Endodontic treatment of C-shaped mandibular molars: Report of five cases

Aim: The aim of this work was to describe the endodontic management of fi ve C-shaped mandibular molars. Summary: Five cases of C-shaped mandibular molars in Caucasian patients were referred to the Postgraduate Clinic of the Department of Endodontology over the last year. Pulp necrosis and/or periapical lesions were identifi ed in all cases. The presence of C-shaped root canals was suspected during routine pre-treatment radiographic examination and was verifi ed clinically during probing and scouting of the canals with small hand-fi les and the aid of an operative microscope. A single C-shaped root canal was only found in one case, while slightly varying canal confi gurations were evident in the other four cases. Root canals were instrumented using Hedstroem files in a circumferential filing manner and obturated using warm lateral or vertical condensation. All teeth received permanent restorations and were followed for up to 12 months. None of the cases presented signs of failure within this period. Conclusions: The C-confi guration is one of the most common variations of root canal anatomy in mandibular molars. Identifi cation and successful treatment of such cases pose a challenge to the clinician. Implications of this anatomical variation may also extend to the prosthetic rehabilitation of these cases

Effect of needle insertion depth and root canal curvature on irrigant extrusion ex vivo

Introduction The aim of this study was to evaluate the effect of needle type and insertion depth, apical preparation size, and root canal curvature on irrigant extrusion by using a recently introduced method. Methods Sixteen human teeth with a straight root canal (group A) and 16 with a moderately curved root canal (group B) were sequentially prepared to sizes 25 or 35, .06 taper and mounted on a plastic vial filled with distilled water to simulate a periapical lesion. The vial was either closed or open to the environment. A point-conductivity probe was used to determine the volume of extruded irrigant into the vial. NaOCl was delivered by an open-ended or a closed-ended needle at 1, 3, or 5 mm short of working length. Results were analyzed by two 4-way mixed-design analyses of variance. The level of significance was set to P < .05. Results The open-ended needle extruded significantly more irrigant than the closed-ended. Irrigant extrusion decreased as needles moved away from working length or when the apical size was increased. Needle wedging increased extrusion, especially when an open-ended needle was used. Root canal curvature did not have a statistically significant effect on irrigant extrusion. Conclusions Needle type, needle insertion depth, and apical preparation size had a significant effect on irrigant extrusio

Factors affecting irrigant extrusion during root canal irrigation: a systematic review

The aim of the present study was to conduct a systematic review and critical analysis of published data on irrigant extrusion to identify factors causing, affecting or predisposing to irrigant extrusion during root canal irrigation of human mature permanent teeth. An electronic search was conducted in Cochrane Library, LILACS, PubMed, SciELO, Scopus and Web of Knowledge using a combination of the terms ‘irrigant’, ‘rinse’, ‘extrusion’, ‘injection’, ‘complication’, ‘accident’, ‘iatrogenic’, ‘root canal’, ‘tooth’ and ‘endodontic’. Additional studies were identified by hand-searching of six endodontic journals and the relevant chapters of four endodontic textbooks, resulting in a total of 460 titles. No language restriction was imposed. After applying screening and strict eligibility criteria by two independent reviewers, 40 case reports and 10 ex vivo studies were included in the review. A lack of clinical studies focusing on irrigant extrusion during root canal irrigation was evident. The reviewed case reports focused mainly on the clinical manifestations and management of the accidents and did not provide adequate details on the possible factors that may influence irrigant extrusion. The data from the included ex vivo studies were inconclusive due to major methodological limitations, such as not simulating the presence of periapical tissues and not assessing the validity of irrigant detection methods. The extensive variability in the protocols employed hindered quantitative synthesis. The choice of factors investigated in ex vivo studies seems not to have been driven by the available clinical evidence. These issues need to be addressed in future studie

Apical negative pressure irrigation versus syringe irrigation: a systematic review of cleaning and disinfection of the root canal system

The aim of this study was to systematically review and critically analyse the published data on the treatment outcome (primary outcome) and on the cleaning and disinfection of root canals (secondary outcomes) achieved by negative pressure irrigation as compared to syringe irrigation. An electronic search was conducted in EMBASE, LILACS, PubMed, SciELO, Scopus and Web of Knowledge using both free‐text keywords and controlled vocabulary. Additional studies were sought through hand searching of endodontic journals and of the relevant chapters of endodontic textbooks. No language restriction was imposed. The retrieved studies were screened by two reviewers according to predefined criteria. Included studies were critically appraised and the extracted data were arranged in tables. The electronic search and hand search retrieved 489 titles. One clinical study and 14 in vitro studies were finally included in the review; none of these studies assessed treatment outcome, four studies assessed the antimicrobial effect, seven studies evaluated the removal of pulp tissue remnants, and four studies investigated the removal of hard tissue debris or both hard tissue debris and pulp tissue remnants. Poor standardization and description of the protocols was evident. Inconclusive results were reported about the cleaning and disinfection accomplished by the two irrigation methods. Negative pressure irrigation was more effective under certain conditions when compared to suboptimal syringe irrigation; however, the variability of the protocols hindered quantitative synthesis. There is insufficient evidence to claim general superiority of any one of these methods. The level of the available evidence is low, and the conclusions should be interpreted with caution

Effects Of Different Rotary Files Combined With Different Irrigation Needles On Apically Extruded Debris

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Effect of Needle Insertion Depth and Apical Diameter on Irrigant Extrusion in Simulated Immature Permanent Teeth

The aim of this study was to compare the amount of irrigant extrusion in simulated immature permanent teeth when the apical diameter and needle insertion depth were varied. Thirty single-rooted maxillary incisors with straight root canals were selected. The root length was standardized to a length of 9 mm. The teeth were divided into two experimental groups according to the degree of apical enlargement (n = 15). The apices were enlarged to a diameter of 1.10 mm or 1.70 mm by using a #3 or #6 peeso reamer, respectively, to simulate immature teeth. The irrigation solution was applied 2 or 4 mm short of the working length (WL) in each experimental group. The glass vial model was used for the collection of extruded irrigant beyond the root apex. A two-way repeated measures analysis of variance test showed that there was no significant difference between different needle insertion depths (2 and 4 mm short of the WL) in the group with an apical diameter of 1.70 mm (p > 0.05). In the group with an apical diameter of 1.10 mm, a 32% increase in irrigant extrusion was observed when the needle was positioned at 2 mm (p < 0.05). Regarding the effect of apical diameter, the group with a diameter of 1.70 mm showed more apical extrusion of the irrigant (34% increase for the needle positioned at 2 mm and 68% increase for the needle positioned at 4 mm). It was observed that the needle insertion depth and apical diameter have a significant effect on irrigant extrusion in immature permanent teeth.Wo