The apical adaptation of different obturation techniques: an in vitro comparaison of carrier-based systems with warm vertical compaction

The aim of study was to evaluate the apical adaptation of different obturation techniques by determining the amount of sealer in the apical third of the canal, the presence of obturator at the last one millimeter, the amount of gutta-percha and the presence of plastic carrier at the foramen. One hundred and eight freshly extracted single rooted teeth were divided into four groups: 1) group A: Warm Vertical Compaction “WVC” (VC), 27 teeth; 2) group B: Herofilll® obturators (HF), 27 teeth; 3) group C: Thermafil® obturators (TF), 27 teeth; 4) group D: RealSeal1® obturators (RS1), 27 teeth. The results showed a significant difference between HF and VC when evaluating the amount of obturation material, the VC having a higher mean (p=0.0001) whereas no significant difference was detected between these two groups in terms of sealer mean area (p=0.268). On the other hand, RS1 showed a higher mean of obturation material (p=0.007) and a lower mean area of the plastic carrier (p=0.025) when compared to TF; these differences were at the 3mm section level. Both HF (p=0.030) and TF (p=0.039) groups had significantly less amount of sealer thickness only at 3mm section level compared to VC group. RealSeal1® showed the most amount of obturation material and Herofill® showed the least

Guided endodontics in managing severely calcified teeth: A review

In our daily practice, we are confronted with calcified teeth which require special attention and care during endodontic treatment. Several etiologies have been incriminated in the presence of pulp calcifications, especially dental trauma and aging. Those calcifications can cause partial or complete pulp canal obliteration. Therefore, endodontic treatment of these teeth can be very risky and should be done by a specialist using ultrasonic tips and a microscope. This treatment requires more time and has a lower success rate compared to other cases. Lately, a technique combining the digital imaging and the cone-beam computed tomography (CBCT) is proposed to form an endodontic guide which allows any practitioner to access the canal more easily. The use of CBCT is important in the planning of the treatment of severely calcified teeth. The guided treatment has many advantages compared to the conventional approach. It is proved to be more precise, more conservative, and less time-consuming. It has a high success rate and reproducible results regardless of the experience of the practitioner. The purpose of this review is to gain a better understanding of the pulpal calcification process and its impact on the endodontic treatment and to give insight into the advantages of using the guided endodontic technique in comparison with the conventional treatment in treating severely calcified teeth

Management of an Immature Necrotic Permanent Molar with Apical Periodontitis Treated by Regenerative Endodontic Protocol Using Calcium Hydroxide and MM-MTA: A Case Report with Two Years Follow Up

Traditionally, immature teeth diagnosed with necrotic pulp and periapical periodontitis were treated by apexification with long-term calcium hydroxide or in one session with mineral trioxide aggregate (MTA) or Biodentine apical plug. However, these teeth become fragile and susceptible to root fracture. Regenerative endodontic procedure is a new therapeutic approach that promotes continuation of root growth in immature necrotic teeth potentially preventing root fracture. Only few case reports have shown the success of this procedure on molar cases. The current case report demonstrates a regeneration of a lower first molar with necrotic pulp and chronic apical abscess treated with Micro Mega-MTA (MM-MTA), a new endodontic biomaterial that has not been described previously. Calcium hydroxide was used as an intracanal medicament for two weeks. Next, calcium hydroxide was removed and after blood clot creation, MM-MTA® was placed over it. Apical healing and continuation of root growth were evident at nine months follow-up. CBCT at two years follow-up confirmed apical closure and complete healing. This case shows that a regenerative endodontic procedure for management of an immature necrotic permanent molar is feasible and can be successfully done using Ca(OH)2 and MM-MTA

Quantitative volumetric analysis of cross-linked gutta-percha obturators

Aim The purpose of this study was to evaluate the effects of technique on the filling quality of 2 recently introduced obturation systems comparatively with warm vertical compaction using micro-computed tomography. Methods 36 single-rooted teeth were selected, root canals prepared, and assigned to 3 groups (n=12), according to the filling technique: warm vertical compaction technique WVC, GuttaCore (Dentsply Tulsa Dental Specialties, Tulsa, OK) and Gutta Fusion (VDW, Germany). Each specimen was scanned using a micro-CT. Percentage of voids was calculated and data statistically analyzed using Kruskal Wallis test with a significance level of 5%. Results All obturations showed satisfactory similar results at the apical level. Differences between the three obturation methods were not significant at 1 mm (−p-value >0.05), 3 mm (−p-value >0.05) and 5 mm (−p-value >0.05). No root fillings were void-free. No significant difference was found between the WVC technique, the GuttaCore technique and the Gutta Fusion technique concerning percentage of apical voids regardless of canal level. Conclusion This study shows the efficiency of cross-linked obturators in filling root canals hermetically by comparing them to the warm vertical compaction technique. Results show that these obturation techniques were equally sufficient concerning apical adaptation making them appropriate to use in endodontic obturations

In vitro evaluation of enterococcus faecalis growth in different conditions on dentinal substrate

AbstractThe aim of this study was to find the best growth conditions of Enterococcus faecalis on a dentinal substrate in order to be used for the development of a complex multispecies endodontic biofilm. Fifty two single rooted extracted human teeth and fifty two dentinal disks were mechanically prepared, sterilized, inoculated with Enterococcus faecalis and divided randomly into 8 groups where the substrate, the inoculation technique, the medium type, and the pre-treatment with collagen type I was varied. Bacterial count was evaluated and colonies were counted and confirmed by colony morphology observation on blood agar and Gram staining at 3,7, 14, 21, and 28 days. On day 14 of the culture, the bacterial count showed the highest values in all groups. Root canals and Type 1 collagen pre-treatment and glucose proved to have significant positive effects on the bacterial count compared to dentinal disks and BHI media only. The increase in bacterial count found with the direct inoculation technique was not significantly different from that of the indirect technique

Calcium silicate‐based root canal sealers:A narrative review and clinical perspectives

Over the last two decades, calcium silicate-based materials have grown in popularity. As root canal sealers, these formulations have been extensively investigated and compared with conventional sealers, such as zinc oxide–eugenol and epoxy resin-based sealers, in in vitro studies that showed their promising properties, especially their biocompatibility, antimicrobial properties, and certain bioactivity. However, the consequence of their higher solubility is a matter of debate and still needs to be clarified, because it may affect their long-term sealing ability. Unlike conventional sealers, those sealers are hydraulic, and their setting is conditioned by the presence of humidity. Current evidence reveals that the properties of calcium silicate-based sealers vary depending on their formulation. To date, only a few short-term investigations addressed the clinical outcome of calcium silicate-based root canal sealers. Their use has been showed to be mainly based on practitioners’ clinical habits rather than manufacturers’ recommendations or available evidence. However, their particular behavior implies modifications of the clinical protocol used for conventional sealers. This narrative review aimed to discuss the properties of calcium silicate-based sealers and their clinical implications, and to propose rational indications for these sealers based on the current knowledge

In vitro evaluation of three engineered multispecies endodontic biofilms on a dentinal disk substrate

AbstractThe aim of this study was the development of a complex multispecies endodontic biofilm using Candida albicans, Proteus mirabilis and Pseudomonas aeruginosa on a biofilm of Enterococcus faecalis in a dentinal substrate design.The endodontic pathology is a biofilm-mediated infection, and the aim of root canal therapy is to reduce, as much as possible, the bacterial population. Thus, it is important to develop a laboratory endodontic biofilm to test the effect of new irrigation and obturation techniques on reduction of bacterial count.The culture of Enterococcus faecalis from ATCC 29212 began with aerobic cultivation on blood agar, followed by transfer to Brain Heart Infusion (BHI) broth with 5% sucrose. Incubation occurred in a shaker at 37 °C for 24 h, followed by an additional 24-h static phase. After 10 d, Proteus mirabilis, Pseudomonas aeruginosa, and Candida albicans were introduced sequentially in three distinct groups. Group 1: the order of addition was Candida albicans, Proteus mirabilis, and Pseudomonas aeruginosa; Group 2: the order was Pseudomonas aeruginosa, Candida albicans, and Proteus mirabilis; and Group 3: Proteus mirabilis, Pseudomonas aeruginosa, and Candida albicans. After 16 days, the biofilm was carefully extracted, transferred to sterile BHI, and dissected using a sterile needle technique. Subsequently, an optical density test, bacterial counts, and colony enumeration were performed on various agar plates.Group 2 in which Pseudomonas aeruginosa was added directly after Enterococcus faecalis followed by Candida albicans and Proteus mirabilis showed significantly greater total bacterial count than the other two groups

Impact of Warm Vertical Compaction on the Sealing Ability of Calcium Silicate-Based Sealers: A Confocal Microscopic Evaluation

The aim of this in vitro study was to evaluate the dentinal tubule penetration of two calcium silicate-based sealers used in warm vertical compaction (WVC) obturation technique in comparison with the single cone (SC) technique by confocal laser scanning microscopy (CLSM). The null hypothesis was that both obturation techniques produced similar sealer penetration depths at 1 and 5 mm from the apex. Forty-four mandibular single-rooted premolars were randomly divided into four equally experimental groups (n = 10) and two control groups (n = 2) according to the type of sealer (Bio-C Angelus, Londrína, PR, Brazil or HiFlow Brasseler, Savannah, GA, USA) with either SC or WVC. The sealers were mixed with a fluorescent dye Rhodamine B (0.1%) to enable the assessment under the CLSM. All the specimens were sectioned horizontally at 1 and 5 mm from the apex. The maximum penetration depth was calculated using the ImageJ Software (ImageJ, NIH). Data were analyzed by Mann–Whitney U and Kruskal–Wallis tests (p < 0.05). A significant difference was shown between the four groups at 1 mm (p = 0.0116), whereas similar results were observed at 5 mm (p = 0.20). WVC allowed better diffusion for both sealers at 1 mm (p = 0.01) and 5 mm (p = 0.034). The maximum penetration of the Bio-C and HiFlow sealers was more important at 5 mm with the two obturation techniques. Within the limitations of this study, WVC enhanced the penetration of calcium silicate-based sealers into the dentinal tubules in comparison with the SC technique at both levels

The 1064-nm Nd:YAG Photobiomodulation vs. 20% Benzocaine Topical Gel in Inducing Mucosal Anesthetic Effect: A Double-Blind Randomized Clinical Trial

The periapical local anesthetic injection may be associated with fear of needles and pain administration. Dental topical anesthetic agents can help to reduce pain perception; however, adverse events can occur. To investigate the efficacy of 1064-nm photobiomodualtion (PBM) in inducing mucosal anesthesia delivered with a flat-top hand-piece compared to 20% Benzocaine topical anesthetic gel, sixty healthy patients were randomly allocated (1:1) to either 20% benzocaine topical gel + placebo laser (T group) or PBM + placebo gel (L group). The 1064-nm Nd:YAG laser was employed and is associated with a novel flat-top hand piece. The applied operational parameters were 0.5 W, 10 Hz, 100 µs pulse width, and 30 J/cm2 for one-minute single application time. The enrolled subjects were asked to assess pain intensity at the time of anesthetic injection with a Visual Analog Scale. Taking into consideration taste, undesirable numbness, and overall satisfaction, the patients were asked to rate their experiences according to a verbal rating scale. Statistical analysis showed no statistically significant difference between the T and L Groups for pain ratings (p = 0.0596). The L Group displayed significantly higher ratings than T Group for taste, undesirable numbness, and overall satisfaction (p < 0.001). The 1064-nm PBM delivered by flat-top hand piece is effective in inducing mucosal anesthesia, eliminating the adverse side-effects of the conventional topical anesthetic gel

The 1064-nm Nd:YAG Photobiomodulation vs. 20% Benzocaine Topical Gel in Inducing Mucosal Anesthetic Effect: A Double-Blind Randomized Clinical Trial

The periapical local anesthetic injection may be associated with fear of needles and pain administration. Dental topical anesthetic agents can help to reduce pain perception; however, adverse events can occur. To investigate the efficacy of 1064-nm photobiomodualtion (PBM) in inducing mucosal anesthesia delivered with a flat-top hand-piece compared to 20% Benzocaine topical anesthetic gel, sixty healthy patients were randomly allocated (1:1) to either 20% benzocaine topical gel + placebo laser (T group) or PBM + placebo gel (L group). The 1064-nm Nd:YAG laser was employed and is associated with a novel flat-top hand piece. The applied operational parameters were 0.5 W, 10 Hz, 100 &micro;s pulse width, and 30 J/cm2 for one-minute single application time. The enrolled subjects were asked to assess pain intensity at the time of anesthetic injection with a Visual Analog Scale. Taking into consideration taste, undesirable numbness, and overall satisfaction, the patients were asked to rate their experiences according to a verbal rating scale. Statistical analysis showed no statistically significant difference between the T and L Groups for pain ratings (p = 0.0596). The L Group displayed significantly higher ratings than T Group for taste, undesirable numbness, and overall satisfaction (p &lt; 0.001). The 1064-nm PBM delivered by flat-top hand piece is effective in inducing mucosal anesthesia, eliminating the adverse side-effects of the conventional topical anesthetic gel