Georgios Mikrogeorgis

Three-Dimensional Reconstruction: A New Method for the Evaluation of Apical Microleakage

The purpose of this study was the evaluation of a new method for studying apical microleakage by using a three-dimensional (3-D) reconstruction method. Fourteen human single-rooted mandibular teeth were used for this work. The canals were prepared with hand instruments by using the step-back technique. To supply a focus to the study of the method, the teeth were divided into two groups that were obturated using two different sealers. India ink was used for passive stain. Serial cross-sections 0.75 mm thick were taken from each specimen by using a special microtome. Each section was photographed under a stereoscopic microscope. Each photograph was digitized and processed to obtain a 3-D reconstruction of the external surface of the teeth, their corresponding prepared root canals, and their apical microleakage. Sample size and experimental methods were not designed to make valid groups; however, apical microleakage was observed in both groups ranging between 2.25 to 8.25 mm height. The 3-D reconstruction method has proved to be a useful tool in the study of apical microleakage.

3D reconstruction of two C-shape mandibular molars

Two mandibular second molars, with an indication of C-shape morphology were processed for 3-D reconstruction. After serial cross sectioning, photographs of the sections were digitized and by using surface representation, 3D reconstruction was achieved. The first molar as the 3D reconstruction showed was single rooted with one C-shaped root canal with two foramens, while the second one was double rooted with two root canals, one C-shaped and one thin, having a common foramen.

Digital Radiograph Registration and Subtraction: A Useful Tool for the Evaluation of the Progress of Chronic Apical Periodontitis

The purpose of this study was to evaluate the suitability of a digital radiograph registration and subtraction software for a sensitive and reliable assessment of the progress of chronic apical periodontitis. Ninety cases of teeth with chronic apical periodontitis have been studied. In each case, a preoperative radiograph was taken, root canals were prepared, and a Ca(OH)2 paste was placed in the root canals. Radiographic control and replacement of Ca(OH)2 paste took place at 15-day intervals. The root canals were obturated 1.5 months after the first appointment. Recall radiographs were taken 0.5, 1.5, 3, 6, and 12 months after the obturation. All radiographs were taken for each case under constant conditions by using a direct digital radiography system. In each case, the preoperative, postoperative, and control and recall radiographs were digitally registered and pairwise subtracted. The resulting images were further processed by using contrast enhancement and pseudocoloring methods. Changes to the periapical tissue structure were easily detectable by using the above-mentioned methodology, even during short time intervals.

Assessment of simulated internal resorption cavities using digital and digital subtraction radiography: a comparative study

AIM To compare the diagnostic accuracy of digital radiography with that of digital subtraction radiography in the detection of simulated internal resorption cavities. MATERIALS AND METHODS Simulated internal resorption cavities of varying sizes were created using round burs in 18 single-rooted teeth with visible pulp chamber, which had been extracted from dentate dry mandibles and split into two halves in a mesio-distal direction. Resorption cavities were created in the buccal half of the root in the cervical, middle, and apical third. Digital radiographs were taken from three different horizontal view angles before and after the creation of the cavities. This process was followed by digital subtraction radiography to evaluate their detection. Seven experienced observers and all specialists in endodontics were asked to examine the digital and digital subtraction images for the presence of the cavities. The data were analyzed using SPSS 14. RESULTS The overall sensitivity of digital subtraction radiography was superior to digital radiography and with statistically better results for all cavities regardless of their location (cervical, middle, apical third) (P < 0.05). The detection of the cavities was affected by the root third in which they were located. Cavities in the apical third were more easily detected compared with those in the middle or cervical third of the root. Small-sized lesions (0.5 mm, 0.6 mm) in the middle and apical third were more frequent and more easily detected using subtraction imaging. CONCLUSION Digital subtraction radiography is superior to digital radiography for the detection and monitoring of the progress of internal root resorption.

In Vitro Comparative Study of the Influence of Instrument Taper on the Fracture Resistance of Endodontically Treated Teeth: An Integrative Approach–based Analysis

Introduction The objective of this study was to examine the influence of instrument taper on the fracture resistance of endodontically treated roots under in vitro experimental conditions. Methods In total, 58 maxillary canines complying with the inclusion criteria were sectioned at approximately 13 mm from the apex. The roots were standardized with respect to the buccolingual‐mesiodistal diameter and weight before being randomly distributed into 3 experimental groups (n = 14) and 1 control group (n = 16). The roots in group 1 were instrumented with hand files up to file 40/.02 and groups 2 and 3 with Mtwo (VDW, Munich, Germany) rotary files up to files 40/.04 and 40/.06, respectively. After mechanical preparation, the roots were obturated with gutta‐percha and sealer. Roots in group 4 acted as uninstrumented controls. A vertical load was applied to each specimen using a universal testing machine until the roots fractured. Data were statistically analyzed by introducing an innovative approach integrating 1‐way analysis of variance, confirmatory factor analysis, and regression analysis. Results The mean fracture load was 357.47 ± 110.54 N for the control group, 338.86 ± 105.23 N for group 1, 297.74 ± 77.31 N for group 2, and 280.10 ± 68.51 N for group 3. However, only the difference between group 3 and the control group was statistically significant (P < .05). Conclusions After instrumentation using hand files up to file 40/.02 and rotary files up to files 40/.04 and 40/.06, only the last appeared to change the fracture resistance of endodontically treated roots. HighlightsThe influence of instrument taper on the fracture resistance of endodontically treated roots was evaluated.Standardization and randomization of the sample with respect to their dimension and weight was performed.Rotary files of same design, settings, and kinematics were used for the preparation of the root canals.Vertical positioning of the roots in molds was confirmed radiographically.Methodology standardization is of great importance concerning in vitro studies on fracture resistance using natural teeth.

A new methodology for the measurement of the root canal curvature and its 3D modification after instrumentation

Abstract Objective: In this study, the three-dimensional (3D) modification of root canal curvature was measured, after the application of Reciproc instrumentation technique, by using cone beam computed tomography (CBCT) imaging and a special algorithm developed for the 3D measurement of the curvature of the root canal. Materials and methods: Thirty extracted upper molars were selected. Digital radiographs for each tooth were taken. Root curvature was measured by using Schneider method and they were divided into three groups, each one consisting of 10 roots, according to their curvature: Group 1 (0°–20°), Group 2 (21°–40°), Group 3 (41°–60°). CBCT imaging was applied to each tooth before and after its instrumentation, and the data were examined by using a specially developed CBCT image analysis algorithm. Results: The instrumentation with Reciproc led to a decrease of the curvature by 30.23% (on average) in all groups. Conclusions: The proposed methodology proved to be able to measure the curvature of the root canal and its 3D modification after the instrumentation.

Diagnosis of vertical root fractures in endodontically treated teeth utilising Digital Subtraction Radiography

Vertical root fractures are commonly associated with root-filled teeth. Diagnosis is challenging because the clinical signs are not completely pathognomonic, and conventional periapical radiography is often unreliable. Digital subtraction radiography (DSR) is able to detect small radiographic changes between two successive radiographs by subtracting out consistent radiographic elements. Its use could possibly assist in the diagnostic procedure. Four cases are presented to demonstrate the potential use of DSR in the detection of vertical root fractures in endodontically treated teeth. After the digital subtractions had been carried out, a dark line in the body of the roots was distinguishable, raising the possibility of the presence of a vertical root fracture. The use of contrast enhancement and pseudocolouring techniques assisted with the diagnosis of vertical root fractures. DSR proved to be a useful diagnostic tool for the detection of vertical root fractures in these four clinical cases.