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Comparison of Apical Extrusion of Sodium Hypochlorite Using 4 Different Root Canal Irrigation Techniques

INTRODUCTION We compared the apical extrusion of sodium hypochlorite delivered with a 27-G needle, self-adjusting file (SAF), passive ultrasonic irrigation, or the EndoVac system (SybronEndo, Orange, CA) during the instrumentation and final irrigation of root canals. METHODS Matched paired single-canal teeth were divided into 8 groups. The experimental groups were needle irrigation size #30 (NI30) and #50 (NI50), SAF size #30 (SAF30) and #50 (SAF50), passive ultrasonic irrigation size #30 (PUI30) and #50 (PUI50), and EndoVac size #30 (EV30) and #50 (EV50). Teeth were embedded in 0.2% agarose gel (pH = 7.4) containing 1 mL 0.1% m-Cresol purple (Sigma-Aldrich, St Louis, MO), which changes color at a pH level of 9.0. Root canals were irrigated with sodium hypochlorite and EDTA using 4 different techniques, and the amount of irrigant was controlled. Standardized digital photographs were taken 20 minutes after the first irrigant was used and were analyzed to determine the amount of extrusion (expressed as a percentage of total pixels). RESULTS The amounts of apical extrusion obtained in the NI30, NI50, SAF30, SAF50, PUI30, PUI50, EV30, and EV50 groups were 30% (3/10), 50% (5/10), 20% (2/10), 70% (7/10), 40% (4/10), 40% (4/10), 10% (1/10), and 10% (1/10), respectively. The overall extrusion frequency, regardless of the apical preparation size, was 40% (8/20) for needle, 45% (9/20) for SAF, 40% (8/20) for ultrasonic irrigation, and 10% (2/20) for EndoVac. Although the SAF group showed more extrusion, the percentage of pixels was significantly higher in the needle irrigation group (P < .01). The EndoVac group showed significantly lower extrusion values than the other techniques in terms of the number of teeth and pixels (P < .05 and P < .01, respectively). CONCLUSIONS The risk of apical extrusion is significantly lower with the EndoVac in comparison with the 3 other techniques.

Radiologic Assessment of Periapical Health: Comparison of 3 Different Index Systems

INTRODUCTION The aim of this study was to evaluate observer variations and observer reproducibility in the interpretation of periapical health using the Strindberg system, the periapical index (PAI), and the probability index for radiologic assessment of periapical health. METHODS Four observers read digital periapical images to evaluate the periapical health of 200 root-filled teeth. Each observer evaluated a tooth twice by using the Strindberg system, twice by using the PAI, and twice by using the probability index. Each observation session was held at 1-month intervals. Three scores were used for the evaluations conducted by using the Strindberg system. Both the PAI and the probability index were considered on 5-point scales and were also dichotomized. SPSS for Windows 15.0 software (SPSS Inc, Chicago, IL) was used for data analysis, and intra- and interobserver agreements were described by using kappa statistics. RESULTS The average kappa values of intra- and interobserver agreement calculated for the Strindberg system were 0.53 and 0.36, respectively. The corresponding average kappa values were calculated as 0.48 and 0.39 for the PAI and 0.45 and 0.30 for the probability index. The highest mean proportion values of intra- and interobserver agreement were observed for the dichotomization of the PAI (88.9% and 87.0%, respectively) followed by the dichotomization of the probability index (86.8% and 82.9%, respectively). CONCLUSIONS The Strindberg system has lower intraobserver variation compared with the PAI and the probability index, whereas PAI has lower interobserver variation compared with the Strindberg system and the probability index. The dichotomization of the PAI and the probability index provided higher intra- and interobserver agreement values in the radiologic assessment of periapical health.

Comparison of apical sealing of two canal sealers between immediate versus delayed post space preparation

The effect of post space preparation on the sealing ability of a root canal filling is important because the sealer is crucial for preserving the apical seal. The question of how, when, and how much of the gutta-percha should be removed is a debate when preparing a post space. This study is aimed to compare the effect of immediate versus delayed post space preparation on the apical seal using AH Plus and EndoREZ sealers. Forty four single rooted teeth were prepared using the step-back technique and were obturated with combinations of gutta-percha/AH Plus and gutta-percha/EndoREZ using the lateral compaction technique. Four teeth were used as positive/negative controls. After the teeth were divided randomly into six groups, post spaces were prepared either immediately after filling or after storage of the obturated teeth in saline at 37°C for one week. The post space preparation procedure was performed using hot pluggers or Gates Glidden drills leaving a 5 mm of root canal filling in the apical part. Leakage was determined by a computerized fluidfiltration device. Immediate and delayed post space preparation of the gutta-percha/AH Plus groups had mean leakage values of 4.97 µl.cmH2O.min-1.10-4 and 4.94 µl.cmH2O.min-1.10-4, respectively. The respective mean leakage values of immediate and delayed post space preparation of the gutta-percha/EndoREZ groups were 4.97 µl.cmH2O.min-1.10-4 and 5.57 µl.cmH2O.min-1.10-4. The mean leakage value obtained in the positive control group was 398.16 µl.cmH2O.min-1.10-4, whereas there was no fluid filtration in the negative control group. Better sealing was achieved in the guttapercha/AH Plus delayed group in comparison to the other groups. Delayed post space preparation in the gutta-percha/EndoREZ group showed the highest percentage of leakage.

Efficacy of XP-Endo Finisher in the Removal of Triple Antibiotic Paste from Immature Root Canals.

Introduction The aim of this study was to evaluate and compare the effectiveness of the XP‐Endo Finisher (FKG Dentaire, La Chaux‐de‐Fonds, Switzerland) with passive ultrasonic irrigation (PUI) and needle irrigation in the removal of triple antibiotic paste (TAP) from the straight immature root canals of extracted teeth. Methods Thirty‐four freshly extracted single‐rooted teeth were used. All canals were prepared up to the ProTaper F5 file (Dentsply Maillefer, Ballaigues, Switzerland). Apices were drilled to simulate teeth with immature apices. The canals were filled with TAP, sealed, and incubated at 37°C and 100% humidity for 1 month. Samples were randomly assigned to 3 experimental groups according to the method used for TAP removal: XP‐Endo Finisher, PUI, and needle irrigation (n = 10). Then, the roots were split into 2 halves. The amount of TAP residue in the apical portion of each segment was evaluated using a scanning electron microscopy and scored. Results The amount of remaining TAP was significantly lower in the XP‐Endo Finisher group compared with the needle irrigation and PUI groups (P < .05). Between the needle irrigation and PUI groups, there were no statistically significant differences (P > .05). Conclusions Within the limitations of this study, the XP‐Endo Finisher removed significantly more TAP than needle irrigation and PUI.

Assessment of the periapical health of abutment teeth: A retrospective radiological study.

AIM The aim was to examine the technical quality of root fillings and periapical status of root-filled and nonroot-filled teeth restored with crowns and bridge retainers through a retrospective analysis of orthopantomographs (OPTGs) in an adult Turkish subpopulation. MATERIALS AND METHODS In this study, the digital OPTGs of adult patients between the ages of 20 and 70 who appealed to the Endodontics Endodontics Department of the Dentistry Faculty at Marmara University (Istanbul, Turkey) for the first time to have their endodontic treatment needs met were used. The periapical health of all teeth restored with crowns and bridge retainers, and the technical quality of the root fillings on abutment teeth were evaluated by radiographic criteria. RESULTS The survey was carried out using the OPTGs of 1000 adult patients composed of 590 (59.0%) women and 410 (41.0%) men. 4656 (20.9%) of the totally examined 22280 teeth were with crowns and bridge retainers. 986 of the total abutment teeth were root-filled and 458 (46.5%) of them had apical periodontitis (AP) while 3670 of the total abutment teeth were nonroot-filled and 930 (25.3%) of them were with AP. The most commonly treated teeth were premolars (33.8%), followed by molars (26.2%), incisors (23.3%) and canines (16.7%). Technical quality was proved to be adequate in 27.5% of the root fillings. A higher frequency of AP was related to inadequate root fillings (P<0.01). CONCLUSION The frequency of root-filled abutment teeth with AP, nonroot-filled abutment teeth with AP, and technically inadequate root-fillings among teeth with crowns and bridge retainers was high in the selected adult population.

Evaluation of the Efficacy of Self-Adjusting File Instrumenton Oval-shaped Root Canals

Purpose;Oval-shaped canals are a challenge when using rotary files because buccal and/or lingual recesses are commonly left uninstrumented. The aim of this study was to evaluate root canal preparation in flat- oval canals treated with ProTaper, Reciproc or self-adjusting file (SAF) instruments. Methodology; 60 mandibular premolars were divided into three groups. After biomechanical preparation, teeth were embedded in acrylic blocks. Roots were then sectioned 4, 8, and 12 mm from the apex using a precise saw, and the cut surfaces in the apical, middle, and coronal thirds were observed under a stereomicroscope at ×40 magnification. Results;The areas of prepared canal walls were significantly higher with the SAF than the ProTaper or Reciproc instruments (p<0.05). The SAF removed the dentin layer from all around the canal, whereas the others left substantial untouched areas. The area in the apical third of the teeth prepared with the Reciproc was significantly higher than with the other techniques, likely due to the high taper of the Reciproc file (p<0.01).Conclusions;In the coronal third, mean increases in the area of the canal were significantly higher with the SAF than with ProTaper or Reciproc. Using the SAF instrument, flat-oval canals were prepared homogenously and circumferentially.

Canal Centring Ability of ProTaper and Mtwo Rotary Systems in Curved Canals

SUMMARY The purpose of this investigation was to compare centring ratio of ProTaper and Mtwo rotary systems. 60 mandibular molar teeth which had 25, 30 and 35 degree curvature in mesio-buccal root canal were used. Group 1 had 25°, Group 2 had 30°, and Group 3 had 35° curvatures. The roots were sectioned horizontally at 2 mm away from the apex. The apical region was then observed under a stereo-microscope. In each group, teeth were instrumented using ProTaper and Mtwo systems. After canal preparation, digital images of apical part of canals were taken. These images were then superimposed by using Adobe Photoshop CS2 programme. The data were analyzed using ANOVA and Student’s t-test. No significant differences were found between each curvature degrees and rotary systems at the apical part of curved root canals (p<0.05).