The Efficiency of the BTR-Pen System in Removing Different Types of Broken Instruments from Root Canals and Its Effect on the Fracture Resistance of Roots.

The study aimed to evaluate the efficiency of the BTR-Pen system in removing different types of instrument fragments from root canals and to assess its effect on fracture resistance of the roots after the removal of the instruments. One hundred thirty human teeth were divided into 10 groups (2 control groups and 8 study groups) according to the localization and type of the fractured fragment as well as the retrieval techniques. Broken instruments were extracted either with BTR-Pen system loops or removed using solely ultrasonic tips. The success rate of instrument removal and consumed time were recorded. All the teeth were subjected to a load at a 1 mm/min rate in a universal testing machine for mechanical testing. The success of removing broken instruments using the BTR-Pen and ultrasonic was 86.7% and 83.3%, respectively ( > 0.05). When the time is compared, the BTR-Pen system (23.97 ± 8.35 min) showed similar results to that of the ultrasonic technique (24.1 ± 8.28 min) ( > 0.05). The BTR-Pen group required less force to fracture than the ultrasonic group ( = 0.024). In conclusion, the BTR-Pen and ultrasonic groups showed no significant difference in terms of the success rate and removal time. The roots that underwent instrument removal using the BTR-Pen system had less fracture resistance.This research was funded by Kocaeli University, grant number: 2020/2391

Effect of EDDY and manual dynamic activation techniques on postoperative pain in non-surgical retreatment: a randomized controlled trial

BACKGROUND: During non-surgical retreatment process, the products such as dentin debris, root canal fillings, irrigation solutions, microorganisms and remaining pulp tissues can extrude to the apical area and can cause the postoperative pain and flare-up. Thus, the aim of this study was to evaluatethe effect of EDDY and manual dynamic activation (MDA) techniques on postoperative pain (PP) associated with retreatment. METHODS: Ninety patients scheduled for retreatment were treated at a single visit. Non-vital mandibular premolar teeth diagnosed with asymptomatic apical periodontitis were included in this study. The patients were divided into two groups (n = 45) on the basis of the need for additional irrigation activation procedures (EDDY and MDA). The patients' post-treatment pain levels were asked to rate the intensity of their pain on a 10-point numerical rating scale (NRS) at the 12th, 24th, 48th, and 72nd h and 7 days.The data were analyzed using the chi-square and Wilcoxon signed-rank test was used for within-group comparisons and Mann Whitney U test was used to compare the groups by time period. RESULTS: The difference in postoperative pain intensity between two groups was statistically significant at 12, 24, 48, and 72 h (p  0.05). Pain intensity after the treatment was lesser in the MDA groupthanin the EDDY group at 12, 24, 48, and 72 h. CONCLUSION: This study could lead us to conclude that the two activation systems can be used during endodontic retreatment with no difference at PP 7 days later. However, a comparison of the groups indicated that the EDDY resulted in significantly more PP at 12, 24, 48, and 72 h. Trial registration ClinicalTrials.gov Identifier: NCT04726670.Open Access funding provided by the Qatar National Library

Comparative Evaluation of Artifacts Originated by Four Different Post Materials Using Different CBCT Settings.

The aim of this study was to evaluate whether cone beam computed tomography (CBCT) images in the presence of four different post materials, obtained from different kVps with varying resolutions and varying metal artifact reduction (MAR) algorithms, differed in artifact estimation, and to compare tooth regions in terms of artifact value. Forty premolar teeth were used in this study. Root canals were treated, and teeth were randomly distributed into four subgroups ( = 10) for the preparation of post materials: titanium, gold (Nordin), quartz fiber (Bisco DT Light), and glass fiber (Rely X). The CBCT images were taken with two different kVps, three different metal artifact reduction (MAR) algorithm options, and two different resolutions. For each protocol, the effective dose was calculated according to the dose area production (DAP) value. The standard analysis of variance technique and the Tukey multiple comparison adjustment method were used to assess interactions among material types, kVp, MAR, and voxel settings. More artifacts were found in the middle third than in the cervical third ( < 0.05). The mean value of artifacts was highest for gold (Nordin), 90 kVp, no MAR, and 100 voxel size. Glass or quartz fiber posts at low resolution, with high MAR and 96 kVp, originated fewer artifacts. Moreover, the use of 90 and 96 kVp with 200 voxel size and high MAR provided the least amount of radiation. The best setting for radiographic follow-up of post materials on the Planmeca ProMax is 96 kVp with low resolution and high MAR; this setting produced one of the lowest effective doses. This study estimated the best scanning protocol by lowering the effective dose to a minimum level according to the "as low as reasonably achievable" principle, as well as assessing the tooth region and the post material generating the fewest artifacts, in order to prevent image interpretation challenges such as false-positive and false-negative results stemming from the deterioration of the visibility of the root canal due to perforation, fractures, and voids in the root canal region.This research was funded by Kocaeli University (Grant number: HD2017/70)

Prevalence, classification and dental treatment requirements of dens invaginatus by cone-beam computed tomography

Background. This study aimed the evaluation of the prevalence, characteristics, types of dens invaginatus (DI) and co-observed dental anomalies to understand dental treatment requirements in anterior teeth that are susceptible to developmental anomalies by using cone-beam computed tomography (CBCT). Methods. In this retrospective study, the anterior teeth of 958 patients were evaluated by using CBCT for the presence of DI. The demographic features, types of DI and treatment requirements were also recorded. The association between sex and the presence of DI was evaluated using chi-squared test. Results. Seventy-three DI anomalies were detected in the anterior teeth of 49 patients (18 females, 31 males). The frequency of DI was 5.11% and the most frequently involved teeth were lateral (57.53%). Forty-six teeth were classified as Type I (63.01%), 24 as Type II (32.87%), and three as Type III (4.10%). Apical pathosis was found to be 20.54% in all DIs detected and accounted for all Type III and one-third of Type II. Conclusions. CBCT imaging can be effective in the detection of dental anomalies such as DI and planning for root canal therapy and surgical treatments. Prophylactic interventions might be possible to prevent apical pathosis with the data obtained from CBCT images

Impact of Virtual Reality Simulation in Endodontics on the Learning Experiences of Undergraduate Dental Students

Abstract: We aimed to evaluate the impact of Virtual Reality Dental Simulators (VRDS) on preclinical training in endodontics for undergraduate dental students. Purposive sampling technique was used to target undergraduate dental students at two dental schools: in Qatar and Turkey. After training on endodontic access cavity preparation on upper anterior teeth using acrylic teeth on dental mannequins and virtual reality haptic dental simulator, a questionnaire based on a combination of open- and closed-ended items was distributed to the participants. The sample included 60 dental undergraduate students. The participants reported positive experiences with VRDS and 76% considered it to be helpful in improving their fine motor skills. Endodontic access cavity preparation on VRDS was perceived to be similar to natural and acrylic teeth by 73.34% and 53% of participants, respectively. Overall, 85% of participants supported the use of VRDS training to supplement conventional training on dental mannequins but also recommended the need for improvements in VRDS training in endodontics. The findings of this study underscore the benefits of VRDS in endodontics. Future research involving larger samples from multiple institutions may help to optimize VRDS in undergraduate dental education

Comparative Evaluation of Artifacts Originated by Four Different Post Materials Using Different CBCT Settings

The aim of this study was to evaluate whether cone beam computed tomography (CBCT) images in the presence of four different post materials, obtained from different kVps with varying resolutions and varying metal artifact reduction (MAR) algorithms, differed in artifact estimation, and to compare tooth regions in terms of artifact value. Materials and Methods: Forty premolar teeth were used in this study. Root canals were treated, and teeth were randomly distributed into four subgroups (n = 10) for the preparation of post materials: titanium, gold (Nordin), quartz fiber (Bisco DT Light), and glass fiber (Rely X). The CBCT images were taken with two different kVps, three different metal artifact reduction (MAR) algorithm options, and two different resolutions. For each protocol, the effective dose was calculated according to the dose area production (DAP) value. The standard analysis of variance technique and the Tukey multiple comparison adjustment method were used to assess interactions among material types, kVp, MAR, and voxel settings. Results: More artifacts were found in the middle third than in the cervical third (p < 0.05). The mean value of artifacts was highest for gold (Nordin), 90 kVp, no MAR, and 100 voxel size. Glass or quartz fiber posts at low resolution, with high MAR and 96 kVp, originated fewer artifacts. Moreover, the use of 90 and 96 kVp with 200 voxel size and high MAR provided the least amount of radiation. Conclusion: The best setting for radiographic follow-up of post materials on the Planmeca ProMax is 96 kVp with low resolution and high MAR; this setting produced one of the lowest effective doses. Clinical Significance: This study estimated the best scanning protocol by lowering the effective dose to a minimum level according to the “as low as reasonably achievable” principle, as well as assessing the tooth region and the post material generating the fewest artifacts, in order to prevent image interpretation challenges such as false-positive and false-negative results stemming from the deterioration of the visibility of the root canal due to perforation, fractures, and voids in the root canal region

Evaluation of dentinal defect formation after root canal preparation with two reciprocating systems and hand instruments: an in vitro study

The purpose of this study was to evaluate the presence of dentinal defects after root canal preparation with hand instruments and two different reciprocating instruments. Sixty freshly extracted mandibular incisor teeth were selected for this in vitro study. On the basis of root length, mesiodistal and buccolingual dimensions, the teeth were allocated into three identical experimental groups (n = 15) and one control group (n = 15). The teeth in the control group were left unprepared. The other groups were: stainless steel hand instruments, WaveOne (R) Primary instruments and RECIPROC (R) R25 instruments. The reciprocating instruments were used with a reciprocating gentle in-and-out motion in a torque-limited electric motor at the appropriate preset mode. Horizontal sections were made 3, 6 and 9 mm from the apex. Samples were stained with methylene blue and viewed through a stereomicroscope. The presence of dentinal defects (fractures, incomplete cracks and craze lines) and their locations were investigated by two endodontists. These data were analysed statistically by Fisher's exact and chi-square tests. No defects were observed in the unprepared group. All instruments caused dentinal defects, with no significant differences between the instrument systems. All experimental groups demonstrated significantly more defects at the 3-mm level in comparison with the unprepared group (p = 0.032). At the other levels, there was no significant difference between the experimental groups and the control group. The use of hand or reciprocating instruments could induce the formation of dentinal defects during root canal preparation

Use of cone-beam computed tomography and three-dimensional modeling for assessment of anomalous pulp canal configuration: a case report

Three-dimensional (3D) reconstruction of cone-beam computed tomography (CBCT) scans appears to be a valuable method for assessing pulp canal configuration. The aim of this report is to describe endodontic treatment of a mandibular second premolar with aberrant pulp canal morphology detected by CBCT and confirmed by 3D modeling. An accessory canal was suspected during endodontic treatment of the mandibular left second premolar in a 21 year old woman with a chief complaint of pulsating pain. Axial cross-sectional CBCT scans revealed that the pulp canal divided into mesiobuccal, lingual, and buccal canals in the middle third and ended as four separate foramina. 3D modeling confirmed the anomalous configuration of the fused root with a deep lingual groove. Endodontic treatment of the tooth was completed in two appointments. The root canals were obturated using lateral compaction of gutta-percha and root canal sealer. The tooth remained asymptomatic and did not develop periapical pathology until 12 months postoperatively. CBCT and 3D modeling enable preoperative evaluation of aberrant root canal systems and facilitate endodontic treatment

Use of cone-beam computed tomography and three-dimensional modeling for assessment of anomalous pulp canal configuration: a case report

Three-dimensional (3D) reconstruction of cone-beam computed tomography (CBCT) scans appears to be a valuable method for assessing pulp canal configuration. The aim of this report is to describe endodontic treatment of a mandibular second premolar with aberrant pulp canal morphology detected by CBCT and confirmed by 3D modeling. An accessory canal was suspected during endodontic treatment of the mandibular left second premolar in a 21 year old woman with a chief complaint of pulsating pain. Axial cross-sectional CBCT scans revealed that the pulp canal divided into mesiobuccal, lingual, and buccal canals in the middle third and ended as four separate foramina. 3D modeling confirmed the anomalous configuration of the fused root with a deep lingual groove. Endodontic treatment of the tooth was completed in two appointments. The root canals were obturated using lateral compaction of gutta-percha and root canal sealer. The tooth remained asymptomatic and did not develop periapical pathology until 12 months postoperatively. CBCT and 3D modeling enable preoperative evaluation of aberrant root canal systems and facilitate endodontic treatment

Radiopacity evaluation of calcium silicate cements

Abstract Background The aim of this study was to compare the radiopacity of calcium silicate cements using a digital imaging method. Methods Four calcium silicate cements, NeoMTA 2, OrthoMTA, ProRoot MTA, and Biodentine, were used in this study. Disk-shaped samples were prepared from each material and placed on a plexiglass plate. An aluminum step-wedge was placed alongside the samples on a digital sensor and exposed to 70 kVp and 8 mA from 30 cm away for 0.32 s. The greyness values ​​of the tested materials were measured digitally with the system software and compared with those of the step-wedge to determine the equivalent aluminum thickness. Results The radiopacity values, expressed in equivalent millimetres of aluminum, of the studied materials ProRoot MTA, OrthoMTA, NeoMTA 2, and Biodentine were 4.32 ± 0.17 mm Al, 3.92 ± 0.09 mm Al, 3.83 ± 0.07 mm Al, and 2.29 ± 0.21 mm Al, respectively. Statistically significant differences were found between the mean radiographic density values of the tested materials (p < 0.05). Conclusion ProRoot MTA was the most radiopaque root canal filling material among the tested materials. All materials, except Biodentine, were found to be compliant with the minimum radiopacity requirements of ISO 6876 and ADA 57 standards