead to perforations. The prognosis of perforated teeth depends on perforation location, perforation size, and time from occurrence. The aim of this study was to retrospectively evaluate the prevalence of root perforations and associated pathological changes in the adjacent periodontal tissues. METHODS Full periapical status surveys and medical records of 2,002 patients with a total of 56,175 teeth were evaluated. RESULTS Of a total of 5,048 root canal-treated teeth, 116 root perforations were identified in 101 patients. Associated pathological changes in the adjacent periodontal tissues were identified in 81 teeth with perforations. The patients age, perforation location and size, and tooth type significantly influenced the occurrence of perforation associated periodontal damage. CONCLUSIONS When a perforation occurs, the main treatment goal is to prevent long-lasting injury to the periodontium. Better knowledge of the prevalence of perforations and their possible predictors may assist the clinician in the prevention and treatment of iatrogenic root perforations.

Diagnosis of artificially induced external root resorption using conventional intraoral film radiography, CCD, and PSP: an ex vivo study.

OBJECTIVE To compare diagnosis of artificially induced external root resorption cavities using conventional intraoral film radiography (Kodak Insight), CCD sensor (Sopix wireless) and PSP sensor (Orex Digident). STUDY DESIGN Two mandibles were obtained from cadavers and teeth extracted from their alveolus. Artificial external root resorptions were simulated using ISO 0.5 mm, 0.8 mm, and 1.2 mm diameter round burs by drilling to the entire depth in different locations at the cervical, middle, and apical thirds of the proximal and buccal root surfaces of 6 teeth in increasing order. Conventional and digital radiographs were obtained from 3 different views of each tooth in 3 steps (small = 0.5 mm; medium = 0.8 mm; and large = 1.2 mm diameter round burs). Three observers examined all images for the presence of resorption cavities. In the first session, each image was evaluated separately; in the second, examiners had access to all views. Data were statistically analyzed using 4-way analysis of variance. Pair-wise comparison between receptors, projection views, size, and location were made by Tukey test. RESULTS Higher proportions of correct readings were obtained with the conventional film (Kodak Insight) and CCD receptor compared with the PSP receptor used in this study (PSP < CCD <or= Film; P < .001). Best results were obtained when examiners had access to all views. Most difficult locations in determining true diagnosis were the apical regions. Highest correct readings were obtained at the proximal cervical regions. CONCLUSION Conventional intraoral film and CCD sensor produced similar results in diagnosing simulated external root resorption.

The diagnosis and conservative treatment of a complex type 3 dens invaginatus using cone beam computed tomography (CBCT) and 3D plastic models.

AIM To investigate the use of 3D plastic models, printed from cone beam computed tomography (CBCT) data, for accurate diagnosis and conservative treatment of a complex case of dens invaginatus. SUMMARY A chronic apical abscess with a draining sinus tract was diagnosed during the treatment planning stage of orthodontic therapy. Radiographic examination revealed a large radiolucent area associated with an invaginated right maxillary central incisor, which was found to contain a vital pulp. The affected tooth was strategic in the dental arch. Conventional periapical radiographs provided only partial information about the invagination and its relationship with the main root canal and with the periapical tissues. A limited-volume CBCT scan of the maxilla did not show evidence of communication between the infected invagination and the pulp in the main root canal, which could explain the pulp vitality. A novel method was adopted to allow for instrumentation, disinfection and filling of the invagination, without compromising the vitality of the pulp in the complex root canal system. The CBCT data were used to produce precise 3D plastic models of the tooth. These models facilitated the treatment planning process and the trial of treatment approaches. This approach allowed the vitality of the pulp to be maintained in the complex root canal space of the main root canal whilst enabling the healing of the periapical tissues. KEY LEARNING POINTS Even when extensive periapical pathosis is associated with a tooth with type III dens invaginatus, pulp sensibility tests should be performed. CBCT is a diagnostic tool that may allow for the management of such teeth with complex anatomy. 3D printed plastic models may be a valuable aid in the process of assessing and planning effective treatment modalities and practicing them ex vivo before actually performing the clinical procedure. Unconventional technological approaches may be required for detailed treatment planning of complex cases of dens invaginatus.

The effect of maintaining apical patency on canal transportation.

AIM To evaluate, ex vivo, the effect of maintaining apical patency on the original canal shape during preparation of curved roots by two different techniques. METHODOLOGY Forty extracted human maxillary and mandibular molars were evaluated. Occlusal surfaces were ground and roots sectioned to the level of the cemento-enamel junction to allow only one root to remain for evaluation in each tooth. Specimens were divided into four experimental groups (10 canals each): Group 1--root canals prepared using the balanced force technique with stainless steel K-files, and patency established with size 10 K-files between each instrument; Group 2--same as Group 1 but without the use of a patency file; Group 3--canals instrumented with LightSpeed instruments and patency established with size 10 K-files between each instrument; and Group 4--same as Group 3 but without the use of a patency file. Specimens were mounted and a series of radiographs taken. Initial and post-preparation digital images were superimposed and the distance between two central axes at 1, 2 and 4 mm from the working length (WL) was measured to obtain an indication of the degree of apical transportation. Results were subjected to statistical analysis using two-way analysis of variance (ANOVA). RESULTS No significant differences were found in degree of apical transportation at different levels of the root canal (P > 0.05) nor in loss of WL between groups (P > 0.05). CONCLUSION In this laboratory study, maintaining apical patency did not influence canal transportation in the apical 4 mm.