Antimicrobial properties and smear layer management of nine different root canal irrigation solutions

The main objective of root canal therapy is cleaning, shaping and obturating the root canal system in three dimensions, as well as preventing reinfection. The objective of this in vitro study was: to establish the antimicrobial efficacy of nine different root canal irrigation solutions, to determine the smear layer dissolving capabilities of these irrigating solutions, at various levels in straight root canals, and to examine the degree of erosion caused by the irrigation solutions on the root canal walls. Antimicrobial Effects: In this test the antimicrobial activity of nine irrigation solutions against E. faecalis was measured using a disc diffusion test. The antibacterial activity of materials was apparent from circular clear inhibition zones forming around the filtration paper. Effect on Smear Layer: Root canals were prepared by using Pro Taper nickel titanium rotary files. During preparation, the canals were irrigated with copious amounts of 3.5% sodium hypochlorite for 15 minutes. Thereafter, the teeth were randomly divided into nine groups. One group was kept as control. The other eight groups received a final rinse with one of the following irrigation solutions: 18% EDTA, Sterilox, Top Clear 17% EDTA, 2% Chlorhexidine, 10% Citric acid, Biopure MTAD, Ozonated water and Smear Clear. A total of 25ml of each solution was utilized to irrigate each root canal system, and left undisturbed in the root canal for 2 minutes. Biopure MTAD was left in the root canals for 5 minutes. Finally, the irrigation solutions were removed from the root canals with 10ml sterile distilled water. Each root was sectioned horizontally with a diamond disc in sections corresponding with the coronal, middle and apical levels of the root canal system. Each fragment was fractured laterally and prepared according to standard methods for biological SEM evaluation. The absence or presence of the smear layer as well as the amount of erosion of the peritubular dentine was assessed. The One-way ANOVA test was used to determine whether there were any statistical significant differences between the different test groups. No significant inhibition of E. faecalis was observed with sterile water (control) and the undiluted solutions of Sterilox, 10% Citric acid and Ozonated water. However, 3.5% NaOCl, 18% EDTA, Top Clear 17% EDTA, 2% Chlorhexidine, Biopure MTAD and Smear Clear showed significant inhibition of E. faecalis. For the 1/10 diluted solutions no inhibition of E. faecalis was observed with sterile water (control), 3.5% NaOCl, Sterilox, 10% Citric acid and Ozonated water. Biopure MTAD and Smear Clear demonstrated significant inhibition of E. faecalis compared to 18% EDTA, Top Clear 17% EDTA and 2% Chlorhexidine. Biopure MTAD was the only solution that showed significant inhibition of E. faecalis using a 1/100 diluted solution. No inhibition was observed with the 1/1000 diluted test solutions.Scanning electron microscope examination revealed that 3.5% NaOCl and Ozonated water had no visible effect on the smear layer. The 10% Citric acid solution slightly modified the smear layer at the coronal and middle levels of the root canals. There was no visible effect on the smear layer at the apical levels. Sterilox and 2% Chlorhexidine removed the smear layer at the coronal levels, modified it slightly in the middle levels and left the smear layer undisturbed in the apical levels of the root canals. 18% EDTA, Top Clear 17% EDTA, Biopure MTAD and Smear Clear removed the smear layer completely at the coronal levels. At the middle and apical levels of the root canals most of the smear layer was removed. However, there were less open dentinal tubules visible at the apical levels compared to the samples examined at the middle levels of the root canals. It was also noted that Top Clear 17% EDTA caused a significantly high percentage of erosion of the peritubular dentine at the coronal levels of the root canals compared to all the other irrigation solutions. Considering all the results of the present study Biopure MTAD demonstrated the best antimicrobial activity against E. faecalis, and removed most of the smear layer at all three levels of the root canal systems without significant erosion of the peritubular dentine.Dissertation (MSc(Odont))--University of Pretoria, 2008.Community Dentistryunrestricte

A micro-computed tomographic evaluation of curved maxillary molar root canals using different root canal instrumentation techniques

Preservation of the original anatomical shape following instrumentation of root canals is essential for endodontic success. Procedural errors created during glide path enlargement might be exacerbated or initiated during subsequent shaping. The aims of this study were to: (1) compare canal centering ability and transportation of pre-curved Senseus K-FlexoFiles (stainless steel), ProGlider file (M-Wire) and One G file(NiTi alloy) after glide path enlargement in curved root canals micro-computed tomography (micro-CT) scanning; (2) compare canal centering ability and transportation of OneShape (NiTi alloy), ProTaper NEXT (M-Wire alloy) and WaveOne Gold (Gold wire) instrumentation techniques in the same canals; (3) compare the change in root canal volume between uninstrumented canals, canals after glide path preparation, and canals after root canal preparation. One hundred and thirty-five curved mesio-buccal root canals of human maxillary molars were randomly divided into three groups. These groups were (1) glide path enlarged using pre-curved size 10, 15 and 20 stainless steel Senseus K-FlexoFiles (n=45); (2) manual glide path enlargement with a size 10 K-File followed by One G (n=45); and (3) manual glide path enlargement with a size 10 K-File followed by the ProGlider (n=45). Micro-CT was used to scan teeth before and after glide path preparation. Each glide path specimen group was randomly assigned to three equal groups (n=15) resulting in nine glide path/shaping groups of fifteen canals each: Group 1 (K-FlexoFile + OneShape)(K/OS); Group 2 (K-FlexoFile + ProTaper NEXT)(K/PTN); Group 3 (K-FlexoFile + WaveOne Gold)(K/WOG); Group 4 (One G + OneShape)(OG/OS); Group 5 (One G + ProTaper NEXT)(OG/PTN); Group 6 (One G + WaveOne Gold)(OG/WOG); Group 7 (ProGlider + OneShape)(PG/OS); Group 8 (ProGlider + ProTaper NEXT)(PG/PTN); and Group 9 (ProGlider + WaveOne Gold)(PG/WOG). After canal preparation with the shaping instruments, all the specimens were scanned again by means of micro-CT. The three-dimensional images obtained before instrumentation, after glide path preparation, and again after final canal preparation were reconstructed and interpreted. Centering ratio values, canal transportation and change in root canal volume were recorded and compared between the three glide path- and nine root canal preparation groups. Canal transportation and centering ability were evaluated over the apical, midroot, and coronal levels (2 mm, 5 mm and 9 mm from the root apex). The results were statistically analysed using a one-way ANOVA for parametric and Kruskal-Wallis H test for non-parametric comparisons. Statistical significance was set at p0.05). The volume of dentine removed by the three glide path groups was statistically significantly similar for K-FlexoFiles, One G and ProGlider (p0.05). However, at the coronal level, centering ratio results following glide path preparation with K-FlexoFiles appeared to affect shaping outcomes for both PTN and OS groups. One Shape performed poorly following all glide path techniques with OG/OS and significantly displayed the worst centering ratio at this level. The results for the combined centering ratio values of the various glide path/shaping groups displayed no statistically significant differences between the different combination groups (p>0.05). Apical canal transportation after shaping was significantly highest for K/OS followed by K/PTN. At the midroot level canal transportation was significantly higher for K/PTN than K/OS and OG/OS, which were statistically similar to each other. Coronal canal transportation after canal shaping was significantly highest for K/PTN followed by K/OS. The most favourable mean combined transportation ratio values of the various glide path/shaping groups were observed in OG/WOG and in PG/WOG groups and the least favourable for the K/OS and the K/PTN groups. The three groups shaped with ProTaper NEXT exhibited the highest volume of dentine removed with the highest displayed by the PG/PTN group. Statistically, the lowest mean volume of removed dentine was by the PG/WOG group. In general, results were more favourable after canal preparation with the WaveOne Gold Primary file following any of the three glide path preparation techniques.Thesis (PhD)--University of Pretoria, 2017.Community DentistryPhDUnrestricte

WaveOne® Gold reciprocating instruments : clinical application in the private practice : Part 1

The WaveOne® NiTi File System was introduced to the dental market in 2011. It was a pre-packaged, pre-sterilised, single-use system that was designed to shape root canal systems to a continuously tapering morphology (Webber et al, 2011; Van der Vyver, 2011). Recently, WaveOne® Gold, a new generation of reciprocating files was launched. According to Webber (2015) this single use shaping files offer the clinician more simplicity, safety, improved cutting efficiency and mechanical properties compared to the previous generation of reciprocating instruments. In this paper the authors will discuss the design features of the instruments and focus on the WaveOne® Gold Primary file. This Primary file can be used in approximately 80-85% of cases as a single file technique for root canal preparation. In Part 2 of this series we will discuss the management of larger diameter root canals systems, more challenging and curved root canal systems and provide the reader with examples on when to use more than one WaveOne® Gold file for canal preparation. In Part 3 of this series we will discuss the management of a ledged canal, using the WaveOne® Gold instruments.http://www.moderndentistrymedia.com/moderndentistrymedia/editions/african-editionsam2018Odontolog

Comparison of canal transportation and centering ability of K-files, ProGlider File, and G-Files : a micro-computed tomography study of curved root canals

The PURPOSE of this study was to compare centering ability and apical canal transportation of K-files (KF), ProGlider (PG) and G-Files (GF) after glide path enlargement in curved canals using micro–CT. METHODS : 30 canals each were randomly assigned to KF; GF and PG. Teeth were scanned before and after glide path enlargement to compare centering ability at three levels: 1 mm (D1) and 7 mm (D7) from the apical foramen and at the point of maximum root curvature (Dmc). Transportation was assessed in 8 directions at D1. RESULTS : KF were significantly less centered than both NiTi groups at D1. At Dmc PG exhibited a significantly more centered enlargement than both GF and KF, which were significantly similar. At D7, PG was significantly more centered than KF but there were no significant differences between GF and KF or between PG and GF (p<0.016). KF exhibited significantly more canal transportation at D1 than the NiTi groups (p<0.05). CONCLUSION : NiTi files cause less transportation than KF. At D1 KF were less centered than both NiTi files. PG remained more centered at Dmc and D7.http://www.journals.elsevier.com/journal-of-endodontics2017-07-31hb2016Odontolog

Glide path enlargement of mandibular molar canals by using K-files, the ProGlider file, and G-files : a comparative study of the preparation times

INTRODUCTION : The preparation of a glide path prior to the introduction of rotary nickeltitanium instruments is a standard adjunct to ensure more safety during root canal preparation. The aim of this study was to compare the mean preparation time of manual instrumentation with K-Files (Dentsply/Maillefer, Ballaigues, Switzerland), G-Files (Micro-Mega, Besançon Cedex, France), and ProGlider (Dentsply/Maillefer) to prepare a glide path in curved root canals. METHODS : The mesial canals of 90 mandibular molars (with curvatures angles between 25° and 35°) were selected. The specimens were randomly divided into 3 groups with 30 canals each, and canal preparations were performed by an endodontist using #10-15-20 stainless steel manual K-files (group KF), #10 stainless steel manual K-file followed by #12-17 G-File instruments (group GF), and #10 stainless steel manual K-file followed by #16 ProGlider instrument (group PG). The total time it took to prepare the glide paths was recorded with an electronic stopwatch. New instruments were used for each canal. RESULTS : Glide path enlargement with the PG group (27.9 ± 8.6) and GF group (41.9 ± 20.1) were shown to be statistically significantly faster than stainless steel KF group (74.9 ± 24.1) using ANOVA (p<0.05). There was no statistically significant difference observed between the mean preparation times of the PG and GF groups (p<0.05). CONCLUSION : Glide path preparation times with the rotary instrument groups were significantly faster than with stainless steel manual K-files.http://www.journals.elsevier.com/journal-of-endodontics2018-04-30hb2017Odontolog

Endodontic management of an unidentified foreign body in a maxillary central incisor of a HIV-positive patient

The Human Immunodeficiency Virus (HIV) has been a focal point of investigation over the last few years. Consideration of endodontic treatment in an HIV-positive patient needs a calculated approach as the choice of materials and chemicals may influence the final result. A recent investigation showed that cases presenting with pre-operative pathology during examinations have a significantly lower prognosis after treatment. This clinical case report discusses the treatment approach of an upper left central incisor of an HIV-positive patient. The treatment approach and the outcome after a fifteen-month follow-up period are outlined.https://www.sada.co.za/the-sadjam2020Odontolog

Waveone® Gold reciprocating instruments : clinical application in the private practice : Part 2

Recently, the WaveOne® Gold system (Dentsply Sirona) was launched into the dental market. In part one of this series, published in International Dentistry – African Edition Vol. 7, No. 4, the authors outlined the clinical guidelines for the use of the Primary WaveOne® Gold instrument for a single-file technique.http://www.moderndentistrymedia.com/moderndentistrymedia/editions/african-editionsam2018Odontolog

Radix Entomolaris : literature review and case report

According to Swartz, Skidmore and Griffen, mandibular first molars have a significantly lower success rate compared with other teeth. Missed canals and the failure to remove all the microorganisms and pulp remnants from the root canal system are probably the main reasons for persistent infection around endodontically-treated molars. It is therefore important that clinicians have an awareness and good understanding of the variations in root canal morphology of the mandibular first molar.https://www.sada.co.za/the-sadjam2018Odontolog

An in vitro comparison of different techniques for glide path preparation

INTRODUCTION : The study compared modification of canal curvature and the incidence of canal aberrations after glide path preparation using four different instrumentation techniques. METHODS : One hundred and twenty S-shaped Endo- Training-Blocks were selected, the canals coloured with ink and digital images acquired. Glide paths were prepared by a single operator with stainless steel K-files by hand (Group 1), stainless steel K-files in a reciprocating hand piece (Group 2), PathFile (Group 3) and X-Plorer files (Group 4). Pre-instrumentation and post-instrumentation images were superimposed to evaluate the parameters investigated. The images were also examined by three blinded operators for the presence of aberrations. Differences in canal curvature modification were analysed with respect to logarithmic transformed change from baseline using ANCOVA (p<0.001) with logarithmic transformed pre-instrumentation values as covariate. The incidence of canal aberrations was analyzed using Fisher’s exact test (p<0.05). RESULTS : There was no difference between PathFiles and X-Plorer files (p<0.001) and both systems demonstrated significantly less modification of curvature compared with hand files and hand files in a reciprocating hand-piece (p<0.001). The Groups differed significantly regarding the number of aberrations (p=0.005). Hand files and hand files in the reciprocating hand piece did not differ statistically (p=0.254; 20% and 6.67%). However, hand files in reciprocating hand piece also did not differ significantly from PathFiles and X-Plorer files (p=0.326). There were no aberrations detected in the rotary NiTi Groups. CONCLUSION : The stainless steel K-files in the reciprocating hand-piece performed better than their use by hand only. Overall, PathFiles and X-Plorer files equally demonstrated the least modification to original canal geometry. Further research utilising the different techniques in extracted teeth is warranted.http://www.sada.co.zaam201

Waveone® Gold reciprocating instruments : clinical application in the private practice : Part 3

The clinical use of the WaveOne® Gold system (Dentsply Sirona) was discussed in Part 1 and 2 of this series. In this article, the authors want to share another unique application of the WaveOne® Gold instruments.http://www.moderndentistrymedia.com/moderndentistrymedia/editions/african-editionsam2018Odontolog