Influence of sealer placement technique and powder/liquid mixing ratio on the quality of single cone root canal filling: a micro-CT analysis

Aim: To assess the influence of two different placement techniques and powder/liquid mixing ratio of a bioceramic sealer on the quality of root canal filling by single-cone using a micro-CT analysis. Methods: Thirty-two single-rooted elements with a mesio-distal diameter of 5,00\ub10,50 mm, a buccallingual diameter of 6,50 \ub10,50 mm and a root length of 14,50\ub10,50 mm measured at CEJ level were selected to be included in the study. After creating the coronal access cavity, root canals were scouted with manual files and the working length was acquired. Root canals were shaped with R40 Reciproc Blue and irrigated with NaOCl 5% and EDTA 17% solutions. Prepared samples were randomly assigned into four experimental groups (n=8), according to the sealer placement technique and the powder/liquid mixing ratio: G1, the sealer (BioRoot RCS, Septodont) was mixed in a 1:5 ratio, as suggested by the manufacturer, and carried into the root canal by a dedicated gutta-percha cone up to the working length; G2, sealer placement as group G1, but using 1:6 mixing ratio; G3, the sealer was mixed in a 1:5 ratio and carried into the root canal by a syringe with a cannula (Apexcal, Ivoclar) up to its complete filling, then a dedicated gutta-percha cone was inserted into the canal; G4, sealer placement as group G3, but using 1:6 mixing ratio. All the samples were submitted to micro-CT analysis. Micro-CT scans were acquired after shaping procedures (t0) and after canals obturation (t1) and then compared to evaluate the presence of voids in the gutta-percha, sealer and dentin interfaces. The normality of the distribution and the equality of variance of the microtomographic datasets were tested with a Shapiro-Wilk and Levene test, respectively; the significance of the differences between groups in terms of the formation of voids was ascertained with the Kruskal-Wallis test. The results were considered statistically significant for a p-value < 0.05. Results: Minimal void volumes were observed among groups. G1 performed the best result: total void volumes were 0,253\ub10,175% of the entire canal space. The other experimental groups follow in order of increasing volume: G3 (0,260\ub10,254%), G2 (0,532\ub10,528%), G4 (0,840\ub10,705%), but no statistically significant difference was observed. All groups showed a similar distribution of voids: in the apical and middle third of the root canal the presence of voids was minimal while the greatest void volumes were detected in the coronal third, due to the canal anatomy and the larger amount of sealer. In this canal portion voids were mainly distributed within the sealer. Concerning the sealer viscosity, the more fluid formulation (1:6) showed an increase of void volumes, although without statistical significance. Likewise, no statistically relevant influence was registered regarding the sealer placement technique. Conclusion: All the examined techniques should be considered effective for the clinician. Under the conditions of the present study, the 1:5 powder/liquid mixing ratio should be preferred when associated with both the sealer placement techniques, according to the clinical situation and the operator preferences. When using the low viscosity formulation, the clinician should insert the sealer slowly and in a controlled way, in order to minimize the formation of voids

Post-orthodontic recontouring using the Injection Resin Technique.

Aim: to present a versatile, rapid and effective technique for post-orthodontic recontouring of lateral upper incisors using flowable composite and a PVS matrix. Methods: a 15-years old female patient presented at the end of the orthodontic treatment with microdontia of the lateral upper incisors. The integrity of the enamel suggested a minimally invasive adhesive technique with a \u201cno prep\u201d approach and the \u201cInjection Resin Technique\u201d was chosen. Alginate impressions of both arches were recorded for the realization of the diagno- stic wax-up. A clear PVS impression material was used to replicate the wax-up, thus obtaining a clear matrix and two small openings were made to allow insertion of the composite tip.The unprepared teeth were submitted to the adhesive protocol, the clear matrix was positioned and an A2-shade flowable resin composite was injected in a controlled manner, taking care to avoid bubbles formation. The resin was light-cured through the PVS matrix for 2 minutes, then without it for 2 more minutes. Composite excesses were removed using a #12 scalpel blade and the restorations were finished and polished. Results: one week after treatment, the patient was called back for a subsequent polishing session and was extremely satisfied with the treatment. Conclusion: sst and minimally invasive solution to complete the aesthetic result of the orthodontic treatment