Valentina Giuliani

Mineral trioxide aggregate as repair material for furcal perforation: case series.

The purpose of treating furcal perforation is to seal the artificial communication between the endodontic space and the periradicular tissue to prevent alveolar bone resorption and damage to the periodontal ligament. These complications are not infrequent in cases of furcal and/or old perforations, which show a worse prognosis than fresh, small, coronal, and apical perforations. Mineral trioxide aggregate (MTA) is widely used to seal perforations because of its biocompatibility and sealability. Ten cases of furcal perforation were selected at the department of Endodontics, University of Florence. All the perforations were cleaned with NaOCl, EDTA, and ultrasonic tips and sealed with MTA without internal matrix. Finally, the teeth were endodontically treated and coronally restored. Clinical and radiographic follow-ups were done at 6 months, 1 year, 2 years, and 5 years. After 5 years, the absence of periradicular radiolucent lesions, pain. and swelling along with functional tooth stability indicated a successful outcome of sealing perforations in 9 out of 10 teeth. One patient dropped out of the study after the 1-year follow-up and could not be contacted for further recalls. The results confirm that MTA without matrix provides an effective seal of root perforations and clinical healing of the surrounding periodontal tissue.

Efficacy of ProTaper Universal Retreatment Files in Removing Filling Materials during Root Canal Retreatment

The aim of this study was to evaluate the efficacy of the ProTaper Universal System rotary retreatment system and of Profile 0.06 and hand instruments (K-file) in the removal of root filling materials. Forty-two extracted single-rooted anterior teeth were selected. The root canals were enlarged with nickel-titanium (NiTi) rotary files, filled with gutta-percha and sealer, and randomly divided into 3 experimental groups. The filling materials were removed with solvent in conjunction with one of the following devices and techniques: the ProTaper Universal System for retreatment, ProFile 0.06, and hand instruments (K-file). The roots were longitudinally sectioned, and the image of the root surface was photographed. The images were captured in JPEG format; the areas of the remaining filling materials and the time required for removing the gutta-percha and sealer were calculated by using the nonparametric one-way Kruskal-Wallis test and Tukey-Kramer tests, respectively. The group that showed better results for removing filling materials was the ProTaper Universal System for retreatment files, whereas the group of ProFile rotary instruments yielded better root canal cleanliness than the hand instruments, even though there was no statistically significant difference. The ProTaper Universal System for retreatment and ProFile rotary instruments worked significantly faster than the K-file. The ProTaper Universal System for retreatment files left cleaner root canal walls than the K-file hand instruments and the ProFile Rotary instruments, although none of the devices used guaranteed complete removal of the filling materials. The rotary NiTi system proved to be faster than hand instruments in removing root filling materials.

Shaping Ability of WaveOne Primary Reciprocating Files and ProTaper System Used in Continuous and Reciprocating Motion

INTRODUCTION The purpose of this study was to compare the shaping effects of Wave One (Dentsply Maillefer, Ballaigues, Switzerland) and full-sequence ProTaper nickel-titanium (NiTi) files (Dentsply Maillefer) used in reciprocating and conventional movements in a simulated canal. METHODS Seventy-five S-shaped canals in resin blocks were randomly allocated to 3 groups (n = 25): WaveOne (group 1), full sequence of ProTaper Universal files in conventional movements (group 2), and full sequence of ProTaper Universal files in reciprocating movements (group 3). Preoperative and postoperative photographs of the simulated canals were taken under standardized conditions, after which they were accurately superimposed. Two methods were adopted to evaluate the shaping ability of the 3 approaches: measuring the differences in apical and coronal curvature modifications and measuring the amount of resin removed for both curvatures on the right and left sides of the simulated canals. Differences in canal curvature modifications and in the amount of resin removed were analyzed using 1-way analysis of variance (P < .0001) followed by a Tukey-Kramer multiple comparison post hoc test and mixed-effects linear model (P < .05), respectively. METHODS Group 3 maintained better coronal and apical canal curvature and less straightening of the simulated canals with respect to groups 1 and 2. CONCLUSIONS When preparing S-shaped canals, full-sequence ProTaper Universal NiTi files used in a reciprocating motion exhibited better shaping effects than full-sequence ProTaper Universal NiTi files used in a conventional motion and WaveOne.

A diagnostic dilemma: endodontic lesion or odontogenic keratocyst? A case presentation

AIM To present a clinical case of odontogenic keratocyst (OKC) simulating a lateral periodontal cyst. SUMMARY A 39-year-old female complaining of swelling and pain in the left mandibular premolar area was found to have a radiolucent lesion between teeth 34 and 35 (FDI). Both teeth had incomplete root fillings, and orthograde re-treatment of both premolars was performed. At 2-year follow-up, radiographic examination showed an increase in the radiolucent defect with respect to the previous examination. A surgical treatment of tooth 34 was then performed, with histological examination of the lesion. Histological features were consistent with an OKC, and the lesion was successfully treated by complete enucleation and application of Carnoys solution. At 2-year follow-up, no clinical signs or symptoms were found and the radiolucent area had disappeared. KEY LEARNING POINTS Odontogenic keratocysts may mimic endodontic lesions. Clinicians should carefully review their cases and consider surgical intervention with biopsy in cases that do not heal.

Effects of pH on surface hardness and microstructure of mineral trioxide aggregate and Aureoseal: an in vitro study.

INTRODUCTION The aim of the study was to evaluate the surface hardness and the morphologic microstructure of white mineral trioxide aggregate (WMTA) and Aureoseal in acid environment. METHODS WMTA and Aureoseal were mixed and packed into 64 cylindrical stainless steel molds. Thirty-two of each group were exposed to pH values of 4.4 and 7.4, respectively, for 7 days. Four specimens, 2 exposed to acid pH and 2 exposed to pH of 7.4, were prepared for evaluation under scanning electron microscope by using scattered electron (SE) and backscattered electron (BSE) detectors. Vickers surface hardnesses were measured in the remaining 60 samples. RESULTS The mean surface hardness values ± standard deviation were 37.54 ± 1.52 and 30.24 ± 1.47 for WMTA and 40.63 ± 1.35 and 28.67 ± 1.07 for Aureoseal after exposure to pH values of 7.4 and 4.4, respectively. WMTA showed higher hardness values in acid environment than Aureoseal, which showed the highest microhardness at pH values of 7.4. The SE detector revealed crystal formation on the WMTA surface at pH values of 7.4 and 4.4. In the WMTA specimens the BSE detector showed more unhydrated structures at pH values of 4.4 than at 7.4. The SE detector did not reveal crystal formation on the Aureoseal specimens at pH 7.4 and 4.4. BSE detection showed amorphous microstructures in the Aureoseal specimens treated in the pH 4.4 acid environment. CONCLUSIONS There was significant interaction between the cements and the environments where the cements hardened.

Endodontic Management in Oculo-Facio-Cardio-Dental Syndrome: A Case Report

INTRODUCTION Oculo-facio-cardio-dental (OFCD) syndrome is an X-linked dominant trait. OFCD syndrome is characterized by congenital cataract with secondary glaucoma ocular defects; ventricular and atrial septal defects or mitral valve prolapses; facial traits such as a long narrow face, a high nasal bridge, a bifid nasal tip; and dental anomalies that include radiculomegaly, oligodontia, root dilacerations, malocclusion and delayed eruption. This clinical report describes the endodontic treatment for a 16-year-old girl who suffers from OFCD syndrome. METHODS The treatment plan included orthograde re-treatment of #9, #10 with apical plug technique and orthograde retreatment and root canal obturation with modified Thermafil (Dentsply Maillefer, Ballaigues, Switzerland) technique of #21, #22 RESULTS The modified Thermafil technique makes it possible to reach the working length even in teeth with radiculomegaly. CONCLUSIONS Prompt treatment of dental caries make it possible to maintain tooth function and prevent difficult root canal procedures with poor prognoses for success.