Dilek Helvacioglu-Yigit

Evaluation and Reduction of Artifacts Generated by 4 Different Root-end Filling Materials by Using Multiple Cone-beam Computed Tomography Imaging Settings.

INTRODUCTION After endodontic surgery, radiographic assessment is the method of choice to monitor bone defect healing. Cone-beam computed tomography scans are useful to check and identify the reasons of failure of surgical intervention or confirm healing; however, the artifact generated by some root-end filling material might compromise this task. The objective of the study was to compare the amount of artifacts generated by 4 root-end filling materials and to test multiple exposure settings used with these materials, when the effective dose generated by each protocol was taken into consideration. METHODS Twenty central incisors were endodontically treated with retrograde obturation by using amalgam, Biodentine, MTA, and Super-EBA (5 of each). They were placed in a skull with soft tissue simulation and scanned by using the Planmeca Promax Max with different kilovolt peaks (kVp): 66, 76, 84, and 96 with and without the use of metal artifact reduction (MAR) algorithm and with low, normal, and high resolution and high definition. The Dose Area Product was registered, and the effective dose was calculated. RESULTS Amalgam generated the highest amount of artifacts, whereas MAR and low resolution created fewer artifacts than other settings. The artifacts were also reduced with 96 kVp. The effective dose calculated with low resolution was remarkably lower than other resolutions. CONCLUSIONS When used as root-end filling material, Biodentine, MTA, and Super-EBA generated fewer artifacts than amalgam. The use of 96 kVp with MAR and low resolution also reduced artifacts on the image and at the same time generated the lowest effective dose.

Efficacy of reciprocating and rotary systems for removing root filling material: a micro-computed tomography study.

This study aimed to use micro-computed tomography (micro-CT) imaging to evaluate the efficacy of the reciprocating and rotary systems for the removal of root filling materials in comparison with hand files. Thirty maxillary incisor teeth were prepared with ProTaper Universal (PTU) system, filled using cold lateral condensation and randomly divided into three groups of ten teeth each. The root fillings were removed with WaveOne Reciprocating and ProTaper Universal Re-treatment (PTU-R) systems and hand files. Micro-CT was used to scan the specimens before and after each treatment step. Percentage of volume of residual root filling was measured. The operating time was recorded. PTU-R instruments yielded better results for removing filling material, even though there was no statistically significant difference between PTU-R and WaveOne groups. Reciprocating and rotary systems showed similar performances in terms of efficacy and operating time for root filling removal.

Evaluation of dentinal defect formation after root canal preparation with two reciprocating systems and hand instruments: an in vitro study.

The purpose of this study was to evaluate the presence of dentinal defects after root canal preparation with hand instruments and two different reciprocating instruments. Sixty freshly extracted mandibular incisor teeth were selected for this in vitro study. On the basis of root length, mesiodistal and buccolingual dimensions, the teeth were allocated into three identical experimental groups (n = 15) and one control group (n = 15). The teeth in the control group were left unprepared. The other groups were: stainless steel hand instruments, WaveOne® Primary instruments and RECIPROC® R25 instruments. The reciprocating instruments were used with a reciprocating gentle in-and-out motion in a torque-limited electric motor at the appropriate preset mode. Horizontal sections were made 3, 6 and 9 mm from the apex. Samples were stained with methylene blue and viewed through a stereomicroscope. The presence of dentinal defects (fractures, incomplete cracks and craze lines) and their locations were investigated by two endodontists. These data were analysed statistically by Fishers exact and chi-square tests. No defects were observed in the unprepared group. All instruments caused dentinal defects, with no significant differences between the instrument systems. All experimental groups demonstrated significantly more defects at the 3-mm level in comparison with the unprepared group (p = 0.032). At the other levels, there was no significant difference between the experimental groups and the control group. The use of hand or reciprocating instruments could induce the formation of dentinal defects during root canal preparation.

Analysis of C-shaped Canals by Panoramic Radiography and Cone-beam Computed Tomography: Root-type Specificity by Longitudinal Distribution

INTRODUCTION The purpose of this study was to document the characteristics of C-shaped canal systems in permanent mandibular second molars using a combination of orthopantomogram (OPT) and cross-sectional cone-beam computed tomographic (CBCT) imaging. METHODS Two hundred participants (94 men and 106 women, mean age = 35 years) who underwent both routine CBCT and OPT examinations were enrolled. One endodontist and 1 oral radiologist examined the images of 339 mandibular second molars and described the radiographic features of C-shaped canals from OPT images as confirmed by CBCT imaging. Root morphology was classified as nonfused (NFRI-II) or fused (FRI-III) based on OPT images. Cross-sectional root canal configurations (C1-C5) were identified from CBCT imaging at 3 different levels (coronal, middle, and apical). Frequency distributions of root morphology and root canal configurations were compared at each level, and interobserver reliability was tested using the Cohen kappa test. RESULTS Of the 339 teeth, 29 (8.6 %) had C-shaped root canal systems. Most of the root canals were NFR type (86%); only 2% had C-shaped root canals (all NFRII). In the FR category, 23 teeth with C-shaped canals were equally distributed between the FRI and FRII subtypes. Interobserver agreement was almost perfect (κ = 0.89 and κ = 0.91; right and left second molars, respectively). Per CBCT imaging, the most common configuration was C3 at all levels; no C5 case was detected. CONCLUSIONS OPT usage can assist in recognizing and diagnosing C-shaped root canal systems. Radicular fusion or proximity is a characteristic feature of C-shaped canal systems. However, nonfused root appearances should also be considered suspicious.

Radiopacity measurements of direct and indirect resin composites at different thicknesses using digital image analysis

Radiopacity is an important property of composite materials for clinical diagnosis. For seven direct composites (Aelite LS Posterior, Aelite All-Purpose Body, Quadrant Universal LC, Clearfil Majesty Posterior, Clearfil Majesty Esthetic, Filtek Ultimate Dentin, IPS Empress Direct Dentin) and six indirect composites (Ceromega, Epricord, Estenia C&B, Tescera, Signum Ceramis, Solidex), diskshaped specimens (N=260, n=10 per group) were fabricated for two thicknesses at 1 and 2 mm. Average radiographic density of each composite material was calculated. Radiopacity values of specimens were expressed in equivalent thickness of aluminum using the calibration curve. Data were analyzed using one-way and two-way ANOVA, followed by Tukeys HSD test (α=0.05). Radiopacity was significantly affected by resin composite type (p<0.05) and thickness (p<0.001). All composites, except Epricord (1.22-1.84), had higher radiopacity values than dentin (1.23-2.24). IPS Empress Direct (5.58-9.38) and Estenia C&B (5.49-9.16) showed significantly higher radiopacity (p<0.05) than the other materials including enamel and dentin.

Micro-computerized tomography analysis of cement voids and pull-out strength of glass fiber posts luted with self-adhesive and glass-ionomer cements in the root canal

Abstract This study evaluated the pull-out strength of different glass fiber posts and measured volume of cement and voids in the cement in the root canal utilizing micro-computerized tomography (micro-CT) analysis after they were cemented with two different luting cements. Canine teeth (N = 40) were endodontically treated and randomly divided into four groups depending on the fiber post and the cement type (n = 10 per group) as follows: Group RU: (RelyX + RelyX U200), Group PU: (PINpost + RelyX U200), Group RF: (RelyX + FujiCEM 2), Group PF: (PINpost + FujiCEM 2). Each tooth was scanned using micro-CT and the percentage of cement and void volume at the coronal, middle, and apical levels was calculated. Pull-out tests were performed by applying tensile load parallel to the long axis of the posts (0.5 mm/min). Data were analyzed using, ANOVA, Kruskal–Wallis, and Mann–Whitney U tests (α = 0.05). Regardless of cement type, the percentage (%) of cement volume in the RelyX post groups (RU:31–36; RF:29–40) was significantly higher than that in the PINpost groups (PU:19–23; PF:18–22) (p < 0.05). The percentage of void volume at the PINpost groups (PU:6–11; PF:8–13) was significantly lower than that in the RelyX groups (RU:2; RF:3) (p < 0.05). No significant differences were observed in pull-out strength (N) between the four experimental groups (RU:358.8 ± 56.2; RF:299 ± 64.8; PU:311.9 ± 61.3; PF:293.1 ± 91.3) (p > 0.05). The micro-CT analysis demonstrated that the percentage of cement and void volumes vary depending on the type of fiber post and cement used. No correlation between cement, void volume, and pull-out strength was observed.

Evaluation of dentin defect formation during retreatment with hand and rotary instruments: a micro-CT study

The purpose of this study was to compare the incidence and longitudinal propagation of dentin defects after gutta-percha removal with hand and rotary instruments using microcomputed tomography. Twenty mandibular incisors were prepared using the balanced-force technique and scanned in a 19.9 μm resolution. Following filling with the lateral compaction technique, gutta-percha was removed with ProTaper Universal Retreatment (PTUR) or hand instruments. After rescanning, a total of 24,120 cross-sectional images were analyzed. The numbers, types, and longitudinal length changes of defects were recorded. Defects were observed in 36.90% of the cross sections. A total of 73 defects were comprised of 87.67% craze lines, 2.73% partial cracks, and 9.58% fractures. No significant difference in terms of new defect formation was detected between the retreatment groups. The apical and middle portions of the roots had more dentin defects than the coronal portions. Defects in three roots of the PTUR instrument group increased in length. Under the conditions of this in vitro study, gutta-percha removal seemed to not increase the incidence of dentin defect formation, but the longitudinal defect propagation finding suggests possible cumulative dentinal damage due to additional endodontic procedures. Hand and rotary instrumentation techniques caused similar dentin defect formation during root canal retreatment.

Use of cone-beam computed tomography and three- dimensional modeling for assessment of anomalous pulp canal configuration: a case report

Three-dimensional (3D) reconstruction of cone-beam computed tomography (CBCT) scans appears to be a valuable method for assessing pulp canal configuration. The aim of this report is to describe endodontic treatment of a mandibular second premolar with aberrant pulp canal morphology detected by CBCT and confirmed by 3D modeling. An accessory canal was suspected during endodontic treatment of the mandibular left second premolar in a 21 year old woman with a chief complaint of pulsating pain. Axial cross-sectional CBCT scans revealed that the pulp canal divided into mesiobuccal, lingual, and buccal canals in the middle third and ended as four separate foramina. 3D modeling confirmed the anomalous configuration of the fused root with a deep lingual groove. Endodontic treatment of the tooth was completed in two appointments. The root canals were obturated using lateral compaction of gutta-percha and root canal sealer. The tooth remained asymptomatic and did not develop periapical pathology until 12 months postoperatively. CBCT and 3D modeling enable preoperative evaluation of aberrant root canal systems and facilitate endodontic treatment.

Retreatment of a maxillary lateral incisor with two separate root canals confirmed with cone beam computed tomography.

The purpose of this report is to present a rare case of a maxillary lateral incisor exhibiting two separate root canals confirmed by cone-beam computed tomography (CBCT). A 65-year-old female patient with an esthetic complaint regarding her maxillary left lateral incisor was referred to our clinic. During a radiographical examination, an endodontically treated root canal and an extra root canal with an apical lesion were observed. The retreatment was performed. CBCT findings confirmed the root canal mophology of the maxillary left lateral with two distinct canals. We conclude that the CBCT imaging is an adjunctive tool for better assessment of complex root canal systems.