Elio Berutti

Penetration ability of different irrigants into dentinal tubules

Dentinal tubules of human root canal walls were infected with a known bacterial isolate. The teeth were divided into two groups and the root canals instrumentated. Different types of canal irrigant were used for each group. In group A, 5% NaOCl was followed by a 10% EDTA rinse and neutralized with a final physiological solution rinse. In Group B, 10% EDTA, a tensioactive agent (TRITON), and 5% NaOCl were used in sequence, with a final physiological solution rinse to neutralize the action of the agents used. Histological examination of group A specimens showed a residual area of infection extending from the canal lumen to a mean depth of 300 microns. Histological examination of group B specimens showed an infection-free area of tubules to a mean depth of 130 microns. Below this was an infected area of variable extent. In some group B sections, no infection was found.

Influence of Manual Preflaring and Torque on the Failure Rate of ProTaper Rotary Instruments

We evaluated the influence of manual preflaring and torque on the failure rate of rotary nickel-titanium ProTaper instruments Shaping 1 (S1), Shaping 2 (S2), Finishing 1 (F1), and Finishing 2 (F2). These factors were evaluated using an in vitro method by calculating the mean number of Endo-Training-Blocks shaped before file breakage under different conditions. Group A (S1 on simulators with no preflaring) shaped 10 blocks before failure, group B (S1 on manually preflared simulators) shaped 59 blocks (p<0.01 versus group A), group C (S2 with low torque) shaped 28 blocks, group D (S2 with high torque) shaped 48 blocks (p<0.01 versus group C), group E (F1 with low torque) shaped eight blocks, group F (F1 with high torque) shaped 23 blocks (p<0.01 versus group E), group G (F2 with low torque) shaped four blocks, and group H (F2 with high torque) shaped 11 blocks (p<0.01 versus group G). Manual preflaring creates a glide path for the instrument tip and is a major determinant in reducing the failure rate of these rotary nickel-titanium files. All instruments worked better at high torque.

Canal Shaping with WaveOne Primary Reciprocating Files and ProTaper System: A Comparative Study

INTRODUCTION This study compared the canal curvature and axis modification after instrumentation with WaveOne Primary reciprocating files (Dentsply Maillefer, Ballaigues, Switzerland) and nickel-titanium (NiTi) rotary ProTaper (Dentsply Maillefer). METHODS Thirty ISO 15, 0.02 taper, Endo Training Blocks (Dentsply Maillefer) were used. In all specimens, the glide path was achieved with PathFile 1, 2, and 3 (Dentsply Maillefer) at the working length (WL). Specimens were then assigned to 1 of 2 groups for shaping: specimens in group 1 were shaped with ProTaper S1-S2-F1-F2 at the WL and specimens in group 2 were shaped with WaveOne Primary reciprocating files at the WL. Pre- and postinstrumentation digital images were superimposed and processed with Matlab r2010b (The MathWorks Inc, Natick, MA) software to analyze the curvature-radius ratio (CRr) and the relative axis error (rAe), representing canal curvature modification. Data were analyzed with one-way balanced analyses of variance at 2 levels (P < .05). RESULTS The instrument factor was extremely significant for both the CRr parameter (F(1) = 9.59, P = .004) and the rAe parameter (F(1) = 13.55, P = .001). CONCLUSIONS Canal modifications are reduced when the new WaveOne NiTi single-file system is used.

Vestibular Surgical Access to the Palatine Root of the Superior First Molar: “Low-dose Cone-beam” CT Analysis of the Pathway and its Anatomic Variations

Apicoectomy of the superior first molar palatine root until recently involved relatively destructive and laborious surgery because of the palatal access route, which not only necessitates an extensive flap, but also the readying of procedures required to deal with a possible hemorrhage from the palatine artery. With the advent of operative microscopy, endodontic surgery has become more precise and less invasive and its technical potential has increased; a possible innovative surgical technique may entail vestibular root access. The possibility of using low-dose, low-cost computed tomography (CT) dedicated to the jaw to obtain anatomic information to plan apicoectomy via the vestibular approach was evaluated; 31 patients were referred to CT with the NewTom apparatus. In 43 superior first molars, the mean distance of the palatine root from the external vestibular cortex was measured, and the frequency that the maxillary sinus lateral recess lay between the roots was determined. The mean root apex-vestibular cortex distance was 9.73 mm. In 25% of cases the maxillary sinus recessus lay between vestibular and palatine roots. CT may play an important role in optimizing palatine root apicoectomy through vestibular access, with regard to precision and preventing complications, with relatively low biological and economic cost, also possibly contributing to the affirmation of this new surgical procedure.

Use of Nickel-Titanium Rotary PathFile to Create the Glide Path: Comparison With Manual Preflaring in Simulated Root Canals

The study compared changes to canal curvature and incidence of canal aberrations after preflaring with hand K-files or with nickel-titanium rotary PathFile in S-shape Endo Training Blocks. The influence of the operators expertise was also investigated. One hundred training blocks were colored with ink, and preinstrumentation images were acquired digitally. Preflaring was performed by an endodontist with PathFile (group 1) and hand stainless steel K-files #10-15-20 (group 2); an inexpert clinician performed preflaring with PathFile (group 3) and hand stainless steel K-files (group 4). Preinstrumentation and postinstrumentation images were superimposed to evaluate the outcomes investigated. Differences in canal curvature modification and incidence of canal aberration were analyzed with the Kruskall-Wallis plus post hoc tests and by the Monte Carlo method, respectively, (P < .05). The PathFile groups demonstrated significantly less modification of curvature (P < .001) and fewer canal aberrations (P < .001). No expertise-related difference was found within instrument groups (P > .05), whereas the inexpert clinician produced more conservative shaping with Pathfiles than did the expert with manual preflaring (P < .01).

Root Canal Anatomy Preservation of WaveOne Reciprocating Files with or without Glide Path

INTRODUCTION This study evaluated the influence of glide path on canal curvature and axis modification after instrumentation with WaveOne Primary reciprocating files. METHODS Thirty ISO 15, 0.02 taper Endo Training Blocks were used. In group 1, glide path was created with PathFile 1, 2, and 3 at working length, whereas in group 2, glide path was not performed. In both groups, canals were shaped with WaveOne Primary reciprocating files at working length. Preinstrumentation and postinstrumentation digital images were superimposed and processed with Matlab r2010b software to analyze the curvature radius ratio (CRr) and the relative axis error (rAe), representing canal curvature modification. Data were analyzed with 1-way balanced analyses of variance at 2 levels (P < .05). RESULTS Glide path was found to be extremely significant for both CRr parameter (F = 9.59; df = 1; P = .004) and rAe parameter (F = 13.55; df = 1; P = .001). CONCLUSIONS Canal modifications seem to be significantly reduced when previous glide path is performed by using the new WaveOne nickel-titanium single-file system.

Computed micro-tomographic evaluation of glide path with nickel-titanium rotary pathfile in maxillary first molars curved canals

INTRODUCTION X-ray computed micro-tomography scanning allows high-resolution 3-dimensional imaging of small objects. In this study, micro-CT scanning was used to compare the ability of manual and mechanical glide path to maintain the original root canal anatomy. METHODS Eight extracted upper first permanent molars were scanned at the TOMOLAB station at ELETTRA Synchrotron Light Laboratory in Trieste, Italy, with a microfocus cone-beam geometry system. A total of 2,400 projections on 360° have been acquired at 100 kV and 80 μA, with a focal spot size of 8 μm. Buccal root canals of each specimen (n = 16) were randomly assigned to PathFile (P) or stainless-steel K-file (K) to perform glide path at the full working length. Specimens were then microscanned at the apical level (A) and at the point of the maximum curvature level (C) for post-treatment analyses. Curvatures of root canals were classified as moderate (≤35°) or severe (≥40°). The ratio of diameter ratios (RDRs) and the ratio of cross-sectional areas (RAs) were assessed. For each level of analysis (A and C), 2 balanced 2-way factorial analyses of variance (P < .05) were performed to evaluate the significance of the instrument factor and of canal curvature factor as well as the interactions of the factors both with RDRs and RAs. RESULTS Specimens in the K group had a mean curvature of 35.4° ± 11.5°; those in the P group had a curvature of 38° ± 9.9°. The instrument factor (P and K) was extremely significant (P < .001) for both the RDR and RA parameters, regardless of the point of analysis. CONCLUSIONS Micro-CT scanning confirmed that NiTi rotary PathFile instruments preserve the original canal anatomy and cause less canal aberrations.

Postoperative Pain after Manual and Mechanical Glide Path: A Randomized Clinical Trial

INTRODUCTION This prospective randomized clinical trial evaluated the incidence of postoperative pain after glide path performed with PathFile (PF) (Dentsply Maillefer, Ballaigues, Switzerland) versus stainless-steel K-file (KF). METHODS In 149 subjects, the mechanical glide path was performed with nickel-titanium (NiTi) rotary PF; in 146 subjects, the manual glide path was performed with stainless-steel KFs. Postoperative pain, analgesics consumption, and the number of days to complete pain resolution were evaluated in the following 7 days. An analysis of variance model for repeated measures was used to compare the variation of pain-scale values (P < .05). The Students t test for continuous variables normally distributed, the nonparametric Mann-Whitney U test for the nonnormally distributed variables, and the chi-square test for dichotomous variables were used (P < .05). Despite homogeneous baseline conditions at diagnosis, tooth type, pain prevalence, and scores, the postoperative pain prevalence curves in PF group evidenced a more favorable trend in terms of time to pain resolution compared with the KF group (P = .004). The difference was also evident in the model adjusted for analgesics consumption in both groups (P = .012). The mean analgesics intake per subject was significantly higher in the KF group (3.7 ± 2.2) compared with the PF group (2 ± 1.7) (P < .001). Mean pain stop values were also significantly higher in the KF group (2.7) compared with the PF group (1.7) (P = .001). CONCLUSIONS The glide path with NiTi Rotary PF leads to less postoperative pain and faster symptom resolution.

MTA obturation of pulpless teeth with open apices: bacterial leakage as detected by polymerase chain reaction assay.

Polymerase chain reaction (PCR) followed by reverse dot blot was used to detect Enterococcus faecalis leakage through mineral trioxide aggregate (MTA) apical obturations of pulpless teeth with open apices. Prepared root canals of 34 extracted teeth were given a standard apical foramen opening and received orthograde apical obturation with MTA; three groups had 1-, 2-, or 3-mm thickness. Sterilized specimens were inoculated with E. faecalis and incubated in sterile medium. DNA extracted from the specimens was amplified by polymerase chain reaction, which yielded a specific segment of E. faecalis 16S rDNA. On day 10 of incubation, no specimens were contaminated. On day 50, almost 17% of specimens were contaminated, with no statistically significant difference between groups (Chi-square = 0.48; df = 2; p = 0.787). Therefore, MTA provides an adequate seal even in cases of orthograde apical obturation of pulpless teeth with open apices.

A scanning electron microscopic evaluation of the debridement capability of sodium hypochlorite at different temperatures

The effect of raising the temperature of the irrigant solution on the smear layer was evaluated in the middle and apical third of 22 human upper incisors. A 5% sodium hypochlorite (NaOCl) solution was used at 21 degrees C and at 50 degrees C. After hand instrumentation and treatment with the irrigant, teeth were fractured into halves and examined by scanning electron microscopy. Characteristics of the smear layer in the two groups of specimens were compared. In the middle third, where NaOCl had been used at 50 degrees C, the smear layer was thinner and made of finer, less well-organized particles than where it had been used at 21 degrees C. In the apical third, the smear layer was of almost the same thickness in the two groups of specimens, although the particles were finer where the NaOCl had been used at 50 degrees C.