Endodontic management of type II dens invaginatus with open apex and large periradicular lesion using the XP-endo Finisher : a case report

Dens invaginatus (DI) represents an endodontic challenge because of its complex root canal morphology. This case report presents the clinical management of a 22-year-old woman with type II DI in right maxillary lateral incisor with a painful swelling. Pulp testing revealed no response with the tooth. Type II DI with open apex and large periradicular lesion was seen on radiograph. The treatment was planned by using cone-beam computed tomography (CBCT) imaging. Canal treatment was completed in two appointments with the aid of a dental operating microscope. In the first appointment, the internal anatomy was modified using an ultrasonic tip, and chemo-mechanical preparation was performed using the XP-endo Finisher instrument and NaOCl; calcium hydroxide intracanal dressing was used for one month. In the second appointment, an apical plug of mineral trioxide aggregate (MTA) Repair HP was performed and the remaining pulp space was then filled with gutta-percha and AH Plus sealer using the continuous wave of condensation technique. At the fourteen-month reevaluation, the patient was asymptomatic, the tooth had remained functional, and radiographic and CBCT assessment showed significant osseous healing of the lesion. Successful non-surgical management of the present type II DI was achieved in the present case. The association of CBCT, dental operating microscope, XP-endo Finisher, NaOCl and MTA Repair HP were important for ensuring a predictable outcome

Evaluation of dentinal micro-cracks, non-instrumented canal area and accumulated hard-tissue debris after canal preparation with Reciproc, WaveOne and BioRace systems

O objetivo desse trabalho foi avaliar a frequência de trincas radiculares, e aporcentagem (%) de área não instrumentada e de debris acumulados após o preparo dos canais com os sistemas Reciproc, WaveOne e BioRace utilizando a micro-tomografia computadorizada (micro-CT). Para isso, 30 raízes mesiais, moderadamente curvas (10º a 20º), de molares inferiores apresentando configuração tipo II de Vertucci foram selecionadas e escaneadas usando uma resolução de 14.16 μm através da micro-CT. A amostra foi dividida aleatoriamente em 3 grupos (n = 10) de acordo com o sistema utilizado para o preparo dos canais radiculares: Reciproc, WaveOne e BioRace. Um segundo e terceiro escaneamento dos espécimes foi realizado após o preparo dos canais até instrumentos de tamanho de ponta #25 e #40, respectivamente. Em seguida, o conjunto de imagens dos canais mesiais (N = 65.340) antes, após o preparo até #25 e após o preparo até #40 foram registradas e examinadas desde a furca até o ápice radicular para avaliar a frequência de trincas radiculares e a % de área não instrumentada e debris acumulados. Os dados foram comparados estatisticamente usando um modelo linear para medidas repetidas com nível de significância em 5%. As trincas radiculares foram observadas em 8,72% (n = 5.697), 11,01% (n = 7.197) e 7,91% (n = 5.169) das imagens dos grupos Reciproc, WaveOne e BioRace, respectivamente. Todas as trincas observadas nas imagens pós instrumentação já estavam presentes nas imagens pré-operatórias correspondentes. Os sistemas de instrumentação não influenciaram na % de área não instrumentada e na quantidade de debris acumulados (p > 0,05), enquanto que uma redução significativa na % de área não instrumentada e debris acumulados foi observada após o aumento do preparo apical em todos os grupos (p < 0,05). Concluiu-se que não houve uma relação causal entre a formação de trincas radiculares e o preparo dos canais com os sistemas Reciproc, WaveOne e BioRace. Nenhum desses sistemas foi capaz de instrumentar todas as paredes dos canais mesiais de molares inferiores e deixá-las sem debris. O aumento do preparo apical influenciou positivamente na capacidade de modelagem e na diminuição de debris acumulados em todos os sistemas testados.The aim of this study was to evaluate the frequency of dentinal micro-cracks and the percentage (%) of non-instrumented canal area and accumulated hard-tissue debris after root canal preparation with Reciproc, WaveOne and BioRace systems using micro-computed tomographic (micro-CT) analysis. For this, 30 moderately curved mesial roots (10º to 20º) of mandibular molars presenting type II Vertucci canal configuration were selected and scanned at a resolution of 14.16 μm using a microCT scan. The sample was randomly assigned into 3 groups (n = 10) according to the system used to prepare the root canals: Reciproc, WaveOne and BioRace. Second and third scans of the specimens were performed after canal preparation up to instruments tip size #25 and #40, respectively. Then, the matched images of the mesial canals (N = 65.340), before and after preparation, were examined from the furcation level to the apex to evaluate the frequency of dentinal micro-cracks and the % of non-instrumented canal area and the amount of accumulated hard-tissue debris. Data were statistically compared using a general linear model for repeatedmeasures with a significance level set at 5%. Dentinal micro-cracks were observed in 8,72% (n = 5.697), 11,01% (n = 7.197), and 7,91% (n = 5.169) of the cross-sections images from Reciproc, WaveOne, and BioRaCe groups, respectively. All dentinal micro-cracks identified in the postoperative cross-sections were also observed in the corresponding preoperative images. The instrumentation systems did not influence the % of non-instrumented canal surface and the amount of accumulated hard-tissue debris (p > 0,05), while a significant reduction in the % of untouched canal walls and accumulated debris was observed after the increase of apical preparation in all groups (p < 0,05). It was concluded that there was no causal relationship between dentinal micro-crack formation and canal preparation procedures with Reciproc, WaveOne, and BioRaCe systems. None of the systems was able to prepare the entire surface area of the mesial root canals of mandibular molars and to yield root canals completely free from packed hard-tissue debris. The increased final apical preparation resulted in a significant positive effect on the shaping ability and in the reduction of debris in all tested systems.25f

Biocompatibility of a self-adhesive gutta-percha material (Bio-Gutta)

Coordenação de Aperfeiçoamento de Pessoal de Nível SuperiorO objetivo desse trabalho foi avaliar a biocompatibilidade de um material a base de guta-percha autoadesiva (Bio-Gutta) em tecido subcutâneo de camundongos. A guta-percha convencional foi utilizada como referência para comparação. Para isso, foram utilizados 30 camundongos, os quais foram distribuídos aleatoriamente em dois grupos (Bio-Gutta e guta-percha convencional). Os materiais avaliados foram implantados na região dorsal dos camundongos. Após 7, 21 e 63 dias, os animais foram sacrificados e 5 amostras por grupo por tempo experimental foram obtidas. As amostras histológicas foram seccionadas em 5 m de espessura e coradas convencionalmente com hematoxilina e eosina. Um escore de I-IV foi utilizado para graduar a reação inflamatória. O teste U de Mann-Whitney com correção de Bonferroni foi utilizado para análise estatística (p < 0,05). Os resultados mostraram que, após 7 dias, a Bio-Gutta induziu uma reação tecidual de leve a moderada (II) e a guta-percha convencional apresentou uma resposta inflamatória de moderada a intensa (III). Após 21 dias, a Bio-Gutta induziu uma leve reação tecidual (I), enquanto que a guta-percha convencional ainda apresentava uma resposta inflamatória moderada (III). Uma reação tecidual de leve a ausente (I) foi observada na Bio-Gutta após 63 dias, ao passo que na guta-percha convencional observou-se uma resposta inflamatória de leve a moderada (II). Houve diferença significativa na mediana do grau de inflamação entre os grupos em cada tempo experimental (p = 0,005, aos 7 dias; p = 0,011, aos 21 dias; e p = 0,003, aos 63 dias). Concluiu-se então que a Bio-Gutta foi mais biocompatível que a guta-percha convencional em tecido subcutâneo de camundongos apresentando uma boa resposta tecidual.The purpose of this study was to evaluate the biocompatibility of a self-adhesive gutta-percha material (Bio-Gutta) in connective tissue of mice. Conventional gutta-percha was used as reference for comparison. Thirty mice were used in this study and they were randomly assigned into two groups (Bio-Gutta and conventional gutta-percha). The tested materials were implanted in the dorsal region of mice. After 7, 21 and 63 days, animals were sacrificed and 5 samples per group per time-point were obtained. Histologic samples were sectioned in 5 m thickness and stained with conventional hematoxylin and eosin. A grade from I-IV was used to graduate the inflammatory reaction. Bonferroni-corrected Mann-Whitney U test was used for statistical analysis (p < 0,05). The results showed that after 7 days Bio-Gutta induced a slight to moderate tissue reaction (II) and conventional gutta-percha presented a moderate to intense inflammatory response (III). After 21 days, Bio-Gutta presented a slight tissue reaction (I), while conventional gutta-percha still showed a moderate inflammatory response (III). A slight to absent tissue reaction (I) was observed in Bio-Gutta after 63 days, whereas conventional gutta-percha showed a slight to moderate inflammatory response (II). There was a significant difference in the median degree of inflammation between the groups at each time-point (p = 0,005, at 7 days; p = 0,011, at 21 days; and p = 0,003, at 63 days). It was concluded that Bio-Gutta was more biocompatible than conventional gutta-percha in subcutaneous tissue of mice showing a good tissue response

Postoperative Pain After Foraminal Instrumentation With A Reciprocating System And Different Irrigating Solutions.

The aim of the present study was to evaluate and compare postoperative pain after foraminal instrumentation using 5.25% sodium hypochlorite (NaOCl) or 2% chlorhexidine (CHX) gel irrigation protocol in nonvital single-rooted teeth after reciprocating instrumentation. Sixty-two volunteers presenting a single root canal diagnosed with asymptomatic necrosis and apical periodontitis were randomized into 2 experimental groups regarding the irrigation protocol (ie, 5.25% NaOCl and 2% CHX gel groups). Endodontic treatment was performed in a single session under reciprocating instrumentation with foraminal instrumentation. Volunteers were instructed to record pain intensity. Scores from 1 to 4 were attributed to each kind of pain after 24, 48, and 72 h. Kolmogorov-Smirnov and Student´s t tests were used to determine significant differences at p0.05, Student´s t test). Postoperative pain showed no statistically significant difference at any observation period when using 5.25% NaOCl or 2% CHX gel (p>0.05). Moreover, no significant difference was observed in the mean number of analgesic tablets used between the groups (p>0.05). In conclusion, the use of 5.25% NaOCl or 2% CHX gel resulted in the same postoperative pain. Therefore, it can be inferred that irrigant choice has no relation with short-term follow up regarding postoperative pain.26216-22

Quantitative transportation assessment in curved canals prepared with an off-centered rectangular design system

Abstract The purpose of this study was to assess the ability of an off-centered rectangular design system [ProTaper Next (PTN)] to maintain the original profile of the root canal anatomy. To this end, ProTaper Universal (PTU), Reciproc (R) and WaveOne (WO) systems were used as reference techniques for comparison. Forty clear resin blocks with simulated curved root canals were randomly assigned to 4 groups (n = 10) according to the instrumentation system used: PTN, PTU, R and WO. Color stereomicroscopic images of each block were taken before and after instrumentation. All image processing and data analysis were performed with an open source program (Fiji v.1.47n). Evaluation of canal transportation was obtained for two independent regions: straight and curved portions. Univariate analysis of variance and Tukey&#8217;s Honestly Significant Difference test were performed, and a cut-off for significance was set at &#945; = 5%. Instrumentation systems significantly influenced canal transportation (p = 0.000). Overall, R induced significantly lower canal transportation compared with WO, PTN and PTU (p = 0.000). The curved portion displayed superior canal transportation compared to the straight one (p = 0.000). The significance of the difference among instrumentation systems varied according to the canal level evaluated (p = 0.000). In its straight portion, R and WO exhibited significantly lower transportation than PTN; whereas in the curved portion, R produced the lowest deviation. PTU exhibited the highest canal transportation at both levels. It can be concluded that PTN produced less canal transportation than PTU and WO; however, R exhibited better centering ability than PTN

Quantitative transportation assessment in simulated curved canals after large apical preparations

evaluate the ability of rotary (ProTaper Universal [PTU] and ProTaper Next [PTN]), reciprocating (Reciproc [R] and WaveOne [WO]) and adaptive (Twisted File Adaptive [TFA]) systems in maintaining the original canal profile in straight and curved parts after apical preparations up to size 40. Methods: Resin blocks with simulated curved canals were randomly assigned to five groups: PTU, PTN, R, WO and TFA. Images were captured from each block before and after canal preparation (n=10). Assessment of canal transportation was obtained for the straight and curved parts of the canal. ANOVA followed by Tukeys test was used (&#945; = 5%). Results: Transportation values were increased at the curved part (P = .00). For both canal levels, TFA system induced the lowest mean of canal transportation followed by PTN, R, WO and PTU systems. At the straight portion, transportation for R and TFA systems were similar (P > .05), and these values were significantly lower than for WO, PTN and PTU (P = .00). At the curved portion, TFA resulted in less canal transportation, followed by PTN, R, WO and PTU systems (P = .00). Conclusions: TFA system produced less canal transportation than other systems tested during large apical preparations