Emmanuel João Nogueira Leal Silva

Lack of Causal Relationship between Dentinal Microcracks and Root Canal Preparation with Reciprocation Systems

INTRODUCTION This study aimed to evaluate the frequency of dentinal microcracks observed after root canal preparation with 2 reciprocating and a conventional full-sequence rotary system using micro-computed tomographic analysis. METHODS Thirty mesial roots of mandibular molars presenting a type II Vertucci canal configuration were scanned at an isotropic resolution of 14.16 μm. The sample was randomly assigned to 3 experimental groups (n = 10) according to the system used for the root canal preparation: group A-Reciproc (VDW, Munich, Germany), group B-WaveOne (Dentsply Maillefer, Baillagues, Switzerland), and group C-BioRaCe (FKG Dentaire, La-Chaux-de-Fonds, Switzerland). Second and third scans were taken after the root canals were prepared with instruments sizes 25 and 40, respectively. Then, pre- and postoperative cross-section images of the roots (N = 65,340) were screened to identify the presence of dentinal defects. RESULTS Dentinal microcracks were observed in 8.72% (n = 5697), 11.01% (n = 7197), and 7.91% (n = 5169) of the cross-sections from groups A (Reciproc), B (WaveOne), and C (BioRaCe), respectively. All dentinal defects identified in the postoperative cross-sections were also observed in the corresponding preoperative images. CONCLUSIONS No causal relationship between dentinal microcrack formation and canal preparation procedures with Reciproc, WaveOne, and BioRaCe systems was observed.

Evaluation of Root Canal Configuration of Mandibular Molars in a Brazilian Population by Using Cone-beam Computed Tomography: An In Vivo Study

INTRODUCTION The aim of this study was to analyze and characterize root canal morphology of mandibular molars of the Brazilian population by using cone-beam computed tomography (CBCT). METHODS Patients who required CBCT radiographic examinations as part of their routine examination, diagnosis, and treatment planning were enrolled in the study. A total of 460 healthy, untreated, fully developed mandibular first and second molars were included (234 first molars and 226 second molars). The following observations were recorded: (1) number of roots and their morphology, (2) number of canals per root, (3) C-shaped canals, and (4) primary variations in the morphology of the root canal systems. RESULTS First molars showed a higher prevalence of 2 canals in the mesial root and 1 in the distal root with 2 separate roots (74%). In the mandibular second molars, the presence of 2 separate roots with 2 canals in the mesial root and 1 canal in the distal root represented 54% of the total. In 32% of the cases, 2 separate roots with 1 canal each in the mesial and distal roots were presented. The incidence of C-shaped canals was 1.7% of first molars and 3.5% of second molars. CONCLUSIONS A higher prevalence of 2 separate roots with 2 canals in the mesial root and 1 canal in the distal root was observed in mandibular first and second molars (74% and 54%, respectively). Also, a lower incidence of C-shaped canals and 3-rooted teeth was observed in a Brazilian population. CBCT is a clinically useful tool for endodontic diagnosis and treatment.

Evaluation of Root Canal Configuration of Maxillary Molars in a Brazilian Population Using Cone-beam Computed Tomographic Imaging: An In Vivo Study

INTRODUCTION The aim of this study was to analyze and characterize root canal morphology of maxillary molars of the Brazilian population using cone-beam computed tomographic (CBCT) imaging. METHODS Patients referred for a CBCT radiographic examination for accurate diagnosis and treatment planning were enrolled in the study. A total of 620 healthy, untreated, fully developed maxillary first and second molars were included (314 first molars and 306 second molars). The following observations were recorded: (1) number of roots and their morphology, (2) number of canals per root, (3) fused roots, and (4) primary variations in the morphology of the root canal systems. RESULTS First and second molars showed a higher prevalence of 3 separate roots, mesiobuccal, distobuccal, and palatal, with 1 canal in each root (52.87% and 45.09%, respectively). Two canals in the mesiobuccal roots represented 42.63% of teeth, whereas mesiobuccal roots of second molars presented 2 canals in 34.32%. The most common anatomic variation in the maxillary first molar was related to the root canal configuration of the mesiobuccal root, whereas the root canal system of the maxillary second molar teeth showed more anatomic variables. CONCLUSIONS Mesiobuccal roots of maxillary molar teeth had more variation in their canal system than the distobuccal or palatal roots. The root canal configuration of the maxillary second molars was more variable than the first molars in a Brazilian population. CBCT imaging is a clinically useful tool for endodontic diagnosis and treatment planning.

Micro-computed Tomographic Assessment on the Effect of ProTaper Next and Twisted File Adaptive Systems on Dentinal Cracks.

INTRODUCTION The aim of the present study was to evaluate the frequency of dentinal microcracks observed after root canal preparation with ProTaper Next (PTN; Dentsply Maillefer, Ballaigues, Switzerland) and Twisted File Adaptive (TFA; SybronEndo, Orange, CA) systems through micro-computed tomographic analysis. METHODS Twenty moderately curved mesial roots of mandibular molars presenting a type II Vertucci canal configuration were randomly assigned to 2 experimental groups (n = 10) according to the system used for the root canal preparation: PTN or TFA systems. The specimens were scanned through high-resolution micro-computed tomographic imaging before and after root canal preparation. Afterward, pre- and postoperative cross-sectional images of the mesial roots (N = 25,820) were screened to identify the presence of dentinal defects. RESULTS Dentinal microcracks were observed in 38.72% (n = 5150) and 30.27% (n = 3790) of the cross-sectional images in the PTN and TFA groups, respectively. All dentinal defects identified in the postoperative scans were already present in the corresponding preoperative images. CONCLUSIONS Root canal preparation with PTN and TFA systems did not induce the formation of new dentinal microcracks.

Apically extruded dentin debris by reciprocating single-file and multi-file rotary system

ObjectivesThis study aims to evaluate the apical extrusion of debris by the two reciprocating single-file systems: WaveOne and Reciproc. Conventional multi-file rotary system was used as a reference for comparison. The hypotheses tested were (i) the reciprocating single-file systems extrude more than conventional multi-file rotary system and (ii) the reciprocating single-file systems extrude similar amounts of dentin debris.Materials and methodsAfter solid selection criteria, 80 mesial roots of lower molars were included in the present study. The use of four different instrumentation techniques resulted in four groups (n = 20): G1 (hand-file technique), G2 (ProTaper), G3 (WaveOne), and G4 (Reciproc). The apparatus used to evaluate the collection of apically extruded debris was typical double-chamber collector. Statistical analysis was performed for multiple comparisons.ResultsNo significant difference was found in the amount of the debris extruded between the two reciprocating systems. In contrast, conventional multi-file rotary system group extruded significantly more debris than both reciprocating groups. Hand instrumentation group extruded significantly more debris than all other groups.ConclusionThe present results yielded favorable input for both reciprocation single-file systems, inasmuch as they showed an improved control of apically extruded debris.Clinical relevanceApical extrusion of debris has been studied extensively because of its clinical relevance, particularly since it may cause flare-ups, originated by the introduction of bacteria, pulpal tissue, and irrigating solutions into the periapical tissues.

Blue Thermomechanical Treatment Optimizes Fatigue Resistance and Flexibility of the Reciproc Files

Introduction: The aim of the present study was to evaluate the influence of Blue thermal treatment on the bending resistance and cyclic fatigue of conventional M‐Wire Reciproc files (VDW, Munich, Germany). The roughness pattern and the microhardness of the files were also assessed. Methods: Flexibility of standard Reciproc R25 files and the corresponding Blue prototypes was determined by 45° bending tests according to the ISO 3630‐1 specification. Instruments were also subjected to cyclic fatigue resistance, measuring the time to fracture in an artificial stainless steel canal with a 60° angle and a 5‐mm radius of curvature. The fracture surface of all fragments was examined with a scanning electron microscope. The roughness of the working parts was quantified by using a profilometer, and the microhardness test was performed using the Vickers hardness tester. Results were statistically analyzed using the Student t test with a level of significance set at P < .05. Results: Reciproc Blue instruments presented a significantly longer cyclic fatigue life and significantly lower bending resistance than the original Reciproc instrument (P < .05). Regarding the roughness pattern, there was no significant difference between Reciproc Blue and the original Reciproc instruments (P > .05), whereas Reciproc Blue revealed significantly lower microhardness than the original Reciproc instrument (P < .05). Conclusions: Reciproc Blue nickel‐titanium showed improved all‐around performance when compared with conventional M‐Wire superelastic nickel‐titanium, demonstrating improved flexibility and fatigue resistance, and reduced microhardness while maintaining similar characteristics of the surface. HighlightsSo far, Blue thermal treatment was not assessed regarding cyclic fatigue and other mechanical features.Reciproc Blue showed overall improved performances when compared with conventional Reciproc, demonstrating improved flexibility and fatigue resistance, and reduced microhardness while maintaining similar characteristics of the surface.

Accumulated hard tissue debris produced during reciprocating and rotary nickel-titanium canal preparation.

INTRODUCTION This study compared the amount of hard tissue debris produced after different apical enlargement with single-file reciprocating systems (WaveOne [Dentsply Maillefer, Baillaigues, Switzerland] and Reciproc [VDW, Munich, Germany]) and a conventional multifile rotary system (BioRaCe [FKG Dentaire, La-Chaux-de-Fonds, Switzerland]) using micro-computed tomographic imaging. METHODS Thirty moderately curved mesial roots of mandibular molars presenting 2 independent root canals were selected and scanned at an isotropic resolution of 14.16 μm. The sample was assigned to 3 groups (n = 10) with respect to the root length and degree of curvature of the mesial root according to the system used for the root canal preparation: Reciproc, WaveOne, and BioRaCe. Second and third scans were taken after the root canals were prepared up to ISO sizes 25 and 40, respectively. The matched images of the mesial canals, before and after preparation, were examined from the furcation level to the apex to evaluate the amount of hard tissue debris (%). Data were statistically compared using a general linear model for repeated-measures with a significance level set at 5%. RESULTS Instrumentation systems per se did not influence the amount of hard tissue accumulation (P > .05), whereas a significant reduction in the percentage of hard tissue debris was observed after sequential enlargement in all groups (P < .05). CONCLUSIONS None of the systems yielded root canals completely free from packed hard tissue debris. The increased final apical size resulted in significantly less debris accumulation for both reciprocating and rotary systems.

Reciprocating Versus Rotary Systems for Root Filling Removal: Assessment of the Apically Extruded Material

INTRODUCTION This study was designed to quantitatively evaluate the amount of apically extruded debris by comparing the ProTaper Universal Retreatment system (Dentsply Maillefer, Ballaigues, Switzerland) with 2 reciprocating single-file systems (Reciproc [VDW, Munich, Germany] and WaveOne [Dentsply Maillefer]) during endodontic retreatment. METHODS Forty-five mandibular premolars with a single canal were prepared with the ProTaper Universal system and then obturated. The specimens were divided into 3 groups (n = 15) according to the system used for filling removal: ProTaper Universal Retreatment system associated with the ProTaper Universal system (until file F4 40/0.06]), Reciproc system (Reciproc R40 [40/0.06]), and WaveOne system (WaveOne Large [40/0.08]). Sodium hypochlorite was used as an irrigant, and the apically extruded debris was collected in glass vials and then dried. The mean weight of debris was assessed with a microbalance and statistically analyzed using 1-way analysis of variance and post hoc Tukey multiple comparison tests (P < .05). RESULTS The ProTaper Universal Retreatment system produced significantly more debris compared with the Reciproc and WaveOne systems (P < .01). The reciprocating systems showed no significant difference between them (P > .05). CONCLUSIONS Under the conditions of the present study, all systems caused apical debris extrusion. Reciprocating systems were associated with less debris extrusion when compared with a conventional rotary retreatment system.

Postoperative Pain after Foraminal Enlargement in Anterior Teeth with Necrosis and Apical Periodontitis: A Prospective and Randomized Clinical Trial

INTRODUCTION The aim of this randomized, controlled, prospective clinical study was to determine if foraminal enlargement instrumentation during endodontic treatment is associated with more postoperative pain compared with standard nonenlargement instrumentation. METHODS Forty volunteers with a single root canal were diagnosed with asymptomatic necrosis with apical periodontitis and randomized into 2 experimental groups (ie, the control group and the foraminal enlargement group). Endodontic treatment was performed in a single visit, and volunteers were instructed to record pain intensity (ie, none, slight, moderate, and severe). Scores from 1 to 4 were attributed to each kind of pain after 12, 24, and 48 hours. The Kolmogorov-Smirnov and Students t tests were used to determine significant differences at P < .05. RESULTS No statistically significant age difference was found between the groups (P > .05, Students t test). Postoperative pain showed no statistically significant difference between the groups at any observation period (P > .05). Also, no significant difference was observed in the mean number of analgesic tablets used between the groups (P > .05). CONCLUSIONS The foraminal enlargement and nonenlargement techniques resulted in the same postoperative pain and necessity for analgesic medication. This may suggest that the use of foraminal enlargement should be performed for endodontic treatment previsibility without increasing postoperative pain.

Exploiting the potential of free software to evaluate root canal biomechanical preparation outcomes through micro-CT images

AIM To propose an automated image processing routine based on free software to quantify root canal preparation outcomes in pairs of sound and instrumented roots after micro-CT scanning procedures. METHODOLOGY Seven mesial roots of human mandibular molars with different canal configuration systems were studied: (i) Vertuccis type 1, (ii) Vertuccis type 2, (iii) two individual canals, (iv) Vertuccis type 6, canals (v) with and (vi) without debris, and (vii) canal with visible pulp calcification. All teeth were instrumented with the BioRaCe system and scanned in a Skyscan 1173 micro-CT before and after canal preparation. After reconstruction, the instrumented stack of images (IS) was registered against the preoperative sound stack of images (SS). Image processing included contrast equalization and noise filtering. Sound canal volumes were obtained by a minimum threshold. For the IS, a fixed conservative threshold was chosen as the best compromise between instrumented canal and dentine whilst avoiding debris, resulting in instrumented canal plus empty spaces. Arithmetic and logical operations between sound and instrumented stacks were used to identify debris. Noninstrumented dentine was calculated using a minimum threshold in the IS and subtracting from the SS and total debris. Removed dentine volume was obtained by subtracting SS from IS. RESULTS Quantitative data on total debris present in the root canal space after instrumentation, noninstrumented areas and removed dentine volume were obtained for each test case, as well as three-dimensional volume renderings. CONCLUSION After standardization of acquisition, reconstruction and image processing micro-CT images, a quantitative approach for calculation of root canal biomechanical outcomes was achieved using free software.